Comprehensive Planning. Lifelong Solutions.

‘Tis the Season…for hospital admissions and long-term care planning!

By Hook Law Center

Author: Stephanie Washington

Co-Author: Letha Sgritta-McDowell

During the holidays, it is not uncommon for emergency rooms to see an increase in visits by the elderly population. As we know, the elderly are more susceptible to catching pneumonia due to their waning immune systems, falling due to lower body weakness and poor balance, combined with vision problems or home hazards like throw rugs and/or clutter that can be tripped over, and even medication mismanagement caused by having too many prescriptions to take or being prescribed a combination of medications by several different doctors that do not work together but against each other.  With the rise of hospital admissions this time of year, come families who are thrust into a situation they have never experienced before; they are often worried, scared, and confused.

We often receive calls from family members trying to understand the processes for hospital admissions, rehabilitation services, and long-term care for their loved one. There are several points at which families can become easily confused.  The first is upon discharge from the hospital.  Hospitals are acute care facilities; meaning that a person’s stay is only temporary.  For longer term rehabilitation and care while a person is recovering from an acute illness, this type of care is provided either at home or in an outside facility.  Any number of terms are used at this juncture.  Families may hear “rehab,” “skilled nursing,” “nursing home,” or simply “therapy.”  The discharge planner at the hospital will offer you and your loved one options for this continuing care.  For individuals who are recovering from an acute illness, this possible discharge to a nursing home is not permanent.  This is merely a suggestion that the elderly person move to a facility where he or she can receive nursing services as well as all available therapy with the goal that they can recover enough to safely return home.  For many seniors who live alone, a short rehabilitation stay is the safest way to receive the care they need.  Understandably, many people would prefer to go home.  The same therapy may be offered on an outpatient basis.

When evaluating outpatient rehabilitation instead of going to a nursing home, the individual and their family need to consider who will be able to take their loved one to any and all doctor’s appointments and therapy sessions as well as who will cook, clean, do laundry and assist the loved one with bathing, dressing and other essential daily activities. It requires a strong support system and/or the ability to hire private duty care providers to ensure a successful rehabilitation in the home.  Therefore, when faced with this decision, it is important that the family consider all options.  If a discharge to a facility is chosen but rehabilitation in the home later becomes feasible, that certainly can happen.

If an individual is discharged to a nursing facility but does not fully recover or if they have needs which will continue long after rehabilitation is finished, then they often face another stressful and confusing crossroads. If the individual was admitted to the hospital for three nights or more prior to their discharge to the nursing facility, then Medicare can pay for up to 100 days, so long as the patient responds to the therapy being prescribed by his or her doctor, or if the stay in the facility is necessary to maintain the individual’s current level of health and functionality.  However, once the patient stops responding to therapy, refuses to participate, or if the care is not necessary to maintain his or her current level of health, representatives from the facility will discuss “discharge.”  Unfortunately, the context of discharge at this stage is often not explained fully, and many family members assume that this discussion means their loved one is being sent home.  As discussed earlier, for many the transition home is complicated and can be potentially dangerous for the senior.  Understandably, the sense that an elderly person is being sent home when provisions are not available to assist them can cause family members to panic.

However, the discussion of discharge at this juncture simply means that the patient is no longer eligible for Medicare-covered rehabilitation services. If, after rehabilitation, the individual still needs assistance with bathing, dressing, walking, eating and other activities of daily living, then the family can (and should) request that their loved one transition to long-term care within the facility.

Many times we hear that family members were not provided options and were simply told that their loved one was being discharged. This often leads to family members scrambling to find care for their loved one. In other situations, when the family asks about staying longer, a facility representative may explain to the family that no beds are available or they cannot accommodate the care needs of the patient.  There are laws in place which require the nursing facility to assist with a safe and appropriate discharge plan for the patient.  If no beds are available at that facility and services and supports are not sufficient in the community, then the facility representative must find another facility which has an available bed and which can accommodate the person’s care needs.  While looking for a suitable bed, the patient is allowed to stay at the same facility in their current bed.

The rules and regulations surrounding hospital discharge planning and discharge from Medicaid covered rehabilitation can be mysterious and, without proper understanding, can cause additional stress in an already emotional and stressful time. If you or your loved one find yourself in this position, you should immediately seek someone experienced with resident rights who can help navigate this process and develop a long-term care plan focused on developing a solution to the problem.  The attorneys and staff of Hook Law Center are experienced and prepared to assist you or your loved one through this process.  Please call us today to schedule an appointment to discuss your rights and options.

Kit KatAsk Kit Kat – Mickey, Our Own Star

Hook Law Center:  Kit Kat, I hear that Hook Law Center has many employees who love pets. One in particular—Mickey—the beloved cat of Cynthia is making medical history. What can you tell us about her cat?

Kit Kat:  Mickey is an 18-pound male cat who has just been diagnosed with gigantism or its scientific name of acromegaly. His length from head to tail is more than 3 feet! He is a beautiful brown tabby with white feet who is 10 years old. On January 11, 2017, he will turn 11. Anyway, he was gaining weight, and at one point he weighed in at 21 pounds, even though he was  on a diet. Such a large figure caused him difficulty in jumping onto chairs, etc. When Cynthia took him to the vet, they treated him for arthritis and an underactive thyroid. Still the vet thought there might be something else affecting his condition. It was suggested that Cynthia collect a blood sample, and send it to a lab at Michigan State University in East Lansing, Michigan. Cynthia recently got the results. The suspected condition of gigantism was confirmed. This is an extremely rare condition in cats, caused by over production of the growth hormone (GH). It usually affects males around the median age of 11, so it looks unfortunately like Mickey falls into a classic case. He also displays some other common signs of the disease with his enlarged lower jaw and head.

Treatment can include radiation therapy. However, at this stage in his life and because of the severity of his case, the vet has not recommended anything other than to continue to address his arthritis and thyroid. Mickey is lucky he is in the home he is in. Cynthia and husband, Carl, have even built him a stand to hold his food and water bowls, so he doesn’t have to bend over so far. Eventually, he will undoubtedly succumb to heart disease or renal failure, though the latter is very common in cats as a whole, even those without gigantism. Cynthia and Carl will do their best to keep him comfortable and extend his life as long as possible. (http://www.cat-world.com/au/acromegaly-in-cats)

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Distribution of This Newsletter

Hook Law Center encourages you to share this newsletter with anyone who is interested in issues pertaining to the elderly, the disabled and their advocates. The information in this newsletter may be copied and distributed, without charge and without permission, but with appropriate citation to Hook Law Center, P.C. If you are interested in a free subscription to the Hook Law Center News, then please telephone us at 757-399-7506, e-mail us at mail@hooklawcenter.com or fax us at 757-397-1267.

Posted on Monday, November 28th, 2016. Filed under Newsletter.

Life-Saving Tech Tip for Cell Phone Users

By Jessica A. Hayes

Your cell phone may have a life-saving feature that you should be aware of. For iPhone users, the feature is called “Medical ID.”  Medical ID lets others access important medical information about you without unlocking your phone.  From the “unlock” screen, a first responder can tap the “Emergency” option in the bottom left corner, then “Medical ID,” and view your name, date of birth, a photo of you, emergency contacts, blood type, height, weight, allergies, medications, and medical conditions – or any other information you wish to include.

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To set up your Medical ID, locate and open the “Health” app that is installed by default onto your iPhone, then press “Create Medical ID.” Enter the information that you would like displayed in the event of an emergency, and be sure to turn on “Show When Locked,” then click “Done.”

For other types of cell phones, a similar feature may be available either as a phone setting or in the form of an “ICE: In Case of Emergency” app. Check for an emergency contact feature in your phone’s settings or consider editing your lock screen or wallpaper to include important information.

In addition to including personal information, you may want to use these cell phone features to indicate that your advance medical directive is a part of the U.S. Living Will Registry, so that medical professionals can access that document if needed.

Don’t have an advance medical directive, or want to participate in the U.S. Living Will Registry? Give the Hook Law Center a call today.

Kit KatAsk Kit Kat – Falling Cats

Hook Law Center:  Kit Kat, what can you tell us about the phenomenon of cats always landing on their feet?

Kit Kat:  Well, the answer is not as simple as it may appear, but it is extremely interesting. Actually, it’s not a definitive answer, because scientists are not really sure how it occurs or if it occurs in only one way. They do agree, however, that cats will right themselves after falling from most distances, even from as little as a height of 2 feet. The only exception is a height of less than 2 feet. From distances less than 2 feet, there is not enough room or time to perform their acrobatics.

Here’s what we know now. Falling cats have been a fascination of the scientific community since the 19th century. George Gabriel Stokes and James Clerk Maxwell were 19th century scientists who were intrigued by the falling cat phenomenon. They experimented and dropped many cats; in all cases, they righted themselves. Yet, later scientists were not satisfied. How could cats accomplish this feat which defied the law of conservation of angular momentum? That law involves the person or object to push off from something, but cats were not pushing off from anything, and they were still able to right themselves. Now enters Etienne Jules Marey, a French scientist and engineer, who used high-speed photography in 1894 to capture 32 shots of cats in midair. His photos revealed what was happening – “…the cat first tucked in its forelegs while stretching out its back legs, then switched them, which allow it to use the inertia of its own mass to flip.” Marey called this ‘the tuck and turn’ method. It is what modern gymnasts do when they accomplish their amazing flips and turns.

20th century scientists have since quantified the process. In 1935, Dutch physiologists GGJ Rademaker and JWG Ter Braak created a mathematical drawing of a falling feline which further refined the theory. By bending at the waist, their drawing showed the cat’s body as 2 can-like cylinders rotating on 2 axes in different directions. The net energy expended created an equilibrium of 0. A 21st century scientist, Greg Gbur of UNC-Charlotte calls this the ‘bend and twist’ method. The research continues. Scientists would like to find one definitive answer, but the crafty feline is not bound to comply. Gbur laments, ‘Probably the cat uses multiple different strategies to turn over. Physics prefers and tends to look for the simplest explanation for a phenomenon, whereas evolution—if I anthropomorphize it—is always looking for the most efficient. Living creatures are doing whatever works best, which may not be the simplest option.’

(Karen Bruillard, “Scientists just can’t stop studying falling cats,” The Washington Post, Animalia section, November 4, 2016)

Upcoming Seminars

Distribution of This Newsletter

Hook Law Center encourages you to share this newsletter with anyone who is interested in issues pertaining to the elderly, the disabled and their advocates. The information in this newsletter may be copied and distributed, without charge and without permission, but with appropriate citation to Hook Law Center, P.C. If you are interested in a free subscription to the Hook Law Center News, then please telephone us at 757-399-7506, e-mail us at mail@hooklawcenter.com or fax us at 757-397-1267.

Posted on Friday, November 18th, 2016. Filed under Newsletter.

What President-Elect Trump and the Republican Party have in Store for You: Estate, Gift and Generation Skipping Transfer Taxes

By Elizabeth Boehmcke

Well, one of the more painful election cycles I have ever experienced is, thankfully, over. Now that the American people have finally cast their votes and elected Donald Trump to the White House and a Republican-controlled Congress, it is natural to wonder what changes, if any, you can expect. Certainly, a lot of promises have been made. And, of course, until the actual change in power takes place in January, it is impossible to predict what the ultimate results will be. However, we thought you might like a preview of what we might expect from our newly elected leaders.

In June, 2016, the House Republicans released “A Better Way: Our Vision for a Confident America”. In it, they reiterated their oft-repeated promise of repealing the federal estate tax and the generation-skipping transfer tax. However, there is no mention of a repeal of the gift tax. This is consistent with the “Death Tax Repeal Act of 2015” introduced in the House and Senate in the spring of 2015. The “Death Tax Repeal Act of 2015” provided for the repeal of estate and generation-skipping transfer taxes; however, it retained the current law with respect to the annual gift tax exclusion amount and the current lifetime exemption ($5.45 million for 2016). The maximum rate for the gift tax would be 35%. All transfers into trust would be treated as taxable gifts unless the trust was a “grantor trust”. Finally our current carryover basis rules and stepped up basis at death rules would continue to apply.

Donald Trump’s Tax Plan as related on his website (www.donaldjtrump.com/policies/tax-plan) states that he intends to repeal the estate tax with a catch. Capital gains on appreciated assets in excess of $10 million is subject to tax. (No tax rate is stated but the current highest capital gains tax rate is 20%. It seems likely that this rate would be applicable.) However, appreciation on small businesses and family farms are to be exempt from this capital gains death tax. In addition, contributions of appreciated assets to private charities established by the decedent or the decedent’s relatives would be disallowed. There is no mention of the gift tax or the generation-skipping transfer tax (this is a tax on transfers to persons more than one generation below that of the transferor and the law on it is very complex).

These plans are not entirely reconcilable. Under President-elect Trump’s plan, a 20% capital gains tax would be imposed on appreciated assets owned at death if the appreciation was in excess of $10 million and the assets in question are not family farms or small businesses. Because it would be very simple to avoid this tax by giving assets away shortly before death (and frankly, this would not be a problem for most Americans), it seems to me that his tax plan would have to address the issue of the gift tax in some fashion.

However, I would anticipate that the desire in Congress to fully repeal the estate tax and the generation skipping transfer tax (again) would likely pressure Mr. Trump to alter his plan to accommodate his fellow Republicans. After all, his plan as stated is not actually workable. The Republican vision as set forth in the “Death Tax Repeal Act of 2015” may well get worked over some more when the lawmakers actually think they have a chance to pass tax reform. The current proposal has “planning opportunities” that would make avoidance of the gift tax possible.

So, what does this mean for you? Unfortunately it means that we are likely walking into a period of uncertainty for how long these taxes may remain on the books and how they may be transformed by Congress. Given that a Republican led Congress also wants to balance the budget, it is possible that these changes may phase in over time. Should you delay making annual exclusion gifts in 2016? Absolutely not. The changes, if they come about, will not be effective before Mr. Trump takes office. Should you stay in touch with the attorneys at the Hook Law Center? Absolutely. We will analyze the changes and inform you of how they will affect you and your existing plan and whether you need to make any changes. However, since the last round of estate and gift tax reform increased the lifetime exemptions in excess of $5 million, most of you will not need to alter your current estate plans to accommodate the tax law changes. Your plans already reflect that you are not subject to the various taxes and are structured to protect your families and your non-tax related goals. For those of you who have been facing an estate or gift tax issue currently, stay tuned.

Kit KatAsk Kit Kat – Learning From Bees

Hook Law Center:  Kit Kat, what can you tell us about bees in northern Alaska which are helping scientists gather information about climate change?

Kit Kat:  Well, I think this is fascinating. Scientists from the University of California, Riverside traveled to Prudhoe Bay, north of Fairbanks, along the Dalton Highway, made famous by the TV show “Ice Road Truckers.” They were looking for the Polaris bumblebee, known scientifically as the Bombus polaris. Increasingly as the earth’s climate warms, this particular bumblebee has migrated north into the Arctic, where climate change is happening at a fast pace. Climate change in the Arctic is evident by the fact that areas once covered only in low plants and lichens are now able to support willow trees. The expedition is being financed by a grant to foster collaboration among scientists. Six scientists participated. Their job—collect specimens and bring them back to the lab for further testing.

One of the scientists, Dr. S. Hollis Woodard, calls the bumblebee ‘…the pandas of the insect world.’ They are the largest of bees, and like the panda, they are big and move slowly. In contrast to the honeybee which tend to live in large colonies of 100,000 bees or more, the bumblebee lives in small clusters, ranging from 50 to a couple of hundred. Most bumblebee colonies live for one season, Most die as the weather turns cold. However, a few hearty females that have already mated, seek refuge under the tundra, and in essence hibernate until spring. They are the only bees which manage to survive in the Arctic, where temperatures go as low as 60 below zero. They do this by shivering their muscles. This can raise their body temperature to a toasty 95 degrees, even though the outside temperature may be at the freezing point.

There is some urgency to the scientists’ work. Just this past September of 2016, the US Fish and Wildlife Service proposed that the rusty patched bumblebee, previously very common, be considered endangered. There are 250 bumblebee species, but scientists become alarmed when even one shows signs of decline.  Each bee that is captured is placed in a plastic tube, which is then given a shot of ordinary compressed air from a can available at the average grocery store. This immobilizes the bees. Then bodies and inside organs are separated and placed in a solution to preserve them. Back at the lab in California, they will conduct the examinations which will tell us more about the bees, how they survive in such adverse conditions, and possibly the implications about changing climate. (James Gorman, “Six Scientists, 1,000 Miles, One Prize: The Arctic Bumblebee,” The New York Times, Oct. 7, 2016) (http://nyti.ms/2dFqzYi)

Upcoming Seminars

Distribution of This Newsletter

Hook Law Center encourages you to share this newsletter with anyone who is interested in issues pertaining to the elderly, the disabled and their advocates. The information in this newsletter may be copied and distributed, without charge and without permission, but with appropriate citation to Hook Law Center, P.C. If you are interested in a free subscription to the Hook Law Center News, then please telephone us at 757-399-7506, e-mail us at mail@hooklawcenter.com or fax us at 757-397-1267.

Posted on Monday, November 14th, 2016. Filed under Newsletter.

State Tax Credit Can Help With Home Improvement Costs

By Stephan A. Lipskis

A recent article in our newsletter discussed Universal Home Design and the advantages it has for individuals of all ages. Fortunately, Virginia has a tax incentive that may help with the cost of retrofitting your home, the Livable Homes Tax Credit (LHTC).  The tax credit can be as much as $5,000, which is a huge consideration when considering the high costs of most renovations.

WHAT HOMES ARE ELIGIBLE?

Fortunately, the LHTC can be used on new purchases as well as existing homes. New construction must meet Universal Visitability guidelines, but renovations need only to increase accessibility using certain eligible means.

WHAT TYPE OF IMPROVEMENTS ARE NEEDED?

The renovation must include several “Universal Visitability” features, such as: zero-step entrances, doors with a width of at least 32 inches, accessible switches, accessible bathrooms, accessible kitchens, among others. These requirements work nicely with the Universal Design concepts discussed in the previous article.

HOW DOES THE CREDIT WORK?

The credit is available for 50% of the cost of applicable features, up to $5,000, which means that $10,000 in costs for applicable renovations can yield a full credit. The simplicity of the design elements required to qualify for the credit (built-in appliances, width of halls and doorways, etc.) means that a little forethought in design may go a long way in saving funds.

After the work is completed, the credit is applied for using a simple form and submitted to the Virginia Department of Housing and Community Development in Richmond. They even allow for electronic submissions! A certificate of approval is provided with the amount of your credit by April 1, and can be relied upon for your tax return. If you do not have enough tax liability to fully use your credit, the balance can be carried forward for seven years.

CONCLUSION

If you are considering updating your home or specifically need to retrofit your home for accessibility, using the LHTC can be an excellent way to defray some of those costs.  If you need help planning for disability, healthcare costs, or retirement generally, please contact our office to arrange a meeting with one of our Elder Law attorneys to review your needs and implement a plan. The author thanks Richard Harrison, Jr., CPA of Richard J. Harrison, Jr., P.C. for providing information related to the Virginia Livable Homes Tax Credit used in this article.

Kit KatAsk Kit Kat – At Rest with Pets

Hook Law Center:  Kit Kat, what can you tell us about the new New York State law which allows pets to be buried alongside their owner(s)?

Kit Kat:  Yes, this is a wonderful option which was recently enacted for the state of New York. There are some stipulations—the pet must be cremated; religious cemeteries are exempt, and all cemeteries are not required to accept pet cremains. It is, however, a step in the right direction. The change has been in the works for about five years says David Fleming, director of government affairs for the New York State Association of Cemeteries. ‘Times have changed; people have a much different view of their pets in the family,’ he said. Currently, the law limits the option to domestic animals, but authorities have been quite flexible and have allowed reptiles and invertebrates. Mr. Fleming further comments, ‘I don’t think the average person is paying to have their tarantula cremated, but maybe they are.’

Heretofore, people who wanted to be buried with their pets had to do so in a pet cemetery. Some actually have chosen this option. At Hartsdale Pet Cemetery in Westchester County, a pet cemetery which originated in the 19th century, 5-7 people are buried each year, says Edward C. Martin, Jr., the cemetery’s director, along with their beloved pets. Mr. Martin is not worried about the impact of the new law. Hartsdale Pet Cemetery has a tranquil and lovely location which is attractive to many, whether human or animal.

The new law will be helpful to those whose preferred companion is a turtle. Turtles live for decades says Barbara Daddario, education director of the New York Turtle and Tortoise Society. It is not unusual for a turtle or a tortoise to outlive its original owner and be passed to a younger family member. With the new law, ‘…it may be a while before the turtle goes in there,’ she said.

This is a terrific plan. You may want to check with your state and determine whether such an option is permitted in the state in which you reside. According to Mr. Fleming of the NY Association of Cemeteries, few others allow it, but he is uncertain as to which other states do/do not permit the practice. (Sarah Maslin Nir, “New York Burial Plots Will Now Allow Four-Legged Companions,” The New York Times (New York Region section), October 6, 2016)

Upcoming Seminars

Distribution of This Newsletter

Hook Law Center encourages you to share this newsletter with anyone who is interested in issues pertaining to the elderly, the disabled and their advocates. The information in this newsletter may be copied and distributed, without charge and without permission, but with appropriate citation to Hook Law Center, P.C. If you are interested in a free subscription to the Hook Law Center News, then please telephone us at 757-399-7506, e-mail us at mail@hooklawcenter.com or fax us at 757-397-1267.

Posted on Tuesday, November 8th, 2016. Filed under Newsletter.
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