A recent PBS special focused on tending to older parents and other struggles faced by many with elder care needs. In a special program called "Caring for Mom and Dad," the station attempted to go deeper into the issues surrounding adult children as they attempt to care for their aging parents. It is one of the first times that a major television station has run a program that focuses on the difficult questions of cost, rights, and medical capabilities of elder care.
Caring for Mom and Dad
Narrated by acclaimed actress Meryl Streep, the program starts with a well-known fact, "America is facing a new reality. Soon the old will outnumber the young, and most will live longer than ever before." The program focuses on a few families and their unique struggles with elder care as well as the sacrifices that they have made in order to care for their aging parents. However, the program also looks at the costs for caring for ailing parents at home, both financially and emotionally.
One of the commentators on the special, Jane Gross, bluntly stated that "There are many scenarios in which by the time this is over, Mom and Dad are broke and so are you." However, the program also focused on what some communities are doing to address the current problems surrounding elder care, such as southwestern Ohio. "If we want in this country to not institutionalize everyone who's old or disabled, if we want to care for them in the community, that means the community has to step up."
The Council on Aging of Southwestern Ohio has taken great strides in addressing the needs of the elderly in their community. The initiative put forth in the area that was proposed by the Council on Aging taxes residents and uses the money to provide home health aides and pay for other necessary expenses for their elderly citizens.
This system implemented around the area prevents many seniors in the area from becoming institutionalized in a nursing home facility and cuts costs for them and their families for their elder care needs. In addition, the program in southwestern Ohio is providing jobs for home health care workers that might otherwise struggle to find work.
However, paying for some of the costs of care is only part of the solution, and "Caring for Mom and Dad" only just started to delve into the many issues surrounding elder care. Issues like addressing the number of elderly caretakers and how they should be trained were not addressed in the program, nor did it address the potential medical and ethical issues of sustaining life for seniors as long as possible with advances in technology. However, this special was a great start for conversations that need to be had at home as well as in society at large regarding the issues surrounding elder care needs across the country.
A recent PBS special focused on tending to older parents and other struggles faced by many with elder care needs. In a special program called "Caring for Mom and Dad," the station attempted to go deeper into the issues surrounding adult children as they attempt to care for their aging parents. It is one of the first times that a major television station has run a program that focuses on the difficult questions of cost, rights, and medical capabilities of elder care.
Most people consider elderly issues as problems with nursing homes, Medicaid, Medicare or Social Security. While these are important problems that need to be addressed with our nation's seniors, the number of elderly residents in cities is forcing them to rethink everything about their infrastructure.
Growing Number of Elderly in Cities
The Organization for Economic Cooperation and Development (OECD) has released a new report detailing the growing number of seniors in our country's largest cities. According to their report, between 2001 and 2011 the number of elderly ages 65 years and older living in well-developed cities has jumped by 24%. This is more than three times the rate of growth for these cities overall. By 2050, the report estimates that over one-quarter of these cities' populations will consist of elderly people, and the fastest growing population is seniors ages eighty years old and older.
Common Infrastructure Issues
The report by the OECD boiled down the issues facing large cities into three basic issues: increasing the supply of affordable housing that is accessible to seniors, making it easier for seniors to get around and stay active, and finding ways to provide more social services for less cost. While many people associate living in cities with a younger generation, city living actually works incredibly well for seniors if the proper infrastructure is in place.
Regardless of where they live, seniors typically move into smaller housing as they age, have more difficulty driving, need increased social interaction, and need proximity to medical and social services. Small apartments, public transportation, lots of people, and access to services are all available to seniors by living in a large city.
Examples of Senior Issues in Cities
In Philadelphia, one in seven citizens is already 65 years old or older. The city has been plagued in recent years by an aging population, poverty, and increasing housing costs. By 2020, the number of seniors expected to increase by another 24%, yet the budget for their services was cut by twelve percent last year. To combat the growing number of problems with their seniors, the city passed new zoning regulations in 2011 that would allow for the building of accessory dwelling units, such as a garage, basement, or backyard apartment for seniors to love into with their other family members.
These issues are not just within the confines of the United States. Other well-developed cities across the world are facing similar issues with their elderly populations. In Cologne, Germany, the city started a program where a senior can move in with college students in exchange for caregiving services. The city is also encouraging small businesses to relocate to residential areas so that it is easier for senior access.
In addition, Helsinki, Finland, developed floor sensor systems that allow for caregivers to monitor their patients remotely so that they can stay in their homes for as long as possible. In Lisbon, Portugal, the city has instructed that all sidewalks be at least five feet wide to accommodate their number of walking seniors and has enacted a public awareness campaign to watch out for the elderly on their public walkways.
Few people realize that nursing homes can file for guardianship over their elderly or disabled residents in order to collect on unpaid debts. Even fewer experts have done research on how often nursing homes initiate proceedings or track their progress through the courts. However, what research has been completed on nursing home guardianships show that not only does the practice happen often, but it seems to be increasing in use.
Nursing Home Guardianship Statistics
The Brookdale Center of Healthy Aging and Longevity has been researching how often these types of cases occur in the state of New York. While it has not released its full report, the Center has stated that its research found that between the years 2002 and 2012, nursing homes accounted for over twelve percent of all guardianship cases in Manhattan. Outside of the city, guardianship petitions by nursing homes over their residents are also a significant percentage of the court requests. Overall, estimates show that as many as two-thirds of all guardianship proceedings across the country are petitioned by an institution or government entity.
Why Guardianship is Important
The purpose of guardianship is to transfer an incapacitated person's right to make decisions for themselves to another person or party that is appointed by the court. Once appointed, the guardian makes all decisions regarding finances and personal affairs for the person. It is different than a durable power of attorney or healthcare proxy and actually supplants them both.
Reasons for Guardianship Petitions
Usually, a nursing home will file for guardianship of a resident if an issue is causing for unpaid debt to accumulate against the facility for long-term care. The most common reasons listed in nursing home guardianship petitions are family feuds, suspected embezzlement by loved ones, absence of family help, or for the purposes of Medicaid coverage. However, many believe that the actual cause of most guardianship petitions is to force family members of the resident to pay their unpaid bills or force a settlement of bill disputes.
In addition, a guardian is typically paid with the incapacitated person's money. This is especially important for a nursing home that is appointed guardian because it can directly take out the money that it is owed by the resident it holds guardianship over. As guardian, a nursing home also has the last say in their resident's care and can ensure that it continues to collect payment for their long-term care by keeping the resident in their facility.
How to Avoid Guardianship Traps
While a guardian does have access to all of the incapacitated person's readily accessible funds, such as a bank account, it does not supplant a trustee of a trust. The best way to protect your or your loved one's assets from an organizational guardianship proceeding is to place all of the assets into a trust before going into a nursing home or other care facility. Conversely, if only a will is used, a guardian has access to all of the assets in the will before the person dies.
The annual "Cost of Care" report by Genworth Financial was released last week that shows that the cost of care for elderly seniors in the United States continues to rise. According to the survey, the median bill for a private room in a nursing home is now $91,250 per year and the numbers are expected to continue to climb.
Cost of Care Report
Genworth Financial tracks the annual expenses for long-term care through its annual Cost of Care survey. Seniors, their families, government agencies, care facilities, and insurers all look to the annual report in order to know what to expect in elder care. The report looks at over 15,000 nursing homes, assisted living facilities, and other long-term care providers across the country.
Over the last five years, the survey has found that the cost of care for seniors has increased four percent every year. Just last year, the cost of care for an ailing senior was only $87,600, compared to the $91,250 this year.
The National Council on Aging released a statement, saying that "Most people don't realize how expensive this care can be until a parent or family member needs it . . . and then it's a real shock." The survey looks at a variety of long-term care services provided around the United States, including nursing home care, adult day care, and home health aides. The survey found that nursing home rates are increasing the fastest at twice the rate of inflation over the last five years. Now, one year in a nursing home costs three times the average cost of tuition for one year at a private university.
Paying for the Costs of Care
The main question that arises from the annual report is who will pay for the enormous nursing home bill? Many seniors believe that their Medicare coverage will cover the costs in a long-term care facility, but in actuality the program does not. Medicare only covers short-term care costs, like recovery after surgery, but not long-term stays in a nursing home or other community.
Medicaid is an option for seniors, but the program requires that an applicant have less than $2000 in assets before qualifying for the program. This means spending down almost all of your loved one's money before they can participate and handling complicated estate planning matters. One final option is the purchase of long-term care insurance, where the insurance company covers the costs of long-term care; however, most policies need to be purchased years or decades in advance in order to qualify with a decent premium rate.
Regardless of who is covering the costs of care, the annual Cost of Care report highlights the problems with the increasing cost of long-term care for seniors in the United States. With costs far outpacing the regular inflation rates, simply affording decent long-term care will be a significant issue for millions of seniors in the near future, affecting them and their loved ones seeking long-term care.
In cases of dementia, Alzheimer's disease, and other issues with cognition, studies have shown that the ability to perform simple math problems and handling financial matters are often the first skills that slip away. Equally important is the research that shows that as people age, even elders that do not have issues with cognition may reach the point where making financial decisions can become incredibly challenging.
Seniors and Financial Skills
The issue of seniors handling their own financial affairs is significant in this day and age. Currently, there are 44.7 million people in the United States that are 65 years old or older, and they account for fourteen percent of the overall population. In a mere ten years, that number will skyrocket to around 66 million people, and this age group has trillions of dollars in wealth. Unfortunately, many seniors are left to manage their financial affairs on their own, despite losing the ability to do so.
Around fifty percent of all adults over the age of eighty have some level of dementia or cognitive impairment. The director of the Alzheimer's Disease Center has said that "If you can detect emerging financial impairment early, you can also step in early and protect the person. It may be if you step in two months from now, they won't be in a position to make a poor decision or be exploited a year from now."
Warning Signs of Cognitive Decline
It can be difficult to determine when you should step in with your elderly loved one and take over the financial responsibilities. However, the National Endowment for Financial Education and the National Institute on Aging recently teamed up for a study to detect the early warning signs of cognitive and financial decline. The study looked at 138 adults over a period of time who were initially deemed cognitively normal when they joined and tracked their ability to handle financial tasks in addition to reevaluating the subjects for cognitive impairment.
The warning signs discovered by the study are subtle and can often be missed by a senior's family members. However, researchers behind the study say to look for the following when determining whether your elderly loved one may be showing signs of decline.
· Difficulty identifying the risks of an investment
· Focusing too much on the benefits of an investment
· Completing tasks on a financial to-do list take longer
· Everyday math becomes more difficult or full of errors
· Financial concepts become harder to grasp
Biology behind Cognitive Decline
Even seniors with healthy brains eventually experience some level of cognitive decline, and it can affect their ability to handle finances. One study found that a person's financial decision making abilities tend to peak at around 53 years old, or at some point in their fifties. Fluid intelligence, or the ability to solve new problems, can start to decline as early as in a person's twenties, but it is offset by crystallized intelligence of experiences and wisdom.
Brain researchers believe that crystallized intelligence tends to plateau in a person's seventies, and that combined with the decline in fluid intelligence might explain why seniors have more problems with cognition and financial decisions. "Our nation's wealth is disproportionately held by older adults, and they are exactly the group, particularly as they reach their 80s and 90s, that are most vulnerable. But our system has the fewest protections for those people."
Consider simplifying your loved one's financial decisions or adding yourself to their accounts. You can also set up an estate plan that helps with financial decision making or create a durable power of attorney form. You can also have financial institutions send you copies of statements to ensure that everything is running smoothly with your elderly loved one's finances.
With millions of Baby Boomers reaching retirement age and beyond without any type of plan, many believe that it is too late to begin planning for elder care. Others have unnecessarily spent tens or hundreds of thousands of dollars in care and other needs because of the lack of an elder law plan. These are some of the most common misconceptions regarding elder law planning as well as how you or your loved one can avoid them.
It Is Too Late to Plan
For single or married elders, one of the most common and most devastating misconceptions about elder law planning is that it is too late. For seniors that are about to go into nursing home care or are already a resident, most have been informed of the five year look-back period for Medicaid and believe that there is nothing that can be done.
However, Medicaid allows for a "crisis plan" that protects between forty and fifty percent of a person's assets that is already, or is about to be, placed in long-term care. Without a crisis plan, seniors are required to spend down to the Medicaid limit before they qualify for coverage under the government program.
Transfer of Assets and Medicaid
In New York, one of the biggest benefits to asset protection planning for Medicaid is that the five year look-back period does not impact the eligibility of Medicaid home care, otherwise known as community Medicaid. While the nonexempt transfer of assets does fall under the five year look-back period, a senior could transfer all or most of their assets and still qualify for home care in the next month. The look-back period can run during the home care and qualifying for long-term care becomes much easier.
Revocable Living Trusts
It is important to note that assets used to fund a revocable living trust count as assets for Medicaid eligibility, and the program is allowed to place a lien against those funds for the services provided to you while you are under Medicaid care. As a result, placing assets in this type of trust is not very productive for the purposes of Medicaid asset planning. However, once the trust creators pass away, the trust become irrevocable and is no longer subject to further claims made by the Medicaid system.
IRA, Retirement Assets and Medicaid
Many seniors do not realize that assets in an IRA or other retirement accounts are not considered assets for the purposes of Medicaid planning as long as the minimum distributions are being taken out every year. Even if the assets in your retirement accounts far outweigh the mandatory maximum for eligibility, you can still qualify for Medicaid care. The only assets that are counted towards Medicaid eligibility are the minimum distributions being taken out annually from the accounts.
However, it is important to have a beneficiary named to the retirement accounts that is not your estate. If you name yourself or your estate becomes the holder of the retirement accounts, Medicaid can place a lien on those funds for compensation of services provided while you were alive, thus affecting the inheritance of your loved ones.
There are more than 44 million people in the United States currently acting as a caregiver for an elderly or disabled loved one, and they devote a significant amount of time, money, and energy to the endeavor. According to researchers over at the Rand Corp. think tank, the informal cost of elder care in the United States that caregivers pay out of their own pocket is more than $522 billion every year and over 30 billion hours of labor. The personal and opportunity costs on caregivers are unfortunately being ignored, and it is causing serious problems for caregivers across the country.
Informal Costs of Elder Care
The Rand Corp. came to this amount by calculating the cost of unpaid work that caregivers perform for their elderly loved ones in addition to the opportunity cost of caregivers, calculated as "paychecks that could be pocketed if the caregivers were working and not taking elders to the doctor, monitoring their health and helping them with daily activities." In total, the $522 billion spent on elder care every year by caregivers is more than the entirety of federal spending on Medicare in 2013.
This study is similar to another report published by the MetLife Foundation in 2011 that estimated the average amount of lost wages and Social Security benefits for caregivers over the age of fifty years old to be around $303,880. That means that the total aggregate loss in wages and Social Security benefits across the country was almost $3 trillion. Unfortunately, caregivers are not receiving the full financial support that they need from government entities and nonprofit organizations.
Problems with the Current Structure
The financial safety net for caregivers is sadly full of holes that they must pay for out of their own pockets. The Medicare program does not cover any type of long-term care, and elderly loved ones do not qualify for Medicaid unless they fall beneath the income and asset threshold for care. Finally, some caregivers relied on their elderly loved one's long-term care insurance coverage, but most of the companies providing those policies have either dissolved or increased their premiums to unsustainable rates.
On the legislative side, it does not look much better. Congress has yet to renew the Older Americans Act that provides the funding for elderly services like nutrition and transportation. In addition, the federal commission on long-term care has yet to come to an agreement on financing long-term care, which is a debate that started all of the way back in 2012.
Possible Solutions to the Caregiver Problem
Experts agree that there is no simple solution to the issues surrounding the informal cost of caregiving. Reforms in this area will require a combination of private insurance and public assistance from state and federal institutions. Some have suggested the creation of a social insurance system to cover the costs of any catastrophic care needs, while others suggest that employers need to do more in terms of helping employees that double as caregivers. Elder care benefits, flexible workplace schedules, and other options to help caregivers have all been suggested to help cover the gaps in the informal costs of caregiving.
Health insurers across the United States received a welcome surprise when they discovered that they will be receiving a 1.25% increase next year in Medicare revenue benefits. This declaration reverses a previous proposal by the U.S. government to decrease the amount of Medicare benefits that insurance companies would receive in order to bring it in line with other government programs for the elderly and disabled.
Medicare Benefits for Insurance Companies
The U.S. government has been slowly decreasing the amount of Medicare benefits received by insurance companies in a bid to bring private Medicare coverage equal to other government aid programs. This year, insurance companies received four percent less in benefits than 2014, and the original proposal for 2016 included benefits cuts of another 0.9%.
Instead, insurance companies like United and Humana will see an increase in benefits next year after a higher estimate of Medicare spending was released by the federal government. The director for the Center for Medicare stated that "Growth rates reflect the actuary's best estimate of Medicare spending, and don't reflect any change in our policies."
Previous Cuts to Medicare Revenues
The main cost cutting measures have been aimed in previous years at the Medicare Advantage plan. U.S. spending on Medicare Advantage patients is estimated to be thirteen percent higher than for elderly individuals enrolled in traditional Medicare plans. Since the annual cuts that began in 2010, the federal government is now only spending about two percent more for people enrolled in the Advantage plan.
The lead representing body for insurance companies, America's Health Insurance Plans, has argued that the annual cuts to insurance companies ultimately cause increasing costs of care for the elderly. In addition to providing more revenue for plans next year, the government is also instituting changes to the system to accurately reflect how ill an elderly patient is as well as their true cost of care.
Effects on Medicare Recipients
The U.S. government stated that it expects the increase in revenue next year to be at around 3.25% when accounting for the changes in Medicare patients' diagnosis. One expert stated that "there's good news in the growth rates and then tough pills to swallow with respect to some of the other proposals." With around 15.8 million elderly and disabled people enrolled in the Medicare Advantage program, the potential effects of revenue decreases and increases can be great.
This is because of the differences in the funding system between that and a traditional Medicare plan. In the Advantage system, the federal government pays insurance companies a fixed amount for each person enrolled in the plan. Whereas, in the tradition Medicare system the federal government pays for each procedure performed on a patient that is covered by the Medicare guidelines. Increases in the revenue for the Advantage plan mean that insurance companies are better covered in case of catastrophic care needs in its Advantage members.
Japan is facing a unique problem in its prison systems: it cannot persuade people to leave. The country has one of the highest proportions of elderly convicts in the world, and crimes committed by this cross-section of the population have quadrupled over the last twenty years. Over twenty percent of all prisoners in Japan are over the age of sixty years old, and the country is facing an issue about what to do with their elderly convicts.
Reasons for Elderly Prison Population
The costs of healthcare in Japan are increasing rapidly, and elderly prisoners face better living conditions in addition to better healthcare than they would if they were to be released. Japan is trying to reduce the number of homeless seniors by more than thirty percent by the time that they host the summer Olympic Games in 2020, but many prefer the government-subsidized life behind bars.
Elderly criminals are cycling in and out of prisons in Japan because they lack the family and financial support to care for them when released. Oftentimes, they are homeless and treated as outcasts in their community. It costs almost double to care for an elderly person in prison than what they would receive in welfare outside of prison, and many prefer the care that they receive as convicts. As a result, Japan's prisons are turning into some type of hybrid nursing homes for its elderly prisoners.
Prisons as Nursing Homes
A Special Corrections Officer for Japan's Justice Ministry has reported that "Many [elderly prisoners] need assistance for walking, bathing and eating. Some groan at night from pain, throw their excrement or wander inside cells because they're suffering dementia." Prison healthcare costs are increasing significantly because of the amount of elderly prisoners. In the last nine years, healthcare costs in Japanese prisons have doubled to six billion yen.
In addition, reentry programs for senior convicts into the outside world do not appear to be improving the system, despite the significant investment in the program. Problems with the program reached global attention in 2006 when a 74 year old recently released convict burned down the West Japan Railroad Co.'s Shimonoseki Station. He told police that he had been released eight days prior and wanted to return to prison because he was hungry and cold.
Prison guards often double as nurses, helping inmates change their adult diapers, wet underwear, help with daily living tasks like bathing, and help them walk. Many elderly prisoners are scared of being released from prisoner because they are fearful of the outside world and face the possibility of elder abuse.
Battling Other Issues
Every year, around 6,400 elderly prisoners are released from prison without a place to go, and one-third of these seniors will be back in prison within the next two years. Most of these repeat offenders are jobless at the time of their arrest and have no good opportunities for employment when their prison sentence is finished.
In addition, elderly prisoners are reluctant to resume life in the outside world because of the difficulty to access healthcare. With a major shortage of nursing home care in the country, convicts are battling with 520,000 other seniors on a waitlist for nursing home placement. While the government is taking steps to make healthcare more accessible and job opportunities easier, Japan has a long way to go before its elderly convicts stop treating its prisons like nursing homes.
In Citrus County, Florida, more than one-third of the residents are senior citizens which is one of the highest rates in the country. However, in just fifteen years over one-quarter of the state will be 65 years old or older. Seeing how Citrus County operates now is giving policy makers and researchers a glimpse into the future of how the entire country will look in just a couple of decades.
A Look at Citrus County
Billboards across the county advertise home health care services, and health care is the dominating labor force for people still working. In addition, lawyers and doctors make house calls, and elderly citizens that can still get around use the county minivan system to be transported to and from the store.
Other services provided by the county also differ from the norm. The library offers free seminars on Medicaid planning, and voters are very active even though the majority participates through the absentee system. With these services provided by the county, the senior citizens are much more engaged and active within the community, but the trade-off is that the economy is supported mainly through low-skill jobs.
Research in Citrus County and other areas with high populations of elderly citizens show that these voters are not typically excited to vote for school funding or other initiatives that benefit younger generations. For example, Citrus County voted to reject a referendum to raise property taxes in order to better fund schools. Having an older population also makes it difficult to attract younger families to fill the service jobs that are required for an older population, and health care jobs make up more than one-third of the jobs in the county.
It is not just the economy that has issues retaining younger people. Churches in the county have struggled to maintain congregations as older members move to be near family or pass away. At the same time, any changes suggested to attract younger church goers is often met with resistance.
The Growing Gray Belt
Citrus County is only one of eight counties in Florida around Orlando and Tampa Bay that is considered the "Gray Belt" of the south. It has the oldest populations in Florida and one of the oldest across the nation. This area looks to be the most elderly area in the country for decades to come, and by 2030 these counties will have senior populations that make up one-third to one-half of their residents. Other states like North Dakota, Michigan, and Texas have their own growing gray belts, but those are attributed more to younger residents leaving and not older residents moving in.
The key issue for states facing a shift in the average age of the population will be balancing the voting concerns of the younger and older generations. With such high participation rates in the elderly population, researchers and policy makers expect to see states with growing gray belts to become less invested in education or transportation and more invested in issues of healthcare and insurance.
In late February, the New York State Department of Financial Services (DFS) issued guidelines to financial institutions located within the state regarding prevention of elder financial exploitation. The guidelines were issued to remind banks and other lending institutions that they are allowed to report possible instances of elder financial exploitation to New York's Adult Protective Services (APS) in addition to outlining the best practices used to identify, investigate, and report instances of elder financial abuse to the authorities.
Federal and State Reporting Law
While not mandated, DFS strongly recommended that financial institutions report any suspected elder financial abuse to APS. A joint task force of the federal OCC and FDIC released their own report in 2013 that clarified that it is not a violation of state or federal law to report suspected elder financial abuse to the relevant authorities.
The report specifically stated that any notification would not violate the Gramm-Leach-Bliley Act's (GLBA) privacy provisions or related regulations. In fact, the joint federal report went so far as to point out that the GBLA and regulations explicitly permit the sharing of nonpublic personal information when elder financial abuse is suspected without complying with notice or opt-out requirements.
In addition, Section 473-b of the New York Social Services Law allows financial institutions operating within the state to report suspected elder financial abuse to APS or other authorities and gives civil immunity to any person who makes the report in good faith. This immunity extends to the employees of a financial institution and the institution itself.
Best Practices to Avoid Exploitation
The report released by DFS stresses the importance that financial institutions play in deterring and preventing elder financial abuse. Bank employees are usually the first people to notice the "red flags" of elder financial exploitation, especially if they are working directly with an elderly client. In order to deter elder financial exploitation, DFS recommends the following best practices for financial institutions:
· Develop a plan and "red flag" procedures for detecting and reporting suspected elder financial abuse
· Hold regular trainings for employees regarding the institution's policies to prevent future exploitation
· Appoint or hire staff specifically to investigate suspected elder financial abuse and report their findings to APS or other authorities
For guidance regarding potential red flags of elder financial abuse, lending institutions are encouraged to review the Financial Crimes Enforcement Network's 2011 advisory report. It describes the most common red flags of exploitation but also encourages financial institutions to immediately investigate whenever any uncharacteristic behavior of an elderly client is noticed.
How to File a Report
When elder financial abuse is suspected, the lending institution should file a Suspicious Activity Report (SAR) with the code of "elder financial exploitation. The bank can make the SAR without fear of civil liability as long as it is made in good faith and should notify either APS or local law enforcement about the SAR filing. Because there is no specificity as to what type of information should be included in an SAR, financial institutions should provide enough information to a reasonable degree explaining the basis of the report.
In January, the Department of Veterans Affairs proposed new regulations regarding when and how a veteran is entitled to the VA pension. The proposed regulations have sparked considerable controversy and outrage over the potential penalties involved with making gifts and eligibility for the pension program.
VA Pension Program
The Department of Veterans Affairs established the VA pension as a way to help veterans and their families once a person has retired from the military. It provides tax-free, supplemental income through the pension program. Additional benefits through the pension program called "Aid and Attendance Benefits" are also offered to veterans who are unable to perform daily living activities, such as bathing, eating, dressing, and so forth. One of the main purposes of the Aid and Attendance benefits is to help veterans offset the high costs of nursing home care.
The Aid and Attendance benefits are part of a needs-based program, but currently the Department of Veterans Affairs does not have any penalties for veterans who divest their current assets in order to apply for these benefits. The proposed regulations would make a change to this particular area.
New Proposed Regulations
The proposed regulations would establish requirement income limits based on pre-application net worth of the veterans in addition to look at any asset transfers or gifts of assets used to qualify for Aid and Attendance benefits in the VA pension program. Right now, there is no net worth limit on these additional benefits, but the proposed legislation would place a clear net worth limit at $119,220.
This is the current maximum community spouse resource allowance for Medicaid in 2015, and it includes annual income as well as assets. The limit would increase with inflation at the same rate as cost-of-living increases for Social Security beneficiaries. The new regulations would also define how the VA pension plan defines and calculates an asset. Under the new rules, the VA would exempt the primary residence as an asset but only property up to two acres.
Gifts and Transfers
Finally, the new regulations would impose a look back period on gifts or asset transfers before application for Aid and Attendance benefits. The look back period proposed would be three years, or 36 months, and a penalty period of ten years for veterans who dispose of their assets below fair market value in an attempt to qualify for benefits. In addition, transferring assets to a trust or converting the assets into a single annuity would fall under the umbrella of transferring below market value. Gifts of money or assets to family members would also be a punishable offense if it is proven that a veteran did so in order to qualify for additional benefits.
The new rules presuppose that any transfers made within the three year look back period are done to quality for pension benefits, unless clear and convincing evidence proves otherwise. The penalty would be calculated based on the value of the assets transferred during the look back window in the amount over the net worth limit.
Some of the country's tech elite are coming together to use their companies' technology, entrepreneurial spirit, and tech savvy to improve home care for the elderly across America. Big names such as Apple's Ron Johnson, former Senator Bob Kerrey, Yelp CEO Jeremy Stoppleman, Facebook CTO Mike Schroepfer, Paypal founder Max Levchin, actress Jessica Alba and many others are working together to create Honor, a modernized home care program for seniors.
Current Elder Care Issues
The goal of the Honor system is to keep parents in their homes and safe for as long as possible. With the number of Baby Boomers in America reaching retirement age and beyond expected to reach 84 million people by 2050, elder care is quickly becoming a concern for families everywhere. Other options like nursing homes facilities can be costly and unpleasant for everyone involved.
Currently, there are 1.5 million people employed as home care workers. These people help seniors with daily living tasks around the home like getting out of bed, making meals, ensuring that medication is taken, and other daily tasks. They either work as independent contractors or employees for around 50,000 home care companies in the United States. Unfortunately, these workers typically earn minimum wage, work part time, and rely heavily on government assistance. As a result, the turnover for home care workers is high and the quality of care for seniors can be poor.
Implementing the Honor System
One of Honor's directors has come out and said that "it is a really big problem on both sides . . . There is a fundamental challenge of how do we care for a much larger percentage of older people in a way that is as respectful and humane and positive as possible. The other side is the workers. Today, this is not a job where they feel respected . . . There is an opportunity to have it become a more professional job, and a better paying job, a job where people have a lot more respect."
The Honor program is set up as an online marketplace for home care workers and seekers. The workers will be able to list their qualifications, skills, experience, and distances able to travel for work. The seniors or their family members will be able to list the type of services that they require, the hours needed to work, and any specific qualifications that come with the job. The Honor system will then match home care workers and seniors, with the final approval given to the seniors and their families.
In addition, the Honor program will give each senior client a simple, touchscreen pad to use so that they can update their families and care givers about any changes in their needs or condition. That way their loved ones stay informed and their care givers can be prepared when they walk in the door. The device also records what services were provided to the senior and for how long in addition to allowing the senior to rate the quality of care.
The results of Biogen's new experimental drug for Alzheimer's disease has provided the best evidence so far that the memory-robbing condition is caused by a protein in the brain that, if stopped from acting erratically, could lead to an effective treatment for the disease. While German psychiatrist Alois Alzheimer was the first to connect dementia to an abnormal protein deposit in the brain, it has taken until now for scientists to understand where the protein, known as beta amyloid, was made and to see it as a potential target in treating Alzheimer's disease.
Clinical Trials of the New Drug
Prior to the testing of this new drug, no clinical trials had been run that had previously reduced beta amyloid in subjects' brains while also slowing the deterioration in their cognition. Now, the findings on BIIB037, Biogen's medication, show that it's possible. In an early stage trial, 166 participants who took BIIB037 showed reduced beta amyloid in the brain and reduced cognitive decline.
Furthermore, with higher doses and longer treatment, patients in the trial saw even more improvements. Based on the Clinical Dementia Rating, BIIB037 showed a 71% reduction in cognitive decline among patients who took the highest dose, compared with those on placebo. The results of this trial show that "it's a major advance in confirming amyloid beta is the right target."
Other Alzheimer's Drug Testing
Researchers have said that BIIB037 is "a chance that this could be the first registered disease-modifying drug for Alzheimer's disease." As Biogen prepares the drug for late=stage trials of BIIB037 later this year, other drug companies have tried and failed to have success with their own Alzheimer's medications.
Two medications, solanezumab, from Eli Lilly & Co., and bapineuzumab, developed by Pfizer Inc., Johnson & Johnson and Elan Corp., both failed to show a significant effect on the disease in their own trials. Eli Lilly is now retesting their drug in earlier-stage Alzheimer's patients, while bapineuzumab has been scrapped by their group. In addition, Roche Holding AG is sponsoring a drug trial of its own amyloid-targeting drug in Alzheimer's patients with mild dementia. However, in December it abandoned their drug study of people with early stages of the disease because of poor results.
Possible Side Effects of the Drug
Although BIIB037 shows some serious promise in terms of fighting Alzheimer's disease, there is also the potential for serious side effects. Most concerning is brain swelling known as amyloid-related imaging abnormalities, or ARIA. "Among patients carrying the ApoE4 gene, which is strongly linked with Alzheimer's, 55% of patients on the highest dose reported ARIA. That resulted in 35% of the ApoE4 carriers on the highest dose discontinuing treatment." Finally, 22% of patients in the trial who took the drug had headaches, versus only five percent on a placebo.
Researchers have also admitted that even with the promising results of Biogen's drug, Alzheimer's disease should still be approached from multiple angles. "It's not an either/or," said the director of global science initiatives at the Alzheimer's Association. "There needs to be as many of those as possible so we can have a fuller understanding of Alzheimer's."
Two weeks after major surgeries, medical treatments, and life-saving procedures a doctor found his patient's advance directive in his medical chart. Suffering from dementia and unable to communicate, the patient was unable to tell his doctors about the document that stated "he wanted comfort care only, no heroics." This story illustrates one of a number of growing problems that medical professionals have with advance directives.
Advance Directives and Living Wills
Advance directives, which commonly include living wills and advance healthcare proxies, dictate the wishes of a person's future care. A living will is used to communicate which treatments and procedures you would like performed in the case that you are unable to communicate them yourself. It is most commonly known for dictating whether a person wishes to be resuscitated in life threatening situations.
A healthcare proxy is used to appoint a person to make healthcare decisions for you if you become incapacitated. However, if a living will also exists then the healthcare proxy is bound by those terms when making healthcare decisions.
A final form commonly associated with advance directives is a "Physician Orders for Life Sustaining Treatment," or Polst form. This document is filled out by health care professionals alongside their patients and can stipulate that only comfort measures be applied, to perform full life-prolonging intervention, or various options in between.
Increase in Advance Directive Popularity
When Congress passed the Patient Self-Determination Act in 1990, healthcare professionals urged their older patients to fill out advance directives and pass them out to their family members. As a result, the number of Americans over the age of sixty rose by 72% between 2000 and 2010. However, since the introduction of this legislation there have also been issues that have arisen with carrying out a proper advance directive.
Problems with Advance Directives
There are many stories of advance directive documents that have been misplaced, lost, stashed in safe deposit boxes, or filed away in a forgotten drawer. One doctor remembered having a patient who's advance directive was found tucked inside of a Bible. Unfortunately, when the hopes of a patient are not backed up by an advance directive, their wishes are overridden by medical necessity.
Advance directives also fail because they are not medical orders. Vague language and outdated vocabulary do not always give medical professionals enough to know how to proceed. Emergency medical personnel operate under standing orders to attempt resuscitation, whatever an advance directive says. Only a state "do-not-resuscitate" or Polst form can prevent that measure from being taken. "You may already be on a breathing machine before you pull into the E.R."
Finally, patients that use a Polst form instead of other advance directives also come across issues. Implementing this type of document requires a coordinated statewide system involving hospitals, nursing homes and hospices. However, some states like Oregon and West Virginia have instituted developed systems for tracking a Polst form, and forty out of fifty states are well along in their implementation of the system.