Major Breakthrough in Medicare Coverage for Chronic Illnesses

hands of old and youngFor years we have accepted the fact that Medicare will only cover physical therapy for patients who are continuing to improve. When my mother broke her hip the therapists informed her doctor that Medicare coverage for rehabilitation would cease after only three weeks of therapy. They told us that she would have to return to her assisted living residence even though she was still not able to walk. Their conclusion: She was no longer improving and it was likely she would never walk again.

Of course this was complicated by the fact that she had dementia and couldn’t remember the exercises they had prescribed for her a few minutes after she left the therapy room. But we accepted their conclusion without making a fuss and she has been in a wheelchair for the last five years.

But a major change has recently occurred in Medicare. One that has been kept very quiet but will have a huge impact on patients who have chronic illnesses. Medicare officials updated the agency’s policy manual in January. This is the rule book for everything Medicare does.  They stated that Medicare will now pay for physical therapy, nursing care and other services for beneficiaries with chronic illnesses like Multiple Sclerosis, Parkinson’s and Alzheimer’s disease in order to maintain their condition and prevent deterioration.

This dramatic change is due to the settlement of a class-action lawsuit filed in 2011 against Kathleen Sebelius , the Secretary of Health and Human Services by the Center for Medicare Advocacy and Vermont Legal Aid on behalf of four Medicare patients and five national organizations, including the National Multiple Sclerosis Society, Parkinson’s Action network and the Alzheimer’s Association. The settlement affects care from skilled professionals for physical, occupational or speech therapy and home health and nursing care, for patients in both traditional Medicare and private Medicare Advantage plans.

The change will have the greatest impact on seniors who want to avoid having to go into an institution to get care. People with chronic illnesses like Parkinson’s or MS may be able to get the care they need and stay in their own homes.

Existing eligibility criteria for Medicare rehabilitation benefits have not changed however. To be admitted to a rehab. facility or nursing home for covered care the patient must have spent three consecutive midnights in the hospital as an admitted patient and the patient must be referred by a Doctor’s order prescribing skilled nursing home care not custodial care.

For home health coverage, the beneficiary must have a Doctor’s order for intermittent care ( every few days or weeks) provided by a skilled professional or outpatient therapy, social work services or a visiting nurse. Beneficiaries receiving skilled services at home are also eligible for home health care aides for assistance with bathing, dressing and other daily activities.

The settlement also provides for a review of claims that were denied in the past three years solely because patients were not improving. Officials have posted a form on the Medicare site to repay beneficiaries for the care they paid for themselves. This form must be submitted by July 23, 2014 for claims that were denied from Jan. 18, 2011 to Jan. 24, 2014. Claims denied between Jan. 25, 2013 and Jan. 23, 2014 must be submitted by Jan. 25, 2015

Can Telemedicine Help Your Aging Parents?

TelemedicineWhat do you do if you can’t get your aging parent to a doctor’s office because of her disability? What do you do if your parent needs to see a specialist who may be hundreds of miles away? A new area of medicine known as Telemedicine may be the answer to your problem.

I first heard of this breakthrough  through the Parkinson’s Disease Foundation’s Newsletter, News & Review available at  www.pdf.orgThe newsletter described the advantages of Telemedicine for Parkinson’s patients. It offers them access to care, particularly to specialists, in locations that are remote or poorly served by medical resources. It also makes it easier for people with Parkinson’s to participate in clinical trials, which could speed up the development of new treatments.

A virtual medical appointment uses a computer, tablet or smartphone with technologies such as Skype or Facetime. These programs are available for free. Skype can be downloaded from Facetime comes as a resident program on any Apple Computer, Iphone or IPad. Patients can communicate with and see their Doctor on the screen of the devise.

Early studies have indicated that the virtual visit may be more effective than seeing your doctor in person. It eliminates the hassle of travel to and from the doctor’s office and sitting in the waiting room. It also helps the doctor see you in your everyday environment. If your parent is prone to fall  it may help a doctor or therapist to identify risk factors and suggest ways to solve them.

Some studies have shown that during Telemedicine appointments, people are more relaxed, can communicate better with their doctors and can remember advice with greater accuracy. In a study done by the University of Rochester with people who have Parkinson’s Disease, researchers found that the quality of care was high and patients actually preferred the telemedicine visit.

According to the AmericanTelemedicineAssociation, there are 3,500 sites around the US that offer telehealth in some capacity. More than 380,000 veterans received telehealth services from the VHA in 2011.

Telemedicine has demonstrated a significant impact on hospital admissions and emergency room visits, as well as, walk-in clinic visits. Ontario Telemedicine Network (OTN) conducted a trial program that involved more than 800 patients with one of two chronic diseases – Congestive Heart Failure or COPD. The results were:

  • 65% reduction in number of hospital admissions;
  • 72% reduction in number of Emergency Room visits; and
  • 95% reduction in number of walk-in clinic visits.

Telemedicine offers the possibility of shifting the delivery of many health care services from hospitals and other healthcare facilities to patient’s homes, thus reducing the load on the healthcare system and reserving hospitals for more critical cases.

One of the biggest hurdles for the expansion of Telemedicine is the patient’s ability to use the technology. We have probably all seen our elders wrestle with learning how to use email on their computers. But the use of a tablet or a computer with touch capability can make the communication almost as simple as dialing a phone.

Find out if your family doctor is familiar with the American Telemedicine Association (ATA). Ask them to check out the website, to learn more about the exciting developments in this area. And see if it might work for them.

No Nursing Homes for Baby Boomers!

retirement communityMany families choose to stay in their home if one spouse needs long term care. But some can no longer stay there due to their needs or just the difficulties of moving about in the house. As 10,000 baby boomers reach retirement age every day, most who need care will not plan to enter a assisted living residence and will never step foot into a traditional nursing home. Increasing numbers will seek out new alternatives for independent living where care can be provided.

Intentional communities for philosophical, religious, and lifestyle groups are emerging. Wikepedia describes an intentional community as “ a planned residential community designed from the start to have a high degree of social cohesion and teamwork. The members of an intentional community typically hold a common social, political, religious, or spiritual vision and often follow an alternative lifestyle. They typically share responsibilities and resources.”

Alex Mawhinney ( , a developer of retirement communities  for over 25 years, reports that “intentional elder neighborhoods are becoming the new paradigm for elder living.” He states that boomers will no longer be interested in “the older generation of elder living options that were available to our parents that follows this model:.

  • Age in place — in a home not designed for aging in place, and eventually aging alone
  • Move in with children or other relatives
  • Move to an institution — and pay dearly for care delivered by strangers, under their rules and according to their schedules. The institution might be a nursing home, an assisted living facility, a rest home, a retirement hotel, or a continuing care retirement community with multiple levels of care.

These elder neighborhoods are taking many different forms. It would behoove you to determine if any of them have been created in your community.

There are SOTELs (service-oriented technically enhanced living—like an upscale Embassy Suites); ecovillages; senior cohousing; and the new lifestyle communities like those being developed by Canyon Ranch.

The common traits of these new alternatives are that they are:

  • Human scaled ( not large and impersonal)
  • Relationship based
  • resident managed/centered, with an overlay of lifelong learning, later-life spirituality
  • giving back to the community

Early Retirement, Medicare, and How the Affordable Care Act Affects Seniors

Affordable Care ActChances are, if you’re alive, you know: the Affordable Care Act (commonly referred to as ‘Obamacare’) is here, and it’s confusing. Between trumped up rumors of plan cancellations and high penalties for those who don’t comply, more misconceptions seem to flood our screens than useful information. However, even if they are buried under layers of content, the facts exist. If you are 50 or older and retired or considering retirement, here are the facts that you need to know about the Affordable Care Act (ACA).

No Surprises

Before ACA, seniors often found themselves surprised by the cost of healthcare—especially if they were retiring before the age of 65. While some employers extend health benefits to retirees, many don’t, and finding affordable private coverage required access to the fountain of youth. Today, it is still legal to charge seniors five times the amount a 20-year-old would pay for the same policy on the private market—a cost that will be reduced to three times the amount in 2014.

Coverage will be much easier to find with the Health Insurance Marketplace, which will allow you to compare plans side-by-side.  Premiums may look more expensive at a first glance, but retirees living on less than they were while employed will qualify for subsidies that will help cover the cost of their premiums in the form of a tax break. If you’re under 65 and shopping on the marketplace, keep the amount of this subsidy in mind—your premium may appear to be over $1,000, but your tax break could lower it to less than half the cost. This amount is often lower than what you’d be paying for your COBRA through your former employer! The ACA will make it easier for you to retire before you’re eligible for Medicare, and you’ll qualify for coverage even if you have a preexisting condition.

Medicare Eligibility

If you’re over 65 and qualify for Medicare, you will be happy to know that Medicare still exists, and it is separate from the healthcare exchanges. In fact, the ACA will strengthen your policy if you qualify for Medicare. If you have Medicare Part D and have faced the price of prescription drugs in the doughnut hole, you’ll be happy to know that this gap will be shut for good by 2020. For now, you will receive a 20% discount on generic prescriptions and more than a 50% discount on brand-name prescription drugs while you are in the coverage gap.

Medicare now covers certain types of preventative care deductible-free, such as mammograms and colonoscopies. It also covers a free yearly “wellness” visit. The ACA has also extended the lifespan of the Medicare Trust—the fund has been extended until at least 2026.

Still Covered?

If you’re covered under your employer’s plan, the ACA also benefits you. More preventative care will be covered—everything from the flu shots to cholesterol screenings. All plans, whether purchased from the exchange or not, must cover the essentials starting in 2014, including hospital and emergency care, doctor visits, prescription drugs, and mental health.  If you have kids under the age of 26, then they can stay under your plan which saves you and them a ton of money.

So even if it seems maddening on the surface, the ACA will allow everyone to have access to the insurance that is appropriate to their needs. If you need help with the exchange, many businesses and community centers have events and programs that can help you through the process. Remember that insurance coverage is an important element to a successful retirement, and if you’re ready to retire early, the ACA has you covered.

Guest post written by: Edward Oberg, currently on hiatus from the insurance game, now spends his time blogging for The Hartford and hunting for monster brook trout that delight in mocking him. He has vowed to defy the accepted wisdom regarding boring insurance reps by being extremely interesting.

When do elderly people lose their youth? of us direct our intentions to ensure that we enjoy a convenient stress-free healthy elderly life.

But when do elderly people really lose their youth and begin to fall prey to the psychological and emotional burdens of the elderly stages of life?

Factors that make elderly people lose their youth

There are 3 great factors that influence the loss of one’s youth.

  • Stress – No matter how old one becomes or how young one still is, the amount of stress greatly affects his or her ability to deal with aging. The human body experiences increased aging due to the hormones that need to be released in a stressful environment. When such processes are repeatedly experienced, the human body can no longer undergo reversible conditions thus fall prey to aging.
  • Support and coping – No matter how great the stress that elderly people experience, as long as they have the right coping mechanisms and support sources, they will stay healthy.
  • Information – When it comes to maintaining one’s youth, the amount of information that has been acquired to deal with all possible problems of aging matters a lot. This involves gathering as much information as possible in not only dealing with the common diseases and problems of elderly life but also maintaining quality of life despite old age.

When do you say goodbye to your youth?

After everything that has been said, you can easily tell when an elderly loses his or her youth. It is the point the he or she gives up and loses hope. Seeing the world through the eyes of youthfulness is seeing it with strength, hope, and glee. No matter how harsh, depressing, or hopeless a situation, with all 3 factors mentioned above adequately provided to your elderly, they will never lose their youth and fall prey to the a disastrous aging process.

this is a guest post written by Alana Vial of Daughterly Care. Please contact me at if you are interested in writing a guest post.

About Daughterly Care:

Daughterly Care is one of the leading privately owned agencies offering Homecare in NSW, which includes residential respite care.

How do your parents transfer their real estate to avoid a family crisis?

GRandma's home in TarrytownIf you have a chance to review your parents’ assets, in many cases you will find that their home is their most valuable investment.

Our parents often have no idea how to divide up their real estate. In many cases they  will let their their children decide amongst themselves after they are gone. This is a recipe for disaster. Most likely, not every child will have the same interest in keeping the property. One might want to sell it; one might want to keep it but has no interest in helping to pay its ongoing costs. And of course all the grandchildren want to keep the property since it often has been such a place of joy for them.

How are you to advise your parents to plan for the disposition of their property in a way that you and your siblings have a say in it? You, your siblings, and your parents must discuss with professional advisers all the options available to them in transferring the value of their real estate.

Let’s look at various options and see how they might work.

Gifting Real Estate Before Death

What if your parents want to give their home to one of their children now rather than wait until they have passed away? One of my clients came to me and said that his mother wanted to transfer her real estate to him.  She wanted to do this to get it out of her estate and protect it from the government if she should need nursing home care. She still intended to live in the house for the rest of her life.

I told him why I thought this was a bad idea. First of all, if she gave him the home, she would transfer the cost basis to him.. She and his father had bought the home for $37,000 in 1955. It was recently appraised for $550,000. All the gain in the house would be taxable when her son sold the house in the future. If she had passed the house to him after her death, all the gain would have been forgiven for tax purposes. This forgiveness of gain is called “step up in basis” and would apply to any capital property like stocks and real estate.

In addition, the house was now a potential target for the son’s creditors. That might not concern him but it should concern his mother. If he should ever have credit problems, the creditors could attach their loans to the house and potentially drive her out and sell the house right out from under her. Also, if her son had marital problems and got divorced, his ex-wife could claim the house as one of the assets in the divorce settlement. All in all, the direct gift of a parent’s home to you is not a good idea.

Gift a future interest in the house to a child

A better approach would have been for my client’s mother to retain a life interest in her home and gift the remainder or future interest in the house to her son.  This is called a life estate. Two entities, the “life tenant” and the “remainderman,” hold title to the property. The life tenant has the right to use the property for life and the remainderman obtains the ownership of the property at the death of the life tenant. The life tenant pays the cost of the property while she is alive. She avoids her child’s creditors and potential ex-spouse. Another benefit is that the property does not have to go through the probate process at her death, simplifying the transfer and reducing the cost.

The life tenant retains any of the tax benefits of owning the house, and most importantly, the life estate is not a completed gift until the mother dies. That means the son can take advantage of the step up in basis and avoid potentially big capital gains taxes when he eventually sells the house.

Set up a Qualified Personal Residence Trust

Another way for parents to transfer their home to their children is through a Qualified Personal Residence Trust (QPRT). It is is an irrevocable (unchangeable) trust set up by your parents. When they put their home into the trust, it becomes a permanent (irrevocable) gift to the beneficiaries of the trust, who are usually one or more of the children. But this is not an immediate gift. When the trust is set up, it is set up with a time limit. The longer the time limit, the smaller the gift to the trust.

For example, if your father as donor was to transfer a $1 million residence to a QPRT, retaining the right to use the residence for a seven-year term, the value of the present gift to the remainder beneficiaries (the children) might be only fifty percent, or $500,000.  If your father survives the seven-year term, the residence will not be included in his estate for tax purposes, nor will any of the appreciation in value of the residence occurring after the initial transfer.  If, after seven years, the residence has appreciated in value to $1.4 million, the parents will have succeeded in transferring this amount to their children at the same tax cost as a transfer of only $500,000.

If your parents wish to remain in the house after the trust term has ended, they will have to pay rent to the beneficiaries of the trust (the children) to avoid any IRS question of an incomplete gift.

Agree to An Option Program

I had a client who had four children. None of them indicated in the family meeting that they were certain they wanted to buy their parents’ home, but they wanted to ability to do so in the future. They didn’t want the sale of the house to be  automatic when their parents passed away. They agreed with their parents to set up an option program.

When their parents were gone, they agreed that a firm they were all familiar with would make an appraisal. That appraised value would be the price any of them had the option to exercise to buy the house. The option period would only be open for one year after their parents’ death. If none of the children had exercised the option by then, the house would be sold and the proceeds shared equally..

In this case if more than one of the children wished to buy the house it could be handled in two different ways. The sale could go to the highest bidder or the children could create a partnership agreement spelling out each of their responsibilities and buy the home as partners. It would be much simpler, however, if only one of them purchased the house.

Create a Family Limited Partnership

If your parents own rental property or some type of property that generates significant income, the situation can become more complex. Some of the children may wish to keep the investment property and some might just want to sell it to get the cash. One of the ways to make an illiquid real estate investment more liquid so the children have various options is to create a family limited partnership.

One of my clients owned a very profitable motel. By just overseeing the staff of the motel and working two or three days a week, he received a very handsome income. He decided he wanted to give his children the opportunity to keep the property and continue to receive a nice income. So he created a Family Limited Partnership. He placed the motel in the partnership. He and his wife became general partners of the partnership and his three sons became limited partners. Each of the partners owns a certain number of shares in the partnership.

In the beginning, my client and his wife owned all the shares, since they had owned the property. But over time they gifted shares in the partnership to their children. Thus, over the years, they transferred the ownership of the property to their children. Each child will own a certain number of shares in the partnership and can buy out his partners in the future. If one of the sons wants to maintain the property and receive the income, he can buy out his brothers. Or all three brothers could hire someone to run the property and receive the income based on the number of shares they own. The benefit of this solution is that the children have a choice.

The Bottom Line

Planning for the transfer of your parents’ real estate is one of the most important things a family can do. If parents and children talk to each other, and know each other’s needs and concerns, the valuable real estate can benefit the entire family. But if family members don’t plan together, this same valuable real estate can become the weapon that drives the family apart. That’s why it’s so important to invest the time and effort in working with a professional to create a real estate plan that works for your family.

Join the War Against Alzheimer’s

losing one's memory

losing one’s memory

Nearly half of all seniors who need some form of long term care, from help at home to institutional care, have dementia. That’s from the World Alzheimer Report which came out a few weeks ago.

The report further states that cognitive impairment is the strongest predictor of who will move into a care facility in the next two years. That is 7.5 times greater than people stricken with cancer, heart disease or other chronic ailments.

More than 35 million people worldwide, including 5 million in the U.S., are estimated to have Alzheimer’s. Unless some miracle cure is found these numbers are expected to double by the year 2050.

Unfortunately the U.S. is investing only $400 million a year in Alzheimer’s research. But the disease’s financial toll is estimated to be $200 billion per year. Compare that to the budget of the National Cancer Institute, part of the Department of Health and Human Services. For the last 6 years it has had a budget of $4.9 billion per year.

It’s time for caregivers, advocates and families stricken by Alzhemier’s to come to together to demand a push to end this brain disease. The world’s governments and researchers came together to turn the AIDS virus from a death sentence to a chronic disease and the same force of will can turn Alzheimer’s around.

If you want to get a clear picture of what Alzhemier’s is like from the patient’s perspective I suggest you read Lisa Genova’s book, “Still Alice” or read Dr. David Hilfiker’s blog, “Watching the Lights Go Out.” He is a retired physician who was diagnosed with Alzheimer’s in September, 2012, Lisa Genova’s book is fictional but was based on her experiences working with support groups for people who contracted the disease.

During my 33 years as a financial advisor I met with many couples and strongly recommended that they put together a long term care plan while they were healthy. I was emphatic when I suggested that they consider buying long term care insurance to protect themselves. Most people don’t realize that medicare will not cover the custodial care that an Alzheimer’s patient will require. It is only available for up to 100 days if a person is expected to recover from an illness or injury.

Long term care insurance covers cognitive impairment from Alzhemier’s or other forms of dementia. Time and time again people told me that long term care insurance was too expensive. But all they had to do was to talk to a few of my clients who discovered that the cost of care was much more expensive! Here in New England care in a residence that focused on those with mental impairment averages more than $8000 per month and in some cases is over $10,000 a  month.