Universal Care Requires Personal Responsibility

Compassionate people around the world are outraged that the richest country on earth doesn’t use its wealth to provide health services for its own citizens. I join them in celebrating Barack Obama’s victory on Tuesday because he understands that these conditions must change. But as we celebrate, let’s remember that his acceptance speech included a call to personal responsibility.

The United States is the only wealthy industrialized nation that doesn’t provide universal health care for its citizens. Some European countries have replaced government-run plans with programs that combine government and private coverage. Obama’s plan takes the latter approach one step farther. Its focus is preventive care, an essential component of any plan to reduce expenditures for the chronic illnesses that plague our nation.

Preventive care will require us to take responsibility for our own health. This is our duty to the nation and to our families. Neither the government nor private insurers can afford to pay for the results of undisciplined or self-destructive behavior. Our families also need us to help care for them and reduce their need for government assistance.

If we all vow to take charge of our health, we can help rebuild this nation with the strength we gain and the money we save.

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Jacqueline Laurette Jones is author of Unmasking a Diagnosis: How to get Help for a Confusing Chronic Illness Without Filing for Bankruptcy.

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Blog Offers Thanks for Spotlight on Elder Abuse

When I vented my frustrations in the post “Elder Law Can Interfere with Good Care,” I had no idea that the title highlighted a growing international controversy. The post was based on my observations of how the technicalities and costs of implementing our laws could lead to real trouble if not addressed.

In my follow up to that post, I shared a different view from Wendy H. Sheinberg, a Certified Elder Law Attorney (CELA) in Garden City, New York. She cited the Constitution, and she assured me that my statements “cast a scary shadow on laws that, for the most part, protect people.” Then a blog devoted to these issues praised my original post.

Spotlight on Elder Abuse posted the following statement:

“Thank you Jacqueline, for highlighting this important issue. There are so many cases of ‘Guardian/Conservator Abuse that needs to be addressed. But, we see very little been done. Imagine – we worked hard, paid our taxes; only to be abused by the system in our twilight years. Animals have more protection than many seniors. This is NOT acceptable in any language!”

I am glad to have played a part in shining a spotlight on this issue. Maybe I have more common sense than I think I have.

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Jacqueline Laurette Jones is author of Unmasking a Diagnosis: How to get Help for a Confusing Chronic Illness Without Filing for Bankruptcy.

Never Assume Anyone Thinks Like You

In yesterday’s post, I exhibited one of my greatest weaknesses. Because I would never deliberately hurt anyone, I usually assume the majority of people feel the same way. The results of my false assumptions could fill a book longer than War and Peace.

The current economic crisis should have been a wake up call for me. Instead, my frustrations with the complexities of caring for my parents overruled my common sense. Please forgive me, read to the end, and contact me with your own stories about dealing with these issues.

Wendy H. Sheinberg, a Certified Elder Law Attorney (CELA) in Garden City, New York, was kind enough to send an email that addressed specific points in my post. About Powers of Attorney, Ms. Sheinberg stated:

Your recent post misstated several facts and cast a scary shadow on laws that, for the most part, protect people. The state does not require the individual to execute these documents. The state has set up a structure that allows for the delegation of authority from the principal to the agent. This always existed as principal agency law and then became more specialized to allow particular delegations of very specific powers in a set way to insure a level of conformity which would then facilitate the use of these designations.

After rethinking my position on conservatorships, I was glad to read Ms. Sheinberg’s explanation of why limiting them won’t work:

The requirement of a guardian/conservator in the absence of such delegation is not found in an “elder law” but in the constitution, which is the very first law this country had. The constitution provides us with the right to be self determining and to address our own property. Such rights may not be infringed upon by anyone absent due process. Due process is a key component of any guardianship/ conservatorship as it limits personal liberties, including the restraining of property rights. These laws must exist. The inability to convey property or make medical decisions has always required capacity. Without capacity one cannot enter contracts, etc. The laws around the finding of a lack of capacity must follow constitutional guidelines, without which all of our freedoms would be at risk. This would result in allowing caregivers to determine on their own when they should be in charge and would infringe on the rights of the senior, without any due process and no oversight. I wonder what would be next on the firing range of constitutional infringement.

Though Ms. Sheinberg doesn’t explain how letting a home deteriorate from lack of use can help anyone, she cites a law that explains why my former neighbor’s home is vacant:

There is no seizure. Some states place a lien on the property to ensure a payback on death. The SCOTUS decision in Ahlbourne upheld the prohibition on the enforcement of liens until death. The lien is only in the amount of the service provided.

I stand behind my information on the requirement that a caregiver in my state live in a home two years before securing the right to remain there after the owner moves into a nursing home. This came straight from two CELAs.

Ms. Sheinberg explains another law that addresses the five year look back period:

DRA 2005, enacted as of 2/8/06, imposed a 5 year look back, which is fully enforced by 2009. This is a federal law. The states have the right to promulgate their own enforcement criteria, for DRA, but it is federal, and is technically required of all states accepting federal funds for Medicaid. Some states have been slower in their enforcement of the application of the new penalty rules, but there has been no hub bub about holding back on the five year look back. It is important for your readers to know that the five year look back and the new transfer rules only apply to transfers made after 2/6/08.

This still does not address the issue of paying for legal assistance to address these issues. Though there is no recognized “hub bub,” current economic realities prohibit many middle income families from getting help because the income guidelines are unrealistic.

This information may come too late to help some readers. Contact a Certified Elder Law Attorney in your state for personalized guidance. Visit the National Elder Law Foundation website to find a CELA near you.

Wendy H. Sheinberg, CELA, is a Partner in the law firm of Davidow, Davidow, Siegel & Stern, LLP, a law firm that concentrates in Special Needs, Elder Law, Estate Planning, Guardianships, Estate Administration Trusts, and Wills. She is one of fewer than 400 Certified Elder Law Attorneys. She has been certified by the National Elder Law Foundation as a Certified Elder Law Attorney and is one of fewer than 70 Fellows of the National Academy of Elder Law Attorneys and a member of its Board of Directors.

You can visit her firm’s website, email her at wsheinberg@davidowlaw.com, or call 516-393-0222.

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Jacqueline Laurette Jones is author of Unmasking a Diagnosis: How to get Help for a Confusing Chronic Illness Without Filing for Bankruptcy.

Radical Change Can Save Medicare, Medicaid

Updated 10/17/08

The next president of the United States must address the challenge of trimming Medicare and Medicaid costs. The vast baby boom generation has just begun to require services. Young and old citizens alike are succumbing to chronic diseases that can require years of expensive treatments. Many enter the system years ahead of schedule because of partial or total disability.

As a person living with and caring for someone with chronic illnesses, I want to share the following strategies that could greatly reduce the costs associated with these and related programs.

Redistribute a large portion of the funds now set aside for nursing home care into agencies that provide home care, day care, and respite services. The current regulations are absurd. Many caregivers provide full-time care for their loved ones because they can’t afford to send them to nursing homes or because most nursing homes have such bad reputations. The stress of attending to someone around the clock can lead to disability, premature death, or an illness that requires both the caregiver and patient to be admitted to a nursing home, in spite of the caregiver’s heroic efforts.

In addition to the in-home medical care and health education now provided, caregivers need help with bathing their patients two to three times a week and cleaning their homes once a week. Sitters and overnight respite care should be available as necessary. If based on individual family circumstances and guided by practical regulations, these services could help to reduce the number and length of nursing home admissions and create new jobs.

Require certification of non-medical home care agencies and training for their personnel. The pay is often so low that many of the workers don’t take their jobs seriously. Requiring certification and training would justify higher fees and wages and attract more responsible individuals into these positions.

Simplify paperwork for medical professionals. The amount of required documentation increases the cost of medical care and frustrates providers. The number of providers who will accept new Medicare patients in my city shrinks almost every month.

Reimburse non-traditional services provided by practitioners of functional medicine (FM). Unlike mainstream or allopathic medicine, functional or systems medicine addresses the causes of disease. FM practitioners focus on prevention as well as treatment of chronic diseases.

Give enough in food stamps to cover the cost of nutritious meals. Malnutrition leads to disease. Most people I know who are on food stamps run out of food long before the end of each month. A friend of mine, who is disabled, receives $10 a month. That won’t buy enough food to keep a cat healthy.

Ask recipients and providers how to improve these programs. Participants understand the weaknesses and strengths of the system.

For more on elder care issues, read my next three posts, “Elder Law Can Interfere with Good Care,” “Never Assume Anyone Thinks Like You,” and “Blog Offers Thanks for Spotlight on Elder Abuse.”

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Jacqueline L. Jones is author of Unmasking a Diagnosis: How to get Help for a Confusing Chronic Illness Without Filing for Bankruptcy. The book is available through Lulu.com and soon will be available through Amazon.com and other online book retailers.

Secrets of Paying for Health Care Unmasked (Part 2)

Here are more ways to pay for needed health care services:

Some providers will agree to barter services. Alternative providers are most open to this.

Insurance companies are covering a broader range of services than they have in the past. Some even cover the services of Certified Nutrition Specialists, Acupuncturists, and Naturopaths.

Research centers at universities often conduct clinical trials. Most participants receive free treatment, which can include travel and lodging costs, and usually receive monetary compensation as well.

The provider may participate in a discount plan. Prudent Choice is just one reputable option.

You can order suggested supplements at discount prices from another source. Needs.com, an international mail-order resource based in New York, sells health products at a substantial discount, promotes monthly specials, and offers free shipping for all orders over a certain price.

If the provider prescribes medication, ask about generic versions, samples, or free or reduced cost prescription plans. Generics are as effective as their brand name counterparts in most cases. Pharmaceutical companies also distribute samples of expensive brand name medications to doctor’s offices and provide their top-selling products to low-income patients through prescription plans. Seniors are eligible for Medicare prescription coverage.

Supplemental health insurance policies can cover gaps in your coverage. They can be used to pay deductibles and co-payments. They also may cover lost income and living expenses.

The provider may agree to discount a procedure that is medically necessary, whether or not you have insurance coverage or enough income. Contact the billing office and explain your situation ahead of time, if possible. If not, do so as soon as possible after the procedure.

Trusted friends, family members, co-workers, or members of your household of faith may be able to help. You may find this option difficult if you haven’t developed a support network, but you might be surprised.

You never know how God will bless you. Whether or not you believe in God, pray for wisdom and help, believe, and watch Him come through. He loves you, and He wants to provide your needs.

This post was updated 10/2/08.

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Jacqueline Laurette Jones is author of Unmasking a Diagnosis: How to get Help for a Confusing Chronic Illness Without Filing for Bankruptcy.