Adamsky Law Offices Blog

            A new study, reported in the Journal of the American Medical Association , shows that when medical personnel know what kind of end-of-life care a patient wants, then the patient is more likely to be spared overly aggressive care and may die at home rather than in a hospital. The patient’s quality of life is usually better and they are more likely to get Hospice care. As a side benefit, the Medicare program saves over $5,000 per person when the individual has an Advanced Directive . Treatment at end-of-life accounts for more than 25% of Medicare expenditures.             Advanced Directives include: Health Care Proxies , Living Wills , and Powers of Attorney for Health Care . These documents let families and health care providers know what type of care a patient may want, and may allow a family member to make medical decisions for a patient who is incapable of expre...

I usually enjoy David Kelley's crazy law-related television shows like Boston Legal and Harry's Law. They are great fun and often give some good portrayals of lawyers and legal issues. But, I'm always laughing at how a client comes in to the office in the morning and somehow they are in Court in the afternoon - sometimes with a jury there. It takes years to get into Court most of the time and at least several days to get a jury together and ready for a trial. But, I'll allow some literary license to TV to keep the story moving. But, I don't like it when they get the law completely wrong and especially when they have the lawyers participate in fraud. Last week's episode of Harry's Law got the Medicaid rules wrong, and put lawyers in a bad light. Let me explain. First, Kelley got Medicaid law all wrong. The couple in question only had a house and the husband needed nursing home care. The wife said she needed to get a divorce to save the house. This is wron...

After staying the same for two years, the community spouse resource allowance (CSRA) and the maximum monthly maintenance needs allowance (MMMNA) will increase for 2012, the Centers for Medicare and Medicaid Services just announced. The 2012 minimum CSRA is $22,728 and the maximum is $113,640. The new maximum monthly maintenance needs allowance is $2,841. The minimum monthly maintenance needs allowance remains $1,828.75 until July 1, 2012.

Good News! Medicare's monthly premium will be lower than expected next year. The basic premium for Medicare Part B will be $99.90 a month, only a $3.50 increase over the $96.40 a month that most beneficiaries have been paying since 2008. Here are the new Medicare figures for 2012: • Basic Part B premium: $99.90/month • Part B deductible: $140 (was $162) • Part A deductible: $1,156 (was $1,132) • Co-payment for hospital stay days 61-90: $289/day (was $283) • Co-payment for hospital stay days 91 and beyond: $578/day (was $566) • Skilled nursing facility co-payment, days 21-100: $144.50/day (was $141.50) Higher-income beneficiaries will pay higher Part B premiums. • Individuals with annual incomes between $85,000 and $107,000 and married couples with annual incomes between $170,000 and $214,000 will pay a monthly premium of $139.90 (was $161.50). • Individuals with annual incomes between $107,000 and $160,000 and married couples with annual incomes between $214,000 and $...

I discuss funeral planning with most of my clients, but not in great detail. I just suggest that they make their wishes known to their family so they can be followed. Dying can be a time for solemn ceremony or whimsical farce. Many notable celebrities and eccentrics have odd funeral wishes. They were collected in the linked BBC article, but here are a couple: Frank Sinatra had a Catholic funeral. But placed in his coffin were a bottle of whiskey, a Zippo lighter, and 10 dimes - to be used, it's reported, for any emergency phone calls. Beverly Hills socialite Sandra West, widow of an oil baron, demanded that she be buried in a lacy nightgown, while sitting in the front seat of her blue Ferrari. After a court fight, her wishes were followed. http://www.bbc.co.uk/news/magazine-15068696

The IRS announced that, for tax year 2012, personal exemptions and standard deductions will rise and tax brackets will widen due to inflation. The Service provided the following details: The value of each personal and dependent exemption, available to most taxpayers, is $3,800, up $100 from 2011. The new standard deduction is $11,900 for married couples filing a joint return, up $300, $5,950 for singles and married individuals filing separately, up $150, and $8,700 for heads of household, up $200. Nearly two out of three taxpayers take the standard deduction, rather than itemizing deductions, such as mortgage interest, charitable contributions and state and local taxes.  Tax-bracket thresholds increase for each filing status. For a married couple filing a joint return, for example, the taxable-income threshold separating the 15-percent bracket from the 25-percent bracket is $70,700, up from $69,000 in 2011. For an estate of any decedent dying during calendar year 201...

The Federal Government announced that Social Security recipients will get a 3.6% increase in benefits next year, the first increase since 2009. The increase applies to checks for 2012. Since 1975, benefits have been tied to inflation and almost always went up, but the recession of the last few years has left the inflation index lower or unchanged, so Social Security benefits were unchanged in 2010 and 2011, as well (they can't go down).  But, this doesn't mean what you get will actually go up, there will be increases in Medicare costs as well. Speaking of which, the open enrollment period for Medicare plans is going on right now (it started and ends earlier this year than in previous years) so it's time to review your plan and either stay with it, or pick a new one for next year.

As you get older, you may (someday) need help with your everyday activities. For some, that means going to a nursing home. But most people want to stay home, so you might think about hiring an at-home caregiver. You need to consider some important employment issues before you do. There are two major options when getting an at-home caregiver. You can either go through a home health agency, or you can hire a person directly. Going through an agency means you are paying the agency for them to provide caregivers. Doing it on your own means you have to find the caregiver and hire that person directly. When you go through a home health agency, the agency is the employer, so you won't have to worry about employer issues such as tax and liability. The agency will take care of screening the employees, doing background checks, and providing insurance. The agency will schedule your caregivers, and should send a replacement if a regular caregiver is not available. Make sure you check on ...

Your Durable Power of Attorney is your most important planning tool. It is the legal document that allows your chosen Agent (family member, friend, or trusted advisor) to continue your personal business if you cannot do so yourself. This includes paying your bills, accepting and depositing your income, filling out legal forms, contracts and tax returns and everything else you do every day. If you die, your Executor will handle the winding up of your affairs, but if you are alive and not able to handle your affairs, someone has to do it for you. The first thing that you have to decide (after you realize you really need a Power of Attorney) is who should be your Agent. This is easy for some people and difficult for others. Whoever you choose, that person needs to be trustworthy. Your Agent will be handling all of your money and property. The duty of an Agent is to handle everything carefully and for your benefit, but your Agent has the ability to do things improperly and incorrectly. Y...

            Marge’s husband, George, would call for her and she would come running. But when she came into the room he would say, “Who are you? I want Marge!” She would say, “It is me, George,” and he would reply, “But you’re an old woman, I want my wife, Marge.” This was devastating for Marge. George couldn’t remember the recent times and what his wife now looked like as an older woman. All he could remember was his young bride. Later, after George’s death, Marge was able to laugh about how silly it was. George would wake up in bed next to his wife and call for “Marge” wondering why an old woman was in the bed with him. You had to either cry or laugh about it.             George had some sort of Dementia. Probably it was Alzheimer’s Disease; a common form. But there are many types of Dementia and not everyone with memory or cognitive issues has Alzheimer’s. Dementias are clas...

I know that many of my clients may be considering Assisted Living. There are many fine facilities in the Merrimack Valley and Southern New Hampshire and I often recommend the good care and services (especially the three meals a day) that elders can get in Assisted Living. It can be fairly costly, but it can provide a safe and healthy environment for you or your loved-one.  I have just learned that Haverhill Crossings and Ashland Farm at North Andover have openings for both their Traditional Assisted Living as well as their Harbor program for the memory impaired. Here is the contact information for these facilities: Frank Quintiliani Area Director of Community Relations Benchmark Senior Living Cell: (603) 560-0660 fquintiliani@benchmarkquality.com

Birth control, breast-feeding equipment, and other medical and preventive services for women will have to be covered by health insurance plans one year from today (by August 1, 2012). The link below is to the Federal Department of Health and Human Services press release on the change in the Federal rules governing health insurance. It is part of the new health care system put in place by Congress, last year. Affordable Care Act Ensures Women Receive Preventive Services at No Additional Cost

With temperatures around 100 degrees Fahrenheit, Elders and people with disabilities may experience more difficulty than others. There are many cooling centers around the state where you can seek relief from the heat. Use the list below, or online, or check with your local municipal offices, Fire Station or Red Cross for more information. The list is online and may be updated - check out http://www.nh.gov/disability/information/community/coolingcenters.htm New Hampshire Cooling Centers ALLENSTOWN - Allenstown Police Department ALTON - Alton Senior Center - 8:00am-4:00pm Monday-Friday ATKINSON - Atkinson Senior Center - 9:00am-2:00pm Monday-Friday BERLIN - Berlin Senior Center 7:30am-3:30pm Monday-Friday BRISTOL - Bristol Area Senior Center - 8:00am-2:00pm Monday-Friday BROOKLINE - Safety Complex - 7:30 a.m. to 4 p.m. Thursday, Friday CANAAN - Mascoma Area Senior Center - 10:00am-4:00pm Monday-Friday CHARLESTOWN - Charlestown Senior Center - 10:00am-4:00pm Monday-Frid...

Americans who take time off work to care for their aging parents are losing an estimated $3 trillion dollars in wages, pension and Social Security benefits, according to a new study by the insurance company, MetLife. Meanwhile, the percentage of adult children providing basic care for their parents has skyrocketed in recent years. Nearly 10 million adults age 50 and over care for an aging parent, MetLife says. For the individual female caregiver, the cost impact of caregiving on in terms of lost wages, pension and Social Security benefits averages $324,044. For male caregivers, the figure is $283,716. The study also identified a dramatic rise in the share of men and women providing basic parental care over the past decade and a half. In 1994, only 9 percent of women and 3 percent of men and were providing care. By 2008, the percentage of women caregivers had more than tripled to 28 percent, while the figure for men had quintupled to 17 percent. "Basic care" is define...

Our law office received an anonymous letter regarding some trash spilled on Broad Street in Nashua on June 16, 2011. The letter noted that our name was found on a prescription bottle (and I assume some sort of internet search was done to match the name). That trash was not ours and has nothing to do with the Adamsky Law Offices nor the Adamsky family. Mrs. Adamsky is a Registered Pharmacist and her name appears on every bottle when she fills a prescription. The bottle probably belonged to one of her patients. Thank you to the good person who picked up that trash. We understand from your letter that it was disposed of properly and that the confidentiality of the careless person who dropped this trash was maintained. You are to be commended for your kind act. And, we agree that everyone should be careful with their garbage and see that it is properly handled. And, we remind everyone to review their procedures for disposing of sensitive information such as prescription bottles. It is re...

One of my clients (or a client's family member) left a case for their glasses at my office this week.  It looks pretty fancy and expensive.  It has a name brand written on it.  If it's yours,  please call and give me the brand name for identification purposes.  Then we will work on getting it back to you.   Ed.

It's clearly Spring around here.  On the way to work this morning I saw several groups of Turkeys.  In each group there was at least one male presenting his tail for the females.  This looks like the classic picture you see of a Turkey around Thanksgiving with his big tail unfurled like a peacock.  But, you won't see that in November, it is courting behavior used in the Spring to find a mate.  Imagine if we humans had some sort of mating system like that.  The males puff themselves up, furl out their tails and strut around waiting for a female to find them attractive ... that would be something  ... oh, wait! Three Turkeys at my Bird Feeder - April 2011 (C) Edward Adamsky, 2011

I have often written about dealing with dementia patients. They do not react like people whose brains are functioning normally. About 5-10% of dimentia patients exhibit violent behavior. The cause of the violent behavior may not be known and it can come from any number of triggers (or nothing). Dealing with a violent family member can be difficult.  Here are some tips: 1.Back down . If your loved-one gets angry because he doesn’t want to take a shower, drop it and try again later when his mood has improved. 2.Apologize , even if it’s not your fault. This will buy you time and good will. 3.Change the topic . Stay calm and change the subject to something your loved-one usually enjoys. 4.Remember the world is distorted for those with Dementia . They are sensitive to noise and become fatigued easily.  What is going on around them may not make sense as their brain cannot comprehend or remember context. 5.Call for help . For emergencies, call 911. For non-emergen...

The New York Times recently posted the article linked below about dementia. I have been discussing this with my clients for years. You cannot usually engage in a logical argument with a one-year old child, and sometimes you cannot do so with an elder who has advanced dementia. You must deal with the disease of the mind in a way that works for that person. The first time I heard of this issue was from a nurse at a nursing home. She said sometimes you just have to lie to someone, but she didn't call it a "lie" she said most of the time the "lies" were not big enough to even be called a "fib" this nurse called it a "fiblet." That is a little white-lie that helps to calm and redirect the patient so she is not upset by the issue. You probably don't want to keep telling someone that her loved-one has died, but you might want to tell her that lunch will arive "soon" even though she just ate. I faced this issue personally with my gr...

NATIONAL TAKE BACK INITIATIVE PELHAM POLICE DEPARTMENT - COMMUNITY ROOM APRIL 30, 2011 10:00 AM - 2:00 PM The "Take Back" initiative addresses a public safety and health issue. More than seven million Americans currently abuse prescription drugs, according to the 2009 Substance Abuse and Mental Health Administration’s National Survey on Drug Use and Health. Each day, approximately, 2,500 teens use prescription drugs to get high for the first time according to the Partnership for a Drug Free America. Studies show that a majority of abused prescription drugs are obtained from family and friends, including the home medicine cabinet. In an effort to address this problem, DEA, in conjunction with state and local law enforcement agencies conducts National Take Back Day to provide a venue for persons who wanted to dispose of unwanted and unused prescription drugs. At the last event in September, the American Public turned in more than 121 tons of pills. DEA has scheduled the second ...

Whenever you give someone more than the annual (yearly) exemption amount, you are supposed to file a gift-tax return. There is a tax on the givers of gifts. Or course, there is a lifetime exemption of $5 million so until you give more than that, you won't owe any tax (it used to be $1 million and could revert back to that if Congress lets it happen in 2013). But, you still have to file a return if you give someone more than $13,000 in any one year. Most people don't make large gifts, so they don't have to worry about gift-tax returns. But many people do give away their home or land (or add their child's name to the deed as a co-owner). If you put your home in joint ownership with your child, you effectively gave that child half of the value of your home. Unless your home is pretty small it's probably worth more than $26,000, so you should file a gift-tax return. Now, the IRS is cracking down on this issue. They have targeted several states and demanded that the stat...

Who should get the old dining room table that came from Grandma’s house? Who should get mom’s diamond ring? What about those Civil War relics from Grandpa’s side of the family? What about the family photos? Dividing up family heirlooms can be a touchy subject. If you leave the decision until after you die, your children may end up fighting over simple personal possessions. Most of the Wills I write for clients say to split the assets equally among the children. That will be easy for the cash, stocks and bonds, but not so easy for the stuff. In many families, the actual division is handled by the children, and done with fairness. In other families, the little things cause no end of trouble. Years of bitter feelings can come from the thoughtless actions of one child after the parents are gone. To avoid these problems, you should plan ahead and talk things over with your family. By bringing children and others in to the conversation, you can make things easier for them later. Children ne...

My wife and I recently took a Winter vacation and went to the Christmas Farm Inn in Jackson, New Hampshire. We had a great time. The Inn was very nice as were the new managers. The food was good, the room was very nice, and the spa was wonderful. It was very snowy up north and Jackson looked like a winter wonderland. At night it was all lit up with lights. Nearby Nestlenook Farm was very pretty. We didn't go there, but heard it is a nice place too. There is much more than I thought there was up in the White Mountain region of New Hampshire. We found great restaurants and fantastic shopping in N. Conway. But, the best part was the peace and quiet, the wonderful outdoors with mountain views, and snowy vistas, and of course the time alone with my wife. http://www.christmasfarminn.com

The New Hampshire Probate Court is now posting online, the notices of probate matters such as appointments of executors and administratators. These are regularly published in local newspapers, but the online listings will give notice to anyone with internet access. This is great for those seeking information on estates in distant locations. It's also a worry for privacy purposes (although Probate has always been public, it's a little less public when it's not online). If you want to check out the notices, go to the link below. http://www.courts.state.nh.us/probate/legalnotices/index.htm

Apparently, the concept of trusts that go on forever (and are not subject to the Estate Tax at each generation) does not sit will with some in Government. They may feel that this is an unfair system that will protect the wealth of the super rich. Many others use the so-called "Dynasty Trusts" so this issue may affect those other than the rich. New Hampshire allows perpetual trusts, so those who don't have one now, may want to consider their use before the tax laws are changed. You can set one up in New Hampshire even if you don't live there. Consider seeing your Estate Planning attorney if you need guidance on this issue. For more information read the Wall Street Journal article at the link below: Tax Report: Dynasty Trusts Under Attack - WSJ.com

The link below (and in the headline) is to a blog about a large HIPAA violation penalty. It is interesting to note that since HIPAA started in 2003 and until today, there have been little or no enforcement actions against doctors offices, hospitals, or other medical places for improper release of protected health information. Everyone has been (perhaps overly) careful to avoid inadvertent disclosure of information. That's great. This big ($4.3 Million!) fine was against an insurance company that failed to properly communicate with its own customers. Patients (insured) wanted access to their own information and records (to which they are entitled) but the company did not properly respond or provide systems for customers to get the information. After attempts to work with them, and a complete lack of cooperation, the government fined the company - most of it for their failure to even respond to the complaints. So, the moral here appears to be that small doctors offices and other...

As we get older, we generally have more health concerns. For a long and healthy life we must handle our health issues properly. Seniors often make mistakes when dealing with their health. Here are seven of the biggest health care mistakes made by the elderly: 1. Failing to Hear or Understand your Doctor – If you did not hear what your doctor said, ask again. If you do not understand the directions, ask for them to be written down. If you are not sure what the doctor was talking about, ask for a simpler explanation. Don’t leave the doctor’s office until you understand what is wrong with you, and what you must do about it. 2. Failing to Discuss Problems with your Doctor – Some problems are embarrassing or personal, some seem minor or trivial. Discuss all issues with your doctor. Sexual or bathroom issues may be symptoms of serious diseases. Other problems show up as simple pains and upsets. Tell your doctor about all of your problems. Maybe your doctor can help, or catch a big problem ...

Many clients ask what they should do about their estate planning after a divorce. In general, a Divorce extinguishes any rights that the ex-spouse had in the estate of the other. A Will clause that leaves assets to “my wife, Jane Smith” will be voided by a divorce, the gift will fail, and it become part of the “residue” of the estate. If the ex-spouse is named as the beneficiary of the residue, then that gift will fail as well, and the Court will use the intestate distribution rules to give the residue to the children or other heirs-at-law. However, it is wise to change all estate planning documents to avoid any questions or ambiguity. It is especially important to review and update beneficiary designations for life insurance and other assets such as Individual Retirement Accounts. The New Hampshire Supreme Court ruled on the issue of an IRA and an ex-wife as the named beneficiary. In The Estate of Robert Tremaine v. Lorraine Tremaine , the Court ruled that the ex-wife of the decedent ...

I have been warning clients and others lately about a new online issue. In Holmes v. Petrovich Development Company, LLC, a California court ruled that emails sent by an employee to her attorney from a computer in her workplace were not protected by attorney-client privilege. This employee used a company email account (rather than a personal account) to send the emails. The company policy made it clear that emails could be monitored and were not private. This makes it pretty clear that there is some risk (in California clearly, and everywhere else, probably) when using corporate email. Since your company probably has a policy that allows emails to be copied, read and monitored, you have little or no privacy in those emails. If you send something to your attorney that you expect to be private, it will lose that privacy and could become public (and used against you) if you use your company email system. This may not apply to use of a web-based email system with your own "private...

The New Hampshire State Committee on Aging (SCOA) advocates on behalf of older residents of New Hampshire. They have issued the following "fact sheet" on Long Term Care (LTC) Long Term Care is a variety of medical and non-medical services to help you live with chronic illness or disability, by providing help with health or personal needs. Services can provide light housework, meal preparation, laundry, paying bills and transportation. LTC is available in your home, senior center, retirement or assisted living facility or nursing home. Plan and think about long term care before you need care and before a crisis occurs. Planning ahead allows you the time to talk with your doctor about your health needs. It is important to talk with your family about LTC services you might need, their costs, and how to pay for them. [You should also see your Elder Law Attorney - Ed.] Medicare DOES NOT pay for long term care support services that are typically needed. It pays only for skilled nur...

Here is a guest article - edited and reposted from http://www.zeiglerseniornews.com/ Washington DC. Happy fifth birthday, DRA. Only Medicaid workers, nursing home personnel and Elder Law Attorneys would be likely to notice the anniversary of the Deficit Reduction Act. It was signed into law by President George W. Bush five years ago, on February 8, 2006. Now universally called "the DRA", the act generated controversy from its first week and is still generating controversy. The DRA made dozens of changes, but none were more important, controversial and confusing than changes in Medicaid rules for long-term care eligibility. Seniors seeking Medicaid coverage for nursing home costs or for the small but growing "Medicaid waiver" home care still run into problems qualifying under the DRA. And these problems will continue. Elder law attorneys who mostly opposed the DRA have since been retained by thousands of seniors seeking to tread the difficult path of protecting asset...

Buy enough life insurance . You can’t be replaced, but someone will have to fill in if you aren’t there. Your family will probably have to pay for some services that you used to provide. You can provide the money necessary, even if you don’t have much now, with life insurance. Set up a trust . Any assets left for a child with special needs, including life insurance proceeds, should be held in trust. Leaving money directly to someone with a special need jeopardizes public benefits. Some families disinherit children with special needs, relying on siblings to care for them. This approach is fraught with potential problems. The best approach is a trust fund set aside for the child with special needs. Write down the care plan . You must write down what a future caregiver will need to know about your special needs child. You may know everything but you need to write it down so it can be passed on. The memo or letter can be kept in the attorney's files or with the parent's estate plan...

An Elder Law Attorney has developed a checklist of possible indications of elderly financial exploitation and it is now available online. It is the feature news article in the newsroom of www.ZeiglerSeniorNews.com The checklist was developed by attorney Pam Wright of West Tennessee Legal Services. It will be a work-in-progress as other indications of possible elder financial abuse are added to the checklist. ZEIGLERSENIORNEWS.NET

The link below is to a CNN editorial article by Carl T. Bogus a professor of law at Roger William University School of Law. He speaks to the Second Amendment and whether or not it was intended to allow citizens to bear arms only to protect the State against foreign invaders or to allow them to fight with their own government (if and when that government became tyrannical). As a resident of New Hampshire, I have to point out that our State Constitution is much clearer on these issues. The right to bear arms does not contain any clauses related to the militia. Article 2-a says "All persons have the right to keep and bear arms in defense of themselves, their families, their property and the state." And a "right of revolution" is written right into our state Constitution. Article 10 says "Government being instituted for the common benefit, protection, and security, of the whole community, and not for the private interest or emolument of any one man, family, or clas...

Here is a good article with a quick summary of Special Needs Trusts. See my similar article in the Merrimack Journal The Advantages and Burdens of Trusts for the Disabled - NYTimes.com

Kim Dayton, a NAELA Elder Law Attorney and Law School Professor has helped from a new Center for Elder Justice. The linked article is from the school's website. Mitchell’s Center for Elder Justice and Policy is coming of age William Mitchell News

Here is a great article on a new wave of Alzheimer's care. Caregivers have realized that the medical version of care is not quite right for those with memory disorders. Giving them love, attention and the foods they want, do the trick better than drugs and diapers. I don't know about you, but I'll prefer the chocolate, bacon and other things I love to drugs and restraints if I'm ever in a memory disorder unit. Alzheimer’s Therapy Focuses on Care - NYTimes.com