Watch Out for These Scams During Medicare Open Enrollment!

Joanna received a call last week from a man claiming to be from the Centers for Medicare and Medicaid Services (CMS). Joanna was told that she was entitled to money back because of “changes” that were made by Medicare. The man on the phone asked for not only Joanna’s Medicare number, but also her bank account information, for a supposed direct deposit. Joanna knew that it didn’t sound legitimate, so she hung up. However, many who receive these phone calls are duped by these unscrupulous tricksters.

For those on Medicare, Oct. 15 to Dec. 7 means open enrollment. For scammers, it has unfortunately become a time to steal unsuspecting seniors’ money and identities. Although Medicare scams occur year-round, the Federal Trade Commission (FTC) warns that they dramatically increase in the weeks leading up to and throughout the annual window for participants to make changes to their health and prescription coverage.

The con artists associated with these scams are not necessarily bent on taking cash directly from their victims. This time around, they are looking to extract social security numbers from seniors.

Keep an eye out for these open enrollment scams:

1. New card cons. In phone calls, emails, or front-door visits, you’re told that Medicare is issuing new cards, and to get yours, you need to provide identifying information such as your Medicare number, birth date or even financial account numbers. Identity theft is the real goal.

What to know: Medicare isn’t issuing new cards and its employees don’t contact participants through unsolicited calls, emails, or visits. They won’t ask for personal identifiers unless you contact the agency yourself.

2. Refund rip-offs. Scammers claim you’re entitled to money back because of “changes” or “enhancements” by Medicare or private insurers, or because of purported lawsuits or actions by government agencies. In these schemes, the goal is to get not only your Medicare number, but your bank account information for a supposed direct deposit.

What to know: If you’re really entitled to a refund, a check will be sent directly to you. You won’t have to “prove” or provide anything. If you get Social Security, CMS already has your direct-deposit account on file, so Medicare wouldn’t ask for it.

3. Pretending to be someone they are not. In seeking your personal information, con artists may also claim to be from state or local health agencies, doctor’s offices or hospitals, or an official-sounding but fake organization, such as the National Medical Office. And they may try to trick you by manipulating your caller ID screen.

What to know: Never trust caller ID. Scammers can easily make it display whatever identity and phone number they choose, thanks to “spoofing” products that are now available. Also, don’t be taken in if callers have personal info about you. Scammers have been known to contact Medicare patients and accurately give the names and addresses of their doctors. It’s unclear how they get the information. If you think a call may be genuine, hang up, look up the agency’s number yourself and call it back. For Medicare, it’s 800-633-4227 (for TTY callers, dial 877-486-2048 toll-free).

4. False freebies. You get a call offering you free medical supplies or a health checkup. The caller may even know something about your medical condition. Or, you’re invited to go somewhere for a complimentary checkup.

What to know: Assume that an unsolicited call promising supplies for diabetes or other medical conditions is another attempt to collect your Medicare/Social Security number. Or to soften you up for pitches for overpriced goods later. Plus, you may be told your credit card is needed for “shipping charges.”

5. Complimentary checkups — offered by traveling clinics or temporary storefronts — can also be just an effort to get you to reveal personal identifiers. There are legitimate ones too, of course, so if you’re thinking of going, first check out the organization that’s offering them.

6. Supplemental swindles. Open enrollment is prime time for insurance sales people to pitch supplemental policies that they promise will save you thousands in out-of-pocket costs. While there are many legitimate policies on the market, not all make sense for everyone. And it’s not unknown for sales people to push this kind of insurance with scare tactics, free lunch seminars, and false claims of being with a government agency.

What to know: As with investment scams, “free lunch seminars” are often a high-pressure pitch for insurance that may be wrong for you but right for the salesman. Be aware that private companies — not the government — sell Medicare Advantage and Medicare Supplement plans (also called Medigap plans).

7. Billing bilking. Told that something isn’t “usually” covered by Medicare, but there’s a way around the rule? Or that you can get a kickback for providing your Medicare number or undergoing unnecessary treatment? You may get this kind of offer if you go to a “free” medical checkup offered by a shady group.

What to know: No matter how it’s said, this is fraud, and possible criminal charges can be filed against both you and the other person. Medicare fraud is a huge problem, costing taxpayers about $60 billion a year. When in doubt, check with Medicare or your supplemental insurance provider. You should only sign a release form allowing others to make Medicare decisions on your behalf if the form’s been carefully reviewed by you, a trusted family member or friend, or an attorney.

8. Bogus Medigap plans sold by con artists. They will call you and claim that supplemental coverage is mandatory.

What to know: Supplemental plans and prescription drug benefits are not mandatory. They are completely voluntary, and they are not marketed via calling campaigns or in-home visits. You can sign up for supplemental coverage yourself during your initial enrollment period. For most Medicare enrollees, initial enrollment starts three months before your 65th birthday.

How to Avoid Medicare Scams

During the next couple of weeks, be on the alert for anyone who claims to be a Medicare sales representative, because that job does not exist. Medicare officials don’t go to door-to-door and will only correspond with recipients via phone or email, if prompted to first. Official insurance communication is always mailed.

Also remember the easiest step to avoid a Medicare scam: never reveal your card number or other personal health and financial information to anyone who’s not a bona fide member of your health care team.

Ignore the scammers by hanging up on suspicious phone calls, as Joanna in our example did, and by disregarding door-to-door visits. A “No Soliciting” sign for your door is a good deterrent for door to door fraudsters and people trying to sell you goods and services, if you find them to be bothersome.

In the end, seniors who believe that they’re are being targeted by con artists in connection with Medicare should call 1-800-MEDICARE to report the activity.

Planning to Protect Loved Ones

Protecting seniors from scams is very important, which is why we continually share information about current scams and how you can protect yourself. It is also very important to plan for your future and for your loved ones. If you have not done Incapacity Planning, Estate Planning, or Long-Term Care 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 us to make an appointment for a no-cost introductory 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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Donate A Tank of Gas – #GivingTuesday

I hope you had a wonderful Thanksgiving holiday with your friends and family.  I spent mine in Newport News. I’m fortunate.  I have a car and the money to fill up the gas tank to make the drive there and back.  For $25 I was able to travel and spend the holidays with my family before returning to work yesterday.

Today is #GivingTuesday, and I’d like to ask you to donate a ‘fill-up’ to VPLC.   #GivingTuesday helps ordinary people like you and me join forces to do something extraordinary in these 24 hours.  VPLC needs to raise $8,000 to help upgrade its website.  Your donation of a “fill-up,” combined with others donating a ‘fill-up,’ will help us reach this goal.   Ordinary people, like you and me, coming together to make a difference – one tank of gas at a time.

Thanks in advance for considering my request and for supporting our #GivingTuesday goal, if you are able.  It’s easy to do.  Click here to be taken to the online donation page.  Just a couple clicks, and you will have made a difference for VPLC and lower-income Virginians.

Best wishes for a safe and Happy Holiday Season,

Toni Maxey

Giving Tuesday gas

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The Ugly Side of Hospice Care

Q. My mother is ready to transition to hospice care. She has very advanced dementia, severe arthritis, and is immobile. With all of the assistance that she needs, we can no longer care for her in my home, even with the help of nurses and aides, and we probably should have transitioned her to a skilled nursing facility years ago. When it comes to hospice care, however, I have heard some stories of lack of care being available when patients need it the most. Is that true? Would nursing home care be a better option?

Thanks for your help!


First, let me clarify that hospice is not typically a place, but rather a type of care. Hospice care can be delivered at home, in an assisted living community, in a nursing home, and in a facility solely dedicated to hospice care, though these facilities are rare.

Unfortunately, what you read about hospice care is sometimes true, based on recent research. A Kaiser Health Care investigation found that the hospice care that people expect — and sign up for — sometimes disappears when they need it most. In fact, families across the country have called for help in times of crisis and have been met with delays, no-shows, and unanswered calls.

As an example, in the small town of St. Paul, VA, Ms. Virginia Varney enlisted Medical Services of America Home Health and Hospice to care for her son, who was dying of skin cancer. On his final day, he was vomiting blood and in intense pain. Varney called at least four times to get through to the hospice provider. Hours later, she said, the hospice sent an inexperienced licensed practical nurse who looked “really scared” and called a registered nurse for backup. The RN never came, and her son died that night.

Varney said that when she signed up for hospice care, “(t)hey told me 24 hours a day, seven days a week, holidays and all. I didn’t find that to be true.”
Varney’s story is one of many reported by Kaiser in their recent article, ‘No One Is Coming’: Hospice Patients Abandoned At Death’s Door.’

And, what is being reported is not new. To better understand the quality of services rendered to terminal patients, The Washington Post also conducted its own analysis a few years ago. Researchers analyzed the Medicare billing records for more than 2,500 hospice outfits, obtaining an internal Medicare tally of nursing care in patients near death, and the Post reviewed complaint records at hundreds of hospices. Their findings were as follows:

• The scarcity of care affects the patients most in need. While many home hospice patients require little more than weekly nursing visits, some encounter crises in which their symptoms — pain, breathing troubles, seizures and so on — flare up in ways that cannot be controlled without sustained attention. For those cases, hospices are supposed to be able to provide either “continuous” nursing care at home or inpatient care at a medical facility. But about one in six U.S. hospice agencies did not.
• No care available when its needed most: At 445 of the hospices, a third or more of patients died without having seen a skilled nurse in the 48 hours before their death.
• The absence of such care left hospice patients to suffer or find other options. Some suffered in pain. Others had breathing difficulties, with some unable to get an answer about why their oxygen tanks weren’t working. And some were compelled to leave their homes, and to drop hospice services and head by ambulance to the emergency room, a difficult place for the frail and dying.
• Economic incentives posed by Medicare payment rates could be a big part of the problem. Providing patients with “routine” levels of care, which typically includes semiweekly nursing visits, can be very profitable. But providing continuous bedside nursing care or inpatient care to needier patients can be a financial and logistical drain for small and mid-size agencies, hospice owners said.
• Quality of hospices is not available to consumers: Though the federal government publishes consumer data about the quality of other health-care companies, including hospitals and nursing homes, it provides no such information about hospices. State inspections are often unpublished and, when they are published, they are often hard to understand. So a family is typically choosing hospice care blindly with no idea if it is truly a good option for their loved one.
• Safety concerns due to infrequency of inspections: The typical hospice provider in the U.S. undergoes a full government inspection about once every six years, according to federal figures, making it one of the least-scrutinized areas of U.S. health care. By contrast, nursing homes are inspected every year, and most hospitals every three years. According to The Washington Post, “the dispersal of patients makes oversight difficult to begin with, but the infrequency of inspections means shortcomings are even less likely to be detected.”
• Rising discharge rates: of patients who need to seek treatment elsewhere: Even though the obvious goal of every hospice organization is to provide care for its patients until death, more than one in three patients are released from hospice care while still alive, according to a new study funded by Medicare. It is normal for hospice to release a small portion of patients before death (15%), but when the rate of patients leaving hospice care alive is double that level, it can signify either that agencies are driving the patients away with inadequate care, or enrolling patients in the first place who aren’t really dying — often in order to pad their profits.

Nursing Home Hospice Care May be a Better Option than Home Hospice Care

As you can see, many hospice providers are failing to provide quality care for patients at end of life, especially when that care happens at home. Unlike hospices, nursing home are staffed with nurses and doctors 24/7, making them (in many cases) a better choice for a loved one’s long-term care needs and end-of-life needs, and hospice care can just as easily be provided in the nursing home as it can at home. Many nursing homes have a contract with one specific hospice provider, so if you have a loved one in a nursing home, you might not have a choice in picking a hospice provider. However, you know that if you’re in a nursing home, you’re not going to be left without care at end-of-life even if the hospice provider fails to show up.

Nursing homes in the DC Metro area cost $10,000-14,000 a month

To protect your family’s hard earned money and assets from the catastrophic costs of nursing home care, the best time to create your long-term care strategy is before you actually need long-term care. If you’re over 65, we recommend that you begin your asset protection planning now. Even if you are currently receiving long-term care services for yourself or a loved one, it’s still not too late to plan and protect assets and improve dignity and quality of life. 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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Critter Corner: Many Hospice Workers Lack Their Own End-of-Life Directives

Dear Bebe,

Hospice workers come into contact with people who are dying every day. I read recently that many of them don’t even have their own advance medical directives. Is this true? Seems like a no-brainer to me!

Noah Directivs-Ovtherown

Dear Noah,

What you read is correct. Many hospice care workers, who deal with death and dying every day, haven’t outlined their own end-of-life wishes for medical care, researchers say.

In a recent study of about 900 hospice care workers, only 44% had completed an advance medical directive outlining their wishes for care if they’re unable to communicate those wishes themselves.

“Advance directives are associated with fewer hospital deaths, fewer intensive care admissions and fewer life-prolonging measures, as well as better quality of life for patients at the end of life,” said study author Terry Eggenberger, an associate professor in the Florida Atlantic University College of Nursing.
The findings seem surprising, the researchers said, given that hospice care workers regularly see the consequences of not providing medical directions in advance. Procrastination, fear of the subject, and cost were the most common reasons for not drafting an advance directive, according to the report.

The findings were published recently in the American Journal of Medicine.

Talking about end of life issues is an emotional and difficult task for most of us, even for hospice workers who deal with death on a daily basis. However, it is an important first step to making sure your wishes are clear. Once you have taken the step of speaking with your loved ones about your wishes, it is important to develop incapacity planning documents, including an Advance Medical Directive, to make your wishes legally enforceable. If you haven’t done so already, be sure to call Mr. Farr to make an appointment for a no-cost initial consultation.

Hope this is helpful,


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Alzheimer’s Turns 100 – Bill Gates is on a Mission to End It Now!

100 years ago, German physician Dr. Alois Alzheimer first wrote about “a peculiar disease.” He described the case of a woman named “Auguste D,” who was experiencing significant memory loss, severe paranoia, and other psychological changes. But, it wasn’t until Alzheimer performed an autopsy on her brain that he found that her brain had shrunk significantly, and there were unusual deposits in and around the nerve cells. This was how Alzheimer’s Disease was first discovered.

This month is National Alzheimer’s Awareness Month, and sadly we are recognizing the 100th birthday of the disease, still without a cure. In fact, Alzheimer’s is so prevalent today that it has directly affected approximately 1 in every 2 families. Here are a few facts and figures about the disease, including a few things that should give us a glimmer of hope:

· Alzheimer’s currently affects more than 5 million Americans and that number is likely to triple by 2050.
· It is the sixth leading cause of death in the USA and is climbing steadily in the rankings.
· Alzheimer’s is the leading cause of dementia and accounts for about 65% of all dementia worldwide.
· Alzheimer’s follows a 14-year course from the onset of the first symptoms until death (there is of course some variability across patients but 14 years is pretty typical.)
· Alzheimer’s is generally detected at the end-stage of the disease (in years 8-10 of that disease course), which is typically far too late to optimize the effects of currently available treatments.
· Many people, including a startling number of physicians, incorrectly believe that memory loss is a normal part of aging. It isn’t! Regardless of the cause of the memory loss, timely medical intervention is best.
· One of the reasons that current treatments are often deemed ineffective is because they are routinely prescribed for patients with end-stage pathology who already have massive brain damage. With earlier intervention, treatment can be administered to patients with healthier brains, many of whom will respond more vigorously to the recommended therapy.
· “We have no cure” does not mean “there is no treatment.” With a good diet, physical exercise, social engagement, and certain drugs, many patients (especially those detected at an early stage) can meaningfully alter the course of Alzheimer’s and preserve their quality of life.
· Through an intense research effort over the past twenty years, scientists have gained a lot of insight about Alzheimer’s disease. Although we don’t know when, better treatments for Alzheimer’s are certainly on the way.
· Take good care of your heart to help your brain stay healthy: Researchers have shown that high cholesterol, high blood pressure, and obesity all confer greater risk for cognitive decline. Maintaining good vascular health will help you age with cognitive vitality.
· Managing risk factors may delay or prevent cognitive problems later in life: Well-identified risk factors for Alzheimer’s disease include diabetes, head injuries, smoking, poor diet, lethargy, and isolation. Most of these risk factors for Alzheimer’s can be actively managed to reduce the likelihood of cognitive decline.

Typically, when someone or something turns 100, it is a happy occasion — like my daughter’s grandmother’s 100th birthday which we just celebrated this past weekend! As you know, this is not the case with Alzheimer’s. In the spirit of National Alzheimer’s Awareness Month and to continue his tradition of giving money to fight diseases worldwide, billionaire Bill Gates  is now trying to put an end to Alzheimer’s for good!

Bill Gates Donates $100 Million to Stop Alzheimer’s

Bill Gates has pledged to invest $100 million into research to find a breakthrough for Alzheimer’s disease.

The billionaire, who is the richest person in the world, announced yesterday that he plans to make an initial $50 million investment into a venture capital fund, Dementia Discovery Fund, that finances new treatments for the degenerative condition. This will be followed up by another $50 million investment in start-up ventures working in research on Alzheimer’s.

In his blog post, Bill Gates said he was confident a breakthrough in treating Alzheimer’s could be found if progress was made in key areas, including developing better early diagnosis and funding more diverse approaches to treating patients. According to Gates, “By improving in each of these areas, I think we can develop an intervention that drastically reduces the impact of Alzheimer’s. There are plenty of reasons to be optimistic about our chances: our understanding of the brain and the disease is advancing a great deal. We’re already making progress—but we need to do more.”

Gates said the money he was investing would be coming from him personally rather than from his philanthropic organization, the Bill & Melinda Gates Foundation. He added that the foundation could play a future role in the fight against Alzheimer’s disease by helping to fund any breakthrough treatments for poorer countries.

Medicaid Asset Protection 

Hopefully, the money Bill Gates pledged will help with a breakthrough towards curing Alzheimer’s. In the meantime, persons with Alzheimer’s and other forms of dementia, and their families, face special legal and financial needs. At the Farr Law Firm, we are dedicated to easing the financial and emotional burden on those suffering from Alzheimer’s 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. If you have a loved one who is suffering from Alzheimer’s or any other type of dementia, please call us as soon as possible to make an appointment for an initial no-cost consultation:

Fairfax Alzheimer’s Planning: 703-691-1888
Fredericksburg Alzheimer’s Planning: 540-479-1435
Rockville Alzheimer’s Planning: 301-519-8041
DC Alzheimer’s Planning: 202-587-2797

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Save The Date – #GivingTuesday is November 28th.

Giving Tuesday November 28th is #GivingTuesday.  It follows Black Friday and Cyber Monday, commercially designed days to have you spend money on material goods.  #GivingTuesday is dedicated to helping everyone make a difference for those who may not have the resources to take advantage of days like Black Friday and Cyber Monday.  And, I’m asking you to make a difference for VPLC on #GivingTuesday.

It’s more important than ever organizations like VPLC exist to educate elected officials, at all legislative levels, on the issues, like predatory lending, affordable healthcare, domestic violence,  affecting lower-income Virginians.

For the cost of a couple of movie tickets and popcorn ($40), a few skipped trips to your favorite coffee spot ($20), or a skipped lunch ($10), you can help VPLC raise $8,000, which will help cover costs with updating their website.

It’s a small price to help a worthy organization like VPLC.  VPLC is committed to leading and coordinating efforts to seek justice in civil legal matters for lower-income Virginians.  I’m asking you to commit a few moments of your time plus a skipped movie, coffee or lunch and help VPLC reach it’s $8.000 goal.  Every gift, in any amount,  counts.

If you’d rather donate now, here’s the link –  All donations through this link are part of VPLC’s #GivingTuesday campaign and count towards meeting our $8,000 goal.

All my best for a safe and wonderful Thanksgiving holiday,

Toni Maxey
Director of Development

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Critter Corner: Caregiving for a Veteran

Dear Ribbit,
My husband is an partially disabled veteran and I am his caregiver. Sometimes, it can be stressful, and I can use all the help, support, and educational resources I can get. A friend told me she thinks that there’s some type of program that offers “comprehensive assistance” for family members who provide care for a veteran, but she’s not sure what it’s called. Do you know anything about such a program and how it might be of help to pay caregiver such as myself?
Karen Foravett

Dear Karen,

Please thank your husband for his service to our country. And, thanks to you and all of the other caregivers out there who take care of veterans!

Caregivers for veterans are a critical part of our health care system. You, and others like you, make it possible for wounded veterans to remain at home rather than in care facilities, helping with daily activities such as bathing, dressing, meal preparation, and medication management. The RAND Corporation estimates that informal caregivers for veterans save the U.S. millions of dollars in health care costs each year, providing in-home assistance to 5.5 million veterans.

Since 2010, the U.S. Department of Veterans Affairs (VA) has offered what it calls a Program of Comprehensive Assistance for Family Caregivers for veterans of the post-9/11 era. The program provides support for informal caregivers of veterans—most often spouses or other family members. Family members who serve as primary caregivers receive formal training and, importantly, financial assistance. Nearly 23,000 caregivers have signed up for the program since it began.

Earlier this year, the program came under fire when many local VA medical centers dropped caregivers from the rolls, seemingly without warning and without cause. Families who had relied on the program for years were told they were no longer eligible, even in cases where the veteran continued to require the services provided by the caregiver. In response, VA Secretary David Shulkin called for a full review of the program. Following the three-month review, the VA reported this past summer that the program has resumed full operations with better processes and clarity in place to ensure that eligible families get and keep the services they need. And a new committee was recently established to advise the VA on issues facing veterans’ families, caregivers, and survivors.

The VA caregiver support program currently offers many helpful resources. It provides online materials about dealing with veterans’ post-traumatic stress disorder, traumatic brain injury, and other common conditions, along with peer support services such as monthly phone calls that allow caregivers to connect with each other. But only a small portion of the 1.1 million people caring for post-9/11 veterans are eligible for and enrolled in the program. Friends or relatives who don’t live with the veteran full time, even if they serve as the primary caregiver, are not eligible.

According to the VA at

The Program of Comprehensive Assistance for Family Caregivers offers enhanced support for Caregivers of eligible Veterans seriously injured in the line of duty on or after September 11, 2001.

Enhanced services for eligible participants may include a financial stipend, access to health care insurance, mental health services and counseling, caregiver training, and respite care.

Who is eligible?

Veterans eligible for this program must:

· have sustained or aggravated a serious injury — including traumatic brain injury, psychological trauma or other mental disorder — in the line of duty, on or after September 11, 2001; and
· be in need of personal care services to perform one or more activities of daily living and/or need supervision or protection based on symptoms or residuals of neurological impairment or injury.

Hop this is helpful,


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Bill to Support 40 Million Caregivers Becomes Law

Q. My friend, Molly, is the primary caregiver for her mother, Anne. Anne suffers from diabetes and high blood pressure, among other things. After a hospital stay for an infected gall bladder, she came home and the responsibility of caring for Anne fell completely on Molly.

According to Molly, her daily routine includes preparing Anne’s bed, giving her medications, checking her blood sugar level, injecting her with the insulin she needs, washing her clothes and bed sheets, washing her hair and body, buying and preparing her food, and taking her to doctor’s appointments. This doesn’t leave much time for Molly, who works part-time and is a mother herself.

I can tell that Molly is under a lot of pressure in her dual roles as a caregiver, mother, and worker. And from what I’ve read, her situation seems pretty common. Molly does not complain because she says that it’s a “labor of love,” but I can tell she is overwhelmed. What is out there to help overextended caregivers, like Molly, who are trying to keep their loved ones in their homes for as long as possible? Thanks!

November is National Family Caregiver’s Month, a time to recognize and honor family caregivers across the country. This annual commemorative month enables us to raise awareness of family caregiver issues; celebrate the efforts of family caregivers; and educate and increase support for family caregivers.

Informal caregivers, such as your friend Molly, provide invaluable support for their loved ones every day and, as you mentioned, she’s not alone. Each year, unpaid family caregivers provide 37 billion hours of unpaid care, valued at an estimated $470 billion — as much as the combined annual sales of Apple, Hewlett Packard, IBM and Microsoft. Family caregivers handle essential medical tasks ranging from giving injections to providing wound care. They also provide meals, transportation, and other services. Similar to your friend, many of them do this while working full time and raising their own families.

Recently, legislation to establish a federal strategy to address the needs of family caregivers became law. The Recognize, Assist, Include, Support and Engage, or RAISE Family Caregivers Act, recognizes the tremendous need for caregiver support and calls for the development of a national strategy to support family caregivers. The law makes it easier to coordinate care for a loved one, get information, referrals and resources, and improve respite options so family caregivers can reset and recharge.

In addition, the RAISE act calls for the following to support the more than 40 million Americans who help loved ones live independently at home:

  • the creation of a family caregiving advisory council of representatives from the private and public sectors, including family caregivers, older adults and people with disabilities, health care providers, employers, state and local officials, and others to make recommendations regarding the national strategy.
  • advisory council meetings that would be open to the public with opportunities for public input.
  • a national strategy that would identify specific actions that communities, health care providers, employers, government, and others can take to recognize and support family caregivers.
  • ways to make it easier for caregivers to coordinate care and receive information, referrals, and resources.
    What She Can Do Now

Women represent 60% of caregivers. The typical family caregiver is a 49-year-old woman who is caring for a 69-year-old woman — most likely her mother. About 32% of family caregivers provide at least 21 hours of care a week in addition to their full-time or part-time jobs.

It is a huge step in the right direction that the RAISE act is now law, and that more will be done to help overextended caregivers, such as your friend Molly. Similar to any new law, things take time to be put into place. For now, below are some tips to help your friend manage in her dual roles:

Ask for help. Ask for help when it’s needed. While there are many things she can accomplish on her own – accepting the help of a friend or neighbor for small tasks adds up to big rewards. Ultimately, one of the most valuable things caregivers, who are also professionals and mothers, have is time.

Accept help. Sometimes saying “yes” when people offer help – and even voicing the need, brings a sense of teamwork and comfort and support. Most importantly, it is a gift of what we are all short of: time and energy to spend with our families and also meeting our needs and aspirations personally and professionally.
Take some pressure off. Everyone may be depending on your friend, but she needs to remember to find some down time in the midst of it all– even if it means calling on help! She should take time for herself to read a good book (or watch a favorite show) or laugh with a friend to help relieve some stress and recharge. This will help her to be more energized to provide the care that she needs to give.

Put together an elder care team. An elder care team can include physicians, home care professionals, an elder law attorney, and financial planners. Family members on this team can also help out and provide your friend with assistance and much needed respite.

Call in professional reinforcements, for the sake of her health and sanity. Outside of getting family, friends, or neighbors to assist, the local Area Agency on Aging is one place to look for relief. The Eldercare Locator provides a database of resources by ZIP code, and our trusted referrals are also quite helpful. If a nursing home becomes a consideration, using the federal government’s online Nursing Home Compare tool is a great starting point – but be sure to call our office first if you’re looking at nursing home care.

Take care of herself. Caregiving can be both emotionally and mentally taxing, and can easily lead to “caregiver burnout.” While many caregivers continue to face some level of stress and pressure when managing their careers and serving as caregivers, it’s important for them to remember the importance of self-care as well. Suggest that your friend take advantage of services that offer respite and support.

Connect. Your friend should continue to make meaningful connections with other people or communities, as deep and meaningful connections with other people are a critical component to happiness.

Hire an Experienced Elder Law Attorney

An experienced elder law attorney, such as myself, can guide your friend and her family through advance medical directives, Medicare and Medicaid issues, estate planning, family caregiver agreements, and other documents that safeguard the current and future care of her mother.
To make an appointment for a no cost initial 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

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Is Alzheimer’s a Spectrum Disease, Similar to Autism Spectrum Disorder?

Mary, a retired college professor, was unhappy when her ophthalmologist insisted that she stop driving. It happened when Mary informed her about her Alzheimer’s diagnosis. Mary’s vision hadn’t changed in 10 years, and she felt perfectly capable of driving at that point in time. At an appointment with her neurologist, Mary expressed her dismay about her car keys being taken away. For Mary, she may forget a word or two here and there, but she honestly felt that her driving was safe and unaffected, thus far.

Mary was one of the many examples that Dr. Gayatri Devi uses in her research. She discusses what she calls being placed in a “diagnostic inbox,” where if you have Alzheimer’s or another form of dementia, it is assumed you have certain symptoms. She disagrees and feels that similar to Autism Spectrum Disorder (ASD), Alzheimer’s should be seen as a spectrum disorder, as well, because everyone with the disease experiences varying symptoms. So, in the case of Mary, some seniors in her situation should indeed stop driving, while others may still be able to drive safely for several more years to come, depending on their symptoms and the severity of them at the time.

Dr. Devi’s research provides some hope of treatment options that treat Alzheimer’s patients’ based on their symptoms. Published more than 50 times in peer-reviewed journals, her current research focus is on neurologic diseases including stroke, dementia and chronic pain. Besides being a strong believer that Alzheimer’s is different for everyone who has it, she recently wrote a book — “The Spectrum of Hope: An Optimistic and New Approach to Alzheimer’s Disease and Other Dementias” — to dispel some of the most-widely believed myths about Alzheimer’s, as follows:

Myth #1: Alzheimer’s typically gets diagnosed in internist’s offices:  According to Dr. Devi, 97% of patients with mild Alzheimer’s disease don’t get diagnosed in their internist offices, and half of patients with moderate Alzheimer’s don’t get diagnosed there either.

Myth #2: Alzheimer’s treatment doesn’t work, so why bother: According to Dr. Devi, Alzheimer’s treatment does make a difference, and patients do benefit from it, as long as behaviors exhibited by the specific patient are treated individually (no one size fits all solutions). “It depends on the individual patient,” Devi said.

Myth #3: If your parents or grandparents have had Alzheimer’s, you are more likely to get it also:  According to Dr. Devi, in most cases, genetics has little to do with it. In fact, less than 5% of Alzheimer’s cases are from genetics.

Myth #4: There is no way to prevent Alzheimer’s:  According to Dr. Devi, “[y]ou can prevent up to 60% of Alzheimer’s cases” by lifestyle changes and modifications to your diet, regardless of symptoms. When it comes to diet, make sure that you’re eating food that’s good for your heart. A Mediterranean diet, for instance, is also a good anti-Alzheimer’s diet. In addition, be sure that you’re active. Exercise 30 minutes a day, three times a week. Controlling risk factors such as high blood pressure and diabetes is also important.

Myth #5: You cannot stop the progression of Alzheimer’s: While there’s currently no way to reverse Alzheimer’s, we can certainly stop the progression, according to Dr. Devi. Similar to colonoscopies and mammograms, Devi said she thinks everyone over the age of 50 should have “baseline brain evaluations” including “a map of our brain’s strengths and weaknesses.” That way, “we can look back and say, look, it’s about the same as it was 10 years ago, nothing to worry about. And, if there’s a problem, we can intervene earlier. Devi says, “(t)he earlier we intervene to treat a person, the better the response to treatment.”
For the best outcome, Dr. Devi encourages people who are worried about memory impairment to seek a diagnosis, because early treatment of symptoms will enable doctors and caregivers to manage the disease more effectively.

Behavioral Therapy for Alzheimer’s

When it comes to autism spectrum disorder, because every child has unique symptoms, each child typically receives therapy to meet their specific needs. The same premise can work for Alzheimer’s.

According to the Alzheimer’s Association, there are strategies available to identify and address needs that the person with Alzheimer’s may have, and that non-drug approaches should always be tried first.

ABA Therapy for Alzheimer’s

For autism spectrum disorder, Applied Behavioral Analysis (ABA) is a popular therapy. Similar to ASD, Alzheimer’s is primarily expressed and diagnosed through abnormal behaviors, which may or may not include:

Severe memory loss, particularly of short-term memory
Decreased logic and reasoning skills
Difficulty communicating
Depression and anxiety
Inappropriate behavior and personality change

According to, all of these issues can be successfully addressed through the use of applied behavior analysis techniques, either applied individually or as part of adjustments made in the environment of care facilities.
Although in many cases Alzheimer’s patients cannot remember what they learned in ABA therapy, certain things do reach the patients, and a clear understanding of what led up to the behavior can help caregivers adjust environmental factors to make life easier for the patients.

For instance, in one experiment, the use of personalized shadow boxes helped some dementia patients find their rooms more easily in a long-term care facility. The therapist treating the patients recognized that short-term memory failure made it difficult for the patients to remember their room numbers in the unfamiliar facility. But long-term memories are often preserved. By taking personal items and pictures that the patients were long familiar with and using those to mark the rooms, patients were more easily able to identify their rooms.

Solving these types of issues not only addresses the immediate problems facing dementia patients, but also serves to reduce the frustrations of their daily lives.

Alzheimer’s Planning at The Farr Law Firm

Regardless of symptoms, persons with Alzheimer’s and their families face special legal and financial needs. Controlling the high costs of caring for a loved one with Alzheimer’s, and navigating the emotionally and physically demanding requirements of caregiving, require the assistance of a highly skilled and specialized expert in the field of Alzheimer’s planning.

Here at The Farr Law Firm, we are dedicated to easing the financial and emotional burden on those suffering from Alzheimer’s 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. If you have a loved one who you believe is suffering from Alzheimer’s or any other type of dementia, please call us as soon as possible to make an appointment for a no-cost consultation:

Fairfax Alzheimer’s Planning: 703-691-1888
Fredericksburg Alzheimer’s Planning: 540-479-1435
Rockville Alzheimer’s Planning: 301-519-8041
DC Alzheimer’s Planning: 202-587-2797

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Planning Ahead for Grandchildren

Q. Two years ago, our daughter Meredith got married. Today, she called to tell us that she is expecting twins! My husband and I are overjoyed, as they will be our first grandchildren. We want to make sure we include them in our planning. We know how expensive it was to send our children to college (and that was 10+ years ago), so we certainly want to put money towards their education. Are there ways to gift our grandchildren money that will benefit their educations, but not disqualify us for Medicaid in the future? Also, should we make updates to our own estate planning documents? We’ve already left everything to our daughter, so won’t it all go to her children, anyway? Thanks for your help!

A. Becoming a grandparent changes everything. I know, because I am a proud grandfather to our sweet and energetic 8-year old grandson, Gregory.

Many will describe the feeling when you first hold your grandchild (or, in your case grandchildren!) as an incredible jolt of joy and overwhelming emotion. And, chances are good that money won’t be the first thing on your mind. But, as you mentioned, it won’t be long before you want to help to create a solid financial foundation for them, including helping pay for their educations. And you are right – having a strategy to help pay for your new grandchildren’s education, without penalizing you or your husband for Medicaid in the future, can give you peace of mind now and you and your husband, your daughter, and her children a sense of relief later.

Giving the Gift of Education

Currently, a single year’s tuition at a public institution is expected to rise above $44,000 by 2030, and it’s predicted to be twice that much at private schools, according to the U.S. Department of Education. Given this, the earlier you start a college savings program such as a 529 college savings plan for your grandchildren, the more impact your gift is likely to have. With a 529 plan, money you set aside has the potential to grow tax-free until it’s needed, and there’s no tax when the money is spent on qualified higher education expenses. If you start a 529 now and let it build for 18 years, the tax savings should be significant.

One major drawback to setting up a 529 plan, however, is that if you need nursing home care in the future, the 529 plan that you have set up for your grandchild could destroy your eligibility for Medicaid. Because you control the account and have the right to cancel the account and take the money out, the government considers your 529 plan a “countable asset.” That means you’ll be required to use that money to pay for your long-term care expenses before you qualify for Medicaid.

Since everyone might need to apply for Medicaid in the future, you should consider contributing to an account in someone else’s name as the custodian/contributor/account owner for your grandchildren, such as your grandchildren’s parent (your daughter). That way, the plan won’t be considered a countable asset for purposes of Medicaid for you, and in any event will hopefully be used up by the time either of you needs Medicaid.

However, even this strategy won’t get you off the hook entirely. When you apply for Medicaid, the state will review your finances during the previous 60 months. Any gifts made during this “look-back” period, including contributions to a 529 savings plan, could hurt your eligibility for Medicaid benefits. This problem is exacerbated if you plan on making regular, ongoing contributions to a 529 savings plan for your grandchildren, because each contribution you make would be a new gift that would begin a new 60-month look-back period.

An effective way to prevent this from happening is by setting up an irrevocable trust such as The Living Trust Plus™ and making the contributions to the 529 plan from the trust. The Living Trust Plus™ functions very similarly to a revocable living trust and maintains much of the flexibility of a revocable living trust, but protects your assets from the expenses and hassles of probate PLUS the expenses of long-term care while you’re alive, PLUS lawsuits and a multitude of other financial risks during your lifetime. You would make a one-time gift to the trust, starting the 5-year lookback period, and your future contributions from the trust to the 529 plan would not count as new gifts. Please note this is the “short version” – the actual mechanics are a bit more complicated.

The Living Trust Plus™ Asset Protection Trust protects your assets (including the money in the 529 plan) from lawsuits, auto accidents, creditor attacks, medical expenses, and — most importantly for the 99% of Americans who are not among the ultra-wealthy — from the catastrophic expenses often incurred in connection with nursing home care.

If you would like more information about the Living Trust Plus™, please contact us for an appointment, or click here to register for one of our upcoming Living Trust Plus™ informational seminars.

Updates to Estate Planning Documents

You now have two potential new estate beneficiaries, and you should make sure that your estate planning documents reflect that. In your current documents, you may have stipulated that the inheritance will go to your daughter and her husband, on the assumption that it will also be used to care for any grandchildren. But what if family circumstances change — your daughter dies and her husband remarries, for example? There’s no guarantee that your grandchildren will receive the benefit you intended. To make sure that your grandchildren receive the inheritance you want to leave, you may need to update your estate planning documents.

Even without the upcoming birth of grandchildren, everyone who has an estate plan in place should not let more than 5 years pass between updating your plan, as the cost to your family if you neglect your plan could be disastrous. Please see our post about when you should update your estate planning documents. New grandchildren is certainly on the list.  Also, be sure to ask about The Farr Law Firm’s Lifetime Protection Program, which ensures that your documents are reviewed and updated as needed, so that they will have the proper effect under the law. Ready to plan or update your planning? Please contact us as soon as possible to make an appointment for a no-cost initial consultation:

Fairfax Estate Planning: 703-691-1888

Fredericksburg Estate Planning: 540-479-1435

Rockville Estate Planning: 301-519-8041

DC Estate Planning: 202-587-2797

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