Article Archive

Changes to the FDIC Insurance Limit and How Revocable Trusts are Now Treated

How Much are Your Accounts Protected? New Interim Rule Simplifies Calculations

On October 3, 2008, FDIC deposit insurance temporarily increased from $100,000 to $250,000 per depositor through December 31, 2009.

Additionally on September 26, 2008, the Federal Deposit Insurance Corporation issued interim final regulations entitled Deposit Insurance Regulations; Living Trust Accounts, as published in the Federal Register, and as announced in FDIC's Press Release, "FDIC Simplifies Coverage Rules for Revocable Trust Accounts" (09/26/08). FDIC Insurance and Revocable Trusts: How Much are Your Accounts Protected?

With the recent rash of bank failures, there's been alot of confusion about the amount of insurance protection offered to bank accounts held in FDIC-insured banks. Coupled with this is the confusing rules that apply to trust accounts. In response, on September 26, 2008, the FDIC Board of Directors issued an interim new rule that applies to coverage offered to "Revocable Trust Accounts." Coupled with this new rule is the temporary increase in coverage from $100,000 to $250,000 per depositor and per beneficiary of a trust that was included in the $700 billion economic bailout package signed into law on October 3, 2008. The increase in coverage is scheduled to continue through December 31, 2009.

FDIC's Definition of "Revocable Trust Account"
The FDIC's definition of "Revocable Trust Account" includes informal trust accounts, including payable on death, or POD accounts, in-trust-for, or ITF, accounts, and Totten Trust accounts, as well as formal accounts that are owned by the Trustee of a traditional Revocable Living Trust.

Summary of the Old Rule
The old rule governing Revocable Trust Accounts provided for the following:
  1. Accounts were insured up to $100,000 per "qualifying beneficiary" designated by the owner of the account;
  2. Qualifying beneficiaries were defined as the account owner's spouse, children, grandchildren, parents and siblings;
  3. Multiple account owners received coverage separately for each owner, per qualifying beneficiary;
  4. "Per-qualifying beneficiary" coverage was available on Revocable Trust Accounts separately from coverage offered in connection with other accounts held in other ownership capacities (such as in individual or joint names) at the same FDIC-insured bank;
  5. An account was covered only if met it three requirements: (1) Title had to include the term POD, or ITF, or Revocable Trust, or a similar term indicating an intent that the account would pass to the trust beneficiaries after the owner's death; (2) Each beneficiary had to be a "qualifying beneficiary" as defined above; and, (3) For POD accounts, the beneficiaries had to be specifically listed in the account records, while the beneficiaries of a formal Revocable Living Trust didn't have to be listed;
  6. In determining coverage, it was necessary to understand each beneficiary's beneficial interest in the Revocable Trust, be it a lump sum bequest, a life estate, or an equal or unequal share of the residuary trust; and
  7. All funds that a owner held in both formal Revocable Living Trust accounts and POD accounts naming the same beneficiaries were aggregated for FDIC purposes and insured only to the maximum applicable coverage limits.
Summary of the New Rule
The FDIC had several goals with regard to the promulgation of the new interim rule:
  1. To simplify the rule so that it would be easier for bank employees and consumers alike to understand and apply;
  2. To eliminate the requirement that a beneficiary be a "qualifying beneficiary";
  3. To eliminate the requirement to look at the actual beneficial interest of each beneficiary of the Revocable Trust for accounts valued at $500,000 or less; and
  4. To set reasonable limits on coverage for trust accounts that have more than five different beneficiaries and hold more than $500,000.
As a result, the new interim rule retains all of the features of the old rule listed above with three important exceptions:
  1. Beneficiaries no longer need to be "qualifying beneficiaries." Instead, any beneficiary named in the Revocable Trust, as long as the beneficiary is a natural person, or a charity or other non-profit organization, is offered coverage;
  2. For accounts with total balances of $500,000 or less, coverage is determined without the need to ascertain each beneficiary's beneficial interest in the Revocable Trust (including life estates which are given $250,000 of coverage); and
  3. Coverage is limited for Revocable Trusts that have more than five different beneficiaries and accounts holding more than $1,000,000.
Using the FDIC's "Edie the Estimator" to Determine Your Coverage
Even though the interim new rule does simplify the calculation of coverage for Revocable Trust Accounts in many regards, figuring it all out can still be confusing. To help consumers determine their coverage, the FDIC website has a tool named "Edie the Estimator" that will calculate the coverage you'll receive on individual, trust, and business accounts held in FDIC-insured institutions.

Source: www.fdic.gov and about.com

Are You Sitting Down? Medicare Premium to Remain Unchanged in 2009

For the first time in eight years, Medicare's monthly premium will remain unchanged for most of the program's 44 million beneficiaries. The Centers for Medicare and Medicaid Services (CMS) announced that the Part B premium will remain at its 2008 level of $96.40 for 2009 for individuals earning $85,000 or less or couples earning $170,000 or less. The premium will go up for higher earners (see list below). The Part B deductible will remain at its 2008 level as well.

The monthly premium paid by beneficiaries enrolled in Medicare Part B covers a portion of the cost of physicians' services, outpatient hospital services, certain home health services, durable medical equipment, and other items.

This is only the sixth time since Medicare was created in 1965 that the Part B premium stayed the same for two consecutive years, said Richard Foster, Medicare's chief actuary.

Anticipating concerns, Foster, who has worked for the agency since the early 1970s, said "There is no political manipulation." The premium will hold steady in part because Medicare's reserves have increased, according to a CMS statement. Foster said monthly rates are likely to go up in 2010 as health costs continue to rise.

AARP warned in a statement that "Lawmakers should not use today's announcement as an excuse to rest. The average 73-year-old in Medicare has seen his or her premium double since joining the program. Americans old and young continue to struggle with skyrocketing health-care costs." (For example, a recent analysis found that the average monthly premium for stand-alone Medicare prescription drug coverage will increase by 24 percent to $37 next year.)

While the Part B premium and deductible will not rise, other Medicare deductibles and co-payments will. Here are all the new Medicare figures for 2009:
  • Basic Part B premium: $96.40/month (unchanged)
  • Part B deductible: $135 (unchanged)
  • Part A deductible: $1,068 (was $1,024)
  • Co-payment for hospital stay days 61-90: $267/day (was $256)
  • Co-payment for hospital stay days 91 and beyond: $534/day (was $512)
  • Skilled nursing facility co-payment, days 21-100: $133.50/day (was $128)
As directed by the 2003 Medicare law, higher-income beneficiaries will pay higher Part B premiums. About 5 percent of current Part B enrollees are expected to be subject to the higher premium amounts. Following are those amounts for 2009:
  • Individuals with annual incomes between $85,000 and $107,000 and married couples with annual incomes between $170,000 and $214,000 in 2009 will pay a monthly premium of $134.90
  • Individuals with annual incomes between $107,000 and $160,000 and married couples with annual incomes between $214,000 and $320,000 in 2009 will pay a monthly premium of $192.70
  • Individuals with annual incomes between $160,000 and $213,000 and married couples with annual incomes between $320,000 and $426,000 in 2009 will pay a monthly premium of $250.50
  • Individuals with annual incomes of $213,000 or more and married couples with annual incomes of $426,000 or more in 2009 will pay a monthly premium of $308.30
Rates differ for beneficiaries who are married but file a separate tax return from their spouse:
  • Those with incomes between $85,000 and $128,000 will pay a monthly premium of $250.50
  • Those with incomes greater than $128,000 will pay a monthly premium of $308.30
Source: Medicare

Medicare Stops Paying for 10 Reasonably Preventable Medical Errors

On Wednesday October 2nd Medicare began refusing to pay hospitals for additional care resulting from "reasonably preventable" errors, the New York Times reports. The new regulations, which apply to a list of 10 errors, are expected to affect hundreds of thousands of the 12.5 million hospital stays for which Medicare pays annually. Hospitals also will be banned from charging patients directly for care related to medical errors (Sack, New York Times, 10/1).

Under the rule, Medicare no longer will reimburse hospitals for the treatment of certain "conditions that could reasonably have been prevented." The conditions for which Medicare no longer will reimburse hospitals for treatment include: falls; mediastinitis, an infection that can develop after heart surgery; urinary tract infections that result from improper use of catheters; pressure ulcers; and vascular infections that result from improper use of catheters. In addition, the conditions include three "never events": objects left in the body during surgery, air embolisms and blood incompatibility. The rule was proposed by CMS in April 2007 and mandated by a 2005 law (Kaiser Daily Health Policy Report, 8/20/07).

The move is not expected to result in major reductions in expenses - $21 million of the program's $110 billion in annual spending on beneficiary care - but it "carries great symbolism in the administration's efforts to revamp the country's medical payment system," according to the Times. Critics of the current system to reimburse health care providers say it increases costs by rewarding quantity instead of quality of care, the Times reports. Economists anticipate the new rules will help reconfigure the payment system to place greater emphasis on prevention and chronic disease management and also discourage unnecessary treatments.

A Growing Trend
Four state Medicaid programs in the last year have announced that they will not pay hospitals for as many as 28 so-called "never events," or preventable errors. Several large insurers - including WellPoint, Aetna, Cigna and Blue Cross Blue Shield plans in seven states - have issued similar rules. At least 20 states also have passed laws requiring hospitals to report mistakes or preventable infections publicly. In addition, CMS requires that hospitals report on 42 quality measures.

Sources: Kaiser Daily Health Policy Report and New York Times

Drugs for Alzheimer's Disease Found to Slow Cognitive Decline: Benefits Last Years

Sept. 22, 2008 - In what some may call a "game changing" discovery, researchers report today their testing shows that the advance of Alzheimer's disease can be significantly slowed by the extended treatment with available drugs. They have also found a combination therapy with two different classes of drugs is even better at helping patients maintain their ability to perform daily activities.

Extended treatment with Alzheimer's disease drugs can significantly slow the rate at which the disorder advances, and combination therapy with two different classes of drugs is even better at helping patients maintain their ability to perform daily activities.

Results from the first long-term study of the real-world use of Alzheimer's drugs, published by researchers from Massachusetts General Hospital in the July/September issue of Alzheimer Disease and Associated Disorders, support a level of effectiveness that may not be immediately apparent to patients or their family members.

"There has been the impression that these drugs only work for some patients and for a limited amount of time," says Alireza Atri, MD, PhD, of the MGH Department of Neurology, lead author of the current study.

"One of the problems in judging these drugs has been that patients naturally continue to decline, which can make them think the drugs have stopped working. But our study, which has some unique strengths, indicates that treatment does have long-term benefit."

Two types of medications have received FDA approval for Alzheimer's treatment.
     
  • Cholinesterase inhibitors have been available since the mid-1990s and act by inhibiting the breakdown of the neurotransmitter acetylcholine.  
  • The drug memantine, which received FDA approval in 2003, is the first of a second class of agents that modulate the actions of the amino acid glutamate and is often used in combination with cholinesterase inhibitors (CIs).
"Clinical trials that drug companies conduct for FDA approval only last six months and enroll patients according to very specific criteria," Atri explains.

"Only large-population studies can really tell us how these drugs work for the full range of patients in real-life situations."

The researchers were able to conduct such a study by analyzing data on patients treated at the MGH Memory Disorders Unit since 1990, including:
      
  • 144 who did not receive any pharmaceutical treatment   
  • 122 treated with a CI alone and   
  • 116 who received both a CI and memantine
As part of their regular treatment, every six months patients received standardized assessments of both cognitive abilities and how well they carried out daily activities.

The results showed significant differences in the rate of symptom progression among all three groups - with the smallest level of decline in those receiving combination therapy.

While there was an average of two and a half years' worth of data on the study participants, the researchers analyzed the information with a statistical model that predicted probable outcomes for up to four years.

Although the model's projection of future benefits is conservative, it predicted that the longer patients kept receiving combination therapy, the smaller their rate of decline would become, suggesting that treatment might even protect brain cells from further damage, a possibility needing further investigation.

"Finding something that could actually modify the course of the disease is the Holy Grail of Alzheimer's treatment, but we really don't know if that is happening or what the mechanism behind these effects might be," Atri explains.

"What we can say now is that providers should help patients understand that the benefits of these drugs are long term and may not be apparent in the first months of treatment.

Even if a patient's symptoms get worse, that doesn't mean the drug isn't working, since the decline probably would have been much greater without therapy."

Atri is an instructor in Neurology at Harvard Medical School (HMS) and associate director of the Center for Translational Cognitive Neuroscience at the Veterans Administration Hospital in Bedford, Mass.

John Growdon, MD, director of the MGH Memory Disorders Unit, professor of Neurology at HMS, and senior author of the paper, explains, "The results of this study should change the way we treat patients with Alzheimer's disease. Cholinesterase inhibitors are approved for use in mild to moderate dementia, while memantine has been approved for advanced dementia. But it looks like there is an advantage in prescribing both drugs as initial treatment."

Information provided by news sources:
The study was entirely supported by grants from the National Institute on Aging and the Massachusetts Alzheimer's Disease Research Center; there was no involvement or support from the pharmaceutical industry. Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School.

Alert of New Scam

Many of our client's recently have received unsolicited official looking letters suggesting that they should obtain a certified copy of their deed. This is a scam; it is deceptive and not necessary. Here is a copy of a bulletin that has been issued by Lapeer County Register of Deeds. This alert applies to all Counties throughout Michigan.

If you have received a letter from National Deed Service, Inc. or Michigan Document Procurement Service, please be aware of the deceptiveness of its contents. This company is not affiliated with Lapeer County Government (or any County) in any way. This company is using tactics to persuade you to pay an outrageous fee to them and in return they will provide you with a copy of your deed. Please understand this company MUST obtain the Certified Copy from the Lapeer County Register of Deeds. Once they receive the certified document from US, they in turn provide it to you for the $69.50 or $49.50! Don't be fooled! If you need a copy of your deed, please call the Lapeer County Register of Deeds. We will be happy to provide you a certified copy at a low cost of $1.00 per page plus $1.00 for the certification...A MUCH LOWER COST THAN WHAT THIS COMPANY IS ASKING!

To see an example of the actual letter click on this link:

http://www.county.lapeer.org/Deeds/Nat%20Deed%20&%20MI%20Procurement.pdf

Source: Lapeer County Register of Deeds

New Law Brings Big Changes to Reverse Mortgages

Two big changes for reverse mortgages will kick in on October 1st thanks to the Housing and Economic Recovery Act of 2008. Larger loans, smaller fees and more protection for seniors in a bill signed by the President - but many still urge caution.

Reverse mortgages were not part of the problem in the current home financing debacle but Congress decided to make some changes, while they were trying to create a bill to stop the slide of the housing market and collapse of mortgage companies. The government has, among other things, raised the allowable limits on these FHA backed reverse mortgages to $417,000, up from about $362,000. The limit can be increased to $625,000 if the borrower lives in a high housing-cost area.

The Housing and Economic Recovery Act that becomes effective in October "makes it easier and less expensive for seniors to access the cash value of their homes on a tax-free basis through a reverse mortgage, and expands the amount that can be borrowed," writes Terry Savage, who frequently appears in publications and on television as an expert on personal finance.

Savage writes, "A reverse mortgage may be the perfect answer for seniors who want to stay in their homes, but have a cash flow problem. They can get a monthly stream of tax-free income, or a lump sum, and it's tax-free. Their ability to access the equity in their home does not depend on their ability to repay, as in the case of a home equity loan."

"Reverse mortgages were largely created for seniors who are cash-poor and house-rich - meaning they have a lot of equity in their homes but little or no savings," writes Michelle Singletary, a personal finance columnist for The Washington Post.

What Singletary likes best about the new law is that it reduces fees on this type of loan. He also sees new protection for senior citizens in the bill.

New protections for senior citizens
He also points out that "except for title insurance, hazard, flood, or other such products, lenders are prohibited from requiring borrowers to purchase insurance, annuities or other similar products as a condition of getting a reverse mortgage.

"The law also restricts individuals who are originating reverse mortgages from working with, employing or providing incentives to other professionals trying to sell seniors other financial products as part of application process.

"Part of the reason the housing act included a provision for reverse mortgages was out of concern that seniors were inappropriately - and sometimes fraudulently - being sold other financial products."

In the article carried by ProJo.com, he says, "In some cases, seniors have been encouraged to use the proceeds for their reverse mortgage to buy annuities or long-term care insurance. The Financial Industry Regulatory Authority (FINRA), which regulates the securities industry, has issued several warnings about reverse mortgages, particularly cautioning seniors about doing business with financial professionals who want them to obtain a reverse mortgage in order to fund a particular investment product."

Many others, however, are not as enthusiastic as Savage and Singletary.

There are a number of problems
Author Dan Solin says, "While reverse mortgages can be a valuable source of cash for seniors, there are a number of problems with them.

"The fees are very high. Typical fees for a reverse mortgage on a $250,000 home can exceed $25,000," he says. He also points out that interest charges are added every year the loan remains outstanding.

"While you may not care as long as you get your money, you should realize that the diminution in the remaining equity in your home will affect the money you will receive if you sell your house and the amount of money your heirs will receive upon your death," he says.

Solin sees the reverse mortgage is "particularly ill-suited" for those who will only remain in their homes for a "relatively short period of time."

He also cautions that if a seniors financial situation causes them to rely on government programs (like Medicaid), the receipt of proceeds from a reverse mortgage may cause them to fail to continue to qualify for these programs.

He also reminds seniors that a reverse mortgage does not alter your obligation to maintain your home, pay property taxes and insurance.

"Before committing to a reverse mortgage, seek financial counseling," he says. It is required for FHA-insured reverse mortgages, but even if you are considering private reverse mortgages, it is critically important that you understand the full financial ramifications of these loans.

Reverse lenders reignite their marketing programs
Another expert that urges caution on senior citizens is Frank N. Darras. "When the President signed into law a $300 billion housing bill to help homeowners renegotiate their mortgages, reverse mortgage lenders reignited their marketing programs focusing on seniors," says Darras.

Darras says the intrigue of reverse mortgages has been that as you age, you can have "your house pay you." The convincing argument is that reverse mortgages can be used to pay for living expenses, prescription drugs, health care, or to pay off an existing mortgage.

Reverse mortgages are actually, in legal terminology, Home Equity Conversion Mortgages (HECMs) and are insured by the Federal Housing Administration. HECMs allows folks to tap home equity and not have to make monthly payments. The HECM has been limited to the value reflected in a home's appraisal. The range and loan limits were, before the new law, between $200,160 and $362,790, depending on the location of the home.

"Be very careful," warns Darras. "Rising costs on a fixed income can be a dangerous combination. Don't let fear and the lure of an easy solution drive your decision. The new legislation is promising to make it less expensive to borrow but it can cost you in the long run, if you are not careful."

If you are not sure about taking out that reverse mortgage, wait until the new law comes into affect in October and more protections are in place to protect you.

"These days, the rest of your life can be 30-40 years, so make your decisions carefully, regardless of great marketing, fancy brochures and short-term fixes," says Darras.

Source: http://www.seniorjournal.com/NEWS/ReverseMortgage/2008/20080811-NewHousingBill.htm

So, You've Been Appointed Trustee of a Trust? Here Are 9 Do's and 1 Don't

Whether it's an honor or a burden (or both), you have been appointed trustee of a trust. What responsibilities have been thrust upon you? How can you successfully carry them out?

Here are nine do's and one don't to get you started:
  1. Do read the trust document. It sets out the rules under which you will operate, so you need to understand it completely.
  2. Do create a checking account for the trust. All income and expenses should go through this account. While you can and should invest the money, a checking account will enable you to make distributions and payments and keep track of them.
  3. Do keep the best interests of the beneficiaries in mind at all times. You have what's called a "fiduciary" duty to them, which is an extremely high standard.
  4. Don't have any personal financial dealings with the trust. For instance, you cannot borrow money from the trust or lend the trust money to anyone, without consulting competent counsel.
  5. Do provide the beneficiaries and anyone else indicated in the trust with an annual account of trust activity. This can be a copy of the checking and investment account statements or a more formal trust account prepared by an accountant or attorney.
  6. Do invest the trust funds prudently and productively. You can't put them all into a promising new company. You need to diversify the trust portfolio among stocks and fixed income securities. It is wise to get professional investment advice. Besides, consulting a professional investment advisor will insulate you from liability.
  7. Do keep in regular contact with the beneficiaries to understand their needs.
  8. Do be aware of any public benefits the beneficiaries may be receiving and make sure you do not jeopardize the beneficiaries' eligibility.
  9. Do file annual income tax returns for the trust.
  10. Don't fly solo. Get professional advice to make sure you are correctly fulfilling your role. Seek the assistance of a competent attorney specializing in trusts and an accountant who understands trust fiduciary accounting and returns.
Source: elderlawanswers.com

Eight Steps to Make Life Easier for Your Heirs

Many people devote a significant amount of time planning how and to whom they will leave their assets. However, they often skip some very basic steps that can cause hassles for their heirs, hitting right at a time of great stress.

Here are eight basic steps you can take at any age to try to make life easier for those you leave behind.

Write a Trust and/or a Will and keep it updated
A Trust and a Will are legal documents that define how your assets/estate will be distributed when you die. The difference between a will and a trust is a will is an instruction to the probate court and a trust is a living private agreement that provides for you during your disability and upon your death what happens to the assets. In both documents someone is named to be responsible to carry out your instructions. In the will, you name an executor also know as a personal representative who will be responsible for carrying out the terms of your will and in a trust you name a trustee. If you have children under the age of 18, the will or a special appointment should name a guardian. You should keep your documents updated and have multiple copies stored in more than one place.

Compile important information in a notebook
This notebook will be the "go to" resource that helps your family and your estate lawyer make important decisions quickly and efficiently. Make certain that your executor knows its location.

Key items to include:
  • A net worth statement that lists your assets and liabilities
  • A list of important contacts
  • Your last wishes including the type of burial and any religious requests
  • A list of key documents - such as wills, trust documents, deeds, and titles - and where to find them
Review your beneficiaries
Most people choose their beneficiaries when they first buy insurance, open an investment account or start a new job. But decades later, life may have changed and old choices may need to be reconsidered. For example, there may have been a divorce, the birth of new children, or the addition of grandchildren.

Assets such as insurance policies, retirement plans, and individual retirement accounts require you to name a beneficiary. Simply contact the companies who manage your investments to make changes.

Make stock and bond certificates easy to find
Don't keep original stock or bond certificates in your home or in a safe-deposit box. Instead, have your investment adviser or fund company hold them. This will keep assets from being overlooked when your estate is settled, and save time and effort for your beneficiaries.

Set aside cash to pay debts
In the wake of a death, it can be difficult for executors to access accounts quickly. Regular monthly bills will still need to be paid, so it's important to have a money market or checking account funded with enough cash to cover two to three months of costs.

Write an ethical will or family letter
This may be the single most valuable possession you leave to your children. Ethical wills can take many different forms - you can tell your personal or family history, explain your estate planning decisions, or express your feelings to close family members.

Keep your home market-ready
Don't let clutter accumulate in your home. If your children are grown, encourage them to remove their childhood possessions from your house once they have space to store it themselves.

Talk to your family now
Remember that it's far easier to have these difficult discussions while everyone is in good health. Try to hold a family meeting at least once every five years that includes everyone significantly involved in your estate.

Regardless of your age, taking these steps will provide peace of mind and help you feel more prepared for whatever comes next. Your heirs will appreciate it long after you are gone.

Source: Deborah Levenson, Braver Wealth Management, The Boston Globe http://www.boston.com/business/personalfinance/gallery/helpyourheirs

An Often Misunderstood Option - Medicare Part A Certified Home Care

The call comes - the one every adult child of an elderly parent dreads. Mom has fallen and can't get up. Amusing when on a TV advertisement but in reality, it is a fear realized for both of you. Now that she is back home and okay what next? Is there anything that will help keep her safe and enable her to live in her own home for even just a little while longer? One underutilized and often misunderstood option is Part A Medicare certified home care. Even the doctors who prescribe it may not fully understand what a great alternative it truly is for the patients who make use of it.

Medicare beneficiaries qualify for the Part A Home Care Benefit by meeting four very simple eligibility criteria. 1) They must be homebound. Medicare language is vague on this topic so that the patient requires "considerable and taxing effort" to leave their home or does so with the "assistance of another". 2) The need for intermittent skilled services must exist. The services of a nurse, physical, occupational or speech therapist are required to achieve goals set on an initial visit with patient and caregiver input. 3) When ordering home care, physicians must establish and certify a plan of care for the patient's services. The patient has to stay under the doctor's care and remain complaint with what the nursing or rehabilitation professionals recommend. 4) The homecare services have to be provided by a Medicare certified agency. Many such agencies exist. How does one know what can be done for Mom and what will it cost?

The great news about Part A Medicare certified home care services is that they are 100% covered. Mom (or Dad in many cases) worked their whole lives paying into the Medicare system and after 65, meeting the above criteria, are able to receive the services now need. Agency staff will be able to verify their Medicare status and at the initial visit, paperwork will be provided that assures that no bill for services will go out to the beneficiary if they are indeed eligible. Unlike Part B therapy services which can also be provided in a patient's home, there are no co-pay or insurance premiums to be paid and no outpatient cap on therapy services.

Upon an initial visit by either a nurse or physical therapist, a comprehensive assessment of the home, Mom's physical condition, and her need for services is made. Caregivers are often included in developing the plans of care. Services will be provided on a short-term, transitional basis (usually less than 2 months) with a focus on teaching both patient and caregiver how to address those identified needs, instead of fostering dependency. Subsequent disciplines will evaluate Mom and set goals with her functional independence and safety as the primary objective. Each service will continue to visit her at home at a frequency (often 2-3 times /week) agreed upon while she progresses.

An agency's home care professionals provide many services to their patients. Nurses are able to provide teaching about newly prescribed medications, heal wounds, and provide education about disease management and safety. Therapists address functional limitations by teaching exercises that improve strength, balance, and coordination. They may recommend additional home modifications or equipment to ensure that Mom is as independent as possible while safe in taking care of herself in her own home. Compromised daily living skills such as bathing or dressing that are so vital to being able to care for herself are addressed by therapy services and may even require a brief period of home health aide service while she is not able to do them for herself. Getting up from a chair or the toilet, walking across the room or apartment complex, or up and down a flight of stairs are very common goals that a physical therapist will focus on in their care plan. Preventing that call from reoccurring - keeping Mom safe and in her own home, where she wants and you need her to be - is the most important objective for all.

About the author: Teri N. Thompson, MPT is the Interim Administrator of Allegiance Home Health Care, Inc. in Troy, MI, a Medicare certified home health agency servicing the Oakland, Macomb and Wayne counties. She is also a physical therapist with more than 15 years home care experience with a clinical focus on geriatric rehabilitation. She can be contacted at tthompson@allegiancecare.com with any questions.

Are My Veterans Benefits Taxable? It Depends!

Military Retirement pay is taxable income like all other similar retirement income. Military retirement pay is paid through the Department of Defense, Defense Finance and Accounting Services (DFAS). The pay stub will have DFAS in the address of the payor. This type of payment is also frequently called an "annuity." This is a payment for the rest of the veteran's life and is taxable.

Payments made through the Veteran's Administration are generally not taxable. The two primary payment types are (1) Compensation and (2) Pension.

Compensation is payment to a service member for an injury or disease that occurred during service or was due to being in the service. This type of benefit is the military's version of worker's compensation. The payment is based on the veteran's disability rating. Disability compensation is not taxable income.

Pension is payment to a prior service member who served in the military during a war time period, is 65 or older or is disabled, and has limited income and resources. This is the VA's version of Supplemental Security Income (SSI). When a prior war time veteran has a disability and meets the criteria listed above in this paragraph, then the VA will pay an amount of money to the veteran to bring the Veteran's income up to a certain level. This income is not taxable income.

When a veteran needs the aid and attendance of another person to assist with walking, bathing, dressing, going to the rest room, medication monitoring, etc., then the veteran may also be able to obtain pension with aid and attendance. This additional income, aid and attendance, is not taxable income.

Compensation and/or pension benefits can be extremely beneficial for prior service members who need long term care and have high health care costs. Not only will the additional income help, but the fact that it is not taxable means the veteran gets to keep all of it.

Both non-taxable compensation and pension benefits may also be available for widowed spouses and children of veterans.

If you know a veteran who has a service related injury or served in the military during a war time period, refer them to an Elder Care Attorney who is accredited with the VA, or to the local Veteran Service Organization.

Source: Victoria Collier, Esq. of the Elder and Disability Law Firm of Victoria Collier of Decatur, Georgia

The SPIC - What you Need to Know about Your Money's Security

The Federal Deposit Insurance Corporation (FDIC) is an independent federal agency of the United States government that was created in 1933 to promote public confidence and stability in the nation's banking system. The FDIC protects you against the loss of your deposits if an FDIC-insured bank or savings association fails. FDIC deposit insurance covers the balance of each depositor's account, dollar-for-dollar, up to the insurance limit, including principal and any accrued interest through the date of the insured bank's closing.

The FDIC insures depositors of an insured bank for up to a total of $100,000, which includes principal and accrued interest. Deposits in separate branches of an insured bank are not separately insured. However, deposits maintained in different categories of legal ownership at the same bank can be separately insured. Additionally, deposits in one insured bank are insured separately from deposits in another insured bank.

In the event of a bank failure the FDIC notifies each depositor in writing, using the depositor's address on record with the bank. This notification is mailed immediately after the bank closes. Additionally, when a failed bank is acquired by another bank; the assuming bank also notifies the depositors.

In the event of a bank failure where there is no bank acquirer for the deposits, federal law requires the FDIC to make payments of insured deposits "as soon as possible" upon the failure of the insured institution. It is the FDIC's goal to make deposit insurance payments within two business days of the failure.

If there is an acquiring bank, it will accept the checks and deposits slips of the failed bank for a short time. You will receive information about new checks and deposit slips from the acquiring bank.

If you have more than $100,000 in a closed bank and you are paid $100,000 by the FDIC, you will be given a "Receiver's Certificate" for the balance in the account and you would then receive payments on the balance of the account as the assets of the bank are liquidated.

Deposits maintained in different categories of legal ownership at the same bank can be separately insured. Therefore it is possible to have deposits of more than $100,000 at one insured bank and still be fully insured.

The categories of legal ownership are as follows:
  1. Single Accounts
  2. Certain Retirement Accounts
  3. Joint Accounts
  4. Revocable Trust Accounts
  5. Irrevocable Trust Accounts
  6. Employee Benefit Plan Accounts
  7. Corporation/Partnership/Unincorporated Association Accounts
  8. Government Accounts
The most common ownership categories are Single Accounts, Self-Directed Retirement Accounts, Joint Accounts, and Revocable Trust Accounts. The following paragraphs provide details on these more common legal ownership categories.

Single Accounts - a single account is a deposit owned by one person. All single accounts owned by the same person at the same insured bank are added together and the total is insured up to $100,000. Single accounts include:
  • Accounts held in one person's name alone
  • Accounts established for one person by an agent, nominee, guardian, custodian, or conservator, including Uniform Transfers to Minors Act accounts, escrow accounts, and brokered deposit accounts
  • Accounts held in the name of a business that is a sole proprietorship
  • Accounts established for a decedent's estate
Certain Retirement Accounts - these are deposits owned by one person and titled in the name of that person's retirement account. Certain Retirement Accounts are added together and the total is insured up to $250,000. Certain Retirement accounts include:
  • All types of IRA's, including, Traditional IRA's, Roth IRA's, Simplified Employee Pension (SEP) IRA's, and SIMPLE IRA's
  • All Section 457 deferred compensation plan accounts
  • Self-directed defined contribution plan accounts, such as self-directed 401(k) plans, self-directed defined contribution money purchase plans, and self-directed defined contribution profit-sharing plans
  • Self-directed Keogh plan accounts
The FDIC defines the term "self-directed" to mean that plan participants have the right to direct how the money is invested, including the ability to direct that the deposits be placed at an FDIC-insured bank.

Note - Naming beneficiaries on a retirement account does not increase deposit insurance coverage.

Joint Account - a joint account is a deposit owned by two or more people. To qualify for insurance under this ownership category, all of the following requirements must be met:
  1. All co-owners must be people. Legal entities such as corporations, trusts, estates, or partnerships are not eligible for joint account coverage
  2. All co-owners must have equal rights to withdraw funds from the account
  3. All co-owners must sign the deposit account signature card unless the account is a CD or is established by an agent, nominee, guardian, custodian, executor or conservator
If all of these requirements are met, each co-owner's share of every account that is jointly held at the same insured bank is added together with the co-owner's other shares, and the total is insured up to $100,000.

Revocable Trust Accounts - A revocable trust account is a deposit owned by one or more people that indicates an intention that the deposits will belong to one or more named beneficiaries upon the death of the owner(s). A revocable trust account can be revoked or terminated at the discretion of the owner. A revocable trust account includes "payable-on-death" (POD) accounts and "in trust for" (ITF) accounts. The beneficiaries of these accounts must be "qualifying," meaning that the beneficiaries must be the owner's spouse, child, grandchild, parent, or sibling. Adopted and step children, grandchildren, parents, and siblings also qualify. In-laws, cousins, nieces and nephews, friends, charitable organizations, and trusts do not qualify.

Deposit insurance coverage is based on each owner's trust relationship with each qualifying beneficiary. Each owner of a revocable trust may be entitled to insurance coverage up to $100,000 for each qualifying beneficiary that the account owner designates in the revocable trust account. If all of the beneficiaries are qualifying and have equal interests, the insurance coverage for each owner is calculated by multiplying $100,000 times the number of qualifying beneficiaries. In addition, if the trust specifies different interest for the beneficiaries, the owner is insured only up to each beneficiary's actual interest in the trust.

All funds attributable to non-qualifying beneficiaries are aggregated and insured up to $100,000 as the single account funds of the trust owner.

Irrevocable Trust Accounts - Irrevocable trust accounts are deposits held by a trust established by statute or a written trust agreement in which the grantor (creator) contributes deposits or other property and gives up all power to cancel or change the trust. An irrevocable trust may also come into existence upon the death of an owner of a revocable trust.

The interests of a beneficiary in all deposit accounts established by the same grantor and held at the same insured bank under an irrevocable trust are added together and insured up to $100,000 only if all of the following requirements are met:
  1. The insured bank's deposit account records must disclose the existence of the trust
  2. The beneficiaries and their interests in the trust must be identifiable from the bank's deposit account records or from the trustee's
  3. The amount of each beneficiary's interest must not be contingent as defined by FDIC
  4. The trust must be valid under state law
A beneficiary does not have to be related to the grantor to obtain insurance coverage under the irrevocable trust account category.

The following are situations where an irrevocable trust would not be insured on a per beneficiary basis, resulting in the trust as a whole qualifying for only $100,000 in insurance coverage:
  • The trust agreement does not name the beneficiaries or provide any means of identifying the beneficiaries
  • The trust agreement provides that a beneficiary will receive no assets unless certain conditions are satisfied
  • If the trust provides that a trustee may invade the principal of the trust with the result that the assets available for the other beneficiaries may be reduced or eliminated
  • The trust agreement provides that a trustee or particular beneficiary my exercise discretion in allocating assets among the beneficiaries, with the result that the future distribution to each beneficiary is impossible to predict
Since irrevocable trusts often contain conditions that affect the interests of the beneficiaries or provide a trustee or a beneficiary with the authority to invade the principal. For this reason, deposit insurance for an irrevocable trust account is usually limited to a total of $100,000.

The FDIC does not insure money invested in stocks, bonds, mutual funds, life insurance policies, annuities, or municipal securities, even if they were bought from an insured bank.

The FDIC also does not insure U.S. Treasury bills, bonds, or notes, but those are backed by the full faith and credit of the United States government.

For more information on the FDIC, go to www.fdic.gov or call 1-877-275-3342.

Separate from the FDIC is the Securities Investor Protection Corporation (SIPC). In the event of a brokerage firm failure, the SIPC offers some protection; however, the SIPC is different from the FDIC. Where the FDIC insures all depositors at an FDIC-insured institution up to a certain dollar limit, the SIPC does not bail out investors when the value of their stocks, bonds and other investments fall for any reason. Instead, the SIPC restores funds to investors with assets in the hands of bankrupt and otherwise financially troubled brokerage firms.

When a brokerage firm fails, the SIPC steps in and works to return cash, stocks, and other securities to the customers. This process can take from one to three months. Some investments that are not protected include commodity futures contracts, currency, and investment contracts, such as limited partnerships, that are not registered with the U.S. Securities and Exchange Commission under the Securities Act of 1933.

Customers of a failed brokerage firm get back all securities (such as stocks and bonds) that already are registered in their name or are in the process of being registered. After this first step, the firm's remaining customer assets are then divided on a pro rata basis with funds shared in proportion to the size of claims. If sufficient funds are not available in the firm's customer accounts to satisfy claims within these limits, the reserve funds of SIPC are used to supplement the distribution, up to a ceiling of $500,000 per customer, including a maximum of $100,000 for cash claims. Additional funds may be available to satisfy the remainder of customer claims after the cost of liquidating the brokerage firm is taken into account.

Source: MSW Group, PLC, CPA's of Farmington Hills, MI. www.mswplc.com. For more information on the SIPC, go to www.sipc.org.

What I Wish I'd Done Differently

by Jane Gross of the New York Times
July 7, 2008, 10:37 am
Given the crisis in supply and demand - too many old people and too few geriatricians - I may not have succeeded. But if I had, many of our crises might have been avoided. Those include unnecessary trips to the emergency room that left her in worse shape than she had been beforehand. It also includes surgery to remove a benign tumor from the outside of her spinal cord after it had already done the worst of its damage and with no regard for her advanced age.

It was after that surgery that she took a precipitous nosedive, moving to a nursing home and suffering a series of T.I.A.'s, or very small strokes, which eventually left her paralyzed, incontinent, unable to speak and barely able to swallow. Later, both Dr. Roseanne Leipzig at Mount Sinai Medical Center in New York City and Dr. Dennis McCullough at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., told me that no doctor familiar with the physiology and psychology of the elderly would have operated on her without at least a discussion of the special risks to the aged.

My second biggest mistake was accepting the conventional wisdom that nursing homes are terrible places, to be avoided under any and all circumstances, and that assisted-living communities, with their pleasant apartments and other amenities, could accommodate my mother's needs until the end of her life. Assisted-living facilities do offer an ever more expensive list of add-on services, including private duty, around-the-clock assistance. But too often they cannot meet the needs of deteriorating patients, forcing a series of relocations, each more destabilizing than the last.

State licensing regulations are wildly inconsistent in terms of how much additional help must be available in an assisted-living facility, even for those willing and able to pay for it. And any reputable facility will admit, sometimes only under stiff questioning of the director rather than the sales staff, that without an on-site skilled nursing facility or a dementia unit, many residents will wind up too ill, too frail or too cognitively impaired to live out their lives there.

If I had it to do all over again, I would plan for the worst and seek out a not-for-profit nursing home that met my standards. Many have assisted-living apartments on site, less attractive than those at for-profit chains like Sunrise and Atria, but offering a smoother transition if and when skilled nursing becomes essential.

My third mistake was being gleeful when my mother, then in her mid-70s, chose to sell her house on Long Island, flee the snow and the need to drive, and move to a retirement complex in Florida. Now when she didn't answer the phone, I assumed, there would be someone to check up on her. She would have grab bars in the shower and a pull cord for emergencies. I wouldn't be so frightened all the time.

What never occurred to me is that once my mother no longer had a home, we lost the option of setting her up with home care. Eventually too incapacitated to live out her days in assisted living and unwilling to move in with either of her children, a nursing home was her only choice - a happy one, as it turned out, but not in the early going, for any of us.

My fourth mistake was not understanding the limits of a long-term care insurance policy that had cost us about $7,000 a year because of my mother's advanced age when we purchased it. It would have paid for retrofitting her own home, or even mine. It would have paid for 24/7 home health attendants. But it was virtually useless in an assisted-living apartment, and once my mother was in a nursing home, the policy benefit wasn't ours to spend.

As long as my mother still had assets and could pay for her $14,000 a month room, the insurance benefit went to the nursing home and reduced her bill accordingly. When she ran out of money, in fairly short order, she was eligible for Medicaid, not because she was old but because she was impoverished. Then the insurance benefit went to the federal government.

All of these mistakes would have mattered less if the trajectory of my mother's decline had been different. But that trajectory, alas, is unknown and unknowable but for its certain ending. So every decision we made - residential, medical, financial - was a crapshoot that changed the landscape for the next decision, usually by limiting options I didn't even realize we had. There's no way around this uncertainty, no way of knowing what's going to happen next so you can plan accordingly. But physicians, social workers, case managers, lawyers and financial advisers with expertise in old age are the best guides. And haste, often the result of panic, is the enemy.

Source: Jane Gross of the New York Times

Challenges Involving Joint Assets, Wills and Trusts

This is the last in the series of articles on "When the Family Cannot Get Along" by Andrew Mayoras, Partner, Barron, Rosenberg, Mayoras & Mayoras, and The Center for Probate Litigation

Last week's article discussed theft and exploitation. What do you do when you discover financial exploitation in a way that is not as overt as theft? For example, what do you do when your father with Alzheimer's or dementia has added his second wife's name to a bank account that was always meant for the family, or your mother changed her will or trust to omit you in favor of your brother or sister? Or even worse, what happens if a caregiver or "friend" ends up receiving everything and the family gets the short end of the stick?

All of these can be successfully challenged in court under the right circumstances, with the help of an experienced probate litigation attorney, but only if the help is sought before it is too late. It is usually not too late even after the exploited senior passes away. Joint assets, including bank accounts and real estate, along with will and trust changes, and outright gifts can be set aside and undone on the basis of incompetence, undue influence, fraud and other reasons. But these legal challenged can only succeed if timely action is taken with the help of a good lawyer.

Incompetence - The test for mental competency varies depending on the document challenged, but for every situation, the crucial factor in the test is whether the individual reasonably understood the nature of the document or transaction when it was signed. For someone with Alzheimer's or dementia, who has good days and bad, this is not always a bright-line test with an easy answer. Medical records are often the best way to determine if a person was considered competent at the time. Independent witnesses are also a great source of information and help. However, the law presumes that a will, trust or asset designation is valid, and it is up to the person challenging it to convince the court otherwise.

Undue Influence - When a person is improperly influenced to change documents or give away assets, to the point that the change is not what the person would have freely chosen to do, then the change can be undone through a successful undue influence claim. Undue influence can occur through threats, flattery, excessive persuasion, or physical or emotional coercion. In fact, the law presumes undue influence has occurred when the beneficiary was acting as the Power-of-Attorney, or otherwise occupied a position of confidence and trust, such as a caregiver. This presumption is useful in many cases, but is not definitive and can be rebutted.

Fraud - Even when competent, vulnerable adults with Alzheimer's or dementia can be tricked into transferring assets or changing bank accounts or estate planning documents based on material statements of fact that are false. When someone relies on a false representation, such as a false promise or another type of lie, the transaction or document can be set aside as invalid.

Accounts of Convenience - For joint bank accounts in particular, and sometimes other joint assets (even including real estate), a loved one with Alzheimer's or dementia may add the name of a child or other trusted relative as a convenience to help with bill paying, financial management or as a "poor man's will" to save costs. If the person did not intend the joint owner to keep the asset on death, but instead only added the joint name as a convenience, then courts can and do order the asset to be turned over to the estate and shared with the other beneficiaries. This also applies to brokerage accounts, stocks, and other investments. The key is always the intent of the person who added the name at the time it was created, not afterwards.

Deciding whether or not to contest the joint nature of an asset, or an unfavorable estate planning document, is not always an easy one, and certainly should not be made lightly. Court battles seeking to set aside documents or transactions can be costly and time-consuming. They can also tear families apart.

Of course, many times the family is already broken beyond repair. Honoring the true wishes of an elderly loved one is often worth the fight. How to know when is the time to fight or not? You must set aside emotions, act with logic, and consult an experienced probate litigation attorney.

And what about those times when you decide not to challenge a will or trust? Does that mean you have no rights? No. All will and trust beneficiaries have rights. Challenging the actions of an executor or trustee is not the same as attacking the will or trust as invalid. Every decision made by a trustee or personal representative, from distributing items of personal property, to cashing in large investments and selling real estate can be questioned. Why?

The answer is simple. Every person who is charged with the responsibility of administering an estate or a trust has a fiduciary obligation to protect the rights of all beneficiaries. This means they must make decisions that are in the best interests of everyone, not themselves. This duty includes the responsibility to share information, including what's in the estate and trust, and what has been done with the property. Every beneficiary in Michigan has a legal right to receive an inventory explaining what is in the trust or estate, and an accounting, which documents what has been down with the trust or estate property. Beneficiaries can request and receive supporting documentation (such as checks, account statements, bills, etc.). Finally, they can also challenge, through probate court proceedings, anything that they believe is not fair, accurate or right. This can be anything from blatant self-dealing to negligence in handing investments. Not sure if something is right? It's time to talk to an experienced attorney.

Conclusion Family feuds and other legal challenges make caring for an elderly loved one much more difficult. When a loved one passes, no one wants their memories marred by a court battle. Unfortunately, legal proceedings cannot always be avoided, especially when someone takes advantage of a vulnerable senior citizen. Knowing your legal rights is the first step. Hiring an experienced and qualified attorney, like those at The Center for Probate Litigation, can make all the difference in the world.

Ethical Wills - Bequeath Your Values Along with Your Valuables

To my son, I leave my passion for knowledge...

You may have already drafted a Last Will and created an estate plan that transfers your worldly possessions. Your estate plan should not end there. What steps have you taken to ensure that you also pass on your values, ideas and beliefs? What wisdom and life lessons do you want to share with those you care about? Do you want to be remembered for your values rather than for the possessions you have left behind? If so, you may want to consider drafting an ethical will. As the name suggests, ethical wills are the spiritual counterparts to "traditional" Wills that distribute wealth. Ethical wills pass on intangible assets such as blessings, life lessons, dreams and hopes as opposed to tangible possessions. While ethical wills are not binding legal documents, they can be an invaluable gift to friends, family members and loved ones.

Preparing to draft an ethical will often involves serious consideration of your values and morals, important lessons learned, hopes and dreams for the future, advice to loved ones, invaluable memories and important events in your life. You may also contemplate themes, such as regrets and forgiveness, personal love, mentors and teachers, cultural beliefs, ancestry or how you would like to be remembered by others.

Although writing an ethical will is a serious endeavor, it does not need to be a complicated process. Unlike "traditional" Wills that are bound by statutory constraints, there is no set form or procedure for creating an ethical will. An ethical will can be a letter to loved ones or to grandchildren not yet born. An ethical will may also be a set of instructions regarding the family business or a detailed account of a life journey. An ethical will may choose to develop and impart a family mission statement or provide blessings for future generations. Additionally, an ethical will does not need to be limited to writing. It may incorporate multimedia messages, such as photos, drawings, music or videos. Your personal preferences are the only constraints.

Bequeath more than your valuables. Create an ethical will and bequeath your values too.

Source: Gina M. Barry, Esquire of the law firm of Bacon Wilson

New Data Added to Government's Hospital Compare Website that is Already Booming

More than 2.5 million visitors per month attracted to features like deaths by hospital and hospital care ratings by consumers

The Website maintained by the Centers for Medicare & Medicaid Services to provide comparative hospital information for consumers - Medicare beneficiaries and their caregivers in particular - has been attracting over 2.5 million visitors per month, but it is certain to get a big boost this week with the additional of new information, including more information on death rates at each hospital.

The latest improvements include the addition of a mortality measure for pneumonia and, for the first time on Hospital Compare, publicly reported measures for hospital care of children. Previously, Hospital Compare had provided only quality information based on hospitalizations of adult patients.

Since its inception in March 2005 Hospital Compare has become a popular tool for consumers and their care givers in making health care decisions.

CMS is an agency of the U.S. Department of Health and Human Services (HHS) and it maintains the Hospital Compare consumer Web site (http://www.hospitalcompare.hhs.gov) that gives consumers better insight into the quality of care provided by their local hospitals.

The addition of patient experience data and Medicare payment and volume information in March 2008 caused the number of page views to jump from an average of 600,000 per month to more than 2.5 million per month. Page views for this year to date have totaled more than 20 million.

"Reporting quality data on the care provided hospital patients is a key to our continuing effort to provide better, value-based health care for all Americans," HHS Secretary Mike Leavitt said.

"Expanding the scope of measures is making Hospital Compare a more valuable tool for all health care consumers."

Earlier this year, Medicare added patient satisfaction information to the Web site.

Today's additions bring the total to 26 process of care measures, three outcome of care measures, two children's asthma care measures, and 10 patient experience of care measures.

Hospital Compare also contains information about the number of certain elective hospital procedures provided to patients and what Medicare pays for those services.

"CMS' goal for updating and enhancing the Hospital Compare Web site is to provide usable and accurate information about hospital performance to providers and communities that will encourage hospitals to excel in the quality of care they provide," said CMS Acting Administrator Kerry Weems. "With these new enhancements, consumers and health care providers will be able to look at individual hospital mortality scores. We hope that this new information will cement the Web site's role as a key driver in improving the quality and reliability of care in the nation's hospitals."

The Hospital Compare website can be accessed at http://www.hospitalcompare.hhs.gov

Short cut URL to mortality information (Minitool): http://www.hospitalcompare.hhs.gov/hospital/mortalitytool/index.asp

Interesting Reading: George Washington's Will Included Arbitration Clause

Arbitration has been used extensively throughout America's history to resolve issues such as the ownership of colonies, the ownership of particular pieces of territory, the recovery of money owed by one state to another, and all sorts of religious matters. In the specific context of wills, no less a personage than the father of our country, George Washington, included an arbitration clause in his will.

For no reason other than I find this bit of historical/T&E crossover trivia interesting, here's a copy of the arbitration clause contained in George Washington's Will:

But having endeavoured to be plain, and explicit in all Devises- even at the expence of prolixity, perhaps of tautology, I hope, and trust, that no disputes will arise concerning them; but if, contrary to expectation, the case should be otherwise from the want of legal expression, or the usual technical terms, or because too much or too little has been said on any of the Devises to be consonant with law, My Will and direction expressly is, that all disputes (if unhappily any should arise) shall be decided by three impartial and intelligent men, known for their probity and good understanding; two to be chosen by the disputants - each having the choice of one - and the third by those two. Which three men thus chosen, shall, unfettered by Law, or legal constructions, declare their sense of the Testators intention; and such decision is, to all intents and purposes to be as binding on the Parties as if it had been given in the Supreme Court of the United States.

Source: Various blogs over the Internet

Theft and Exploitation of Assets

Court disputes are not always about a person's physical and mental well-being. Often they are also necessary to help prevent a loved one from losing assets. This can happen in many different ways, some overt and some more difficult to spot. The easier ones include theft or exploitation by a greedy family member or caregiver. Taking money, convincing the elderly person to sign over deeds or bank accounts, or other clear signs of financial abuse can be revealed just by reading over the person's financial documents such as bank statements.

Sometimes more challenging to spot is the mismanagement of affairs due to disability or reduced competence, including forgetting to pay bills or buying expensive things that are not needed. This may not seem too alarming, but these seniors are the ones targeted most often by those looking for opportunities to exploit.

The most difficult one to spot is the sale of unsuitable investments by an unsavory annuity salesman or tricky reverse mortgages. These are discussed in more detail below.

Knowing when to intervene or not is not always easy. Many seniors suffering from Alzheimer's, dementia or other conditions do not want to admit they need help with their financial decisions. Often, their children do not want to insult them by asking too many questions. But when you have a loved one diagnosed with dementia or Alzheimer's, or who otherwise exhibits signs of confusion or memory loss, you owe it to them to probe. Make sure their investments are secure and appropriate, and their assets are protected.

In doing so, pay attention to the warning signs. The National Center on Elder Abuse lists many warning signs of exploitation, including:
  • Sudden changes in bank account or banking practice, including an unexplained withdrawal of large sums of money,
  • The inclusion of additional names on a bank signature card; unauthorized withdrawal of the elder's funds using the elder's ATM card;
  • Abrupt changes in a will or other financial documents;
  • Unexplained disappearance of funds or valuable possessions;
  • Substandard care being provided or bills unpaid despite the availability of adequate financial resources;
  • Discovery of an elder's signature being forged for financial transactions or for the titles of his/her possessions;
  • Sudden appearance of previously uninvolved relatives claiming their rights to an elder's affairs and possessions;
  • Unexplained sudden transfer of assets to a family member or someone outside the family;
  • The provision of services that are not necessary; and
  • An elder's report of financial exploitation.
If you discover any of these warning signs, talk to an elder law attorney knowledgeable in financial matters immediately. Often, children or other trusted family members are the ones exploiting or even stealing money from someone suffering from Alzheimer's or dementia. In other cases, there are greedy financial planners or mortgage brokers who target vulnerable adults with high-commission, inappropriate investments or mortgages.

Be especially careful of annuities and similar risky investments. This is not to say that all annuities are risky or inappropriate. Quite the contrary, there are many fixed-rate annuities that are very safe. In fact, even more aggressive investments are suitable in the right circumstances.

But there are many annuity salespeople who love to target older adults with confusing equity indexed annuities that sound great at first blush, but when examined closely, have no business being in an elderly person's portfolio except in rare cases. In fact, the NASD and SEC have both issued warning bulletins of these exact investments due to concerns that they are being marketed to seniors who do not need or understand them.

These types of annuities are usually sold through promises that they are safe, but also have the ability to share in the market when it goes up. Sounds great, right? Enjoy the market upswings but have no danger of losing money in the downswings.

The problem is that equity-indexed annuities do not live up to these lofty promises. In fact, they are considered long-term investments. How many senior citizens have a need for long-term investments? Some do, if they have other significant assets and want to leave a portion of their funds for beneficiaries down the road. Sadly, many who buy these annuities do not have other assets.

The catch with these annuities is that they are very complex and difficult to understand, carry hidden costs and charges, and typically have large surrender fees that last for 15 to 20 years or more. These surrender fees mean that the investor cannot take their money out, even in case of emergency, without paying a large penalty.

If the elderly investor has placed substantially all of her savings into such an annuity, she often realizes that she is trapped between a rock and a hard place. If his happens to you or someone you care about, call an experienced attorney immediately.

Reverse mortgages can also be tricky. Sometimes they are a legitimate and appropriate way for seniors to receive cash for equity in their home. But sometimes, these are merely scams targeted at depriving senior citizens of their most valuable asset. Other times, the elderly person simply did not understand what he signed.

In more overt cases of theft, adult protective services can sometimes be of benefit. But exercise caution - the caseworkers are sometimes able to help, and sometimes not. And other times, calling in adult protective services can result in court proceedings that are not wanted.

Criminal charges can also be brought against someone who steals or exploits money from a vulnerable adult. Michigan has a law in place for exactly that purpose. The problem is that convincing police or prosecutors to pursue someone criminally for financial abuse of an elderly person is often very difficult for a variety of reasons, including lack of resources and difficulty in establishing proof when the primary witness has poor memory.

The best way to stop financial elder abuse is awareness and prevention. By speaking with your loved ones about their finances, offering assistance, and probing when you become concerned, you can usually prevent theft, financial abuse, and unsuitable annuities and reverse mortgages.

Zero Percent Capital Gain, Is It True? Yes, It's True!

In 2008 a zero percent capital gain rate is making its first appearance, but that does not mean all capital gain will be taxed at zero percent. Notice there will be a zero percent rate; which does not mean that the capital gain rate is zero!

What's the difference? For most sales of capital assets (stocks, bonds, mutual funds, etc.) held long-term there are two capital gain rates that apply. "Long-term" means that the stock or other property must have been held longer than one year before being sold. From May 6, 2003, through December 31, 2007, those rates have been 5% and 15%. And for 2008-2010, the 5% capital gain rate is reduced to 0%.

Why are there two rates? The idea is that long-term capital gain rates are more favorable than ordinary income tax rates-the rates that apply to wages, self-employment income, alimony, and other types of ordinary income. Currently, the ordinary rates range from 10% to 35%. So, if someone is in one of the higher brackets (25%-35%), a 15% rate that is applied to capital gain is certainly a tax benefit., however, if someone is in the 10% or 15% bracket, a 15% capital gain rate would clearly not be very helpful. So, a lower capital gain rate is available to the extent a taxpayer is in one of the lower brackets.

So the 0% rate applies to the extent an individual is in one of the lower brackets. What exactly does "to the extent" mean? Essentially, it means that if all taxable income (ordinary income plus capital gain income) falls within the 10% or 15% tax bracket for an individual's filing status, any long-term capital gain on the return will be taxed at 0%.

If some of the individual's taxable income is in the 15% or higher tax bracket, some or all of the long-term capital gain on the return will be taxed at 15%. The amount of long-term capital gain taxed at 15% is computed as follows:

Your taxable income - Endpoint of 15% tax bracket for your filing status = Maximum long-term capital gain subject to 15% tax rate.

Confusing? We agree. For example: Let's assume Mack, a single taxpayer, has 2008 taxable income of $38,000, including $10,000 of long-term capital gain. For 2008, the 15% tax bracket for a single filer like Mack ends at $32,550. Based on the calculation above, $5,450 ($38,000 - $32,550) of his capital gain will be taxed at 15%, and the remaining $4,550 will be taxed at 0%.

Now assume that Mack's taxable income is $50,000. In this case, up to $17,450 ($50,000 - $32,500) of long-term capital gain could be taxed at 15%. Thus, all of Mack's $10,000 long-term capital gain will be taxed at 15%.

Anything else? Here is a great strategy. While lower-income individuals aren't typical investors, this tax benefit could help out folks such as retirees who have little or no taxable income. And the children of older individuals could combine the annual gift exclusion ($12,000 in 2008) with this capital gains break and give appreciated long-term assets to their older parents. The children could give appreciated assets to the parents or parents could give appreciated assets to the children. Mom and Dad or the children then could sell the assets tax-free.

Don't worry about that holding-period requirement, either. In the case of a gift, the tax law says the recipient's holding period is the same as the donor's. A person could turn around and sell it the next day and get the long-term capital gains rate which would be zero.

Source: www.bankrate.com, www.csmonitor.com, www.forbes.com

Coming Soon: Five-Star Rating System for Nursing Homes

You can eat at a five-star restaurant or stay at a five-star hotel. By year's end, you'll also be able to select a five-star nursing home. The Centers for Medicare & Medicaid Services (CMS) has announced plans to implement a one- to five-star rating system for nursing homes to help consumers evaluate a nursing home's quality when selecting a facility. The ratings would appear on the agency's Nursing Home Compare web site.

CMS will base the ratings on government inspection results, as well as staffing data and quality measures. Yet to be determined is whether the ratings will include other information, such as whether nursing homes treat patients with dementia or those on ventilators.

"We know the public is hungry for information," said acting CMS Administrator Kerry Weems. He said lower ratings "will likely put" nursing homes "on the path to improvement . . . I don't think we're going to see many people who are very anxious to put a loved one in a one-star home."

But the new rating system was criticized both by consumer advocates and the nursing home industry, for different reasons.

Toby Edelman, senior policy attorney with the Center for Medicare Advocacy, said that two of three criteria CMS plans to use for the ratings - staffing data and quality measures - are "self-reported by nursing facilities and are inaccurate." Edelman said, "Relying on nursing homes to describe accurately how well they are doing . . . just doesn't make sense."

Meanwhile, Bruce Yarwood, president of the American Health Care Association, a long-term care industry trade group, criticized CMS's use of government inspection results as criteria for the ratings and said CMS should consider consumer and staff satisfaction. Yarwood said, "We do not believe that an index which relies on a broken survey system is an accurate way to measure quality."

For a Detroit News article on the new rating system, click here.

Exercise 'slows down Alzheimer's'

Being physically fit could hold back the advance of Alzheimer's disease, US researchers have suggested. A study by Dr Jeffrey Burns, from the University of Kansas School of Medicine published in the journal Neurology, looked at 121 people aged over 60, around half of them in the early stages of the disease.

Those with Alzheimer's who were less fit had four times more signs of brain shrinkage than those who were fit. The Alzheimer's Research Trust said other research showed exercise reduced the risk of dementia.

Some 700,000 people in the UK are living with dementia, with this number predicted to grow quickly over the next two decades, as the proportion of older people in the population increases.

Other studies looking at the relationship between dementia and exercise tend to focus on whether being active can reduce the risk of the condition developing in the first place.

Dr Jeffrey Burns, from the University of Kansas School of Medicine, said his was one of the first to look at whether exercise could affect the progress of the illness.

His volunteers underwent a treadmill test to see how fit they were and then their brains were scanned for shrinkage, which is one way of measuring the severity of their Alzheimer's.

Brain volume
While there was no relationship between brain size and exercise in people tested who did not have Alzheimer's, Dr Burns said the four-fold difference in those who did was evidence that exercise might help.

He said: "People with early Alzheimer's disease may be able to preserve their brain function for a longer period of time by exercising regularly and potentially reducing the amount of brain volume lost.

"Evidence shows decreasing brain volume is tied to poorer cognitive performance, so preserving more brain volume may translate into better cognitive performance."

Susanne Sorensen, head of research at the Alzheimer's Society, said: "Exercise increases blood flow to the brain, delivering oxygen and nutrients to brain cells.

"This is one possible explanation why dementia progresses slower in people who are physically fit.

"Exercise also reduces your risk of developing dementia so it's important to take regular exercise. A healthy heart means a healthy brain."

Rebecca Wood, chief executive of the Alzheimer's Research Trust, said: "This adds to previous research showing that exercise helps reduce the risk of dementia and slows down its onset.

"A balanced diet and regular exercise can improve the quality of life of older people with dementia, as well as those who do not have the condition."

Source: news.bbc.co.uk/2/hi/health/7505091.stm

Guardianship & Conservatorship Disputes

What do you do when you discover an invalid Power of Attorney or Patient Advocate Designation? What happens when an Attorney-in-Fact is not acting in the best interests of your vulnerable loved one? How do you help your parent with Alzheimer's or dementia when he or she refuses to acknowledge needing help, even when it is obvious to you that the situation is becoming dangerous?

In any of these cases, the only safe way to protect a vulnerable adult is through guardianship and/or conservatorship proceedings.

Both proceedings are handled in probate court and involve someone asking for a decision-maker to be appointed because the person in need of protection is unable to make or communicate informed decisions. Guardians make medical, placement and other decisions, while Conservators handle the finances. One person often serves in both roles at the same time, but courts can appoint different people as well.

First, what if your parent, or someone else in the family, disagrees that a guardian or conservator is necessary? Judges will examine whatever records you can present them with, including medical and financial records, as well as listen to family members and others who give testimony about why the person needs help making decisions. Sometimes courts will even appoint an independent physician to examine the person and file a written report.

Judges do not take this decision lightly; they have to find clear and convincing evidence to take away someone's legal right to make their own decisions. But Judges do worry about whether the person is making safe choices. The best interest of the vulnerable person is most important.

Often, whether a guardian or conservator is needed is the easy part. Who gets appointed in these roles? Typically, it is a family member or other loved one of the person to be protected, or ward. And, the ward's choice does matter! This is especially true for someone with early stages Alzheimer's or dementia who still retains some decision-making ability but requires assistance. Even an incompetent person's choice will carry great weight if it was expressed through a Power of Attorney or Patient Advocate signed when the person was still competent.

In fact, Michigan law requires probate judges to honor the ward's preference in most cases, and if not, the judge must follow a list of people required by statute. This list includes a spouse, adult child, or other relative, and certain others (in that order). A person can only be skipped over for someone lower on the list of priorities only if he or she is unwilling or unsuitable to serve.

This choice is not set in stone however. Probate judges do have a large amount of discretion in making this important choice, and will usually decide based on what is in the best interests of the protected person.

How does the judge decide when the family fights about who is most suitable? Often siblings both feel they would be the best choice. Second marriages present significant difficulties when the spouse of the incompetent person does not get along well with the children from the prior marriage. Sometimes, there is even a fight between the ward and his or her own children.

Because probate judges make the decision, and their choices are almost never overturned by appellate judges, family members vying for appointment must do everything they can to convince the judge that they are most suitable, and that their opponent is not suitable. This process is not fun for anyone who participates, but sometimes is necessary. Compromise is usually the best solution, but when it simply is not possible, then the judge will decide. Sometimes the decision is one that neither side is happy with - such as the selection of an outsider, such as an independent attorney or guardianship company.

The best way to protect yourself - and more important, protect your elderly loved one - is to have an experienced probate litigation attorney represent you in court. Knowing what to say, and how to present your case in the best light to the particular judge assigned, can make all the difference. Judges are human beings too; experienced attorneys who know the tendencies of your particular judge are a great benefit.

Once the Guardian and/or Conservator is appointed, the person or persons appointed serve with similar fiduciary obligations as an Attorney-in-Fact (discussed in last week's article). Again, they have the strictest of duties to act in the best interests of the ward they are required to protect.

Unlike in a Power-of-Attorney situation, they have the additional requirement of reporting to the probate court. Each year, every guardian and conservator must file a detailed report, so that the probate court can make sure that the ward is properly protected. Probate courts often also require bonds to be posted when the protected person has significant assets.

Guardians and Conservators are also subject to removal petitions, where someone asks the court to replace them or terminate the guardianship/conservatorship altogether. These can be filed by anyone interested in the ward's welfare. In fact, even the protected person can seek this relief by writing a simple letter to the judge.

Certainly, no one should choose to initiate a guardianship or conservatorship proceeding unless they have no other good choice. But when diplomacy has failed, or when a loved one's Alzheimer's, dementia or other condition causes them to be too stubborn to admit that they need help making decisions, this path is the only safe choice. With an experienced attorney guiding the family, protective proceedings through probate court help many people sleep at night knowing their loved one is safe.

Senior Citizens that Bring Companions to Medical Visits are More Satisfied with Care

Companions are a valuable quality of care resource that could enhance the experience for millions of vulnerable Americans

July 14, 2008 - Almost two out of every five Medicare patients age 65 or older appear for their medical visits accompanied by family members or companions, which seems to contribute to a greater satisfaction with their doctor and about everything else associated with the visit. The report in today's Archives of Internal Medicine, one of the JAMA/Archives journals, says this is especially true among those in poor health.

Families are increasingly understood to be important to patient care, according to background information in the article. However, little is known about which specific attributes of their involvement are most helpful to patients or result in the greatest improvements in quality of care.

Jennifer L. Wolff, Ph.D., and Debra L. Roter, Dr. P.H., M.P.H., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues studied a sample of 12,018 Medicare beneficiaries 65 years or older who participated in a 2004 survey. These older adults were representative of approximately 30 million Medicare beneficiaries living in the community.

The researchers found that:
  • 38.6 percent of participants reported regularly being accompanied to medical visits
  • Companions included spouses (53.3 percent); adult children (31.9 percent); other relatives (6.8 percent); roommates, friends or neighbors (5.2 percent); non-relatives (2.8 percent); or nurses, nurse aides or legal or financial officers (less than 1 percent)
  • 63.8 percent of companions helped with communication, including 44.1 percent who recorded physician comments and instructions, 41.5 percent who communicated information about the patient's medical condition to the physician, 41 percent who asked questions, 29.7 percent who explained physician's instructions and 3.3 percent who translated the English language
  • 28.4 percent of companions were reported to be present for company and moral support, 52.3 percent to assist with transportation, 16.6 percent to help schedule appointments and 8.4 percent to provide physical assistance
Beneficiaries with regular companions were more highly satisfied with their physician's technical skills, information-giving and interpersonal skills.

Those whose companions more actively helped with communication rated their physicians' information-giving and interpersonal skills more favorably.

This relationship was stronger among patients who reported themselves to be in worse health.

"Findings establish that visit companions, most often spouses and adult children, are commonly present in older adults' routine medical encounters, actively engaged in the exchange of health information between patients and their physicians and influential in patients' perceptions of physician interpersonal rapport and information giving," the authors write.

"Moreover, visit companions tend to accompany patients who are especially vulnerable; in this study, accompanied patients were older, less educated and in worse health than their unaccompanied counterparts."

"Results presented in this article suggest that patients' visit companions, hidden, but in plain sight, are a valuable quality of care resource whose efforts, if further optimized, could enhance the experience of care for millions of vulnerable Americans," they conclude.

Source: Jennifer L. Wolff, Ph.D., and Debra L. Roter, Dr. P.H., M.P.H., of the Johns Hopkins Bloomberg School of Public Health, Baltimore

Drink More Red Wine - it is Good for You. Red Wine May Improve Heart Health in Old Age.

June 4, 2008 - Scientists have long maintained senior citizens can extend their lives by strict adherence to a diet that rigidly restricts calorie intake. Now, scientists may have discovered how to accomplish this without starving yourself. It is a choice most seniors will gladly choose over severe calorie restriction - drinking red wine. A new study says low doses of the resveratrol in red wine may achieve the same longevity results as starvation dieting.

How do the French get away with a clean bill of heart health despite a diet loaded with saturated fats?

Scientists have long suspected that the answer to the so-called "French paradox" lies in red wine. Now, the results of this new study bring them closer to understanding why.

Writing this week in the online, open-access journal Public Library of Science (PLoS) ONE, researchers from industry and academia, including the University of Wisconsin-Madison and the University of Florida, report that low doses of resveratrol - a natural constituent of grapes, pomegranates, red wine and other foods - can potentially boost the quality of life by improving heart health in old age.

The scientists included small amounts of resveratrol in the diets of middle-aged mice and found that the compound has a widespread influence on the genetic causes of aging.

Specifically, the researchers found that low doses of resveratrol mimic the heart-healthy effects of what is known as caloric restriction, diets with 20 to 30 percent fewer calories than a typical diet.

The new study is important because it suggests that resveratrol and caloric restriction, which has been widely studied in animals from spiders to humans, may govern the same master genetic pathways related to aging.

"Caloric restriction is highly effective in extending life in many species. If you provide species with less food, the regulated cellular stress response of this healthy habit actually makes them live longer," says study author Christiaan Leeuwenburgh, chief of the division of biology of aging at UF's Institute on Aging.

"In this study, the effects of low doses of resveratrol (on genes) were comparable to caloric restriction, the hallmark for life extension."

Previous research has shown that high doses of resveratrol extend life in invertebrates and prevent early death in mice given a high-fat diet. The new study extends those findings, showing that resveratrol in low doses, beginning in middle age, can elicit many of the same benefits as a reduced-calorie diet.

"Resveratrol is active in much lower doses than previously thought," said Tomas Prolla, a UW professor of genetics and a senior author of the new report.

The group explored the agent's influence on the heart, muscle and brain by looking to see which genes were switched on and off during the aging process.

In the new study - which compared the genetic responses of animals to either restricted diets or normal diets including small doses of resveratrol - the similarities were remarkable, explains lead author Jamie Barger of Madison, Wis.-based LifeGen Technologies, who spearheaded the research.

In the heart, for example, there are at least 1,029 genes whose functions change with age. In animals on restricted diets, 90 percent of those heart genes experienced alterations in gene expression, while low doses of resveratrol thwarted age-related change in 92 percent. The new findings, say the study's authors, reveal how red wine's special ingredient helps keep the heart young.

In short, the authors note that a glass of wine or food or supplements containing even small doses of resveratrol are likely to help stave off cardiac aging.

That finding, may also explain the remarkable heart health of people who live in some regions of France where diets are soaked in saturated fats but the incidence of heart disease, a major cause of mortality in the United States, is low. In France, meals are traditionally complemented with a glass of red wine.

"There must be a few master biochemical pathways activated in response to caloric restriction, which in turn activate many other pathways," explained Prolla. "And resveratrol seems to activate some of these master pathways as well."

Resveratrol is currently sold over-the-counter as a nutritional supplement with supposed anti-cancer, anti-viral, anti-inflammatory and anti-aging benefits, although few scientific studies have verified these claims in humans. That may soon change: Researchers at the University of Florida hope to explore the effects of resveratrol on older people in a phase 1 clinical trial, set to begin this summer.

The study will assess the supplement's effects on memory, physical performance, inflammation and oxidative damage, according to Steve Anton, a principal investigator of the upcoming trial and an assistant professor of aging and geriatrics in the UF College of Medicine.

Mitochondria, the tiny power plants that keep a cell functioning, are especially vulnerable to the oxidative damage that accumulates during the aging process.

"In animal studies, (resveratrol) seems to promote mitochondrial health," said Todd Manini, also a principal investigator of the upcoming trial and an assistant professor of aging and geriatrics in the UF College of Medicine. "Mitochondria are everywhere: They're in the brain, in the muscle, the liver. So it could have kind of a global impact on many different organ systems."

Source: www.seniorjournal.com

Senior Citizens Learning to Fall Like a Skydiver Can Reduce Hip Fractures by 70 Percent

Parachutist's landing best reduces hip impact whether you jumped from an airplane or tripped on a curb

July 7, 2008 - Senior citizens could reduce their risk of hip fracture by nearly 70 percent if they learn to fall like skydivers, new research from the University of Michigan suggests.

In the first study to examine the effectiveness of different sideways fall strategies, computer simulations showed that the parachutist's landing method best reduces hip impact whether you jumped from an airplane or tripped on a curb.

The parachutist's strategy involves crouching, leaning so that the outside of your lower leg hits first and then rolling onto your backside. In the simulations, landing in this position subjected the hip to just 25 percent of the force necessary to break it.

"A hip fracture can mark the beginning of a downward spiral. If you fall and break a hip and you're over 65, you have a 20 percent chance of not surviving another year and another 20 percent chance of not regaining your mobility," said James Ashton-Miller, a professor in the departments of Biomedical Engineering and Mechanical Engineering. Ashton-Miller is an author of a paper on the research published in the Journal of Biomechanics.

"In this study, we asked whether it matters what you do in the air after you start to fall. We found that a parachutist's landing style reduces your risk of injury, and you can land a fall safely with or without your hands," he said.

A hip fracture often occurs when a person trips and lands on his or her side, Ashton-Miller said. The study showed that the typical reduction in muscle strength that occurs with age does not impair an individual's ability to accomplish the safest strategy.

The study also found that reaction time is as important as the body's position during a fall. A delay of more than two-tenths of a second in deploying the parachutist's strategy increased the impact force of the fall by at least 70 percent.

Falling on a non-slippery surface, you have seven-tenths of a second from stumble to impact, Ashton-Miller said. Typical reaction time is two-tenths of a second. That leaves five-tenths of a second to put the fall strategy into practice. So it's best to know how to fall in advance.

Click to view UM video

"When you start to fall, you need to know what to do. You can't hang around trying to decide what to do. What people tend to think is that there's no time to do anything, and that's absolutely not true," said Ashton-Miller, who says he learned this firsthand as an avid skier.

The researchers tested four fall strategies. The "broomstick" strategy involved keeping the body stiff. This was the control. The "hip lateral flexion" strategy allowed the hips to swivel by 30 degrees but the other joints remained stiff. The "spine and hip" strategy confined the knees to a maximum bend of 20 degrees, but other joints could operate normally. And the "free" strategy allowed all joints to move freely.

When a computer simulation of a man falling was given these constraints, it identified the free strategy as the least likely to break a hip. And it pinpointed the parachutist's style as the best way to allow the joints to move so the muscles dissipate energy and thereby lower the impact force. Ashton-Miller said future experiments and simulations will study women falling as well, and he expects the results to be similar.

Strategies were tested with and without the use of an arm to help break the fall. And time delays of one-, two- and three-tenths of a second were simulated, along with the effects of age on muscle strength.

Source: This research was funded by the U.S. Department of Health and Human Services. The paper is called "Effect of pre-impact movement strategies on the impact forces resulting from a lateral fall." Ashton-Miller is a research professor in the Institute of Gerontology and in Internal Medicine at the U-M Health System.

What Happens When The Family Can't Get Along?

Dealing with a loved one with Alzheimer's disease, dementia or another condition causing loss of competence is difficult enough. The problem becomes even more troublesome when the condition acts as a spark to ignite family conflict. Sibling rivalries, second marriages, the refusal to accept reduced competency, and simple greed are but some of the situations that add fuel to the fire and foster dramatic family feuds. Often the fire grows so great that families become torn in half, spending months - or even years - battling in probate court. Sadly, many families are never able to repair the damage, emotionally or financially.

No one wants to end up in probate court fighting in a public family squabble. What can be done to avoid it? Sometimes nothing. If someone else is determined to steal from, cheat, take advantage of, or improperly care for someone suffering from Alzheimer's or dementia, you may have no choice but to go to court. Other times, however, messy and expensive probate court battles can be prevented, or at least minimized. How? Two ways: Know when to call an experienced probate litigation attorney, and know your legal rights.

The first one is easy. Anytime you suspect that someone is not acting properly towards an elderly loved one in a way that will either jeopardize that persons' care or well-being, or may result in a loss of assets, then you should call an attorney who regularly represents clients in contested probate matters. Many such attorneys offer a low-cost or even free consultation. For example, the experienced attorneys at The Center for Probate Litigation will provide a free consultation to discuss your specific situation and let you know whether action is required. Too many families regret waiting and doing nothing - when in doubt, call an expert.

The second way to protect your family and often avoid drawn out court proceedings is to become educated about your legal rights. The Center for Elder Law and The Center for Probate Litigation will be issuing a series of articles for families of a loved one with Alzheimer's disease or dementia to educate about what they may face when a family dispute or conflict threatens to surface. These articles will be included in upcoming E-Letters, on the following topics:
  • Challenging a Power of Attorney or Patient Advocate Designation
  • Guardianship & Conservatorship Disputes
  • Theft and Loss of Assets
  • Challenging Changes to a Joint Asset, Will or Trust
By Andrew Mayoras, The Center for Probate Litigation

Medicare News: End-of-Life Options for Medicare Patients Detailed in New Regulation

June 5, 2008 - Medicare beneficiaries with terminal illnesses have their right to determine how they receive end-of-life care outlined for the first time in a new regulation to be published today by the Centers for Medicare & Medicaid Services.

Specifically, the rule says, patients who choose hospice, or palliative care, over curative treatment are entitled to such things as participation in their treatment plan; the right to effective pain management, the right to refuse treatment and the right to choose his or her own physician.

In the first overhaul of regulations governing the hospice industry since 1983, the new Medicare Conditions of Participation (CoP), include explicit language on patient rights that had not existed under the previous regulations.

Although many hospice patients are already active in their own treatment plans, this regulation is the first to set out a detailed list of patient rights.

"As more patients and their families come to understand and select hospice care, we felt it was critical to outline what rights patients have to control the care they receive in their final days," said Kerry Weems, acting administrator of CMS.

"End-of-life care has changed markedly in the past 25 years and it is time to update our regulations to reflect advances in medicine and hospice industry practices as well as patient rights," Weems added.

Electing hospice care is a decision those with terminal illnesses can make when they wish to forego further curative treatment in favor of care designed to ease pain and other symptoms. Hospice services provide comfort care to the patient and can include services for family members. Hospice services can be provided in the patient's home or in an inpatient setting. Currently there are nearly one million Medicare beneficiaries receiving care from over 3,000 Medicare-approved hospices nationwide.

The rule reflects comments received since the publication of the proposed rule in May 2005. In addition to the new patient rights' section, final regulation also includes:
  • A requirement that patient needs be initially assessed within 48 hours of electing the hospice benefit. The rule also requires that a comprehensive assessment occur within five days of electing the hospice and that updated assessments be done at least every 15 days thereafter.
  • A requirement that each patient receive a full drug profile that examines issues ranging from the effectiveness of current drug therapies to potential drug interactions to drug side effects. A treatment team will consult with a qualified individual, such as a pharmacist, to ensure that drugs meet the needs of every hospice patient.
  • A provision allowing a hospice to contract with another Medicare-certified hospice for nursing, medical social services, and counseling services under extraordinary or other non-routine circumstances, including travel of a patient outside of the hospice's service area.
  • Removal of a provision requiring an inpatient facility only providing respite care to have an RN on duty 24 hours a day. The patient's needs, acuity and plan of care will drive the nursing and staffing requirements.

The regulation, to be in the Federal Register on June 5, can be viewed at www.cms.hhs.gov/CFCsAndCoPs/05_Hospice.asp

Man's Best Friend: Study Shows Lonely Seniors Prefer Playtime With Pooch Over Human Interaction

A Saint Louis University study shows there is some truth in the old cliche that describes a dog as "man's best friend."

"Or at least a less aggravating friend," said study author William A. Banks, M.D., professor of geriatrics in the department of internal medicine and professor of pharmacological and physiological sciences at Saint Louis University School of Medicine.

Nursing home residents felt much less lonely after spending time alone with a dog than they did when they visited with a dog and other people. The research was published in the March 2006 issue of Anthrozoos 18(4).

"It was a strange finding," said Banks, who also is a staff physician at Veterans Affairs Medical Center in St. Louis. "We had thought that the dog acts as a social lubricant and increases the interaction between the residents. We expected the group dog visits were going to work better, but they didn't.

"The residents found a little quiet time with the pooch is a lot nicer than spending time with a dog and other people," he said.

Thirty-seven nursing home residents who scored high on a loneliness scale said they wanted to receive weekly, 30-minute visits from dogs. Half spent time alone with the dog, and the other half spent time with one to three other nursing home residents and the dog. While both groups felt less lonely, the group that had one-on-one quality time with the dog experienced a much more significant decrease in loneliness after five to six weeks of visits.

The main way pets reduce loneliness in nursing homes is simply by being with people, not by enhancing socialization between people - for instance, giving nursing home residents something to talk about or an experience to share, Banks said.

"There is no need for a dog to be a social lubricant or icebreaker in a nursing home. Residents live with each other, eat breakfast, lunch and dinner with each other, play bingo with each other," Banks says. "The study also found that the loneliest individuals benefited the most from visits with dogs."

Source: www.sciencedaily.com

Hidden Social Security Option

Did you elect to take Social Security benefits before your full retirement age? If you did and are now looking for extra income, there may be an answer. Once you reach full retirement age, you can pay back the money you have received and reapply for full retirement benefits.

Although you can collect Social Security benefits between age 62 and your full retirement age, if you do, your benefits will be lower. For example, if you were born in 1944 and decide to retire at age 62, four years before your full retirement age of 66, your total benefit reduction is 25 percent. If your full benefit was to be $1,000 a month, your reduced benefit will be $750.

A little-known provision of Social Security allows you to withdraw your application for early benefits and reapply for your full benefits. The catch is that you must be able to pay back all the money you received so far. However, because you do not have to pay any interest on the benefits you received, if you can find the money to repay the benefits, it may be worth it. You could think of it as an interest-free loan.

Articles on the potential benefits of withdrawing your early Social Security benefit from USA Today and MSN have examples of how it works.

Click here to download the withdrawal of application form.

All You Need to Know about Identity Theft

Take steps to respond to and recover from identity theft as soon as you suspect it.

The following questions are answered below:

  • What are the steps I should take if I'm a victim of identity theft?
  • What is a fraud alert?
  • What is a credit freeze?
  • What is an identity theft report?
  • What do I do if the police only take reports about identity theft over the Internet or telephone?
  • What do I do if the local police won't take a report?
  • How do I prove that I'm an identity theft victim?
  • Should I apply for a new Social Security number?

WHAT ARE THE STEPS I SHOULD TAKE IF I'M A VICTIM OF IDENTITY THEFT?

If you are a victim of identity theft, take the following four steps as soon as possible, and keep a record with the details of your conversations and copies of all correspondence.
  1. Place a fraud alert on your credit reports, and review your credit reports. Fraud alerts can help prevent an identity thief from opening any more accounts in your name. Contact the toll-free fraud number of any of the three consumer reporting companies below to place a fraud alert on your credit report. You only need to contact one of the three companies to place an alert. The company you call is required to contact the other two, which will place an alert on their versions of your report, too. If you do not receive a confirmation from a company, you should contact that company directly to place a fraud alert.

    Equifax: 1-800-525-6285; www.equifax.com; P.O. Box 740241, Atlanta, GA 30374-0241

    Experian: 1-888-EXPERIAN (397-3742); www.experian.com ; P.O. Box 9532, Allen, TX 75013

    TransUnion: 1-800-680-7289; www.transunion.com ; Fraud Victim Assistance Division, P.O. Box 6790, Fullerton, CA 92834-6790

    Once you place the fraud alert in your file, you're entitled to order one free copy of your credit report from each of the three consumer reporting companies, and, if you ask, only the last four digits of your Social Security number will appear on your credit reports. Once you get your credit reports, review them carefully. Look for inquiries from companies you haven't contacted, accounts you didn't open, and debts on your accounts that you can't explain. Check that information, like your Social Security number, address(es), name or initials, and employers are correct. If you find fraudulent or inaccurate information, get it removed. See Correcting Fraudulent Information in Credit Reports to learn how. When you correct your credit report, use an Identity Theft Report with a cover letter explaining your request, to get the fastest and most complete results.

    Continue to check your credit reports periodically, especially for the first year after you discover the identity theft, to make sure no new fraudulent activity has occurred.

  2. Close the accounts that you know, or believe, have been tampered with or opened fraudulently.

    Call and speak with someone in the security or fraud department of each company. Follow up in writing, and include copies (NOT originals) of supporting documents. It's important to notify credit card companies and banks in writing. Send your letters by certified mail, return receipt requested, so you can document what the company received and when. Keep a file of your correspondence and enclosures.

    When you open new accounts, use new Personal Identification Numbers (PINs) and passwords. Avoid using easily available information like your mother's maiden name, your birth date, the last four digits of your Social Security number or your phone number, or a series of consecutive numbers.

    If the identity thief has made charges or debits on your accounts, or has fraudulently opened accounts, ask the company for the forms to dispute those transactions:

    • For charges and debits on existing accounts, ask the representative to send you the company's fraud dispute forms. If the company doesn't have special forms, use the sample letter to dispute the fraudulent charges or debits. In either case, write to the company at the address given for "billing inquiries," NOT the address for sending your payments.

    • For new unauthorized accounts, you can either file a dispute directly with the company or file a report with the police and provide a copy, called an "Identity Theft Report," to the company.

      • If you want to file a dispute directly with the company, and do not want to file a report with the police, ask if the company accepts the FTC's ID Theft Affidavit (PDF, 56 KB). If it does not, ask the representative to send you the company's fraud dispute forms.

      • However, filing a report with the police and then providing the company with an Identity Theft Report will give you greater protection. For example, if the company has already reported these unauthorized accounts or debts on your credit report, an Identity Theft Report will require them to stop reporting that fraudulent information. Use the cover letter to explain to the company the rights you have by using the Identity Theft Report. More information about getting and using an Identity Theft Report can be found here.

    Once you have resolved your identity theft dispute with the company, ask for a letter stating that the company has closed the disputed accounts and has discharged the fraudulent debts. This letter is your best proof if errors relating to this account reappear on your credit report or you are contacted again about the fraudulent debt.

  3. File a complaint with the Federal Trade Commission.

    You can file a complaint with the FTC using the online complaint form; or call the FTC's Identity Theft Hotline, toll-free: 1-877-ID-THEFT (438-4338); TTY: 1-866-653-4261; or write Identity Theft Clearinghouse, Federal Trade Commission, 600 Pennsylvania Avenue, NW, Washington, DC 20580. Be sure to call the Hotline to update your complaint if you have any additional information or problems.

    By sharing your identity theft complaint with the FTC, you will provide important information that can help law enforcement officials across the nation track down identity thieves and stop them. The FTC can refer victims' complaints to other government agencies and companies for further action, as well as investigate companies for violations of laws the agency enforces.

    Additionally, you can provide a printed copy of your online Complaint form to the police to incorporate into their police report. The printed FTC ID Theft Complaint, in conjunction with the police report, can constitute an Identity Theft Report and entitle you to certain protections. This Identity Theft Report can be used to (1) permanently block fraudulent information from appearing on your credit report; (2) ensure that debts do not reappear on your credit report; (3) prevent a company from continuing to collect debts that result from identity theft; and (4) place an extended fraud alert on your credit report.

  4. File a report with your local police or the police in the community where the identity theft took place.

    Call your local police department and tell them that you want to file a report about your identity theft. Ask them if you can file the report in person. If you cannot, ask if you can file a report over the Internet or telephone. See below for information about Automated Reports.

    If the police are reluctant to take your report, ask to file a "Miscellaneous Incident" report, or try another jurisdiction, like your state police. You also can check with your state Attorney General's office to find out if state law requires the police to take reports for identity theft. Check the Blue Pages of your telephone directory for the phone number or check www.naag.org for a list of state Attorneys General.

    When you go to your local police department to file your report, bring a printed copy of your FTC ID Theft Complaint form, your cover letter, and your supporting documentation. The cover letter explains why a police report and an ID Theft Complaint are so important to victims.

    Ask the officer to attach or incorporate the ID Theft Complaint into their police report. Tell them that you need a copy of the Identity Theft Report (the police report with your ID Theft Complaint attached or incorporated) to dispute the fraudulent accounts and debts created by the identity thief. (In some jurisdictions the officer will not be able to give you a copy of the official police report, but should be able to sign your Complaint and write the police report number in the "Law Enforcement Report" section.)

WHAT IS A FRAUD ALERT?

There are two types of fraud alerts: an initial alert, and an extended alert.
  • An initial fraud alert stays on your credit report for at least 90 days. You may ask that an initial fraud alert be placed on your credit report if you suspect you have been, or are about to be, a victim of identity theft. An initial alert is appropriate if your wallet has been stolen or if you've been taken in by a "phishing" scam. With an initial fraud alert, potential creditors must use what the law refers to as "reasonable policies and procedures" to verify your identity before issuing credit in your name. However, the steps potential creditors take to verify your identity may not always alert them that the applicant is not you. When you place an initial fraud alert on your credit report, you're entitled to order one free credit report from each of the three nationwide consumer reporting companies, and, if you ask, only the last four digits of your Social Security number will appear on your credit reports.

  • An extended fraud alert stays on your credit report for seven years. You can have an extended alert placed on your credit report if you've been a victim of identity theft and you provide the consumer reporting company with an Identity Theft Report. An automated Identity Theft Report, such as the printed ID Theft Complaint available from this Web site, should be sufficient to obtain an extended fraud alert. With an extended fraud alert, potential creditors must actually contact you, or meet with you in person, before they issue you credit. When you place an extended alert on your credit report, you're entitled to two free credit reports within twelve months from each of the three nationwide consumer reporting companies. In addition, the consumer reporting companies will remove your name from marketing lists for pre-screened credit offers for five years unless you ask them to put your name back on the list before then.

To place either of these alerts on your credit report, or to have them removed, you will be required to provide appropriate proof of your identity: that may include your Social Security number, name, address and other personal information requested by the consumer reporting company.

As mentioned, depending on the type of fraud alert you place, potential creditors must either contact you or take reasonable steps to verify your identity. This may cause some delays if you're trying to obtain credit. To compensate for possible delays, you may wish to include a cell phone number, where you can be reached easily, in your alert. Remember to keep all contact information in your alert curre