Bernard A. Krooks - Littman Krooks LLP > New York Elder Law Blog > 2013 > December

Archive for December, 2013

Understanding Palliative Care

Monday, December 30th, 2013

Palliative care is a branch of medicine devoted to improving quality of life for people diagnosed with serious illnesses. Receiving such care can make a huge difference in patients’ lives, but many people do not know that it exists, or confuse it with hospice care. One of the hurdles to overcome in making this relatively new specialty more widely available is helping people understand when it is appropriate and why it is so important.

Palliative care focuses on providing relief from the pain, stress and other symptoms of serious illnesses. Hospice care is a type of palliative care that focuses on people who are dying. However, palliative care is also appropriate for patients who are continuing treatment for their illnesses and are expected to live much longer or even recover.

In hospitals and other settings where palliative care is provided, it is delivered by a team of doctors, nurses and specialists to provide additional support beyond that provided by the patient’s primary treatment team. A palliative care team may assist patients with cancer, cardiac or pulmonary disease, Alzheimer’s Parkinson’s, ALS or other illnesses. The team concentrates on addressing symptoms such as pain, fatigue, nausea and depression, improving patients’ ability to endure necessary medical treatments and bettering their quality of life.

Pain relief is often a major focus of palliative care. Patients who have serious illnesses or are recovering from major surgery may suffer from debilitating pain, and both doctor and patient may be wary of opioid use because of the danger of dependence. However, pain relief is an important part of treatment, and a palliative care team can help a patient find the best way to relieve suffering.

Relief from pain is not the only aspect of palliative care. It also includes more general help with quality of life issues such as accessing community services, living comfortably at home and obtaining medical and personal care services that a person with a serious illness may need.

The use of palliative care results in fewer emergency room trips and lower medical costs, in addition to making life more enjoyable for patients and improving prospects for recovery. Advocates for palliative care want the services to become universally available in hospitals, nursing homes and assisted living facilities, but there is much road to travel before that goal is reached. This type of treatment was first defined as a medical specialty in 2007, and many doctors are unfamiliar with it. Doctors who are untrained in palliative care may – like much of the public – equate it with hospice care, and therefore not request it for some patients who may need it.

Palliative care is available at most large hospitals in the United States, but patients may have to request it. Depending on the patient’s reason for seeing a doctor, palliative care may be covered by private insurance, Medicare and Medicaid. Patients who would benefit from palliative care, and their families, should advocate for the patient and request the services they need.

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Increased Payouts Coming to Social Security Beneficiaries in 2014

Friday, December 27th, 2013

The amount of monthly Social Security benefit checks will increase by 1.5 percent in 2014. The annual cost-of-living adjustment is expected to add $19 to the average Social Security check for retired workers, for an average monthly benefit of $1,294. The benefit for couples who both receive benefits is expected to climb by an average of $31, yielding an average monthly benefit of $2,111.

The cost-of-living adjustment happens every year and is based on the Consumer Price Index, the government’s measure of inflation. This increase is one of the lowest since automatic cost-of-living changes started in 1975. The basis for the small increase is the fact that consumer prices did not rise much overall in the past year. For example, the price of gasoline actually dropped. However, many essential goods and services, such as the cost of housing and medical costs, rose by more than 1.5 percent.

The cap for Social Security taxes will also increase in 2014. Most workers will pay 6.2 percent of their income into the system, until their earnings reach $117,000, up from $113,700 in 2013. The change will affect about 6 percent of workers.

Also in 2014, retirees below age 66 may earn up to $15,480 before some or all of their Social Security benefits are temporarily withheld, up $360 from 2013. Beneficiaries who earn more than that will have $1 withheld for every $2 they earn over the limit. People who will turn 66 in 2014 may earn up to $41,400, after which $1 is withheld for every $3 they earn. At age 66 or older, there is no earnings limit.

Finally, the maximum possible benefit a retiree can claim increases to $2,642 in 2014, up from $2,533 in 2013.

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Different Types of Assisted Living Facilities Meet Different Needs

Tuesday, December 17th, 2013

Assisted living facilities are residences for senior citizens where help is provided with daily living activities, as needed. This can include making doctor’s appointments and taking medication, as well as bathing, dressing and grooming. Meals and housekeeping are also provided at such facilities. In the state of New York, all types of assisted living residences are licensed as adult care facilities by the Department of Health. However, there are different types of adult care facilities, which may also be called enriched housing programs or adult homes.

First, all adult care facilities are distinguished from nursing homes in that they are for people who do not need round-the-clock medical services or skilled nursing. People who need for medical staff to be present on a continuous basis are better served by a nursing home.

The two kinds of adult care facilities in New York, enriched housing programs and adult homes, both offer long-term care in a residential setting, including meals, laundry, housekeeping, supervision and assistance with personal care and medication. One major difference is that the law has stricter supervision requirements for adult homes, although a number of enriched housing programs may offer the same level of supervision. In addition, enriched housing programs usually provide apartment-style residences, while adult homes generally provide private rooms or two-person rooms.

The same types of service provided in enriched housing programs and adult homes may also be provided by assisted living residences and assisted living programs. In order to refer to themselves as providing “assisted living,” these facilities must meet additional requirements of providing certain disclosures and rights for residents. The goal of assisted living facilities is to provide the care necessary to allow individuals to live as independently as possible, emphasizing personal dignity and freedom of choice.

Finally, an assisted living residence that offers aging-in-place services and obtains additional certification may be designated an enhanced assisted living residence. A special needs assisted living residence is an assisted living residence that provides specialized care and meets additional certification requirements.

For more information, refer to the New York State Department of Health’s website on assisted living, available at http://www.health.ny.gov/facilities/assisted_living.

 

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New Program Enlists Doormen to Watch for Elder Abuse

Friday, December 13th, 2013

A new program in New York City is training doormen who work in apartment buildings to watch for elder abuse.

The Harry and Jeanette Weinberg Center for Elder Abuse Prevention, part of the Hebrew Home at Riverdale, developed the program, which offers free training for doormen, porters, concierges and other building staff, at the building where they work.

Joy Solomon, the director of the Weinberg Center, said that many elderly people who were being abused did not come forward on their own, so advocates realized they would have to reach out to others who might be likely to spot the signs of abuse. The center has already helped to educate people such as estate lawyers, speech therapists, and those who deliver hot meals to seniors. Now building staff are being enlisted to help as well.

Many buildings in the city have a growing population of elderly residents. An analysis of census data by Queens College found that by 2040, an estimated 21 percent of adults in New York City will be age 60 or older, an increase from 17 percent in 2010.

At a training she led recently, Ms. Solomon told of an elderly resident of an Upper East Side apartment building, who was taken advantage of by a woman. Building staff witnessed the woman removing valuables from the man’s apartment, but did not step forward, perhaps because they did not want to overstep their bounds. Solomon said that when a staff member knows that something is wrong, it is important to take action. Several older apartment building residents said they would much prefer that building staff say something about a situation that does not appear right, rather than staying quiet out of a fear of prying into someone else’s business.

For elderly residents who do not have frequent visits from friends and family, a doorman may be the first person to notice an injury, signs of confusion, or other evidence that the person needs help.

Solomon said that the training would be provided initially to buildings with large populations of older people, but would eventually be available to anyone requesting it.

 

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To Save on Taxes, Make Charitable Gifts Before Year’s End

Monday, December 9th, 2013

 

If one wishes to make charitable gifts as part of a tax-saving strategy, now is the time.

Although tax returns are not due until April 15, December is an excellent time to do a “dry run” on one’s tax return, to get an estimate of what one expects to pay in taxes, and to determine what charitable giving one may want to do before the end of the year, in order to reduce taxable income and lower one’s tax bill.

Newly retired individuals may benefit especially from such a dry run on their tax returns, as retirees are often unclear on how to manage taxes in retirement. If there are problems with withholding on pensions, Social Security or IRA withdrawals, then one may end up paying penalties and interest at tax time. IRA account owners can make use of a key strategy to deal with any underpaid taxes. It is possible for IRA owners to make a distribution and withhold the whole sum for taxes. The IRS will not consider it a late payment, but will treat it as taxes paid throughout the year.

Another IRA strategy for retirees is charitable IRA rollovers. After age 70 1/2, owners of traditional IRA accounts must begin taking required minimum distributions. However, they can make direct transfers of up to $100,000 from an IRA to qualified charities, and this counts toward the required minimum distribution, while not being counted as income.

Anyone wishing to make charitable contributions before the end of the year needs to be aware of the rules for timing different types of gifts so that they count for the current year. One may also wish to make gifts to friends and family members before the end of the year without triggering a gift tax. The limit is $14,000 for individual givers and $28,000 for married couples – to as many individuals as they wish.

When donating to a charity by check, the effective date of the donation is the date the check was mailed. When giving to non-charity donees, the gift is effective when the check clears.

Giving stock to a charity by certificate form is effective on the date of transfer in the records of the issuer.

Giving stock to a charity by electronic transfer is effective on the date the issuer shows that the stock is received, which can take several days. For non-charity donees, the gift is effective when the transfer is made on the books of the corporation, which can take weeks.

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