Mason Law Elder Law Update July 2007

Elder Law Update
North Carolina Edition

Issue Two

July 2007

In This Issue

Driving and the Elderly: Making a Tough Call

Evacuation Planning for Older Adults

Signing Up For Social Security and Pensions

This Month's Favorite Links
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My Generation!
Turn on your speakers and prepare to rock!

Christian Science Monitor article "When does it pay to take Social Security benefits early?"

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Dear Bob, RAM Casual

Welcome to Issue Number 2 of Elder Law Update. Quite a few people have joined since June 1, so if you missed our first issue, you can read it by clicking HERE. Remember, the goal of Elder Law Update is to give you a quick look at some interesting developments and other information I hope you'll find useful. I've also thrown in a bit of humor . . . look under favorite links.

In This Issue

We have two new contributors. My friend Dr. Beth Hodges is an Asheboro family practitioner with a large geriatric practice. Many of you know her. She and I have a number of patients/clients in common and I've enjoyed working with her. She has written a number of newspaper columns and always has something interesting to say. In this issue, a bit further below, she dives right into a fairly emotional topic. Hint: It has to do with car keys.

Our second new contributor is Barbara Dunn, MSN. I work with Barbara out of our Savannah office. Barbara is a geriatric care manager and has an impressive resume. She is particularly adept at helping seniors and their families identify needs and locate the resources that can help them. In addition to running her own care management practice, she is Chairman of the Disaster Services Committee of the Savannah Chapter of the American Red Cross. In this issue, she'll start off a three part series on emergency preparedness and the elderly. In Savannah and coastal Carolina emergency is often spelled "HURRICANE". We're 30 days into hurricane season, and Barbara has some timely advice. We may be a hundred miles or so "inland" in central North Carolina, but I know of several people receiving Elder Law Update who have loved ones on the coast.

Finally, Social Security expert Warren Coble urges anyone thinking about Social Security retirement benefits to start planning NOW for the best time to signup. It just might make you some money. Read his comments below. In my monthly rambles around the 'net I saw an article that goes well with Warren's column. The Christian Science Monitor ran an excellent article entitled "When does it pay to take Social Security benefits early?" That's a question I'm regularly asked, and the article does a good job of answering it. Read both Warren's article and the Christian Science Monitor column for ideas on when you might want to begin your benefits and when the best time is to apply for those benefits.

Medicare Advantage Plans Update

In the last issue I wrote of abusive marketing techniques used by private companies selling Medicare Advantage plans. In Georgia authorities have arrested several sales people and in North Carolina the Insurance Commissioner and others have been looking closely at hundreds of complaints.

Great news! Seven of the largest (and in the opinion of many most abusive) marketers of Medicare Advantage plans have entered into an agreement with the Centers for Medicare and Medicaid Services (CMS - the federal agency that runs Medicare and Medicaid) to cease marketing efforts of Private Fee-for-Service Plans until they've cleaned up their act. In a five month period CMS received over 2,700 complaints directed to abusive and fraudulent sales tactics used by these companies.

North Carolina Medicaid Update

Many of you have been following efforts to implement the provisions of the Deficit Reduction Act. As I have previously reported, the new rules (when implemented) will have a drastic effect on transfers made by people who might have to qualify for nursing home Medicaid benefits within five years. The North Carolina Division of Medical Assistance has been attempting to implement hardship rules that take an extreme view of what constitutes "hardship". A second effort by DMA to persuade the North Carolina Rules Review Commission to adopt its rule failed in a 6 to 1 vote Thursday, June 28.

Meanwhile DMA and various advocates have been working with (maybe "working on" is more apt) legislators to shape a possible legislative solution in the Budget Bill. The Budget Bill should be presented to the Governor sometime this month, and at that time we'll know more about what is going on with Medicaid.

I promise to send out an ALERT as soon as we have definite news.

I hope you enjoy this issue. PLEASE pass it on. You can do so by clicking HERE or at the bottom of this newsletter.

Have a great Fourth!

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.

DRIVING AND THE ELDERLY: MAKING A TOUGH CALL
-Beth Hodges, MD

Throw Mama from a train, if you must, but don't throw her in the front seat of a Buick. I often am asked by families how to assess whether an elderly parent or grandparent should be driving or asked to do the difficult task of taking away his or her driving privileges. It is never an easy job, but it is one of immense importance.

The ability to drive is one of the most tightly held freedoms we in America, especially rural America, hold. It can be the difference between being able to continue to live independently or having to go into senior housing or to depend totally on friends and neighbors. Giving it up can result in a total change of life circumstances.

But driving it not a right, it is a privilege - a privilege available only to those physically and mentally capable of the task. Here are some of the parameters that must be met in order to maintain that privilege. If you have an elderly relative teetering "on the brink," read on carefully.

Vision must be adequate to see road signs and obstacles. This can be an issue during the day, but even an elderly person who sees adequately during the day can have more difficulty at dusk, in inclement weather, or at night.

Hearing must be adequate to pick up the sounds of trains or emergency vehicles that can be heard before they are seen.

Physical strength and agility must be adequate to perform emergency road maneuvers quickly. The reflexes of many elderly can be slowed to the point that this is not feasible. Severe arthritis or cardiac conditions or debility after a stroke can also affect these skills.

Mental faculties must be present enough to allow split-second decisions. I was behind an elderly lady at a road construction site once who, when faced with the workman flagging her to stop, forgot for a moment what that meant and plowed right through several orange barrels, some roadside equipment, and a few construction workers. Her family admitted in the emergency room that Grandma's memory had been lagging a bit, but they didn't see the harm in her driving 2 miles to the grocery store. After all, she'd been doing it for 60 years. Another elderly gentleman of my aquaintance got into his truck to drive half a mile down a straight road to his daughter's house. The police found him two and a half hours later in a town 70 miles away after he ran a red light and caused a major traffic accident.

So what to do if Aunt Elsie won't hand over the car keys? The most dangerous thing you can do is nothing. If she cannot or will not see reason on the matter, speak to her physician. Often, hearing the news from her own doctor can carry more weight.

If the elderly person is borderline in his or her abilities, the doctor can order a driving skills evaluation test from the physical therapy department of many hospitals. It is not covered by Medicare, but may give families peace of mind or give the elderly person in question incontrovertible proof he or she has to hang up the car keys.

If it is clear to all that Uncle Frank shouldn't be buying a new Mustang, but he refuses to adhere to the doctor's recommendation, the doctor is legally bound to write a letter to the DMV, who will then send Uncle Frank a notice stating he has to have some medical forms filled out in order to keep his license. If the physician's answers on the forms are concerning, the DMV will revoke or limit driving privileges, as indicated. If Uncle Frank ignores the letter from the DMV, his driver's license will be revoked automatically.

Helping your older family members make this difficult transition is not easy, but please remember: It can be the difference between life and death - and not necessarily theirs.

Beth Hodges, MD, is a principal in Hodges Family Practice, with offices in Asheboro and Ramseur, North Carolina.

EVACUATION PLANNING FOR OLDER ADULTS

-Barbara Dunn, MSN

Editor's note: This is the first in a three part series telling you how to begin devising an emergency evacuation plan for the elderly.

Hurricane Katrina dramatically illustrated the importance of planning the safe evacuation of older adults. Unfortunately, both communities and families often overlook evacuation planning for older adults. This series of articles aims to raise the awareness of family members about the need to have an evacuation plan in place and to identify a few key measures to increase the older adult's safety and comfort should an evacuation be necessary.

This is a big topic. I'll show you how to get started. In this issue of Elder Law Update we'll discuss a few preliminary considerations. In the next two issues I'll review important and very specific areas to address with your older loved one.

First, draft an evacuation plan with your older adult loved one, making sure his or her wishes are included in the plan. Make sure the loved one has a copy of the plan and schedule time to review it periodically. Many older adults say they won't evacuate. Don't be deterred;forge on with planning.

Increasing your loved one's comfort and safety during an evacuation begins with a written evacuation plan, that reflects the older adult's unique evacuation needs. The four critical areas to address are mobility needs, communication needs, medication needs, and, yes, pet needs.

Caution!

Evacuations tend to be "equal opportunity events" leaving all of us subject to whatever comes our way-especially without prior planning. "My parents will never go to a shelter" or "my aunt will not evacuate on public transportation" are not wise positions to take. A life could be in jeopardy. Emergencies by their very nature come unannounced and are chaotic. Many will be forced to rely on public transportation and shelter.

Further, older adults often have no family members nearby, leaving others to plan for their well-being during an evacuation. Remember, if you don't plan for the older adult in your life, someone else may and you may not be happy with the outcome. Last, even if you live near your loved one, don't assume you will be able to reach him or her. Be prepared for everything and anything.

In the next issue of Elder Law Update I'll show you how to plan for mobility needs, communications needs, and medications. If it looks like Coastal Georgia or the Carolinas may be visited by a hurricane before the next issue, we'll complete this article in a special alert.

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.

SIGNING UP FOR SOCIAL SECURITY AND PENSIONS
-Warren Coble, SCSA

Most pension plans and Social Security (SSA) require that you file in advance of the time you want your benefits to begin. SSA has a mechanism known as "protective filing" which assures you will be paid benefits from the time you tell SSA you want your benefits. Most pension plans begin monthly benefits the month you file a written application, sometimes later. Failure to apply as soon as you are eligible to apply for either SSA or pension benefits means simply that you have lost money. Again, from last month's tip, advance planning is most important. You can apply for benefits usually up to three months before the month of eligibility. Contact your specific pension plan or SSA for exact details.

For Social Security Retirement and Disability benefits, filing is available via the Internet at www.ssa.gov. Survivors, Auxiliary (Child), and Supplemental Security Income claims must be filed through a Social Security Office, either by telephone or in-office interview. Appointments may be scheduled through the local office servicing your area (See the Office Locator at Online Services at www.ssa.gov) or through the national toll-free number 1-800-772-1213. You may also visit a local office to schedule an appointment. Without an appointment, you may wait hours to be seen for a claim.

The important things to remember: 1. Plan ahead, and 2. Apply timely to avoid any potential loss of benefits.

Warren Coble is a member of the Society of Certified Senior Advisors and welcomes your questions regarding Medicare, Social Security and Senior Life in general! Email Warren by clicking HERE.

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!).