Critter Corner: What is the NOTICE Act?

Dear Baxter,

I read that the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act passed the US Senate earlier this week. Can you explain what observation care means, and what this new law would entail?


Inda Hospitalle


Dear Inda,

Observation care is a hospital classification used when patients are not well enough to go home but not sick enough to be admitted to the hospital. In many situations, if patients are being wheeled into a hospital bed and getting treatment, then they assume that they have been admitted, but this is not always the case. It’s a distinction that’s easy to miss until patients are hit with big medical bills after a short stay.  Also, a 3-day hospital admission is required for Medicare and private insurance to cover short-term rehab that might take place in a nursing home after discharge from the hospital.

The Senate approved legislation on Monday, July 27, 2015, requiring hospitals across the nation to tell Medicare patients when they receive observation care, but have not been admitted to the hospital. The law would require hospitals to provide written notification to patients 24 hours after receiving observation care, explaining that they have not been admitted to the hospital, the reasons why, and the potential financial implications.

A handful of states already require observation care notices, including New York, Connecticut, Maryland, Pennsylvania, and Virginia. In 2013, Medicare officials attempted to control the use of observation care by issuing the so-called “two-midnight rule,” which would require hospitals to admit patients who doctors expect to stay at least two midnights. But Congress delayed its enforcement after hospitals said the rule was confusing and arbitrary.
Since then, the federal government has been “pushing very hard” to encourage hospitals to educate patients about observation care. The NOTICE ACT is expected to be signed into a law by President Obama, and hospitals will have to comply with the NOTICE Act 12 months after it becomes law.

Hope this is helpful. You can read the text of the NOTICE Act here.

Doggy kisses,


New Alzheimer’s Risk Factors Presented at Alzheimer’s Association International Conference

Image from 2015 AAIC-

Q. My grandmother, Pearl, and her three siblings, Rebecca, Helene, and Morris, all died from Alzheimer’s. I heard that a family history of Alzheimer’s is a major risk factor for the disease. Do you know what some of the other risk factors are, and are there any preventative measures I could take? Thanks for your help!

A. As you mentioned, a family history of Alzheimer’s is one of the major risk factors for the disease. However, this past week, at the 2015 Alzheimer’s Association International Conference (AAIC) in Washington, DC, researchers from around the world shared study results that confirmed other risk factors and preventative measures. Below are some of the highlights from this year’s conference:

Prevalence of Alzheimer’s

  • It is estimated that by 2050, around 13.8 million older adults in the US will be living with Alzheimer’s.
  • Worldwide, around 36 million people are living with Alzheimer’s; in the US alone, around 5.3 million people are living with the disease – of whom 5.1 million are aged 65 and older.
  • Over the next 10 years, the number of seniors with the condition is expected to rise to 7.1 million.
  • This year, it is estimated that around 700,000 people in the US aged 65 and older will die from Alzheimer’s, making it the 6th leading cause of death in the country – the only cause of death in the top 10 for which there is no way to prevent, slow, or cure it.

Risk Factors
According to the researchers at AAIC, if we are aware of what triggers the condition, more can be done to reduce the risk of developing it. Below are risk factors discussed at the conference:

  • Age is the most well-established risk factor for Alzheimer’s, as the vast majority of individuals with the disease are age 65 and older. The risk for Alzheimer’s doubles every 5 years after the age of 65, while after the age of 85, the risk rises to almost 50%.
  • A family history of Alzheimer’s and the presence of certain genes, are also considered to be risk factors for the disease.
  • Physical activity in early and mid-adulthood may be an important factor for healthy cognitive aging. In fact, a study at the Northern California Institute of Research and Education (NCIRE) in San Francisco involving more than 3,200 adults aged 18-30 who were followed-up for 25 years, revealed that subjects who watched at least 4 hours of TV daily or who had low physical activity levels had poorer memory, executive function, and processing speed in cognitive tests taken in mid-life. Based on these findings, researchers believe physical activity in early and mid-adulthood may be an important factor for healthy cognitive aging. According to researchers, “Sedentary behaviors, like TV viewing, could be especially relevant for future generations of adults due to the growing use of screen-based technologies. Because research indicates that Alzheimer’s and other dementias develop over several decades, increasing physical activity and reducing sedentary behavior beginning in early adulthood may have a significant public health impact.”
  • Individuals with diabetes may be at greater risk for Alzheimer’s and other dementias. The Kaiser Permanente Division of Research in Oakland, CA analyzed the health history of 490,344 individuals age 60 and older who had no history of dementia. Of these participants, 334 had type 1 diabetes. The incidence of dementia among the seniors with type 1 diabetes was assessed over 12 years of follow-up, and was compared with dementia incidence among participants with type 2 diabetes, and those without diabetes. Compared with participants without type 1 diabetes, adults with this condition were found to be at 83% higher risk for dementia.
  • Cognitive ability in childhood and job complexity in adulthood may play a role. In one study that was presented, Serhiy Dekhtyar, PhD, of the Karolinska Institute in Sweden, and colleagues gathered data on the childhood cognitive ability – as determined by school grades at the age of 10. The incidence of dementia among the 7,574 adult participants was assessed via 20 years of follow-up, and data on their educational attainment and occupational complexity was also gathered. During follow-up, 950 cases of dementia occurred.  The results of the analysis revealed that participants who fell into the lowest 20% of childhood school grades were at 21% greater dementia risk, compared with those who had higher school grades, regardless of their occupational complexity in adulthood. Higher childhood school grades alongside greater job complexity – as determined by high complexity with data and numbers – were found to be at 39% reduced risk for dementia, while a 23% lower risk was found among individuals with higher job complexity alone. These findings, the team says, suggest that cognitive performance in childhood and early adulthood is important for “cognitive reserve” – the ability for the brain to recover quickly from any damage sustained, preserving memory and thinking later in life.
  • Loneliness in older age is a well-known risk factor for depression, and it could it also be a risk factor for Alzheimer’s. Dr. Nancy J. Donovan, of Brigham and Women’s Hospital and Harvard Medical School in Boston, MA, and colleagues suggest so. The team presented a study at the AAIC in which they assessed data from more than 8,300 adults aged 65 and older who were part of the US Health and Retirement Study from 1998-2010. Every 2 years, the researchers collected data on participants’ loneliness, depression, health status, cognitive function and memory and social network. At the study baseline, 17% of participants reported loneliness, with around half reporting depression. Over a 12-year follow-up period, the team found that the loneliest subjects experienced cognitive decline around 20% faster than participants who did not report loneliness. In addition, participants who reported depression at study baseline also experienced faster cognitive decline.

Early Detection is Key

Research suggests that the process of Alzheimer’s disease begins more than a decade before clinical symptoms appear. Therefore, early detection may have a major impact on the course of the disease, and in successfully treating symptoms.
At present, there is no single test to diagnose Alzheimer’s.  Doctors currently rely on medical evaluation, including mental status testing and physical and neurological examinations, in order to make a diagnosis. Additional research presented at the AAIC has offered new insight into potential ways to predict the risk for dementia, including detection through a saliva test or cerebrospinal fluid. These new ways to detect Alzheimer’s are bringing us closer to early diagnostic techniques.

Medicaid Planning for Alzheimer’s and Other Types of Dementia
Alzheimer’s is the biggest health and social care challenge of our generation, and a diagnosis of the disease is life-changing.  When it comes to planning for long-term care needs, generally, the earlier someone with dementia plans, the better.  But it is never too late to begin the process of Long-term Care Planning, also called Lifecare Planning and Medicaid Asset Protection Planning.

Medicaid planning can be initiated by an adult child acting as agent under a properly-drafted Power of Attorney, even if you are already in a nursing home or receiving other long-term care.

Medicaid Asset Protection

People with Alzheimer’s live on average four to eight years after they’re diagnosed, but some may live 20 years beyond their initial diagnosis. Do you have a loved one who is suffering from Alzheimer’s or any other type of dementia? Persons with dementia and their families face special legal and financial needs. At The Law Firm of Evan H. Farr, P.C., we are dedicated to easing the financial and emotional burden on those suffering from dementia and their loved ones.  We help protect the family’s hard-earned assets while maintaining your loved one’s comfort, dignity, and quality of life by ensuring eligibility for critical government benefits such as Medicaid and Veterans Aid and Attendance. Please call us as soon as possible to make an appointment for a no-cost 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


Strong or Vulnerable? Social Security in its 80th Year

For 80 years, Social Security has been protecting American families from both expected and unexpected challenges. Last week, the Social Security Board of Trustees released its annual report to Congress, which projects that Social Security’s condition isn’t as troubling as many think.

The 2015 report presents an honest, open discussion about the value of Social Security and its importance to millions of retired workers, spouses, children, veterans, and persons with disabilities. As you will gather from the report, despite its flaws and funding issues, Social Security is likely here to stay.

Below are some of the highlights:

  • Future Viability of Social Security for retirees: For the Old Age and Survivors side of Social Security, which is what funds benefits for retirees and their families, the trustees expect that the program will be able to pay full benefits until 2035, which is a year later than it expected in last year’s report. After that date, the report says that tax revenue from payroll taxes and other sources will provide enough funds to cover $0.79 of every dollar of benefits due under the law. These projections assume that no legislative changes to Social Security get made.
  • Disability Insurance portion of Social Security in trouble: The large number of baby boomers who haven’t yet hit retirement age, but who have become disabled have left the Disability Trust Fund in poor financial shape. Although making the transition to retirement benefits could ease the Disability Trust Fund’s burden, it’s likely too late to avoid a problem without more dramatic action. Proposals to make transfers from the Old Age and Survivors Trust Fund would meet the immediate need, but it would also move up the date on which the total program’s money runs out to 2034.
  • Lawmakers must raise new revenues: In order to close Social Security’s overall long-term financing gap and ensure 100% of benefits could be paid well into the future, lawmakers must raise new revenues for Social Security, consider program cuts, or a combination of those two options. Simple adjustments to the program’s financing have received support among Americans and could put the program on sound footing. Examples include raising the payroll tax gradually (currently 6.2% each for the employee and employer), or requiring higher income Americans to contribute more by subjecting more earnings to the payroll tax (currently only the first $118,500 in wages is taxed for Social Security).

Many people who read about Social Security’s future funding shortfall think that it means the end of Social Security. This misconception can cause people nearing retirement to make a huge mistake by claiming Social Security benefits early under the belief that Social Security will run out of money if they wait to collect benefits. The funding shortfall should not be ignored; however it is still critical to make careful claiming decisions and consider the benefits of deferring benefits until full retirement age or until age 70.

Reasons to Defer Your Social Security Benefits

If you collect Social Security benefits at age 62 (the earliest you can do so), you’ll pay a penalty of 25% or more in your monthly benefits by filing before full retirement age. That is why, if you’re working, in good health, and can afford to do so, experts generally suggest you wait at least until full retirement age. The chart and considerations below explain why:

Typical Social Security Monthly Retirement Payments

Considerations (why you should defer collecting Social Security, if you can):

  • Extra years of bigger checks: Payments continue as long as you’re alive, so those extra years of bigger monthly checks can matter a lot.
  • Boosting benefits by working longer: The later years of our careers are often some of the best-paying, helping to boost benefits even more down the road. Every year you pay into Social Security increases the size of your monthly check once you start collecting.
  • No penalties for working once you reach FRA: You no longer face a penalty for working once you hit FRA. You can work as much as you want and still receive your full benefits. (However, depending on how much you make, you may have to pay federal taxes on part of your benefits. IRS Publication 915 provides more information.)
  • Survivors benefits based on your earnings: If you die before your spouse, he or she can often collect a survivor’s benefit based on your earnings. But if you elect to take early benefits, your spouse will receive a reduced check after you’re gone.
  • If you need the money earlier, the option is available: If you’re unemployed and out of savings, or if you’re only working part-time and finding it impossible to make ends meet, then none of the above is as important as your immediate need, and you should consider taking benefits as soon as you can.
  • If you’re uncertain where you stand, start with a careful inventory of the living costs you’ll have when retired, along with an estimate of your income from other sources. Make sure essentials are covered first, then look at the things you’d really like to do and see how they fit into the budget. You’ll have a much better sense of when you want to turn to Social Security.

For lots of additional details about Social Security, including spousal benefits, please visit our Social Security FAQ page.

What if you are living on social security alone and you or a loved one becomes incapacitated? You must take this into account when planning for retirement.  Every adult over the age of 18 should have an Incapacity Plan that includes a Financial Power of Attorney, an Advance Medical Directive, and an Advance Care Plan. If you don’t have an Incapacity Plan in place, now is the time to get started.  Please call The Law Firm of Evan H. Farr, P.C. as soon as possible to make an appointment for a no-cost consultation:

Fairfax Social Security Law: 703-691-1888
Fredericksburg Social Security Law: 540-479-1435
Rockville Social Security Law: 301-519-8041
DC Social Security Law: 202-587-2797

Critter Corner: Why Do Women Get Alzheimer’s More than Men?

Dear Angel,

I read that women get Alzheimer’s more often than men. Do you know of any scientific reasons why this happens?

Thanks in advance,

Alice Heimersen-Wemmen


Dear Alice,

Among people who are 71 and older, an estimated 16 percent of women have Alzheimer’s and other dementias, compared with 11 percent of men, according to the Alzheimer’s Association.

Research has not yet pinpointed a particular reason why this is the case, but possibilities include genetics, estrogen, and the rate at which their brain cells die, according to research conducted by the Neurocognitive Disorders Program at Duke University.

In addition, three studies presented this week at the Alzheimer’s Association International Conference in Washington, D.C., highlighted the greater vulnerability of women’s brains:

-Researchers found that memory and thinking skills in women with mild cognitive impairment declined twice as quickly as they did in men.

-A study at Oregon Health Science University suggested that older women have a higher risk of experiencing cognitive dysfunction after undergoing surgery with general anesthesia than older men do.

-A University of California, San Francisco study found that women have more amyloid plaque (one of the hallmarks of Alzheimer’s) in their brains than men of the same age and same cognitive ability.

“There may be a greater biological vulnerability” to Alzheimer’s in women, says Katherine Lin, a Duke University student researcher. Lin used data from the Alzheimer’s Disease Neuroimaging Initiative to look at how the cognitive abilities of about 400 people with Mild Cognitive Impairment changed over a period as long as eight years.

To help answer questions about sex differences and Alzheimer’s, the Alzheimer’s Association has launched the Women’s Alzheimer’s Research Initiative to raise $5 million for research grants. The initiative will begin accepting applications for funding from researchers worldwide this fall.

If you or a loved one have been diagnosed with Alzheimer’s disease, it is important to plan for future needs. To make an appointment for a no cost consultation, please contact us.

Purrs and Kisses,


Filial Responsibility Revisited

Q. I was on Avvo recently looking up “filial responsibility.” I saw you answered a question where a husband sued his wife’s children to pay him monthly for the care of their mother in a dementia unit, and they were ordered to pay him $2,000 a month over and above the actual cost of her care.

I also saw that you wrote an article on your blog about parents who were being pursued for their deceased son’s medical bills. I am concerned that my mother and father may be faced with the same situation, since there is an outstanding balance that my brother couldn’t pay before he died last year. I heard filial responsibility laws were rarely enforced. However, I do live in Virginia, a state that has such a law, as you have pointed out in your articles. Do you think my parents have a reason to be concerned? If something should happen to my folks, should I be worried that debt collectors will come after me?

A. More than half of U.S. states, including Virginia and Maryland, have filial responsibility laws, which say adult children are responsible for financially helping parents who are unable to pay for care. In certain situations, as in the article you described, parents can also be responsible for debts of adult children. As you mentioned, the laws were rarely used in the past, but this has been changing.

Updates in the Mohn Situation

To remind our readers, last year a debt collector pursued Peg and Bob Mohn of Bangor, Maine for their late son Earl’s unpaid medical bills. Earl wasn’t married and had been sick off and on for most of his adult life. He had no assets when he died that creditors could have filed claims against. The Mohns, who are in their 70s, did not budget to cover their adult son’s medical expenses.

To collect the debts, a lawyer by the name of James Havassy of the Hamilton Law group (based in Pennsylvania) sent the Mohns multiple letters demanding payment of debts to physicians’ offices that had treated Earl several years before he died.

The letters the Hamilton Law Group stated the following:

Notice is hereby given to you that a spouse, parent and child of an indigent person all have the legal responsibility to care for and maintain or financially assist them,” said the letter, signed by Havassy, who is an attorney. “Therefore, in accordance with the Filial Responsibility Law, as we can prove that the debts of your relative were not timely paid as they became due, you are fully responsible for this debt.

Believing they had no other choice, the Mohns set up a payment plan and had been paying $50 a month since October toward their son’s debt of about $2,000. However, payment was not deducted from their account in May of this year and beyond. Why? Because, that month, the Pennsylvania state attorney general’s office proceeded with a lawsuit against the Hamilton Law Group, claiming that the debt collector improperly used the state’s Colonial-era Filial Responsibility Law “to coerce payments from debtors’ relatives, who were not responsible for the debt.”

The lawsuit describes what the Hamilton Law Group did as “an unfair and unconscionable means to collect a debt, and the collection of these debts was not expressly permitted by law.” The lawsuit cited six examples, including the Mohns. One woman received collection notices for an anesthesia bill owed by her adult son, who has his own health insurance. A man was pursued for the cost of his mother’s and adult sister’s dental services. Another man was pursued for his father’s debt to a cardiologist. Two of the people claimed their credit profiles were “negatively marked.”

The lawsuit seeks restitution for the people affected, includingthe Mohns, and a court order barring the allegedly improper methods of debt collection.

Is There Still Reason to be Concerned?

Filial Responsibility Laws were drafted centuries ago so family members would take responsibility for each other and the government wouldn’t have to. Its use waned when the modern public support system was developed, but the law gained new life in 2012 when the state Superior Court ruled that George Pittas, of Allentown, PA, was responsible for nearly $93,000 in bills from the rehabilitation center that had treated his mother after a car accident.

Important considerations about Filial Responsibility laws:

-The law doesn’t always make parents and their children responsible for each other’s debts. The debtor must be indigent and the person targeted for payment must have the ability to pay.

-The law is not designed to collect money from family members in situations where public money is available and has been applied for.

-To enforce filial responsibility laws, a nursing home usually needs to prove that a resident can’t pay in order for an adult child of that resident to be responsible.

-There is also no consensus about enforcing filial responsibility laws among states. Such laws remain on the books in Alaska, Arkansas, California, Connecticut, Delaware, Georgia, Indiana, Iowa, Kentucky, Louisiana, Maryland, Massachusetts, Mississippi, Montana, Nevada, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Utah, Vermont, Virginia and West Virginia, and in the territory of Puerto Rico.

-You can still be on the hook for medical bills if you share any property or financial accounts with your parents. If you jointly own a home, for example, the state may put a lien, or hold, on the property, and require you to repay Medicaid benefits when you decide to sell the home.

Know Your Rights

If you or your parents are contacted by a debt collector, you are entitled to receive paperwork that explains how much you owe and to whom you owe it. If you don’t believe you owe the money, you should ire an attorney and within 30 days you should write a letter to the debt collector explaining that.

If you or your parents are asked to pay a relative’s debt under the Filial Responsibility Law, contact the state attorney general’s office (800-441-2555 or

You can file complaints about debt collectors with that office, the Federal Trade Commission (202-326-2222, and the Consumer Financial Protection Bureau (855-411-2372,

Plan Ahead

There is only one way to make sure you do not fall victim to any filial (or parental) support action, and that is by planning ahead. Adult children with elderly parents need to be proactive regarding how their parents are financing their long-term care. Some families of modest means may assume Medicaid will cover a parent’s care once the parent has depleted savings and other resources. But it’s a huge mistake to assume that Medicaid will be easy to obtain.

Elder Law Asset Protection

Medicaid laws are the most complex laws in existence, with 8 separate bodies of law (4 at the Federal level and 4 at the state level) dealing with Medicaid and Medicaid eligibility.  To do proper Medicaid asset protection planning, families need the help of an experienced elder law attorney, preferably a Certified Elder Law Attorney such as myself. In your situation, whether your parents are years away from needing nursing home care, are already in a nursing facility, or somewhere in between, the time to plan is now, not when your parents are about to run out of money.  Call us today to make an appointment for a no-cost 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

A “Guardian Angel” When One is Needed Most

Photo from Huffington Post

Marjorie never felt alone at her nursing home. Although her husband died last year, and her children couldn’t be there a lot of the time to visit her, she seemed content. Her ability to speak clearly and her memory were diminishing and most people couldn’t understand what she wanted or needed, but somehow she always felt like her voice was being heard. It was through a doula, or as she put it five years ago, a “guardian angel,” named Cara, that she found comfort, compassion, advocacy, and motivation.

When she was diagnosed with Lewy Body Dementia, Marjorie’s doctor initiated an end-of-life conversation with her. He stressed how important it was for sick people to have companionship to help them find comfort during a time when they need it most. The talk compelled Marjorie to think of another challenging time in her life when she felt comfort, and she recalled the doula from her labor and delivery. She did research and came across an article in the New York Times titled, “In Death Watch for Stranger, Becoming a Friend to the End,” by N. R. Kleinfeld, and she realized there are doulas out there that can help her during this time of her life, as well.

While she still had her wits about her, she indicated in her Advance Medical Directive that she would like to have a doula, should she be in a position where she needs someone to provide end-of-life compassion and support. If it weren’t for the doctor initiating the conversation, and Marjorie planning in advance with an experienced elder law attorney, she would have never had Cara there as her “guardian angel.” In addition, without Medicaid Planning, she would have never been able to afford the $14,000 a month nursing home bill, without depleting her hard-earned assets.

In ancient Greece, the word doula was used to describe a household servant. It is most often used to mean an individual trained to provide comfort and support to women during labor and childbirth. More recently, it has been associated with those trained to provide support at the end of life. Now, hundreds of individuals facing the end of life are not alone as a result of a relationship with an End-of-Life Doula. To learn more about end-of-life doulas and how to find one, visit the International End-of-Life Doula Association Website.

The End-of-Life Conversation

A landmark report titled “Dying in America” was released last year by the Institute of Medicine. It found that few people make their wishes known and too many deaths are filled with breathing machines, feeding tubes, powerful drugs, and other treatments that fail to extend life and make its final chapter more painful and unpleasant. The report found that end-of-life counseling, in conjunction with incapacity planning documents, can discern the type of treatment patients want in their last days, with options ranging from care that’s more focused on comfort than extending life to all-out medical efforts to resuscitate a dying patient.

Medicare just announced that beginning in 2016, doctors may be compensated for end-of-life advice to patients. Some doctors already have such conversations with their patients without billing extra. But an opening to roughly 55 million Medicare beneficiaries could make such talks far more common.

Supporters say counseling and planning in advance would give patients more control and free families from tortuous decisions. They suggest that patients should make their wishes known about end-of-life care at different stages of their lives, as early as when they get a driver’s license.

Comment period for the proposal closes on Sept. 8, 2015. Coverage would begin in 2016. You can read the proposal here.

Important Incapacity Planning Documents

Once an end-of-life conversation occurs, and important decisions are discussed, it is important to work with a qualified elder law attorney (preferably a Certified Elder Law Attorney) to ensure that the Incapacity Planning documents listed below are in place. Doing so is the best way to ensure that your wishes are met should you become unable to make important decisions for yourself. Incapacity planning documents include an Advance Medical Directive, a Financial Power of Attorney, and a Revocable Living Trust (RLT). Read more about these documents in this recent blog post.

The Time to Start Elder Law Planning is Now!

What if you’re like Marjorie in our example, and you want a doula to be by your side for comfort and compassion, in your time of need? What if you were in a coma and you want all life saving measures to be taken, or for the plug to be pulled? To ensure your wishes are met, it is important to start your planning now, so you are prepared in case a crisis occurs. If you have not done Incapacity Planning or Estate Planning, or if you have a loved one who is nearing the need for long-term care or already receiving long-term care, please contact The Law Firm of Evan H. Farr, P.C. as soon as possible to make an appointment for a no-cost 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

Caregiving for a Veteran: Programs Mentioned at WHCOA


Dear Commander Bun Bun,

In Mr. Farr’s recent article on the White House Conference on Aging (WHCOA), he talked a lot about caregiving, but didn’t mention anything about veterans, in particular. Can you elaborate on anything discussed at WHCOA that has to do specifically with caregiving and veterans?

Thanks for your help!

Cara Giver-Foravett


Dear Cara,

Thanks for pointing that out! Veteran’s Administration (VA) Secretary, Bob McDonald, took part in the national discussion around aging and shared how the VA supports older veterans at the 2015 White House Conference on Aging. Below are some key points from his discussion about VA programs, services, and supports that empower veterans to remain healthy, happy and safe as they age:

  • Clinical programs: The Office of Geriatrics and Extended Care offers a continuum of clinical programs that can address the unique health care needs that often accompany aging. These programs are found across all health care settings within the VA (e.g., hospital, outpatient clinic), as well as out in the community and in veterans’ homes.
  • Home and community-based programs, such as Home Based Primary Care, are particularly important for enabling many veterans to remain in their own homes and continue to be around their loved ones. For a complete listing of programs and information on how to decide what programs might be best for you or a loved one, visit
  • Supporting caregivers at home: Caregiver Support Coordinators (CSC) at each VA medical center serve as clinical experts on caregiver issues and are knowledgeable of both VA and non-VA support services and benefits available for older Veterans and their family caregivers. VA has a National VA Caregiver Support Line (CSL) (855-260-3274), which serves as a resource for caregivers of veterans.
  • Monthly Education Calls for Caregivers: Caregivers who are caring for older veterans engaged in VA healthcare are invited to participate in monthly education calls. With an overarching theme of “Care for the Caregiver,” groups are held three times each month, with a different topic of discussion each month.
  • Online Workshop for Caregivers: Building Better Caregivers™ (BBC), a 6 week online workshop, is available to caregivers of older Veterans who have dementia, memory problems, post-traumatic stress disorder, a serious brain injury, or any other serious injury or illness. BBC helps caregivers in two key ways: it offers training in how to provide better care, and helps caregivers learn how to manage their own emotions, stress and physical health. Following the completion of the 6 week workshop, caregivers are invited to join the BBC Alumni Community for on-going support and resources.

To find out more about VA’s Caregiver Support Program or to find the closest Caregiver Support Coordinator, please visit At you will also find a description of more than two dozen programs for all caregivers, training tips, and advice on caregiving, including the importance of taking time to take care of yourself.

Did you know that later this year, all veteran’s benefits will be on one Website? You can read more about this and the Veteran’s Aid and Attendance benefit in our recent blog post.

Hop this helps,

Commander Bun Bun



What Happens When Caregivers Are Too Sick To Perform Their Duties?

Q. I am a caregiver for my husband, Ed, who has had Parkinson’s disease for fifteen years. While fully coherent, his physical capabilities have been greatly reduced. Confined mainly to a wheelchair, he requires my help to dress, shower, toilet, walk, and exercise, and has trouble communicating and swallowing food.

Normal routine has set in, but unforeseen circumstances can sometimes occur. Although I take vitamins and exercise regularly, sometimes I wonder: What if I fell and broke my leg, and my husband and I were both immobile? What if I got Alzheimer’s and no longer had my wits about me? Last year, I had the flu for a week during a time when our respite care worker was unavailable, and my daughter left her own family and took a costly emergency flight from California to help. We can’t expect her to do that every time.

Do you have any suggestions for a caregiver, for when they fall ill themselves and can’t perform their duties?

A. Caregiving brings up a lot of difficult emotions. Not surprisingly, the high stress of caregiving (often called “caregiver burnout”) greatly increases the likelihood of serious health problems in the caregiver.

A recent survey conducted by the UCLA Center for Health Policy Research found that nearly a third of the estimated 3 million-plus informal caregivers in California reported emotional stress so severe it disrupted their lives. The same study found that nearly 75% of the middle-age caregivers were overweight or obese, and a proportion of them already have chronic health problems: Nearly 10% have diabetes; more than 6% have heart disease; more than 34% have hypertension. These caregivers will likely need their own caregivers if their health deteriorates.

In addition, if a caregiver is experiencing chronic emotional stress, it can affect virtually every organ system in negative ways, according to NIH. Prolonged stress has been shown to cause numerous health problems, such as high blood pressure, panic attacks, backaches, sleep disorders, and more.

So if you’re a caregiver, it’s very important to keep a close watch on your health, both physical and emotional. The strategies below should help make caregiving easier and less stressful, so you are less likely to fall ill yourself:

  • List your tasks — and get help when you need it: Get it all down on paper so you can clearly see the big picture. Then, don’t be ashamed or afraid to ask for help with specific tasks from a sibling, a neighbor, or someone in your church, synagogue, or mosque, or from a respite care professional.
  • Put yourself on the todo list: Your own health can suffer when you cut corners on your own self-care practices to make time for all the other things you’re trying to juggle. Therefore, you need to put self-care — such as exercising or meditation — on your list and treat it like any other important appointment.  If you don’t know how to meditate, please click here for an excellent free e-book that will quickly explain the benefits of meditation, and quickly teach you with several different meditation techniques.
  • Sign up for respite care — and use it: Every once in a while, you will need a few hours, a few days, a week— to decompress. That’s where respite care is invaluable, whether it means another relative who steps in temporarily, a professional aide who comes into the home for a brief time, or a geriatric care facility that’s set up for short stays.
  • Take mini-breaks during the day: Don’t wait for respite care to give yourself a breather. Building a few 10-minute breaks into your day can work wonders. Use the time to meditate, listen to music, or take a quick walk (even if it’s just around the house).
  • Find someone to talk to, when needed: Talking about your situation to a listening ear can relieve an enormous amount of pressure. Vent to a friend. Talk to a therapist. Even better, join a support group so you can connect with others in your same position. You can find Internet-based groups through ElderCare Online’s Caregiver Support Network and the Caregiver Action Network.
  • Strengthen your relationships: Hard conversations (and decisions) go easier when adult children, parents, and siblings feel like they’re on the same page. When bolstering those relationships, include frank discussions about caregiving and end-of-life wishes, so you don’t have to embark on them during an emergency. Make sure your loved ones have indicated their wishes in their estate planning documents.

Although you may be taking preventative measures, such as eating right, exercising, and meditating, you never know when there will be a challenge, such as an illness. Therefore, it is wise to be prepared in advance.

In case you get sick, be prepared:

  • Keep a two-week supply of medications in proper containers to correspond with times of day for dispensing.
  • Prepare a list of responsibilities by time of day so that someone taking your place will know what is required.
  • Don’t be afraid to call emergency medical personnel if you are really in trouble and isolated
  • Keep extra meals in your freezer to cover several days and keep handy the names of restaurants that deliver.
  • Prepare a list of the contact information of people to call for help, beginning with those who might stay the longest, including others who could offer even an hour or two. Be sure to discuss this plan with the people on your list and make them familiar with your needs.
  • Make long-term plans for your loved one, should you become seriously ill or worse.
  • Make sure you have your medical records and those of your loved one updated and easily available.
  • Work with an experienced elder law attorney (preferably a Certified Elder Law Attorney such as myself) to ensure that the Incapacity Planning documents, such as an Advance Medical Directive and Financial Power of Attorney, are in place.
  • Consider Medicaid Asset Protection using our Living Trust Plus™ Medicaid Asset Protection Trust so that if something happens to you, and your loved one suddenly needs nursing home care, at least your loved one will not have to go broke paying privately for nursing home care.

Caregivers: Take Care of Yourself

At The Law Firm of Evan H. Farr, P.C., we recognize that caring for a loved one strains even the most resilient people. We commend all you caregivers   — strong, courageous, and committed to providing long-term patient care. We hope you take advantage of services that offer respite and support.

Remember, part of taking care of yourself is planning for your own future and as well as for the future care needs of your loved one. To make an appointment for a no cost consultation, please contact us.

Fairfax Elder Law: 703-691-1888
Fredericksburg Elder Law: 540-479-1435
Rockville Elder Law: 301-519-8041
DC Elder Law: 202-587-2797

Highlights from the White House Conference on Aging

Photo from

This past Monday, on the cusp of the 50th anniversary of the creation of Medicare and Medicaid and the 80th anniversary of Social Security, the once-a-decade White House Conference on Aging was held. During the conference, 200 advocates, health care workers, and government officials discussed caring for seniors, addressing topics such as health care policies, dementia research, nursing home safety, leave for caregivers, enhanced geriatric training for health care workers, and more.

In preparation for the rapid growth of the senior population, the White House unveiled several initiatives aimed at improving health outcomes among older adults. Below are a sampling of the issues that were discussed:

Supporting Elder Caregiving

-A major priority: The conference’s planners made it clear that improving the caregiving infrastructure in the country would be a major priority when it released a “policy brief” on the topic leading into the conference. Conference panelist Ai-Jen Poo, Director of the National Domestic Workers Alliance and Co-Director of Caring Across Generations, stressed the importance of establishing systems to support and value the nation’s 50 million professional and family caregivers, whose numbers will double by the year 2050. We need “to see caregivers as a huge part of the solution for the future, as a huge part of the equation for quality of life” for our elders, she said.

Improving family leave for caregivers: A recent study by University of California-San Francisco researchers estimated that at least 2.5 million more home health and personal care aides will be needed to provide long-term services to seniors between now and 2030. Part of addressing the issue, the President said, is improving family leave for workers and giving them more flexible hours.

Resources for caregivers: New resources have been developed to educate and inform caregivers, including:

Factsheet for caregivers: HHS will release a new fact sheet on educating family caregivers about insurance coverage through the Affordable Care Act.  This resource describes some of the unique health needs family caregivers may have and their health care coverage options.

Handbook for federal employees: The Office of Personnel Management (OPM) will issue the “Enhancing Workplace Flexibilities and Work-Life Programs” handbook, which explains the workplace flexibility and work-life programs for federal employees supporting the elder care needs of their family members.

Private Sector Actions: The SCAN Foundation is investing $2 million in assisting community-based aging networks in developing the skills and capacity necessary to build collaborative partnerships with the health care sector.  Bank of America announced the introduction of the Bank of America Merrill Lynch Longevity Training Program for human resources and benefit plan professionals.

Training, Education and Research about Alzheimer’s and Other Dementias

Training for health care workers: HHS announced that it will develop an Alzheimer’s disease and related dementias training curriculum next year to build a health care workforce with the necessary skills to provide high quality dementia care and ensure timely and accurate detection and diagnosis of dementia.

Training for caregivers: The HHS Office of Women’s Health will develop related training to help family caregivers maximize their own health and address specific care needs of persons with dementia.

Education for seniors: The HHS Administration on Community Living is launching a $4 million Brain Health Awareness Campaign to help older adults better understand changes that occur in the brain as people age and reducing the fear of discussing concerns with family members and clinicians.

Dementia-friendly communities: The Dementia Friendly America Initiative announced plans to support dementia friendly communities and to expand to 15 additional pilot sites across the country. This work is based on a model implemented in Minnesota through which communities across the state are actively working to increase dementia awareness and implement strategies to help support individuals in the community with dementia and their family caregivers.

Making it Easier to Age-in-Place

Accessibility in the home: As the older population grows, housing that meets their needs is increasingly important.  To help address these needs, the U.S. Department of Housing and Urban Development released a guide to help older homeowners, families and caregivers make changes to their homes so that older adults can remain safe and independent.

Transportation: The U.S. Department of Transportation will launch the National Aging and Disability Transportation Center in fall 2015.  This $2.5 million investment will provide technical assistance to improve the availability and accessibility of transportation options that serve the needs of people with disabilities, seniors and caregivers.

Private sector actions: Home Depot also released a tip sheet and “how to” video highlighting simple home modification steps to help individuals age in place.  Washington State University will test new models of using technology to keep older adults safe and healthy as they live independently in their own homes, including a partnership with the Good Samaritan Society to equip 1,500 homes across the country with wireless sensors to help clinicians monitor those older adult residents who voluntarily chose to participate for health concerns.

Utilizing Technology to Support Older Americans 

Availability of Federal data sets: As part of the President’s commitment to making Federal government data open and more easily usable, the Administration announced that by September 2015, federal data sets relevant to aging and to elderly Americans will be made easily available on This resource will continuously be updated with datasets on aging, much like it is for other important Administration priorities such as climate, public safety, and education.

Private sector: Private sector leaders announced new actions to use technology to improve support for older Americans.

Tracking personal wellness on a smartphone: Seniors will be able to track their health behavior with personal wellness smartphone technologies from Walgreens and WebMD.

Accessibility: Peapod has adopted “best in class” web accessibility standards to ensure that all individuals, including those with disabilities and those who are unable to shop at traditional stores, can use its website and mobile applications.

Matching seniors with caregivers: Honor, a tech-enabled company that matches seniors with care professionals, will offer $1 million in free home care across 10 cities in the country and work with established care providing organizations in those communities to ensure this care goes to helping older Americans.


-Access to information and resources: The Administration launched to provide older Americans, their families, friends, and other caregivers, a one-stop resource for government-wide information on helping older adults live independent and fulfilling lives.  The Web site links to a broad spectrum of Federal information, including how to find local services and resources in your community for everything from healthy aging to elder justice to long-term care, as well as how to find key information on vital programs such as Social Security and Medicare.

Reauthorizing the Older Americans Act

The White House Conference was established under the Older Americans Act: The Conference on Aging was established in 1961 and has been organized under statute by the Older Americans Act, passed in 1965. Congress has not reauthorized the law, and the pending bill does not include a statutory requirement or agenda for the conference. Nevertheless, the White House convened yesterday’s gathering.

Reauthorizing the Act: The Department of Health and Human Services Secretary, Sylvia Burwell, told the conference that another way to help the aging population would be for Congress to reauthorize the Older Americans Act, which would provide funding for meals and job training for seniors and for senior centers. The law has not been reauthorized since it expired in 2011.

Upgrading Nursing Home Care

Improvements to nursing home care: CMS aims to improve meal delivery, overhaul quality and safety requirements and make sure nursing home staff members are trained on caring for residents with dementia.

Senior Health

“A culture of prevention in America”: The U.S. Surgeon General, Vice Admiral Vivek Murthy, called for a “culture of prevention in America.” The nation has a high rate of obesity; almost half of adults have some chronic condition. The solution is a combination of healthy nutrition, physical activity and mental health care, he said.

Exercise: NIH issued a call to all state and territorial health departments to support physical activity events for older adults beginning with Go4Life Month in September 2015.  In addition, the Surgeon General joined with the YMCA in issuing a challenge to the 850 YMCA associations across the country to host intergenerational physical activity events during the first week of August to promote opportunities for young and older Americans to be active together.

Fall prevention

CDC online course: To reduce the occurrence of falls among older Americans, the Centers for Disease Control and Prevention (CDC) is launching a free on-line course offering continuing education credits to physicians, nurses and other health professionals on making falls prevention a routine part of clinical care.

HHS monetary awards: The HHS Health Resources and Services Administration announced $35 million in awards to health professions’ training programs to expand geriatrics education to prepare the health care workforce to respond to the needs associated with advancing age.

Education on Medicare’s preventative benefits: CMS is working with AARP and other partners to disseminate information to patients and members on Medicare’s preventive benefits.  Efforts to increase use of recommended preventive services will include, for example, co-branding CMS publications on preventive services and distributing a user-friendly check list to help Medicare beneficiaries understand and use their Medicare preventive benefits.

Fall prevention tool: Kaiser Permanente will implement the CDC’s evidence-based falls prevention tool, known as STEADI (Stopping Elderly Accidents, Deaths Injuries) across all of its regions and make Kaiser’s evidence-based falls prevention program widely available to other health systems and health plans.

Retirement Planning

Automatic enrollment in 401(k)-type plans: About a third of the workforce lacks access to a workplace retirement plan.  By the end of the year, the U.S. Department of Labor will publish a proposed rule clarifying how states can automatically enroll employees in 401(k)-type plans to save for retirement.

Improving the Retirement Security of Federal Workers: 55% of employees leaving government transfer their money out of the Thrift Savings Plan (TSP) within a year.  To help encourage more employees to keep their money in the TSP, the independent Federal Retirement Thrift Investment Board will soon begin to make age-appropriate lifecycle funds the default investment for newly hired federal workers who are automatically enrolled in the plan.

TSP for military service members: Unlike civilians, military service members are not currently automatically enrolled in the TSP.  Congress is currently considering proposals by the Department of Defense and the bipartisan Military Compensation and Retirement Modernization Commission to automatically enroll service members in the TSP at 3% of basic pay.

Protecting Defined Benefit Pensions: To ensure that more retirees continue to enjoy a steady, reliable stream of income in retirement, the U.S. Department of the Treasury has recently issued guidance clarifying that employers sponsoring defined benefit pension plans generally may not offer lump sum payments to retirees to replace their regular monthly pensions.

Better access to Social Security benefit information: To assist Americans in their financial planning, the Social Security Administration is providing individuals with an easily transferrable data file with the information contained in their monthly Social Security benefit statement, and has released a guide to help developers understand how they could incorporate the data into new software.

I hope this information is helpful in summarizing some of the key points from the Conference. For more details, please visit the 2015 White House Conference on Aging website and check out this fact sheet.

Paying for Long-Term Care

At the Conference, Mirian Rose, a senior research analyst at the Benjamin Rose Institute on Aging in Cleveland, indicated that “Most people don’t have long-term care insurance. They think Medicare is going to pay for a nursing home or long-term home health services, and that is not true. So there’s a lot of education and more thinking at the policy level that needs to happen.”

In reality, most people needing long-term care — and their families — sadly wind up shouldering these costs alone because Medicare does not pay one penny for long-term care bills and the private long-term care insurance market is getting pricier and shrinking.

Medicaid Planning in Virginia, Maryland, and Washington, DC

Medicaid planning is what is needed to overcome the fact that our country’s health insurance system does not cover long-term care. Medicaid planning can be started while you are still able to make legal and financial decisions, or can be initiated by an adult child acting as agent under a properly-drafted Power of Attorney, even if you are already in a nursing home or receiving other long-term care.  In fact, the majority of our Life Care Planning and Medicaid Asset Protection clients come to us when nursing home care is already in place or is imminent.

Generally, the earlier someone plans for long-term care needs, the better.  But it is never too late to begin the process of Long-term Care Planning, also called Life Care Planning and Medicaid Asset Protection Planning.

Planning for long-term care will enable you to evaluate your options and make smarter decisions ahead of time. As a result, you’ll have the peace of mind that no matter what happens, you will know what to do as a family. If you or your loved ones have not yet done Long-Term Care Planning, please call us as soon as possible to make an appointment for a no-cost 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

Virginia’s New Privacy Expectation Afterlife and Choices Act Protects Digital Assets

Picture from Huffington Post.

Kathleen’s sister, Marie, was very tech savvy and enjoyed all that social media has to offer. She tweeted every day about books she was reading and news stories of interest, posted quilting pictures and photos of her grandchildren on Pinterest, Facebook, and Instagram, and kept up with friends and former colleagues on LinkedIn. She also did all of her banking online, and paid most of her bills through online bill pay. When she passed away suddenly, Kathleen, who was named as her sister’s executor (or personal representative), was concerned that she wouldn’t have access to the digital assets that had both sentimental and monetary value for her sister.

In the past, when a person died, access to a digital service officially died with them. Even giving your password to your spouse or a trusted loved one is forbidden under Facebook’s terms of service. In fact, in 2004, Yahoo famously denied access to a US marine’s e-mail account to his family after the marine was killed in action in Iraq. Luckily, all of this has changed in Virginia with a new law permitting limited access to a deceased loved one’s online accounts.

The Privacy Expectation Afterlife and Choices Act, which became effective in Virginia on July 1, 2015, aims to assure that a person’s electronic footprint remains off-limits after death — even to his or her close kin — except under very strictly controlled circumstances. The legislation gives the personal representative of an estate the power to access a decedent’s online accounts and information in certain circumstances, with a judicial order. The following is a summary of the law’s key provisions:

  • Limited access is permitted: Section 64.2-111(A) allows a Personal Representative limited access to electronic records.  The access is limited to the eighteen months preceding death and does not include the right to electronic communication and stored contents.  Records older than eighteen months can be obtained under Section 64.2-111(C), if a court concludes they are necessary to settle an estate.
  • Permission must have been granted in the estate planning documents: Access to stored content is provided under Section 64.2-111(B), as long as the decedent’s Will gave consent for the Personal Representative to access the contents of his or her online accounts.  
  • Privacy of joint users is protected: Section 64.2-113 protects the data of a joint user on the account from access by a personal representative of the decedent. 
  • Personal representative cannot send email/post content using deceased person’s account: Section 64.2-114 forbids a Personal Representative from using a decedent’s electronic account to send email, post content, or for other uses.

Why was the law passed?

The Virginia Legislature passed the Privacy Expectation Afterlife and Choices Act to address two concerns.First, the prevalence of online bank and brokerage statements has made the Personal Representative’s job of finding and accounting for estate assets increasingly difficult.Also, the Virginia Senate and the information technology lobby wanted to protect the privacy of decedents, which is why the access is limited to the person’s Personal Representative and why consent and opt-out provisions were included in the law.

How can you grant digital access to a personal representative?

If you want your personal representative to have access to your content after you die, be sure that your Will expressly grants that authority; please note that if our firm did your Will after August 1, 2012, the necessary language is already in there.Should you want your service providers to keep your data closed, make sure your privacy settings are properly set.

How can you get your digital assets prepared?:

  • Identify and inventory: Make a list of your online accounts, memberships, and subscriptions.
  • Identify the person best suited to take control of your digital assets following death: You should consider naming a special Digital Executor in your Will.  For instance, for elderly couples, you might name someone other than your spouse – such as an adult child who is technologically able to handle these matters.
  • Provide access: The obvious issue with a hard copy is choosing a secure place to store it. Therefore, a password-protected Excel spreadsheet is a good starting point, as long as your trustee has access to the document when it’s needed. Online services for storing passwords include  Keepass, Lastpass,  Assetlock, PasswordBox, SecureSafe and Deathswitch.
  • Update your estate plan. Your estate plan should provide clear instructions regarding your digital assets. If someone inherits your computer, does he/she receive all of your files, online music, digital photos, and loaded software?  If you have a social network site where you communicate regularly, how do you want your illness or death to be communicated? Do you want your Facebook page to be shut down or do you want a memorial page created in your honor? If you blog regularly, do you want a goodbye post to be displayed? Do you want your letters and e-mails deleted? Finally, if you have digital photos, should they should be copied and distributed and to whom?  Specifically addressing these issues is imperative for today’s generation.

While states are slowly taking steps to define the legal standing of a digital executor, the burden remains on each of us to inventory our digital assets and ensure access for a smooth transition. Otherwise we risk losing these assets forever. For more details on digital assets and laws in other states, please read our blog post, What Happens to Your Online Data After You Are Gone?

Protect your Digital and Traditional Assets

Now is a good time to start planning for your digital assets AND your traditional assets. Call us today to make an appointment for a no-cost consultation:

Fairfax Estate Planning: 703-691-1888
Fredericksburg Estate Planning: 540-479-1435
Rockville Estate Planning: 301- 519-804
DC Estate Planning: 202-587-2797

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