Tuesday, September 30, 2014

Should Seniors get a High-Dose Flu Shot?

Have you gotten your annual flu shot yet?
Yesterday I went to get my flu shot. I was surprised when I was asked whether I wanted a “High-Dose” shot. This was something new to me, and I didn’t know how to respond. Since I expect that other seniors are also unfamiliar with high-dose shots, I thought I would post this brief article on the subject.
Warning: I am a lawyer, not a medical professional. I hope readers with more medical training will feel free to comment on this subject or email me with additional information.    
To find out more, I went to the website of the Centers for Disease Control and Prevention (CDC), the government’s health protection agency, to see what it says about whether seniors should be getting the high-dose shot.
Here is what the CDC says: “Fluzone High-Dose vaccine contains four times the amount of antigen (the part of the vaccine that prompts the body to make antibody) contained in regular flu shots. The additional antigen is intended to create a stronger immune response (more antibody) in the person getting the vaccine.”
The CDC then goes on to try to answer some of the questions older adults may have.
Why is a higher dose vaccine available for adults 65 and older?
Human immune defenses become weaker with age, which places older people at greater risk of severe illness from influenza. Also, ageing decreases the body's ability to have a good immune response after getting influenza vaccine. A higher dose of antigen in the vaccine is supposed to give older people a better immune response, and therefore, better protection against flu.
Does the higher dose vaccine produce a better immune response in adults 65 years and older?
Data from clinical trials comparing Fluzone to Fluzone High-Dose among persons aged 65 years or older indicate that a stronger immune response (i.e., higher antibody levels) occurs after vaccination with Fluzone High-Dose. Whether or not the improved immune response leads to greater protection has been the topic on ongoing research. A study published in the New England Journal of Medicine indicated that the high-dose vaccine was 24.2% more effective in preventing flu in adults 65 years of age and older relative to a standard-dose vaccine. The confidence interval for this result was 9.7% to 36.5%).
Is Fluzone High-Dose safe?
The safety profile of Fluzone High-Dose vaccine is similar to that of regular flu vaccines, although some adverse events (which are also reported after regular flu vaccines) were reported more frequently after vaccination with Fluzone High-Dose. The most common adverse events experienced during clinical studies were mild and temporary, and included pain, redness and swelling at the injection site, headache, muscle aches, fever and malaise. Most people had minimal or no adverse events after receiving the Fluzone High-Dose vaccine.
Who can get this vaccine?
Fluzone High-Dose is approved for use in people 65 years of age and older. As with all flu vaccines, Fluzone High-Dose is not recommended for people who have had a severe reaction to the flu vaccine in the past.
Does CDC recommend one vaccine above another for people 65 and older?
The CDC and its Advisory Committee on Immunization Practices have not expressed a preference for any flu vaccine indicated for people 65 and older. CDC recommends flu vaccination as the first and most important step in protecting against the flu.
Based on this information, I personally decided to get the high dose shot. It's covered by Medicare. 

I hope the information above helps you be better informed when you get your flu shot this year.
Further Reading:
Fluzone High-Dose Seasonal Influenza Vaccine, Questions and Answers, Centers for Disease Control and Prevention (page last reviewed and updated: September 3, 2014).

Saturday, September 27, 2014

Goodbye Department of Public Welfare

Governor Corbett has signed a new law that changes the name of the Pennsylvania Department of Public Welfare to the Department of Human Services. The two word change results from the enactment of House Bill 993 (Act 132 of 2014).
According to a department press release, the Department of Public Welfare has more than 16,000 employees and oversees 94 county assistance offices. It is involved with adoption services, child protection services, juvenile justice facilities, state hospitals, long-term care, early childhood education, child support, Medicaid, employment and training services, mental health, and supports for individuals with physical and intellectual disabilities, among other things. Many of its services have little to do with what people traditionally think of as “welfare.”
"For the past several years, advocates, families, legislators, and providers have diligently worked to make this change happen," said department Secretary Beverly Mackereth. "Our new name will reflect the services and supports our agency currently provides to individuals and their families."
As an elder law attorney, I have had a number of clients who refused to apply for needed benefits because they didn’t want to accept “welfare.” The welfare stigma was a prime motivator for the name change, which was supported by five former Pennsylvania Governors, many former Welfare Secretaries, and a coalition of non-profit groups.   
The new law will take effect in November, but the change will be phased-in slowly in order to reduce costs. The law allows for the continued use of the welfare name on badges, licenses, contracts, deeds, stationary and any other official documents until existing supplies are exhausted. A reference to the Department of Public Welfare in a statute or a regulation shall be deemed a reference to the Department of Human Services.
Further Reading:

Monday, September 15, 2014

Help for Grandparents Raising Grandchildren

Raising a grandchild creates unique legal, financial, medical, educational and family issues for the grandparent. Unfortunately, grandparents may lack easy access to the information and support they need to fulfill their caregiver role.

If you are a Northeastern Pennsylvania grandparent raising a grandchild you are fortunate that information and support is available to you through the NEPA Intergenerational Coalition
The Coalition was created to provide a support system and advocacy network for grandparents and other family caregivers raising grandchildren. It holds monthly support group meetings in locations in Luzerne, Lackawanna, and Wyoming counties. Here is a link to a flyer containing support group information: http://tinyurl.com/lq2fxpy.

Conference on October 24, 2014 is Free for Grandparents

The Coalition will be holding its 8th annual conference on Friday October 24, 2014 at the Mohegan Sun conference center. The conference will include many social service support agencies and information on legal issues. The conference is free for grandparents. For information about the conference contact Anne Hogya, Director Pittston Memorial Library, 47 Broad Street, Pittston, PA, 570-654-9565, ahogya@osterhout.lib.pa.us.
To contact the NEPA Intergenerational Coalition, you can call the Pittston Memorial Library, which houses the group, at 570-654-9565. When you call the Library ask for Howard Grossman or Anne Hogya. Or you can email the group at nepagrg@yahoo.com or find out more through its website at www.grgnepa.com.
If you live outside this area, www.USA.gov has a webpage on Grandparents Raising Grandchildren to help you find grandparent programs in your state and get information about benefits, assistance, and more.

Related Reading:

Thursday, September 11, 2014

No Medicaid Penalty for Gifts to a Disabled Child

As we age many of us will reach a point where we need help with our daily activities. If our care requirements go beyond what our family can provide we will have to pay for help in meeting our daily needs.
This kind of help is called “long-term care” and it is expensive. Average costs range from $19 an hour for home help with household tasks to $240 a day for a private room in a nursing home. (See 2014 Survey details the cost of Long-Term Care Services and Supports). It's no wonder that seniors struggle with finding ways to obtain the care they need and pay for it without using up all of their income and savings.  
The problems of aging and the cost of care become even more complicated for seniors who have been providing financial support for a disabled child. What will the child do for financial support when the parent’s money is gone?
In general, Medicare does not pay for long-term care. Medicaid is the major governmental program that helps seniors pay for long-term care. But you have to qualify financially for Medicaid and the law may limit your ability to give away assets in order to meet the qualification level. It imposes a period of ineligibility for benefits if assets have been given away during the preceding five years. 
Exception to the Transfer Penalty Rules
The section of Medicaid law that penalizes transfers of assets includes a number of exceptions. One important exception applies to transfers that are made by a parent to his or her disabled child. This exception is found in the federal law at 42 U.S.C. § 1396p(c)(2)(B)(iii).
Several years ago the Pennsylvania Medicaid agency (the Department of Public Welfare or “DPW”) issued a policy clarification to help spell out the “disabled child” exception from the Medicaid transfer penalty rules. The policy clarification (PMN15789440) was dated May 18, 2011.  It answers four key questions:
1.     Can assets be transferred to an individual's disabled child? 
2.     Is there an age limit for the individual’s disabled child?
3.     If assets are transferred will a penalty period be imposed?
4.     Could the asset transfer affect the eligibility begin date? 
Here are the answers to these questions as provided by DPW’s Division of Health Services:
1.     Yes, assets (income and resources) may be transferred to an individual’s child, who is disabled per Social Security (SS) standards for the sole benefit of the child.  The disability must be documented.
2.     No, there is no age limit for the individual’s disabled child, including an adult child.
3.     No, a penalty period will not be imposed if the asset is transferred to an individual’s child who is documented as disabled per SS standards. 
4.     Yes, if an individual applying for Medical Assistance (MA) and payment of Long Term Care (LTC) services must reduce resources to be eligible, it could affect the begin date of eligibility, if the assets are transferred to an individual’s disabled child.  I.E. Mr. B is requesting MA LTC effective 2/15/11 and has resources totaling $15,000.  He has a child, who is documented as disabled per SS standards.  On 2/28/11, he transfers $8,000 to his child for the child’s benefit.  Mr. B would be eligible for MA LTC on 3/01/11 if all other conditions of eligibility are met. 
Important Note: If you are considering making a gift to a disabled child you must first factor in the issue of maintaining a disabled beneficiary's eligibility for means-tested government benefits like Medicaid and SSI. Consult an experienced elder law attorney before you make the gift.