Posted by admin on January 14, 2017 · Leave a Comment
Hot off the Press and ready to view!
We invite you to look at the 2017 VPLC Legislative Agenda to see our legislative priorities for this year’s General Assembly session.
Each page has details of issues our staff is advocating, what we hope to accomplish and bring awareness around to legislators, and quotations to inspire you to make your voice hear on these issues as well.
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Posted by admin on January 12, 2017 · Leave a Comment
Mark has been a loving caregiver for his mother, Roberta, who has had Alzheimer’s for over five years. Roberta now needs more care than Mark can provide. Mark has spent lots of time and energy seeking quality options in long-term skilled nursing facilities, with “person-centered” care being of utmost importance to him.
Person-centered care is a holistic approach that focuses on quality-of-life, health, and well-being. Person-centered living encompasses care, services and meaningful engagement that is planned according to residents’ personal preferences, values, and goals. This approach honors each senior’s dignity, choice, self-determination, and individuality, which enhances quality-of-life and quality-of-care for seniors.
Recently, according to an article in the Washington Post, major changes have been made by the Centers for Medicare & Medicaid Services (CMS) to improve the care and safety of the nearly 1.4 million residents in the more than 15,000 long-term care facilities that participate in the Medicare and Medicaid programs. The new rules offer residents more control of their care, by making their care more person-centered. This is the most wide-ranging revision of federal rules for such facilities in 25 years.
Until now, a person’s care was decided by the nursing home staff, and the resident and/or his or her family was often told about what that care will entail, what will specifically be done, and who will do it. The new regulations, proposed late last year by Health and Human Services Secretary Sylvia Mathews Burwell, take effect in three phases. The first kicked in in November 2016.
Here are highlights of the requirements now in effect:
Plan of care: Residents and families must be involved in the process of writing a plan of care, which must be completed within 48 hours of admission.
Greater food choices: Residents are entitled to alternative meals and snacks … at non-traditional times or outside of scheduled meal times.
Roommate selection: Residents can also choose their roommates, which may lead to siblings or same-sex couples being together.
Visitor hours: Residents now have a right to receive visitors of their choosing at the time of their choosing, as long as it doesn’t impose on another resident’s rights. Facilities may only limit visits by non-family members based on “clinical and safety” requirements.
Better grievance procedures: Nursing homes must now appoint an official who will handle complaints and follow a strengthened grievance process. Decisions must be in writing.
Challenging discharges: “Residents can no longer be discharged while appealing the discharge. They cannot be discharged for non-payment if they have applied for Medicaid or other insurance, are waiting for a payment decision or appealed a claim denial. If a nursing home refuses to accept a resident who wants to return from a hospital stay, the resident can appeal the decision. Also, residents who enter the hospital have a right to return to their same room, if it is available. A state’s long-term-care ombudsman must now get copies of any involuntary discharges so the situation can be reviewed as soon as possible,” according to Susan Jaffe of the Washington Post.
Expanding protection from abuse: The definition of abuse now includes financial exploitation. Nursing homes are prohibited from hiring any licensed professional who has received a disciplinary action because of abuse, neglect, mistreatment or financial exploitation of residents.
Ensuring a qualified staff: Facilities must have enough skilled and competent staff to meet residents’ needs. There are also specific training requirements for caring for residents with dementia and for preventing elder abuse.
Note: Consumer groups had urged federal officials to set minimum staffing levels for registered nurses and nursing staff, but the industry had opposed any mandates and none were included in the final rule.
Better infection control: Facilities will update the nursing home’s infection prevention and control program, including requiring an infection prevention and control officer and an antibiotic stewardship program that includes antibiotic use protocols and a system to monitor antibiotic use.
“With proper implementation and enforcement, this could really transform a resident’s experience of a nursing home,” said Robyn Grant, director of public policy and advocacy for the Consumer Voice, a national group that advocates for residents’ rights. When asked about the changes, CMS Acting Administrator Slavitt said, “The health and safety of residents of long-term care facilities are our top priorities. The advances will give residents and families greater assurances of the care they receive.”
At the Farr Law Firm, our mission is to protect seniors and their families by preserving dignity, quality of life, and financial security. Person-centered care ensures that nursing home residents are supported in achieving the highest level of physical, mental, and psychosocial well-being that is individually practical. In addition, the staff places a premium on active listening and observing, so staff can adapt to each resident’s changing needs regardless of cognitive abilities. Person-centered care is aligned with our mission, and we applaud the Centers for Medicare & Medicaid Services (CMS) on these new regulations.
Affording Nursing Home Care
Quality of care is always the most important factor when it comes to our loved ones. Most of us are also concerned about the affordability of nursing home care. This is a legitimate concern, as nursing homes in the Metro DC Area cost $10,000-14,000 a month. To protect your family’s hard earned money and assets from these catastrophic costs, there is no time like the present to begin Medicaid Asset Protection Planning. Please call us to make an appointment for a no-cost initial consultation:
Fairfax Elder Law Attorney: 703-691-1888
Fredericksburg Elder Law Attorney: 540-479-1435
Rockville Elder Law Attorney: 301-519-8041
DC Elder Law Attorney: 202-587-2797
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Posted by admin on January 7, 2017 · Leave a Comment
Q. It is clear that the Republican congesss wants to pass a measure to repeal the Affordable Care Act (ACA) outright. In my view, the ACA has been good for seniors because it eliminates pre-existing condition exclusions, keeps children on parents’ policies to age 26, eliminates gender discrimination in pricing, and provides significantly more preventive and screening tests without cost. What will happen if it is repealed?
A. When it comes to healthcare reform, President-Elect Donald Trump and Congressional Republicans have expressed their desire to make the repeal of the ACA their number one priority this month – even as they struggle to find agreement on how to go about doing that.
According to the New York Times, “(b)efore the new members could even be sworn in, Senate Republicans revealed the parliamentary language that congressional Republicans will use to dismantle Mr. Obama’s signature domestic achievement, the Affordable Care Act, without fear of a filibuster by Democrats in the coming months.” Debate began on the Senate floor yesterday, bypassing the Senate Budget Committee to speed passage.
The question remains: What will happen to more than 20 million Americans now insured under the Affordable Care Act, or to the 27% of Americans with pre-existing medical conditions who, under the health care act, cannot be denied coverage by insurance companies?
This is how the repeal will affect seniors and others:
• 53.8 million people on Medicare. The ACA contains provisions designed to strengthen Medicare. According to Elder Law Answers, “(r)epealing the ACA may eliminate those provisions, potentially destabilizing Medicare. The ACA also established programs to reduce Medicare waste, fraud, and abuse. Thanks to these measures, according to the Center on Budget and Policy Priorities, the Medicare hospital insurance fund is projected to remain solvent eleven years longer than before the ACA was enacted. These factors combined with the fact that millions of near-seniors aged 50-64 could lose coverage, leaving them in poorer health when they become eligible for Medicare, could raise future Medicare costs for existing beneficiaries.”
• 12 million people on Medicaid. That’s the number who are newly insured thanks to the ACA’s expansion of Medicaid. Repeal the ACA, and they lose their coverage.
• 37 million seniors who take advantage of preventative care. The ACA requires insurers to provide free preventative care coverage to Medicare beneficiaries. Without that requirement, seniors may end up having to pay for many preventative care services.
• 9 million people on the exchanges. These people get substantial subsidies to buy coverage, and they wouldn’t be able to afford it otherwise. The Republican answer for them is to make available bare-bones catastrophic plans, which don’t cover any routine medical needs but will help if they become very ill or are the victim of an accident.
• 1.4 million young people. These people, between the ages of 19 and 25, are allowed to stay on their parents’ insurance thanks to the ACA. The Republicans insist that this is one of the parts of the ACA they want to keep.
• 52 million people with pre-existing conditions. The Kaiser Family Foundation estimates this many Americans have conditions that threaten their ability to get coverage, and whom insurers are now required to cover. If you’ve bought insurance since the ACA went into effect, you were probably relieved to find that you didn’t have to document every time you’ve been to the doctor in the last decade the way you used to, with the threat that if there was something the insurance company didn’t like the look of, they’d deny you. Republicans say they want to protect all those people, but they can only do it by requiring insurers to cover you if you maintain “continuous coverage.” If you don’t because you lost your job or started your own business, then you will be placed into a “high-risk pool,” which is almost guaranteed to be underfunded and outrageously expensive.
• 8 million seniors saved over $11.5 billion (since 2010) on prescription drugs due to the closing of the donut hole. When a prescription drug benefit was added to Medicare in 2006, it included a “donut hole,” where your drug benefits disappeared after a few thousand dollars, then started up again after you spent a huge chunk of your own money. It sometimes meant catastrophically high drug costs for seniors on fixed incomes, which is why the ACA phased it out. Repeal the law, and the donut hole comes back.
• Hospitals. Before the ACA, hospitals had to spend billions of dollars treating people who had no insurance and showed up to emergency rooms; some of those costs would be borne by the states. Because so many people now have insurance under the ACA, the hospital industry has been willing to accept some cuts to their reimbursements, which helped make the whole thing more affordable. If the ACA is repealed, the American Hospital Association warns that the nation’s hospitals will lose hundreds of billions of dollars.
As you can see, actions resulting from a repeal of the ACA will certainly have a major effect on seniors and others. We will continue to keep you updated on this issue, as more information becomes available.
Have you planned for your future and for your loved ones? Regardless of possible changes in the law, the need to plan in advance remains. If you have not done Incapacity Planning, Estate Planning, or Long-Term Care Planning (or had your documents reviewed in the past several years), or if you have a loved one who is nearing the need for long-term care or already receiving long-term care, please don’t hesitate to call us as soon as possible for a no-cost initial consultation:
Fairfax Elder Law: 703-691-1888
Fredericksburg Elder Law: 540-479-1435
Rockville Elder Law: 301-519-8041
DC Elder Law: 202-587-2797
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Posted by admin on January 7, 2017 · Leave a Comment
Dear Baxter,
I am getting older, and so is my dog, Brutus. In his old age, he is overweight and very lazy. What are some resolutions I can make that will help make me a better pet owner, and to make my pet healthier?
Thanks!
Pat Owner
—–
Dear Pat,
The start of a new year can signal a fresh start for you and your pet. Here are ten resolutions you can consider this year to make it your pet’s healthiest year yet!
Try a New Activity with Your Pet: From long walks to scenic hikes, you can incorporate your pet into a new exercise routine. It’s a great way to bond, it’ll get you both out of the house, and both owner and pet will reap the rewards of a healthy physical activity. Meet-up groups are a great way to socialize and find like-minded pet owners to join you in your exercise, too!
Groom Your Pet Daily: Brushing your pet serves many purposes. It removes excess fur from the coat, and helps keep the coat shiny and healthy. Daily grooming is also a bonding activity that demonstrates to your pet how much you love them by taking care of them in a very soothing manner.
Measure Your Pet’s Food – Every Time!: Many owners “eyeball” their pet’s daily intake and pour that into a bowl, usually resulting in overfeeding and weight gain. It’s important to use a measuring cup to ensure your pet isn’t taking in more calories than they need. The recommended feeding guidelines on the bag are good place to start to figure out how much food your pet really needs. Older pets and less active pets usually have lower energy needs.
Choose an Age-Appropriate Diet: Growing pets have very specific nutrient requirements to ensure their bodies grow healthy and strong. For example, some senior pets may have lower energy requirements, but have other medical issues like degenerative joint disease that may be helped with the appropriate diet. Choosing a diet specifically tailored to your pet’s life stage is a great way to keep them in optimal health.
Make an Appointment with Your Vet: Yearly examinations by a veterinarian are a key component of good preventive care. Many medical conditions such as diabetes, arthritis, or obesity are common in aging pets and much easier to manage when detected in the early stages of the disease process. Veterinary visits are also the perfect time to ask for advice on updating your pet’s diet and exercise regimen.
Teach an Old Dog a New Trick: Studies show that mental stimulation can help reduce cognitive deterioration in aging animals. In other words, keeping your senior pet’s brain active can actually make it healthier! Teaching your pet new tricks and practicing those they already know are a great way to keep those neurons firing. Puzzle feeders, which force a pet to think through a task in order to be rewarded with a treat, are also an excellent way to keep a pet’s mind engaged.
Update Pet ID Info: If any of your contact information has changed in 2017, don’t wait — update their tags and microchip information today! It’s the best way to ensure a lost pet makes their way safely home.
Hope this is helpful!
Baxter
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Posted by admin on January 4, 2017 · Leave a Comment
From the presidential candidates’ views on Social Security, Medicare, and Medicaid, to a new president being elected, we covered a lot of ground in 2016. It was a year that included the passing of the Special Needs Trust Fairness Act to help special needs individuals, overtime pay for caregivers being instated and subsequently shut down in Virginia, and amazing new technological innovations to help seniors age-in-place. At the Farr Law Firm, we celebrated the birth of two babies (belonging to paralegals Arlene Figueroa and Natasha Cranford), and the marriage of attorney Justin Cohee to his lovely bride, Ashley. And we grew with the addition of an experienced estate planning and estate administration attorney, Sara Entis.
To celebrate the new year, we’ve ranked our most popular articles from this past year. Check out the list to see the year’s highlights and tell us what you’d like to see next year. As always, thank you for reading our newsletter and blog!
16. Sharing Your Legacy – A No-Cost Service for Our Clients: At the Farr Law Firm, we are now offering our clients a way to easily capture and pass on their personal legacies . . . and best of all, we are offering this as a gift to all of our clients, whether you’re a current client, a future client, or even a past client! This article discusses Legacy Stories and The Living Legacy Project.
15. The Little-Known Pitfalls of Medicare Advantage Plans: Nearly 18 million people are currently enrolled in Medicare Advantage (MA) Plans. Many baby boomers are enticed by them, as many of them offer $0 premiums, but what most people don’t realize is that there can be enormous unexpected out-of-pocket expenses when you get sick.
14. The Most Important Day of the Year (and only 20- 30% realize it!): National Healthcare Decisions Day (NHDD) is an annual observance that is celebrated in April to raise awareness about Advance Medical Directives. It is an extremely important day that emphasizes advance care planning and raises awareness, especially for anyone who is reluctant to talk about death, those who are experiencing declining health, and those who don’t want to discuss loss of decision-making control.
13. One Typo Could Cost You Your Computer: Cyber crooks are using .om websites to spread computer malware, remotely access PCs and Macs, and to steal log-in credentials. Malicious criminals for years have been buying domain names with a missing or misplaced letter in website addresses belonging to well-known companies, and they simply wait for you to make a typo.
12. What Medicare Won’t Cover: Medicare is our country’s health insurance program for people age 65 or older. The program helps with the cost of health care, but it doesn’t cover all medical expenses or ANY of the cost of long-term care. This article discusses what Medicare covers and what it is not covered.
11. $10,000 – $12,000? That’s for a Year, Right?: The cost of a nursing home in the metro DC area is $10,000- $12,000 A MONTH, an amount that is catastrophic for most of us. Each few years, Genworth conducts surveys of long-term care across the U.S. and summarizes the data in a Cost of Care Study, in an effort to help Americans plan for the potential cost based on their preferred location and setting. This article discusses the findings from the 2016 survey.
10. New, Overlooked, and Odd Tax Deductions for Seniors: It’s important to be aware of all the deductions and tax credits available to you so you don’t miss out on valuable savings — and a bigger refund. This article discusses some tax deductions that you should be taking advantage of that can save you hundreds, or even thousands, of dollars, including some that are pretty odd.
9. Huge Rate Hike for Federal Government Long-Term Care Insurance Policies: According to the Federal Long-Term Care Insurance Program (FLTCIP) Website, a new contract was recently awarded to John Hancock Life and Health Insurance Co., that will result in larger out-of-pocket costs for Federal Long-Term Care Insurance Program enrollees (an increase of 225%).
8. Virginia’s New Emergency Contact Program: Virginia’s Emergency Contact Program is a free public service which allows citizens to store emergency contact information. This new program gives law enforcement a way to notify a participant’s family or friends in the event of a serious crash or other emergency that leaves him or her unable to communicate.
7. I’m Not Dead Yet! Many adult children and grandchildren have had experiences with their families being torn apart by an inheritance battle. Minimizing the risk of an inheritance war requires several actions that combine psychology, a lot of self-awareness, a good dose of common sense (and of course, an experienced estate planning attorney!)
6. New Virginia Regulations Limit Caregiver Pay: Last year, the federal Department of Labor extended the overtime and minimum-wage protections of the Fair Labor Standards Act to most home care workers, including the homecare workers paid by the state using tax-funded Medicaid dollars. In Virginia, Medicaid caregivers used to be paid “straight time” — their standard hourly wage — for any hours they worked beyond 40 each week. After court battles, the Department of Labor rule went into effect in January 2016, and for the first time, the Commonwealth of Virginia had to start paying time-and-a-half for overtime. Despite the national mandate, the Virginia General Assembly capped hours at 40 again as of July 1, 2016.
5. Home Health Aides Are Quitting Their Jobs: The in-home care industry has been anticipated to be the largest job creator between 2012 and 2022, with an estimated 1 million new caregivers required during that time. In a recent survey, it was found that one quarter of workers said they were very likely to leave their job in the next year or were currently looking for a different job. Some are questioning whether there will be enough people willing to fill the positions and the need for home health aides in the future.
4. Special Alert to Existing Clients and Potential Clients: A once-popular estate planning tool, called a “Credit Shelter Trust” or – also called a “Bypass Trust” or a “Family Trust” — may now cost families more than it saves. If your estate plan includes one, it could be doing more harm than good, and you need to consider updating your documents as soon as possible.
3. Enough is Enough! I Quit: Most of us, when we have a vulnerable loved one, want to take care of them, but in many cases, we can only do so much. How can we maintain our sanity, while ensuring their loved one has the best care?
2. The Death of Long-Term Care Insurance?: John Hancock Life Insurance Company announced in November 2016 that it is leaving the long-term care insurance market, just as dozens of other insurance carriers have done before it, and that it will discontinue the sale of individual long-term-care insurance policies starting next year. The company, among the top three in market share for traditional long-term-care insurance, will no longer issue new policies after February 2017, according to a memo sent to distribution partners and producers.
1. Guess What! I’m Getting Married!: When you see a subject line like this one, the first thing that comes to mind could be happiness for the couple who is planning to share their life together. The second may be shock or even suspicion, because it seemed to have come out of nowhere, or because the person getting married is a disabled or vulnerable elderly person. This article discusses some red flags that you and your loved one should look out for when he or she is embarking on online dating for the first time.
Thank you for making these our top stories of 2016. We promise many new and exciting things to come in 2017! We also hope you will consider taking the advice that these articles offer. Please consider attending one of our monthly seminars in Fairfax or Fredericksburg and, as always, if you or a loved one are nearing the need for long-term care or already receiving long-term care, or if you have not done Long-Term Care Planning, Estate Planning, or Incapacity Planning (or had your planning documents reviewed in the past several years), please call us for a no-cost initial consultation:
Fairfax Elder Law: 703-691-1888
Fredericksburg Elder Law: 540-479-143
Rockville Elder Law: 301-519-8041
DC Elder Law: 202-587-2797
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