Thursday, December 29, 2011

Great Songs about Aging


Before Christmas I was playing with my guitar - trying to learn the chords to the song “Beloved Wife” as sung by Natalie Merchant.  Maybe because my wife and I have been married for over 40 years this song really gets me. I love it.  And I started thinking of other songs about aging that I’ve grown to love as well.  I decided to make a list.  

As I worked on my list I realized that there must be a lot of great songs out there – related to aging – that I’ve never even heard. So, I sent out an email that asked participants in the National Academy of Elder LawAttorneys' member’s listserv to suggest additional songs. The response was overwhelming - from Country and Bluegrass, Folk and Blues, Rock and Broadway, the suggestions flooded in. While I was already aware of many of the songs, there were quite a few that were new to me. Some of them made me laugh, others tore me up completely. 

I had a wonderful Christmas holiday sorting through and listening to the suggested songs.  And I promised to compile a list of some of the ones that most appealed to me (with emphasis on songs that are easily available via hyperlink).   

So, here is Jeff Marshall’s List of Great Songs about Aging – with help from my friends - in alphabetical order with hyperlinks. Thanks to everyone who contributed. I hope you enjoy them. And if you decide to come up with your own list, perhaps you will share a song or two by adding a comment below.  
 

100 Years – Five for Fighting


Angel Band – Old and in the Way

As Good As I Once Was - Toby Keith

Beloved Wife - Natalie Merchant

Borrowed Time – John Lennon

Cat’s in the Cradle – Harry Chapin

Done Got Old - Junior Kimbrough

Don’t Blink – Kenny Chesney

Don’t Let Us Get Sick – Warren Zevon

End of the Line – Traveling Wilburys

Father and Son – Cat Stevens

Forever Young – Alphaville

Gentle Annie – (Stephen Foster) - Jay Unger

Glory Days – Bruce Spingsteen


Grandma’s Hands – Bill Withers

Grow Old Along With Me - Mary Chapin Carpenter

Hands of Time - Ron Sexsmith

Hazy Shade of Winter – Simon and Garfunkel

He Went To Paris - Jimmy Buffett

Hello in There – John Prine

In Color - Jamey Johnson

It was a Very Good Year - Frank Sinatra

Just Breathe - Pearl Jam

Living Years - Mike & the Mechanics

My Generation – the Zimmers

My Way – Frank Sinatra

No Time at All – from Pippin

Not Dark Yet – Bob Dylan

Ol' Man River - Paul Robeson

Old Friends – Simon and Garfunkel

Old Man – Neil Young

Our Town – James Taylor

Remember When – Alan Jackson

Rockin` Chair - Hoagy Carmichael

September Song – Willie Nelson

Shouldn’t I be less in Love with you - from “I Love You, You're Perfect, Now Change”

Silver Threads Among the Gold – John McCormack

Skin – Chris Trapper


Stop This Train – John Mayer

Summer of 69 – Bryan Adams

Teach Your Children - Crosby, Stills & Nash

That Lonesome Road – James Taylor

The Circle Game – Joni Mitchell

The Dutchman - Steve Goodman

The Way - Fastball

The Way We Were – Barbara Streisand

Through the Years – Kenny Rogers

Time - Pink Floyd

Time Passages – Al Stewart

Too Old To Cut the Mustard Anymore – Rosemary Clooney with Marlene Dietrich

Turn, Turn, Turn – The Byrds

Waitin' On A Woman – Brad Paisley

When I Get My Wings - Will Hoge

When I Go – Dave Carter and Tracy Grammer

When I'm Gone - Phil Ochs

When I’m 64 – The Beatles

When You’re Old and Lonely – The Magnetic Fields

Where’ve You Been - Kathy Mattea

You’re Aging Well – Dar Williams

Saturday, December 24, 2011

PA Expands Support Program for Caregivers


As many as 400,000 Pennsylvanians suffer from Alzheimer’s or another type of dementia, and seven out of 10 of those are cared for at home by family, neighbors or friends. It is estimated that more than 1.3 million Pennsylvanians are informally caring for elderly parents or other family members or friends at home. Most are unpaid.

The economic value of the Pennsylvania’s caregivers has been estimated at more than $15 billion a year. These informal caregivers are the heart and soul of our long-term care delivery system. Often working under conditions of tremendous stress, they provide the majority of care and services received by our frail and elderly citizens. Without the support of these unpaid individuals many more care recipients would be forced into Medicaid funded nursing homes at an enormous added cost to taxpayers. There is little doubt that Pennsylvania’s caregivers are deserving of all the support the state can provide.

Pennsylvania has finally updated a long running program that provides some financial support, services and training for those who are giving care to another individual. Since 1990, the Pennsylvania’s Family Caregiver Support Program has worked to keep care recipients at home.

When it began in 1990, Pennsylvania’s program was a model for the rest of the nation. But limitations in the program constrained its usefulness and resulted in allocated funding going unspent. Support was available only to caregivers who were related to and living with the care recipient. And the initial financial reimbursement limits of $200 per month for out of pocket expenses (e.g. adult diapers) and $2,000 for one-time home modifications (e.g. ramps) were never increased during the over two decades of the program’s operation.

Act 112 of 2011 signed into law on December 22, 2011, expands Pennsylvania’s two decades old Family Caregiver Support Program. It amends the law that is codified at 62 P.S. Sections 3061-3068, with implementing regulations located in Title 6 of the Pennsylvania Code at Chapter 20. The new law will be effective date in 60 days. It will probably take a while for the regulations to be updated by the Department of Aging.

Here are some highlights of program changes specified by Act 112:

  • The word “Family” is replaced with “Pennsylvania” in the name of the Act because individuals who are primary caregivers but who are not relatives of the care receiver will now be able to participate. The new name is the “Pennsylvania Caregiver Support Act.”

  • Definitions are added for the terms “adult with chronic dementia” and “care receiver."
    • Adult with chronic dementia" is defined as “A person 18 years of age or older residing within this Commonwealth who has an irreversible global loss of cognitive function causing evident intellectual impairment which always includes memory loss, without alteration of state of consciousness as diagnosed by a physician and is severe enough to interfere with work or social activities, or both, and to require continuous care or supervision.”
    • "Care receiver" is defined as “A functionally dependent older adult or other adult with chronic dementia who is being cared for by a primary caregiver.” 

  • The term “primary caregiver” is redefined to delete the requirements that the caregiver be a relative of and reside in the same household as the care receiver. A primary caregiver is the “one identified adult family member or other individual who has assumed the primary responsibility for the provision of care needed to maintain the physical or mental health of a care receiver and who does not receive financial compensation for the care provided.”

  • Section 4 of the Act describes the primary persons to be served as “unpaid, primary caregivers who provide continuous care to a care receiver.” The Department of Aging is directed to give priority in awarding assistance paid by Lottery funds to primary caregivers who are caring for an adult 60 years or older with chronic dementia, such as Alzheimer’s disease.

  • Section 5 of Act makes only modest modifications to the level of reimbursement available to caregivers. Eligibility is only available if the care receiver’s household has limited income. Two levels of income eligibility are established: (1) 200% of poverty and (2) 380% of poverty.
    • (1) In general, the maximum amount available to a qualified primary caregiver whose care receivers' household income is under 200% of the Federal Poverty Guideline (FPG) cannot exceed $200 per month for out-of-pocket expenses incurred for services including respite services and consumable supplies like incontinence pads. This is the same amount first established in 1990. However, Act 112 does provide for a limited exception: In individual cases of demonstrated need the maximum amount can be increased up to $500 per month. The need must be specifically documented in the care plan and reimbursement is limited to $200 if the Area Agency on Aging’s average monthly reimbursement exceeds $300 across its entire caregiver support program caseload. The maximum amount available for home modifications remains at the 1990 level of $2,000. (Note that 200% of the 2011-2012 FPG is $1,815 a month for a 1 person household and $2,452 a month for a 2 person household).
    • (2) Where the care receivers household income is greater than 200% of the FPG but under 380% the primary caregiver must pay some portion of the out of pocket expenses covered by the act, based on a sliding scale established by the Department of Aging. If the care receiver’s household income is above 380% of the FPG no benefits can be paid under the act.

The Act’s removal of the caregiver support program’s familial and residency restrictions are important and legislators and advocates who have been working toward that goal for years are to be congratulated. However, the failure of the Legislature to approve additional increases in the 21 year old reimbursement levels is disappointing. An earlier version of the legislation that would have increased the reimbursement and home modification ceilings more substantially was unanimously approved by the House, but reduced in the Senate back to near the 1990 amounts. 


For some caregivers a little more reimbursement could make the difference in avoiding institutional placement of the care receiver. Pennsylvania recently scored 46th in the nation in support of caregivers. The meager and constrained increases in Act 112 are unlikely to make for much of a change in that embarrassing ranking.

Tuesday, December 13, 2011

Medicaid Home Equity Disqualification Threshold increases to $525,000

Medicaid long term care benefits are a primary source of payment of the cost of care for many seniors who reside in nursing homes. It also pays for frail seniors to be able to remain in their homes under programs like Pennsylvania’s Aging Waiver and Life programs.
For many of these recipients of Medicaid long term care benefits it is crucial that the equity they own in their homes is exempted in determining their eligiblity. Prior to the enactment of the Deficit Reduction Act of 2005 (DRA), Medicaid disregarded the full value of an Medicaid long term care applicant’s primary home as long as the home owner was residing there or evidenced an intent to return to the home.
Section 6014 of the DRA made a fundamental change in this treatment. This provision (which is codified at 42 U.S.C. 1396p(f)) specifies that some individuals with substantial home equity are disqualified for Medicaid long-term care assistance. The idea was to force individuals with substantial equity in their homes to tap into that equity to pay for their care before applying for Medicaid long term care benefits.
The DRA initially set an equity interest of $500,000 as the threshold for disqualification. States were given the option to increase this level to $750,000 but Pennsylvania declined to do so. The law also specified that beginning in 2011 the threshold would be adjusted for inflation based on the percentage increase in the consumer price index -Urban (CPIU). 
As a result, effective January 1, 2012 the disqualification standard is increasing from $506,000 to $525,000. This means that in 2012 Medicaid will not pay for long-term care services for some individuals whose equity interest in their home exceeds $525,000.  This provision applies to both institutional care and Waiver programs. 

However, there are significant exceptions to the application of the home equity disqualification rule. The $525,000 limitation will not apply if the applicant has a spouse, a child under age 21, or a child who is blind or disabled, any of whom lawfully reside in the home. The limitation is also to be waived in the case of a demonstrated hardship. (See 42 U.S.C. 1396p(f)(4). In Pennsylvania see also 55 Pa.Code § 178.62a).

The home thus remains conditionally excluded as a resource regardless of the value of the equity interest of the applicant for Medicaid long term care if either one of the following conditions is met:

1. The applicant/recipient has less than a $525,000 “equity interest” in the home.

In determining the value of home equity, States should follow the basic policies of the Supplemental Security Income (SSI) program. The equity value of a resource is the current market value minus any encumbrance on it. Current market value is the going price of the home, or the amount for which it can reasonably be expected to sell on the open market in the particular geographic area involved. An encumbrance is a legally binding debt against the resource. This can be a mortgage, reverse mortgage, home equity loan, or other debt that is secured by the home. States should follow their existing policies to determine current market value. States should also apply their usual verification procedures if an encumbrance is alleged.

If the home is held in any form of shared ownership, e.g., joint tenancy, tenancy in common, or other arrangement, only the fractional interest of the applicant for medical assistance for nursing facility or other long-term care services should be considered. For example, if the home is owned in joint tenancy by an applicant and a sibling, one-half of the home’s current market value should be used in calculating the equity value of the individual, unless the individual can rebut the presumption that he or she has equal ownership interest in the property. See CMS State Medicaid Director Letter dated July 27, 2006, Enclosure to Section 6014, Section II

A nursing home applicant with home equity under $525,000 and who has no qualified relative residing in the home must state his or her intention to return to the residence for the property to be excluded. If the applicant does not intend to return to the residence, it will be excluded for six months while the applicant makes a good faith effort to sell it. (See 55 Pa.Code 178.51(a))  Proceeds from the sale of an excluded residence are also excluded if the applicant intends to purchase another excluded residence within three months. (See 55 Pa.Code 178.77).

2. The applicant/recipient’s spouse or child who is under age 21 or is blind or permanently and totally disabled is residing in the individual’s home.


Readers should note that the home equity limitation described in this article does not change the general rule that excludes a home of any value for purposes of determining eligibility for Medicaid. The limitation applies only to Medicaid payment for nursing facility services, or other long-term care services.

The $525,000 cap may create an eligibility problem for unmarried individuals, and for married couples where neither is able to reside at the premises. Because they tend to live longer, the rule disproportionately impacts widows and other older women.

For further information see: “CMS State Medicaid Director Letter dated July 27, 2006, Enclosure to Section 6014, Section II” which is available on the Marshall, Parker and Associates website, www.paelderlaw.com, at http://www.paelderlaw.com/pdf/cms_transfer_of_assets.pdf.  

Tuesday, December 6, 2011

Why Single People should do Estate Planning


If you are unmarried and don’t have children you may think that “estate planning” is unimportant to you. Many singles believe that estate planning is only a concern for married couples or people with children or people who are very wealthy. But this is not true. Single people of modest means can benefit from forethought and preparation for the future – a future that someday may involve their incapacity and will certainly include their death. 

Most people think that estate planning only involves signing a will and taking other steps to ensure that upon your death the things that you own pass to the right people, in the right manner, at the right time. But it’s much more than just planning for death.

Estate planning also involves planning for possible future incapacity though the use of tools like powers of attorney and health care directives. These legal documents will help you retain control over your affairs in the event of your temporary or permanent incapacity so that the decisions that will be made for you will be the ones you want made, and the person making the decisions will be the person you choose. 

Although you may not be aware of it, you already have an estate plan - because the government has prepared one for you. The government plan is your default – it governs what happens if you don’t take the time to plan for yourself. Here is what the government plan does:

  •  It says who is authorized to make health care decisions for you if you get sick and can’t make your own. It also specifies the kinds of decisions this “representative” can make on your behalf.  The authority granted under Pennsylvania law (Act 169 of 2006) is very broad.  If you don’t want that family member who never liked you to have the authority to “pull your plug’ you should probably take the time to create a Health Care Power of Attorney.
  • The Government plan says that a court will decide who will be given authority to handle your financial affairs if you are no longer able to manage on your own. A Judge will decide, based on limited facts, perhaps after a court  hearing that lasts only a few minutes, to turn all your finances over to someone. If you don’t want to leave your financial fate to a Judge and appointed guardian, you should take the time to create a financial power of attorney. Your financial power of attorney document will authorize the person you choose to step in for you and it will state the amount of authority they will have, and won’t have. 
  •  
  • Your Government plan says who will be in charge of distributing your money, property, and personal belongings when you die. It also sets up a default list of people who will get your stuff. If you are unmarried and have no children, this can get very complicated and confusing, and people who you didn’t like (and perhaps didn’t even know) can wind up with your money, property, and special personal items. If this doesn’t sound good to you, you need to take the time to create your own Will.

If you are single, you can stick with your government estate plan or you can opt out of it and create your own. But, unless you can figure out how to live forever and in good health, your estate plan is likely to someday become very important.  

This blog and the Marshall, Parker and Associates website have a number of articles that can get you started on the job of preparing your own financial power of attorney and health care directive.   Of course, these documents are too important to your future to be "do it yourself."  See a experienced elder law and estate planning lawyer to make sure you get things right.