Articles Tagged with NYC elder law

Recently, the board for End Of Life Choices New York approved an aggressive new document that would allow individuals to stipulate in advance that they may refuse food and water should they develop dementia at some point. The goal of the directive is to allow individuals to speed up their death in late-stage dementia, if they so choose.

Despite being considered a terminal illness, states that already have end of life directives in place do not have laws that cover the condition, putting the new policy into uncharted ethical waters that have not been explored. The move comes as patients across New York and the rest of the country seek alternative options to address the very real possibility that they may become incapacitated with a severely debilitating condition.

The new document would allow patients one of two options should they find themselves in an assisted living situation with dementia. The first would allow patients to accept so-called comfort feeding by providing oral food and water if they patient appears willing to accept the nourishment. The second, would stipulate that the patient would receive no food or water, even if he or she appears to accept the feedings during the final stages of dementia.

Health and Human Services Secretary Alex Azar recently tapped former CVS executive Daniel Best to lead the agency’s effort to help lower drug prices for millions of Americans on Medicare coverage. Best was most recently a vice president of industry relations for the company’s Medicare Part D business and included CVS’s prescription drug plans, Medicare Part D plans and other clients.

“Daniel Best recognizes what President Trump and I, and every American know: prescription drug prices are too high,” Azar said in a statement announcing the appointment. “He has the deep experience necessary to design and enact reforms to lower the price of medicines that help Americans live healthier and longer lives.”

At a March 19 speech in Manchester, New Hampshire, President Donald Trump reaffirmed his pledge to lower prescription drug prices. “If you compare our drug prices to other countries in the world, in some cases it’s many times higher for the exact same pill or whatever it is, in the exact same package made in the exact same plant,” President Trump said during the speech. “We’re going to change that.”

The Centers for Medicare and Medicaid Studies (CMS) recently made a pair of announcements regarding changes to some of the important services the agency offers to millions of seniors across the country. Both of which aim to improve customer experience for CMS enrollees and help combat the threat of identity theft against those seeking vital medical treatments paid for in part by the federal government.

To help protect seniors from identity theft, CMS has begun phasing in new Medicare cards that no longer display enrollees’ Social Security numbers. Pennsylvania residents will be among the first to receive the new cards that assign each person a randomly generated eleven-digit number.

Social Security numbers are vital for accessing key financial information, medical records, and legal documents and should a Medicare enrollee’s card fall into the wrong hands, it could result in a serious case of identity theft. The new cards are tied directly to existing accounts so those who receive the new cards will have all their medical information will still be available with their doctors.

A federal court in Connecticut recently dismissed a lawsuit brought by a Connecticut man who felt jilted after being excluded from his still-living father’s estate on the grounds the plaintiff had yet to suffer any actual injury. The case is a cautionary tale for both testators and heirs in situations where familial tensions can manifest themselves into lengthy and expensive court battles that may end up doing little to resolve tensions.

The petitioner in this case filed suit against his father, sisters, and PNC Bank which was acting as the trustee to the father’s living trust. The petitioner alleged his sister, who was acting as the testator’s health care proxy and using a general power of attorney to make financial decisions, asserted undue influence on the testator to exclude him from the estate.

Unfortunately for the plaintiff in the case, the federal judge ruled that his lawsuit failed to live up to the basic principles of when and why courts can hear cases. The judge determined that because the plaintiff’s father was still living and he had yet to be excluded from any expected inheritance, the testator’s last will and testament could not be invalidated as of yet.

A recent survey conducted by Nationwide Mutual Insurance Company reveals just how far apart the expectations Americans have for their Social Security benefits are compared to the actual payments they will receive upon retirement. According to the survey by Nationwide’s Retirement Institute, more than half of the 1,0000 retirees or soon to be retirees surveys intend to rely on their Social Security benefits as their main source of income during their golden years and may fall well short of their needs.

The results give experts pause for alarm, particularly because of the gap between what those surveyed expect to receive and what they are actually likely to get when they apply for their retirement benefits. Future retirees expect to receive $1,628 per month in Social Security benefits but are more likely to receive $1,257 each month, a difference of almost 30 percent. However, this could be due in part to the fact that those surveyed intended to retire at 66 while many Americans recently retired at 62 which limited their benefits and brought the nationwide average down.

The survey also reveals major disconnects future retirees have about other financial aspects on retirement. Other surveys revealed that almost 40 percent of those on the cusp of retirement do not intend to spend any of their Social Security benefits on health care, an optimistic but unlikely outcome given recent trends in senior health care costs. A recent report by Fidelity Investments showed retired couples will likely spend up to $280,000 on healthcare over the remainder of their lives.

Proposed work requirements to Medicaid eligibility could result in some family caregivers losing their vital coverage, according to a recent analysis of Kentucky’s reforms by advocacy group Justice in Aging. Medicaid is vital to helping caregivers take care of their own health while caring for a loved one but depending on how states implement work requirements or defines “work,” family caregivers may end up losing their health insurance or face additional hurdles to keep it.

Caregivers are unpaid individuals like  spouses, partner, family members, friends, or neighbors involved in assisting others with activities of daily living and/or medical tasks. The selfless work they do for others in need is vital to the health and wellbeing of the individual and cannot be taken for granted or impeded by barriers that would cause widespread hardship.

According to the National Alliance for Caregiving and AARP, an estimated 43.5 million caregivers have provided unpaid care to an adult or child in the last year and of that number, 34.2 million Americans have provided unpaid care to an adult age 50 or older in the same time period. The majority of caregivers care for one other adult while about one in six care for two-adults. About 15.7 million adult family caregivers care for someone who has Alzheimer’s disease or other dementia.

The country’s largest trade group for health insurance companies is sounding the alarm on proposals from President Trump that would expand the sale of plans that cover fewer services to people who cannot afford some of the current short term plans. America’s Health Insurance Plans (AHIP) claims the proposal would lead to more Americans becoming uninsured or underinsured, resulting in higher healthcare costs in the future.

The rule proposed by the Trump administration would lift restrictions from the previous administration that limited short term health insurance coverage to a maximum of three months and allow individuals to purchase short-term health insurance for up to one year. The administration claims the move would create an alternative for those unable to afford plans compliant with ObamaCare covering a comprehensive list of services.

Opponents of the plan say the rule changes would mean insurance companies could end up charging individuals with pre-existing conditions more for their health care coverage, a major restriction placed on companies under current statutes of the Affordable Care Act (ACA). Instead, members of the AHIP suggest the short term health insurance plans be limited to only six-months of coverage, ensure clear disclosures to consumers about what short term plans do and do not cover, and inform consumers of the potential availability of discounted coverage through the marketplace.

A recent report by Bloomberg warns that states across the country could face a serious pension crisis much sooner than many expect or wish to acknowledge. The research points out that within the next five to 10-years, many large states could find themselves in insolvency due to enormous unfunded pension systems worth hundreds of billions of dollars, unless major changes are made to the system very soon.

While some states are in much better financial shape than others, having set aside the necessary assets to pay pensions for the near future or having the luxury of enough time to make requisite changes, others may need to see the writing on the wall. States with pensions promising to pay large sums of money to retirees will be in much worse shape, as cash flows and current pension reserves to do align with actuarial problems.

New York is one of the few states named by Pew with at least 90 percent pension funding in 2016, along with South Dakota, Tennessee and Wisconsin. Nearby New Jersey had one of the least funded pension systems, with only 31 percent of their $280 billion liabilities funded. States and cities with serious pension liabilities could find their systems break down in the near term if markets do not perform as expected and still fall apart in the next decade even if the stock market does well.

State regulators recently took control over dozens of nursing homes owned and operated by a New Jersey-based company that is responsible for over 100 facilities in eight states across the country, including three in New Jersey. In addition to operating homes in the Garden State, Skyline Health Care, LLC, owned by Joseph Schwartz, is the parent company for nursing homes and other facilities in Arkansas, South Dakota, Tennessee, Pennsylvania, Massachusetts, Nebraska, Kansas, and Florida.

According to reports, the company has failed to make its payroll in both Nebraska and Kansas, prompting state health department officials to take receivership of a combined 36 nursing homes, adult day cares, and assisted living facilities serving thousands of patients in those states. New Jersey Health Department officials acknowledged they are aware of the issues with Skyline Health Care facilities in Nebraska but has not received any reports of problems in New Jersey.

Nebraska health authorities placed 21-nursing homes and 10-assisted living facilities owned by Skyline in receivership in late March after determining that Skyline became unable to pay staff and ensure the future care of residents. Around the same time, Kansas state courts authorized a temporary receivership and are seeking a permanent one for 15-skilled nursing facilities with 845 patients, making it the largest takeover ever by that state’s Department for Aging and Disability Services.

The New York Assembly health committee recently held the first of two meetings on a proposed legislation that would allow some terminally-ill individuals with less than six-months to live the option to use medication to die in their sleep in cases where their suffering is unbearable. The committee members heard testimony from a variety of individuals including patients and their families, health care providers, legal experts, medical ethicists and religious leaders.

The committee’s exploration comes in the wake of a ruling by the New York Court of Appeals last year that ruled against three terminally-ill patients asserting they had a Constitutional right to die under their own conditions. The petitioners asked the Court of Appeals to shield their doctors from criminal charges in cases where physicians prescribe patients a lethal medication to end their lives.

New York’s Medical Aid in Dying Act, sponsored by Assemblywoman Amy Paulin and Sen. Diane Savino, would permit terminally-ill patients deemed mentally fit to end their lives by using medication provided to them by a physician. Proponents of the law assert that doctor-assisted dying is oftentimes the only alternative to a long and agonizing death, during which the patient may experience complete loss of their bodily functions and mental faculties.

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