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Drug Abuse is on the Rise for Seniors

Many seniors are from a generation that, on the whole, still scorn drug abuse and stigmatize those people who engage in such activities. However, as the baby boomer numbers increase in senior living environments, they bring with them a more freewheeling attitude about drug use and misuse rooted in the culture of the 1960s and onward. Many of the senior baby boomers have experienced illegal drugs first hand, and because of a sense of nostalgia, their views may be more tolerant to the overuse or abuse of drugs.

The opioid epidemic in America is now firmly rooted in the senior population. Statistics indicate that opioid addiction has been growing as fast or even faster among seniors compared to other age groups. The National Institute on Drug Abuse (NIDA) estimates 115 Americans die every day from overdosing on opioids and according to 2014 report by the government Agency for Healthcare Research and Quality, the rate of hospitalization for opioid overuse among those people 65 and older has increased over five-fold since 1993 and continues to worsen.

The crisis has grown mainly from doctors prescribing opioids like OxyContin much more frequently beginning in the mid-1990s under guidelines and assurances from pharmaceutical companies that opioid pain relievers were not as addictive as previously reported. However, this opioid class of drug is highly addictive, and many patients prescribed the medication end up abusing their prescriptions. Based on controversial research in 2009, the American Geriatric Society (AGS) announced that they were in favor of prescribing opioids, asking doctors to consider opioids for any senior with moderate or severe pain. Since seniors often have multiple chronic pain conditions, it is easy to see how addiction rates can skyrocket among the senior population. But, it is more than just opioids.

According to the Drug and Alcohol Dependence Journal, of the 63% of senior study participants who had an alcoholic drink over the course of one month, 13% had engaged in binge drinking, which is defined as having five or more drinks in a single session of imbibing. Bars and pubs are becoming one of the new normal amenities in life plan communities, and it can put seniors at significant risk. Stumbling and falling after having too much to drink or driving a small golf cart while impaired can have disastrous consequences. There is also a danger of mixing prescription medications with alcohol, which can be fatal.

Beyond opioids and alcohol, there is marijuana. As more and more states legalize medicinal (and recreational) marijuana and provide them in edible forms, more seniors are turning to pot as a painkiller and anti-nausea treatment. Contrary to what many believe it is not harmless, especially in a geriatric patient. The strains of marijuana available are potent and can create confusion, delirium, and even psychotic episodes in seniors and their interactions with legally prescribed medications are often hard to assess.

Professional staff in the aging services industry are trained to look for signs of drug misuse and abuse. The Center for Disease Control (CDC) is now recommending doctors to opt for short-term, fast-acting medications instead of long-lasting drugs and prescriptions.  But seniors who experience multiple, chronic pains may find this means they take more pills as their conditions are usually degenerative.

The best way to solve the problem is through education. As a senior, one should be aware of their medications and the proper doses to take. Encourage each doctor to prescribe the lowest necessary dose and look to alternative options to address pain. Never exceed the recommended dose as prescribed and follow the instructions given by the doctor.  Do not take prescription medication with alcohol. If a senior is having trouble understanding their medications or gets confused with the dosage, encourage them to talk to a trusted family member. Consider drafting a medical power of attorney document that will allow someone the senior trusts to be their advocate for a safe and happy senior life.

Call our office today at (775) 853-6700 to schedule a consultation, or click here now to send us a message! Let’s discuss how we can help you with your planning.

Why You Should Be a Tech-Savvy Senior

Although the “digital divide” is closing, there are still many senior citizens who remain apprehensive about jumping into technology use. However, technology can be a very useful tool in the hands of seniors. Let’s discuss the benefits of becoming a tech-savvy senior.

Social Connections

Technology is an excellent way to maintain social connections, even when seniors may not be able to get out and about. Social media is an excellent way to keep in contact with family and friends. Many seniors are finding their way to online social media sites like Facebook. Family and friends can share photos and videos and send messages. Texting is another excellent way to stay connected to family and friends. In fact, many grandparents are realizing that if they want to communicate more with their grandchildren, they must learn to embrace texting. Another excellent way to preserve social connections is to use video communication like FaceTime and Skype. These allow the senior to see the person while talking to them.

Safety

Technology provides many options for the safety of senior citizens. Medical alert technology helps seniors in trouble to access the help they need in the event of an accident, such as a fall. Of course, security systems provide safety for seniors against break-ins and home invasions.  Apps that provide medication reminders can be very beneficial to seniors. For example, if a senior has an app to remind them to take medication, they do not run as much risk of forgetting to take the medication or forgetting they have taken the medication and overdosing himself or herself. Technology that provides safety for seniors helps them maintain their independence.

Convenience

Technology can make tasks easier for senior citizens. Let’s take, for example, online grocery shopping services. These services allow seniors to order groceries and household needs online. Then the senior can go to the store, pull into the designated area, and the groceries are brought right to their car and loaded for them. This cuts down on the amount of lifting and can help those who have mobility issues. Online shopping is another use of technology that brings more convenience to the lives of seniors. Many seniors are unable to get out and about or just prefer to avoid crowds on the road and in stores. For this reason, online shopping can be very appealing and convenient.

Exercise

Technology is a useful tool for seniors who want to stay active. Devices like the Fitbit or other step trackers can motivate seniors to get up and get moving. There are also a number of apps for cell phones and iPads or other tablets that provide seniors with exercise programs and tracking. In addition, the internet also offers many programs to help seniors get exercise.

Entertainment

Technology provides entertainment for people of all ages, including senior citizens. Services provide access to movies and music. Devices have apps for many kinds of games that seniors can play. Many of these activities can be done virtually with friends and family as well. Kindles and other e-readers can make books more readily available to senior citizens. Many books are available in electronic format for free through libraries and others are available to buy online. The print is adjustable which helps with poor eyesight. Not only do many of the apps provide entertainment, but they can also keep the minds of seniors sharp. Crossword, Sudoku, and other puzzle and brain games can be entertaining and keep seniors’ minds alert.

Seniors should not be afraid of technology. It can make life easier, more convenient, and more fun. Seniors can find new ways to keep up with busy family and friends. If technology makes you or a senior you love apprehensive, look for free classes at your local library, senior center, or through community education.

If you have any questions about something you have read or would like additional information, please feel free to contact us for a consultation.

Giving Gifts While on Medicaid Can Be Risky

Mabel’s children were concerned that Mabel would need long-term nursing-home care in the near future. It was the holidays, and Mabel always got a lot of joy out of generosity. But her children had heard that people in Mabel’s circumstances should not give gifts.

The concern is real. For Medicaid to cover the huge expense of nursing-home care, Mabel would have to show that she owned nothing more than around $2,000. And she must also show that she had not given away money or assets over the prior five years (2.5 years in California). That Medicaid rule – the “look-back period” or the “transfer penalty” – would charge Mabel dearly for her generosity. Depending on the size and number of gifts, the penalty could be substantial.

Many wrongly think that there is no penalty for gifts of up to around $15,000 annually. That misunderstanding confuses tax law with Medicaid law (and it also misstates tax law, but that’s another subject). The Medicaid rules are entirely different from the tax rules. In the Medicaid context, gifts of any amount that are given during the look-back period can be penalized.

There are exceptions. These include gifts to spouses and siblings under certain circumstances, disabled children, and children who are caregivers and who live at home with the elder for a span of time. But overall, gifts and Medicaid do not go together. The Medicaid rules are complicated and the consequences for mistakes can be very costly. There are a number of options to protect assets and still qualify for benefits, but these options must be weighed with great care. This is why it’s best to consult attorneys who, like us, are qualified by experience and expertise in Medicaid law.

There is one harmless deception Mabel’s children might consider, to keep Mabel happy and still satisfy the Medicaid rules. The children might help Mabel fill out checks for all the gifts she’d like to give, together with a greeting card for each gift. Everybody could thank Mabel, tear up the check later, and tell her what they “bought” with that amount. It may be that that little device would be worth it, so Mabel could enjoy the holidays too.

Otherwise, the sooner you consult a qualified elder law attorney, the more other options may be available. If we can be of assistance, please don’t hesitate to reach out for a consultation.

How Seniors Can Give Care When They Need it Too

When Jeanette’s mother was hospitalized, Jeanette’s father begged her, with tears in his eyes, to take care of mother if he ever couldn’t. Of course, Jeanette said “yes.”

Years later, when Jeanette’s father had gone and mother’s hearing and eyesight failed, she could no longer drive, and she had fallen several times, Jeanette remembered that promise.

Jeanette’s first step in keeping that promise is to make sure that if mother hasn’t already done so, she should visit us, your friendly elder-law counselors. We will check to see that mother has done the financial planning and powers of attorney that every adult needs, especially older adults, particularly those in mother’s situation.

As Jeanette keeps her promise, she will join a community of millions who are taking care of aging parents. The challenge is enormous. Caregivers can feel the loss of freedom keenly.

Family emotional issues left unaddressed for years, may re-emerge. Jeanette might be spending money she’s not sure she has. She can’t sleep for worry. She is wrestling with the demands of caregiving, at the same time she’s striving to meet commitments to her own family and workplace. Her or another family member’s health can act up. Time off from work is harder and harder to come by, yet she may face daily demands and frequent emergencies.

The great numbers of people in Jeanette’s situation pose a substantial public-health issue. Congress has recently passed the RAISE Family Caregivers Act, to establish a national strategy to provide assistance to so many of us.

It’s very important that caregivers also take care of themselves. Time-honored flight attendants’ advice is good here, too: Put on your own oxygen mask first. For advice on self-care and how to manage caregiver stress, visit the Mayo Clinic website, here.

Then, take full advantage of the numerous resources listed below. Remember:

Keep the home fires burning – but don’t you burn out yourself.

Area Agencies on Aging

This is a national association of nonprofit agencies serving as a clearinghouse for information on public long-term support and benefits. Services include elder transportation, emergency assistance, respite care (temporary supervision of the elder to provide rest for the caregiver), individual counseling and support groups, and caregiver education classes and training.

Caregiver Action Network

This website provides advice organized by the stage of the process the caregiver is in, helpful care checklists, and advice on cost management and juggling work and family obligations with caregiving responsibilities.

Caregiving.com

Here find podcasts, a story-telling project, a directory of caregiving consultants, an extensive free webinar library covering numerous topics including “decision fatigue,” plain old fatigue, boundary-setting, respite care, and many others.

Family Caregiving Alliance

This is the first community-based nonprofit in the country to address the needs of families and friends providing long-term care for loved ones at home. The site provides information, support, and resources state-by-state, as well as sponsoring research initiatives for caregiver programs and policies.

National Alliance for Caregiving

This site provides a long list of resources, including government programs for family caregivers, care locators, caregiving calendar to coordinate group volunteer efforts, financial information, and organizations that address caregiving for specific conditions like cancer and Alzheimer’s.

Parenting Our Parents

Peer-to-peer networking, family coaching, videos, and website compendiums.

If you have questions on anything you have read or would like additional information, please don’t hesitate to contact us for a consultation.

Medicaid and Planning for When Your Ill Spouse Leaves Home

You may see it coming: Much as you want to and hard as you try, you just can’t take care of your ill spouse at home anymore. At this emotionally difficult time, the last thing you need is the stress of not knowing where to find the money to pay for the steep costs of institutional care.

Advance planning is a must. As as soon as you can – ideally at least five years before serious health problems arise – take advantage of many elder attorneys’ willingness to talk with you for free, or for a modest initial-consultation charge.

We are here to help you navigate the complexities of the Medicaid program. This is a governmental fund available to meet the staggering expense of institutional care, but the ins and outs of the qualification rules are complicated and mistakes can be costly. Here’s a thumbnail to help you grasp what your attorney will be telling you.

The Difference Between Resources and Income

Medicaid assistance is available only to those who own very little. The Medicaid rules determine what “owning very little” actually means. A person can only own around $2,000.00 of what Medicaid calls “resources.”

Resources include cash in the bank, CDs, the cash value of insurance policies, investments, and the like. Income includes regular paychecks, Social Security, or payments received for child support. Both income and resources are potentially “counted” by Medicaid as “available.” To qualify for assistance, available income and resources must be carefully spent or transferred away.

Exempt Resources

Some resources are not counted or, in other words, are exempt. This means the Medicaid rules exclude them from adding up to the $2,000.00 limit. These resources are sheltered from Medicaid’s requirement that the applicant must spend down almost everything before assistance will be available.

A married couple’s residence, one motor vehicle, household goods and furnishings, medical equipment, jewelry, and other items are exempt. This means that an ill spouse can still qualify for Medicaid assistance even if the couple owns those resources. There’s no need to give them away or sell them to qualify.

The distinction between “exempt” and “non-exempt” assets can be tricky, though, and should first be assessed by a qualified elder-law attorney before any action is taken.

What the Well Spouse Can Keep

The Medicaid rules permit a spouse who remains at home to keep a portion of the couple’s resources. This is known as the “community spouse resource allowance” (CSRA). Of course, you’d like to see the healthy spouse keep as much as possible within the CSRA limits. Planning can arrange the distribution of resources to make that happen.

Here is where the difference matters between “resources” and “income.” Medicaid distinguishes between the healthy spouse’s income and the couple’s resources. Resources over the CSRA limit must be spent down or carefully transferred. As to income, the healthy spouse can keep it up to a certain level, so he or she will have enough money to live on. The Medicaid rules call this the “monthly maintenance needs allowance” (MMNA).

For example, if the healthy spouse gets Social Security benefits of only $500.00 a month, but her allowed MMNA is as high as $2,000.00, it makes sense to convert some of the couple’s resources into raising her income up to the MMNA limit. This is not a simple matter, though, and should be done only on the advice of a qualified elder-law attorney.

Planning for Medicaid eligibility can be complicated. Please consult an elder-law attorney as soon as possible. The sooner you plan, the more strategies are available to protect your resources. An initial consultation with a qualified elder-law attorney, for free or for a modest amount, could save you many thousands of dollars.

Don’t delay. If you’re in need of a long-term care plan, or maybe you’ve started and don’t quite know what to do next, contact our office for a consultation today.

Medicare Launches App to Help Beneficiaries Find Out What’s Covered

At the doctor’s office and want to know if a procedure is covered by Medicare? There is an app for that. Medicare has launched a free app that gives beneficiaries a quick way to see whether the program covers a specific medical item or service. 

The “What’s Covered” app allows you to search or browse to learn what’s covered and not covered under Medicare Parts A and B, how and when to get covered benefits, basic cost information and other eligibility details. You can also see a list of covered preventive services.  The app does not give results for extra benefits that Medicare Advantage plans may cover but that Original Medicare does not, such as certain vision, hearing or dental benefits. 

Examples of the types of questions the app can answer include:

               When are mammograms covered?

               Is home health care covered?

               Will Medicare pay for diabetes supplies?

               Can I get a regular cervical cancer screening?

               Will my Medicare benefits cover a service to help me stop smoking?

Although the app provides beneficiaries with basic information, it doesn’t provide personalized information. It doesn’t ask details about each user’s specific insurance information, so it doesn’t take into account the user’s supplemental insurance, co-insurance, and deductibles. Essentially, the app provides another way for Medicare beneficiaries to get the same information that is available online and in the Medicare handbook.

The app is part of an initiative by the Centers for Medicare and Medicaid Services (CMS) focused on modernizing Medicare and empowering beneficiaries. Other initiatives include:

  • Enhanced interactive online decision support to help beneficiaries better understand and evaluate the coverage options and costs of original Medicare compared to Medicare Advantage plans.
  • New price transparency tools that let consumers compare the national average costs of certain procedures between settings, so people can see what they’ll pay for procedures done in a hospital outpatient department versus an ambulatory surgical center. 
  • A new webchat option in the Medicare Plan Finder.  
  • New easy-to-use surveys across Medicare.gov so consumers can tell CMS what they want.

To get the new “What’s Covered” app, go here: https://www.medicare.gov/blog/whats-covered-mobile-app.

A Final Retirement Account Distribution Must Still Be Made After Death

Federal law requires that beginning on April 1 of the year after you reach age 70 1/2, you must begin withdrawing a minimum amount from your non-Roth individual retirement account (IRA) or 401(k) accounts. These withdrawals are called required minimum distributions (RMDs).

But what if you die after age 70 1/2 and before all the account funds have been distributed? In the eyes of the law, death is no excuse not to take RMDs from an IRA or 401(k). Your heirs must take the final RMD before they can take control of the account.  

The rules for inheriting an IRA as a spouse are different than the rules for a non-spouse beneficiary, but regardless of who is inheriting the IRA, the heir must take the RMD for the year the account owner died. The full RMD must be taken by December 31 in the year the account owner died, even if he or she died at the beginning of the year. To take the RMD, beneficiaries must contact the custodian of the account and submit a death certificate. If the account owner died before he or she was required to begin distributions, then the beneficiaries do not need to take an RMD. 

The money from the RMD will go directly to the beneficiary listed on the account, not the estate. That means it will be taxable income for the beneficiary. If there is more than one beneficiary, it will be split evenly. 

To find out the best way to deal with an inherited IRA, contact an elder law attorney. To find one near you, go here: https://www.elderlawanswers.com/elder-law-attorneys