MetLife has released its annual survey of long-term care costs:
Most Medicaid beneficiaries nationally are enrolled in some form of managed care, and, with current budget pressure and health reform on the horizon, states are expected to increase their reliance on managed care to deliver services in their Medicaid programs. At a policy briefing at 9:30 a.m. EDT Tuesday, September 13, the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) will release data from a new comprehensive 50-state survey of Medicaid managed care programs. The survey documents the diversity of state Medicaid managed care programs and examines how states monitor access and quality. It also explores emerging initiatives to improve care coordination, including managed long-term care and efforts targeted toward dual eligibles. And it offers perspective on the directions that Medicaid managed care may take in the coming years and under health reform.
At the briefing, Julia Paradise, an Associate Director of the KCMU, and Vernon K. Smith, Managing Principal, Health Management Associates, will present the survey findings. A panel of state Medicaid officials will offer perspectives, including Craigan Gray, Director, Division of Medical Assistance, North Carolina Department of Health and Human Services; Jason Helgerson, Medicaid Director, Office of Health Insurance Programs, New York State Department of Health; and Joe Vesowate, Deputy Director, Managed Care Operations, Medicaid and CHIP Division, Texas Health and Human Services Commission. Diane Rowland, Executive Vice President of The Kaiser Family Foundation and Executive Director of the KCMU, will moderate.
WHAT:
Policy Briefing, Comprehensive 50-State Survey of Medicaid Managed Care Programs
WHEN:
Tuesday, September 13, 2011
9:30 a.m. – 11 a.m. ET (Registration and breakfast beginning at 9 a.m.)
WHERE:
Barbara Jordan Conference Center (Kaiser Family Foundation Office)
1330 G Street NW, Washington, D.C. (one block west of Metro Center)
RSVP:
Please register online to attend this event in person.
http://kff091311.eventbrite.com/
Although we are blessed with many good long-term care facilities in North Georgia, sometimes people don’t get good care in long-term care facilities. That was the case recently when a West Virginia jury awarded $91.5 million to a family after an 87 year old woman died during her stay at a Charleston nursing home. The jury decided she died of dehydration and that the dehydration was the result of preventable neglect.
The key phrase here is “preventable.” While there is never an excuse for abuse or neglect, none of us want to see our loved ones injured so, … what can you do about it? If you see a problem (or think you see a problem), report it. The first place to report it would be at the nurses station in the facility where your loved one resides. Why? So they can do something about the situation before your loved one gets hurt. If that doesn’t generate a response, then you can report it to management or to the Long-Term Care Ombudsman. If that doesn’t work, then contact a lawyer.
Lovingood McGuffey is committed to helping your loved ones get the right care at the right time. We want to help you plan for the best. However, if you are not getting the care you deserve, we can also counsel you about your rights within the health care system. Contact us at (706) 428-0888 for a free consultation.
See West Virginia Jury Awards $91.5 Million in Nursing Home Death
Lillian Baral, a resident of Queens, New York, died at the age of 92. Prior to her death, her doctor diagnosed that she suffered from Alzheimer’s disease or dementia. A hospitalization in 2004 showed she had not been compliant in taking her medications properly and a plan of care was called for to determine whether it was safe for her to live at home alone. A medical summary from 2006 showed that Lillian’s ability to communicate orally was impaired, she was confused, she required assistance with activities of daily living, she required supervisions due to memory deficit, she was at risk or falling and she required baseline homecare services. Lillian’s doctor found that she needed 24 hour supervision and assistance.
Lillian’s brother (Mr. Baral) contracted with a company recommended by Lillian’s doctor to provide services for Lillian. Later, to reduce expenses, Mr. Baral terminated the company’s employment and directly hired one of the caregivers (Pzeverski) that had been working with Lillian. A second caregiver (Jakuboski) was also hired. During 2007, the caregivers were paid $40,760 and $8,820 respectively. They were also reimbursed $4,716 and $850 for expenses, respectively.
Mr. Baral managed his sister’s finances. Lillian had 2007 income from various sources which equaled or exceeded $94,229; this included distributions from IRAs and pensions. No income tax return was filed for 2007 and no taxes were paid. Later, Mr. Baral filed a substitute for return pursuant to section 6020(b) on the basis of information provided by third parties.
On November 9, 2009, the IRS sent Mr. Baral (on behalf of Lillian who died in 2008) a notice of deficiency for 2007. The IRS took the position that Lillian had taxable income of $94,229, that she was entitled to a personal exemption of $3,400 plus a standard deduction of $6,650. The IRS calculated a tax deficiency of $17,681.
When the tax court examined this case, it found that the expenses reimbursed to Pzevorski ($4,716) and Jakubowski ($850) were not deductible because Mr. Baral did not provide the receipts to the court; because the receipts were not provided, they could not be substantiated as relating to medical care. The implication was that if the receipts had been provided then they probably would have been deductible.
The court then examined whether payments totaling $49,580 made to Pzevorski and Jakubowski were deductible. Significantly, neither Pzevorski nor Jakubowski were licensed healthcare providers. Thus, they were not deductible as medical expenses per se because the providers were not licensed. HOWEVER, the court found that payments to them could be deducted if their services qualified as “long-term care services” as defined in Section 7702B(c) of the tax code.
After analyzing the tax code, the Court found that the care Pzevorski and Jakubowski provided constituted “maintenance or personal care services” for a “chronically ill individual” provided pursuant to a “plan of care prescribed by a licensed health care professional.” Thus, Lillian could deduct $43,273 of the payments made to Pzevorski and Jakubowski (the amount paid which exceeded 7.5% of her adjusted gross income).
See Estate of Lillian Baral v. Commissioner, decided July 5, 2011.
The Administration on Aging has published its July, 2011 newsletter. You can download it at the following link:
These days, more and more so-called “experts” are springing up to assist seniors with their estate planning. Many of them claim they can prepare your estate plan, offering a wide range of advice to solve all of your problems. Some of them claim they can get you on Medicaid, or VA benefits, or protect your assets. Unfortunately, many of these so-called experts hold credentials earned in weekend courses, followed by open-book examinations and their knowledge is quite “limited.” Frequently these individuals and businesses are selling “products” since they really don’t know enough to plan holistically. Frequently they are slick salesmen focused on a commission and they cause more harm than good. The credentials they hold are window dressing designed to make it look like they know what they’re doing when they’re really (at best) a one-trick pony; they don’t have the training to really evaluate your situation and provide meaningful advice tailored to meet your needs. So what does the law say about this?
Georgia law defines the “practice of law” and prohibits non-lawyers from engaging in it. Georgia statutes (O.C.G.A. § 15-19-50) define the practice of law as:
Georgia statutes (O.C.G.A. § 15-19-51) then go on to provide that it is unlawful for any person other than a duly licensed attorney at law:
It is also illegal for any corporation, voluntary association, or company to do or perform any of the acts recited above. Any of the acts described above are misdemeanors, which means they are criminal.
In 2005, the Georgia Supreme Court considered a case where a business claimed to provide advice to debtors. The business was explained as one where searches were made of courthouse records and where the business learned of a pending debt collection. The company would then contact the debtor and offer its “non-attorney” services. Those services included assessing the debtor’s situation, contacting the creditor’s attorney, attempting to negotiate a settlement. “Under the specific facts of this case, the company is required to exercise legal judgment to assess the validity and value of a creditor’s claim, evaluate procedural and evidentiary issues which may affect the outcome of the litigation, and advise clients as to their legal rights and obligations with regard to the debt and reasonableness of a settlement offer. Thus, under O.C.G.A. 15-19-50, the company and non-lawyer representing the company are engaging in the unauthorized practice of law.” In re UPL Advisory Opinion 2003-1, decided 11/21/2005.
The facts of the above case and those in a typical “estate planning” for public benefits consultation are remarkably similar. In public benefits cases, individuals are very concerned about their potential liability for health care debt, now and in the future. Routinely, salesmen indicate they are familiar with the law and offer to “assess” a potential customer’s situation. They then offer to provide advice concerning how to qualify for benefits. Sometimes they do this alone and other times they claim there is an attorney affiliated with their office. So, what does the State Bar of Georgia say about so-called estate planners who “have a lawyer” to “do the paperwork.” A formal advisory opinion from the State Bar makes it clear that it is improper for lawyers to lend their name so non-lawyers can provide legal opinions. See Formal Advisory Opinion No. 00-2. That opinion states: “a lawyer is aiding a nonlawyer in the unauthorized practice of law whenever the lawyer creates a reasonable appearance to others that the lawyer has effectively substituted the legal knowledge and judgment of the nonlawyer for his or her own.” Further, where an attorney prepares documents for signature in front of a nonlawyer, the attorney is likely assisting the nonlawyer in creating the appearance that the nonlawyer is qualified to render legal advice. “A lawyer permitting a nonlawyer to do this would be in violation of Standards of Conduct 24, 4, and 5.”
An individual can suffer serious harm when a non-lawyer provides legal advice. In just one example, CBS reported the story of Mary Lynch, a “spry Pennsylvania grandmother.” An estate planning group sold her a kit to prepare a living trust. According to the news report, it was a trap used to find out what senior citizens owned. “And once they do that, they can target, like let’s say, your mom and hard-pressure sell, to buy this annuity and earn a 10-percent commission.” Even when there is no allegation of intentional wrong-doing, inappropriate advice given by individuals and companies with inadequate training and experience can cost you tens of thousands of dollars.
If someone who is not an attorney offers you legal advice, you can do something about it. You can call the State Bar of Georgia’s hotline for the Unauthorized Practice of Law. That number is (404) 527-8743. You can get more information about the Unauthorized Practice of Law at:
Georgia UPL Rules and Statutes
The VA has developed a caregiver support section on its website, located at http://www.caregiver.va.gov/support_landing.asp.
If you have questions about how to access these services, you can call 1-855-260-3274. You can also contact your local Caregiver Support Coordinator for assistance.
The June 2011 issue of Bifocal, Journal of the ABA Commission on Law and Aging, is now available for download: June 2011 Bifocal
The ABA Commission on Law and Aging distributes Bifocal six times a year to elder bar section and committee officers and members, legal services providers, elder law and other private practitioners, judges, court staff, advocates, policymakers, law schools and elder law clinics, law libraries, and other professionals in the law and aging networks.
The U.S. Department of Veterans Affairs (VA) has released the 2011 edition of Federal Benefits for Veterans, Dependents and Survivors. This publication has information about health care, pensions, education and training, home loans, life insurance, transition assistance and how to appeal a decision on a claim for benefits.
Political Rant
Ok, this is a rant. I happen to be a Democrat. I do not apologize for it. I agree with many (but not all) of the social positions of the Democratic party, while rejecting others. I do this, in part, because i spend most of my time working with the elderly and individuals with special needs, most of whom would be kicked to the curb by the current Republican party. I differ with some Democrats, for example, because I am what the media would call pro-life (Does anyone else find it odd, by the way, that most Republican “pro-lifer’s” support the death penalty?) Despite my apparent liberal bent, I am perplexed when I see evidence in the newspaper that the Democratic party still cow-tows to ultra liberals who are clearly WAY (WAY WAY) out of touch with reality – people like House Minority Leader Nancy Pelosi. Anyone else would have been canned after the beating our party took in the last Congressional elections. Anyone else except, apparently, Ms. Pelosi.
While I’ve never met Ms. Pelosi (I’m sure she’s a swell person), it doesn’t take long to find that she isn’t taken seriously by anyone outside the DC beltway. She is, simply put, so far out of touch with main stream America that she’s a lightning rod. You have to wonder “why has our party vested leadership in someone who without question alienates many within the party and virtually everyone outside the party?” It makes no sense. Is anyone still silly enough to think America is effectively governed by mandate instead of by consensus? (Of course, the answer is yes, both parties are that silly as seen by their recent Keystone cop antics in barely avoiding a default on the public debt). What we need is a return to reason. Obviously, it won’t come from the so-called Tea Party which is out of touch with all but the far-right Republicans. What we need are common sense Democrats like Sam Nunn to step up to the plate. Unfortunately, most of them have deserted us, wandering over to a Republican party that is equally brain-dead. Where are the blue dog Democrats who were fiscal conservatives but still had a heart for those less fortunate and in need to a helping hand? Unfortunately, I think Elvis has been spotted more often in recent days.