Although not specifically mentioned in the article, most of the Medicare spending for a person occurs in the last months before their death.  Usually, that spending outweighs all previous Medicare spending on that person.

In the article, a respected orthopedist discovered that he had pancreatic cancer.  There was a procedure available that would triple a patient’s five-year survival odds from 5 to 15 percent, although with a poor quality of life.  The orthopedist decided that he was not interested.  He went home the next day, closed his practice and never set foot in a hospital again.  He focused on spending time with his family.  He received no chemotherapy, radiation or surgical treatment.  Several months later, he died at home.  Medicare did not spend much on him.

The article points out, just like us, doctors die too.  What is unusual about them is not how much treatment they get compared with most Americans, but with how little.  They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want, but they tend to go serenely and gently.

Sixty-four percent of all doctors have advance directives – specifying what steps should or should not be taken to save their lives.  The article points out that only 20% of the general public has such advance directives.

The article goes on to point out some interesting facts.  We have all seen CPR on TV.  We see CPR performed that is successful in 75% of the cases and 67% of TV patients go home.  In reality, a 2010 study of more 95,000 cases of CPR found that only 8% survive for more than a month.  Of these, only about 3% could lead a mostly normal life.  The article points out that even physicians are reluctant to discuss end of life decisions with their patients.

According to the article, “the result is that more people receive futile, life-saving care and fewer people die at home than did say, 60 years ago.”  As the article points out, written directives can give patients far more control over how their lives end.

It is critically important to discuss end of life decisions and to have written directives.  You need to be in control of your end of life decision making.  You need to dictate what is an acceptable quality of life and what is not an acceptable quality of life.  Quantity does not equal quality.

Be sure that your doctor has your choices in his records.  For me, there will not be heroics, but I want to be able to pass according to my wishes and as gently as possible, and as pain-free as possible.

If you have not made your written directives, please take care of it.

Proposing a change and then implementing that change are two entirely different things. Implementing a change and it passing the muster of both federal and state law is yet another barrier.
I anticipate that there are going to be changes in reimbursement rates to doctors, hospitals and other medical providers. We will also probably also see some reduction in the reimbursement rate for home healthcare and nursing home care.

It will be interesting to see just how long those receiving the reduced benefits can operate in such an economic condition.

I am a strong believer in home healthcare. If the reductions in reimbursement rates shut down the ability to receive home healthcare, such a procedure is counterproductive. Clearly, keeping someone in their home is less expensive than putting them in a nursing home.

Stay tuned for more reports.

I do recommend to anyone that is listening to keep a journal.  I have made some real discoveries about myself.  Sometimes just “talking it through” in my journal gives me some perspective and many, many times gives me solutions.  Probably the most important part of my journal experience is that I try to do it in the morning.  It gives me an opportunity to sit back, calm down, and think about myself for a few moments.  Particularly helpful is my gratitude journal.  Each day, I try to write down from one to five things that I am grateful for.  Sometimes I repeat myself, but that is alright.

I encourage you to keep a journal.  I encourage you to write down your thoughts for the day and what you are thankful for.  Write down those important events and your thoughts at the time that you are going through them.  My firm belief is that you will find it therapeutic.

Why is this the subject of my blog?  Many of my clients are going through terribly difficult times.  I hope that they will take time to write down their thoughts and to gain perspective.  We try to make their journey along the elder care continuum a journey that is not so scary and instead can turn into a wonderful victory lap.  The journal may help.

If you are a parent or a grandparent, I hope that you will take time to share with your family in writing both the good times and the bad times; the successes, as well as the failures; and the important events, when they happened, and how they affected you and the family.

Once in a while, I see family members that look at their grandparent and view their life based on how they see them at that moment. In fact, that elderly person sitting before them may be a rich reservoir of historical and family observations. Most likely that person has fought and won many battles and has enjoyed great successes.

When I was taking care of my grandmother, I would on occasion remind the people that were caring for her who she was – a woman who had raised three children and eventually buried them all; a woman who had cared for two invalids her entire adult life; a woman who had taken in both her mother and her grandmother and cared for them and never regretted or complained one moment about it; a woman deeply religious and lived that religion every day; a woman who was a wonderful, inspirational grandparent to my children and who taught them what true love is.

So, if you are a grandparent, take some time to write down your memories. Grab something like The Grandparents Book. If you are the child, spend some time with your parents; find out the family history; get it while you can. Everyone will be blessed.

Medicaid has long had Home and Community Based Services, which is a program that provides services in the home, versus requiring a person to go to a nursing home.  According to the speaker, Kansas has the sixth highest percentage of seniors in nursing homes.  Part of that is due to the lack of Home and Community Based Services in the “rural and frontier” areas.

It sounds as if one of the Medicaid changes in Kansas may be to increase the availability of Home and Community Based Services.  If this is truly the intent of the changes to Medicaid, such changes will be welcome by me and others trying to help seniors and those with chronic illnesses.  In fact, the speaker went on to say that 18.6% of people in long term care in Kansas could actually be in a HCBS setting, rather than in a nursing home.

There is a tremendous amount of structural changes to the way Medicaid is going to be handled in Kansas.  I am always concerned when bureaucrats claim that they are going to “eliminate” so much  bureaucracy.  It just seems like the bureaucracy gets shifted, and suddenly no one knows how to get anything done.

But again, if the net result of all of this is to expand HCBS services, this will be a great change and will in fact, save us all money.

As I began my search for a new building, it was very important to me that I find something that our elderly and disabled clients could easily get to, that they could park their cars and easily walk into the office.  I needed to be sure that it had good parking and that it was accessible to those who might have difficulty with mobility.  At the same time, I needed to keep in mind that many families who come to us may be located out of state.  The ability to provide communication with them through telephone, internet, telephone or video conferencing was very important.

For over a year, I looked.  I finally discovered an office building at 2604 General Hays Road.  Not only does it have great parking, it is also very accessible.  The building that we will be using doubles our floor space.  Our care coordinators will have their own offices and it will go from one conference room to three.  This is important because many times, our delay in being able to see families was occasioned by this lack of an available conference room.  We will now have three conference rooms and each care coordinator will have an office space in which to meet with the families.

The unusual twist to the location is that it is where I first started practicing when I started my own firm in 1985.  At that time, I had about 20% of the building.  To say it was deja vu when I first walked back into the office to view it as a possible location is an understatement.

It has been fun watching the new office being reconstructed to fit our needs.  New windows were installed throughout and new heating and air conditioning is being put in.  Each office will have not only telephone connections, but also internet and high speed computer setups.  The staff will have more privacy as will our families that come to us.

Working out the logistics of the move has been a challenge for my staff but they have all stepped up to the plate.  Our goal is to move into our office with as little down time and as little interruption to our families as possible.

As I write this blog, our goal is to move in between Christmas and New Years and be operational after the first of the year.  I know that there will be some glitches but that is okay.

I hope that you will stop by the new office at 2604 General Hays Road after the first of the year and see the new offices of Clinkscales Elder Law Practice.

I am Randy Clinkscales and the founder of Clinkscales Elder Law Practice, P.A.  I have been practicing for many years at a general practice representing families in various matters.  Like most of us, circumstances change the course of our lives.  In taking care of my grandmother, I discovered that there was a real need for someone to focus on issues facing the elderly and disabled.  As a result, in 2005, I focused my practice on elderly and disability law.  It did not take long before I began retooling the entire office.  I brought in staff members to focus on specific areas.  We have a staff member dedicated solely to various benefit planning, such as Medicare and Medicaid.  I also brought in a person whose primary focus is Veterans pension benefits.  I also discovered that there was a real need for someone to help my clients achieve one of their principal goals – to stay in their home as long as possible or if they needed to move into assisted living or a nursing home, someone who can be sure that they are getting good care.  As a result, I brought in someone who has a lot of experience in healthcare – our care coordinators (we now have three) who are assigned to each family that we are helping with a Life Care Plan.

I have been in my current office at 201 W. 11th Street, Hays, Kansas, since 1987.  In 1987, my wife and I bought the office and we painted, remodeled, put down new woodwork, installed new carpet and have called it home for almost 30 years.  Now, our staff and our practice has outgrown our office so we are going to be moving to 2604 General Hays Road, Hays, Kansas.  In the next blog, we will talk about the move.

Many attorneys that do not specialize in elder law do not understand what Medicaid is or how it works.  According to my client, an attorney told him that this is what he needed to do.

Clearly, I would have been able to protect all of the assets for this family; he would not have had to sell his farm equipment, his personal belongings or his home.

The story is still out on how this is going to work out for this family.  We are scrambling to try to undo what has been done, but it is going to be a challenge.

Please, I urge you – do not try to take action on your own!  Medicaid is very tricky.  You can only rely on a qualified elder law attorney to give you good, solid advice.  Try to find one that is a member of the National Academy of Elder Law Attorneys (NAELA) and even the Kansas Chapter of the National Academy of Elder Law Attorneys.  Find one who has done hundreds of Medicaid cases versus someone who just dabbles.  Ask around.  Please do not sell your home or your property until you talk to someone who can give you good advice.

]]> http://clinkscaleslaw.com/lorem-ipsum6/feed/ 0 http://clinkscaleslaw.com/welcome-2/ http://clinkscaleslaw.com/welcome-2/#comments Thu, 01 Dec 2011 19:29:43 +0000 Clinkscales Elder Law Practice, P.A. http://clinkscaleslaw.com/?p=2537 Welcome to the Clinkscales Elder Law Practice blog. This is our first attempt at a blog.

I am Randy Clinkscales and the founder of Clinkscales Elder Law Practice, P.A. I have been practicing for many years at a general practice representing families in various matters. Like most of us, circumstances change the course of our lives. In taking care of my grandmother, I discovered that there was a real need for someone to focus on issues facing the elderly and disabled. As a result, in 2005, I focused my practice on elderly and disability law. It did not take long before I began retooling the entire office. I brought in staff members to focus on specific areas. We have a staff member dedicated solely to various benefit planning, such as Medicare and Medicaid. I also brought in a person whose primary focus is Veterans pension benefits. I also discovered that there was a real need for someone to help my clients achieve one of their principal goals – to stay in their home as long as possible or if they needed to move into assisted living or a nursing home, someone who can be sure that they are getting good care. As a result, I brought in someone who has a lot of experience in healthcare – our care coordinators (we now have three) who are assigned to each family that we are helping with a Life Care Plan.

I have been in my current office at 201 W. 11th Street, Hays, Kansas, since 1987. In 1987, my wife and I bought the office and we painted, remodeled, put down new woodwork, installed new carpet and have called it home for almost 30 years. Now, our staff and our practice has outgrown our office so we are going to be moving to 2604 General Hays Road, Hays, Kansas. In the next blog, we will talk about the move.