Comprehensive Planning. Lifelong Solutions.

New Medicare Cards Coming Soon

By Jessica A. Hayes

Between April 2018 and April 2019, Medicare will be issuing new Medicare cards to all of its beneficiaries, approximately 60 million Americans, in an effort to cut down on identity theft and fraud. Instead of using Social Security Numbers to identify individuals, they will now be using randomly generated identification numbers, called “Medicare Beneficiary Identifiers” (MBIs), which will contain both numbers and uppercase letters and be 11 characters in length. An MBI is confidential and should be protected as personally identifiable information. Beneficiaries do not need to do anything to receive these new cards; they will be provided with them automatically and free of charge.

While this is designed to reduce instances of identity theft and fraud, consumers should be aware that there is nonetheless the potential for scammers to use this development to their advantage. They may contact Medicare beneficiaries and inform them that there is a fee that must be collected before a new card may be issued. Or perhaps they will make beneficiaries believe they will lose their benefits if the scammers’ demands are not met right away. Scammers are creative and convincing, but knowledge up front about the free rollout of new cards is the best defense against the unscrupulous.

In anticipation of thousands of calls from beneficiaries and medical providers as a result of this change, the Center for Medicare & Medicaid Services has set up a website, is sending out handbooks to all beneficiaries, and has call centers ready to field questions. More information is available at https://www.cms.gov/Medicare/New-Medicare-Card/index.html.

Kit KatAsk Kit Kat – Vika of the Solomon Islands

Hook Law Center:  Kit Kat, what is a vika?

Kit Kat:  Well, it’s a giant, tree-dwelling rat that has recently been discovered in the Solomon Islands, which are located in the South Pacific Ocean, east of Papua New Guinea. Indigenous peoples had sighted it for years, but scientists could never catch a glimpse of it. That is until recently when Hikuna Judge, a ranger at the Zaira Resource Management Area on the island of Vangunu, spotted an injured, giant rat waddling away from a fallen tree. Mr. Judge joined Dr. Tyrone Lavery of the University of Queensland (Australia) in the reporting of the new species, dubbed Uromys vika. It’s been about 80 years since any new rat species have been discovered in the area.

Uromys vika is indeed quite large. It can measure up to 1.5 feet from nose to tail with a weight of nearly two pounds. It also has small ears and very wide feet, which help it navigate in the dense tropical forests of its native environment. Its tail is smooth, but it also has tiny scales, similar to an opossum’s. It is further distinguished by its preferred discarded food—ngali nuts. The vika drills a hole in the center of the nut with its teeth to extract the nut’s soft core. Then it discards the shell. Now that is known that this is the consumer of the discarded nuts, scientists will have an easier time studying it and its habits.

Researchers suspect it remained undetected for so long, because they believe there are relatively few of them. Vika is now considered critically endangered, because this particular island of Vangunu is rapidly losing rain forest to logging. The rain forest is its home. However, Dr. Lavery is hopeful. He says, ‘Now that we know it definitely exists, we can work out ways to conserve it.’ (Joanna Klein, “The Elusive Giant Coconut-Cracking Rat of the Solomon Islands,” The New York Times, Science section, Sept. 29, 2017)

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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 Friday, October 13th, 2017. Filed under Newsletter.

Protecting Public Benefits from Child Support Payments

By Shannon Laymon-Pecoraro

The majority of us know that a parent has a duty to support his or her minor children, and that the law presumes that upon reaching majority, a child is capable of self-support. Very few people understand that the responsibilities of a parent may extend beyond the age of majority when the child is disabled and unable to support him or herself. In Virginia, a court order may require a parent to support an a person over that age of 18 who is “severely and permanently mentally or physically disabled,” provided the disability began before age 18 (or 19 if certain factors are met) and, as a result of such disability is unable to live independently and support himself. The affect of such an order may have a significant impact on the child if not carefully considered.

The purpose of requiring child support is to ensure a child can experience a similar standard of living as he would have if the parents lived in the same household. Virginia utilizes a guideline calculation to determine the support obligation, although the parents can voluntarily enter into their own agreement. The public benefits being received by the child may factor into what the child support payment should be.

Although many parents want to offset their support obligation by public benefit income received by the child, it is unlikely to occur if the child is receiving Supplemental Security Income (SSI). Nearly all courts that have addressed the issue have determined that since the benefit is not a reflection on the work history of a retired or disabled parent, no offset should be made. If, however, the child receives a benefit other than SSI from the Social Security, it is likely the result of a retired or disabled parent and a support obligation may therefore be reduced.

Pursuant to the Social Security Administration and the Department of Medical Assistance Services, child support is a form of unearned income to the child. The Social Security Administration will disregard the first $20 of unearned income, and thereafter reduce an SSI benefit dollar-for-dollar. If SSI is lost, the child will lose his or her automatic entitlement to Medicaid and will need to meet the requirements of the traditional or long-term care Medicaid program.

The good new is that the Code of Virginia specifically permits the court to order child support payments be made to a special needs trust or an ABLE savings trust account. The good news is that the Social Security Administration has determined that when a court requires child support payments into a first party special needs trust, such payments will not be considered income to the child, and will therefore not detrimentally impact that child’s benefits. In contrast, although formal policy has not yet been published, it is believed that court ordered payments into an ABLE savings trust account will still be considered income to the child, and therefore cause a reduction in benefits.

Kit KatAsk Kit Kat – Wildlife Healers

Hook Law Center:  Kit Kat, what can you tell us about the South Florida Wildlife Center which specializes in the rehabilitation of small animals?

Kit Kat:  Well, this is an interesting story. This particular center, which is located in Ft.Lauderdale, has developed an expertise over the last 10 years in rescuing baby opossums. Opossums are the only marsupial in the United States. At first, it was trial and error. Baby opossums have a very different digestive system, than other young mammals and young birds. However, through collaboration with researchers in Australia, which has the bulk of the world’s marsupials, techniques improved drastically. Baby opossums of 17 grams are now regularly saved and eventually re-released into the wild.

The discovery that made the critical difference was what to feed them. Regular formula for other baby animals did not work. It contained lactose, and baby opossums cannot digest that. They would do OK with it for a few days, but then diarrhea took over. Eventually, they discovered by diluting it with water, the babies could handle it. They also began giving them injections of saline which helped them not get dehydrated. In the wild, the mother opossum has antimicrobials in her pouch as well as secretions in her saliva which helped nurture them. Remember that baby opossums generally stay in the mother’s pouch for about 85 days, as they continue to develop to the point that other baby mammals are at birth—eyes fully open and moving around significantly.

So kudos to the South Florida Wildlife Center, which is HSUS-affiliated! They not only save baby opossums, but other wildlife as well, such as squirrels, birds, pelicans with ripped pouches—the list goes on. On one May day this year, 33 animals were admitted, 68 in the hospital, 165 in the nursery, and a whopping 649 were being cared for. They are an exemplar in their field!

(Karen E. Lange, “The Heart of Healing,” All Animals, September/October 2017, p.18-23)

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, October 9th, 2017. Filed under Newsletter.

Assuring an Inheritance for your Heirs

By Elizabeth Boehmcke

Many of our clients come to us primarily for estate planning. They are interested in making sure that their assets are distributed to their beneficiaries in the amounts and in the manner that they want. For many of our clients, that means devising ways to transfer assets to children after the death of one or both spouses. However, because we are elder law attorneys, most of our clients are also advised about long-term care planning and asset protection strategies. We believe that good estate planning does not and cannot happen in a vacuum and attention should be paid to all matters that may impact a client’s goals.

For instance, many clients feel strongly that it is important to provide some measure of an inheritance to their children. However, it is clear in reviewing their overall financial picture that if one of the spouses requires long-term care, there may be very little to no inheritance left to give. For clients in such circumstances, pre-planning for long-term care costs may well allow them to assure an inheritance that could otherwise be lost.

We can create a trust that provides for the payment of the income of the trust back to the creator (or the “grantor”) of the trust and which, upon the death of the grantor, distributes the remaining assets of the trust to grantor’s beneficiaries (typically the grantor’s descendants but could also be a continuing income interest for the surviving spouse). If the trust is created and funded more than 5 years before the grantor applies for Medicaid, the Department of Social Services cannot consider the assets held by the trust in determining the eligibility of the grantor for Medicaid. In addition, Medicaid cannot put an estate recovery lien against the property held in the trust upon the death of the Medicaid recipient. Thus, the assets put in the trust are preserved for the heirs of the grantor. Only the income paid out by the trust can be assessed against the grantor and counted as part of his income for Medicaid purposes. Not quite like having your cake and eating it too, but you are certainly licking the icing.

What assets are appropriate for such an income only trust? Truly any assets can be used for such a trust. A residence can be a good asset to transfer into the trust for these purposes because a residence typically does not produce any income. The grantor can maintain a right to live in the house via a lease agreement with the trustee of the trust and pay the carrying costs of the house (insurance, real estate taxes, maintenance etc.) instead of rent. Thus there is no income to be distributed to the grantor and the grantor continues to live in the house and pay the expenses he or she was already paying. If the grantor wants to downsize or needs to move into a nursing home, for instance, the trustee can sell the house and reinvest the proceeds. If the grantor is still living independently, the assets can be invested in income-producing property that can be distributed to the grantor for living expenses. If the grantor is on Medicaid, the property can be invested in very low or no-income producing property that minimizes the income that is payable to the grantor (and thus to the nursing home for care). If it is not appropriate to transfer a residence into the trust (for instance because it still has a mortgage on it), other assets – from cash to stocks and bonds – can be transferred to the trust.

The trust is structured in a way to preserve the income tax benefits that are available to the grantor if nothing were done. For instance, the grantor can still exclude $250,000 of capital gains if he or she transfers his or her primary residence to the trust and the trust later sells the house. In addition, all of the assets in the trust receive a step-up in basis to the fair market value of the assets as of the date of the grantor’s death, just as if he or she had held them in his or her name alone at death. This means that when the assets are distributed from the trust to the grantor’s beneficiaries, they will be able to sell them with far less capital gains tax to pay than if the same assets were gifted outright to the beneficiaries before the grantor’s death.

Part of the beauty of an income-only trust plan is that while the grantor is living a healthy and independent life, he or she can benefit from the income generated by the assets (or continue to live in the home). However, it should be noted that the gift of the assets into the trust is a completed gift at the time of the transfer. The grantor has no ability to change his or her mind later, to access the principal of the trust or to compel the trustee to distribute the assets back to him or her. This limitation on the ability for a grantor to change the plan in the future is why we do not advise clients to put all of their assets into a trust of this sort. It is important that clients have sufficient other assets in their own names to continue to live their lives, pay their bills and support themselves. Thus, while the income only trust is not miracle cure in the sense that it cannot protect all of a client’s assets from the costs of long-term care, it can assure that at least some part of the estate is preserved for the heirs.

Make an appointment with any of the experienced attorneys at the Hook Law Center to discuss whether an income-only trust can be an appropriate part of your estate plan.

Kit KatAsk Kit Kat – White Giraffes

Hook Law Center:  What can you tell us about white giraffes? Are there really such creatures?

Kit Kat:  Yes, there really are! Two such giraffes were recently spotted in Kenya in Garissa County near the Ishaqbini Hirola Conservancy. Technically, reticulated giraffes come from eastern Africa, and have large brown spots which are separated by cream lines. The two which were sighted in Kenya appeared to be whitish, with the baby giraffe being a tad darker than its mother. As the giraffes mature, those with leucism, like the ones observed in Kenya, become lighter. They are not really albinos. They have the condition known as leucism, meaning they have pigmentation in their soft tissue, but not very much in the skin cells. Animals with leucism also have normal eye color; those with albinism usually have red eyes. Leucism exists throughout the animal kingdom, and species as diverse as birds, lions, fish, moose , and snakes all have been noted to have the condition.

Giraffes currently are classified as ‘vulnerable’ to extinction. This classification is somewhat less alarming than the ‘endangered’ classification, but it does mean that they warrant protection. In the last thirty years, the giraffe population has declined by 40 percent. At present, it appears there are 97,600 giraffes worldwide. However, they are extinct in at least seven countries in Africa. According to the Giraffe Conservation Association, half of all baby giraffes die before the age of six months, because they are the victims of other animal predators like lions and hyenas.

This was the third sighting of giraffes with leucism over the past few years. One of the other sightings occurred in another part of Kenya and in Tanzania. According to Dr. Abdullahi H. Ali, founder of the Ishaqbini Hirola Conservancy mentioned previously, the two giraffes will be monitored to gather information about their life span. The normal life span is in the range of 25 years. Time will tell whether these two recent specimens will be so fortunate. (Yonette Joseph,“Rare White Giraffes Cause a Stir in Kenya,” The New York Times, September 16, 2017)

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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 Friday, September 29th, 2017. Filed under Newsletter.

Myths about Public Benefits

By Letha Sgritta McDowell, CELA

In my years as an elder law practitioner, I’ve had clients come into me professing extensive knowledge of public benefits (particularly Medicaid) that were wildly off-base. There are any number of myths that have to do with public benefits planning, and I thought I would take this chance to “myth bust” some of the most common myths about benefits.

  1. “They are going to take my house.” False! While I am never exactly sure who “they” is, no person or entity takes away a home or other property for that matter. This includes the Medicaid agency, nursing facility or assisted living facility, social services, etc. However, some planning in advance may be prudent in order to achieve the goal of avoiding “estate recovery.” Estate recovery is the process by which the state Medicaid agency recovers from an individual’s assets after their death. With proper planning, this result is often avoidable.
  2. “My income is too high to qualify.” False! Different public benefits programs have different eligibility requirements. One of the most confusing is the benefit known as “Medicaid.” While we tend to use it as a blanket term, there are a number of different programs which fall under the Medicaid umbrella. Each program has different eligibility requirements so, while your income may be too high to qualify for one program, you may be well within the guidelines for another. The Medicaid program that pays for nursing care and the Special Pension Benefit commonly referred to as “Aid & Attendance” typically only require that the applicant’s monthly income is less than the cost of their care.
  3. “I must have practically no assets to qualify.” False! While many public benefits programs require countable assets to fall within certain limits, there is no limit on the amount of non-countable assets a person can have. Proper planning allows the conversion of countable assets into non-countable ones and allows the applicant and/or his or her spouse to protect assets and still qualify for benefits.
  4. “I have to give everything away in order to qualify for benefits.” False! In many cases, giving assets away causes penalties which could have been avoided with proper planning. And, when you give assets away to children or other family members, you have lost your ability to control them and potentially subject them to creditor claims or divorce actions which you may never have seen coming.
  5. “I have to do planning at least five (5) years before needing care.” False! Many asset protection strategies can be implemented at the time you need care. However, it is critical to have the proper tools in place to allow an agent to assist you in asset protection planning should you need care in the future.
  6. “A Revocable Trust protects my assets.” False! While revocable trusts can be a power estate planning tool, a revocable trust does not protect your assets from the claims of creditors or the cost of nursing care. However, there are other types of trusts which can be used to protect assets.
  7. “Adding my children’s names to the deed to my house will protect my home.” False! Adding a child’s name to any asset, including a home, can cause a period of ineligibility for public benefits. In addition, adding them as an owner of an account makes the account “their” money in the eyes of the law. This means it could be subject to the claims of their creditors or other financial problems. In addition, this may cause the accidental disinheritance of a child or other family members. AND, in many cases, the home is an exempt asset anyway.

Whether you are considering your long-term care plan early or are facing an immediate nursing care need, it is never too late to plan to protect assets. Don’t let these common “myths” about asset protection planning prevent you from taking action or influence you to make decisions which may have possibly devastating consequences.

Kit KatAsk Kit Kat – Pet Investigaors

Hook Law Center:  Kit Kat, what can you tell us about the Humane Society’s undercover investigators?

Kit Kat:  Well, these brave people perform a humanitarian service which makes a huge difference in the lives of animals. They investigate abuse, and they have to go undercover using fake names and identities to protect themselves. One such investigator is named Amy Winter (her alias). Her current assignment is working at a pet shop in New York City, where she investigates the sale of sick puppies from the Midwest. Though only 26, she is on her last assignment. This kind of work takes a toll. She has been travelling around the country staying for a few months at a time in a particular location investigating animal abuse. She cannot use social media, and must not get too close to her co-workers. Later this year, she will enter a police academy to train as an animal protection officer. Her five-year stint is longer than most investigators who last only 2-3 years. She has investigated 2 industrial pig farms, a calf ranch, a tiger facility, a horse stable, and 3 research laboratories. She says, ‘For all the cases of mine, I felt I made some impact on the animals, which means the world to me.’

In her current assignment at the pet store, she hears customers ask repeatedly, “Are these puppies from puppy mills?” The staff are instructed to say definitely not. So, she goes about her business of secretly recording what is going on at this particular store. She hope her information will be enough to shut down this particular store. She says, ‘A lot of very sick puppies are being sold. I think a lot of people are going to be shocked.’

Another undercover agent named Cody investigated an egg factory farm in Iowa. What he witnessed there was so horrifying that he lost weight and was having nightmares. After that final assignment, he decided to study law and help animals through the legal channel.

We owe these investigators a tremendous debt. They are helping society monitor the management of animals. When things are not done in an appropriate way, the investigators are there to call attention to the matter, and to hopefully, make corrective action happen. (Julie Falconer, “True Grit,” All Animals, September/October 2017, p. 24-28)

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, September 22nd, 2017. Filed under Newsletter.

The Equifax Data Breach: Take This One Step Now

By Jessica A. Hayes

As you have probably heard by now, Equifax, one of the three major credit reporting agencies, was hacked earlier this summer. As a result, nearly half the U.S. population’s personal data, including full names, addresses, dates of birth, and Social Security Numbers, is at risk. This is enough information for the hackers to open up credit cards in your name, apply for loans, and go on spending sprees. You may not find out immediately – especially if the hacker also has your mail forwarded to a different address. Because there is about a 50% chance your information was involved in the breach, now is the time to act.

The most important thing you can do now to protect yourself against someone else using your personal information is to place a credit freeze with each of the three credit reporting agencies. A credit freeze is a tool which prevents credit inquiries and the opening of new lines of credit. Anyone who attempts to open a credit card using your information, for example, will be automatically declined. If you wish to open a new line of credit yourself, or to permit a mortgage lender, for example, to make a credit inquiry on your record, you may temporarily lift the credit freeze either for a period of time or for a certain lender.

I first wrote about credit freezes in this newsletter back in June, following my own experience with identity theft. Because significantly more of you may be affected by the Equifax breach, I think it worth repeating.

If you put a credit freeze into place with a credit reporting agency, the agency will require you to use a Personal Identification Number (PIN) anytime you want to lift the freeze. To best protect yourself, you should place a credit freeze with each of the three agencies, meaning you will need to keep track of three different PINs. Keep them in a safe place to avoid losing them.

The three credit reporting agencies’ webpages on credit freezes are located here:

Experian: https://www.experian.com/freeze/center.html

Equifax: https://www.freeze.equifax.com/Freeze/jsp/SFF_PersonalIDInfo.jsp

TransUnion: https://www.transunion.com/credit-freeze/place-credit-freeze

Each agency charges a small fee to place a credit freeze; however, Equifax has recently announced that it will waive this fee in light of the breach.

When you go to place your credit freeze with each agency, this would also be a good time for you to request a copy of your credit report. Review it carefully to ensure that all entries relate to you. If you see something that does not belong on your credit report, contact the credit reporting agency directly to request a correction.

Kit KatAsk Kit Kat – Veteran & Service Dogs

Hook Law Center:  Kit Kat, are service dogs assigned to veterans long after their service has ended?

Kit Kat:  Well, yes, and this is an interesting story. Retired Army Sgt. Toby Yarbrough had served overseas and returned home with post-traumatic stress disorder and seizures after suffering a traumatic brain injury while on active duty. Mr. Yarbrough credits his service dog, Duke, with saving his life. Were it not for Duke, Mr. Yarbrough said he probably would have committed suicide. He has detailed his experiences in a self-published book entitled “The Quiet Healing.” Mr. Yarbrough now lives in Chesapeake, VA. Duke is still with him, and accompanies him to work every day at a payroll company in Newport News, VA. Also, they are accompanied by Sasha, a 3-year old former rescue dog, who has taken over for Duke, because he is aged at 13.5 years old and suffers from arthritis and spinal degeneration.

Mr. Yarbrough, Duke, and Sasha came to the attention of some local part-time filmmakers—Andrew Lauto and Jacob Woodward, who then collaborated with Dave Alegre of Virginia Beach who owns Green Thumb Studios, a multimedia business. They plan to make a short film of about 20 minutes in length about Mr. Yarbrough and his dogs. They also will feature other veterans with service dogs and those who train the dogs. It, too, will be called “The Quiet Healing,” and they hope to have it ready to air around Christmas on YouTube and Vimeo. They are also considering entering it in some film festivals.

This is a wonderful story which may give hope to others! When someone is down, seek help. There is always a solution to every problem. (Victoria Bourne, “Filmmakers to tell story of veteran with PTSD and his service dogs,” The Virginian-Pilot, Sep. 5, 2017, pg. 3)

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, September 18th, 2017. Filed under Newsletter.

Palliative Care and Hospice: Quality of Life for Patients with Serious Illness

By Shannon Laymon-Pecoraro

Hook Law Center, P.C. recently had the pleasure of hosting Dr. Marissa Galicia-Costillo from Sentara Norfolk General at our most recent Coffee with Colleagues seminar to discuss the difference between hospice and palliative care. While many people have heard of hospice, few have heard of palliative care, and even fewer understand the difference between the two. A brief synopsis of the takeaways from the presentation are provided herein.

Palliative Care

Palliative care, by definition, is medical care for people with serious illness that focuses on relief of symptoms to improve the quality of life for the patient and the family. Unlike hospice care, palliative care is appropriate at any stage of a serious illness (such as organ failure, Parkinson’s, dementia, and cancer) and can be provided in conjunction with curative treatment. As a result, it is never too early to bring in a palliative care team who can help define what goals you have for treatment.

Instead of treating the actual illness, a palliative care team focuses on various symptoms such as pain, shortness of breath, nausea, loss of appetite, fatigue, and sleeplessness. Aside from these physical symptoms, the team may also address mental, social, and spiritual issues. The goal with palliative care is to manage symptoms to improve overall quality of life. Because quality of life varies among individuals, a palliative care team works to understand what is important to you and help set treatment goals based on your priorities. From there, the team uses your goals to guide the care you receive.

In our area, palliative care is currently provided in facility settings, most often a hospital.

Hospice Care

Hospice care is a type of palliative care provided during the last stage of a serious illness. At such point, curative treatment ends and the focus becomes comfort management. Hospice eligibility requires the patient to be considered “terminal” and prepares the patient and the family for end of life. Essentially, the doctors indicate that it would not be surprising if the patient were to die within six months. The goal is to stop focusing on treatment, and allow an individual to spend their last days as comfortable as possible.

Hospice care can be provided in a facility setting and in the home. Our area does not yet have a hospice house, although plans are underway to build one.

Kit KatAsk Kit Kat – Great Danes Saved

Hook Law Center:  Kit Kat, what can you tell us about 84 Great Danes that were rescued in New Hampshire?

Kit Kat:  Well, this story has a happy ending, but it was not such a wonderful existence for 84 Great Danes that were recently discovered in a puppy mill in northern New Hampshire. They were housed in a 15,000 sq.ft. mansion. The mansion may have had crystal chandeliers, but it was a prison of sorts for the dogs. Living in a mansion doesn’t sound too bad, but the place was a wreck. There was trash everywhere, and some wooden floors were covered in diarrhea. In other rooms, the smell of urine was so strong, that rescuers had to take breaks and tag team each other during the removal of the dogs to a shelter.

The staff of the Animal Rescue Team are to be commended for the way they handled the rescue and re-location of these dogs to a shelter. Neither dog nor human suffered any injuries. The whole process took and entire day—from 5 AM to 11 PM, and it rained heavily that day. Dogs had to be coaxed one-by-one to get in cages. Some of the dogs were so large, though, they couldn’t fit into standard cages, so the team secured a couple of horse trucks to carry them. Once at the shelter, the dogs have been receiving veterinary care. Some have pressure sores from spending too much time on hard surfaces. Others have issues with their eyes or cardiac problems. Volunteers are helping to fill staffing gaps. A lot of hands are needed to care for so many large animals. They are providing the dogs with lots of tender, loving contact and help in the feeding process. All together these 84 dogs require 225 pounds of food per day! The dogs have also received 9,946 medical treatments to date.

This is a wonderful story that indeed ended well; however, it’s a shame any animal has to endure such treatment, even for a portion of their existence. (Holly Hazard, “Animals Saved: 84 Great Danes,” All Animals, September/October 2017, p.6)

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, September 8th, 2017. Filed under Newsletter.

Exercise & Foreign Language

By Hook Law Center

While exercise and learning a second language may not be at the top of your list of priorities, a new study may shed light on how people acquire new skills and how learning and can be enhanced. Learning is a continual process which enriches us at every stage of life. Scientists already had lots of information about animals and people and how exercise improved their learning capability and long-term mental acuity, but the latest study decided to examine how exercise could facilitate the acquisition of a second language. Learning a second language becomes more difficult after childhood when the brain begins to lose plasticity. Prior studies have not come to any conclusion about what types of exercise are best, or when they are optimally performed to have maximum impact.

The researchers from China and Italy recently published their results in PLOS ONE. Using 40 college-age males and females they designed a control group and an experimental group. The control group would learn in a traditional fashion—seated and in rote memorization sessions. The experimental group, on the other hand, rode stationary bicycles at 60% capacity for 20 minutes before instruction began and throughout 15-minute segments of instruction. Both groups were presented vocabulary on a large screen, paired with pictures. 40 words were given at each session, and there was some repetition of the material. After a brief rest, all completed a computerized quiz. The trial lasted over a period of two months, and eight different groups of words were presented. The results were significant for those in the experimental group. Those that exercised while learning had higher learning rates on simple vocabulary tests, but more amazing, was the fact that they were also more skilled at recognizing entire sentences, though the latter skill did not manifest itself until after several weeks of instruction. In addition, the experimental group’s learning gains persisted a month after instruction ceased, as compared to the control group. In the interim, there had been no direct teaching.

The implication in the real world is this. According to Dr. Simone Sulpizio, a professor of psychology and linguistics at the University of Vita-Salute San Raffaele in Milan, Italy, and a co-author of the study, ‘We are not suggesting that schools or teachers buy lots of bicycles. A simpler take-home message may be that instruction should be flanked by physical activity. Sitting for hours and hours without moving is not the best way to learn.’ More studies will be needed to get specificity on what types of exercise yield the best results in learning new skills. However, one can undoubtedly conclude that exercise causes the release of neurochemicals in the brain which, in turn, causes new brain cells to grow and new connections between neurons. This is the essence of all learning—new pathways are acquired, and the brain is changed forever. (Gretchen Reynolds, “How Exercise Could Help You Learn a New Language,” The New York Times, Phys Ed section of Well, August 16, 2017)

Kit KatAsk Kit Kat – Pets & Harvey

Hook Law Center:  Kit Kat, how is Texas dealing with all the stranded pets during Hurricane Harvey?

Kit Kat:  Well, they’re doing amazingly well, for the most part. One man, Joe Garcia, made sure his aging German shepherd, Heidi, was not left to fend for herself. After loading his belongings in a plastic tub and getting it aboard a rescue boat, he went back to his flooded home in Spring, Texas (north of Houston) to get her. She’s a large dog, but he maintained her head above water, and they both safely boarded the rescue boat. In another case, Belinda and Scott Penn, also of Spring tried to stick it out in their home with their 2 dogs—Winston and Baxter (a West Highland terrier and a Shih Tzu, respectively). They retreated a while to their 2nd floor, but after a day like this, they decided to take advantage of a rescue boat. Wading through high water with the dogs at their hips, they arrived at Belinda’s mother’s apartment in Woodlands. Ms. Penn commented, ‘Every situation is different, but for us, it was not an option to leave our pets behind. They are my best friends.’

Other pets have been rescued by Good Samaritans. A woman in Corpus Christi posted on social media that she had taken in a neighbor’s dog which had been left in the backyard. A photographer for The Daily Mail rescued a dog he found chained to a pole in Victoria. In Dickinson, a reporter from CNN rescued 2 retrievers floating in an unattended boat.

Shelters have been set up to take these abandoned animals. In San Antonio, for example, as of Monday, August 28, two hundred animals have been sheltered. More are coming. The San Antonio shelter is in an air-conditioned warehouse. Cats, thank goodness, were taken to a separate location. Whoever had that idea got it right—cats get very nervous when they hear barking dogs.

There is such an influx of animals to be cared for that arrangements have been made to take animals already in the shelters before the hurricane to shelters in other states. On Tuesday, August 29, a flight full of cats and dogs left San Antonio for New Jersey. On Wed., August 30 another flight took a plane full to Seattle.

The efforts of those in rescue services have been heroic. Recovery will take a long time, but at least it is good to know that our furry friends were not forgotten in the chaos. (Matthew Haag, “Saving Pets is Paramount for Many Fleeing Tropical Storm Harvey,” The New York Times, August 28, 2017)

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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, September 1st, 2017. Filed under Newsletter.

The VA Choice Program

By Letha Sgritta McDowell, CELA

Regardless of your personal politics, there are criticisms from both political parties about our current president and the actions he takes or hasn’t taken. In particular, healthcare and the repeal and replacement of the Affordable Care Act, commonly called Obamacare, has consumed the news lately. Prior to the spectacle around Obamacare, many healthcare advocates protested the care our nation’s veterans received (or didn’t receive) through the Veterans Health Administration. On August 12, 2017, President Trump signed an emergency spending bill which authorized an additional $2.1 billion dollars to fund the VA Choice Program.

In 2014, reporters revealed that wait times to get an appointment within the VA Healthcare system were as much as 115 days. Many veterans died waiting to be seen by a doctor in the VA healthcare system. In addition, other problems were reported in the VA, including an outbreak of Legionnaires’ disease, mismanagement of prescription drugs, and cover-ups regarding care veterans were receiving. As a result, the government created the VA Choice Program which allows veterans to choose local healthcare providers outside of the VA system. Using VA Choice does not affect any other veteran’s benefits.

In order to be eligible for the VA Choice Program, the veteran must already be enrolled in the VA Healthcare system and meet one of the following requirements:

    • Be told there is more than a 30 day wait for their appointment
    • Reside more than 40 miles from the nearest VA Healthcare facility with a full time primary care physician
    • Need to travel by air, boat, or ferry to the closest VA facility
    • Face an unusual or excessive burden to travel to a VA facility
    • Reside in a state or territory without a full service VA facility

The ability to receive care from a provider in the community has reduced dangerous wait times for veterans and the continued funding of the VA Choice program is critical for many veterans, especially those in rural areas like eastern North Carolina. Appointments with local providers has increased by 10% since 2014 and the implementation of the VA Choice Program.

Unfortunately scandal is not new to the VA Healthcare system. In 1945, VA Administrator Frank Hines resigned amidst scandal of poor care provided at VA hospitals. In 1972, Ron Kovic publicly protested VA healthcare and led a 19 day hunger strike at a federal building in Los Angles to shed light on poor care at VA facilities. In 1986, the Inspector General found that 93 physicians providing care at VA facilities had sanctions against their licenses. In 2003, an investigative team under George W. Bush found that more than 236,000 veterans had waited for more than six months for follow-up medical visits. These are just a few of the headlines about the VA.

Many veterans feel that the VA Choice Program gives them the ability to get the care they need out from underneath the bureaucracy that exists within the VA and on which much of the blame for poor care is placed. The emergency spending bill which extends the VA Choice Program is seen by many as a welcome relief and will hopefully continue to improve the care received by those willing to sacrifice for this country.

Kit KatAsk Kit Kat – Forest Fires

Hook Law Center:  Kit Kat, what can you tell us about forest fires, and why they sometimes may be beneficial?

Kit Kat:  Well, this is an interesting proposition—should we let forest forest fires burn themselves out or should they be actively fought? The case for letting forest fires burn without active efforts to contain them is gaining acceptance. There are several reasons for this. First, scientists now believe that, in North America before European settlement, 20-30 million acres would burn in an average year. Today, it is more typical that only 4-5 million acres burn every year. Second, burned-over land is not a wasteland. It is actually a fertile area where many types of species survive and even thrive. Take for example, the black-backed woodpecker—the mainstay of its diet is grubs which absolutely abound in burned-out trees. For some beetles, it is their ideal habitat to lay eggs. They can sense that an area has become burned over, and will rush from miles away to deposit their eggs. Third, forests periodically need to be thinned, and fire is nature’s way of accomplishing this. Finally, human lives of forest firefighters are put at risk in each fire that is fought. Families of firefighters have come to realize that fighting fire to protect property is a high price to pay, and they are increasingly suing governments for wrongful death. According to Dr. Timothy Ingalsbee, a former firefighter and now head of an advocacy group, ‘Families are no longer going to be mollified by politicians showing up at the memorial talking about their fallen heroes.’

Firefighting on a large scale started in the 19th century when it was in vogue to protect timberland for the commercial value. By the 1930s techniques had gradually improved to allow for large-scale firefighting efforts. So the debate continues. Most agree it would be better to let some acreage burn naturally—it’s a question of how much acreage. Also, some argue that money would be better spent on loans to homeowners who live on the edges of forests to build fire-resistant structures which actually have a good track record of being unharmed in fires, if the proper building materials are used. California could prove to be a test case. With 39 million inhabitants, the issue is very important. Even there, efforts by the US Forest Service are being made to allow fires caused by lightning to burn naturally in 3 national forests in the state. In summary, this is an important issue that can affect everyone, whether you live in a wooded area of not. Federal and state tax dollars to the tune of almost $2 billion annually are spent in firefighting.

(Justin Gillis, “Let Forest Fires Burn? What the Black-Backed Woodpecker Knows,” The New York Times, August 6, 2017)

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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, August 25th, 2017. Filed under Newsletter.

Preventing Dementia and Cognitive Decline

By Jessica A. Hayes

The National Academies of Sciences, Engineering and Medicine (NAS) have recently published a report which indicates that it may be possible to prevent dementia and age-related cognitive decline. Just seven years ago, scientists were unwilling to recommend or endorse any interventions, but the most recent findings are encouraging.

The three strategies recommended for preventing dementia and cognitive decline are being physically active, engaging in cognitive training (education, mental stimulation, and cognitive exercises), and controlling high blood pressure. There are other strategies warranting research – engaging in social activities, getting adequate sleep, maintaining a healthful diet, and managing depression, for example – but more research is required before they may be formally recommended.

The NAS report indicates that the three recommended strategies have been found to work in some situations, but not others. For example, cognitive training and physical activity were found to have the potential to delay age-related cognitive decline, but not dementia; and the only strategy identified as a potential way to prevent or delay Alzheimer’s disease is managing high blood pressure, although this strategy appears to have no impact on age-related cognitive decline.

These findings are encouraging, although more research is required before we can fully understand the causes of and potential interventions for dementia and age-related cognitive decline. Because the biological changes associated with some types of dementia begin ten years or more before any symptoms appear, individuals can lower their risk by making healthy lifestyle changes early – as early as when individuals reach their 40s. Furthermore, because Alzheimer’s and related dementias often have several causes, scientists recommend individuals implement several strategies to prevent or reduce age-related cognitive decline or dementia, not just one.

To review the NAS’ complete report, visit: http://nationalacademies.org/hmd/reports/2017/preventing-cognitive-decline-and-dementia-a-way-forward.aspx.

Kit KatAsk Kit Kat – Suburban Deer

Hook Law Center:  Kit Kat, is there a problem with too many deer in the suburbs?

Kit Kat:  Well, that might depend on whom you ask. Take, for example, the town of Oakton, VA. Three neighbors have completely different ideas about the subject. One loves deer and has a deer feeder in her yard. Another permits bow hunters on her property to cull the deer. The third has installed an 8-ft fence to keep the deer out. That kind of sums up the range of reactions to deer in the suburbs. Overall, the number of deer in the Northern Virginia suburbs has been declining. Where there are active deer management programs, there is a definite decline in the number of deer.

Kevin R. Rose, a district wildlife biologist at the Virginia Department of Game and Inland Fisheries (VDGIF), has the following advice regarding deer. First, do NOT feed deer under any circumstances. Besides the fact that it is illegal to feed deer in many localities from Sept. 1 to the end of April, it causes them to artificially congregate, which increases the likelihood of disease transmission. Food also attracts other animals than deer, like raccoons, which are rabies carriers. Bears are also attracted to feeding stations. Feeding bears, at least in Virginia, is illegal at any time of year. Deer are perfectly capable of feeding themselves, even if they have to forage off of evergreens, twigs, and tree bark. He also discourages providing deer with salt licks. Those, too, artificially congregate deer in specific places.

When asked about the most effective way to thin deer populations in suburban areas, Mr. Rose responded that the quickest way is sharpshooting. However, this method is not permitted in every locality, nor in every neighborhood of every locality. Local ordinances regulate the use of firearms. A more effective method is through the use of bow and arrow. Though slower, archery has proven very effective in Fairfax County, VA which has an organized program.

In conclusion, while deer are very attractive, gentle creatures, it appears best to not interfere with their normal rhythms of life. It may seem harsh, but there is a balance in nature which we must respect. (Kevin Ambrose, “Oh, deer, what should we do? Addressing the suburban deer dilemma.” The Washington Post, Capital Weather Gang section, August 3, 2017)

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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, August 18th, 2017. Filed under Newsletter.

Beware of Public Benefits: The Cautionary Tale of Overpayments

By Shannon Laymon-Pecoraro

Recently, I have seen an increase in the number of notices from the Social Security Administration and the Department of Medical Assistance Services relating to benefits received by a person not eligible to receive benefits any longer due to a change in circumstances. Some of these cases were the result of administrative error; however, a majority of the cases were the result of beneficiaries, or their representatives, not understanding the rules surrounding benefits.

Most people do not realize that even a change in household size, income, or assets could impact means-tested benefits. A common example I see is that a child receives Supplemental Security Income (SSI), but something happens to disrupt eligibility. This could be an increase in a family member’s income, potentially due to a new job, or an increase in assets, such as when someone received a personal injury settlement or an inheritance. A family member does not think to report this change of events, despite their affirmative obligation to report these changes to the appropriate agency, which leads to the agency discovering the ineligibility period months, or years later, resulting in a large overpayment due to the agency.

Although Social Security and Medicaid each have their own rules and a number of different programs, ineligibility for one program may detrimentally impact the other. For example, the child receiving SSI is automatically eligible for Medicaid, and as a result of ineligibility for SSI, may be ineligible to receive Medicaid. Not only would money paid by Social Security need to be repaid, but you may need to reimburse Medicaid for services rendered, including payments made to a private insurance company to keep you on the Commonwealth’s plan, during the period of ineligibility.

Often, individuals receiving benefits depend on the benefits for basic survival. In the event of an overpayment, the individual often cannot afford to repay a lump sum to the agency or otherwise suffer the loss of a reduced benefit. As a result, any change in financial circumstance should be addressed with the appropriate agency as soon as possible, bearing in mind that family changes will affect an individual under the age of eighteen.

Because of the severe impact on an individual when there is a misstep, you should not “dabble” in public benefits planning. When receiving public benefits, it is important to work with someone who is knowledgeable in the area. An experienced Elder Law or Special Needs Planning attorney can help navigate the benefits maze by explaining the benefits you are or may be eligible to receive, your responsibilities, and what things to watch out for.

Kit KatAsk Kit Kat – Shelter Tests

Hook Law Center:  Kit Kat, what can you tell us about how shelters determine which dogs are good adoptees and which may be too dangerous to adopt?

Kit Kat:  Well, this is a complicated issue. Shelters themselves are beginning to re-examine their protocols for determining which dogs are suitable to be adopted and which are too aggressive and have to be put down. In the past, shelters thought they were being objective and used prompts that were supposed to tease out who was OK for adoption from those who were not. For instance, they would place a fake, plastic hand on a stick in front of the dog. If they grabbed it, and bit it, they failed the adoption test. Or they would have a hooded person shaking a cane, and see how the dog reacted. Since the adoption tests have proven not to be perfectly reliable, the shelter community in some areas is beginning to adopt a system that relies more on observation of behavior at the shelter. That can be misleading, too, as shelters are an artificial environment where dogs do not get as much individual attention as they deserve. There are also smells and many more dogs than they would ever encounter in real life.

Shelters, however, deserve a lot of credit for even looking at this issue. The Maricopa County shelter which serves the Phoenix, AZ area takes in approximately 34,000 dogs in any given year. In the first half of 2016, 536 dogs were euthanized for behavioral reasons. In the first half of 2017, with a new director, they stopped the behavioral testing, and only 31 dogs have been euthanized for aggressive behavior. According to Dr. Gary J. Patronek, an adjunct professor at the veterinary medicine school at Tufts University, ‘The tests are artificial and contrived. During the most stressful time of a dog’s life, you’re exposing it to deliberate attempts to provoke a reaction. And then the dog does something it wouldn’t do in a family situation. So you euthanize it?’

It is reassuring that shelters are doing all they can to save as many dogs as possible. Shelters which handle large numbers of dogs, like those in LA and NYC, even go as far as placing their dogs in playgroups outside the shelters. Dogs Playing for Life is one such group in which playgroups are used to observe the dogs’ behavior. This issue will continue to be debated. However, much progress is being made in the attempt to treat dogs in the most respectful way possible. (Jan Hoffman, “Is This Dog Dangerous? Shelters Struggle With Live-or-Die Tests,” The New York Times, Science section, July 31, 2017)

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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, August 11th, 2017. Filed under Newsletter.