Ten Myths About the Dying Process

The following article, Bury the Top 10 Myths About the Dying Process, is by Tani Bahti, RN, CT, CHPN, Founder and Executive Director of Passages – Support & Education in End of Life Issues, and Author of “Dying to Know – Straight Talk About Death & Dying.”
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The current debate about end of life decision-making in healthcare is avoiding the most important ingredient; understanding the natural process of dying. It is critical that this information be provided compassionately and thoroughly before those facing a potentially terminal illness can make a truly informed decision.

Those of us who work directly with the dying understand that the body has a natural wisdom built into it, to protect itself and promote comfort.

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Legislature Tinkers With Power of Attorney Law

The Maryland legislature once again has tinkered with the law governing powers of attorney in Maryland. That law includes Power of Attorney Forms, which if used, or if one’s power of attorney is “in substantially the same form” as one of the form documents, then the law bestows certain rights on the holder of the power of attorney, namely, the right to obtain payment of one’s legal fees from the person or institution who refuses to honor the power of attorney where a legal action is taken to compel acceptance. This right to legal fees differs from the general “American rule” of jurisprudence which holds that each litigant in a legal action must pay his own legal fees.

Unfortunately, the forms in the statute are generally not sufficiently comprehensive and lack certain important provisions.

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When a Mere Guardianship is Not Enough

Father, who had been enjoying late middle age, had a brain aneurysm and now is in a permanent coma. Unfortunately, he did not have a power of attorney or advance directive, so his adult son could not access his bank account, in which he had $20,000. He has no other assets. Father’s hospital and nursing home bills now exceed $300,000.

Son applied for Medicaid for his father but was denied benefits because Medicaid will not be allowed if Father has more than $2,500. Unfortunately, without a power of attorney, no one has the authority to spend the funds in Father’s bank account so that he can get Medicaid benefits.

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Gifts to Disabled Children

Medicaid law allows a parent to gift any amount of assets to a disabled son or daughter and still get Medicaid to cover the parent’s long term care in a nursing home. If the child who receives the gift is not disabled as determined by the Social Security Administration, however, then any such gift, if made within five years preceding the date of the Medicaid application, will cause Medicaid ineligibility for the parent who made such gift.

The Medicaid rules state that both outright gifts to a disabled child, and gifts to a trust for the sole benefit of a disabled child are exempt transfers — that is, transfers that do not cause Medicaid ineligibility for the parent who makes the gift.

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The Other Side of Caregiving

Several months ago, I shared with you Carol Allen’s Reflections of a Non-Expert Care Giver in which Carol discussed how the experience of caring for her mother, who suffered from dementia, enabled Carol to shift her attention from the outer expression of life to its inner reality. For Carol, this was a positive, life affirming experience.

For others, such experience is a struggle of monumental proportions. Such is the case for Sandra Tsing Loh who relates her experiences managing her aging father’s care in the article/book review entitled Daddy Issues in the March, 2012, issue of the Atlantic magazine.

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Do I need a Lawyer to Apply for Medicaid?

Mr. GoodSon is in a bind. His mother has been in a nursing home for over a year. He applied for Medicaid when mother first entered the facility, and although the Medicaid caseworker indicated to him that the application was fine, she ultimately denied the Medicaid application because mother had a few hundred dollars too much in her bank account. So GoodSon reapplied for Medicaid. This time, he could not get all the bank statements requested by the Medicaid caseworker from the bank. GoodSon again got the message not to worry about it, but in the end the Medicaid application was denied for failure to submit all the requested information

You’ve heard the old adage, “the third time is a charm”. So it was in this case, too. However, while the third Medicaid application was successful and Medicaid was granted, it was granted with a 6 month penalty period, or period of Medicaid ineligibility as a consequence of mother having made gifts to family members in the years prior to entering the nursing home.

By the time Medicaid started to pay, there was well over $100,000 in outstanding charges at the nursing home, and mother had no money to pay it. Mr. GoodSon is retired with only his house and barely adequate retirement savings. Nevertheless, the nursing home sued both mother and Mr. GoodSon. However, it is GoodSon who is at risk of losing everything — mother already is destitute.

To make matters worse, Mr. GoodSon did not seek my assistance until a few days before the court was to enter summary judgment — in other words, the nursing home was about to get a judgment against mother and Mr. GoodSon for the outstanding debt because Mr. GoodSon had been pursuing his legal defense without a lawyer.

We quickly ascertained that GoodSon had a number of defenses to the lawsuit, and we were able to defeat summary judgment notwithstanding the short time I had to do so. We next educated the lawyer for the nursing home about the reasons his client could not collect the entire outstanding balance from Mr. GoodSon. Indeed, Medicaid and nursing home collection law is highly complex. Having done so, we were able to persuade the nursing home to settle the matter for a fraction of the outstanding balance.

Fortunately for Mr. GoodSon, he sought out competent legal assistance not a moment too soon. Had he not done so, he could have suffered financial devastation.

While Mr. GoodSon and his mother are an extreme case, many people find themselves paying tens of thousands of dollars more than they have to by attempting to navigate the complex matter of paying for nursing home care without proper guidance.

Don’t let yourself fall into the trap that caught Mr. GoodSon — seek out competent counsel as soon as possible if you or a loved one will require nursing home care.

Medicare Open Enrollment Ends Early This Year

The Medicare open enrollment period ends this year earlier than prior year open enrollment periods, December 7 instead of December 31.

The open enrollment period to make changes to your Medicare coverage, or to add coverage such as Medicare Part D drug coverage ends December 7, 2011. Now is the time to act if you desire to make changes to your coverage.

To learn more, you may log onto the online Medicare Open Enrollment Center by clicking -Here-

Reflections of a Non-Expert Caregiver

Carol Allen cared for her mother, who had Alzheimer’s disease, for more than five years. Carol has spoken and written articles about her experience. Rather than “losing someone to Alzheimer’s,” Carol has been able to celebrate life through the process of caring for her mother.

Carol writes: “You hear of people ‘losing someone they love to Alzheimer’s’. And certainly they are going, going, going, never to return. But it gives us, the caregivers, the time needed to shift our attention from the outer expression of life to its inner reality. . . . There is a whole human being in front of us still desiring the same thing we all desire: to be loved for who we are right now. This is a wonderful opportunity to pour out our love and express it in ways that we never expressed it before.”

To read all of Carol’s Reflections of a Non-Expert Caregiver, click here.