Does Size Matter?

Does the size of your brain predict the likelihood of developing Alzheimer’s disease?  One study released December 2011 in Neurology, the medical journal of the American Academy of Neurology, finds that smaller brain size has a high correlation with the risk of developing Alzheimer’s.    Technically, the researchers found that the thickness of regions of the cortex known to be vulnerable to Alzheimer’s disease.  The study was conducted among people in their mid-seventies who have not shown signs of memory loss.


Predicting who may be at a higher risk for the disease is important, as early detection may be an important step to slowing down or stopping the progression of memory loss and cognitive function.


Another marker, according to the press release, is abnormal levels of protein in cerebrospinal fluid.  For more information on this study, click here.



Alzheimer’s or a Vitamin Deficiency?

According to an article in today’s New York Times by health writer Jane Brody, below normal levels of B-12 can sometimes mimic the signs of Alzheimer’s Disease.


According to Brody, Vitamin B-12 is absorbed less readily as we age, and a deficiency can cause symptoms of memory loss and confusion–the same symptoms as an early Alzheimer’s diagnosis.


A study in the American Journal of Clinical Nutrition found that supplementing people without deficiencies of B-12 did not improve cognitive impairment with normal levels of the vitamin, but did improve cognition among women with a low intake of B vitamins.


Although I’m not a doctor, it seems to me that testing for Vitamin B-12 deficiency in older adults should be a routine procedure.

There’s a Criminal Employed in Your Nursing Home

The Inspector General of the U.S. Department of Health and Human Services issued a report this past March, analyzing 35,000 nursing home employee records of nursing homes against criminal records maintained by the Federal Bureau of Investigations (FBI).


92% of nursing homes employ one or more people with a criminal conviction.  Nearly half of nursing homes employed people with five or more criminal convictions.  Although most of the convictions took place prior to employment, 16% of the convictions were for offenses after being hired.


Although nursing home facilities are prohibited from hiring or employing persons found guilty of abusing, neglecting or mistreating residents, apparently this prohibition does not extend to workers who had previously been found guilty of crimes against property.


The NY Times reported that although most of the criminal convictions were for activities such as burglary or shoplifting, some  were for personal crimes such as assault.


Residents in nursing homes are a vulnerable section of our population.  These residents are often left alone with aides and supervision is poor.  Nursing homes must do a better job in screening employees.



The Survey Says: NY a Winner in the High Cost of Long Term Care

In this survey, New York “only” comes in fifth in the country on the list of most expensive annual cost for a private room at a nursing home.  The survey is using median rates, and also averaging the cost of nursing homes throughout New York State. On Long Island, the cost of a semi-private room is right around $430/day.  That translates to $146,000 annually.  Each year.  $146,000.00.


If you find this as shocking as I do, you should contact an elder lawyer who may be able to help you protect your hard-earned assets.



Big Banks Exit Reverse Mortgage Market

What is a Reverse Mortgage?


Seniors (you must be over age 62) can tap the home equity in their homes by obtaining a reverse mortgage in either a lump sum or multiple payments.  The homeowner is not obligated to repay the loan, and the payment is deferred until the homeowner dies, sells the home, or leaves the home by entering a nursing home.

It is available regardless of your current income.  The Housing Department has a website on frequently asked questions about reverse mortgages, found here.

The Problems for Banks


According to the New York Times, both Bank of America and Wells Fargo exited the reverse mortgage business because the loans have become so risky.  With the falling housing market, there is a greater chance there will not be sufficient equity to repay the loans.  Homeowners are still responsible for property taxes (as we know, this is a major percentage of Long Island homeowner budgets) and insurance.  Banks are not allowed to assess borrower’s ability to keep up with these payments.


What Does Met Life Know that These Major Banks Don’t?


Just as Bank of America and Wells Fargo exit the reverse mortgage business, MetLife has come on strong.  They’ve entered the reverses mortgage market as a hedge against declining interest rates.  According to Bloomberg, the loans are guaranteed by “by the Government National Mortgage Association, a U.S.-owned insurer of mortgage- backed securities commonly known as Ginnie Mae. The agency guarantees the loans that are issued by lenders like MetLife and subsequently sold to investors.”



The Real Reason You Should Have Paid Attention in High School French


In a recent interview in the New York Times Science Section, cognitive neuroscientist Ellen Bialystock was interviewed about recent studies that have found that being bilingual delays the onset of Alzheimer’s symptoms by an average of five to six years.

Unfortunately, the occasional use of a second language does not qualify for bilingualism.  The second language must be used regularly in your every day life.

The study of 211 diagnosed Alzheimer’s sufferers found that the onset of symptoms in bilingual patients occurred more than 5 years after those monolingual patients, and were diagnosed 5 years later.  Interestingly, the monolingual patients were more educated.

Too Late to Learn a Second Language?


It is probably too late for most of us reading this to learn to speak a second language fluently enough to reap the benefits of this study.  However, it has been well documented that those adults who remain socially, mentally and physically active are better protected against the onset of dementia.

So, you might say that a bit of je ne sais quoi can delay non compos mentis.


The Five-Year Lookback– Frequently Asked Questions

One of the  questions I am frequently asked in my elder law practice is “what is the five-year lookback?”

Simply put, if you give away money or property during the five years before you apply for Medicaid, that transfer triggers a penalty period during which you are ineligible for Medicaid.

How Does the Penalty Period Work?


The penalty period is calculated by dividing the amount you have gifted or transferred by the average cost of nursing home care in our area, as published yearly.

The 2011 Nassau and Suffolk County average nursing home cost is $11,445.00

So, for example, if you give $91,560 to family members, at $11,445 a month you wouldn’t qualify for Medicaid for eight months.  If you give your home to your children, and retain a life estate, you have also given a gift, the fair market value which is countable towards the transfer penalty.

When Does the Penalty Period Start?


The Penalty period starts the day you apply for Medicaid.  New York State will review the Medicaid application to see if any gifts or transfers for less than fair market value are made for the five years prior to the application.  In other words, the full five years must pass before the gift is protected.  The penalty period does NOT start on the day you transfer the assets.

What Happens After Five Years?


If you need nursing home care, you will be eligible for Medicaid at the end of the five years after the transfer, as long as you have no other unprotected assets.  Contacting an elder lawyer while you are still well enough to transfer assets into an irrevocable trust is essential.

I Hereby Leave my Life Insurance to….the State of New York?

Here’s an astounding statistic: According to the New York Times, New York has received $400,287,736 in unclaimed life insurance property since 2000 and paid out $64,772,228.


Why does so much money go unclaimed?  The first problem is that someone needs to notify the insurance company that the policy holder has died.  If the beneficiaries don’t know about the policy, this essential first step goes undone.


It is worth getting your affairs in order, putting your life insurance policies in with your other essential estate planning documents and advanced directives.  Let your beneficiaries know where to look for your important papers (I have a folder in my file cabinet labeled “Important Papers”—simple but effective).


New York State does not need your unclaimed funds, your beneficiaries do!

A Physician’s Guide to End-of-Life Decisions (MOLST)

The denial of death is one of the strongest of human defense mechanisms. In fact, there’s an entire book about it.  We don’t want to think about our end-of-life care wishes. (Although some have instructed, “Wave a martini in front of me — if I don’t respond, pull the plug.”) I don’t like to think about it any more than the next person. But I also don’t like to think about my family and doctors arguing over keeping me on a ventilator when I could have easily told them in advance what I want in that situation. In the past, the only option would be the use of an “advance directive” or health care proxy.  That’s still a good idea, but some might wish to also involve their doctors in the discussion. Another technique known as Medical Orders for Life-Sustaining Treatment (or MOLST) is becoming more popular. As a recent article in The Wall Street Journal makes clear, a growing number of states, including New York, are promoting MOLST to help guide physicians with a patient’s specific instructions.

New York is one of the more forward-thinking states in instituting the program known as Medical Orders for Life Sustaining Treatments (MOLST)

MOLST is different from other advance directives such as living wills and health care proxies because it is physician generated instead of client/patient generated.  A licensed physician must always sign the MOLST.  It is printed on bright pink paper so that hospitals and nursing homes cannot fail to notice it.

While the MOLST is a good addition to helping people get their wishes fulfilled, it is most often employed for the elderly who are in need of life-sustaining care.  It should not replace the health care proxy and living will you would create along with your wills and financial powers of attorney.

I found myself filling one of these out several years ago, when we had to check my mother into a nursing home.  Despite years of seeing gerontologists and living in an assisted living facility, this was the first time we’d been presented with the option of discussing the MOLST.

You may want to discuss this with your physician or elder law attorney so that you too can participate in your own decisions on your end-of-life care.


Is the Doctor In? Not if You’re on Medicaid

A major difficulty for people on Medicaid is the inability to find doctors and dentists willing to accept the plan.  For those people who need primary care, the result is often hours and hours in clinics waiting to see a general practitioner and month-long waits for specialists.


According to the New York Times, having a Medicaid card does not in any way assure access to care.  Medicaid patients cannot find surgeons willing to operate on them, or find mental health specialists willing to see them.


Unfortunately, the new health laws that depend heavily on Medicaid to help the already uninsured are only likely to put a bigger burden on states that are looking for ways to cut back.