March 3rd, 2010, 
I feel the season changing.
The subtle smell of new growth. The sun refusing to go easy into the night. The moon less eager to rush into the day. I just had my 47th birthday. I too feel less eager to close my eyes at night. I spent my birthday skiing in powder up to my knees. The day before it was bleak, grey, windy, cold and wet. On my birthday, the sun shined and the powder forced me to just lay back and enjoy. For those of you who don’t ski, it can be effortless if you just relax into it. When I decided to sit back and glide down the slope I began to notice the lakes in the distance, the hawks in the sky, the music in my head.
There are many challenges we as Americans young and old currently face. Most of us spend our days trying to put out one fire after another and then go through the rote tasks before we go back to sleep and do it all again like pre-programmed zombies. I know that it can feel like you are a salmon swimming upstream, trying to get to places that we need to be, but having to face serious challenges along the way. However, this is it. THIS IS IT.
If you have children and have to get them off to school and yourself off to work, take two minutes to watch their faces as they chew their toast with two missing teeth. They are cute. If you have a long drive in traffic, turn off the news and turn on some funny morning guys and laugh or put on pretty music and find something pleasing about the sky. If you’re really lucky you will pass someone picking their nose or arguing with themselves behind the wheel. Who knows maybe you will get a glimpse of a wildly cute dog tonguing the air from the back seat of a sedan. Like Julie Andrews sang, these are a few of my favorite things.
If you have money problems trust that it is temporary and that you will be o.k.. Give yourself three minutes to fret about it and understand that while today is cold and bleak, the seasons are changing. I promise that tomorrow the sun will shine, it inevitably does (even in Seattle). So, just relax and enjoy the glide.
LOVE SUSAN
August 30th, 2010, How did I get Mrs. B to go to the hospital? I drew a chart of where she was when I first met her, where she was the previous Friday, where she wanted to be and where she was…. knocking at death’s door. It went from the peak of a mountain to the valley. I called 911 with her blessing.
One of my recommendations in my initial report was that she organize her paper work. It was scattered about her desk and should an emergency arise, it would be difficult to present the appropriate paper work without a frenzy which is exactly what I was thrust into when the paramedic asked me for her Medicare card.
Mrs. B had pneumonia. She was placed on antibiotics. She spent three weeks in the hospital. Both of her daughters came in from various parts of the world. So many friends came that I had to put visitation restrictions on her door. She is a fighter.
One day I came in and she was standing and sitting and standing and sitting. She was trying to work her muscles because she felt as if she would never walk again. Her whole body shook and no anti-depressant could stop it. She was scared. She became nauseous. She vomited blood. Instead of being transferred to the transitional care unit for rehabilitation, she was rushed to the intensive care unit. The diagnosis after two endoscopies? A massive pulsating ulcer—that could burst at anytime and end her life.
In the meantime, her husband was at home with in home care assistance and friends to ensure his safety. She did not communicate to with him. He was scared and sad. I had to find a way to both enable her to release the guilt she was carrying around about his imminent placement in an assisted living facility without directly confronting her and find a way to for her communicate to him before he was taken from his home and moved to another…without his wife of 40 years.
I interviewed Mrs. B’s daughter and a close family friend, a Guatemalan man that they raised and who will be the conservator when things go very south. They told me of the nicknames that Mrs. B and her husband had for one another and memories that would evoke feelings of joy and nostalgia. I set out and wrote a love letter to him on her behalf. Bidding him fair well with love, signed “all my love twinkle.” Mrs. B approved of the content and Mr. B held onto it as if it were laced with sticky honey. Not all lies are bad.
August 12th, 2010,
Within 5 days of delivering the report, Mrs. B asked me to come to her home. She was shadowed by another woman who she sponsored at AA and who was there at our first meeting. We will call this woman, her shadow. At first I was suspicious. It is not just that I have an inherently distrustful nature, it is that I have seen these types linger around frail older adults with assets many times and THEY HAVE DONE BAD THINGS TO MY CLIENTS. In time, I came to not only trust the shadow, but because Mrs. B’s daughters were out of the country, I came to rely on her for doing the things that a daughter would do.
When I arrived, Mrs. B was sitting up in her bed upstairs eating a peanut butter and lettuce sandwich. Because she had to sleep in an upright position, she developed stenosis. She complained of pain. Overall she seemed determined and strong. Mrs. B again reiterated her desire to move her husband elsewhere and the conflict she felt about “institutionalizing” him. The consensus was that she would tour a facility by her home that I recommended. I asked her to articulate her wish list, and certainly regaining her strength was primary. However, it was clear that her mental attitude was an impediment, so we discussed anti-depressants. Being the stoic person that she was, she had stopped taking them.
I spoke with Mr. B, he was bored. Every day that I spoke with him he said he was bored. He had very bad hygiene, could not make his own meals, pick his clothes out or do his own laundry. I came to feel that placing him was the right and kind thing to do. He sat and sat and sat all day without any social interaction.
We had a plan. Mrs. B. would tour the assisted living facility the following Monday. By the time I left, she was up and about and demonstrating her new lift. She looked happy and hopeful. The next Monday when I met her at the facility, she looked like she was knocking on death’s door.
What happened? I kept asking myself this question. Just two days before it seemed like you could swim in her eyes. When I saw her that Monday, she did not look spry and her lids were heavy over her big blues. She could barely get out of the car and I needed to get wheelchair assistance. She had fallen the night before. There was no one there to help her.
The next morning I got phone call after phone call from one of her many friends “Mrs. B… keeps saying she is dying and she won’t let us take her to the hospital or the doctor.” I rushed back from my appointments and cancelled my day. Both she and her husband had fallen the night before and this time she was in terrible pain and scared. He was oblivious. She could barely breath. She was gagging on her coughs.
I gave her two choices I would either bring her to the hospital or I bring a doctor to her. She told this doctor, (a geriatric concierge medical doctor who did her residency in geriatrics) was accused of being a quack while conducting a bedside examination and dismissed her. Now what?
August 12th, 2010,
This story begins 7 months ago when an attorney colleague asked me to call one of his clients who was frail. He knew that I was the person that had the skill set to ensure that she was getting her needs met and that she had a plan to stay healthy and safe. This person was the Magnificent Mrs. MB. Her daughter came in from Canada to assist her after she had a minor heart attack in the hospital after being hospitalized for a bleeding ulcer. One year earlier, Mrs. MB had an extensive and highly invasive surgery because she had esophageal cancer. They used her stomach to re-construct her esophagus and now, for the rest of her life, she must sleep in an upright position. She had COPD and now emphysema and used oxygen.
Mrs. MB is 76 years old and for almost her entire adult life was the care taker for her husband who in the 1980’s was in an automobile accident and suffered minor brain damage. Now in his 80’s he has a rather well entrenched case of dementia. I conducted a mini mental status examination and other standardized test on him that confirmed this diagnosis.
I did not meet with MB then. She did not want to hire me. Distrustful and afraid of change, she rejected her daughter’s pleas.
Exactly one month ago she called me. I went to meet with her. She had the biggest, bluest most alert eyes I have ever seen. They said I can size you up in a second and swallow you. I took her history. I found out that she was a retired psychiatric registered nurse. I found out that she wanted her husband out. She wanted her husband out. She had had enough. She was too frail to care for him and any suggestion of in home care for respite relief or getting him out of the house to an adult day health care center was not going to cut it. As time went on and as will be revealed later, I came to find out why I was being hired to be this seemingly affable man’s henchwoman.
As for her, she wanted her life back, she wanted to be social again and herself entertained moving into a nice assisted living facility. She had been an alcoholic and for the last 20 years a valued mentor to many suffering from that disease. Her social life centered around those functions. In order for her to accomplish that, it was clear that she needed major nutritional counseling. She was very thin. She needed a lift put into her home to assist her with the 15 stairs to her room and grab bars installed. And, her legal affairs had to be put in order. Her estate plan was woefully outdated.
This seemed like a very easy case, one that my initial retainer could cover. I went back to my office, wrote a report with my recommendations and findings and summarily delivered it. One of my recommendations was that she re-consider moving her husband. I thought that she was underestimating the value of having a routine every day suddenly evaporate. It could be lonely and isolating. Certainly she could get some relief through the adult day health care center or in home care. However, I would come to find out that there were people lining up to be at this woman’s side, every day, all day.
July 26th, 2010, 
Many older adults have asked me questions about shingles, a common viral illness, also known as herpes zoster or zoster. When I tell them that it is a form of herpes, they look at me the way I suppose I looked at a woman when she ordered sweetbreads when I waitress at a deli in Chicago. How could you eat cow brains to a college kid looks like how could I have herpes to a clean cut older adult.
The truth is that while people of any age can get a shingles infection once they have had a chicken pox infection; it is most common in people over the age of 60 (accounting for over ½ of all cases). It also strikes those who have altered immunity due to certain medications or treatments, such as chemotherapy, radiation therapy or steroid treatments or certain chronic conditions.
Shingles usually appears as a blistering rash along one side of the trunk, chest, back or face. There is a test for shingles in case you are not sure what to make of a new rash. It consists of a laboratory examination of cells taken from the skin.
There is also vaccine to prevent shingles, and it has been available for more than two years, but only a small percentage of my clients have reported being vaccinated. Many are distrustful of the vaccine and some think it is too expensive. Because the condition is particularly dangerous on the face (it can affect the eye and lead to temporary or permanent blindness), I urge everyone to get vaccinated.
There is also a risk of developing post herpetic neuralgia (pain, headaches, and nerve problems that occur as a complication of shingles). Post herpetic neuralgia lasts for at least 30 days and can continue for months to years. It most commonly occurs on the forehead or chest. The pain associated with post herpetic neuralgia may make it difficult to eat, sleep, and perform daily activities. It may also increase the risk for depression.
To address the first concern, I will cite to The Shingles Prevention Study, a large government-funded study, found that the vaccine prevented about 50 to 60 percent of shingles episodes in older adults. It also prevented about 70 percent of post herpetic neuralgia cases. Additionally, in the in the May 4, 2010 issue of Annals of Internal Medicine, scientists reported that the herpes zoster vaccine is safe and well-tolerated for most older adults. Finally, the vaccine has been recommended by CDC’s Advisory Committee on Immunization Practices, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American College of Physicians.
Please talk to your doctor about this because the vaccine is not appropriate for adults with weakened immune systems and those with allergies to gelatin, the antibiotic neomycin or any component of the shingles vaccine.
The vaccine costs can range from $150 to $300. Private insurance coverage varies. The vaccine is covered under the Medicare Part D drug benefit.
I never had the chicken pox and I never ate cow’s brains so where does that leave me? Can I catch shingles from an infected person? Or can you, my non vaccinated client pass it on to me? It appears only if I come in direct contact with the rash. The upshot? You can sneeze on me, cough on me but you cannot order or eat sweetbreads in front of me.
July 14th, 2010, 
I just assisted an older adult with a slip and fall. This gentleman is 80 years old and tripped in a local grocery store. This had nothing to do with any balance issues, it everything to do with a mat that was protruding from the floor. This significance to the aging world is this: now due to the growing Medicare shortfall in Washington liability insurers (which include carriers who write CGL policies, auto policies, homeowners’ policies and those defendants who are self-insured such as supermarkets) are required to determine and report whether a claimant is covered and is entitled to Medicare benefits. If the claimant received Medicare benefits during their treatment for the injury, Medicare is and will be relentless in its pursuit of a 100% reimbursement.
This new law will pose new challenges for plaintiff’s attorney and the plaintiff. If the attorney or insurance carrier does not comply, they risk being sued by the Government for reimbursement up to five years post-closure and monetary fines. If there is a settlement and Medicare does not know about it and mistakenly pays for services it has a right to recover, it can go after the attorneys whose fees are paid out of the settlement.
Also the Medicare recipient can lose his or her benefits. Lawyers could be exposed to malpractice claims for not handling a client’s benefits properly. Insurers can be liable for monetary fines for failure to report. If a plaintiff loses his Medicare benefits, the plaintiff may bring a legal malpractice claim against the attorney and a bad faith claim against the insurer for not making sure Medicare benefits were protected.
This is bad for older adults because there is and will be less of an incentive to assist older adults with their legitimate personal injury claims. A settlement amount will have to cover Medicare charges up to 100%, attorney fees and provide money for the plaintiff. If that type of recovery does not seem likely, most attorneys will strongly consider rejecting the case.
Finally, negotiations with the liability insurance carrier will become more difficult. They will demand information about your client, such as social security number, so that they can comply with the requirements and avoid fines. Once the claim is settled, it can take up to four months before Medicare signs off on the settlement.
May 3rd, 2010, 
The Senior Medicare Patrol is a trained group of individuals, mostly retired professionals and other senior citizens, who can, as a result of their training, recognize and report instances or patterns of health care fraud. They also are educated as to how threats to financial independence and health status may occur when citizens are victimized by fraudulent schemes.
The SMP program empowers seniors through increased awareness and understanding of healthcare programs. This knowledge helps seniors to protect themselves from the economic and health-related consequences of Medicare and Medicaid fraud, error and abuse. The activities of the SMP program also serve to enhance the financial, emotional, physical and mental well-being of older adults — thereby increasing their capacity to maintain security and independence in retirement, and to make better financial and healthcare choices.
The result of training the almost 2.6 million beneficiaries, counseling over 1.0 million beneficiaries and 97,000 media outreach events? Over $105.7 million in savings, including Medicare and Medicaid funds recovered.
How can you protect yourself from healthcare fraud?
1) Only go to your personal doctor, hospital or clinic for medical help. Only they should make referrals for special equipment, services, or medicine.
2.) Never show anyone your medical or prescription records without first talking to your doctor or pharmacist.
3) If someone calls and tries to threaten or pressure you into something simply hang up the phone.
4.) If someone comes to your door and says they are from Medicare or some other health care company, SHUT THE DOOR! ….. It’s shrewd to be rude!
5.) Do your homework and talk to your healthcare provider before buying or investing in internet “cure-all” or “miracle” products or services.
6.) Don’t keep mail in your mailbox for more than one day. People can and will steal
personal information right out of your mailbox!
7.) Rip up, shred or otherwise destroy your Medicare or other healthcare papers and other important documents instead of just throwing them away, but remember to record your doctor’s visits, prescriptions, etc., in a healthcare journal Crooks will go through the trash!
8. Treat your Medicare and Social Security numbers like credit cards. If someone offers to buy your Medicare or Social Security number, DON’T DO IT…It’s simply not worth it.
9. Remember that Medicare doesn’t SELL ANYTHING.
10. Follow your instincts – if it seems too good to be true, IT USUALLY IS!
11. ALWAYS READ your Medicare Summary Notice (MSN) or health care billing statement (Explanation of Benefits). Your MSN & other Explanation of Benefits forms are generally stamped “This is Not a Bill” and come in AFTER you receive medical care. Look for three (3) things on your billing statement(s):• Charges for something you didn’t receive • Billing for the same thing twice• Services that were not ordered by the Doctor.
12. Every State has a SMP look up the number on Google and call!
February 6th, 2010, 
I thought that mixing old blood with young blood was a metaphor for multigenerational encounters—like Larry King and his wife. Now, it seems that science has found a way to be scientific about it and go literal. I never use the word goolish, but there it is. Taking blood from young adults and mixing it with octogenarian blood is kinda creepy.
The experiment, led by Harvard Stem Cell Institute in Boston, showed that mixing blood from young people with the one from elderly might help reverse effects of ageing. Apparently, the blood of the young animals seemed to rejuvenate ageing blood stem cells in the bone marrows of the older mice.
Old mice also make too many myeloid blood cells, which contribute to inflammation and the development of cancer, and too few lymphoid blood cells, which orchestrate tissue repair. In this study however such age-related changes were reversed.
I’m no scientist, but I think that this will cause vampirism. I imagine a world where packs of older adults stalk young people, forcing themselves upon them until they’ve reached a state of homeostasis. It will be a dark place.
On the other hand, from a public policy standpoint, maybe we won’t have to solve the problem of how we are going to afford to house and care for elderly frail adults, because there will be none. Everyone will have super youth powers and no one will need assistance with their care.
In case you have not heard, caring for our aging population is a huge problem that we, the public, have been zombies about (ya know walking around in a mindless stupor thinking the government will care for us). So on balance, I guess if it is a choice between being a zombie and a vampire, I will choose the latter. But of course I will have to have a little “work done” so that my outer appearance is consistent with my blood, also known as the vital life force.
January 21st, 2010,
This week I came to truly understand the connection between nutrition and what we typically call age related diseases. Because it is a new year and because most people make resolutions having to do with their health, I will take this as an opportunity to educate the public about why diet and exercise can help stave off strokes, diabetes, heart disease and Alzheimer’s disease.
First let me say that I am personally appalled at what I heard on a public radio station the other day, it was on the Pat Morrison Show. (I love her!) http://bit.ly/7NHP3z. Anyhoo, a woman from the University of San Diego who teaches in the woman’s studies department and who is the co-editor of “The Fat Studies Reader” actually stated that being fat has little do with mortality. I know, huh? There is an organized group for fat people, the National Association to Advance Fat Acceptance. That group even has an acronym NAAFA.
Being fat is not acceptable. This is my blog and I get to say that. It is irresponsible to promote the idea that being fat is o.k. Being fat is not like being Black, or Jewish, or Hispanic or whatever minority or particular race which you inherently are. There is nothing that you can change about that. You can change being fat. There are fast food restaurants that charge the same for salads as they do for tacos or Big Macks. They have grilled chicken, etc. If someone is poor, and I believe that social factors such as income can impact food choices, there are healthy choices.
If being obese impacts the price of medical services, you should be discriminated against. If you being fat causes me to pay more in premiums, I can be angry with you.
Putting My diatribe aside, if you don’t want to have a heart attack, or a stroke or contract Alzheimer’s disease, stop eating the things that make you fat and exercise. Eating high fat foods causes plaque and cholesterol to build up in your arteries which cause atherosclerosis. This causes the arteries to narrow and makes the heart pump harder to get blood to go where it needs to go. This strain on the heart causes heart attacks. If the blood can’t get to the heart or the brain, the organs die. The brain and the heart die. You don’t need a degree in medicine to understand this. I bet the NAAFA won’t teach you this either.
If that is not convincing enough, autopsies of individuals who had Alzheimer’s disease had much more plaque in their arteries than those who did not have Alzheimer’s. In many people high cholesterol can be controlled by diet and exercise. If you are part of an organization supporting the right to be fat, quit and go for a walk.
Diabetes and high blood pressure have also been implicated as a risk factor for eventually developing Alzheimer’s disease. Type 2 diabetes is by far the most common variety of diabetes, usually occurring in people who weigh too much and exercise too little.
I am the opposite of a mean spirited person. But, I am deadly serious about educating people and providing them with the truth. The truth is being fat is not good for your health and anyone who tells you otherwise is BIG FAT LIER.
December 18th, 2009, 
Work and kids and work and kids and my husband and my kids and work. When I had a chance to fly away on business I was almost salivating. I had been thinking for days I have to get away. Yes, they are my life, what I live for. But, I had to get away.
And there starts my journey. I had a two hour lunch meeting in San Francisco. With round trip it should have taken me four hours, total. Oh what I would have accomplished in four hours. A flight, a business lunch and a deal! But that four hours turned into 24 hours, and by the time I was on the plane home, the sound of my kids fighting with my husband and themselves before school was like a sweet symphony. My little angels. I couldn’t wait to see the source of so much joy and terror.
Has anyone heard of a ground stop? Well, apparently, the ground at the San Francisco Airport Stopped on my way up. By the time I got to my lunch appointment at the hotel, two hours late, my mascara was smudged all over my face and the restaurant had just closed. I pleaded with the waitress to feed me and shoved food in my mouth as I tried to impress a founding partner in a rather large important to my business firm. Was that charming or disturbing? Only time will tell.
Just as I was about to take him up on offer to drive me to the airport I received a call from the airline that my flight had been delayed until 9:00 p.m. But, I just wanted to come for lunch. I guess the ground stopped in Los Angeles too. So as we said out goodbyes, without shaking hands of course, you know the swine flu way, I contemplated my options. I was curiously desirous of getting home to my family.
“How about a spa treatment” my husband suggested. Nope, no spa, it was an airport property and I guess that people who stay at airport hotels and have gone through their own various travel nightmares don’t need massages. After I go through security I need a massage. Oh well.
Five hours to kill, hummmmmmmmmmmmmmm. After speaking with a lovely young woman who used my triple A discount to lure me, I stayed over- night—without pajamas, or anything else, including a plug for my laptop or cell phone. Now, all I wanted was my annoying children, demanding, yet handsome husband who doubles as a masseuse and my bed.
The next morning after I boarded my on time flight home, I called home. My 9 year old and 6 year old in the background shouting names at each other, my husband shhhhsing them, the dog peeing somewhere in the house, I took a deep breath, sipped my carry on Starbucks, and smiled. Whether I struck a deal with my intended target or not, which is what I want, I had what I needed and no ground stop would keep me from that.
December 4th, 2009,  Social Security establishes the age at which workers and their families may begin receiving retirement benefits. If you were born before 1938, this is set at age 65. If you were born between 1938 and 1954, the full retirement age increases progressively from 65 up to 66. If your birth year is 1955 or later, your full retirement age increases progressively up to 67. Age 67 is currently the oldest full retirement age though this could increase in the future.
Many people ask me if they will lose their social security benefits if they stay on the job or go back to work. With the economy being as it is, many older adults have put off retirement and are working past the time planned. If you have reached full retirement age you will not lose your benefits. This is the result of legislation passed in 2000.
Only those under full retirement age and already receiving Social Security Retirement Benefits are affected by the following (2008) limits. For that group of individuals the formula is as follows:
If you are under full retirement age you can earn up to $13,560 without penalty. For every $2.00 over the limit your benefits will be reduced by one dollar. If you are reaching full retirement age this year, you can earn up to $36,120 without penalty. Your benefits are reduced by $1 for every $3 earned over the limit. For example, if you earn $40,000 a year and your Social Security payout is $13,000 a year, that payout would fall by $1,293 (about 10%) to $11,707.
Again, if you have reached full retirement age, there is no penalty for earned income.
If you can make do without Social Security benefits until age 70, you will receive a larger monthly benefit. When they begin, monthly benefits will be increased substantially above the base full retirement age, increasing at about 7 to 8% for each year of delay beyond full retirement age. Conversely, if you begin before reaching your full retirement age, the monthly benefits are paid at a permanently reduced amount (up to 20 to 25% less) to reflect receiving benefits for more years.
Another question is whether an individual will continue to receive Social Security benefits as a widow (or widower) if that person remarries. The answer is yes, if you are at least 60 when you remarry. (A widow or widower isn’t actually eligible for benefits until age 60 or, if disabled, until 50.) Or you could apply to receive benefits based on your new spouse’s work record instead if those benefits would be higher. If you remarry before turning 60, however, you will be ineligible for widow’s benefits throughout your marriage.
November 23rd, 2009, 
In honor of National Memory Week I feel compelled to write about what I have witnessed first-hand. I could sum it up in a one liner, (but I like to write so I won’t)!
The older individuals that I have met don’t remember that they felt anxious or stressed to the point of making themselves sick about the economy or their stock portfolios or the burst real estate bubble. Many can’t remember their children’s names. If they could, I bet that they would kick themselves for the energy they put in that direction instead of pursuing joy.
It is hard to avoid the pain that life can bring, but the next time you worry about how you are going to be able to pay a bill or send your children to college, try to take a moment and recognize that those are just thoughts that you can control by making new thoughts. This is a luxury that people who have a cognitive impairment lack.
So, use your brain wisely and think about good things, because life is good.
November 4th, 2009, 
In order to understand the permutations of Medicare Part D, you must have a Lewis Carroll like sense of the absurd and a gift for games of logic and language.Hopefully this blog will give you the keys to unlock the mysterious door to this provision and help you determine when you will go into the hole and when you will come out of the hole.
What is Medicare Part D?
Medicare offers prescription drug coverage for everyone with Medicare. This is called “Part D.” This coverage may help lower prescription drug costs and help protect against higher costs in the future. It can give you greater access to drugs that you can use to prevent complications of diseases and stay well.
If you join a Medicare prescription drug plan, you pay a monthly premium. Part D is optional. If you decide not to enroll in a Medicare drug plan when you are first eligible, you may have to pay a penalty if you choose to join later.
There are two ways to get Medicare prescription drug coverage. You can either join a Medicare prescription drug plan that adds coverage to the original Medicare plan, or join a Medicare Advantage Health Plan (like an HMO or PPO) that includes prescription drug coverage. You get all of your Medicare health care including prescription drug coverage through these plans.
Medicare Advantage Plans (like HMOs and PPOs) that include prescription drug coverage as part of the plan are health plan options that are approved by Medicare but run by private companies. They are part of the Medicare Program. If you join a Medicare Advantage Plan you are still in Medicare.
What is the donut hole?
The standard Medicare Part D benefit includes an initial $295 deductible. After meeting the deductible the beneficiaries pay 25% of the cost of covered Part D prescription drugs, up to an initial coverage limit of $2,700. Once the initial coverage limit is reached, beneficiaries are subject to another deductible, known as the “Donut Hole,” in which they must pay the full costs of drugs.
When total out-of-pocket expenses on formulary drugs reach $4,350 – including the costs of the deductible and coinsurance, beneficiaries reach the “Catastrophic Coverage” benefit. Beneficiaries entitled to Catastrophic Coverage pay $2.40 for a generic or preferred drug and $6.00 for other drugs, or a flat 5% coinsurance, whichever is greater. This out-of-pocket amount is calculated annually. Beneficiaries who reach the out-of-pocket threshold in one year have to begin to meet it again on January 1st of the next year.
Only certain costs, such as money spent on formulary drugs (or non-formulary drugs that have been granted an exception by the plan), costs paid by the beneficiary’s family, a charity, or a State Pharmaceutical Assistance Program such as ConnPACE, count toward the true out-of-pocket spending requirement.
Costs paid for non-formulary drugs, cost of drugs purchased outside the United States, costs paid for by other insurance, including ADAP plans (CADAP in Connecticut), and Premiums paid to the Part D plan, do not count towards the requirement.
Do Medicare Prescription Drug Plans have Doughnut holes?
Each state offers at least one plan with some type of coverage during the coverage gap or donut hole. However, plans with gap coverage may charge a higher monthly premium so as to provide more coverage during the gap which occurs in many plans. Some plans may only offer generic drug coverage during the gap.
Tip: On your monthly statements from your Medicare Part D provider, follow the cost of your prescription, amount paid by your plan, amount paid by you.
Resources: http://www.medicareadvocacy.org/PartD_DoughnutHole.htm
“Find & Compare Plans that Cover Drugs” [Medicare]
November 3rd, 2009,
Have you ever heard of a double negative? That is what it is like to have role models that represent everything that you do not want to be and who conduct themselves in a ways that you find inappropriate and offensive.
I call them the anti-models.
It takes a great deal of strength and maturity to find something positive when confronted by these people. To someone who holds onto grudges, I say “thanks for showing me what I do not want to be like.” And I act accordingly. When at the mercy of someone who reacts instead of seeks to understand, I say “thanks for showing me what I would look like if I didn’t take a minute to think before I hit the send button or leave an angry message.” And I act accordingly.
When I have to deal with someone whose emotional quotient is low, whose maturity level stagnated, I say “I will act like an adult because my success in life and business depends on it.” When I am being judged by one who is in no position to judge, I tell myself that “being judgmental is not attractive.” When gossip gets the better of people, I say “I will not republish falsehoods.”
My parents were great anti-role models on many fronts. For years I never understood what a gift they gave me. I complained that I was not given chances, that I was robbed of happiness as a child. While it is all true, and if Iwas not a forgiving, non-grudge bearing person, I might have let those technicalities ruin my life. But, as an adult, I recognize their anti-role model value, and am a better mother and spouse because of their conduct.
So as we get older let others be our teachers, even if their messages are repugnant because role models come in all forms..
October 17th, 2009, 
The answer is, perhaps. Under the law, if you have been taking care of your parent or have promised to take care of your parent you are legally required to continue giving your best effort.
Under the California Family Code you cannot leave a helpless, indigent parent home alone. Specifically, the code states that: “Except as otherwise provided by law, an adult child shall, to the extent of his or her ability, support a parent who is in need and unable to maintain himself or herself by work.” Family Code, Section 4400.
Family Code Section 4403 enables the parent or the county to bring an action to enforce the duty of support and recover attorneys’ fees for pursing that action.
Additionally, a criminal action could ensue. California Penal Code, states that it is a misdemeanor to fail to provide necessary food, clothing, shelter, or medical attendance for an indigent parent. (Section 270c).
There are exceptions to these rules. First, if your parent abandoned you for at least two years when you were a child, you may not be required to care for that parent now. Nor would you be liable for supporting your parent if he/she is receiving certain governmental aid. (WIC § 12350)
September 29th, 2009, 
Yes.
How could this be? How could our government ask that people become more self reliant, yet take away opportunities to pay for their own care?
The government is scheduled to decrease the amount of money one can borrow under a HECM (Home Equity Conversion Mortgage, i.e., reverse mortgages insured by the federal government) by 10% effective for all loans on which applications are taken on or after October 1, 2009. It is still unclear as to whether loans currently be processed will be grandfathered into the current HECM program.
September 28th, 2009, 
Are you facing challenges with aging family members? Are you having trouble getting clear, practical and useful answers? Steve interviews elder issues expert and gerontologist Susan Geffen about everything from elder abuse to reverse mortgages, from long-term care to Alzheimer’s.
Also, are you frustrated with your financial situation? Do you wonder where your money went at the end of the month and why others are getting ahead when you are not? Steve talks about the basics of getting out of debt, getting the most out of your money and how to set yourself up for personal financial success.
September 21st, 2009, 
My kids went back to grammar school today and I am arguably old enough to be a grandmother if I was a naughty or careless twenty year-old. But, I wasn’t, careless, that is! I chose education and freedom to travel around the world instead of a life of family servitude.
Last night at Target during my last minute rush to get school supplies, it was as if I was at Harrods fighting over the last remaining magenta cashmere sweater. If only I had an umbrella to ward off the woman who thought she could wrestle the last box of number two pencils from my grip. I swear!
What does this have to do with aging? Everything. Getting older is about passages strung together with pearls of wisdom. It is like methodically stepping from one paver in a garden to another. Getting school supplies leads to college applications, which leads to graduations, which results in tears of joy and then comes weddings and children in laws and grandchildren and then, the need for my services.
Maybe some people meander and their path goes around and about, but it always ends in getting older, day by day and year by year. You can’t fight that off with an umbrella. But, you can be prepared and takes steps to ensure that you live a carefree, not careless, future.
September 18th, 2009, 
I just finished my new book, “The 7 Triggers of Mental Health Decline in the Elderly and How to Disarm Them Forever.” In the course of writing, I had many opportunities to reflect upon my own feelings and heed my own advice. But I must admit that I am a hypocrite (and apparently a poet as well).
In particular, the notion of what we choose to pay attention to has challenged me a lot. Lost in the discussion of what can trigger a decline in mental health is nostalgic reminiscence. For me, that practice does not work as I inevitably experience a feeling of loss and the palpable sensation of emptiness.
For example, when I think about my college years, arguably one of the best periods of my life, I feel like I have lost something that I cannot regain, like a broken branch of a tree. When I think about how much my children have grown, I feel like I have lost an opportunity to get parenting exactly right. When I think about my deceased mother, I think about how I lost a chance to get being a child and sibling right. When I think about my father, I think about how I am losing a trusted confidant as I take on more responsibility for his well being.
I give a lot of power to the notion of being in a state of “loss” and a lot of lip service to being in a state of “possibility.” The former causes pain and longing, the latter, I am sure, will create a sense of excitement. Deciding to alter the way we perceive things is like exercising a new muscle; it is a conscious effort that takes energy. The pay off for changing this process will be better mental health.
So I make this pledge:
Starting today I am going to concentrate on the delightful future that is in store for me. I will adhere to the cliché that the present is a gift. I will go on a thought process diet and only digest words of wisdom that inspire me to do great things and find beauty in my reflection. How about you? Are you ready to change?
September 16th, 2009, 
#1 Not wanting to be a burden to our children, our spouse, or relatives.
Love is shown in many ways. One of the best ways to show it is by making sure that the financial and physical burden of being cared for does not fall on our loved ones.
#2 Access to Quality Care
The cost of being cared for is extremely expensive. Unless you have huge cash reserves, long term care insurance is the only realistic way of paying for care without going broke and ending up in a nursing home.
Remember. After the age of 60, there is a 70% likelihood that you will need long term care.
#3 Aversion to Welfare
Most of us have worked hard all of our lives and expect to remain in our homes when we get older. Unfortunately, for millions of Americans, the government is now their caretaker because the high cost of health care has depleted their assets.
#4 Asset Protection
It is sad how many people lose everything they have worked for when they get older and need long term care. Many people still think the government will take care of them, but they don’t realize that it will probably be in a nursing home and they will have had to spend their entire life savings to get to a place they don’t want to be.
#5 Control and Independence
There are many important decisions that have to be made about our living space and healthcare as we grow older. If you are like me, you want to remain in your own home. Long term care insurance can help insure that you have many favorable options available to you, including assisted living and in home care.
#6 Peace of Mind
For those who have already purchased a long term care policy from a reputable company, they would tell you that it is a huge relief to know that they have this important coverage.
September 3rd, 2009, 
You can bring a horse to water but you can’t make it drink
Here’s one for you. She fell, and then she fell again. She has fallen so many times that it would be more efficient to list the times when she didn’t. But she doesn’t need help. She’s not, as she has said, “an idiot.” Wait a minute. Now I am not a judgmental person, but I will play the role of devil’s advocate, yes, aunt of a client whose name shall remain safe with me, YOU are an idiot.
Why? Because you have at your disposal many nieces and nephews ready willing and able to help you find the care that you need, and you can afford it, but you are not one of those old people. Yet, you lay on your floor for 7 hours with a towel over your head until someone, I mean some people—plural, picked your 300 pound body off of the floor. You have cracked your head open twice from falling and you are bound to break your hip and die. That’s what often happens to 76 year old women who break their hips.
I know that this sounds a bit ungerontologist like, but I adopt this demeanor to make a point, as ineloquent as it might sound….You can take a horse to water, but you cannot make it drink. She may be an idiot, but she is not delusional. Or is she?
Where is that line? It is the same question I have when I ponder the criminal defense not guilty by reason of insanity. Isn’t everyone who kills another person insane? Isn’t every person who chooses to live life on their terms when those terms mean self neglect insane? O.K., maybe it is a bad analogy, but we as a society and our legal system are going to have to seriously start thinking about this right to self determination.
Is it her right to break her hip and die on her floor? Is it the right of a person suffering from Alzheimer’s to be euthanized if that is a wish communicated when that person was as lucid as Albert Einstein, who as I might remind you, was the genius among geniuses who discovered, merely by thinking about it, that the universe was not as it seemed?
Is it the right of an older adult to slam the door on me when I come to see how they are doing upon being hired by an adult child? Is it my right to call those people idiots (even though it was in my non-judgmental role as devil’s advocate)?
I say, yes, yes and yes again. I believe in the right to self determination, period. HOW ABOUT YOU?
August 10th, 2009,  “You could easily become poverty stricken and destitute if you don’t have Long Term Care Insurance policy, or rich children, or a gazillion dollars in the bank!”
Long Term Care Insurance is not a luxury or for the rich. It is a necessity that you should not ignore.
For years, Americans have believed that Medicare would take care of them when they get older, but that just isn’t true. Nursing homes are home to over 8,000,000 Americans, and that number is going to double in the next 10 years! Continue reading Report: How To NOT Be A Burden On Your Children
August 4th, 2009, 
Aid and Attendance is a special pension benefit offered by the Department of Veterans Affairs (VA) created to help veterans pay for in home care, an assisted living facility or nursing home. As a prerequisite, the veteran must generally meet certain requirements: Continue reading Veteran’s Aid and Attendance Benefits
August 1st, 2009, 
“Everyday, elderly people are forced to move out of their homes and into crowded nursing facilities because they can’t afford the care they need to live alone.”
If you are at least 62 years old, it doesn’t have to be this way if you own your own home. You just have to understand some of your options. Continue reading Report: How A Reverse Mortgage Can Help Your Family
July 25th, 2009, 
I am always very surprised when I do a presentation and only 1 percent of the audience raises their hand when asked if they have an advance directive. It is, let me repeat, IT IS A CRITICAL DOCUMENT FOR ANYONE OVER THE AGE OF 18!!!
For those of you who have met me at one of my lectures, you know that I am not a soap boxy type of person except for two subjects:
- The need for advance directives and the value of long term care insurance.
- Long term care insurance is the subject of another blog.
An advance directive allows you to avoid a court, a doctor or board of directors of a hospital imposing their will and agenda that may be contrary to your formally unexpressed wishes.
Continue reading Advance Directives And You
July 1st, 2009, 
I was in a car accident a couple of years ago and injured, among other parts of my body, my lower back. I can’t talk about the case in any more detail, but I can say that the defense attorney who told me that my injuries were not injuries at all. He said they were natural age related changes to my infrastructure, but he was a j— , (I need to be kind here) and severely misguided. One thing that I learned in my grad school physiology class is that there are few age related diseases. Many less than imagined.
First, many of the ailments that we encounter as we age are not as much age related as they are lifestyle related. For example, take Type 2 Diabetes. Yes, that is more prevalent in the older adults, in fact it is often referred to as “adult onset diabetes,” but it is not a necessary evil.
In fact, Type 2 Diabetes is also increasing dramatically among children, adolescents and younger adults. That’s probably because with older adults, there is a tendency to exercise less, lose muscle mass and gain weight. Many kids today are corn syrup and Nintendo DS junkies (but of course, not mine.)
In a nut shell, people with Type 2 Diabetes can’t make or respond to insulin properly. Insulin works like a key that opens the doors to cells and allows the glucose in. Without insulin, glucose can’t get into the cells and so it stays in the bloodstream. As a result, the level of sugar in the blood remains higher than normal.
With Type 2 Diabetes, insulin is still produced but the body doesn’t respond to the insulin normally. Glucose is less able to enter the cells and do its job of supplying energy. This in turn, causes the blood sugar level to rise, making the pancreas produce even more insulin. Eventually, the pancreas can wear out from working overtime to produce extra insulin. Then, the pancreas may no longer be able to produce enough insulin to keep a person’s blood sugar levels within a normal range.
What does a healthy lifestyle have to do with this process? Being overweight raises your insulin resistance and the kind of food that you eat can affect your blood glucose levels. It stands to reason that if you exercise the resulting decrease in body fat will result in improved insulin sensitivity.
So, dad (if you are reading this blog) please stop eating hot dogs and ribs and cherry pie because I love you. And, while you are at it go take a swim or something. On the other hand, you are almost 80 so go ahead and feast upon your fatty favorites and enjoy your day sitting at the race track. I love you and I want you to be happy and live life on your terms, but please don’t forget to take your Vytorin after!
June 10th, 2009, 
What a grumpy man….I just met with an 88 year old man who used profanity that even I, the queen of naughty language, never heard. Maybe he was making some of the words up. Or, maybe they were bad words at the turn of the 20th century. If I sound rough, it is only because I had to smile as he berated me to a pulp. Actually, I understand why he was a grouch; once fiercely independent he was now being told that his right to drive was being rescinded.
They say that your personality gets magnified when you get older. So, if you are a very pleasant and reserved person in your youth and adult years, you will be extremely reserved and perhaps even an outright recluse as an older adult.
It stands to reason than the opposite is true. If you were prone to angry outbursts and lacked the ability to hold your tongue, when you get old the people around you should either take cover or grow a thick skin in a Darwinesque “Survival of the Species” way.
Failure to do so will result in withdrawal from your loved one’s life at a time when they most need you or when you have a limited opportunity to find joy in between the lines. It will never get better than it is in the present; your parent no longer has the ability to adapt to your emotional needs, and maybe they never did.
When I was at an American Society on Aging Conference, there was a session entitled “How to take care of a parent who didn’t care for you.” If I tell you the room was packed that would be an understatement.
I knew why I was there, but it just could not be possible that all of those professionals had the same struggles as me. Actually, they did and more…there were tales of not just verbal abuse (the type that I endured) but physical and sexual abuse as well.
There was a story of how one police department called a daughter who was sexually abused by her mother and stepfather as a child and told her that if she did not come and take care of her mother, she would be arrested for neglect and abuse.
That was a lie, you have no legal obligation to care for a sick parent. Any obligation that we have is self imposed by religious beliefs, our culture, or pure love.
Maybe you are just a good person. And what does that mean? When you get old your attributes will be enhanced and you will be a truly GREAT PERSON!
June 10th, 2009, 
Don’t shoot the messenger. Laughing is good for the soul, even if it’s about getting older!
Two old women are sitting in a convalescent home and a lady went by flashing. One woman said to the other, “Did you see what she is wearing.” The other replied, “No, but whatever it is she needs to get it ironed!”
Not to discriminate against old women, here’s a joke about old men!
Two old men are talking. One said, “I am having a lot of trouble, I can’t remember anything anymore.”The other replied, “Why don’t you do what I did? I went to a memory school.” “Oh,” said the other man, “What is it’s name?” In response, the man asked him a question, “What is the name of flower that has thorns on it?” “A rose,” the other replied. “Rose,” screamed the man to his wife, “What was the name of that memory school?”
Now, let’s stick it to the government…..
The Senate is investigating deceptive sweepstakes practices. These companies target the elderly and make them think they will receive a bunch of money, but in reality they never see any of it.
The most popular of these scams is called… Social Security.
June 10th, 2009,
Sex, Sex and more Sex. When does it end? Where does Viagra begin? I would like to believe that getting older just means that you are better. It’s a quality over quantity thing.
I am 46 and cannot imagine a life without this wondrous joy; the mystery of two souls melding together to momentarily transcend, collide and transcend again.
If sex is purely meant for reproductive biological purposes, then as a woman I would call it quits in my post menopausal fifties having no “reason” to do it. That means in four years, I would be done, relegated to a life of vicarious thrills a la the internet.
But, if women in their fifties no longer had sex because it served no social utility, one of two things would happen.
First, old men, who could procreate until their last dying breath, would be limited to young’uns because a generations of woman would be foreclosed from offering their assistance. Let’s face it, millions of middle class men would be left out–there just aren’t enough uber rich guys for this proposition to make sense.
Second, the drug companies would be losing a huge source of revenue as would the networks on advertising revenue.
Simply speaking, having sex exclusively for reproductive reasons is not an economically sound policy; there is just too big a market for fornication.
Now that I have established, in my ever so non-scientific and un-gerontologist way that that our species will and does engage in sexual intercourse for pleasure, who is to say what that is supposed to look like?
Whether it is Brad and Angelina (arguably the most beautiful couple in the universe) or Max and Irene Fischer of Long Island New York, parents of three and grandparents of 6, it is still beautiful poetry in motion. In the end, it is still the mystery of two souls melding together to momentarily transcend, collide and transcend again.
May 27th, 2009, 
“Vitnesses schmitnesses, I saw you blinking at those boys you shlut.” This is what an elderly woman said to me after her 90 year old husband backed into my car despite my intense honking efforts in the Junior’s Delicatessen parking lot.
The “boys” were actually young men who were simply giving me their cards as witnesses for my insurance company because the woman’s elderly husband kept asking me why I hit him.
If you ask the person from whom you are taking the keys “to drive or not to drive” the answer is almost always a resounding yes. This is especially true if the driver is a man, once strong, macho and in charge of himself and the world.
Continue reading To Drive Or Not To Drive, That Is The Question?!
May 27th, 2009,
Raise your hand if you think that you should buy a worthless piece of property for $50,000 off an infomercial. Well if you are 85 years old, live alone and forget to take critical medication than the answer is, I guess.
That is precisely what a client’s father did this year. That was just a couple of days before he went into the hospital because of severe dehydration. Thereafter, he ended up in a nursing home to rehabilitate for three weeks.
When he got home and learned of his shopping spree, he was outraged and in complete denial. There was just no way that this fiscally responsible man would have done that.
Ahhh, those pesky IADLs (Instrumental Activities of Daily Living)—medication management, what a drag. This gentleman is on seven medications all of which have to be taken at different times throughout the day.
How could this have been avoided? Continue reading Not Taking Your MEDS…Can Be Expensive!
May 27th, 2009, 
Once upon a time lived a very bad girl. She took and took from her kind hearted mother even when her mother, wife of a once very prominent dentist, was well into her 90’s and had very little left to give.
Now I use that term “give” lightly as most of the time it was less give than outright petty theft.
Everyone knew that this daughter stole this woman’s check book and depleted her life’s savings, forged her signature on loan documents, destroyed her home with dozen of urine spewing cats, but no one did anything.
Why? Would it further surprise you to know that this 95 year old woman is my wonderful and funny and brilliant aunt? That this girl is my 53 year old adopted cousin? Continue reading Stealing Cookies
May 25th, 2009, 
The other day something unusual happened. I received a call from an 88 year old woman who needed my advice about her daughter in law’s pushy (for lack of a better word) behavior.
Fearing that she would be institutionalized against her will, she wanted to know what her rights were. When I got to the woman’s house, she and her middle aged care-giver, greeted me with a warm smile and a welcoming gesture.
As she spoke of her daughter barging in, her eyes began to tear. The daughter, the wife of a son who passed away in his twenties, had begun a campaign to rid the home of the caretaker and the cat that the caretaker brought in and to place my client into some form of assisted living.
The daughter had even gone to a doctor’s visit where she made not so subtle illusions to the house being in a state of filth and disarray and run over by pets.
Concerned, the doctor had a social worker come to the home. The social worker reported that the house and living conditions were in perfect order.
Later that day, the grandson barged into the home and removed the cat that my client had come to love, insisting that my client had allergies and that she simply forgot about them.
My client was afraid that she would be snatched and institutionalized when she went to put her garbage out. Was this a paranoid delusion? Was the care giver up to no good?
Or, was this a case of elder abuse?
My findings were that my client’s mental capacity was very much in tact. Furthermore, she was very happy with her caretaker and wanted a pet. I spoke with my client’s doctor who agreed.
To this day, I do not know what her daughter in law’s motive was. Although she was in the will, placement of my client into an institutionalized setting would deplete her inheritance. My suggestion was two fold.
First, I could have the family participate in a family mediation to have everybody’s concerns aired and my client could assert her right to independence and autonomy, she could make her 80 year old sister a proxy under a durable power of attorney for health care or she could voluntarily submit to a conservatorship over herself. Short of that, she could get a restraining order.
That seemed a bit extreme. When I followed up with her she told me that she suggested to her daughter in law a cooling off time. They will meet in a couple of weeks to smooth things over with or without my mediation.
Empowered by two professionals assessment that she is not incompetent, I suspect that my client will now be in a position to assert her boundaries that she created over 88 years on this planet.
May 1st, 2009, 
If you are taking care of your kids and your parents, you are a proud (or maybe not proud) member of the sandwich generation, so good luck!
We didn’t grow up thinking it would be this way. We figured we’d have kids and our parents would fend for themselves. At least that is the way it was always presented to us on TV and other forms of the media.
Continue reading Are you a member of the sandwich generation?
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