Critter Corner: Who Are the Oldest Living Man, Woman, and Pet Bunny?

Dear Commander Bun Bun,

I have read that it has become more common for people to live to be over 100. I am just curious — do you know who the oldest living man and woman are, what they say their secret is, and who the world’s oldest pet bunny is? Thank for your research!

Al Duss-Twanns


Dear Al,

Mbah Gotho, an Indonesian man, was born on December 31, 1870, according to the date of birth on his identity card. Indonesian officials at the local record office have confirmed Mr. Gotho’s birth date is genuine; however there is no independent, third-party verification of his claimed age, which is required to be recognized by the Guinness World Records. If it is true, it would make him a staggering 145 years old—and the oldest living man in recorded history!

Nevertheless, Mr. Gotho has outlived all 10 of his siblings, four wives, and even his children. His nearest living relatives are grandchildren, great grandchildren, and great-great grandchildren.

One of Mr Gotho’s grandsons said his grandfather has been preparing for his death ever since he was 122. In 1992 (24 years ago) he even bought a burial site close to the graves of his children.

Mr Gotho spends most of his time sitting and listening to the radio because his eyesight is too poor to watch television. He has had to be spoon-fed and bathed for the past three months as he has become increasingly frail.  When asked what his secret to longevity is, Mr Gotho replied: “The recipe is just patience.”

The oldest living woman is Emma Morano, an Italian supercentenarian who is, at the age of 116 years, 298 days, one of the ten verified oldest people ever. When she received the news about being the oldest, she said “My word, I’m as old as the hills,” a caregiver confirmed.

Ms. Morano now lives in a small lakeside town near the Switzerland border, still in her own one-bedroom home. Doctors make house calls, but for a 116-year-old, her health is good.

As a teenager, a doctor told her to eat raw eggs for her anemia, and so she has every day since, according to a New York Times profile in 2015. She also eats minced meat and pasta daily.

According to Morano, leaving an unhappy marriage also helped her live so long.  She separated from her husband in 1938 and never remarried. She kept busy working at a factory and then as a cook, and didn’t retire until she was 75 — 41 years ago.

Her physician, Carlo Bava, credits Morano’s longevity to genetics, but also to her emotional balance. “She is always very serene,” Bava said, “The beauty of Emma is that it is normal that she smiles, but also in difficulties, she is very decisive.”

As far as pet bunnies go, Hazel, a 16-year-old miniature grey rabbit set the world record for being the oldest living rabbit. I hope to surpass that age in the future!

Hope you enjoy this article!

Commander Bun Bun

How to Live Past 100

100th. Anniversary

Q. This past year, I became interested in genealogy, and have been compiling my family tree using online resources. With some research, I found that generations before mine have included not-so-distant relatives who have lived past 100. My parents, unfortunately, both died in their 70’s. I wonder what my ancestors did right to live so long. I would like to replicate some of the habits of centenarians, so my family has a better chance of a long life ahead. Based on what you’ve read and heard from clients, do you have any suggestions to help?

A. Not long ago, someone who had lived to be 100 was a true rarity. Even today, those reaching 100 are contacted by the White House, and often the national and local media. Now, closer attention to good nutrition and access to better medical care are paying off, and living past 100 has become more common. In fact, one in 26 baby boomers is now expected to live to 100 and many more will reach the mid-to-late 90s, according to the book, Celebrate 100: Centenarian Secrets to Success in Business and Life. This week, as we celebrate National Centenarians Day, we recognize the 55,000 Americans aged 100 or over. In 1980, the number was 32,000.

Born just a decade or so after the turn of the century, centenarians were teenagers during the Great Depression, young people during World War II, and, for some, grandparents by the time the 1960s rolled around. Their stories are different, but they share common themes.

Understanding centenarians is important for seniors to become knowledgeable about the lifestyle choices that can influence longevity. To explore this topic further, let’s look at countries where seniors are living the longest, including Japan, and countries spanning the Mediterranean and East Asia, such as those with strong economies and healthcare systems. Here are some facts about aging in those countries:

  • Diet: John Beard, director of Aging and Life-course at the World Health Organization (WHO) attributes longevity to diet. For instance, the diet in Japan includes plenty of fresh fish and vegetables, combined with low levels of meat and saturated fat. The diet in Southern Europe is a Mediterranean diet, that traditionally consists of a small amount of wine, fresh vegetables, olive oil and, again, little meat and saturated fat. A recent study found that people consistently consuming a Mediterranean diet were both physically and mentally healthier as they aged.
  • Lifestyle: Active lifestyles into older years are the norm in Japan, helped by the country’s extensive rural landscape getting people outdoors, and further aided by a well-established health infrastructure. Beard believes that in countries such as Italy, Spain and France, cultures of physical activity and warmer climates have a role to play. In countries with cold, harsh winters, maintaining an active lifestyle becomes a challenge.
  • Social Relationships: Sarah Harper, professor of Gerontology at the University of Oxford cites other reasons for Japanese longevity. “They tend to have a society which tends to promote a strong family set up and stress-relieving cultural activities,” she says. Furthermore, Japan has less social inequality than many other countries, enabling everyone to experience these benefits. Social relationships are important in Southern Europe, as well, and family ties are strong. This is helpful because when people have a greater sense of belonging to a community, or family, and maintain a healthy work-life balance, they stay healthy longer.
  • Economy: In general, countries with a smaller wealth and class divide have a healthier aging population. For instance, “in Singapore, there’s a range of wealth and advantage; there are very few people at the bottom,” says Beard. “This uniformity means more members of the population can live the lifestyles needed to ensure good health — well into their eighties and beyond.”
  • Good Health Programs: If entire populations can access good health programs — such as screening services — chronic conditions that generally affect older populations can be picked up early and treated before they’re irreparable.

For “secrets” on how to live past 100, read this recent CNN article about what people in Acciaroli, Italy are doing.

Centenarians May Be Living Longer, But Disease Takes its Toll

When looking at centenarians in the U.S. and other countries, life span is not necessarily matched by increases in “health span,” or time spent living in good health. Longer life spans have been accompanied by a tremendous increase in the disease burden due to Alzheimer’s disease. Alzheimer’s is now the number 12 cause of disease burden in the US, and the fourth leading cause of death. Its impact on health has become much more severe over the course of two decades; the number of years of life lost prematurely because of Alzheimer’s increased by 392 percent—far more than any other disease. Other wealthy countries have witnessed similar but not as dramatic increases.

How Do We Care for “the oldest of the old”?

Once people get to be centenarians or even beforehand if they are afflicted with diseases, such as Alzheimer’s, many will need help in their daily life. This is an “intense burden for the health care system in the U.S.,” says Kathrin Boerner, associate professor of gerontology at the University of Massachusetts Boston, adding that we are “totally not ready for it.”

Many of these seniors want to stay in their own homes, but that isn’t always possible. This makes it all the more important to plan in advance!

Hoping to Live Past 100? Plan for your future and your loved ones.

Luck and genetics play roles in longevity, of course, but you can’t control that. If you want to better your odds of hitting 100, focus on what you can do, such as eating healthy, exercising, and cutting down on stress. As you are taking care of yourself and enjoying your life, it is also a good idea to plan for your future and for your loved ones. Our firm is dedicated to helping protect seniors preserve dignity, quality of life, and financial security. If you have not done Long-Term Care Planning, Estate Planning, or Incapacity Planning (or had your Planning documents reviewed in the past several years), or if you have a loved one who is nearing the need for long-term care or already receiving long-term care, 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



Hospice Care for Healthier Patients. . . Something Isn’t Right!

Seriously ill senior man

Linda Rodgers was shocked to see her father in so much pain when she visited him at his hospice facility. In a letter she wrote to the editor of USA Today, she described how her father had his pain controlled by medication while in the hospital, before admission to hospice, but was in severe pain from Wednesday through Sunday in the hospice facility.

Linda described how the hospice nurse visited her father at the time of admission on Wednesday, slapped a pain patch on him, and never came back to adjust the pain medications to make sure his pain was controlled. Although he was suffering, the only visits he received were from an aide on Thursday and Friday morning for a brief period of time, but there was nothing done to assist him further. Linda was appalled that the hospice did not even try to control her father’s pain, which was so severe he could not be touched or moved once under the hospice’s services, and no services were provided on the weekend, even though all hospices are reimbursed by Medicare for services every day the patient is there.

Unfortunately, Linda’s father’s case is not at all unusual, but some hospices are better than others. Hospice is designed to be an alternative to regular medical care for people in the final months of life. Instead of continuing to try curing or delaying a fatal disease or condition, hospice ends curative treatment altogether, and is supposed to focus on pain control.

Hospice use is currently on the rise. In fact, today roughly half of older Americans who die have received some hospice care — which has created a boom in the industry. In 2012, Medicare spent more than $15 billion on hospice care. But, hospices are being scrutinized. . . and for good reason.

Medicare data suggests that for-profit hospices actively seek out healthier patients in order to book greater profits. One way they do so is by admitting a greater proportion of patients with diseases such as dementia or Alzheimer’s, where predicting the end of life is often uncertain. Nonprofits, in turn, are more likely to serve short-living patients, such as those with late-stage cancer, where death is imminent and the cost of care is more expensive.

The Washington Post investigated whether hospices are safe and how they sometimes decline to provide proper care. To conduct the study, The Washington Post analyzed the Medicare billing records for more than 2,500 hospice providers, obtained an internal Medicare tally of nursing care in patients near death, and reviewed complaint records against hundreds of hospice providers.

Let’s explore the findings uncovered by The Washington Post:

  • Lack of information: About one in three hospice patients were not given key information about what the choice of hospice care entails at the time they enrolled, according to a report by the Office of Inspector General of the Department of Health and Human Services. In the investigation, government inspectors reviewed a random sample of the documentation that patients sign to indicate they want hospice care. In many cases, the patient was not informed that electing hospice meant that they intended to forgo a cure for their terminal illness — a critical distinction between hospice care and other health services. Hospices provide “palliative care” – which is designed to be care focused on the prevention and alleviation of pain and suffering. Some hospice families claim they were pressured into hospice treatment without fully understanding that doing so meant forgoing curative treatment, and that their loved one was mistreated or ignored.
  • Lack of attention by physicians: According to The Washington Post, “In about 14% of cases, the physician who is supposed to approve the enrollment of a patient in hospice care paid only cursory attention to the matter. They provided scant information about the patient’s prognosis, and appeared to have limited involvement in determining that the [patient] was appropriate for hospice care,” according to the report.
  • Patient neglect: Hospices provide care at home or inpatient care at a medical or nursing facility. However, when some home hospice patients encounter crises—including pain, breathing troubles, or seizures — and need sustained attention, they are sometimes not getting the assistance they need. According to The Washington Post investigation, one in six U.S. hospice agencies, serving more than 50,000 terminally ill patients, did not provide crisis care to any of their patients in 2012. In fact, at 445 hospices, a third or more of patients died without having seen a skilled nurse in the 48 hours before their death.
  • Safety concerns: 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 a year, and home health agencies 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: Even though the obvious goal of hospice is care for their 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. This is a sign that patients may be leaving to seek treatment elsewhere. 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.
  • Lethal doses: With the surge of hospices enrolling patients who aren’t close to death, hospice patients who are not actively dying are nevertheless being treated with powerful pain-killers that are routinely used by hospice providers in order to ease suffering and at the same time hasten death. There are no statistics on how often such abuses may be occurring, but complaints from around the country illustrate the potential dangers of overdosing and drug dependency and addiction caused by enrolling a non-dying relative in hospice care.
  • Quality of hospices: Though the federal government publishes consumer data about the quality of other health-care companies, including hospitals, nursing homes, and home health agencies, 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.
  • Attitudes of nurses and clinicians: Nurses and clinicians who work for hospice providers feel powerless to change the system. Although they feel frustrated and may disagree with the aggressive treatment and whether it is necessarily warranted, they have to do what they are legally required to do.

Beginning in 2009, and continuing every year since, MedPAC has called on Centers for Medicaid and Medicare Services (CMS) to change the incentive structure to discourage the cherry-picking of longer-living patients. Just recently, CMS finally took the advice — in part. CMS proposed a new structure for this fiscal year that would pay providers about $40 less per day for each day a patient stayed on the service after 60 days. In a letter commenting on the proposal, MedPac described the adjustment as a “positive step,” and also “modest and incremental.”

Still, many hospice providers are failing to provide quality care for patients, and the industry suffers from safety concerns due to infrequent inspections, lack of crisis care, lack of reporting consumer data, admission of people who aren’t dying and who eventually get discharged, and other issues. Unlike hospices, nursing home facilities are inspected once a year and have much consumer data and research available to help you choose the right facility, making them (in most cases) a better choice for a loved one’s long-term care needs. However, the two are not mutually exclusive, because hospice care can and often is provided to patients residing in nursing homes.

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 these catastrophic costs, 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 services for yourself or a loved one, it’s still not too late to plan. 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

Critter Corner: Questions to Ask at a Nursing Home Interview

Dear Baxter,

My husband and I are evaluating nursing homes for his mother. We set up several tours. We are wondering if you could suggest questions to ask at these meetings? Thanks for your help!

Wanda Fine-Darytwan

Dear Wanda,

When you visit a nursing home to check it out, it’s important to be prepared. It is a good idea to conduct tours of at least three separate facilities. Here are some basic questions to ask during the tour:
Problems or special needs:

•How would your home deal with my father’s [dementia, weight loss, disability following stroke, or ____________________ ].


•How do you handle incontinence?
•How often do staff members help incontinent residents use the restroom?
•How many residents are in diapers?
•How many residents have indwelling catheters?
•Do you utilize condom catheters for male residents with urinary incontinence?


•How flexible is your menu—can residents make choices, or are all Monday meals the same, for instance?
•How do you identify residents who are losing weight?
•What do you do to make sure residents are eating, especially those who have lost interest in food?
•Can residents eat meals whenever they want, or are meals only at scheduled times?
•Are healthy snacks available?
•Does your home honor religious or cultural dietary restrictions? Could you show me a sample menu of a [gluten-free, dairy-free, Kosher, low salt, or ______________] diet?
•How do you ensure that your meals meet high nutritional standards?


•What do you do to prevent falls?
•How often do residents fall?
•What do you do when there’s a fall?

Health inspections

•Please show me your last three survey inspection reports.
•How has your home fixed any problems that were identified?
•How quickly were the problems addressed?

Medical care

•How often is a doctor on site?
•Are dental services available?
•How do you keep track of residents’ medical records?
•If you have computerized health records, have you ever had any problems with the system?
•Do residents receive preventive care such as annual flu and pneumonia shots?
•Does your home arrange for regular hearing or vision screening?
•If Mom has a medical need, who contacts the doctor?
•If Mom needs to see her doctor, who arranges for transportation?
•What hospital arrangements do you have for emergencies?


•What is annual rate of your nurse and nurse aide turnover?
•What do you do to try to improve turnover?
•How often do you use agency temp nurses?
•What proportion of families would you say hire private nursing aides or sitters to supplement your staff?
•How often do nurses and aides update doctors on residents’ health status?
•What kinds of background checks do you perform prior to hiring?
•Do you have volunteer programs?
•Do you have a relationship with local schools or houses of worship?


•Do you have an emergency evacuation plan?
•Do you hold regular fire drills?
•Who helps residents with bathing?
•Do you do nightly bed checks?
•How often does the staff check on residents during the day?

Overall direction

•What improvements have you put in place in the past year?
•What other improvements are planned?
•Do you often have to put residents on a waiting list?
•Where would we direct our questions and concerns if we were to enroll our dad here?

Feel free to tailor these questions to your situation. And for an even more complete list of questions, please see our website at

Hope this is helpful and that you find the right place for your loved one!



CMS Finalizes Commitment to Person-Centered Care for Nursing Home Residents

Disabled man walking with assistance

Q. My father has Alzheimer’s, and he is no longer able to live safely on his own. Since my mother died, I have been his caregiver, and although trusting his care to strangers isn’t going to be easy, I know a nursing home is the right place for him at this time. My husband and I have been visiting and touring skilled care facilities in the area to try to find a good fit. How do I know if a place is the right one? When talking to the admission staff, I heard the term “person-centered” care being mentioned a lot. What does that refer to and does our government do anything to ensure quality care for nursing home residents? Also, how do I pay for long-term care when the cost for five months is more than what I make in a year (and dad doesn’t have that kind of money either)? Thanks for your help!

A. More than 15 million Americans devote time and energy to caring for a loved one with Alzheimer’s disease or other dementia, according to the Alzheimer’s Association, but sometimes a loved one’s health needs become too much to handle at home. At that point, as you are aware, you begin to look at other options, such as nursing home care.

When searching for the right nursing home, many people rely on online rating sites alone. When it comes to quality of care, in my experience with clients and in writing the Nursing Home Survival Guide, I have found that while online rating sites are worthwhile, they do not tell the whole story. There are also some important things you should do (and look out for) before selecting a nursing home for a loved one:

  • Consider what is important to you—nursing care, meals, physical therapy, a religious connection, hospice care, or Special Care Units for dementia patients? Do you want a place close to family and friends so they can easily visit?
  • Take a tour during regular business hours.
  • Have a meal.
  • Schedule another visit late in the evening or on a Sunday afternoon, to get a sense of round-the-clock life in the facility.
  • Pay attention to smells, sounds, and temperature.
  • Talk with friends, relatives, social workers, and religious groups to find out what places they suggest. Check with healthcare providers about which nursing homes they feel provide good care. Use their suggestions to make a list of homes that offer the types of services you want.
  • Observe whether residents are engaging in activities or sitting around listlessly. Also, ask the administrator about activities for residents. There should be calendars of activities posted in elevators and around the facility on bulletin boards.
  • Check the bulletin boards for information on resident and family council meetings. Leaders of these groups, which advocate for residents in the home, can provide insight on any concerns about the facility.
  • Observe whether residents are sitting around waiting to be fed at mealtimes or waiting to go to bed after dinner. If so, the facility probably doesn’t have enough staff.
  • Ask about the level of staff turnover, which tends to be fairly high in nursing homes. If they’ve had four administrators in one year, it may be a red flag.
  • Ask the facility if it practices “consistent assignment,” meaning that the same aide is assigned to care for the resident each day. In facilities that don’t use consistent assignment, residents can have as many as 20 or 25 different people caring for them in a month.
  • Ask about the ratio of staff to residents. A good minimum ratio would be about one to five during the day, one to ten in the evening, and one to fifteen at night.Please keep in mind that nursing homes have to meet certain standards. The Centers for Medicare and Medicaid Services (CMS) requires each State to inspect any nursing home that gets money from the government, which is almost all of nursing homes. Homes that don’t pass inspection are not certified. Ask to see the current inspection report and certification of any nursing home you are considering. Visit for more information.

In conjunction with the things described above or if you need to make a decision about a facility quickly,’s Nursing Home Compare is a very helpful resource for consumers, as it offers 1 to 5 star ratings for all nursing homes that participate in Medicare (for short-term rehabilitation) or Medicaid (for long-term care). The ratings are based on the facility’s performance on health inspections, staffing hours for nurses and nursing assistants, and quality measures, such as the prevalence of pressure ulcers and falls among residents.

What is Person-Centered Care and What is the Federal Government Doing to Ensure it?

Person-centered care promotes the importance of keeping the person at the center of the care planning and decision-making process. It promotes choice, purpose, and meaning in daily life. With person-centered care, nursing home residents are supported in achieving the highest level of physical, mental, and psychosocial well-being that is individually practical. In addition, the staff places a premium on active listening and observing, so staff can adapt to each resident’s changing needs regardless of cognitive abilities.

This week, the Centers for Medicare Medicaid Services (CMS) issued a final rule to make major changes to improve the care and safety of the nearly 1.5 million residents in the more than 15,000 long-term care facilities that participate in the Medicare and Medicaid programs. The policies in this final rule are targeted at reducing unnecessary hospital readmissions and infections, improving the quality of care, and strengthening safety measures for residents in these facilities. According to CMS,”(t)hese changes are an integral part of its commitment to transform our health system to deliver better quality care and spend our health care dollars in a smarter way, setting high standards for quality and safety in long-term care facilities.”

The changes announced are part of the first comprehensive update since 1991. This rule will bring best practices for resident care to all facilities that participate in Medicare or Medicaid, implement a number of important safeguards that have been identified by resident advocates and other stakeholders, and include additional protections required by the Affordable Care Act. CMS received nearly 10,000 public comments, which were considered before finalizing this rule.

The health and safety of residents of long-term care facilities are our top priorities,” said CMS Acting Administrator Slavitt. “The advances will give residents and families greater assurances of the care they receive.”

Changes finalized in this rule include:

  • Strengthening the rights of nursing home residents, including prohibiting the use of pre-dispute binding arbitration agreements.
  • Ensuring that nursing home staff members are properly trained on caring for residents with dementia and in preventing elder abuse.
  • Ensuring that nursing homes take into consideration the health of residents when making decisions on the kinds and levels of staffing a facility needs to properly take care of its residents.
  • Ensuring that staff members of nursing homes have the right skill sets and competencies to provide person-centered care to residents. The care plans developed for residents will take into consideration their goals of care and preferences.
  • Improving care planning, including discharge planning for all residents with involvement of the facility’s interdisciplinary team and consideration of the caregiver’s capacity, giving residents information they need for follow-up after discharge, and ensuring that instructions are transmitted to any receiving facilities or services.
  • Allowing dietitians and therapy providers the authority to write orders in their areas of expertise when a physician delegates the responsibility and state licensing laws allow.
  • Updating the nursing home’s infection prevention and control program, including requiring an infection prevention and control officer and an antibiotic stewardship program that includes antibiotic use protocols and a system to monitor antibiotic use.

The final rule is available on the Federal Register at

Affording Nursing Home Care

Similar to your situation, most of us are concerned about the affordability of nursing home care. This is a legitimate concern, as nursing homes in Northern Virginia cost $10,000-14,000 a month. To protect your family’s hard earned money and assets from these catastrophic costs, there is no time like the present for your father to begin Medicaid Asset Protection Planning. Please call us to make an appointment for a no-cost initial consultation:

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

Does Medicare Pay for Hearing Aids?

Sid watches the baseball game with the television turned really high. His wife has been noticing that it is getting louder and louder. In fact, she can hear it outside the house in her garden and the neighbor said he can even hear it. She also noticed that she has to repeat things she says to her husband over and over again, but wasn’t sure at first if that was a problem, or if he just wasn’t listening to her! She is afraid that her husband is losing his hearing, but is concerned about the cost of a hearing aid, since they live on a fixed income.

Sid is not alone. Most people gradually lose some hearing as they get older. In fact, more than 48 million Americans, including 1 in 6 baby boomers and two-thirds of those over 70, have some type of hearing loss that seriously disrupts their life. Experts expect that number to rise as boomers are aging.
Many men and women who need hearing aids, however, often feel they can’t afford them, and that’s not surprising. Prices for a single hearing aid can range from $1200 for a low-end device to $4,000 – $5,000 or more for a higher-end one, and 80% of wearers need two. Battery costs are $30 to $150 per year. This is simply undoable for many seniors, who desperately need hearing aids!  And sadly, up to now, Medicare has not paid at all for hearing aids.

Will Medicare Ever Start Covering Hearing Aids?

Democratic congressmen recently joined senior advocacy groups in calling for Medicare to pay for hearing aids and other audiology services. Their call was backed by research that says impaired hearing can socially isolate seniors and may contribute to their risk of developing dementia.

Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare, noted hearing-impaired seniors may not hear an approaching car, a ringing phone, or an alarm alerting them to danger. They also may not clearly hear their doctor’s instructions for taking medications. According to Richtman, “Medicare covers a wheelchair for seniors who can’t walk, and it provides test strips for people with diabetes. Hearing loss is another debilitating condition that must be recognized and covered.”

Frank R. Lin, an ear, nose and throat research specialist at Johns Hopkins University in Baltimore, concurs with Richtman. He recently co-authored a study that concluded hearing loss “must be recognized as a public health concern.” Dr. Lin said because diminished hearing is part of the normal process of aging, it is often seen as “inevitable and even inconsequential.” But, in addition to cognitive decline, poor hearing increases the risks of falls and other health hazards.

The Status of Medicare Coverage for Hearing Aids

In response to this problem, three Democratic congressmen — Reps. Rosa DeLauro of Connecticut, Jim McDermott of Washington state, and Debbie Dingell of Michigan have separately proposed legislation to remove the specific exclusion of hearing aids from the 1965 Medicare amendment to the Social Security Act. Some bills include vision and dental coverage as well. No estimate of the potential cost was given.

While the future of these bills in a Republican-controlled Congress may be uncertain, supporters point to the research showing the health dangers and costs of untreated hearing loss. They also point to the fact that with Medicare beneficiaries receiving an average of $1,300 a month, the cost of good quality hearing aids can be out of reach for many seniors. We will continue to keep you up-to-date on the progress of this important issue through Social Media, so if you don’t already, be sure to follow us on Facebook or Twitter.

Making Hearing Aids Affordable for Those Who Need Them

If Medicare doesn’t cover hearing aids, how can those who need them afford them? A survey conducted by Consumer Reports found that 40% of those who bargained got a price break. Other than that, there is some limited help available, as follows:

-Flexible Spending Accounts (FSAs): For those with these accounts, the cost of a hearing aid and batteries is considered reimbursable.

-Veteran benefits: Vets get hearing aids if their hearing loss is connected to their military service or linked to a medical condition treated at a VA hospital. Veterans also can get devices through the VA if their hearing loss is severe enough to interfere with activities of daily life.

-Federal employee assistance: Federal employees and their families are entitled to coverage through some insurance plans. Health plans pay for a basic hearing aid, and employees pay for extras and upgrades themselves.

-Nonprofits: Sertoma helps people with hearing problems and runs a hearing aid recycling program, SHARP through its 420 clubs (1-816-333-8300). HEAR Now, sponsored by the Starkey Hearing Foundation provides hearing aids for people with limited income. Clients pay for evaluations and a fee of $125 per aid.

-Private insurers: Few private insurance companies cover hearing aids, but only three states — New Hampshire, Rhode Island and Arkansas — require that insurers provide coverage for adults.

-Affordable Care Act: A few states include some coverage for hearing aids and related services under their health insurance exchanges. Information about this coverage is available from the Hearing Loss Association of America and through the Department of Health and Human Services.  This government site gives additional information on proposed essential health benefits benchmark plans by state.

-Health Reimbursement Accounts (HRA): It’s up to your employer, who funds this type of account, to decide if hearing aids and batteries are reimbursable. Check with your company’s benefits department.

Not Wearing a Hearing Aid When You Need One

Unfortunately, only 1 out of 5 people who could benefit from a hearing aid wear one. Although not wearing a hearing aid won’t cause hearing loss, there is some evidence that wearing an aid when you need one may help protect the hearing you have left.

Some people may not realize they have a problem. Others believe waiting won’t cause any harm; still others are simply embarrassed to admit they can’t hear well. But if you don’t wear a hearing aid when you need one, or only wear it some of the time, you can completely lose the ability to process sounds.

In addition, as mentioned previously, not wearing a hearing aid is a safety concern, since hearing loss has been linked to falls, social isolation, depression, even dementia. So remind yourself that needing help with hearing is no different than needing glasses to read. Ask your doctor to check your hearing regularly and, if necessary, refer you to an ENT or audiologist who can diagnose the extent of hearing loss and suggest aids or assisted devices that can help. Hopefully Medicare will begin approving them, or you can use some of the suggestions described above for paying for them.

Medicaid Planning for Dementia

What if your apparent hearing loss is actually a symptom of dementia? A diagnosis of dementia is life-changing for both diagnosed individuals and those close to them. Generally, the earlier someone with dementia 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 Lifecare Planning and Medicaid Asset Protection Planning.

At the Farr Law Firm, 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 any time 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

Caution: The Hidden Dangers of Heartburn Medicine

Jim Palmer, former player for the Baltimore Orioles and TV commentator, has something in common with millions of other individuals, including myself. He has GERD (Gastroesophageal Reflux Disease), which occurs when stomach acid backs up into the esophagus. Similar to my personal situation, Palmer had suffered from frequent and persistent heartburn for many years that he thought was normal. His diagnosis and subsequent treatment was delayed several years until his symptoms worsened and he finally consulted his doctor about it.

Palmer has talked to the media and various organizations about his own personal struggle with heartburn associated with GERD. The following are excerpts from a speech given by Palmer about his experience with GERD, that closely mirror my own experiences:

“I have been sharing with the media my personal experience with frequent and persistent heartburn and gastroesophageal reflux disease (GERD). Since I began this campaign, I have found that more and more people are identifying their own experiences with frequent and persistent heartburn as reflux disease.

“…I tried changing my eating habits in an effort to allow three hours between eating and going to bed. None of these efforts solved the problem.”

“I normally ate late at night after broadcasting a game and invariably ended up with heartburn. I tried taking over-the-counter products to no avail. I also tried elevating my bed, avoiding the common heartburn food triggers like chocolate, caffeine, and tomatoes, and changing my eating habits in an effort to allow three hours between eating and going to bed. None of these efforts solved the problem.”

“I now recognize that I suffered needlessly before getting the appropriate treatment.”

To keep his GERD under control, Palmer’s gastroenterologist prescribed medication – a proton pump inhibitor (PPI) – for treatment. Through the years, Palmer has spoken publicly in a positive way about his experience with PPIs. He stated that his heartburn and other symptoms of GERD have been under control since taking one pill a day, and that he suffered needlessly before getting the “appropriate treatment.” Similar to Palmer, to alleviate my own symptoms, I have been taking a PPI (omeprazole) for the entire time I have had GERD, until I learned the dangerous truth about it. Now, I am in the process of working with a local chiropractor, Dennis Sievers, who is one of the few doctors in the country who has a program for helping people who are dependent on PPI’s get off of them completely.

PPI Use Increases Risk for Dementia and Heart Disease

Currently, an estimated one in 14 Americans are dependent on an over-the-counter PPI to treat GERD. Considered the most effective treatment for GERD, PPIs are approved by the Food and Drug Administration (FDA) for use.

Sounds good, right? Not quite. The problem is that studies have linked long-term use of PPIs to an increased risk of dementia, cardiovascular disease, and renal failure, but until this year, scientists haven’t known exactly why. Results published in the journal Circulation Research earlier this year found that vascular cells chronically exposed to PPIs accelerate blood vessel aging— an effect that can have an adverse impact on cardiovascular health. This type of damage is synonymous with age-related chronic conditions and neurodegenerative disorders such as Alzheimer’s disease, cardiovascular disease, and cancer.

In another study in JAMA Neurology, German researchers, using a database of drug prescriptions, studied PPI use in 73,679 men and women older than 75 who were free of dementia at the start of the study. Over an average follow-up period of more than five years, about 29,000 developed Alzheimer’s disease or other dementias.

After controlling for age, sex, depression, diabetes, stroke, heart disease and the use of other medicines, they found that regular use of PPIs increased the risk for dementia in men by 52% and in women by 42%, compared with non-users.

“Our study does not prove that PPIs cause dementia,” said the senior author, Britta Haenisch of the German Center for Neurodegenerative Diseases. “It can only provide a statistical association. This is just a small part of the puzzle.

“Clinicians, pharmacists and patients have to weigh the benefits against the potential side effects,” she continued, “and future studies will help to better inform these decisions.”

In an editorial accompanying the study, Lewis Kuller of the University of Pittsburgh wrote that the findings “provided an important and interesting challenge to evaluate the possible association,” which is a “very important issue given” how commonly the drugs are used by the elderly, who are already at increased risk for dementia.

Holistic Treatment for GERD

Many people, such as me,  start take PPIs when they can’t  get rid of their heartburn by making lifestyle changes, such as losing weight and cutting out alcohol, caffeine and spicy and fatty foods. And many people stay on them a lot longer than they need them. PPIs are technically supposed to be taken for only two to eight weeks, although most people who start taking them wind up staying on them forever, because if you try to go off these medications, your symptoms actually get worse because of something called the “rebound effect.”

The companies that make PPIs say they’re safe for most people if they use them the way they’re supposed to. And doctors say many people really need to take a PPI for severe heartburn.

Kenneth DeVault, a gastroenterologist at the Mayo Clinic who is president of the American College of Gastroenterology says if someone really needs a PPI, they should take one. But they should try everything else first, keep an eye out for any side effects, and talk to their doctor about how long they should stay on it.

As I mentioned earlier, I am in the process of working with a local chiropractor, Dennis Sievers, a gifted doctor that is helping me alleviate my GERD symptoms and wean me off of dangerous PPIs that I have been taking for at least 20 years. Before starting my course of treatment with Dr. Sievers, I read numerous articles and a couple of self-help books on how to wean yourself off of PPI’s. I tried these methods, but none of them were in any way successful for me. I am about three quarters of the way through my treatment with Dr. Sievers, and so far his treatment has been successful. I will keep my readers updated on the ultimate result of this treatment, but so far I have great hopes. If you live in Northern Virginia, and you are also a long-term taker of PPI’s, I highly suggest you make a visit to Dr. Sievers (his website is or any other holistic practitioner who helps people with this condition.

At the Farr Law Firm, we care about our client’s health, quality of life, and well-being, which is why we share this sort of information.  Remember, part of taking care of yourself is planning for your future and for your loved ones. If you have not done your own Incapacity Planning or Estate Planning, or if you are caring for a loved one who is beginning to need more care than you can handle, please contact us as soon as possible to make an appointment for a no-cost initial consultation:

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

Critter Corner: Is HIPAA Keeping Pace with Technology?

Dear Angel,

There is so much technology available these days where you share health information. Things such as wearable fitness trackers, social media sites, and health apps did not exist when Congress enacted the Health Insurance Portability and Accountability Act (HIPAA) in the 90’s. When it comes to HIPAA and privacy of personal health information, is there anything being done to keep pace with these new technological developments?


Kip N. Pace


Dear Kip,

From what I’ve read, the U.S. government is aware of the situation you described and is taking action to keep pace with technology. In fact, the U.S. Office of the National Coordinator for Health Information Technology (ONC) issued a report to Congress this week laying out the gaps that exist in health data protection.

HHS had three goals in its report to Congress:

  1. analyze the scope of privacy and security protections of an individual’s health information for these new and emerging technology products not regulated by HIPAA;
  2. identify key gaps that exist between HIPAA-regulated entities and those not regulated; and
  3. recommend addressing those gaps in a way that protects consumers while leveling the playing field for innovators inside and outside of HIPAA.

While the report doesn’t lay out a plan for solving health data privacy concerns that fall outside of HIPAA, it offers a starting point for creating such a solution. According to the report, “Wearable fitness trackers, health social media and mobile health apps are premised on the idea of consumer engagement,” HHS said. “However, our laws and regulations have not kept pace with these new technologies. The report identifies the lack of clear guidance around consumer access to, and privacy and security of, health information collected, shared and used by [entities not covered by HIPAA].”

The HIPAA Privacy Rule

The HIPAA Privacy Rule establishes national standards to protect individuals’ medical records and other personal health information and applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically.  The Rule requires appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization. The Rule also gives patients’ rights over their health information, including rights to examine and obtain a copy of their health records, and to request corrections.

The Privacy Rule is located at 45 CFR Part 160 and Subparts A and E of Part 164.

HIPAA was passed with the best of intentions: to protect individual patient’s medical records from being disclosed to just anyone who asks to see their contents. The law requires doctors and other healthcare providers to get written authorization from a patient before they can share most health information about him or her with a “third party” — and that includes most caregivers, even those who are close relatives. At the Farr Law Firm, a HIPAA authorization form is part of our incapacity planning.

I will let you know if I hear of any updates when it comes to HIPAA and privacy in health technology.



Do New Electronic Medical Record Systems Make It Difficult to Access Advance Directives?

Q. I have heard several horror stories about Advance Directives being unavailable when needed, as more hospitals are implementing new systems to store and access electronic medical records. Or, in other cases, patients’ documents are being rendered unreadable by incompatible software.

What if a patient’s doctor uses one record system and the emergency room another? If the software doesn’t match up, the ER doctors may be unable to tell if the patient has a preference, such as a “do-not-resuscitate” order.

If this is truly the case, then why even bother with Advance Directives? And, if I do plan ahead, will I have to carry a copy with me so the provider knows it exists or is there another way to guarantee that my Advance Directives will be accessible, if and when they are needed?

A. Incapacity planning, including Advance Medical Directives, a General Financial Power of Attorney, and an authorization to disclose protected health information (HIPAA Authorization), is extremely important for everyone, as it communicates patient choices when they can no longer speak for themselves.

Ideally, patients with advance directives in place would be confident that their doctors and nurses – no matter where they receive care – could know in a split second their end-of-life wishes. However, according to a news report in USA Today/Kaiser Health News, doctors cannot always easily get hold of their patients’ advance directives at the hospital, even in an emergency, and Electronic Health Records (EHRs) sadly aren’t yet helping to solve this availability problem.

Ironically, electronic medical records, which are supposed to help find patient information, create their own problems:

● One problem is that different medical records systems are incompatible, meaning that hospitals often can’t share your Advance Directive among them or even, more surprisingly, between different departments of the same hospital. As a result, you could be admitted to an Emergency Department, which may have one EHR system, and it might not be able to get hold of your Advance Directive in the hospital’s main EHR system.

● Another problem is that it can take too long to find your Advance Directive because most EHR systems aren’t set up to store Advance Directives. “If [medical staff are] not able to access the advance directive quickly and easily, they’re honestly likely not to use it,” says Torrie Fields, senior program manager for palliative care at Blue Shield of California.

● Older patients, who are increasingly likely to have a directive, often get treatment from varied sources — surgeons, hospitals, nursing homes, primary physicians. That increases the odds of unaligned systems, said Dr. Irene Hamrick, who directs geriatric services in family medicine at the University of Wisconsin-Madison.

● An additional complication stems from system design. Many electronic medical records systems don’t have a dedicated tab to mark where such information — if it exists — is stored. After doctors and nurses click through various pages, they still don’t know whether they looked in the right place. Time doesn’t always allow this kind of search.

A survey of ER doctors last year found that 93% are “less frustrated” when Advance Directives are “easily accessible,” and the vast majority of them said the documents let them provide better care and that family members are more satisfied.

Changes May Lie Ahead

Developers of medical records systems are introducing functions that could make it easier to find and read an Advance Directive. For instance, Epic Systems, a company that is among the top sellers of EHR systems, has added a tab intended to indicate clearly whether a patient has an advance directive on file.

The issue has also gotten attention in Congress. Lawmakers have expressed interest in making directives “portable” — that is, easily accessible. Legislation introduced in the Senate by Sen. Mark Warner (D-Va.) includes provisions that could push health facilities to ensure compatibility across different health records for Advance Directives. Rep. Earl Blumenauer (D-Ore.) is also working on legislation, he said in an interview.

Hospitals and health systems are making adjustments, too. The hospital at Oregon Health Science University, California-based Sharp Hospice and Gunderson Health in Wisconsin are among those that have made in-house software revisions to make advance directives easy to find in electronic health records — for instance, having IT teams add tabs on the record’s main page to indicate if a patient has end-of-life planning documents. Representatives of those hospitals said such efforts aren’t the norm, though.

Meanwhile, a number of states, including Virginia, Vermont, North Carolina and Arizona, have created online databases for residents to upload and store their Advance Directives, but these are only helpful if you wind up in the hospital and your home state. If you’re traveling visiting another state, you’re basically out of luck Recent figures are hard to come by, but in 2007, nine states were counted to have these in place. In these instances, doctors in those states can go online to find a patient’s Advance Directive on those sites. Although they’re secured websites, and directives are password protected, requiring special logins from patients and doctors, specifics vary from state to state.

Rest Assured that Farr Law Firm Clients NEED NOT WORRY- Your Documents ARE ALWAYS Accessible with Docubank
Incapacity Planning documents only do what you want them to do if your loved ones know they exist and can locate them when needed. At The Law Firm of Evan H. Farr, P.C., we provide a service called DocuBank to ensure that that the Advanced Medical Directive and other healthcare documents you’ve completed through our firm will be very easily accessible when you need them most, such as when you are hospitalized.

DocuBank is an electronic storage and access service for healthcare directives and other vital health information, such as allergies, medications, and a list of your physicians. DocuBank stores all of your health information so it is available whenever needed.

How does DocuBank work?

● Once we have registered your documents with DocuBank, DocuBank transmits your Advance Medical Directive and other healthcare information to hospitals within moments, 24 hours a day, 7 days a week, around the world.

● Your documents are stored safely in DocuBank’s system and available immediately by using a Member Number and PIN Code located on your DocuBank Emergency Card.

● Hospitals can access your documents by placing a toll free call to 1-800-DOCUBANK to have them faxed, or by clicking the Hospital Button, or using the pop up box on the DocuBank home page to print them immediately.

● When a hospital calls into DocuBank, they also receive a cover page listing your three Emergency Contacts with phone numbers as well as your primary doctor so that they can be reached in an emergency.

Read more about Docubank here.

Why Bother with Advance Medical Directives?

People can have dreadful accidents or face incurable illness at any age. Could hospitals take important decisions like whether to provide, withhold, or withdraw a specific medical treatment into their own hands in the U.S.? Maybe or maybe not. To protect yourself, however, and guarantee that this won’t happen to you or a loved one, Advance Directives are imperative.

An Advance Medical Directive is the document that gives you control over your medical care if you’re unable to speak for yourself. In your Advance Directive, you designate someone to make health care decisions for you if you can’t, and you also give guidance on the types of treatments you would or would not want.

The Time to Plan is NOW

To ensure your wishes are met, it is important to start your planning while your mind is still sharp and your judgment is sound, so you are prepared in advance if a crisis occurs. 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 for a no-cost initial consultation:

Fairfax Estate Planning and Incapacity Planning: 703-691-1888
Fredericksburg Estate Planning and Incapacity Planning: 540-479-1435
Rockville Estate Planning and Incapacity Planning: 301-519-8041
DC Estate Planning and Incapacity Planning: 202-587-2797

Critter Corner: Nursing Home Preparation

Dear Baxter,

My father will be moving to a nursing home next month. What do you suggest we do to prepare for this big move?


Bea Forehegos


Dear Bea,

The move to a nursing home is more like a journey than an event, for most residents, caregivers, and families.  After you have chosen a facility, it is wise to do as much preparation as you can. Some things you might consider are as follows:

Make a list of all the requirements that will come from the nursing home, and try to see what can be done before admission.

Make another list of all the things that the move will entail — who has to be contacted or what services have to be shut off or relocated.

Become informed — Read as much as you can on the subject and discuss your fears and concerns with others who have gone through the experience before. Try to have an understanding of what your rights are with regards to nursing homes and care. One of Mr. Farr’s books, The Nursing Home Survival Guide, is a good resource.

Make a plan for the move — how it is going to happen, what will be taken, who will organize the resident, or who will even tell him or her that it is happening.

If you are the caregiver and/or a family member, make a plan for yourself as to what kind of support you will need during this time, and the time immediately following it. Sometimes when a room or bed in a nursing home becomes available, you have very little time before the move.

If there are several family members who are involved in the caregiving, it might be wise to have at least an informal meeting as the process is unfolding, so that everyone is caught up and on the same page. Be prepared for the fact that not everyone will handle this process emotionally in the same way, even if you are all agreed that it is necessary. If there are divisive issues about money or care, you may have to get professionals involved to protect you and your loved one. Please see our trusted referrals for names of local professionals that can help!

Emotional preparation

Prior to the move, the prospective resident should be involved in as much of the decision-making as possible. Fear of the unknown can make an admission more difficult. Both the caregiver and resident should be able to spend some time in the facility, with the staff, other residents, and other family members until some kind of comfort is developed. That could mean, if allowed, going to activities, having a meal there once a week or a couple of times, going to the family council or family information night meetings, or meeting with the  activities  director before admission.  Add many facilities, there is a chance to experience this type of preview by using temporary respite care services at the facility. In some cases, more cognitively aware residents can go to a resident’s council or be “buddied up” with a present resident.

If your father has not done Long-Term Care Planning (even when he is already receiving long-term care), please call Mr. Farr to make an appointment for an initial no-cost consultation.

Hope this is helpful!

Arf Arf,


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