How To Protect The Family Home From Medicaid Recovery

Because the home is the largest asset a couple can keep while still qualifying for Medicaid, it is also usually the main target of estate recovery.

Sidney and Rachel's Story:
Sidney and Rachel had lived in their home since it was new. They built it just after Sidney got a promotion to regional sales manager for a shoe distributor. Through the years, the house was remodeled twice and expanded to add a loft bedroom. Even when their children were grown with families of their own, they all remained close, with frequent family gatherings for holidays and birthdays.

Sidney and Rachel had paid off the mortgage and two second mortgages before Sidney retired. So in addition to being the center of family life, the house had also become the couple's biggest asset.
Rachel always hoped the house would remain in the family when she and Sidney were gone. She often talked about leaving it to their oldest son, Mark, who promised that he and his wife would continue the tradition of hosting the family for holidays and birthday dinners. However, as Sidney's Alzheimer's disease progressed, Rachel worried that Sidney would need to move into a nursing home. With the high cost of long-term care, Rachel knew their savings wouldn't last long. Sidney would eventually need to qualify for Medicaid to pay the bills.

Her biggest question was, "Will I lose my home?"

A Common Question Indeed
For a great many people who need Medicaid benefits for long term care, the home makes up most of their life savings.  Often, it's all a couple has to pass on to their children.
You may not know that the home is an exempt asset according to Medicaid. It continues to be exempt as long as the community spouse lives there.  However, after both the ill spouse and the healthy spouse pass away, the property may no longer be protected.

What Is Estate Recovery?
According to the Omnibus Budget Reconciliation Act of 1993 (OBRA-93), the state has the right to take back whatever it paid for the care of a Medicaid applicant. And because you have to be "broke" to qualify for Medicaid, usually the only property of substantial value that a person on Medicaid is likely to own when they die is their own home. When OBRA-93 was passed, each state established an Estate Recovery Unit (ERU) to go out and find what assets they can take back from those that received Medicaid benefits!

Because the home is the largest asset a couple can keep (while still qualifying for Medicaid), in most states it is also the main target of estate recovery.
After both the community spouse and the ill spouse die, the state's estate recovery unit has the authority to take just about any property that the Medicaid recipient had their name on.  In most cases, that means going back to the house.

For example, if Sidney dies before Rachel after living in a nursing home for two years and Medicaid has paid the nursing home $3,000 per month, the state will have paid $72,000 for Sidney's care ($3,000 per month times 24 months). If the family home where Rachel lives is worth $100,000, the state would have a claim for the first $72,000 that comes from the sale of the house.

So, the house is protected while Rachel is alive. However, when she passes, the state may force the sale of the house. Whatever's left over after Medicaid is paid back ($100,000 minus the $72,000 taken out to repay Medicaid) would go to their children.
 
A Married Couple Strategy For Protecting The Family Home From Recovery
According to federal law, a married Medicaid applicant is allowed to transfer the home to his or her spouse - without any penalty. Once the transfer is made (meaning the ill spouse no longer has any interest in the house), the community spouse may be able to make some changes to that asset. In some states the community spouse can even give the house away!

That sort of gift, of course, would create a period of Medicaid ineligibility if the community spouse needs nursing home care within the five-year look-back period.

The family home remains one of the most difficult assets to protect because of timing, but there are proven strategies that make it possible to protect the home from Medicaid Recovery.

The Society of Medicaid Planners offers a free download of their report “Medicaid Secrets Revealed by Dan Stemen. The report offers information on qualifying for Nursing Home Medicaid without losing the family home to recovery or spending down your life savings.

The National Care Planning Council provides a resource for long term care planning with educational information and lists of professional elder care service providers.

Elder Abuse, Something to Look For!

Many elderly people rely entirely on family or other trusted individuals to help them. Whether it is for physical needs or emotional needs, as people grow older they tend to need more and more help from others. This dependence on caregivers or family members makes an older person more vulnerable for abuse.

For example, an older person relying on her children to provide meals and transportation and help her with financial decisions finds it difficult to complain when one of her children takes advantage of her. If, for instance, the child takes her money, hits her or neglects her care, the parent may be threatened with loss of support from the child if the parent complains. The child may also use threats of violence to keep the parent in line.

It is estimated that 5% to 10% of elderly Americans are suffering abuse. According to the National Committee for the Prevention of Elder Abuse, 

“Spiraling rates of elder mistreatment are reported by both practitioners and researchers. In a recent national study of Adult Protective Services (APS), typically the agency of first report concerning elder abuse, there were 253,421 reports of abuse of adults age 60+ or 832.6 reports for every 100,000 people over the age of 60 (Teaster, Dugar, Otto, Mendiondo, Abner, & Cecil, 2006). The National Elder Abuse Incidence Study (National Center on Elder Abuse, 1998) found that more than 500,000 persons aged 60+ were victims of domestic abuse and that an estimated 84% of incidents are not reported to authorities, denying victims the protection and support they need.” 

Much attention has been focused on abuse in nursing homes but most of the elder abuse in this country is at the hands of family members or other caregivers in the home.
In 2004, Utah Adult Protective Services workers investigated approximately 2,400 allegations of abuse, neglect or exploitation of vulnerable adults. In Utah, a vulnerable adult is defined as an elder adult (65 years of age or older) or an adult (18 years of age or older) who has a mental or physical impairment, which substantially affects that person's ability to protect or provide for themselves. The majority of the victims were females between the ages of 60-89 and 60% of the perpetrators were family members/relatives, while 24% were non-related paid caregivers.

The protective needs identified were as follows:

• self-neglect 31%
• physical abuse 16%
• exploitation 19%
• caretaker neglect 12%
• emotional abuse 19%
• sexual abuse 3%

In conducting the investigations, it was not uncommon to find that adults who were self-neglecting were also being exploited or abused. As stated previously, these statistics are based on approximately 2,400 cases, thus, if only one in ten cases are ever reported, it is possible that there were actually 24,000 or more cases in Utah that year. We suspect 9 out of 10 is close to the actual ratio of unreported versus reported cases in Utah.

We also believe that Utah's lack of reporting elder abuse is not unlike other states in the country. We suspect all the states are experiencing close to the same ratios of underreporting as in Utah.
There are a number of reasons why incidents of abuse, neglect, or exploitation are not reported to Adult Protective Services or other authorities. One of the most common reasons is the victim's fear of losing support. Many of the perpetrators are family members and the victim fears that reporting the crime will result in removal of the caregiver, as the perpetrator may face incarceration or may discontinue relations with the victim once accused, charged, or convicted. Many of these victims fear that by reporting abuse they will be left alone and expected to care for themselves or they will be forced to live in a nursing home.

Many states have implemented mandatory reporting laws to assist in the prevention of abuse, neglect or exploitation of vulnerable adults. Utah is one of the many states to have a mandatory reporting law (U.C.A. § 76-5-111). Utah law states that any person who has reason to believe that a vulnerable adult has been the subject of abuse, neglect, or exploitation shall immediately notify Adult Protective Services or the nearest law enforcement agency. Anyone who makes the report in good faith is immune from civil liability in connection with the report; however, any person who willfully fails to report is guilty of a class B misdemeanor.

It is important to note that the anonymity of the person or persons making the initial report and any other persons involved in the subsequent investigation shall be preserved and may only be released in accordance with the rules of the division (U.C.A. § 62A-3-311). In addition, all investigation information is confidential.

The following is a list of indicators of abuse, neglect or exploitation. It is important to note that the following lists are merely indicators and may not always be violations.
Signs of Abuse: 

• Unexplained bruises, welts, fractures, abrasions or lacerations
• Multiple bruises in various stages of healing
• Multiple/repeat injuries
• Low self-esteem or loss of self determination
• Withdrawn, passive
• Fearful
• Depressed, hopeless
• Soiled linen or clothing
• Social Isolation  

Signs of Neglect/Self-Neglect: 

• Dehydration
• Malnourishment
• Inappropriate or soiled clothing
• Odorous
• Over/under medicated
• Deserted, abandoned or unattended
• Lack of medical necessities or assistive devices
• Unclean environment
• Social Isolation  

Signs of Exploitation: 

• Missing/"disappearing" property
• Inadequate living environment
• Frequent/recent property title changes or will changes
• Excessive home repair bills
• Forced to sign over control of finances
• No/limited money for food, clothes and other amenities 

Prevention can only occur if there is awareness, the statutes are adhered to, and any suspicions of abuse, neglect or exploitation of vulnerable adults are immediately reported to Adult Protective Services and/or law enforcement.

All states have agencies that receive complaints of abuse. In some states failure to report abuse of the elderly is a crime. To contact an abuse complaint department, call your local area agency on aging. To find an area agency on aging in your area go tohttp://www.longtermcarelink.net/eldercare/ref_state_aging_services.htm

Here's Some Tips for Keeping The Folks Happy & Healthy

If you're fortunate enough to have one or both parents still living, you may have noticed a role reversal taking place in your relationship. Remember the days when Mom shuttled you to the doctor whenever you were sick? Now, it may be you who's driving her to her medical appointments. Perhaps you've become even more involved in managing her healthcare needs – serving as her healthcare proxy, moving her into your home to care for her, or even having to select a nursing home for her to live in.  

Whatever the case, it's natural to feel challenged – and, yes, intimidated – in the role you've undertaken. But if you stay positive and proactive, you'll be in a great position to advocate for your parents' optimal care. And, really, what better way is there to say "Thank You" for all they've done for you over the years?  

The following six recommendations will help you understand what may be happening to your parents as they age – and what you can do to help. 

1. Stay vigilant to sudden changes. 
Typically, sudden changes arise from sudden problems. Your elderly father who becomes confused one week but was alert and oriented the week before, or becomes unsteady walking and starts falling, is likely experiencing an acute problem – an infection, medication side effect, or perhaps, a heart attack or stroke.

If you pay attention to your parent's baseline health and behavior, you'll be alert to sudden, and subtle, fluctuations. Being attuned to what's “normal” for your parent is critical in advocating for his care. By informing his physician of these changes, you help ensure that he receives a proper diagnosis and timely treatment – especially important in acute conditions.

2. Investigate the source of gradual decline. 
Several years ago, I met an elderly woman living in a nursing home. Her family, assuming she had dementia, had moved her there after she had gradually stopped speaking.

After performing a brief procedure on her, I asked how she was doing. “I'm OK,” she replied.

A miracle? Not exactly. I'd removed bullet-sized pieces of wax from her ears. She'd stopped speaking because her ears were too plugged to hear.

A host of conditions can cause gradual decline. Before jumping to the conclusion – as many people do – that Alzheimer's disease is the culprit, recognize that your parent may be experiencing an altogether different problem: a vitamin B12 deficiency, an underactive thyroid, Parkinson's disease or depression, to name a few.

When discussing your parent's decline with her physician, make sure the two of you consider all the possibilities. To prepare for the appointment, make notes detailing how her decline has manifested itself – loss of appetite, a failing short-term memory and so forth – and how long you've noticed these changes. That way, you won't leave anything out. To help you, I've created a free checklist that either you or your parent can complete at seniorselfassessment.com – make sure you print or email the “Test Result Details” at the bottom of the page to analyze your responses and give you advice based on your answers.

3. Know thy parent's medicine cabinet.
Familiarize yourself with the medications your parent takes: what each one is for and how often he takes them. Make sure you notify each doctor your parent visits of all the medicine he takes, including over-the-counter products. Ask what side effects you might observe from each medication and whether it's potentially dangerous if your parent takes them together. You also want to tell the doctor whether your parent drinks alcohol or caffeinated drinks and whether he smokes, as these substances can affect some medications' efficacy and safety. To recognize which medications might cause the symptoms your parent experiences, check out drugscanmakeyousick.com.

4. Discourage ageist attitudes.
Simply put, ageism is prejudice against the elderly. It exists in many forms but can be particularly damaging to an older person's self-esteem when it assumes that all of her woes are age-related. Here are a couple of ways of expressing ageism to an elderly parent:

“What do you expect at your age?”
“You're not getting any younger.”

If you're ever tempted to utter something similar, remind yourself that by chalking up everything that ails her to her age, you sell your parent short. If she's depressed, it may have nothing to do with the fact that she's 80 and everything to do with a biological predisposition to depression. And remember that right-knee pain in a 90 year-old can't be just from age if there's no problem with her left knee. (More about Dr. Stall and a more in-depth article on the attitude of society towards medical care for the elderly can be found at http://www.longtermcarelink.net/eldercare/medical_care_issues.htm )

5. Address not just symptoms—but emotions, too. 
There is disease and then there is “dis-ease” – that is, a lack of ease, security or well-being. “Dis-ease” can manifest itself as myriad emotions in an elderly person: fear, grief, boredom, embarrassment and sadness among them. The fact is, these emotions can be every bit as debilitating as disease.  

Take the case of a parent who's incontinent. Too embarrassed to socialize, she cuts herself off from friends. Without companionship, she becomes lonely. Instead of allowing her to become a hermit, discuss with her doctor how to address the incontinence. Together, you can consider different solutions that will ease her embarrassment and reinvigorate her social life.

6. Strive to maximize your parent's quality of life.
No matter our age, we all want to enjoy life to the fullest and have the capability to do the things we want to. Improving the enjoyment of life and a patient's functional ability are the cardinal goals of geriatric care. But you don't need a medical diploma on your wall to help your parent achieve either of those goals.  

Being there to solve a problem or provide company are tremendously worthwhile services you can provide – no expertise required. Remember, as your parent gets older, his quality of life becomes more important to him than how much longer he lives. And he doesn't necessarily need medications or surgery to ensure that he's living the latter part of his life to the fullest.  

If he enjoys books but has difficulty reading regular-sized type, check out sight-saving titles at the library. If he's grieving the loss of his best buddy, introduce him to new acquaintances at the senior center. If he's living in a nursing home, bring your kids there to share a meal with him.

Sometimes, it's the small gestures that have the most profound impact. As the child of an elderly parent, you are uniquely positioned to deliver these life-changing gifts.  

Dr. Robert Stall is a geriatrician practicing in Tonawanda, New York and a clinical associate professor at the University of Buffalo's School of Medicine and Biomedical Sciences. He serves as medical director and attending physician at Beechwood Homes in Getzville and Blocher Homes in Williamsville. To learn more about senior care issues, visit his website at stallgeriatrics.com or call 716-213-4345. For information on a new program offering balance assessment and fall prevention tips, call 716-213-0772.

Options For End of Life Caregiving

There are many decisions to be made when imminent death is approaching for a loved one.  Questions regarding what type of care, medical assistance and even physical location for their last days confront us.

If care at home has been given, should loved ones be moved to a facility or remain at home?  If in a care facility should they be moved home for their last days?  Will 24-hour care become necessary and more medical assistance be required?

If you are asking these questions, a Hospice service might be a good solution. Hospice can be provided to a person who has a life-limiting illness wherever that person lives. A nursing facility or long-term care facility can receive visits from hospice personnel in addition to the other care and services provided by the facility.

Hospice care is a special way of caring for a patient who is in the last stages of life. Hospice provides a team of professionals who aid the patient and family caregivers. This could include nurses, social workers, physicians, clergy and aides who all work together to plan and coordinate care, 24 hours a day or as needed.

The Hospice Foundation of America outlines the following services of hospice:

• Hospice is a special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments.
• Hospice care neither prolongs life nor hastens death. Hospice staff and volunteers offer a specialized knowledge of medical care, including pain management.
• The goal of hospice care is to improve the quality of a patient's last days by offering comfort and dignity.
• Hospice care is provided by a team-oriented group of specially trained professionals, volunteers and family members.
• Hospice addresses all symptoms of a disease, with a special emphasis on controlling a patient's pain and discomfort.
• Hospice deals with the emotional, social and spiritual impact of the disease on the patient and the patient's family and friends.
• Hospice offers a variety of bereavement and counseling services to families before and after a patient's death.

To be eligible for hospice a physician must certify the patient to be terminally ill with a life expectancy of six months or less and treatment for a cure is no longer provided.

The focus for the patient has changed to supportive care and quality of remaining life.

Hospice is paid for by private insurance, Medicare or Medicaid Hospice Benefit or personal funds.

Here are the conditions that apply for Medicare Hospice Benefits:

• You are eligible for Medicare Part A (Hospital Insurance)
• Your doctor and the hospice medical director certify that you’re terminally ill and have 6 months or less to live if your illness runs its normal course.
• You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness.
• You get care from a Medicare-approved hospice program
• You understand that Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness. Medicare.gov

Special benefit periods apply to Medicare hospice care and some services do not apply.
Be sure to understand the rules and requirements of Medicare payment before you commit.

Hospice is available to anyone, regardless of age or illness. If Medicare or private insurance is not available, hospice services may be available for low income individuals through grants or charitable donations. Many hospices are non-profit and will provide services to anyone in need.

“Many families or their loved ones' doctors often wait too long to order hospice. Hospice is a very valuable service and should be ordered at an earlier stage of illness. Many do not consider hospice for Alzheimer's, degenerative old age or other debilitating illnesses where a person is going downhill fast. They should.

It is unfortunate that many people who died in a hospital emergency room or who received heroic treatments to prolong life in a hospital may have had the alternative of dying at home in familiar surroundings, with family or other loved ones at their side.
When someone is in crisis or appears to be going downhill fast but there really is no hope for recovery, family often call 911 and start a process which can result in great stress and great emotional discomfort. The loved one who is dying ends up in a hospital and may die there or be transferred to a nursing home where death eventually occurs.
When there is no longer hope for prolonging life, especially when this decision is made months in advance, hospice is usually a better alternative to other medical intervention”. National Care Planning Council

The days leading up to the moment of death of a loved one can be rich with meaning and expressions of love. Family and caregivers should allow others to help with the care and daily responsibilities.  They need to free themselves from the details of caregiving and instead need to use hospice to allow more time to reminisce, give thanks for a life shared and say goodbye.

Downsizint,Organizing, Handicap Remoldeling or Relocating

When Robert and Anne bought their family home thirty years ago, their plan was to live through retirement in this home. They had furnished their home with refurbished antiques acquired from their many trips together. It was one of their cherished antique coffee tables that Robert tripped over, breaking his hip.  Now with his return from the hospital in a wheelchair, the overwhelming task of making their home accessible for Robert’s wheelchair and safe for both of them faced Anne.

Remodeling for wheelchair access, organizing home furnishings and daily living items or downsizing and relocating to a smaller living area are monumental tasks that are many times thrust on senior home owners.  Sometimes the need to do this is brought on by injury or age related illness. Home and yard maintenance can become a daunting chore for even the healthiest of seniors, requiring them to make a downsizing decision.

There is a large and growing industry of specialists who understand these challenges of elderly homeowners and are ready and willing to help with remodeling, organizing or the sale of the home and with the move to a new location.

A professional organizer provides skills in making the home safe and manageable. Relocating furniture, removing hazards such as electrical cords, throw rugs, heavy objects on shelves that might fall are some of the ways they make a home more senior friendly.  They specialize in helping seniors part with items that clutter or have no valued use, so to make rooms less crowded or to make ready for a move to a smaller living space.

Handicap remodeling services and senior safety services offer help in adding wheelchair ramps and widening doorways. Bathrooms are made more accessible and safe, with hand rails, walk-in bath facilities and easier access to toilets.

If moving to a smaller retirement home or care facility is the best solution there is another senior specialty provider to call on called a Seniors Real Estate Specialist.

The Senior Real Estate Specialist concentrates more on a complete service package for the sale of the property and/or the purchase of a new living arrangement. The specialist also arranges for the services of a relocation specialist or Senior Move Manager to provide a complete, stress-free package for the elderly homeowner.

A move often requires downsizing and getting rid of a tremendous number of acquired possessions. The relocation specialist or Senior Move Manager, as they are often called, will typically provide a turnkey operation that includes assessing and identifying items to keep, arranging for auction or other disposal, cleaning the home, moving the belongings and setting up the new residence. The manager may also work closely with a real estate agent to arrange for the sale of the home and may also be involved in the financial transactions necessary to move into a new living arrangement.

All the help available to seniors may in itself be overwhelming.  How do seniors choose the right service provider for their needs?  How do they know they will hire someone qualified, responsible and honest?  Area Agencies on Aging and State Better Business Bureaus are good resources to check out available service providers.

Family, friends and religious leaders can be valuable resources to seniors in referring service providers and helping to manage the hiring and supervision.

The National Care Planning Council’s website www.longtermcarelink.net provides educational articles and information on eldercare providers throughout the nation.

Elder Law Attorneys Specialize in Helping the Elderly

Many elderly persons rely entirely on their children, family members or other trusted individuals to help them. This dependence upon caregivers or family members makes an older person more vulnerable to abuse and financial exploitation. Legal arrangements and protective actions by family may be necessary to shield loved ones from making bad decisions or from being taken advantage of.

Though you wouldn’t think a child could take advantage of his or her mother or father, there is no way to know what someone will do who is desperate for money or who feels entitled to an inheritance. For example:

David’s parents' health was failing and living alone in their home was becoming a concern. His sister Jill wanted to look into assisted living for them. David immediately became upset at Jill for wanting to spend their money. He packed up his parents and brought them to his home. Being single and working, he was not available to them during the day, but left food and water on the table to sustain them until he returned home in the evening. Jill lived over 300 miles from David and when she could get to his house to visit; she found her parents' care was not acceptable. They could not remember if they took their medications or if they had even eaten a meal that day. David was also draining their savings account and when confronted about it, became angry and complained that he needed their money to pay expenses for their care. Clearly Jill felt her brother's care of their parents was abusive, but David’s defense was he provided a home for his parents in which he could care for them. This family needs a professional advisor to help them understand and clarify the issues concerning their parents' care.

Making legal decisions about property, finances, power of attorney, and final wishes are important tasks to complete for the final years of life. Having legal documentation for a will, for medical treatment and for the person designated to be responsible for parents' welfare can avoid family disputes and financial abuse, and help to conserve assets that are needed for care.

Elder law attorneys specialize in legal issues affecting the elderly. They are knowledgeable about Medicare and Medicaid programs. They work with the elderly in assisting them and their families with all aspects of estate planning and implementing necessary legal documents for the final years of life. In addition, they help individuals to apply for and possibly accelerate coverage from Medicaid. An elder law attorney can also help with disputes with Medicaid. Below is a partial list of what an elder law attorney might do:

• Preservation or transfer of assets seeking to avoid spousal impoverishment when a spouse enters a nursing home
• Medicaid qualification and application and Medicaid planning strategies
• Medicare claims and appeals
• Veterans Benefits claims
• Social security and disability claims and appeals
• Disability planning, including use of durable powers of attorney, living trusts and living wills
• Help with financial management and health care decisions; and other means of delegating management and decision-making to another in case of incompetence or incapacity
  Probate
• Administration and management of trusts and estates
• Long term care placements in nursing homes and assisted living
• Nursing home issues with patients’ rights and nursing home quality
• Elder abuse and fraud recovery cases

A Certified Elder Law Attorney (CELA) is an elder law attorney who is highly proficient in meeting the legal needs of elders and in understanding and applying the rules of Medicaid. A CELA has successfully handled a requisite number of pertinent cases in order to receive that designation. This experience will make an attorney with this designation more competent with elder planning issues than other attorneys lacking this designation.

Most elder law attorneys do not specialize in all of the areas iterated above. When considering an attorney you will want to find one who has experience in the area you need help.

According to The National Academy of Elder Law Attorneys -- http://www.naela.org/:

“Ask lots of questions before selecting an elder law attorney. You don't want to end up in the office of an attorney who can't help you. Start with the initial phone call. It is not unusual to speak only to a secretary, receptionist or office manager during an initial call or before actually meeting with the attorney. If so, ask this person your questions.

• How long has the attorney been in practice?
• Does his/her practice emphasize a particular area of law?
• How long has he/she been in this field?
• What percentage of his/her practice is devoted to elder law?
• Is there a fee for the first consultation and if so, how much is it?
• Given the nature of your problem, what information should you bring with you to the initial consultation?"

A good way to choose an attorney is by referral from friends, family, clergy or other associations. Before you meet for your initial consultation, prepare the items you want discussed and taken care of. Bring pertinent documents and questions. Be sure you get clear answers and that you understand what your attorney is proposing.

Two-way communication is the best way your attorney can understand your needs and concerns. Does the attorney listen to what you say, appear to really care about your concerns or return your phone calls? If not find another attorney. Most Elder law Attorneys sincerely want to help make you or your parent's elder years a well planned for, peaceful experience for all involved.

There are a number of ways attorneys charge for their services. They may charge a flat hourly rate. Or they may charge hourly for some services and add on additional expense for out-of-pocket costs such as paperwork, stamps, phone calls, etc. Or they may charge a single fee for a mutually agreed-upon course of action or plan. Some attorneys who specialize in appeals for veterans benefits or Social Security may work on a contingency basis. It is important to understand how you will be billed so there will be no surprises in the end.

The National Care Planning Council lists elder law attorneys throughout the United States. To find someone in your area go to http://www.longtermcarelink.net/a2cfindattorney.ht

Medication Errors and the Elderly

At 83 years old, Martha still lived in her own home, and enjoyed working in her garden and canning peaches. It was becoming harder to motivate herself, to get up in the mornings and accomplish the day's tasks. She confided to her daughter that she felt anxious and tired. Her daughter, who was taking medication for her anxiety, took Martha to her own doctor, not Martha's and got her a prescription for Valium. In doing so, the daughter's doctor, who had never seen Martha and who did not have her medical history, was only aware of a few medications they told him she was taking.

Martha, in fact, was taking 9 different medications as well as herbal supplements.

The addition of Valium to her existing list of prescribed drugs sent her to the emergency room with respiratory distress. If she had gone to her own doctor, he would have found that a dosage adjustment of her current medications would have solved her anxiety.

Medication errors are common in the elderly. Many seniors take on average 6- 8 different prescriptions as well as over the counter drugs. Many times the elderly will not go back to their doctor to have their dosage evaluated and changed if necessary. Family members should be aware, that elderly parents may tend to take the family's advice over going to their own doctor. Even though children want to help increase the health and stamina of their parents, they may in fact be causing damage by misdirecting their loved ones.

Where a younger person can benefit from herbal supplements like Ginkgo Biloba, Saw Palmetto and others, in older people, these herbals may cause adverse reactions with their prescription medications.

In 2003, a panel of experts put together a list of potential medications that would not be appropriate to give to seniors. This is called the “ Beers List ” after one of the research professionals.

Dr. Donna M Fick, R.N. one of the panel members for updating the “Beers List,” states in her article on Seniorjournal.com:  

"Just as our bodies physically slow down as we age, changes occur in the way that older bodies handle pharmaceuticals, and this has motivated experts to develop a list of drugs that may be harmful to elderly patients.

"With age, drugs tend to build up in the body, and the distribution and elimination of drugs from the body changes as well," says Dr. Donna M. Fick, R.N., associate professor of nursing at Penn State. "Many drugs, like diazepam (Valium) and other anti-anxiety drugs build up fast." 

An on-line article on HealthSquare.com, Titled "Drugs and the Elderly," talks about physical symptoms and medications.  

“ Among the first signs that a drug may not be working properly in an older person is a change in mood, energy, attitude, or memory. Too often, these alterations are overlooked, ignored, or chalked off to "old age" or senility. Older people may themselves feel that their blue mood is caused by something external such as the death of a friend or simply by boredom. Nothing could be farther from the truth. Virtually every heart medication, blood pressure drug, sleeping pill, and tranquilizer has been known to trigger depressive symptoms.

When a psychological symptom appears in an older person, examine his or her medication or drug use first. Consider, too, factors like alcohol intake, poor nutrition, and hormone imbalance. And never dismiss the possibility that a real psychological problem has developed and may itself require medication.”

There are many things family members can do to help monitor medications for their elderly parents.

• Make a list of medicines prescribed and all supplements being taken.
• Give this list to the doctor and pharmacist and have one on hand for emergencies.
• Use the same Pharmacy to fill all prescriptions. Pharmacies keep a record of your prescribed drugs and will verify your doctor's instructions. They will also tell you if foods or over the counter supplements will interact with a prescription.
• Dispense pills in a daily pill organizer box.
• Have a family member be responsible to call or physically monitor the taking of medication

Family members who live long distances from their elders have available to them new technology in medication monitoring.  

• Alarms for pill boxes, watch alarms, medical alarm bands and necklaces that ring a reminder.
• Computerized pill box dispensers that ring a designated number if the pills have not been taken.
• Home Telehealth -

“Technology has developed computer and computer cameras to help the elderly in their homes stay safe and healthy. Home telehealth-set up by medical professionals in the home--enables providers to monitor such things as medications and blood pressure and actually see the patient. Patient questions are answered and advice is given, while the monitoring nurse views through the video phone how his or her patient looks physically.” The 4 Steps of Long Term Care Planning, Pg 92  

• Home Care Agencies – Home care companies offer a variety of service options in helping families care for and properly dispense medication to their elder parents.

Find a home care agency in your area http://www.longtermcarelink.net/a7homecare.htm

Overmedication or taking medication incorrectly may lead to early mental confusion and decline in health in seniors. “If medication problems were ranked as a disease in cause of death it would be the 5 th leading cause in the United States”. (from article on LongTermLiving)