Choices for End-of Life Caregiving

PlanForCare.org
November 5, 2010

There are many decisions to be made when imminent death is approaching for a loved one. Questions regarding what type of care, medical assistance and even physical location for their last days confront us.

If care at home has been given, should loved ones be moved to a facility or remain at home? If in a care facility should they be moved home for their last days? Will 24-hour care become necessary and more medical assistance be required?

If you are asking these questions, a Hospice service might be a good solution. Hospice can be provided to a person who has a life-limiting illness wherever that person lives. A nursing facility or long-term care facility can receive visits from hospice personnel in addition to the other care and services provided by the facility.

Hospice care is a special way of caring for a patient who is in the last stages of life. Hospice provides a team of professionals who aid the patient and family caregivers. This could include nurses, social workers, physicians, clergy and aides who all work together to plan and coordinate care, 24 hours a day or as needed.

The Hospice Foundation of America outlines the following services of hospice:

• Hospice is a special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments.
• Hospice care neither prolongs life nor hastens death. Hospice staff and volunteers offer a specialized knowledge of medical care, including pain management.
• The goal of hospice care is to improve the quality of a patient's last days by offering comfort and dignity.
• Hospice care is provided by a team-oriented group of specially trained professionals, volunteers and family members.
• Hospice addresses all symptoms of a disease, with a special emphasis on controlling a patient's pain and discomfort.
• Hospice deals with the emotional, social and spiritual impact of the disease on the patient and the patient's family and friends.
• Hospice offers a variety of bereavement and counseling services to families before and after a patient's death.

To be eligible for hospice a physician must certify the patient to be terminally ill with a life expectancy of six months or less and treatment for a cure is no longer provided.
The focus for the patient has changed to supportive care and quality of remaining life.

Hospice is paid for by private insurance, Medicare or Medicaid Hospice Benefit or personal funds.

Here are the conditions that apply for Medicare Hospice Benefits:

• You are eligible for Medicare Part A (Hospital Insurance)
• Your doctor and the hospice medical director certify that you’re terminally ill and have 6 months or less to live if your illness runs its normal course.
• You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness.
• You get care from a Medicare-approved hospice program
• You understand that Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness. Medicare.gov

Special benefit periods apply to Medicare hospice care and some services do not apply.
Be sure to understand the rules and requirements of Medicare payment before you commit.

Hospice is available to anyone, regardless of age or illness. If Medicare or private insurance is not available, hospice services may be available for low income individuals through grants or charitable donations. Many hospices are non-profit and will provide services to anyone in need.

“Many families or their loved ones' doctors often wait too long to order hospice. Hospice is a very valuable service and should be ordered at an earlier stage of illness. Many do not consider hospice for Alzheimer's, degenerative old age or other debilitating illnesses where a person is going downhill fast. They should.

It is unfortunate that many people who died in a hospital emergency room or who received heroic treatments to prolong life in a hospital may have had the alternative of dying at home in familiar surroundings, with family or other loved ones at their side.

When someone is in crisis or appears to be going downhill fast but there really is no hope for recovery, family often call 911 and start a process which can result in great stress and great emotional discomfort. The loved one who is dying ends up in a hospital and may die there or be transferred to a nursing home where death eventually occurs.

When there is no longer hope for prolonging life, especially when this decision is made months in advance, hospice is usually a better alternative to other medical intervention”. National Care Planning Council

The days leading up to the moment of death of a loved one can be rich with meaning and expressions of love. Family and caregivers should allow others to help with the care and daily responsibilities. They need to free themselves from the details of caregiving and instead need to use hospice to allow more time to reminisce, give thanks for a life shared and say goodbye.

http://www.planforcare.org
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The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in Wills and Trusts, Estate Planning, Guardianship, Probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for Family Law issues such as Divorce, Child Custody and Visitation, Support, and Military Family Law. 

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

Health Care Reform "Death by a Thousand Cuts"

Newport Elder Law Attorney Jeremy Howe found the following article regarding the repeal of Obama's Health Care Plan.

The article: “Republicans to Take On U.S. Health Law’s Taxes, Rules” from Bloomberg Businessweek (November 3rd) was reported today, November 4th, in Lawnewswatch.com. The article states that rather than repeal the health-care overhaul, the Republican strategy will resemble “death by a thousand cuts.”

The full article follows below.

Republicans to Take On U.S. Health Law’s Taxes, Rules

November 03, 2010
By Laura Litvan and Drew Armstrong


Nov. 3 (Bloomberg) -- Congressional Republicans pledged to repeal the health-care overhaul President Barack Obama signed into law in March. Once they consolidate power, the strategy will more likely resemble death by a thousand cuts.

House and Senate Republicans already have written at least 30 bills to roll back provisions in the law. The success of some efforts would mean WellPoint Inc. and competing health insurers may escape regulations to set their patient-care spending, while Boston Scientific Corp. and other medical-device makers dodge $20 billion in tax increases in the next decade.

With networks projecting that Republicans have won the seats needed for control of the House, the party also plans to target budgets of agencies implementing the health-care law.

“You can literally open the bill and point your finger to a page and say, ‘Here’s something we should go after,’” said Representative Michael C. Burgess of Texas, a Republican on the House Energy and Commerce health subcommittee. “It’s all bad.”

The party’s drive will force Democrats to vote on whether to defend unpopular parts of the law, said Tom Scully, the former chief of the Medicare program under President George W. Bush. Democratic control of the Senate and Obama’s veto pen assures there won’t be an outright repeal of the law or big changes, he said.

Democrat Losses

Bloomberg’s Managed Health Services stock index slid less than 1 percent at 4 p.m. New York time as WellPoint gained 30 cents, or less than 1 percent, to $56.05 in New York Stock Exchange composite trading. The Standard & Poor’s 500 Pharmaceutical Index gained 54 cents, or less than 1 percent. The S&P Biotechnology Index lost $4.77, or less than 1 percent.

“This outcome seems to be positive for the group in general,” Les Funtleyder, a health-care portfolio manager for Miller Tabak & Co. in New York, said in a note to clients. Health insurers have the most to gain, while biotechnology and pharmaceutical companies are less likely to see positive effects from the political contests, he said.

Republicans gained at least 60 House seats yesterday across the U.S. They picked up six in the Senate, winning in Illinois, Indiana, Arkansas, Pennsylvania, North Dakota and Wisconsin. They won’t get the 10-seat gain needed to control the Senate as races in Alaska and Washington are yet to be decided, and the Denver Post projected Democrats will hold the seat in Colorado.

‘Political Battle’

“Very little will happen in the next two years, but it will be a big political battle,” said Scully, senior counsel at the law office of Alston and Bird LLP of Washington.

Aetna Inc. Chief Executive Officer Ron Williams said today that the Hartford, Connecticut-based company “would welcome a renewed willingness to discuss market-based solutions” to improving the health-care system and controlling medical costs, without specifically commenting on the election.

Most of the action may be in the courts, where 21 states are challenging the law’s requirement that all Americans buy health insurance. Successful challenges could accomplish what Republican lawmakers can’t, by eliminating an important component of the overhaul.

If congressional Republicans strike some requirements of the law, health-care groups may pressure Congress to make other changes and set off a domino effect, said John Fortier, a congressional scholar at the American Enterprise Institute. “It’s not that the entire thing unravels if one piece fails, but the rationale for some of the things and the reason for some of the deals fails and potentially, some of the support.”

Changes From House

Efforts to change the law will originate in the House, where Republicans will decide which bills go to the floor and can hold oversight hearings on how the law is evolving. Democrats still control the Senate’s agenda. It will take a two- thirds majority of both chambers to override any Obama veto.

Congressional Republicans can “embarrass” Democrats with votes on the health overhaul, including during debate over a fiscal 2012 budget plan early in the next session, said Senator Orrin Hatch of Utah. Hatch in January will become top Republican on the Finance Committee.

House Republican leaders will begin with a January vote to repeal and replace it with a scaled-back measure patterned after legislation by Republican Leader John Boehner of Ohio, said John Murray, a spokesman for House Republican Whip Eric Cantor of Virginia.

Boehner’s Alternative

The approach by Boehner -- who is expected to become speaker -- would expand coverage to 3 million Americans by 2019 without requiring Americans to have insurance. It would let businesses pool resources to buy coverage and allow insurance purchases across state lines. Boehner’s proposal would leave about 52 million people without insurance, meaning the proportion of Americans with coverage would remain unchanged in 2019 at 83 percent, according to the Congressional Budget Office.

The health law would expand coverage to a projected 32 million Americans who currently lack insurance, largely through an expansion of the federal-state Medicaid program and new online health-purchasing exchanges. The overhaul is projected to cost $938 billion over 10 years while resulting in a reduction in the annual budget deficit by slowing the growth in spending on health care, according to CBO.

Its more contentious elements include a first-ever mandate that most Americans obtain health coverage -- the provision being challenged in court, largely by Republican state attorneys general -- and new taxes on the wealthy and on high-end insurance plans.

Coverage Mandate

Health insurers say the mandate requiring all Americans to have coverage is a necessity because otherwise people will only buy insurance when they get sick. The industry says removing the mandate would jeopardize consumer protections in the law, such as a requirement that insurers accept people with preexisting conditions.

Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, the industry’s Washington trade group, declined to discuss how a Republican victory would affect the mandate.

Republicans don’t necessarily oppose regulations on excluding people with pre-existing conditions, or other protections that have won support in polls. Their push to undo the individual mandate may make it harder to realize these rules, by burdening insurers with the new requirements without bringing in healthy new customers.

‘Delay and Dismantle’

In the event Boehner’s proposal gets stopped in the Senate, Republicans will embark on an approach they call “delay and dismantle” that targets individual provisions in the law, said Murray. Some of the proposals may result in lower payments to health-care providers and states.

Republicans said they want to go after a requirement in the law mandating that businesses of all sizes report to the IRS any expenditures exceeding $600. The Senate on Sept. 14 narrowly failed to repeal the provision after seven Democratic senators joined all of the chamber’s Republicans.

Burgess, a doctor first elected to Congress in 2002, has legislation requiring congressional and executive branch aides to get their health coverage from the insurance exchanges.

Representative Brian Bilbray of California wants to repeal $20 billion in taxes in a decade on medical device makers including Minneapolis, Minnesota-based Medtronic Inc. and Boston Scientific.

Medical Devices

Representative Charles Boustany, a Louisiana Republican, has a bill that would force Congress to reconsider the “CLASS Act,” a long-term disability insurance program, and end it should it require more funding than it generates from premiums.

Other legislation would deny agencies funds they need to implement the law. Bills introduced by Fred Upton, the Michigan representative who may head the Energy and Commerce Committee next year, and Virginia’s J. Randy Forbes would bar the Internal Revenue Service from hiring workers to review incomes that would help determine which Americans qualify for subsidies.

Congress should revoke a rule requiring insurers to spend at least 80 percent of the premiums they take in on patient care, Boustany and Burgess say. The measure will force some insurers to pull out of markets where they don’t meet the threshold, insurers and Republican lawmakers say.

“That will potentially be very disruptive to insurance coverage,” Boustany said.

Bipartisan Support

Some Senate Democrats will apply pressure on their leaders for changes, Hatch predicted. He’s seeking bipartisan support for legislation that would scrap the individual mandate and a requirement that most employers provide coverage to workers.

“We’ve got to have two, three, four, five Democrats who will work with us on this bill, because they’ve been getting killed at home,” Hatch said in an interview.

The Republican strategy may negatively affect segments of the health-care industry. The expansion of coverage to 32 million newly insured people may deliver more than $500 billion in added revenue for insurers, hospitals and other providers from 2014 to 2019, according to CBO projections.

--With assistance from Matt Barry, Chris Flavelle, Lisa Lerer and Catherine Dodge in Washington. Editors: Adriel Bettelheim, Steve Walsh

To contact the reporter on this story: Laura Litvan in Washington at llitvan@bloomberg.net; Drew Armstrong in Washington at darmstrong17@bloomberg.net

To contact the editors responsible for this story: Mark Silva at msilva34@bloomberg.net Adriel Bettelheim at abettelheim@bloomberg.net

http://www.businessweek.com/news/2010-11-03/republicans-to-take-on-u-s-health-law-s-taxes-rules.html


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The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in Wills and Trusts, Estate Planning, Guardianship, Probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for Family Law issues such as Divorce, Child Custody and Visitation, Support, and Military Family Law. 

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

Early Incentive Pay Not Attached to Pension

Divorce Results from Newport Attorney Jeremy Howe

Newport RI Divorce and Estate Planning Attorneys Jeremy Howe & Associates secure a favorable decision for a divorce client in RI with pension issues.

Hired by client to review the terms of his pension plan along with the terms of his divorce decree and the Qualified Domestic Relations Order that had been entered at the time to divide his pension for the benefit of the ex spouse. His company had informed him that if he elected his early retirement, his ex-wife would receive about one third of his “early incentive pay.”

We brainstormed the issues with a colleague and had conversations with legal counsel for the company. Ultimately we sent a letter stating our position that the ex-wife should not receive any portion of our client’s early incentive pay since it was not part of his pension.

He received the entire amount.

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The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in Wills and Trusts, Estate Planning, Guardianship, Probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for Family Law issues such as Divorce, Child Custody and Visitation, Support, and Military Family Law. 

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

Deceased Ex-Husband and RI Pension Funds

Results by Newport Attorney Jeremy Howe

Newport RI Estate Planning and Divorce Attorney Jeremy Howe and Associates drafts a Qualified Domestic Relations Order to secure retirement funds from ex-husband who died before reaching retirement age.

Hired by the Wife to complete the QDRO due to the fact her now ex-husband died before reaching retirement. The original QDRO that had been presented to the company was rejected and a final, revised version was never submitted by the original attorney before the husband passed away.

We consulted with the original attorney to reach a resolution. We drafted an Order that was acceptable to the Plan, and the division was made so our client could receive her portion of those retirement funds.

We also assisted our client in understanding the issues with regard to the potential rights of the ex-husband’s heirs and the company’s duty to all parties involved.

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The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in Wills and Trusts, Estate Planning, Guardianship, Probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for Family Law issues such as Divorce, Child Custody and Visitation, Support, and Military Family Law. 

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.