Elder Law Update
North Carolina Edition
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This Month's Favorite Links
Check Them Out!
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ElderLawAnswers
(A Great Q & A Resource)
Special Needs Answers(Good source of info on Special Needs Planning by the Academy of Special Needs Planners)
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PLEASE VISIT MASON LAW
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I WANT TO KNOW
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Dear Bob,
Welcome to Issue Number 3 of Elder Law Update. If you have recently joined, you can read our two "back issues" by going HERE. They're
Coming! New Medicaid Rules Near
July has been hot and busy. August will be hotter
and busier. Further below I explain that restrictions on transfers of assets by
people prior to qualifying for Medicaid will be tougher than ever . . . soon.
Please read on. And for a clearer understanding of the Medicaid rules
applicable to nursing home residents, please go to an article I have prepared
and posted on the Mason Law website. See the "Basics of Medicaid Eligibility" by clicking here.
Implementation of the new rules is certain to be
complex and filled with uncertainty. I'll do my best to keep you updated.
New Advance Directives Forms
Within the past day, the General Assembly has
enacted new Health Care Advance Directives legislation and sent it on to the
Governor for signature. The effective date will be October 1.
The legislation contains significant changes to
advance directives executed on or after October 1. A fair amount of controversy
filled the air over in Raleigh as the legislation wound through the committee
process.
Fresh on the heels of the high profile Schiavo
debacle people from both ends of the political/religious spectrum weighed in.
The legislation does eliminate some of the more egregious definitions I had
problems with, but the new forms a more complex than ever.
The forms do work for any particular preference,
but unfortunately they will not be easy for the average reader to follow and
understand, and people will need to be careful when completing the forms.
Advocates, time to saddle up . . . there will be a
few months of learning ahead and then you'll need to be in a position to help.
Further In This Issue
Speaking of Hot Summers, Dr. Beth Hodges has an
interesting short article on cautions every senior needs to exercise in the
heat. Her article appears just below. For those of you who are medical doctors
or have access to Medical Economics (a national journal for physician
practice management), Beth and her husband/partner Cisco Hodges, MD are the
featured story in the July issue . . . they made the cover!
And for many readers, when not broiling under the
sun some summer activity may involve dodging hurricanes. Geriatric Care Manager
Barbara Dunn continues her three part series on hurricane (and other emergency)
planning for seniors with episode 2. Barbara has a wealth of knowledge in this
area and, in addition to running her own practice, is Chair of the Disaster Services Committee for the Savannah Chapter of the Red Cross.
Finally, resident Social Security expert Warren
Coble gives us some timely pointers as to what to expect when applying for Social Security benefits . . . and what you'd better be ready to prove.
Stay tuned to your inbox. I believe we'll have a
number of timely ALERTS during August.
I hope you enjoy this issue. PLEASE pass it on. You can do
so by clicking HERE or at the bottom of this newsletter.
Bob Mason
Certified Elder Law Attorney
Certified by the
National Elder Law Foundation, recognized by the American Bar Association as
the certifying entity for specialization in Elder Law.
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They're Coming! New Medicaid Rules
Near
Implementation of new Medicaid
transfer restrictions has moved closer to reality. As of this writing House and
Senate conferees are ironing out technical differences in a Medicaid Hardship
Waiver rule that will open the way to the Department of Medical Assistance to
begin implementation of the Deficit Reduction Act nursing home Medicaid rules.
I will keep you posted as this legislation moves from committee to the General
Assembly for certain approval and then on to the Governor.
My best guess for a new rules
start date? Hard to say, but perhaps September 1. Maybe more likely October 1.
Less likely later than that.
Hardship Rules must be in place
before DMA may begin implementation of the DRA. Under federal requirements and
the NC Administrative Procedures Act (APA) the rules were required to be put in
place either through the arduous administrative rule making process of the APA
or by the General Assembly.
 DMA had no success implementing a
harsh version of the Hardship Rule through the administrative rulemaking
process. See my earlier report on those efforts by clicking here. The governor could have
enacted emergency rules upon a finding of urgency, but apparently he declined
to do so. DMA took the issue to the General Assembly.
Through the very hard work of the
Elder Law section of the State Bar Association, AARP, key legislative leaders,
and (yes) DMA, a Hardship Rule agreeable to all parties was hammered out.
The new DRA Rules are very harsh
in the treatment of seniors who have transferred assets before attempting to
qualify for Medicaid nursing home benefits. Please read my report "The
Basic Rules of Nursing Home Medicaid Eligibility" for a more complete
description of how DRA will operate.
Earlier versions of the Hardship
Rule would have required that a couple have essentially NO assets before a
hardship waiver of the new DRA Rules could be granted. After much effort, a
Hardship Rule has been crafted that would allow a Community Spouse to retain
the previously protected income, slightly more than $60,000 of Countable
Assets, and a homeplace with equity of less than $500,000 . . . and still
qualify for a finding of Hardship if other hardship conditions are met.
This is good news. Many
thanks are due Senator Martin Nesbitt of Buncombe County, Doug Heron of the Bar
Association staff, Bill Wilson and Mary Bethel of AARP and the leadership of
the Elder Law Section of the Bar Association.
Trying to predict when actual
implementation of the new rules will begin is a bit like trying to predict
where and when, exactly, a hurricane will make landfall. I put a 40%
chance on September 1, 40% on October 1, and 20% later.
More ALERTS will be sent as
implementation plans are known. Look for continuing discussion in the
next few issues of Elder Law Update.
Bob Mason
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 SUMMER AND THE ELDERLY: KEEPING IT COOL
-Beth Hodges, MD
Summer is full of long days, fun in the sun, and social events galore, but it can be a particularly hazardous time for our elderly. Here are a few tips for keeping Grandma safe:
- Avoid being outside in the worst heat of the day (usually 10am-4pm) Older folks' internal thermostats can't regulate their body temperature as easily as ours can, so they are more sensitive to heat exhaustion or heat stroke. Their skin is also thinner and they can burn more easily.
- Make sure elderly relatives are drinking enough water, especially if they are on blood pressure medication. Not only can they become dehydrated very easily, but early stages of the problem can cause their blood pressure to drop when they stand, putting them at risk for falls.
- Ask them when they last had a tetanus booster. An adult needs a tetanus booster every 10 years, or sooner if he gets a bad skin injury. Since many elderly do not go in for regular physicals, their tetanus immunity can wane, putting them at risk for the infection. A tetanus infection is usually fatal, and those that live through it can be neurologically devastated. We do have tetanus in this area. Several cases are reported each year, most of which are in the elderly.
- Try to find out if they are taking their medications as directed. Late summer is when many of our elderly hit their "donut hole" in terms of prescription coverage. Unfortunately, quite a few of them just quietly stop taking their medications until January and the start of a new coverage year. Many hospitalizations and even deaths in the elderly come as a consequence of this.
- Encourage the use of insect repellent when outside. Mosquitoes and ticks can carry diseases that are particularly dangerous to the elderly.
Summer is a great season. Let's keep it a safe one for our elder population.
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 EVACUATION PLANNING FOR OLDER ADULTS
-Barbara Dunn, MSNEditor's note: This is the second in a three part series telling you how to begin devising an emergency evacuation plan for the elderly.
In the last issue of Elder Law Update I stressed the absolute importance of starting on a written evacuation plan for older loved ones. I also promised to discuss some specific areas you must consider. These may seem obvious, but you must think through and plan for each. Mobility Needs Label every single piece of durable medical equipment (DME) no matter how recognizable you think it is. Walkers and canes packed into a van or bus begin to look the same. Is an electric scooter needed? Be sure to plan for an extra battery. A dead battery is useless, whether going by private or public transportation. Does the vehicle have the means to transport the scooter? Too often families face having to leave the scooter behind. If a wheelchair is necessary, will it fit in the trunk or back seat and who has the upper body strength to load it? Planning to take mom or dad home with you? If so, are there mobility barriers where you are going? How will your loved one bathe, negotiate the front stairs, or fit the wheel chair through the bathroom door? Do the bathrooms have grab bars and are there scatter rugs that need to come up? Communication NeedsEyeglasses and hearing aids can be a problem during an evacuation. Be sure to plan for an extra pair of eyeglasses along with the prescription. Even with a prescription, replacing broken or missing glasses hundreds of miles from home is time consuming and difficult at best. Don't forget to label the glasses in some way. Does your loved one wear a hearing aid? Take along plenty of batteries-you can't predict how long your loved one will be gone. Medication NeedsHave a current, accurate, list of all medications. Keep it updated. During a hurricane evacuation is not a good time to be asking "Is Dad really on this medication or was it discontinued at the last visit?" Have a current list of your loved one's medical providers. Even then, your loved one's primary physician will likely evacuate too and may not be reachable for medication issues. What plans do you have for a back up provider? Consider one of the web based vehicles that make medical records available no matter where you are (www.medicalsummary.com is one example). If medications are running low, will the pharmacy plan permit an early, emergency, refill? Some will, some will not. Ask your pharmacy, and then put it in your plan. Next month, in the last installment of this series, I'll point out a few very important and overlooked items . . . and I'll point you to some great resources.
Barbara Dunn, MSN, is owner of Elder Care of Coastal Georgia, as well as Chair of the Disaster Services Committee of the Savannah Chapter of the American Red Cross. You may email comments and questions to Barbara by clicking HERE.
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 SIGNING UP FOR SOCIAL SECURITY AND PENSIONS
Be Ready To PROVE IT!
-Warren Coble
Signing up for Social Security requires proof, or documentation, regardless of the type of benefit one is applying for. Generally, either original documents or documents certified by the custodian of the original record (Register of Deeds, Clerk of Court, etc.) are required.
Documentation for Retirement Benefits usually includes proof of age (birth certificate before age 5), military service (DD214 showing active duty dates) earnings (W2 form for the year prior to filing), and direct deposit information. Additionally, a complete marital history (name of spouse, Social Security number if known, age or birth date of spouse, and beginning and ending dates of marriage, where the marriage began and ended, and if the spouse is deceased) is needed. Proof (marriage license, divorce decree, etc.) of the marital history is not required for retirement benefits. However when a spouse is applying for spousal benefits and survivor benefits, proof of the marital history is required.
For Disability Benefits, the above information is also required, in addition to documentation of the disabled person's medicines, medical condition and treatment history, work history, and educational history. While helpful, actual medical records are not required. The Disability Determination Service will obtain the medical records. However, providing the actual copies of the medical records at the time of application does speed up the disability process.
Further information regarding documentation and proof requirements can be found on Social Security's website, WWW.SSA.GOV or by calling SSA's National toll-free number, 1-800-772-1213.
Social Security expert Warren Coble welcomes your questions regarding Medicare,
Social Security and Senior Life in general! Email Warren by
clicking HERE. |
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The Usual Disclaimer: This newsletter is for general information only. Please do not rely on anything you read in this email as definitive legal advice applicable to you. All situations are different, including yours. Nothing you read in this newsletter is a suitable substitute for professional advice you may receive from your attorney, your accountant, or your tax advisor.
All contents copyrighted 2007 by Mason Law, PC. Contents may be republished with written permission of Mason Law, PC (which permission will usually be given!). |
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