Medicaid Ranks Highly Among Americans in Poll

A New York Times article from October 9, 2014 reports high satisfaction level from low-income people in three Southern states who use Medicaid.  Respondents preferred Medicaid over private insurance.  The study of residents of Arkansas, Kentucky, and Texas, found those surveyed preferred Medicaid compared with private coverage as the former offered better “quality of health care” and made them better able to “afford the health care” they needed.  This is the same result reached by repeated surveys showing the program, much maligned as a political target as being substandard, is quite popular among the people who use it.    A 2011 survey from the Kaiser Family Foundation found that 86 percent of people who had received Medicaid benefits described the experience as somewhat or very positive. A slightly more recent Kaiser survey showed that 69 percent of Americans earning less than $40,000 a year rated the program important to them or their families. Medicaid’s political opponents would have you believe that its restricted list of doctors and additional red tape make it worse than being uninsured.  But, other pollsters and surveys find Medicaid ranks higher on consumer satisfaction levels than private insurance.

Kaiser’s top pollster says the Medicaid is “surprisingly popular” and has seen the program get high marks from the public for more than 10 years.  The public at large rates Medicaid highly as well, saying that Medicaid is important to them and their families.  Now covering some 67 million Americans, Medicaid is not the country’s largest health insurance program.  Moreover, a Majority of Americans support Medicaid expansion as part of the Affordable Care Act.  In fact, it’s only when compared to Medicare that Medicaid looks unimpressive, stated Robert Blendon, a public health professor at Harvard University who studies public opinion on health care issues and was a co-author on the subject recent study.

The Harvard researchers said those surveyed gave private coverage the edge when it came to seeing “doctors you want, without having to wait too long” and “to have doctors treat you with care and respect.”  But Medicaid surpassed private insurance on whether the available programs enabled respondents to “be able to afford the health care you need,” and on the overall question of “quality of health care.”

Estate Planning: The Problems of Disinheritance and Alternative Solutions (There’s always a better way)

Parents and children each have duties imposed on the other by society, custom and tradition.  After the teen years, the family mobile dynamic often becomes broken, breaking the parent/child bond, and leading to estrangement.  When carried to the extreme, vengeful or unhappy parents may seek retribution by exercising the only remaining power they have left—disinheritance.

Disinheritance may be a parental attempt to save a wayward child from alcohol or substance abuse issues.  Other issues include parental concerns over a child’s spouse, concerns that a child never properly applied him/herself, abuse issues that cut both ways, or which ultimately lead to the denial of access to grandchildren.

I posit that the choice of disinheriting a child is akin to the death penalty—one reserved for only the gravest of circumstances and wrong-doing and then only implemented after a series of appeals.  Otherwise, if there are siblings, they will have to deal with the repercussions the disinherited child will inevitably raise.  These actions will be taken towards and involve the survivors who did inherit.  Those children’s relationships with the disinherited will forever be strained until some compromise is reached or one of them dies.  Moreover, the hurt inflicted by the disinheritance becomes “permanent” in the psychological sense, and there are always more than one side to any story.  And, is that really the legacy any parent wishes to leave—that of being such an old, unforgiving, crotchety cuss that the parting shot with one foot in the grave was the ultimate “gotcha?”

The result of the ultimate “Gotcha!” or disinheritance, is that the surviving children who were received an inheritance is that they may have to buy peace by carving out an appropriate, equitable share to the disinherited child.  In that case, the parent has effectively projected his/her own problems onto another child or grandchild, instead of having the courage and character to appropriately and properly address those issues with the estranged child themselves, during their lifetime.

And, of course, the disinherited child may bring a will or trust court action to invalidate the parent’s estate plan, with the hope of receiving an intestate share equal to the other children’s shares.  Not only will the lawsuit be stressful and upsetting to the other family members, it will be particularly hard on any child who is in charge of administering the estate.  Any court action will also diminish how much is left to distribute.

Reconciliation is possible, but difficult and not a frequent outcome.   A better alternative is for the parent to finish life being as good a parent as he/she can be, and at least try to be better than the child, adult child or not, and leave some incentive there to stop the cycle from passing on to the next generation.  Several alternatives should be considered:

·        Consider reducing the inheritance until such time as when (if ever) the parent and child are reconciled;

·        Put incentives in place in a trust that would reward the desired behavior and work towards normalizing the full inheritance;

·        Leaving some or all of the child’s inheritance to that child’s own children (who may themselves be the objects of neglect or abuse).

Leaving a reduced inheritance demonstrates that the child was once a part of the parent’s life.  It also provides an incentive to the child not to contest the will or trust. The use of incentives in a trust protects the principal, yet simultaneously incentivizes the person to turn away from destructive behaviors.  The last alternative recognizes that the grandchildren are not to blame for their parent’s choices and behavior.  It prevents inadvertent punishment of the grandchildren by allowing them to be recognized in the estate while bypassing the individual who was intended to be punished.  While it is an alternative to outright disinheritance, I view it as the last gasp of an otherwise dysfunctional parent who themselves would rather take bitterness to the grave than to appropriately address their own role in the dysfunctional relationship and make appropriate provision to heal the dysfunction, such as funding psychological assistance or a rehabilitation program.

We will be happy to explore each option with you in confidence in our offices.  Just reach out and contact us to arrange a mutually convenient time to meet.

Medicare/Medicaid and the Rising Cost of Sexual Activity for Seniors

As Bill Mahr humorously, but perhaps, ineloquently stated as a “New Rule” last Friday night on his HBO show “Real Time,” the feds have been investigating the rising costs for durable medical equipment to see if certain types of equipment should be added to the competitive bidding list.  Enter the swelling controversy surrounding the penis pump, more formally known as the “vacuum erection system.”  Over the five-six year period between 2006-2011, Medicare paid an average of $451 per pump.  That left a $90 co-pay per patient with Medicare picking up the remaining 80%.  Comparatively, the VA paid only $186 for each device.  And, is anyone surprised that any average shopper could find less expensive pumps online?  Medicare purchased 473,000 pumps over the period investigated.  Predictably, there is controversy underlying adding these devices to the competitive bidding program, as many conservative groups argue that these expenditures are wasteful and detract from true “health” related expenditures.

But, perhaps we shouldn’t jump past the “health” aspects of sex so cavalierly.  Sure, in 2006 Congress barred medications like Viagra from being covered under Medicare Part D, the bill’s sponsor stating he didn’t want to have taxpayers subsidizing “grandpa’s recreational sex.”  But, there is a larger bias here that is arguably being overlooked:  the health aspects of sex in any adult human’s life.  The clear bias exists that seniors are, or should be, asexual.  Yet, how is that any different from the argument against younger, college age women who many on the left have argued should be insured for birth control pills.  It seems at some base level, Americans are just prudish at worst or giggling adolescents in general when it comes to a healthy discussion about human sexuality.  Is sex really just to procreate?  Recent studies say no and that more than half of men and 40% of women over age 65 are sexually active.

So, at least one author urges that we just insist that Medicare not get ripped off by price-gouging device suppliers and continue to cover the devices, perhaps as well Viagra and then the discussion will shift to condoms and safe sex and STD control for seniors as well as the general population.  This all in the name of health and to avoid “ageism.”  At some point, we all must address the limits the system can bear and the “Pentagon-Contractor” nature of the abuse and over-charging that is a huge source of the problems.  One thing is for sure, as millions of Baby-Boomers age into retirement, “No-Sex for Grandpa” rules probably are not going to work.

Aging Parents Can Forget to Pay Premiums Leading to Policy Lapses With Disastrous Consequences

If your older relative has a long-term care policy, photocopy the page listing the company, policy number and claims contact information. Keep the insurance company updated on new addresses, yours (if you are the third-party designee) and your relative’s. It wouldn’t hurt, if the policyholder is becoming forgetful, to check bank statements or call the company to make sure premiums are current.  One story reported by the NY Times shows the calamity that befell a Virginia family because paying the premiums slipped dad’s mind.  State legislatures seem hesitant to correct the problem by mandating insurance companies give more formal notice to policy holders or their third-party designees.

Children of Abusive Parents More Likely to Suffer Depression in Caring for Them as Elders

A Boston College study conducted from 2003-2005 shows that the impact of abuse never fades.  The study surveyed over 1,000 participants and ranked them into the following three categories:  1) those with no history of childhood abuse or neglect; 2) those who had been abused and were caring for their non-abusive parent; and 3) those who had been abused and were, to borrow the study’s memorable title, “caring for my abuser.”  Researchers also compared caregivers neglected as children with those who were not neglected.

Unsurprisingly, adults who were abused by their parents as children were more likely to show signs of depression, like lack of appetite, insomnia, trouble concentrating, sadness and lethargy, when caring for those elderly parents as adults.  But a stronger link arose for those category 3, caring for the abusive parent.  Those abused children caring for their abusive parent were still affected by that abuse and suffered from more depression than those in the other categories.

So, a person falling into one of these categories, especially category 3, has to really ask themselves whether they wish to subject themselves to this kind of risk to their own health as adults.  Worse, this finding raises the ugly specter of whether the abused child will succumb to the increased risk that they will abuse their charges, perpetuating a sorrowful cycle, if the care-giving becomes overwhelming.  Clearly, the natural feelings of revenge could easily surmount any obligatory honor or other societal barriers that otherwise keep in check these more primitive urges.

Whether it is those that are forced to care for their elderly parents who were abusive to them when they were children because there is no alternative or if there are other factors which place the adult children in such a precarious position, those who must engage or who choose to engage in the caregiver role must steel themselves for the impact on their own health.  They should be aware of the signs and symptoms of depression and methods of dealing with it such as therapy or support groups.  What is clear is that more resources need to be made available to care for the aging other than reliance on unpaid family caregivers.  For, as this article concludes, “Not only nice people get old.”

NY Times Article:  A Risk in Caring for Abusive Parents

People All Over the Nation Are Now Using the Affordable Care Act–the White House Wants Their Stories

Expecting a continued battle over health care, the White House moved Wednesday to recruit volunteers for its campaign to defend and promote the law, which is likely to be a defining issue in many congressional races this year. A White House website invites supporters and beneficiaries of the law to provide their names, email addresses and personal experiences.

“Whether you have new coverage today or know someone who does, we want to hear your story,” David Simas, an aide to President Obama, said in an email to people who had expressed interest in the issue.

Jessica Santillo, a White House spokeswoman, said the invitation was part of a systematic new effort by the administration to “highlight stories of everyday Americans benefiting from the law.”

The administration hopes to encourage enrollment and reverse public opinion polls that show approval of the health care law lagging behind disapproval.

Read more:  New York Times Article

Related Article:

Emergency Visits Seen Increasing With Health Law

Use These 5 Strategies to Avoid Stress in Older Family Members or Those Cognitively Impaired

Following are five suggestions that may help elderly family members better enjoy the holiday festivities when all the younger family members are stirring up a ruckus celebration:

1. Prevent your elderly family members suffering from dementia from too much excitement or things like camera flashes, multiple blinking lights, over-exhuberant youngsters asking too many questions and generally just too many simultaneous visitors.  Their own inability to process information at the same pace can lead to frustration and disruptive behavior on their part in response.

2. Try to help the elderly stay in a good frame of mind by playing softer music and familiar songs to soothe their mood(s).  Perhaps predictably, those suffering from various forms of cognitive impairment, such as Alzheimer’s or other dementia, have shown positive reactions to hearing their favorite kind of music.

3. Protect your aging parent with dementia from loud noises, even loud talking and laughter that seem part of a normal day of celebration. A person with dementia can become upset by loud noises, even if they are happy sounds.

4.  Like most of us, but especially those elderly suffering from cognitive impairment, need quiet time, for rest, reflection and repose.  Too much conversation and holiday excitement among family members can agitate the elder.  Subtle signs of fatigue or frustration are indicators that a break from the action is appropriate for them.

5. Stay on their current schedule. Keep the elderly family member(s) eating at that same times that they always do.  Otherwise, disrupting their routine could create unnecessary stress or confusion.

Our thanks to Dr. Mikol Davis at http://agingparents.com for this information.

 

CFPB Has Published Guideline Booklets to Help Lay Persons Managing Money Under Fiduciary Obligations (Powers of Attorney, etc.)

The Consumer Financial Protection Bureau has published new guideline booklets to help lay persons properly manage other people’s money when acting as a fiduciary.  For example, if you are managing money for your elderly parent or anyone by virtue of that person naming you agent under a power of attorney, you are subject to fiduciary duties the breach of which may subject you to a lawsuit or other legal action.  So, to help ensure you stay within the bounds of what the law allows you to do, it’s worth taking a look at these brochures and make sure anything you do stays within these bounds.

The Managing Someone Else’s Money guides are for agents under powers of attorney, court-appointed guardians, trustees, and government fiduciaries (Social Security representative payees and VA fiduciaries.)

The guides help you to be a financial caregiver in three ways:

They walk you through your duties.

They tell you how to watch out for scams and financial exploitation, and what to do if your loved one is a victim.

They tell you where you can go for help.

Remember, an ounce of proper planning and prevention is worth a pound of cure!

VA Study Shows Top Concerns of the Dying

A study by the Veterans Affairs Medical Center in Durham, North Carolina, shows that the top concerns of terminally ill patients and their families are the following:

  • Prevention of pain is most important. People fear dying in pain more than they fear death.  These folks need reassurance that pain management is available.
  • Patients want to be involved in decisions regarding their treatment.  The study doesn’t report it, but it may well be that loss of control or the desire to maintain control are part and parcel of this driver.
  • Patients and their families want to know what to expect from the fatal condition and treatment.  Again, although not specifically reported, it seems reasonable to infer that removal of a degree of uncertainty about what may help people better cope with their predicament.
  • Dying persons and their families search for meaning in their lives and relationships at the end of life. Practicing one’s faith, life review, and saying goodbye were listed as important activities.
  • Perhaps interrelated with the previous finding, altruism becomes more pronounced in people who are dying, as the study showed people want to contribute to the well-being of others. They find peace in helping loved ones come to grips with their impending death in order to let them go. They also like to leave behind means to care for the needs of their survivors.
  • Patients want to be seen as a whole person, not a disease.

Research from this study and others indicates that it is helpful to talk openly about death and to give your care receiver a chance to talk about death. Thus, doing away with the placebo of denial seems to work more fruitful results.  If the patient allows an opening such as, “When I’m gone” or, “I need to get my finances in order,” take it.  If the uncomfortable is not discussed, or the chance is missed and it doesn’t come up again, direct questions as to the reality of the situation are appropriate, such as asking, “Are you afraid of dying?”  Alsl found to be appropriate are discussions about funeral plans and any advanced directives or other legal matters that have not been completed.

As in other phases of life, arguments with the patient about whether he or she can recover or to remain positive and believe he or she is not going to die are counter-productive.  Denial is less than optimal.  The study concluded that a care receiver will be more peaceful if their loved ones make it known that they have accepted his or her death and release him or her with love.