The problem: My father is 86, my mother, 84. My father doesn't think he needs a will because my mother will inherit everything when he dies. We're concerned that he does need a will to ensure that everything goes smoothly upon his passing. Is there a way to spell out what will happen when he dies?
The rules: Everyone should have a will - regardless of age, health or wealth - as a part of a comprehensive estate plan. Without an appropriate plan, a person's estate could pass through "intestacy," which means New York state law would determine how the estate is distributed.
Strategy: Your parents should create a comprehensive estate plan, which may include joint ownership, beneficiary designations and wills.
How it works: It may be true that your father's assets will pass to your mother immediately upon his death. But that depends on how he owns his assets. For instance, if your parents own their assets together as "joint tenants with right of survivorship," those assets will go directly to the surviving spouse automatically when one of them dies. This also is true if your parents have named each other as beneficiaries on their "in trust for" accounts, retirement accounts, annuities and life insurance policies.
However, if your father owns any assets in his name alone, without a designated beneficiary, those accounts and assets will need to pass through probate via the instructions in his will. A will controls the disposition of probate assets upon death.
In their wills, your parents can name their beneficiaries, appoint an executor to administer their estate and provide for the payment of funeral expenses and/or taxes. If any of their children have disabilities, their wills also could create a special needs trust for that child's benefit.
Result: With proper planning, your father can dictate how his assets will be distributed after he dies, and his family can have certainty in knowing how his estate will be distributed.
Written by Karen E. Klein, Newsday, 9/23/06.
Wednesday, September 27, 2006
Thursday, August 3, 2006
Senate OKs plans to allow prescription drug imports from Canada
WASHINGTON (AP) — The Senate opened the way Tuesday to let Americans import prescription drugs into the United States from Canada, seeking to ease a regulatory ban on cheaper medicine crossing the border.
The proposal, which was approved 68-32, would create a Canadian loophole on a Food and Drug Administration ban on importing prescription medicine into the United States. It was offered as part of a $31.7 billion Homeland Security Department spending blueprint for the fiscal year that begins Oct. 1.
The department's Customs and Border Protection bureau began aggressively seizing Tamiflu, Viagra and other incoming prescription medications at borders in November. Prescription drugs — even those manufactured in the United States — are generally sold at cheaper prices in Canada.
"We should demand that (Customs and Border Protection) focus on the true priority that we face on the war on terror," said Sen. David Vitter, R-La., of efforts to secure U.S. borders. "Stripping small amounts of prescription drugs from the hands of seniors .... that should not be a priority."
Vitter's plan, which was embraced by Democrats, specifically would prohibit Customs and Border Protection from stopping people with doctors' prescriptions for FDA-approved drugs from bringing the medicine into this country from Canada.
But Republican leaders vociferously opposed the plan for fear, they said, the drugs could be unsafe for consumers — or even present a terror risk.
Sen. Judd Gregg, R-N.H., said the proposal was an attempt to push the FDA into reversing itself while "creating a massive hole on our capacity to secure our borders and protect ourselves."
"If I were a creative terrorist, I would say to myself, 'Hey, listen, all I've got to do is produce a can here that says 'Lipitor' on it, make it look like the original Lipitor bottle, which isn't too hard to do, fill it with anthrax," Gregg said.
Lipitor is a cholesterol-lowering drug.
Aides warned that the drug import plan was likely to be stripped out of the legislation — as it has been in past years — whenever it got to a conference of House and Senate lawmakers who will negotiate the final version. The administration also has opposed efforts to loosen the restrictions.
Two House spending bills this year — to fund the Homeland Security and Agriculture departments in 2007 — include the drug importation plan, said Kirstin Brost, spokeswoman for Rep. David Obey of Wisconsin, the top Democrat on the House Appropriations Committee.
The House has approved efforts to import drugs in six spending bills over the last seven years, Brost said, but the idea far has survived the conference only once. But that year, 2000, the plan was eventually dropped because it was written in a way that couldn't be carried out, Brost said.
While importing drugs into the United States is illegal, the FDA generally has not stopped small amounts purchased for personal use. Still, the FDA says it cannot guarantee the safety of imported drugs.
Customs and Border Protection began seizing controlled substances in September 2004, and expanded that operation last November to include non-controlled substances. The Bush administration has opposed efforts to loosen the restrictions.
As of March, Customs officials had seized nearly 13,000 packages of drugs coming into the country, although the medications' origins were not known, according to data provided by Sen. Bill Nelson, D-Fla.
"This is going to ensure that Americans, especially the frail, elderly, or those with debilitating conditions, are going to be able to at least have a chance of affording the medications that they need," Nelson said.
Copyright 2006 The Associated Press. All rights reserved. Updated 7/11/2006, USA TODAY
The proposal, which was approved 68-32, would create a Canadian loophole on a Food and Drug Administration ban on importing prescription medicine into the United States. It was offered as part of a $31.7 billion Homeland Security Department spending blueprint for the fiscal year that begins Oct. 1.
The department's Customs and Border Protection bureau began aggressively seizing Tamiflu, Viagra and other incoming prescription medications at borders in November. Prescription drugs — even those manufactured in the United States — are generally sold at cheaper prices in Canada.
"We should demand that (Customs and Border Protection) focus on the true priority that we face on the war on terror," said Sen. David Vitter, R-La., of efforts to secure U.S. borders. "Stripping small amounts of prescription drugs from the hands of seniors .... that should not be a priority."
Vitter's plan, which was embraced by Democrats, specifically would prohibit Customs and Border Protection from stopping people with doctors' prescriptions for FDA-approved drugs from bringing the medicine into this country from Canada.
But Republican leaders vociferously opposed the plan for fear, they said, the drugs could be unsafe for consumers — or even present a terror risk.
Sen. Judd Gregg, R-N.H., said the proposal was an attempt to push the FDA into reversing itself while "creating a massive hole on our capacity to secure our borders and protect ourselves."
"If I were a creative terrorist, I would say to myself, 'Hey, listen, all I've got to do is produce a can here that says 'Lipitor' on it, make it look like the original Lipitor bottle, which isn't too hard to do, fill it with anthrax," Gregg said.
Lipitor is a cholesterol-lowering drug.
Aides warned that the drug import plan was likely to be stripped out of the legislation — as it has been in past years — whenever it got to a conference of House and Senate lawmakers who will negotiate the final version. The administration also has opposed efforts to loosen the restrictions.
Two House spending bills this year — to fund the Homeland Security and Agriculture departments in 2007 — include the drug importation plan, said Kirstin Brost, spokeswoman for Rep. David Obey of Wisconsin, the top Democrat on the House Appropriations Committee.
The House has approved efforts to import drugs in six spending bills over the last seven years, Brost said, but the idea far has survived the conference only once. But that year, 2000, the plan was eventually dropped because it was written in a way that couldn't be carried out, Brost said.
While importing drugs into the United States is illegal, the FDA generally has not stopped small amounts purchased for personal use. Still, the FDA says it cannot guarantee the safety of imported drugs.
Customs and Border Protection began seizing controlled substances in September 2004, and expanded that operation last November to include non-controlled substances. The Bush administration has opposed efforts to loosen the restrictions.
As of March, Customs officials had seized nearly 13,000 packages of drugs coming into the country, although the medications' origins were not known, according to data provided by Sen. Bill Nelson, D-Fla.
"This is going to ensure that Americans, especially the frail, elderly, or those with debilitating conditions, are going to be able to at least have a chance of affording the medications that they need," Nelson said.
Copyright 2006 The Associated Press. All rights reserved. Updated 7/11/2006, USA TODAY
Thursday, July 13, 2006
Clues to the mind robber: Alzheimer Drug Experimentation
WALTER Skotchdopole worked for 20 years as a police officer and 20 years in the film industry before succumbing to the relentless decline of Alzheimer's disease. In his prime, he joked with everyone he met. By his early 70s, he had become a shell of his former self.
"He's there, but he's not," says his son James Skotchdopole. "There's no real interaction, no real stake in life."
Walter Skotchdopole had tried several drugs, with no noticeable improvement. But when he began experimental treatments with Enbrel (etanercept) — a drug commonly used to treat rheumatoid arthritis — it was as if someone flipped a switch.
Within minutes of his first injection, he was making jokes. Later that afternoon, he ditched his cane to dance with a worker at his assisted-living facility. After a year and a half of weekly injections, Skotchdopole still gets confused sometimes, but requires far less help than he used to.
"The results we've seen are unprecedented with any kind of treatment," says Dr. Edward Tobinick, an assistant clinical professor of medicine at UCLA who led a recent pilot study of Enbrel's effects on 15 Alzheimer's patients.
Though still preliminary, the study's findings add to a growing list of approaches that scientists are taking to uncover the biological roots of Alzheimer's and hit the disease where it hurts.
About 4.5 million Americans have Alzheimer's disease, and healthcare costs total $100 billion a year, according to estimates by the Alzheimer's Assn. and the National Institute on Aging. By 2050, there could be as many as 16 million people with the disease.
Since 1992, the Food and Drug Administration has approved five drugs for treating the forgetfulness, communication problems and other traits of Alzheimer's. All of them target one of two key brain chemicals that help brain cells communicate and facilitate learning and memory. But the drugs — Aricept (donepezil), Razadyne (galantamine), Exelon (rivastigmine) and the newest, Namenda (memantine) — treat only symptoms, not the underlying disease. They just slow the rate of decline, and only for a year or two.
Researchers think they can do better by focusing on the root causes of Alzheimer's.
Most research targets the accumulation of a sticky protein called amyloid in the brains of Alzheimer's patients. The protein forms clumps, called plaques, that damage brain tissue. Various research groups are developing drugs that might reduce this buildup, keep the amyloid from clumping together or get rid of plaques after they've have formed.
Trials of a vaccine designed to clear the brain of amyloid were halted by Elan Pharmaceuticals in 2002, because 18 of 300 participants developed serious brain inflammation. But scientists continue to work on more selective vaccines that could help the body fight amyloid without harming surrounding tissue, says Dr. John C. Morris, director of the Alzheimer's Disease Research Center at Washington University in St. Louis.
Tobinick and colleagues have focused on the inflammation that happens in the brain as a result of both amyloid buildup and the accumulation of another protein, called tau, which forms "tangles" that damage brain cells. The researchers chose to investigate Enbrel because it disables an inflammation-promoting molecule called tumor necrosis factor-alpha. TNF-alpha causes joint pain in people with autoimmune diseases such as rheumatoid arthritis. In Alzheimer's, it sparks the immune system to attack brain tissue.
When used to treat patients with arthritis, Enbrel is injected into the arms or abdomen. That doesn't work with Alzheimer's patients. Studies show that TNF-alpha is as much as 25 times more abundant than normal in the spinal fluid of people with Alzheimer's. So, with a tiny needle, Tobinick injects the drug into the back of the neck, above the spine, which is thought to improve delivery to the brain.
The procedure is simple, he says, and the preliminary results, published in April, have been both quick and long lasting. "Memory improves. People have a better grasp of language. They can do things they couldn't do before."
Attacking inflammation makes sense, says Sue Griffin, director of research at the Geriatric Research Education Clinical Center at the University of Arkansas, in Little Rock. "There is really good evidence," she says, "that quelling neuroinflammation is a very good thing for Alzheimer's disease." A population study published last year in the Journal of Geriatric Psychology and Neurology found that people who'd used anti-inflammatory drugs daily for more than two years had a 25% lower risk of developing Alzheimer's.
Still, many researchers remain cautious. The Enbrel study was extremely small. It lacked controls — people taking a placebo to compare with patients who got the real drug. And it has not yet been replicated by other scientists.
Tobinick, who owns a patent for his treatment method as well as stock in Amgen, the company that produces Enbrel, says he is eager for other scientists to replicate his results.
James Skotchdopole, meanwhile, remains hopeful that his father will enjoy a longer life, that his 10-year-old daughter will get a chance to really know her grandfather, and is more optimistic about his own future. "I'm 42, and I see 75 as not that far away," he says. "I'm excited that there is progress. I felt my future was a fait accompli."
Source: Los Angeles Times (19 Jun 2006)
"He's there, but he's not," says his son James Skotchdopole. "There's no real interaction, no real stake in life."
Walter Skotchdopole had tried several drugs, with no noticeable improvement. But when he began experimental treatments with Enbrel (etanercept) — a drug commonly used to treat rheumatoid arthritis — it was as if someone flipped a switch.
Within minutes of his first injection, he was making jokes. Later that afternoon, he ditched his cane to dance with a worker at his assisted-living facility. After a year and a half of weekly injections, Skotchdopole still gets confused sometimes, but requires far less help than he used to.
"The results we've seen are unprecedented with any kind of treatment," says Dr. Edward Tobinick, an assistant clinical professor of medicine at UCLA who led a recent pilot study of Enbrel's effects on 15 Alzheimer's patients.
Though still preliminary, the study's findings add to a growing list of approaches that scientists are taking to uncover the biological roots of Alzheimer's and hit the disease where it hurts.
About 4.5 million Americans have Alzheimer's disease, and healthcare costs total $100 billion a year, according to estimates by the Alzheimer's Assn. and the National Institute on Aging. By 2050, there could be as many as 16 million people with the disease.
Since 1992, the Food and Drug Administration has approved five drugs for treating the forgetfulness, communication problems and other traits of Alzheimer's. All of them target one of two key brain chemicals that help brain cells communicate and facilitate learning and memory. But the drugs — Aricept (donepezil), Razadyne (galantamine), Exelon (rivastigmine) and the newest, Namenda (memantine) — treat only symptoms, not the underlying disease. They just slow the rate of decline, and only for a year or two.
Researchers think they can do better by focusing on the root causes of Alzheimer's.
Most research targets the accumulation of a sticky protein called amyloid in the brains of Alzheimer's patients. The protein forms clumps, called plaques, that damage brain tissue. Various research groups are developing drugs that might reduce this buildup, keep the amyloid from clumping together or get rid of plaques after they've have formed.
Trials of a vaccine designed to clear the brain of amyloid were halted by Elan Pharmaceuticals in 2002, because 18 of 300 participants developed serious brain inflammation. But scientists continue to work on more selective vaccines that could help the body fight amyloid without harming surrounding tissue, says Dr. John C. Morris, director of the Alzheimer's Disease Research Center at Washington University in St. Louis.
Tobinick and colleagues have focused on the inflammation that happens in the brain as a result of both amyloid buildup and the accumulation of another protein, called tau, which forms "tangles" that damage brain cells. The researchers chose to investigate Enbrel because it disables an inflammation-promoting molecule called tumor necrosis factor-alpha. TNF-alpha causes joint pain in people with autoimmune diseases such as rheumatoid arthritis. In Alzheimer's, it sparks the immune system to attack brain tissue.
When used to treat patients with arthritis, Enbrel is injected into the arms or abdomen. That doesn't work with Alzheimer's patients. Studies show that TNF-alpha is as much as 25 times more abundant than normal in the spinal fluid of people with Alzheimer's. So, with a tiny needle, Tobinick injects the drug into the back of the neck, above the spine, which is thought to improve delivery to the brain.
The procedure is simple, he says, and the preliminary results, published in April, have been both quick and long lasting. "Memory improves. People have a better grasp of language. They can do things they couldn't do before."
Attacking inflammation makes sense, says Sue Griffin, director of research at the Geriatric Research Education Clinical Center at the University of Arkansas, in Little Rock. "There is really good evidence," she says, "that quelling neuroinflammation is a very good thing for Alzheimer's disease." A population study published last year in the Journal of Geriatric Psychology and Neurology found that people who'd used anti-inflammatory drugs daily for more than two years had a 25% lower risk of developing Alzheimer's.
Still, many researchers remain cautious. The Enbrel study was extremely small. It lacked controls — people taking a placebo to compare with patients who got the real drug. And it has not yet been replicated by other scientists.
Tobinick, who owns a patent for his treatment method as well as stock in Amgen, the company that produces Enbrel, says he is eager for other scientists to replicate his results.
James Skotchdopole, meanwhile, remains hopeful that his father will enjoy a longer life, that his 10-year-old daughter will get a chance to really know her grandfather, and is more optimistic about his own future. "I'm 42, and I see 75 as not that far away," he says. "I'm excited that there is progress. I felt my future was a fait accompli."
Source: Los Angeles Times (19 Jun 2006)
Thursday, June 22, 2006
Estate Tax Changes may be Slipped into Pension Legislation
Republican lawmakers, who so far have been unable to win Senate approval of either full estate tax repeal or a significant reduction in the tax that wealthy heirs pay, are now considering another tactic: slipping estate tax "reform" into a pension bill now in a House-Senate conference committee.
The pension legislation, H.R. 2830, which seeks to put the nation's defined benefit pension plans on a sounder footing, is being finalized by a conference committee reconciling different House and Senate versions.
The "primary advocate" for attaching estate tax reform to the pension bill, according to the National Underwriter, an insurance industry publication, is Sen. Trent Lott (R-MS). Lott said he doubts that a deal on reducing the estate tax can emerge in the Senate, and so is viewing the pension bill conference report as an alternative vehicle.
“Conference reports are not amendable, and this would be a circuitous way to move estate tax reform forward without providing opportunity for consideration of alternatives on the Senate floor,” said David Stertzer, chief executive of the Association for Advanced Life Underwriting.
But such a last-minute inclusion of estate tax provisions could doom the contentious pension bill, which has taken months to hammer out. "Adding additional controversial issues to the package could kill the chances for enactment this year,” said Kenneth Cohen, senior vice president and deputy general counsel of the Massachusetts Mutual Life Insurance Company.
The latest Republican compromise proposal on the estate tax would exempt any individual estate under $5 million from the tax ($10 million for couples) and would lower the tax rate to a sliding scale starting at 15 percent and rising to 30 percent for estates over $30 million. These changes would cost the U.S. Treasury about 80 percent as much as full repeal, or about $800 billion over the first ten years in which its budgetary effects would be fully felt, according to the Center on Budget and Policy Priorities.
Source: elderlawanswers.com
The pension legislation, H.R. 2830, which seeks to put the nation's defined benefit pension plans on a sounder footing, is being finalized by a conference committee reconciling different House and Senate versions.
The "primary advocate" for attaching estate tax reform to the pension bill, according to the National Underwriter, an insurance industry publication, is Sen. Trent Lott (R-MS). Lott said he doubts that a deal on reducing the estate tax can emerge in the Senate, and so is viewing the pension bill conference report as an alternative vehicle.
“Conference reports are not amendable, and this would be a circuitous way to move estate tax reform forward without providing opportunity for consideration of alternatives on the Senate floor,” said David Stertzer, chief executive of the Association for Advanced Life Underwriting.
But such a last-minute inclusion of estate tax provisions could doom the contentious pension bill, which has taken months to hammer out. "Adding additional controversial issues to the package could kill the chances for enactment this year,” said Kenneth Cohen, senior vice president and deputy general counsel of the Massachusetts Mutual Life Insurance Company.
The latest Republican compromise proposal on the estate tax would exempt any individual estate under $5 million from the tax ($10 million for couples) and would lower the tax rate to a sliding scale starting at 15 percent and rising to 30 percent for estates over $30 million. These changes would cost the U.S. Treasury about 80 percent as much as full repeal, or about $800 billion over the first ten years in which its budgetary effects would be fully felt, according to the Center on Budget and Policy Priorities.
Source: elderlawanswers.com
Thursday, June 8, 2006
Senate Gearing Up for Estate Tax Repeal Vote
Senate Republicans are preparing to revive the debate over permanent repeal of the estate tax on June 6, but the real action will be on the Democratic side.
Republicans concede they lack the votes for full repeal, but they are hoping they can work out a compromise that would persuade enough Democrats to exempt the families of many wealthy individuals from paying federal estate tax. Sens. John Kyl (R-AZ) and Max Baucus (D-MT), who is the senior Democrat on the Senate Finance Committee, are reportedly negotiating.
Kyl is proposing increasing the estate tax exemption to $5 million and reducing the top estate tax rate to 15 percent from its current 46 percent.
Currently, only estates worth more than $2 million are taxed by the federal government. The threshold is scheduled to rise to $3.5 million in 2009. For the year 2010, estates will be entirely free from federal taxation. However, the law that includes this provision expires at the end of 2010. Thus, unless Congress acts in the interim, the estate tax exemption will then revert to $1 million.
Baucus is under pressure from fellow Democrats who say that even a compromise would deplete federal revenue by hundreds of billions of dollars and make it more difficult to shore up social programs and balance the budget. According to the Center on Budget and Policy Priorities, reducing the top rate to 15 percent would lose nearly as much revenue as full repeal, which will cost the U.S. Treasury an estimated $1 trillion. The Republicans need Baucus to deliver about a half-dozen Democrats to reach the 60 votes required to overcome any filibuster.
Almost all Democrats support raising the exemption threshold for eligibility to $3.5 million for an individual and $7 million for a couple.
Meanwhile, House Democrats have released a report detailing the effect that a repeal of the tax would have on the estates of oil company executives and members of the Bush cabinet. According to the report, estate tax repeal would save the estate of Vice President Cheney between $13 million and $61 million, and would save the estate of Defense Secretary Donald Rumsfeld between $32 million and $101 million. The family of retired ExxonMobil chief Lee R. Raymond would receive a $164 million windfall.
Republicans concede they lack the votes for full repeal, but they are hoping they can work out a compromise that would persuade enough Democrats to exempt the families of many wealthy individuals from paying federal estate tax. Sens. John Kyl (R-AZ) and Max Baucus (D-MT), who is the senior Democrat on the Senate Finance Committee, are reportedly negotiating.
Kyl is proposing increasing the estate tax exemption to $5 million and reducing the top estate tax rate to 15 percent from its current 46 percent.
Currently, only estates worth more than $2 million are taxed by the federal government. The threshold is scheduled to rise to $3.5 million in 2009. For the year 2010, estates will be entirely free from federal taxation. However, the law that includes this provision expires at the end of 2010. Thus, unless Congress acts in the interim, the estate tax exemption will then revert to $1 million.
Baucus is under pressure from fellow Democrats who say that even a compromise would deplete federal revenue by hundreds of billions of dollars and make it more difficult to shore up social programs and balance the budget. According to the Center on Budget and Policy Priorities, reducing the top rate to 15 percent would lose nearly as much revenue as full repeal, which will cost the U.S. Treasury an estimated $1 trillion. The Republicans need Baucus to deliver about a half-dozen Democrats to reach the 60 votes required to overcome any filibuster.
Almost all Democrats support raising the exemption threshold for eligibility to $3.5 million for an individual and $7 million for a couple.
Meanwhile, House Democrats have released a report detailing the effect that a repeal of the tax would have on the estates of oil company executives and members of the Bush cabinet. According to the report, estate tax repeal would save the estate of Vice President Cheney between $13 million and $61 million, and would save the estate of Defense Secretary Donald Rumsfeld between $32 million and $101 million. The family of retired ExxonMobil chief Lee R. Raymond would receive a $164 million windfall.
Wednesday, May 17, 2006
Report: Strict asset transfer rules are not an answer to controlling Medicaid spending
A Kaiser Commission on Medicaid and the Uninsured has issued a report, Asset Transfer and Nursing Home Use: Empirical Evidence and Policy Significance, which concludes that, “Eliminating asset transfers for Medicaid nursing home coverage will not substantially alter the private market for long-term care and is not the answer for controlling growth in Medicaid spending.”
The University of Michigan’s Health and Retirement Study produced data for the study to determine the extent to which individuals needing nursing home care make asset transfers. Four categories of individuals were screened: (1)those eligible for Medicaid in the community prior to entering a nursing home; (2)those who became Medicaid eligible within a year of admission; (3)those who became eligible more than a year after admission; and (4)those who never received Medicaid coverage and resided in a nursing home for more than a year.
Forty-three percent of the approximately 2.6 million individuals entering nursing homes between 1998 and 2002 received Medicaid assistance at some point during their stay. Nearly half of these were eligible prior to entering the facility, and only 5 percent of this group transferred more than $50,000 in cash in the six years preceding their admission to the facility. When including transfers involving deeds for this group, only 20 percent made gifts of more than $50,000. For the rest of the Medicaid population, the vast majority made transfers of less than $50,000 within the same time period (including transfers involving deeds).
By contrast, individuals who never received Medicaid assistance for their nursing home care made transfers with greater frequency and higher value. Half of these individuals made gifts in the six years leading up to their institutionalization, and two-thirds of the transfers were cash transfers exceeding $5,000.
All told, the report notes that $6.6 billion in liquid assets were transferred by the Medicaid population within the six years leading up to their qualification for Medicaid. Medicaid spent $100 billion in fiscal year 2004, so Medicaid would recover only six percent of its costs if it blocked all of these transfers. However, the report reviewed activity dating back six years (one year longer than the five-year- look-back period of federal law), so some of these transfers could not be blocked by Medicaid. Also, potentially inflating the amount that Medicaid could save is the evidence that individuals who never attained Medicaid eligibility after lengthy stays in institutions made the most frequent and highest value transfers. This evidence suggests that transfers made prior to entry are frequently not made for the purpose of attaining Medicaid eligibility. Federal law does not allow a penalty for a transfer not made for the purpose of establishing Medicaid eligibility, so other transfers netted in the analysis could not be restricted by Medicaid.
Source: Washington Weekly, Volume XXXII, Issue No. 16, April 28, 2006.
The University of Michigan’s Health and Retirement Study produced data for the study to determine the extent to which individuals needing nursing home care make asset transfers. Four categories of individuals were screened: (1)those eligible for Medicaid in the community prior to entering a nursing home; (2)those who became Medicaid eligible within a year of admission; (3)those who became eligible more than a year after admission; and (4)those who never received Medicaid coverage and resided in a nursing home for more than a year.
Forty-three percent of the approximately 2.6 million individuals entering nursing homes between 1998 and 2002 received Medicaid assistance at some point during their stay. Nearly half of these were eligible prior to entering the facility, and only 5 percent of this group transferred more than $50,000 in cash in the six years preceding their admission to the facility. When including transfers involving deeds for this group, only 20 percent made gifts of more than $50,000. For the rest of the Medicaid population, the vast majority made transfers of less than $50,000 within the same time period (including transfers involving deeds).
By contrast, individuals who never received Medicaid assistance for their nursing home care made transfers with greater frequency and higher value. Half of these individuals made gifts in the six years leading up to their institutionalization, and two-thirds of the transfers were cash transfers exceeding $5,000.
All told, the report notes that $6.6 billion in liquid assets were transferred by the Medicaid population within the six years leading up to their qualification for Medicaid. Medicaid spent $100 billion in fiscal year 2004, so Medicaid would recover only six percent of its costs if it blocked all of these transfers. However, the report reviewed activity dating back six years (one year longer than the five-year- look-back period of federal law), so some of these transfers could not be blocked by Medicaid. Also, potentially inflating the amount that Medicaid could save is the evidence that individuals who never attained Medicaid eligibility after lengthy stays in institutions made the most frequent and highest value transfers. This evidence suggests that transfers made prior to entry are frequently not made for the purpose of attaining Medicaid eligibility. Federal law does not allow a penalty for a transfer not made for the purpose of establishing Medicaid eligibility, so other transfers netted in the analysis could not be restricted by Medicaid.
Source: Washington Weekly, Volume XXXII, Issue No. 16, April 28, 2006.
Thursday, May 11, 2006
Caregiving: A growing field
Usually one family member is the primary caregiver. Women make up 75% and are either a spouse or an adult daughter. Nearly two-thirds of caregivers are working full or part-time.
Spouses, on average, provide 40-60 hours of care per week and adult children provide 15-30 hours of care per week.
The Economic Value of the care provided by families is $196 billion nationwide (1997) - $13.5 billion in New York.
Caregiving costs U.S. businesses an estimated $11.4 billion per year in lost productivity by contributing to the following: replacing employees, absenteeism, partial absenteeism, workday interruption, eldercare crisis, supervisor’s time.
Caregivers adjust their work schedules due to caregiving responsibilities by incorporating the following: making phone calls at work (84%), arriving late/leaving early (69%), taking time off during the day (67%), making up work on weekends/evenings (29%), using sick days (64%), decreased hours (33%), taking a leave of absence (22%).
In 2000, New York had 3.2 million people over the age of 60. By 2010, New York will have 5.5 million people over the age of 60. Also in need of caregiver assistance are families with a disabled child or an older person with disabilities under the age of 60.
The fastest growing segment of the aging population in New York are those 75+ and those 85+. These individuals will need more supportive services, including caregiver supports if they are to remain independent.
The average monthly out-of-pocket expense for a family caregiver is $171 (food, transportation and medication expenses account for top 3 expenses). Total un-reimbursed monthly expenses for family caregivers is $1.5 billion.
Most caregivers start out providing a small amount of care, gradually taking on more responsibility. Caregivers also underestimate the number of hours that would be required and the duration of caregiving responsibilities. The average length of care provided is about 8 years.
Caregiving responsibilities take a toll on the health of the caregivers, and on employee productivity due to increases in absenteeism, early retirement and turnover. Half of surveyed caregivers made additional visits to their health care practitioners. Half reported more than 8 additional visits per year.
Source: Caregiver Fact Sheet
Spouses, on average, provide 40-60 hours of care per week and adult children provide 15-30 hours of care per week.
The Economic Value of the care provided by families is $196 billion nationwide (1997) - $13.5 billion in New York.
Caregiving costs U.S. businesses an estimated $11.4 billion per year in lost productivity by contributing to the following: replacing employees, absenteeism, partial absenteeism, workday interruption, eldercare crisis, supervisor’s time.
Caregivers adjust their work schedules due to caregiving responsibilities by incorporating the following: making phone calls at work (84%), arriving late/leaving early (69%), taking time off during the day (67%), making up work on weekends/evenings (29%), using sick days (64%), decreased hours (33%), taking a leave of absence (22%).
In 2000, New York had 3.2 million people over the age of 60. By 2010, New York will have 5.5 million people over the age of 60. Also in need of caregiver assistance are families with a disabled child or an older person with disabilities under the age of 60.
The fastest growing segment of the aging population in New York are those 75+ and those 85+. These individuals will need more supportive services, including caregiver supports if they are to remain independent.
The average monthly out-of-pocket expense for a family caregiver is $171 (food, transportation and medication expenses account for top 3 expenses). Total un-reimbursed monthly expenses for family caregivers is $1.5 billion.
Most caregivers start out providing a small amount of care, gradually taking on more responsibility. Caregivers also underestimate the number of hours that would be required and the duration of caregiving responsibilities. The average length of care provided is about 8 years.
Caregiving responsibilities take a toll on the health of the caregivers, and on employee productivity due to increases in absenteeism, early retirement and turnover. Half of surveyed caregivers made additional visits to their health care practitioners. Half reported more than 8 additional visits per year.
Source: Caregiver Fact Sheet
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