One-Third of Nursing Home Residents Injured or Killed In Treatment

Photograph by:
 Chalmers Butterfield

A federal study has found that about one-third of nursing home residents receiving skilled care were harmed by the treatment in the facility. The  study, conducted by the Department of Health and Human Services, Office of Inspector General (IG), is entitled, “Adverse Events in Skilled Nursing Facilities: National Incidence among Medicare Beneficiaries.” "Adverse events" reported include medical errors and more general substandard care that results in patient or resident harm, such as infections caused by the use of contaminated equipment.   A “skilled nursing” facility (SNF) provides specialized care and rehabilitation services to patients following a hospital stay of three days or more. There are more than 15,000 skilled nursing facilities nationwide, and about 90 percent of them are also certified as nursing homes, which provide longer-term care.

According to the study, an estimated 22 percent of residents experienced at least one adverse event that resulted in a prolonged stay, transfer back to a hospital, permanent harm, a life-sustaining intervention, or death. An additional 11 percent experienced temporary harm while in the nursing home. Physician reviewers determined that 59 percent of these adverse events and temporary harm events were clearly or likely preventable. 

Projected nationally, the study estimated that 21,777 patients were harmed and 1,538 died due to substandard skilled nursing care during one month, August 2011, the month for which records were sampled.  These projections suggest that as many as 261,324 patients are harmed, and 18,456 patients killed, annually, from skilled nursing facility care and treatment.

Veterans and Their Families Missing Benefit Opportunities

According to the most recent VA demographic report, there is an estimated U.S. veterans population of over 21 million, with approximately 2 million being WWII veterans. Of the total population, approximately 322,000 of these veterans are receiving VA non-service connected pension benefits. The number of surviving spouses receiving pension benefits is roughly 318,000. These statistics begged Karen McIntyre, President Veterans Information Services, Inc., to ask, "Why so Few?"

She recently wrote in the Veterans Information Services, Inc., newsletter, Veterans Family Matters that:

Non-service connected pension benefits are a needs based VA benefit for war time veterans and their surviving dependents. These benefits have absolutely nothing to do with an injury, condition, or death related to military service. Even though these benefits are needs based, the veteran or dependent does not have to be poor to receive them, because medical expenses such as Medicare and insurance premiums, prescriptions, full costs of assisted living, doctor and hospital co-pays, etc. are used to offset income and assets. 

Although some veterans and surviving spouses are obviously not eligible due to their financial situation or non-wartime service there is a huge number who are eligible, but do not know it. Unfortunately, the ability for our veterans and their families to get financial assistance for medical care has been a well kept secret that is just now being "let out of the bag". 

A single veteran, who served 90 days active duty with even one day during a qualified war time, may be eligible for up to $1,758.00 per month to help pay for home care, assisted living, nursing home care, and other medical necessities. A married veteran may be eligible for up to $2,085.00 per month, a surviving spouse for up to $1,130.00 per month, and a veteran married to a veteran for up to $2,790.00 per month. None of this money affects Social Security or other sources of income and ALL is tax free to the claimant.

Sadly, many vets and their families are unaware of these benefits.

Others incorrectly assume that they are ineligible, or relying upon shoddy assessments and/or poor advice, believe that there is nothing that they can do to become eligible for these benefits.  Others confuse the standards for eligibility with those for Medicaid. Eligibility planning for veterans benefits is very different than planning for Medicaid eligibility, and there are, as a result, a wider array of opportunities to qualify for these benefits.

If you know a veteran, pass this information along.  At a minimum, we owe those who served, and the families that sacrificed for and with them, an obligation to ensure that they receive what is promised to them. 

 

MyRA?

President Obama announced a new retirement savings program for people who do not currently have an employer-sponsored plan during his 2014 State of the Union message. The new investment product, called myRA, is a starter savings account aimed at low- and middle- income workers.

Similar to a Roth IRA, the myRA accounts will allow workers to invest money after tax and withdraw the money in retirement tax-free. Unlike a Roth IRA, however, the savings will be backed up by U.S. Treasury bonds, so investors will have a safer investment alternative designed never to risk the principal investment. The accounts, which are voluntary, will be available to married couples with modified adjusted gross incomes up to $191,000 and to individuals earning up to $129,000.

Workers can open a myRA with a minimal initial $25 investment. The plans are funded through paycheck deductions with contributions as small as $5 at a time. Savers will earn variable interest on the accounts, and there are no fees on the account. Principal contributed to the account can be withdrawn without penalty at any time.  There will be a penalty, however, for withdrawing the earnings i.e., interest, from the account before age 59 1/2. 

Once an account holder has accumulated $15,000, the account holder must roll the account into a traditional Roth IRA, which will then be subject those rules. In addition, the accounts last only 30 years, so at the end of that time the funds must be rolled into a traditional Roth IRA, even if the $15,000 maximum limit has not been reached.  It is unclear whether an account holder can open a new account after a period of time in order to avoid contributions being rolled up, and subject to traditional Roth IRA withdrawal rules.  

Employees who switch jobs will be able to keep their myRA accounts without cashing them out. Workers would also be able to contribute to the same account from multiple part-time jobs. The new accounts will initially be offered through a pilot program with employers who choose to participate and should be available at the end of the year.

Critics contend that the myRA initiative will do little to address the retirement savings gap because enrollment will not be automatic and contributions will be invested only in low-return Treasuries.  The requirements that the myRA rolls up into a traditional Roth IRA at either the $15,000 limitation or upon thirty years is at best going to create confusion.  At worst it will cause account participants to mistake the flexibility and ease of the accounts prior to roll-up in planning, and fail to carefully consider the more cumbersome rules governing Roth IRA distributions after roll-up.  Unexpected tax consequences may follow.

"Qualified" distributions from a Roth IRA are not included in gross income for individual tax purposes. That is deceivingly simple: a "qualified" distribution from a Roth IRA is tax-free, i.e., no taxes due on the principal, and no taxes due on the earnings.

The reason that "simple" is deceiving is the rules that define a qualified distribution.  To be qualified, the distribution MUST be:

• Made on or after the date you become age 59 1/2; OR
• Made to your beneficiary, or to your estate, after you die; OR
• Made to you after you become disabled within the definition of the IRS code; OR
• Used to pay for qualified first-time homebuyer expenses.

But,  even if one of the qualifications above are met, the distribution is STILL not qualified if it is made within a five-tax-year period. Complicating matters further is that tax-years are NOT necessarily the same as five calendar years.

So, in effect, there are two sets of rules that must be met before a Roth IRA distribution becomes qualified, and therefore tax-free: The distribution rules and the five-tax-year rules. Unless both sets of rules are met, the distribution will NOT be qualified, and the earnings will be subject to tax, and possibly penalties.

The direct investment in treasuries may be a safer alternative for many investors, and it will benefit the treasury by encouraging direct investment.  But, is the myRA an example of the government giving with one hand only to take with the other?  Perhaps, only time will tell. 

For the press release detailing the new myRA account, click here.

Appealing Medicare Refusal to Cover Care

Sometimes Medicare will decide that a particular treatment or service is not covered and will deny a beneficiary's claim. Many of these decisions are highly subjective and involve determining, for example, what is "medically and reasonably necessary" or what constitutes "custodial care." If a beneficiary disagrees with a decision, there are reconsideration and appeals procedures within the Medicare program.

While the federal government makes the rules about Medicare, the day-to-day administration and operation of the Medicare program are handled by private insurance companies that have contracted with the government. In the case of Medicare Part A, these insurers are called "intermediaries," and in the case of Medicare Part B they are referred to as "carriers." In addition, the government contracts with committees of physicians -- quality improvement organizations (QIOs) -- to decide the appropriateness of care received by most Medicare beneficiaries who are inpatients in hospitals.

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What Are the House Ownership Options When Parents and Adult Children Live Together?

Bailey House,  Somers Hamlet Historic District
in Somers, NY, USA

Increasingly, several generations of American families are living together. According to a Pew Research Center analysis of U.S. Census data, more than 50 million Americans, or almost 17 percent of the population, live in households containing two adult generations. These multi-generational living arrangements present legal and financial challenges around home ownership.

Multi-generational households may include "boomerang" children who return home after college or other forays out into the world, middle-aged children who have lost jobs in the recent recession, or seniors who no longer can or want to live alone. In many, if not most, cases when mom moves in with daughter and son-in-law or daughter and son-in-law move in with mom, everything works out well for all concerned. But it's important that everyone, including siblings living elsewhere, find answers to questions like these:

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