Wills, Trusts & Estates Prof Blog

Editor: Gerry W. Beyer
Texas Tech Univ. School of Law

Saturday, January 18, 2020

Rich People Don’t Just Live Longer. They Also Get More Healthy Years.

SandtimerPaola Zaninotto, a professor of epidemiology and public health at University College London, was a lead author a recent study published in The Journals of Gerontology: Series A. The study showed that the wealthy live longer and also have eight to nine more healthy years after 50 than the poorest individuals in the United States and in England.

The study analyzed data two existing data sets containing more than 25,000 people over 50. Instead of income, the study defined wealth as the person's financial assets such as their home and possessions, minus their debts. For Americans, the average wealth was $29,000 for the poorest group, $180,000 for the middle group and $980,000 for the richest group, Dr. Zaninotto said.In both countries, wealthy women tended to live 33 disability-free years after age 50 and wealthy men 31 disability-free years, while those that were poor eight to nine years less healthy years.

Race, social class and education level did not have any measurable effect on the results, but wealth did. “More wealth means it’s easier to get to your appointments and access additional services that would not be available to people with less,” said Dr. Corinna Loeckenhoff, who was not involved in the study and is the director of the Healthy Aging Laboratory at Cornell University. But there are other factors to consider in one's longevity, such as a healthy diet, exercise, and reducing stress. The researchers had previously found that older Americans tended to be less healthy than older Britons, largely because of obesity.

See Heather Murphy, Rich People Don’t Just Live Longer. They Also Get More Healthy Years., New York Times, January 16, 2020.

Special thanks to Lewis Saret (Attorney, Washington, D.C.) for bringing this article to my attention.

January 18, 2020 in Current Affairs, Disability Planning - Health Care, Estate Planning - Generally | Permalink | Comments (0)

Thursday, January 16, 2020

Dying in the Neurosurgical I.C.U.

BrainscanWhen a doctor diagnoses a patient with brain death, no matter what a doctor does, the organs and rest of the body inevitably follows. But when an injury is devastating to the brain but has not incurred in becoming brain dead, the decisions of the physician as well as the family of the patient can be much more difficult.

Often times inconsistent communication and support between medical staff members and families exacerbate the situation. A new field, neuropalliative care, seeks to focus “on outcomes important to patients and families” and “to guide and support patients and families through complex choices involving immense uncertainty and intensely important outcomes of mind and body.” Together, family members and neuro-I.C.U. caregivers can agree on the appropriate action when the patient has not provided a legal document dictating their wishes, including transitioning the patient to comfort care and allowing the patient to die.

Doctors often think it is most important to be precise and not make mistakes; to predict the future and provide patients and their families with medical certainty. But usually connection and empathy are far more important than certainty. Patients and families want to know that the physicians care about them and that they appreciate their pain in difficult circumstances.

See Joseph Stern, M.D., Dying in the Neurosurgical I.C.U., New York Times, January 14, 2020.

Special thanks to Lewis Saret (Attorney, Washington, D.C.) for bringing this article to my attention.

January 16, 2020 in Current Affairs, Disability Planning - Health Care, Estate Administration, Estate Planning - Generally, Science | Permalink | Comments (0)

Sunday, January 5, 2020

Older People Need Geriatricians. Where Will They Come From?

GeriatricsAs the population of the country ages, the need for geriatricians - doctors that specialize in caring for the elderly - also increases. Geriatrics became a board-certified medical specialty only in 1988, and though the demand for this type of physician is getting higher, the supply of them unfortunately is not. The number of fellowships that train geriatricians has not increased by much and therefore is virtually stagnant.

A federal model estimates that one geriatrician can care for 700 patients with complicated medical needs. Following this guideline, the country will need 33,200 of these doctors by the year 2025, and currently America has 7,000 - half of which do not practice full time.  It is estimated that 30% of Americans over the age of 65 needs a geriatrician, especially those that suffer from 3 or more chronic conditions and have reached the age of 85. Geriatricians earn on average $233,564 a year, much less than what anesthesiologists, radiologists, and cardiologists are compensated. This may be due to Medicare paying less than traditional insurances and often slower pay outs.

A miraculous influx of doctors specializing in geriatrics is highly unlikely, and thus geriatricians are taking an alternative approach. Dr. Mary Tinetti, chief of geriatrics at the Yale School of Medicine, says that the "most important thing geriatricians can do is make sure all their other colleagues” understand these patients’ needs, she said, including nurse-practitioners, physician assistants, therapists and pharmacists. Currently cardiologists and oncologists often focus on older patients. The Senate Committee on Health, Education, Labor and Pensions voted to reauthorize a $41 million program that educates health professionals in geriatrics just last month and is awaiting a floor vote.

See Paula Span, Older People Need Geriatricians. Where Will They Come From?, New York Times, January 3, 2020.

Special thanks to Lewis Saret (Attorney, Washington, D.C.) for bringing this article to my attention.

January 5, 2020 in Current Affairs, Disability Planning - Health Care, Estate Planning - Generally, New Legislation | Permalink | Comments (1)

Friday, December 27, 2019

Alzheimer’s Tests Soon May Be Common. Should You Get One?

AlzThough doctors could determine that a person had Alzheimer's disease by particular symptoms, a formal diagnosis could not be performed until examining the brain during an autopsy. This may be a thing of the past, with two diagnostics tests on the horizon - a blood test that can detect the protein beta amyloid and a brain scan that can detect the protein tau.

These types of diagnostic testing may become more widespread, and with proteins developing on a person's brain before symptoms of the disease appear, a diagnosis can be formed before a patient develops Alzheimer's most feared symptom - dementia. A positive test could help a person get their affairs in order and form a plan for their future. And a drug company, Biogen, claims to have the first treatment that may slow the course of the disease if begun early enough. But how would knowing that one day you may not recognize any of your loved ones affect your choices today? Medical insurance companies are banned from denying coverage for patients with Alzheimer's diagnoses, but nothing is stopping long-term care insurers or even life insurers from denying them.

Dr. Daniel Gibbs, 68, a neurologist in Portland, noticed little slip ups in his memory and decided to get brain scans for beta amyloid and partake in cognitive tests. He was diagnosed as being in the early stages of Alzheimer's disease, and now has severe worries about his future, going so far as telling his family that if he gets something like pneumonia, they should withhold treatment. 

See Gina Kolata, Alzheimer’s Tests Soon May Be Common. Should You Get One?, New York Times, December 20, 2019.

Special thanks to Lewis Saret (Attorney, Washington, D.C.) for bringing this article to my attention.

December 27, 2019 in Current Affairs, Disability Planning - Health Care, Disability Planning - Property Management, Estate Planning - Generally, Science | Permalink | Comments (0)

Monday, December 2, 2019

Article on How Reliant are Older Americans on State and Local Government Pensions?

PensionPhilip Armour, Michael Hurd, &Susann Rohwedder  recently published an Article entitled, How Reliant are Older Americans on State and Local Government Pensions?, Elder Law eJournal (2019). Provided below is an abstract of the Article.

State and local government pension plans cover about 19.5 million participants, and many participants are heavily reliant on these pensions for retirement income. Most of these plans, however, are underfunded. Based on data from the Health and Retirement Study, we examined the lifetime work histories of those observed at ages 67 to 72 in 2004, 2008, or 2014. Seventy-seven percent of single persons and 61 percent of couple households had never worked for state or local (S&L) government. Among those single and couple households who did work for S&L government, we found that they have on average more years of education and more economic resources. Among currently retired and near-retirement households, we compared economic preparation for retirement according to their lifetime employment in the S&L sector, and we examined how economic preparation would be affected if pension benefits were cut. Based on stochastic simulations, which account for uncertainty about length of life and out-of-pocket medical expenditures, we found that economic preparation for retirement among those with S&L government work histories would only be modestly reduced if their pension income were cut. Under a 50 percent cut to all pension income of households with any S&L sector work, only an additional three to four percent of these households would no longer be prepared for retirement. The change is modest because households with S&L employment have better preparation than other households; some of the cuts are paid for by reduced taxes; and the affected households will bequeath less.

December 2, 2019 in Articles, Current Affairs, Disability Planning - Health Care, Disability Planning - Property Management, Elder Law, Estate Planning - Generally | Permalink | Comments (0)

Saturday, November 30, 2019

Article on Supported Decision-Making: A New Approach for Older Clients with Cognitive Impairment

BrainscanMargaret Castles published an Article entitled, Supported Decision-Making: A New Approach for Older Clients with Cognitive Impairment, Elder Law eJournal (2018). Provided below is the abstract to the Article.

There has been a flurry of law reform activity around elder rights in the last few years. In 2017 the Australian Law Reform Commission’s Report “Elder Abuse – a National Legal Response” made far reaching recommendations. Earlier this year the Commonwealth Government published the results of its Inquiry into the Quality of Residential Aged Care in Australia, and has recently announced a Royal Commission into Aged Care Quality and Safety.

 

November 30, 2019 in Articles, Current Affairs, Disability Planning - Health Care, Disability Planning - Property Management, Elder Law, Estate Administration, Estate Planning - Generally, Professional Responsibility | Permalink | Comments (0)

Wednesday, November 27, 2019

Thanksgiving for Caregiving

CaregiverNovember is National Family Caregivers Month, celebrating the more than 40 million people that give unpaid care, three-quarters which is to a family member. Many of these caregivers give so much of their time while also working full-time and providing for their own children. In addition to the $7,000 per year in out-of-pocket expenses, caregivers stand to lose wages and Social Security benefits of approximately $234,000 for male caregivers and $324,000 for women.

So how can these important and precious caregivers balance their lives with the caring?

  • Consider possible financial support, and not necessarily straight from the one they are caring for.
  • Share the burden, either from another family member or other source, whether professional or otherwise.
  • Improve workplace support for caregivers at both the federal and employer levels.
  • Improve support for the care recipient.
  • Technology advances that can help with support and caregiving.

See Naomi Cahn, Thanksgiving for Caregiving, November 21, 2019.

November 27, 2019 in Disability Planning - Health Care, Elder Law, Estate Planning - Generally | Permalink | Comments (0)

Monday, November 18, 2019

Analysis: New Jersey's New Aid-in-Dying Law - Implications for Physicians, Estate Planners, & Malpractice Attorneys

LawNew Jersey's Medical Aid-in-Dying for the Terminally Ill (MAID) Act passed earlier this year, and now has been held up by the state's highest court. Besides the patients themselves, many others across industries are affected by this new law, most importantly physicians, estate planners, and malpractice attorneys due to the possible ethical and legal implications.

Physicians may be tested on their belief that the new law violates their Hippocratic oath, and some may even face an ethical or religious dilemma if their beliefs run counter to the concept of suicide. How can a physician be sure that the patient's informed consent is not tainted my momentary depression or mental illness? Should a psychiatric assessment be performed every single time? And when it comes to practical issues, can there be legal pitfalls for the doctor?

For an estate planner, the issues are also just as nuances. Certain documents may need to be redrafted if they were done so before physician assisted suicide was an option. And a morbid truth may be that future heirs and even future decedents may try to use assisted suicide to time death for financial gains or planning certainty. Practitioners may be able to advise clients as to the preferred state to claim residency in for tax purposes, and which state’s assisted suicide law are the most beneficial. 

See Alex Raybould, Analysis: New Jersey's New Aid-in-Dying Law - Implications for Physicians, Estate Planners, & Malpractice Attorneys, Lewis Bris Bois, November 6, 2019.

Special thanks to Jim Hillhouse (Professional Legal Marketing (PLM, Inc.)) for bringing this article to my attention.

November 18, 2019 in Current Events, Death Event Planning, Disability Planning - Health Care, Estate Administration, Estate Planning - Generally, New Cases, New Legislation | Permalink | Comments (0)

Monday, November 11, 2019

Here’s a Way You Can Help Fight Alzheimer’s

AlzMicrosoft founder Bill Gates has become a prevalent advocate for Alzheimer's Disease in recent years, and believes that finding enough volunteers to participate in medical studies that will help us understand the disease better is a compounding problem. As the population ages, more and more individuals are suffering from this terrible condition. Nearly 6 million Americans are living with the disease today, and it is estimated that by 2050, the number could be as high as 14 million.

No new drug for Alzheimer's has been presented in over 15 years, in part due to the fact that clinical studies for the disease run 4 to 8 years compared to 1.5 years with studies for cardiovascular diseases. After the expensive process of diagnosing Alzheimer's, it is still difficult for a potential patient to enter into a clinical trial. 1 out of 10 people screened for certain types of Alzheimer’s trials will actually qualify, and 80% of do not meet their recruitment goals on time. So how can these issues be resolved?

  • Increase awareness of Alzheimer’s disease so patients start seeking help earlier in the disease’s progression.
  • Develop better diagnostics so that doctors can detect the disease sooner and help people enroll in the right clinical trials, including blood tests.
  • Raise awareness of—and  hopefully openness to—clinical trials among doctors and patients alike.

See Bill Gates, Here’s a Way You Can Help Fight Alzheimer’s, Gates Notes, November 5, 2019.

Special thanks to Lewis Saret (Attorney, Washington, D.C.) for bringing this article to my attention.

November 11, 2019 in Current Affairs, Disability Planning - Health Care, Estate Planning - Generally, Science | Permalink | Comments (0)

Tuesday, October 29, 2019

Preplanning for Medicaid Benefits - a Critical Step in Caregiving [Tennessee]

MedicaidIn Chattanooga, Tennessee, the cost of skilled care for chronic conditions such as Alzheimer's disease within a nursing home can run as high as $7,000 to $10,000 per month. If these numbers are seem daunting, one should start preplanning now for the possibility of turning to government benefits such as Medicaid.

The path towards Medicaid eligibility for long-term care is no walk in the park; regulation changes and clarifications, application forms, modernization of online portals, and other issues can be major pitfalls for any client. Here are some tips on how to navigate the path:

  • Learn about the basic benefits, resource limits, eligibility criteria, and evidence requirements at your state's government website
  • Gather important asset information (Medicaid has the right to know about the last five years, known as the look-back period)
  • If your assets or income exceed Medicaid's allowance, research appropriate ways to "spend down" without giving assets away or attempting to hide assets - make sure to only take advice from knowledgeable sources
  • Be aware that the most common reason for a denial of benefits is insufficient evidence

See Sally Brewer, Preplanning for Medicaid Benefits - a Critical Step in Caregiving, Chambliss Law, October 4, 2019.

Special thanks to Jim Hillhouse (Professional Legal Marketing (PLM, Inc.)) for bringing this article to my attention.

October 29, 2019 in Current Affairs, Disability Planning - Health Care, Elder Law, Estate Planning - Generally, New Legislation | Permalink | Comments (0)