July 29, 2015

State Supreme Court finds Conflict of Interest Where Personal Representative Used Estate Property to Operate Decedent's LLC After Death

When a business owner passes away, there are inevitably additional concerns for the estate. For instance, should the business be closed, or should the business continue to be operated by surviving family members? How should the company's assets be distributed among heirs? Experienced New York elder law attorneys can assist in making these difficult decisions and minimize the risk of problems like what occurred in recent Georgia case involving just this situation.

In a recent decision from the Georgia Supreme Court, James Myers, Sr. died, leaving his son, Anthony Myers, as his executor. Unfortunately, Anthony began using estate assets for personal gain, and soon his brother brought an action in the probate court to return the misappropriated funds and to remove Anthony as representative. The Supreme Court found that indeed Anthony had mishandled the estate. The following are some of the important lessons for executors.

The language of a company's operating agreement or articles of organization control what should happen upon an owner's death

One of the biggest problems in the case of Myers v. Myers was Anthony's continued operation of his father's company, Buckshot Properties, LLC, following his father's death. James Myers, Sr. was the sole member of the LLC. According to the company's operating agreement, upon the death of any member of the LLC, the company was to be dissolved and its assets distributed per his will. This means that the company's assets would be eventually distributed to Anthony, his brother, and his mother, per the terms of the will. Sadly, this is not what Anthony did. Instead, he continued operating the business. The Court found that because the company specifically required dissolution, Anthony had no right to continue operating the business following his father's death. Therefore, it is important to always obtain the decedent's business documents and have them reviewed by an attorney to ensure how it is to be handled during probate.

What the executor did amounted to a "conflict of interests," because he was a fiduciary for the estate

In Myers v. Myers, Anthony made 5 big mistakes that cost him dearly.

1. The executor improperly used the estate's truck for personal reasons

The law does not permit a representative to use estate property for personal reasons unless he or she compensates the estate. While there are often exceptions to this rule, such as where the will expressly permits it or the court has given permission, an executor should not assume it is okay to use a decedent's vehicle.

2. The executor improperly used the company's funds to perform maintenance on the house.

Although one would think it is perfectly fine to use the decedent's funds to maintain the estate property, this was not the case. Since the business was supposed to be closed, continuing to operate the business and use its funds in this way was improper.

3. The executor failed to pay rent to the estate for using estate property

While no doubt many adult children may feel they are entitled to live in a parent's house following the parent's death, this is definitely not always the case. Instead, since the property became an estate asset, Anthony was wrong to use the property for any reason without paying the estate rent.

4. The executor failed to keep accurate records of rent paid to the estate

The decedent owned rental properties, which were managed by his company, Buckshot Properties, LLC. The executor made a critical error by not keeping accurate record of all the money paid by tenants. This made it difficult for the court to determine just how much money should have been in the estate for distribution to the other heirs, and as such, it was improper.

5. The executor used estate funds to pay personal bills

Quite possibly the biggest error Anthony made was misusing the estate's money. This is a common mistake for surviving heirs and executors. Here, Anthony used thousands of dollars to pay personal bills with his father's assets. This is almost never acceptable.

The lesson to be learned from the Myer case is that an executor owes a duty to the estate and its beneficiaries to handle the assets with care and keep good records. Once an executor starts co-mingling funds, misusing estate funds, and ignoring his or her responsibilities, there can be unintended consequences, such as years of prolonged litigation against loved ones. While New York probate law may differ from Georgia in many ways, these general lessons should be a constant reminder to follow the law and seek competent counsel early.

July 23, 2015

Techniques for Coping with Caregiver Stress - Part 2

Earlier this week we shared information on techniques that can be used to ease the strain of caring for an elder loved one. We discussed the importance of enlisting close friends and family members as well as taking time for yourself. In other instances, different options may be considered, for example:

1. Seek professional assistance with things that are beyond your abilities

Not all things require a loving caregiver. If you are concerned about your parent's ability to pay for medical care, a nursing home, or other such financial matters, do not hesitate to contact an elder law attorney for advice regarding estate planning, end of life decisions or selecting appropriate care. There are also private and public options for obtaining assistance with daily care giving, depending on your eligibility and ability to pay. Care giving can be a full time job, so treat it as such. Seek out qualified professionals for advice and suggestions.

2. Dedicate time for your children

One of the most difficult scenarios is serving as a caregiver while simultaneously raising children. Research shows that the majority of adult children providing care to older adults are women. The average age is about 46. This means they may also have children of their own living with them. These multi-generational living environments can be very beneficial; however, they come with the added stress of maintaining a functional household, watching out for teenagers and young adults, planning for college expenses, and so forth. In addition to these existing stressors, the caregiver must also worry about her own parent or disabled family member.

No matter what, remember that while you love the person for whom you are caring, your children are still a priority. Do not forget to say you love them, ask about their day, and take a few minutes each day to be involved in their lives. If you are lucky, your children may even assist with care giving duties. This can be a unique experience for young adults and lead to a lifetime of respect and compassion for older adults. Just remember, you must take care of yourself to be of any use to others.

July 21, 2015

Techniques for Coping with Caregiver Stress - Part 1

With an aging population, more adult children are finding themselves faced with the difficult dilemma of caring for aging parents. In fact, the Centers for Disease Control estimate that nearly 34 million Americans provide caregiver services to someone over 18 who suffers from illness or disability. Roughly 83% are family members. This means there are approximately 28.2 million unpaid family caregivers providing these services to loved ones every year.

While caring for an elderly loved one can be a rewarding endeavor, it is not without its complications. This is especially true when it comes at the peak of one's careers or perhaps while still raising minor children. Unfortunately, AARP only about 61% reach out to friends and family for help. But there is hope.

What is caregiver stress, and how do I recognize it?

Caregiver stress is exactly what it sounds like. It is caused by ongoing and constant responsible for a loved one who needs routine care. This may mean assisting a loved one with activities of daily living (ADL's), such as eating, bathing, using the restroom, changing adult diapers. It can also include monitoring medications, providing transportation to and from doctor appointments, supervising and making physical changes to the home environment, and even acting as a health care surrogate or power of attorney for decision making. All of these can create an overwhelming amount of stress and lead to personal negative health consequences.

Signs that someone is suffering from caregiver stress include:

• Exhaustion
• Nervousness or constant awareness and heightened alert for dangers
• Becoming isolated from friends and family
• Budgeting problems and financial insecurity
• Feelings of depression or despair

These are just a handful of the many signs and symptoms. If you or someone you love is experiencing any of these signs of caregiver stress, here are just 4 simple strategies that can help. Nothing is 100% effective, but these may help reduce some of the worry and stress and allow a caregiver to regroup and refresh.

1. Enlist the help of family or close friends

It can sometimes seem impossible to find the time to go shopping, watch a movie, or spend time alone. A caregiver may feel that she has no support, and this may be true for some. However, most people are able to think of someone they can call, whether it is a close friend or family member who lives nearby. While they too may be busy with life's challenges, do not hesitate to ask if they would be willing or able to watch your loved one for just two hours per week. Start small. Expect people to balk or be nervous. If two hours is too much, see if they would be willing to try just 30 minutes whenever they have some free time. If so, this could provide a much-needed break.

2. Make time for yourself

As the first suggestion indicates, it is crucial to find moments to be alone and do the things you need to do, even if only a few minutes each week. If you are able to free up just two hours per week, be sure to take the time to do something you enjoy. Perhaps you would like to tend to a garden. Maybe it is as simple as going grocery shopping alone. Some caregivers find it nice to go to a movie alone. If your role has become particularly exhausting, you may just choose to take a nap. Whatever you decide, you must find time to be yourself. Much like the advice given to young parents, you need this time to refresh so that you can face the challenge of being a caregiver.

July 17, 2015

New LGBT Training for Elder Care Service Providers

A recent study at the University of Miami found that nearly 75% of all elder care service providers reported having members of the LGBT community as clients. Yet, less than 33% of these service providers had any type of specialized training geared towards the needs of seniors in this community. This study has prompted a new initiative in Florida called the "Protect Our Elders" campaign, aimed at addressing common problems that prevent elderly members of the LGBT community from seeking elder care.

Results of the Study

The University of Miami surveyed 48 facilities and agencies throughout southern Florida that provide some type of elder care services. This included hospitals, nursing homes, care facilities, churches, libraries, and more. Of those surveyed, 83% of the facilities and agencies said that not only would they be willing to offer LGBT training but that they also think that their employees would be interested.

In addition 92% of agencies that cater specifically to seniors responded that they would host LGBT competency training. Health care agencies were the least responsive to LGBT training, with only two-thirds of the agencies saying that they would be willing to offer this type of training.

Protect Our Elders Initiative

Advocates in southern Florida estimate that nearly 43,000 LGBT residents in the area are 65 years old or older. The study was commissioned after many in that community mentioned situations where they went for elder care services but felt mistreated or uncomfortable. Others were fearful of moving into a long-term care facility and stayed in their homes much longer than they should because they feared going back "into the closet" if they went to a nursing home.

The initiative plans to give introductory training to southern Florida agencies and service providers at no charge with follow-up programs offered for a small fee. If the initiative is successful, they plan to expand the program to other states. The Protect Our Elders campaign also plans to create a directory of LGBT-friendly senior care companies, home health care agencies, retirement homes, and the like by 2016.

The Need for LGBT Training

The main reason why agencies said that they did not offer LGBT training in the past was that there was a perceived lack of a need for LGBT training, and it was not a priority in their organization. However, elderly LGBT residents come from a generation where being gay could cost you a job or worse, and many still refer to their partners as their cousin or roommate. Seniors that identify as LGBT have heightened fears of isolation, dwindling finances, and loneliness because of a lack of children or estrangement from family members.

Thankfully, other organizations are also helping to train elder care service providers on LGBT issues. SAGE, a national LGBT rights organization, has created a cultural competency program that is being implemented at some organizations in south Florida. SunServe, Compass, and the Pride Center also plan on developing LGBT training with the Protect Our Elders campaign as well as develop more elder care services for members of the gay senior population.

July 14, 2015

Recognizing Signs of Elder Abuse

The Administration on Aging established the National Center on Elder Abuse in 1988 as a national resource for the compilation and distribution of information regarding elder abuse and neglect. The purpose of the center is to prevent elder abuse through information and education in every state across the country. It helps national, state, and local community organizations with their efforts to prevent and educate about elder abuse. As such, the center is encouraging people across the country to learn to recognize the signs of various types of elder abuse.

Need for Elder Abuse Recognition

With the number of seniors increasing rapidly across the United States, it is incredibly important that people learn and recognize the signs and symptoms of elder abuse. New York has one of the largest populations of seniors in the country, with almost four million people residing in the state ages sixty years old or older. According to the U.S. Census Bureau, there were 41.4 million people age 65 or older in the United States in July 2011, up from 40.3 million in April 2010. The number of seniors is projected to reach 92 million by 2060, with 18.2 million age 85 or older.

Types of Elder Abuse

The Administration on Aging separates various types of elder abuse into five separate categories: physical, sexual, emotional, neglect, and financial. Each type of abuse comes with its own set of actions and warning signs, yet all are detrimental to seniors.

This type of abuse occurs when a person physically harms a senior. It includes hitting, kicking, slapping, tripping, pushing, burning, or other shows of force against an elderly person. Signs of physical elder abuse include:

· Bruises, black eyes, welts, marks, and lacerations
· Bone fractures, open wounds, cuts, and healing injuries
· Sprains and dislocations
· Signs of being restrained
· Sudden changes in behavior

This type of elder abuse happens when a person forces a senior to take part in a sexual act against their will or when they are unable to competently give consent. Symptoms of sexual elder abuse include:

· Bruises around genital area
· Unexplained sexually transmitted diseases
· Unexplained genital or anal bleeding
· Torn, stained, or bloody clothing

This type of abuse refers to all types of behaviors that harm an elderly person's self-worth or emotional well-being. It includes name calling, scarring, embarrassing, destroying personal property, or not allowing a senior to see friends and family. Signs of this type of abuse include:

· Being emotionally upset or agitated
· Being extremely withdrawn or non-communicative
· Unusual behavior usually attributed to dementia

This type of elder abuse occurs when a person or organization fails to meet the senior's basic needs. These include food, shelter, clothing, and healthcare. Symptoms of neglect include:

· Dehydration, malnutrition, bed sores
· Poor hygiene or untreated health problems
· Hazardous or unsanitary living conditions

This type of abuse happens when a person illegally takes advantage of a senior's money, property, or assets. Signs of financial abuse include:

· Sudden changes in bank accounts or banking practices
· Inclusion of names on accounts
· Unauthorized withdrawals
· Abrupt changes in estate planning documents
· Disappearance of valuables
· Discovery of forged documents or signatures

July 10, 2015

How to Manage Your Parents' Finances

As parents age, it can become harder for them to manage their own finances and accounts. Sometimes, the child needs to step in and help them with their financial needs, especially in cases where dementia or other cognitive impairments may be beginning to set in. Experts recommend the following tips if you find yourself in the position of needing to help manage your parents' finances in addition to your own.

Find the Documents

The first thing to do when managing your parents' finances is to find all of the important and necessary documents. Be sure to check all desk drawers, filing cabinets, and safety deposit boxes. You should look for all bank account and investment information, retirement accounts, insurance policies, and the titles and deeds to any significant property. You should also look for all medical records and expenses at this time, as it will most likely be a growing financial concern in the near future.

Check the Cash Flow

Check the receipts, bills, checking accounts, and savings to see whether the bills are being paid on time. Use this time to also check and see if your parents are spending money on things that they don't need or are accidentally paying the same bill more than once. This can also help you check for any financial scams or abuse, such as fake telemarketers asking for money for a charity or someone taking money out of the accounts that should not be doing so.

Streamline Spending

Find ways to streamline the financial process for your parents. Consider automatic bill pay or electronic billing to cut down on the amount of paper and mail. Also look into cutting up credit cards and canceling other means of spending that your parents do not normally use. This includes cutting down on expensive television, phone, or internet bills as well.

Split the Responsibilities

This process is not something that you need to go through alone, so consider splitting the responsibilities amongst your siblings or other loved ones that are willing to help out. Typically, assigning one person to the day-to-day finances and another to long-term planning tends to work the best when divvying up responsibilities. If you do not trust your family with this role, consider using a financial advisor.

Sign a Durable Power of Attorney

Finally, have your parents sign a durable power of attorney that grants you financial and legal decision making authority in the case that your parents are no longer able to make those decisions on their own due to incapacity. An estate planning or elder law attorney can easily draft a durable power of attorney document that can spring into effect if needed.

It is important to sign this document before any dementia or cognitive impairment sets in, otherwise the power of attorney could be challenged and thrown out in court. You can also get a separate power of attorney with the banking institutions where your parents keep their finances that is specifically for their accounts to streamline the process later on.

July 7, 2015

Technology Provides for Easier Blood Sugar Monitoring

New technology in the elder care arena is promising easier, faster, and safer means for monitoring blood sugar for seniors with diabetes. If successful, these new gadgets could reduce the rate and intensity of long-term complications that can come with the disease. This new diabetes technology relies on wireless internet, nanotechnology, and predictive algorithms to automate and simplify the blood sugar testing process.

Common Diabetes Treatment

Diabetes affects more than 29 million people in the United States alone and is caused by the body's inability to metabolize sugar into energy. If left untreated, diabetes can cause serious, and potentially fatal, long-term complications such as blindness, heart disease, kidney damage, loss of limbs, and more. The most common way to track diabetes and monitor blood sugar levels is the finger prick test.

For the millions of seniors with diabetes, they are required to prick their finger every day, sometimes multiple times per day, and test their blood sugar on tiny strips. Some seniors are required to prick themselves up to ten times per day. This is a painful and tedious method of checking blood sugar that can become very difficult for the elderly as they age. In addition, this test only gives a snapshot of their current sugar levels and does not show whether it is rising or falling. However, new technology aims to change the way that seniors track their diabetes.

New Technology for Diabetes

One new piece of technology hopes to do away with blood sugar testing altogether and instead use a senior's tears. One of the head researchers at Google is developing contact lenses that measure a person's blood sugar levels through the natural tears in their eyes. A miniature glucose sensor, wireless antennae, and other features would all be built into the lens. The technology would be invisible to the wearer because it sits on the iris and not the pupil.

Another new piece of technology that is already on the market is the continuous glucose monitor (CGM). Today, CGMs are used by fifteen percent of people with Type 1 diabetes, up from only six percent a few years ago. The technology works by taping a small radio transmitter above the waist that is attached to a razor thin wire which goes underneath the skin to test the sugar in a person's cells. The data is collected every five minutes and wirelessly transmitted to the device that can also be synched to a smartphone through Bluetooth.

One CGM company is aiming to eliminate the small device completely and have the wire transmit information automatically to a person's smartphone. It would also send an alert when that person's blood sugar levels rise or fall to an unhealthy level. It is hoping to gain FDA approval by the end of this year. This continuous tracking of the blood sugar levels can provide real time data to seniors with diabetes in order to help them make healthier decisions regarding their own care.

July 2, 2015

Thinking about Retiring Abroad

One of the most common hopes of retiring individuals is that they can move to the beach or go someplace abroad. A new study by the National Association of Real Estate Investment Trusts revealed that only a tiny percentage of seniors in their 60's, around one percent per year, move. Most retirees remain in their own homes, but for those that do retire abroad there are certain considerations that must be made before the move.

Financial Concerns Retiring Abroad

Some of the most common locations for retirees to move to oversees today include Ecuador, Thailand, and Portugal. However, many are unaware of the Financial Crimes Enforcement Network Report 114. Otherwise known as an F-Bar, this document is required for any retiree that has a bank account overseas that contains a balance above $10,000. Failure to submit an F-Bar results in severe penalties, such as fines up to $100,000 or fifty percent of the balance of the account.

Healthcare and Basic Amenities

Many seniors who retire abroad are also in for a shock when it comes to the level of healthcare and basic amenities. The level of difference from the United States and another country can be distressing to some, where the diversions, cultural attractions, sports, and basic necessities are all different. In order to avoid these problems, family members and other advisers for seniors need to make sure that they have as much information as possible before they make the move.

The largest issue for the elderly abroad is access to quality medical care. Country to country, even in the same geographical area, the quality of medical care can vary widely. Information about all other country's medical care can be found on the U.S. State Department website. Advisers highly recommend signing up for private insurance and medical care abroad, otherwise a person can wait weeks for a simple appointment.

In addition, getting the medication that seniors require is also an important issue to discuss. In countries like China and India, prescription medication counterfeiting is rampant and many people are not actually taking the drugs that they need. In other countries like Mexico and Ecuador a prescription is not even necessary for some medications, but it also means that a person could have a severe reaction and no medical professional to turn to.

What to Look For

The first step in any overseas retirement move is to choose the proper country. The best way to do this is to prioritize the most important aspects of your living situation and not compromise on a single one. In addition, remember the importance of communication and that you may be moving to a place where very few people speak English. Even going to the grocery store or the bank can become a stressful event.

You should also look into any potential safety concerns for seniors abroad. The risk of danger typically increases with the crime rate in that country or city. There are also a number of countries that are experiencing political unrest, violent protests, and acts of terrorism. The U.S. State Department also keeps an updated list of travel alerts, so seniors can review them before making a decision to move.

June 30, 2015

Red Tape in Medicaid Applications

Medicaid is one of the most utilized government programs for elderly American citizens that are in need of medical assistance that they cannot afford. In order to qualify for the Medicaid program, an applicant must meet a number of criteria and an application can either be filled out online or in paper form. However, many applicants to the Medicaid program have run into issues of red tape and other problems when attempting to apply for benefits.

Online Medicaid Application

The online application for Medicaid can be found on the federal Medicaid program website. For seniors that are tech savvy, the online application can be filled out in about 45 minutes. The website contains all kinds of information like eligibility, benefits, and required documentation needed to be considered for the program. After an online application is submitted, there may be follow-up phone calls by the program to make sure that everything regarding their application is in order, but usually an accepted applicant can receive their benefits card within 45 days of submitting the online application.

Difficulties with Applying

One of the biggest issues regarding the online application for Medicaid is that many seniors are not comfortable enough with computers and technology to fill out the application online. This means that either errors are submitted on the online application, or elderly applicants face problems submitting a paper application to the program. One common complaint is that "a computer can't answer your questions, but a knowledgeable caseworker can." That is why some previous applicants to the Medicaid program encourage others to go in person to the Medicaid office to fill out their applications for coverage.

By filling out a Medicaid application in person at a local Medicaid office, the application can be completed with the help of a dedicated caseworker, the errors submitted are marginalized, and the delays on the application are greatly reduced. Unfortunately, some applicants have noted long wait times when many people go to the Medicaid office at the same time. It is important to plan accordingly if you wish to fill out an application in this manner. On average, a person waits about two hours before they are helped in person at a Medicaid office.

How to Get Help

There are many resources available to help Medicaid applicants with their issues on the application. Questions regarding the program can be answered at any local Medicaid office or Social Security office. You can also call in and ask a question about the application process, but typically callers are placed on hold before they can speak to someone about their problems.

Finally, you can get information regarding the Medicaid application process from a local hospital and hospital social worker. These employees will be able to offer access to the Medicaid application as well as answer any questions that an applicant may have about the process. Some hospitals outsource this job to specialized companies, and if your hospital does this then they can give you the information necessary to contact a specialist there.

June 26, 2015

Florida Rejects Medicaid Expansion

The Florida House of Representatives rejected an expansion of the state's current Medicaid system that leaves hundreds of thousands of people caught in the state's coverage gap. This gap applies to people living in the state who make too much money to apply for coverage but too little to cover the costs of their medical care. It has the possibility of having a serious effect on elderly people who live down in Florida full-time or have made it their primary residence for Medicaid eligibility purposes.

Florida Medicaid Program

Florida currently has 1.3 million people enrolled in the federal exchange for healthcare insurance, more than any other state in the country. Most of these people qualify for subsidies, but if these subsidies were invalidated then they would lose their access to coverage. This is of particular concern now as the U.S. Supreme Court is currently ruling on the case of King v. Burwell, which will determine whether federal tax subsidies that allow for low and middle income people to purchase insurance through the marketplace will be unconstitutional.

Proposed Medicaid Expansion

The proposed Medicaid expansion would raise the income limits for eligibility, and one hundred percent of the cost of coverage would be covered by the federal government through 2016, with ninety percent coverage by the government after that. Without the expansion, around 700,000 people remain in Medicaid's coverage gap. Furthermore, it has driven many in Florida out of the marketplace altogether with 24% of its population completely uninsured, the second highest uninsured rate in the nation.

One advocate of the proposed Medicaid expansion in Florida said, "If the Medicaid dollars [were] accepted, in combination with the exchange, you'd pretty much have a path to coverage for everybody. People [would be] able to get primary preventative care and ultimately [wouldn't] have to bankrupt themselves to access coverage, as happens to many in Florida."

Effects on Florida Citizens

The downsides of rejecting the Medicaid expansion affect many in Florida, young and old. In regards to children, one researcher found that 28% of the population under consideration for Medicaid in Florida are parents, so their rejection affects their children, too. "When parents are covered, it improves the financial security of the family. It also improves the health of the parents, which reduces conditions like maternal depression."

Furthermore, it reduces the percentage of children that are uninsured across the state. "Florida has a very poor enrollment rate in the Medicaid and CHIP programs, and that's why Florida has the highest uninsured rate of kids in the South." Studies have found that when the entire family is covered by programs like Medicaid, enrollment has improved.

The lack of Medicaid expansion also affects the elderly in Florida. Many seniors across the state are living on a fixed income or may be close to outliving their funds. However, these seniors are still caught in the middle of the coverage gap and are unable to qualify for Medicaid. This means that they must spend down their assets and leave nothing for their loved ones or go without Medicaid coverage for their healthcare needs.

June 24, 2015

CVS Investing Big in Elder Care

CVS Health Corp. CEO Larry Melo recently announced that the company is investing billions into the purchase of a nursing home pharmacy operator in an attempt to transform into a dominant healthcare player for senior needs. CVS purchased the company Omnicare, Inc. in its bid to outgrow CVS' drugstore chain persona into something more all-encompassing for healthcare needs and focus more on the growing population of aging seniors in this country.

Recent Changes to CVS

This is not the first major change that CVS has made to its healthcare focus in recent years. In 2011, the company announced that it will no longer be selling cigarettes in its mission to improve its consumers' health. It also changed its name from CVS Health to CVS Caremark and aggressively expanded the number of in-store health clinics. By 2017, CVS aims to have another 600 in-store health clinics for consumers and in 2013 the company purchased a drug-infusion company to expand its healthcare competencies.

Purchase of Omnicare, Inc.

The purchase of Omnicare, Inc. cost CVS $12.7 billion including debt. It is by far one of the largest and most aggressive moves that CVS has made into becoming a major healthcare provider. The company expects that the purchase of Omnicare will add adjusted earnings of twenty cents per share to its stock in the next year. The only other deal that is comparable to the purchase of Omnicare was CVS' purchase of Caremark Rx, Inc. in 2007 for $21.7 billion.

The purpose of these major changes is to "move away from being solely a pharmacy and PBM to becoming more of a vertical integrator of health care," focusing primarily on an aging population with greater care needs. Omnicare provides medications and helps nursing home facilities manage their residents' medications. CVS hopes to use this platform to move its care services towards more long-term care needs and assisted-living operations.

Growth of CVS Healthcare

The pharmacy unit for CVS is by far the company's largest driver of growth, with revenues increasing by 18.2% in that sector last year. The demand for pharmacy and medications continues to grow as more patients and medical professionals look to manage the costs of medications in a time of soaring drug prices. With the purchase of Omnicare and other vertical companies in the drug supply chain, CVS is poised to provide quality medications to seniors and other patients at a lower price.

Currently, CVS is the nation's largest provider of prescription drugs and the second largest pharmacy benefits manager in the United States. The company handles health plans for insurers and employers alike. In total, CVS operates 7,700 retail pharmacies, 900 walk-in clinics, and manages the pharmacy benefits of over 65 million people across the country. With the purchase of Omnicare, CVS hopes to increase the number of consumers cared for by millions as more seniors are in need of long-term care and medication.

June 20, 2015

Annual Report Ranks States' Quality of Elder Care

The United Health Foundation, a nonprofit organization that is focused on improving healthcare and overall health, published its third annual report earlier this year that analyzes how well each state across the country is taking care of their seniors. Based on thirty-five different benchmarks, the study breaks down each individual state's strengths and weaknesses for various elder care needs in addition to comparing states as a whole.

Elder Care in the United States

Almost one in seven citizens in the United States is now 65 years old or older, and the need for quality checks on our nation's elder care system is increasing. By 2030, it is estimated that over one-fifth of the country's population will be elderly. By 2050, it is estimated that nearly 83.7 million people will be 65 years old or older, more than double the elderly population in 2012.

As a result, elder care needs threaten to swamp the existing healthcare system in America at both state and national levels. The massive increase in the number of elderly has the potential to impact Social Security, Medicare, Medicaid, and other state and federal elder care programs. Unfortunately, the states that are expected to see the greatest increase in senior population also have some of the worst levels of care for the elderly in the United Health Foundation report.

Elder Care Report Results

Some of the highlights of the foundation's report show that Vermont is now considered the healthiest state for seniors with a decrease in chronic alcoholism as well as increases in quality of hospice care, mental health days, and community support. Other top states for elder care include New Hampshire, Minnesota, Hawaii, Utah, Massachusetts, and Iowa. On the other side of the spectrum, Louisiana ranks as the state with the worst level of senior care in the country. Other states at the bottom of spectrum for senior care include Mississippi, Kentucky, Arizona, Oklahoma, and West Virginia.

New York was ranked 21st across the country for its quality of elder care by the United Health Foundation study. Among the strengths highlighted, New York has seen a decrease in the numbers of seniors smoking, high SNAP enrollment, and a ready availability of home healthcare providers. Unfortunately, the state is facing challenges with a high percentage of seniors in poverty, low volunteerism rates, and a higher percentage of hospital deaths.

In addition, New York saw an increase of seniors receiving a flu vaccination by thirteen percent to 62.2% last year, and smoking among the elderly in New York has decreased twenty percent from 8.1% to 6.5%. The average poor mental health days among seniors across the state also decreased 22% from 3.2 to 2.5 days per month. However, hospice care in New York increased last year by ten percent to 31.7% of decedents that were elderly and food insecurity for seniors also increased across the state by six percent to 15.7% of seniors over the age of sixty years old.

June 18, 2015

Six Things on a Caregiver's To-Do List

Millions of people across the country are currently part of the "sandwich generation" They are caring for their children and simultaneously caring for an elderly parent. Despite the fact that so many people are struggling to handle this responsibility, there are very few resources that caregivers can use for support. This article highlights six things that a caregiver can do to prepare for some of the most common stressful situations that occur with elder care.

Have a Talk with Your Parents

Before cognitive issues or even caregiving needs arise, you should sit down and have a conversation with your parents about everything regarding their care. You should discuss their wants and needs regarding caregiving as well as review their finances, estate plan, health issues, end-of-life decisions, and more.

Update Documents

In addition to having a talk, take that time to update any important documents necessary to your parents' care. This includes wills, trusts, powers of attorney, healthcare proxy forms, and living wills. This not only prepares you for caregiving but also updates all financial companies, government organizations, medical professionals, and more about your parents' care. Updating documents early is also important because if cognitive issues arise, such as Alzheimer's disease or dementia, then your parent may be deemed mentally incompetent to manage their affairs.

Complete a Medicine List

One of the most important things to know as a caregiver is what medications your parent is currently taking. In the case of an emergency where they cannot communicate to medical professionals what they are on, your parent could be misdiagnosed or given a medication that could cause complications. Even in a normal situation, elderly parents tend to have more than one doctor, and without a current list of medications one doctor could give a drug that counteracts another.

Ensure Access to Information

Make sure that as a caregiver you can get access to information and documentation when you need it. HIPAA laws, regulations, and company policies may forbid you from accessing your parents' information without their consent. Be sure to get authorization from all necessary parties regarding their information, and also remember to be added on as an authorized user to any bank safety deposit boxes if forms are being kept in there.

Review Parental Finances

As awkward as it is for some people to talk to their parents about money, it is important to review your parents' finances in order to plan for future care. By anticipating future costs and planning ahead, you can try to prevent your parents from outliving their money and being forced to live on public funds or your money.

Research Care Providers and Living Situations

Finally, put some time into researching care providers and different living situations that your parents would be comfortable with. Discuss how comfortable they would be with being admitted to a hospital, rehab center, nursing home, assisted living community, independent living community, or hospice care. This can save everyone time, money, and stress when an emergency arises. In addition, researching these things ahead of time allows your parents to give their input and makes them feel in charge of their own care.

June 15, 2015

New Rules Bring More Oversight to Insurers' Medicaid Plans

The federal government has proposed new rules for private healthcare insurers that have Medicaid and children's health plans for the first time in over a decade. The proposed rules would cover healthcare plans for millions of people across the United States and calls for insurers to provide a report of what portion of money they're paid by the government is actually going towards health benefits and is recommending that states take that into account when setting their rates.

Medicaid Program

Medicaid and CHIP cover more than 70 million people in the United States, and 12.6 million people were added last year alone from the expansion of the Affordable Care Act. The Medicaid program is state-run, but it is overseen in part by the federal government and the Centers for Medicare and Medicaid Services. Private Medicaid plans operate in 39 states across the country and cover more than half of all Medicaid beneficiaries.

California has the largest number of members enrolled in the Medicaid program, followed by New York and Florida. In 2012, states were allowed to opt out of expanding their Medicaid program and 21 states decided not to increase their eligibility. The federal government is currently paying for the full cost of expansion through 2016 and ninety percent of the cost thereafter.

The last time that major changes were proposed for the Medicaid system was back in 2003, well before significant expansions were made to the program. Since then, the Medicaid program that covers the low income, the elderly, and the CHIP program for children has all expanded exponentially. The main reason for this expansion is the introduction of the Affordable Care Act, but managed-care firms have also expanded their care of beneficiaries.

Proposed Medicaid Rules

The proposed new rules for the Medicaid program call for managed Medicaid plans to report what is called a "medical loss ratio." Using this ratio, the state governments could set the rates that they pay plans. According to the new rules, insurers should be using about 85% of the premiums that they take on benefits. It is intended to cap the amount that insurers can spend on administrative costs.

Additional rules were proposed that include rules for private plans that provide long-term care for the elderly and disabled. This is also important given the large, and growing, number of elderly beneficiaries of the Medicaid system.

Blowback from the Industry

Not everyone is happy about the proposed rules for Medicaid plans and the medical loss ratio. One industry group leader criticized the new rules, saying that having one medical loss ratio for all states does not make sense because some states already have medical spending levels built into their contract plans.

Another trade group called the new rules "arbitrary" and claims that it could undermine other critical services that are not healthcare. The group named some critical services as transportation to and from appointments as well as social services for these Medicaid beneficiaries.

June 10, 2015

Home-Based Care Plan Improves Dementia Care

A new study has shown that a program that gives families with loved ones who suffer from dementia the tools necessary to help better care for them has lowered the use of nursing homes. This new program uses a telephone-based program where non-medical managers use assessments and evidence-based protocols to help educate and offer support to people treating family members with dementia and other cognitive impairments. This study highlights the need for new dementia care programs and proves that this type of system can be implemented on a large scale.

Results of the Study

According to one of the primary researchers of the study, almost fifteen percent of seniors over the age of seventy years old have some form of dementia. The study looked at around 250 caregivers that enlisted in the program and 250 caregivers in their normal routine that did not use the program. At the end of the study, the research showed that the caregivers enrolled in the new program were more satisfied with the level of care and had more confidence in their ability to care for their loved one.

In addition, the study found that nursing home use with the caregivers using the program was lower than the normal routine group. It found that many caregivers using the program called regarding care management strategies, and the researchers further surmised that the program is best suited for caregivers treating family members with moderate to severe dementia issues.

Furthermore, the telephone-based evidence system is easy to replicate with other providers and in other geographic areas. This model based itself on best practices and involved the entire care team in its implementation. It involved aspects of care that are not always a part of dementia treatment such as non-medication based approach to care, a method of safe return if a dementia patient wandered off, and the creation of advance directives for care.

More Dementia Care is Needed

Care for seniors with dementia is one of the most pressing needs for elder care. According to research, over fifteen percent of seniors over the age of seventy years old have some level of dementia or other cognitive impairment. The percentage quickly increases for seniors over the age of eighty years old. Nevertheless, this study showed that an evidence-based care model for caregivers treating family members with dementia is a system that can work.

However, there is still room for improvement and overall there is a greater need for quality dementia care. In many cases, when a senior with dementia requires a certain level of care their family members are forced to place them in a nursing home facility or other assisted living. One small issue in this study was that the new program does cost more than routine care overall, but the difference was not significant. As one doctor pointed out, "if it gave better care and did not cost significantly more, why wouldn't you want to implement a similar program?"