Responding to the Grieving Client · author of Another Country: Navigating the Emotional Terrain of our Elders, will be a featured keynote speaker at this year’s NAELA Symposium,

February 2000Volume XII ● Issue I

February 2000Volume XII ● Issue I

In this issue...

President’s Message ................. 3

Calendar of Events ................... 5

Peripatetic Essay .................... 16

Available Resources ................ 25

(continued on page 4)

TM

1

IntroductionThe classic American law school

curriculum is neither intended nor de-signed to prepare lawyers for one of thesignificant challenges likely to be facedrepeatedly over a lifetime of active prac-tice: responding to clients who needboth legal advice and are grief stricken.This challenge is not limited to trust andestate lawyers whose work with the be-reaved is a foreseeable, oft repeated partof their practice. All lawyers will comeinto contact with grieving people at sometime, in some way.

Grief comes to people in many formsand under a variety of circumstances,often combining in ways that naturallylead to the need for legal counsel. True,the client may be the surviving spouseof a recently deceased, much loved, long-time marital partner. But no less impor-tant is the role of the personal injury law-yer in recognizing and dealing with griefover other losses: parents of a badly in-jured, totally disabled child; or the em-ployment law attorney whose client haslost a personality-defining job to illegaldiscriminatory treatment; or the domes-tic relations lawyer whose client is ingrief over the loss of a long-term rela-tionship. Nor is grief a stranger to theexecutive suites of major corporationswhose officers consult regularly withcounsel in mega law firms.

Yet lawyers are not trained to recog-

nize the often paralyzing symptoms ofgrief, much less to respond effectivelywhen they do. Perhaps just as signifi-cantly, many lawyers are probably ill-equipped to recognize and deal effec-tively with their own grief, or that of theircolleagues, even when significant legalmatters entrusted to them can be put atrisk. Judgment, decisiveness, energy,competency and ability to act can be im-paired or temporarily destroyed by grief.It is safe to assume, however, that themajority of lawyers would have difficultyadmitting — to themselves, to their col-leagues, and perhaps most especially, totheir clients — that they have lost theability to function effectively because oftheir own grief over the loss of a lovedone, whether through death, divorce,separation, illness, or injury.

Images of control, mastery and win-ning predominate in our legal culture.Vulnerability, neediness and dependencyare definite taboos. But grief can disablea lawyer from functioning effectively (andethically) just as surely as alcoholism,drug addiction, depression, mental ill-ness, or aging. Lawyers are trained to bevaliant gladiators – to win cases, to res-cue clients, and to be in full charge. Yet,lawyers have a duty to their clients, totheir law firms, and to themselves toknow how to recognize and respond ap-propriately whenever grief enters intotheir professional lives.

Responding to theGrieving Client

By Nicholas McConnell, Esq.,Naomi Naierman, and Johanna Turner

Recognizing andResponding to theGrieving Client

When you encounter a grievingclient in your practice, a deeper un-derstanding of grief can be invaluable.When grief is left unresolved, it canshatter an individual’s self-worth, in-terfere with cognitive function, andleave the person emotionally unwill-ing or unable to act in his/her own bestinterests. Grief may even precipitateclinical depression, violence or seriousphysical illness. Grief has the powerto make the strongest person helpless.Given this potential impact, it is notsurprising that the bereaved client maybe unable to tend to business and le-gal decisions, including the dispensa-

2

NAELA News ● February 2000

PHOTO OF AUTHOR-Clinical psy-chologist and lecturer, Dr. Mary Pipher,author of Another Country: Navigatingthe Emotional Terrain of our Elders, willbe a featured keynote speaker at thisyear’s NAELA Symposium, to be heldMay 3-7 in Philadelphia, PA. One of Dr.Pipher’s prior books, Raising Orphelia,has been hailed as an insightful look atthe intergenerational cultural conflict be-tween teens and their parents. Now, Dr.Pipher has turned her thoughtful atten-tion to the culural differences betweenour elders and their children. AnotherCountry: Navigating the Emotional Ter-rain of our Elders is a book that shouldbe required reading for every elder lawattorney. This will be a must-attend ses-sion at a symposium that is sure to ad-dress issues of interest to all those in at-tendance.

Five Sessions on EthicsFollowing Charlie Robinson’s rous-

ing luncheon presentation at the ChicagoInstitute in support of multi-disciplinarypractices, a general session entitled “TheQuestion of Multi-Disciplinary Practice:Point-Counterpoint” will be presented atthe Philadelphia Symposium. The ses-sion, featuring Lawrence Fox, Esq. andJames Jones, Esq., will be moderated byAlex Moschella, Esq. chair of the NAELAMulti-Disciplinary Practice Task Force,and will be followed by a breakout ses-sion devoted to audience questions andanswers. A. Frank Johns will pass theNAELA leaderhsip torch to incomingpresident Judith Stein, but before he re-linquishes the presidency, he will addressthe question of why elder law attorneysought to be enabled to represent familiesas a unit. In addition, Rebecca Morgan,Esq. and Robert Fleming, CELA, will mod-erate an interactive ethics presentation.Finally, John Lombard, Esq., ACTEC El-der Law Committee Chairman, will present“The Patient’s Perspective on MedicalCare”—an insightful and proactive analy-sis of the problems facing our clients.

Mastering Litigation“What Elder Law Practitioners

Should Know about Ligitation,” a ses-sion geared to NAELA members whocustomariy do not litigate or litigate lim-ited areas, will be presented by John J.Ford, Esq., chair of the NAELA Litiga-tion SIG, and Susan G. Haines, Esq., vicechair. Four panelists from different per-spectives will present ideas on how tobetter serve clients in evaluating, litigat-ing or referring claims presented to thepractitioner: What is the case worth?What will it cost to litigate? Can you beata State agency in court? and more.

Rene H. Reixach, Esq. and MaryCatherine Rabbitt, Esq. will examine thepros and cons of federal court litigation

including injunctive relief, limitations ondamages, emerging issues under the FalseClaims Act, and an assessment of recentSupreme Court decisions affecting accessto federal courts, due process and Sec-tion 1983 in the session titled “LitigatingMedicaid Claims in Federal Court.”

Settling a personal injury case wherepublic benefits are involved is like tryingto find a path through a dense jungle!The most serious of the pitfalls is themalpractice quicksand—difficult to spotand once you’re in it, it is tough to getout. “The Role of the Elder Law Attorneyin the Settlement of a Personal InjuryCase,” by Susan G. Haines, Esq. will guideattorneys through the Medicare and Med-icaid quicksand.

Experience All thatPhiladelphia Has to Offer

Philadelphia is an unusual major city—a city of neighborhoods. TheWarwick—site of the NAELA Symposium—is located in the RittenhouseSquare District, a large, tree-lined, grassy park area in the midst of a busy partof Center City Philadelphia. Nearby you will find Chinatown, South Philadel-phia, with its largely Italian population and neighborhood restaurants. Alsoclosely located is University City, the neighborhood with an international fla-vor surrounding the University of Pennsylvania.

There is something in Philadelphia to appeal to everyone: the nationalhistoric area that includes Independence Hall, the Liberty Bell, and the BetsyRoss House, mu-seums, upscaleshops, boutiques,night life, and thenation’s oldestzoo. Philadelphiais also known forits many goodrestaurants. Don’tmiss a great sym-posium in a greatcity—bring thekids along andmake it a familygetaway you’resure to remember!

Nationally Renowned Author toKeynote Philadelphia Symposium

Various Tracks to Offer Something for Everyone

3



President’s MessageNooks of Nostalgia

By A. Frank Johns, CELA

A. Frank Johns

Just what is a nook?1 Andhow does a nook compare to acranny? Are there ever nookswithout crannies?2 Howeverthose spaces, nooks and cran-nies, are described, we carrymany of them in our minds.Some are bio-nooks of func-tion, like the information storedfor walking, talking or seeing.Some are bio-nooks of history,like short-term history (thename of a person you met yesterday), orlong-term history (the name of your kin-dergarten teacher). Nostalgia3 is a spe-cial kind of space, nook or cranny in themind – something in the past, longinglyremembered.

For any place other than Tallahas-see, that October evening was very hot.In Tallahassee, hot is often how theweather is described all the way up tothe Florida State-Florida game playedsometime around Thanksgiving.4 Thathot fall night in Tallahassee had with itthe usual humidity level hovering above90 percent. If not already cooled by thoseafternoon thundershowers you can seta clock to, then the heaviness of the aircould be hard to live with, even for bornand bred Floridians. That October night

in 1964 was one of thosenights when the storms hiteverywhere but there.Clothes stuck to flesh likebreakfast eggs to anunsoaked skillet too long inthe day.

It was my freshman yearat Florida State. In order toearn my way through school,I held down a job as studentassistant at the campus Pres-

byterian house. On that hot, steamyevening, as the sun loosened its holdand dusk began to settle, I made my waydown Copeland Street at the entrance toFSU and Wescott Hall, by Bill’s BookStore and across West Park Avenue,lined with large water oaks, hanging acanopy of Spanish moss, gently wavinghigh above the median. After rushingacross the sprawling campus, the refresh-ing air-conditioning was downright chill-ing as I entered the student facility. Myjob was to be at the student house, as-suring the speakers that everything wasin order, greeting other students and as-sisting in the preparation of the eveningmeal (for some the attraction). As new asI was, I didn’t really know that the real

The NAELA News is published by theNational Academy of Elder Law Attorneys, Inc.

1604 N. Country Club Road ● Tucson, AZ 85716-3102520/881-4005 ● 520/325-7925 Fax ● www.naela.org

© Copyright NAELA 2000

Articles appearing in the NAELA News may not be regarded as legal advice. The natureof elder law practice makes it imperative that local law and practice be consulted beforeadvising clients. Statements of fact and opinion are the responsibility of the author anddo not imply an opinion or endorsement on the part of the officers or directors of NAELAunless otherwise specifically stated as such.

Publications Chair .......................................................... Howard J. Altas, CELA, Melville, NYCo-Editor .............................................................................. Alex L. Moschella, Somerville, MACo-Editor ......................................................... William J. Brisk, CELA, Newton Highlands, MAAssociate Editor ............................................................. Sharon K. Gruer, Great Neck, NYAssociate Editor ................................................................... Steven H. Stern, Islandia, NYExecutive Director ........................................................................... Laury L. Adsit, Tucson, AZCommunications Director ................................................. Jihane K. Rohrbacker, Tucson, AZCommunications Coordinator .................................................. Kimberly Ehmke, Tucson, AZGraphic Designer ..................................................................... Kristin L. Hager, Redmond, WA

Board Of DirectorsBoard Of Directors

1999 - 2000National Academy ofElder Law Attorneys

P R E S I D E N TA. Frank Johns, CELA

Greensboro, NC

P R E S I D E N T - E L E C TJudith A. Stein, Esq.

Mansfield, CT

V I C E P R E S I D E N THoward J. Atlas, CELA

Melville, NY

T R E A S U R E RCharles Patrick Sabatino, Esq.

Washington, D.C.

S E C R E T A R YWilliam J. Browning, CELA

Worthington, OH

P A S T P R E S I D E N TRebecca C. Morgan, Esq.

St. Petersburg, FL

D I R E C T O R SDonna R. Bashaw, CELA

Laguna Hills, CA

Thomas D. Begley, Jr., CELAMoorestown, NJ

Dennis J. Christensen, Esq.Mount Pleasant, SC

Joyce M. Collins, Esq.Hyannis, MA

Ronald A. Fatoullah, CELAGreat Neck, NY

Dan Kellogg, CELARenton, WA

John (Jay) F. Kearns, CELAWest Hartford, CT

Bernard A. Krooks, CELANew York, NY

Julia E. Merkt, Esq.El Paso, TX

Alex L. Moschella, Esq.Somerville, MA

Julie R. Osterhout, CELAFort Myers, FL

Steven C. Perlis, CELAArlington Heights, IL

Mary T. Schmitt Smith, CELABloomfield Hills, MI

John J. Wargo, CELARacine, WI

Stuart D. Zimring, Esq.North Hollywood, CA

E X E C U T I V E D I R E C T O RLaury L. Adsit

Tucson, AZ

M A N A G I N G D I R E C T O RDeborah J. Barnett

Tucson, AZ

4


tion of wills and trusts.The challenge for you, the witness

to another person’s grief, is to offer hon-est encouragement and patient, sensitivesupport. These responses can help chan-nel grief’s power toward wholeness. Youmay be responsible for some aspect ofthe individual’s well-being, and the bur-den and complexity of the relationshipmay seem hard to bear. Remember thatnone of us has the answers and none ofus can alleviate the pain, but we can con-tribute our understanding, practical as-sistance and respect. Although it is easyto become caught up in the emotions ofgrief, your value to your client will bestrengthened if you can find the rightbalance.

Helpful Responses to aGrieving Client● Take stock of your own grief.

Your first responsibility is tounderstand your own grief historyand reactions. Every loss encoun-tered may trigger feelings of yourown. If you have unfinished griefbusiness, keep it separate from thesupport you now offer. Theoccasion can serve as a reminder tobe mindful of your own griefreactions.

● Acknowledge the loss and name thename.You may shy away from speakingfirst of the loss. Yet by acknowledg-ing it before you say anything else,you make clear that there is nothingmore important. Use the specificname; it is comforting to themourner to hear the name live on, “Iwas very sad to hear of Bill’s death,”or, “I’m so sorry about Jeanne’sdeath.”

● In early conversations, do a“memory check.”Memories are the griever’s constantcompanions, but at times they maybe difficult to bear. Because of theirpower, memories can elicit lovingcomfort or stabbing pain. You mighttry phrases like, “I know you havesome fine memories of Ruth,” andwait for what follows. If remem-

brances flow, add your own storiesthat illustrate positive qualities ofthe person who died.

● Honor the deceased in a meaningfulway.Close friends and family memberswill have their own types of memori-als, but a charitable donation is awelcome expression from any friendor acquaintance. Note the family’sdesignated charity, and if you aren’taware of a preference, try to choosea charity that indicates: “I rememberwhat was important to Don.”

● Use the power of touch.The mourner’s need for physicalcontact is powerful, as is themessage this contact conveys. Ifappropriate for the situation and/orperson, a gentle hand on theshoulder, or light touch on the handcan often express what wordscannot.

● Be comfortable with tears.Expect tears. You may offer a tissue,but stay put when tears flow. Ifpossible, don’t let your bodylanguage communicate your discom-fort. If you are tearful yourself, youare giving the gift of honest soul-to-soul connection. It is alwaysappreciated and never inappropriateto be sincerely moved, no matterwhat the relationship.

● Acknowledge personal experiences.By briefly referring to your ownlosses, you communicate that youare emotionally available andunderstand the power of grief. Butremember that this is not about you,it is your client’s experience that isimportant at this moment. Do notassure grieving individuals that youknow just how they feel. Sincehistories and relationships areunique, you don’t really know.

● You don’t have all the answers.As compassionate or resourceful asyou may be, you are only oneparticipant in the grief journey. Andalthough many of these suggestionsare part of therapeutic technique,you are not a therapist. You mayhave a personal need to makeeverything better, or the bereavedmay want to transfer to yourshoulders the role of the person who

Responding to theGrieving Client(continued from page 1)


National Academy ofElder Law Attorneys

ARIZONAKay RichterTucson, AZ

(520) 318-1301

CAROLINASMichael J. McCannHendersonville, NC

(828) 693-0811

Patricia L. HarrisonColumbia, SC

(803) 256-2017

NORTHERN CALIFORNIAGregory Wilcox, CELA

Berkeley, CA(510) 665-8400

SOUTHERN CALIFORNIAElizabethanne M. Angevine

Whittier, CA(562) 464-1150

COLORADOR. L. Steenrod, Jr.

Denver, CO(303) 534-5100

FLORIDAG. Mark Shalloway, CELA

West Palm Beach, FL(561) 686-6200

KANSASKristin L. McCord

Mission, KS(913) 831-4045

ILLINOISHoward S. Berk

Chicago, IL(312) 332-4622

MASSACHUSETTSEmily Starr

Worcester, MA(508) 754-8882

MISSOURIMartha C. Brown

St. Louis, MO(314) 961-6476

NEW JERSEYEugene Rosner, CELA

Clark, NJ(732) 382-6070

TEXASJulia E. MerktEl Paso, TX

(915) 545-1063

WASHINGTONSean BleckSeattle, WA

(206) 340-2200

Please note that this list does not include theNAELA chapters currently in formation.

Chapter PresidentsChapter Presidents

5


Responding to theGrieving Client(continued from page 4)

died. Neither inclination is healthyor practical. You may need to clarify– for both of you – what your roleshould be.

● Allow a reasonable amount of timefor making decisions.Big decisions are best delayed untilthe newly bereaved are well on theirway to acceptance. Yet there arealways some choices that must bemade. Describe the tasks andtimelines well in advance, and workto create a calm environment, e.g.,“We need to submit an inventory ofthe estate by May 15. We cancontact the broker in March, butlet’s talk about who can help you gothrough the household items inApril to assess their value.”

● Know the danger signs.The power of grief can seem jarring,so it’s natural to wonder whenprofessional help may be important.It is wise to intervene if youobserve:● signs of drug or alcohol depen-

dency,● deepening of extreme, exagger-

ated emotions,● prolonged isolation,● physical or cognitive changes,● preoccupation with death, or,● verbalization of suicidal

thoughts.

● Identify resources and use them.In addition to traditional localresources, such as religiousadvisors and licensed professionals(including psychologists, psychia-trists, social workers, and nursepractioners) the hospices in yourcommunity will be staffed withtrained grief counselors who canidentify even more resources in yourarea. Most hospices offer griefeducation and bereavement care as acommunity service. If you can’tlocate a program in your area, callthe National Hospice Organization’sHelpline at 800-658-8898.

● Build your own “GriefCompetencies”To enhance your skills and tobecome more comfortable with the

subject of grief, consider what youcan do to build your own “griefcompetencies.” Start a journal, joina book discussion, share copingstrategies, enhance your resourcefile, or get training on listeningskills. If you have access to acomputer network, use it to create abulletin board of ideas with yourcolleagues and friends.

The Power of GriefAs a witness to grief, your own re-

wards can be extraordinary. While sup-porting a grieving client, you will learnimportant lessons about yourself andabout human nature. Your presence andyour gifts will contribute to mutual heal-ing. You will be making a powerful state-ment that good lawyering goes beyondthe technical boundaries of the lawschool curriculum. And, above all, youwill be helping to create a climate of hopefor someone who has turned to you at atime of deepest need.

Nicholas McConnell, Esq., Member,Jackson & Campbell, LLP, in Washington,DC; Naomi Naierman is President andCEO of the American Hospice Foundation;Johanna Turner is Principal of Said &Done

Calendar of EventsCalendar of Events

February 21-25, 2000Second Annual Conference “ConductingElder Abuse Investigations” in Tucson,AZ, sponsored by the Pima County ElderAbuse Task Force. For registrationinformation contact Detective SergeantTammie Penta at (520) 791-4499, ext.1720.

March 18-21, 2000Alzheimer’s Association’s 12th AnnualPublic Policy Forum, “AlzheimerAdvocacy: The Future is Now,” CapitalHilton Hotel, Washington, DC. For moreinformation contact the Alzheimer’sAssociation at (202) 393-7737 or email [email protected].

March 25-28, 2000American Society on Aging’s AnnualConference. Town and Country Hotel andConvention Center, San Diego, CA. Formore information contact ASA at (415)974-9600.

March 28-31, 2000The National Council on the Aging’sAnnual Conference & Expo, WashingtonHilton & Towers, Washington, DC. Formore information contact NCOA at (202)479-1200 or visit www.ncoa.org.

April 18-19, 2000Oregon State University’s AnnualGerontology Conference, “The ChangingContext of Aging,” CH2M Hill AlumniCenter, Corvallis, OR. For moreinformation contact Terri Allen at the OSUProgram on Gerontology, (541) 737-1014,or by e-mail at: [email protected].

May 3-7, 1999The National Academy of ElderLaw Attorneys’ Symposium onElder Law, “The Elder Law Practicewith Quality and Compassion,”May 2-7, 2000, The Warwick,Philadelphia, PA. For moreinformation contact Jenifer Moweryat (520) 881-4005, ext. 114, or e-mail: [email protected].

If you find the above sugges-tions helpful, you may benefit fromadditional ideas provided in: ThePower of Grief: Responding to theBereaved, a publication of theAmerican Hospice Foundation(AHF). For a sample copy, send$3.00 and a self-addressed stampedenvelope to American HospiceFoundation, 1130 Connecticut Av-enue, NW, Suite 700, Washington,DC 20036-4101. An order form isavailable at the AHF website,www.americanhospice.org; or call202-223-0204. The American Hos-pice Foundation offers other book-lets as well: Grief at Work: A Guidefor Employees and Managers; Griefat School: A Guide for Teachers andCounselors; and, Grief and Faith:Spiritual Paths Through Loss. (continued on page 13)

6


President’s Message(continued from page 3)

attraction for that evening was thespeaker, Doak Campbell. By the end ofDoak Campbell’s talk, not only would Iknow that he was the real attraction, butI would carry his words with me, never toforget them.

But that is notthe nook of nostalgiato which the title re-fers. The title to DoakCampbell’s talk was“Nostalgia.” As stu-dents sat talking toeach other, waiting forthe speaker, an oldman, shouldersbowed and slumpedby age, made his wayin a shuffling gait to the front of the room.He stood before the group in silence,waiting. One by one, the audience real-ized he was standing there in silence,waiting for theirs. A hush fell over theroom. Doak Campbell took a step forward,his rounded shoulders straightening, hisjaw lifting to give salutation. The word“NOSTALGIA“ rang in the air, injectingthe room with a deep, sonorous tonalquality, at once commanding attentionrightfully due. President EmeritusCampbell asked how many of us werefreshmen at Florida State. Most of us inthe audience raised our hands. PresidentCampbell went on to explain that for allthe years that he had been at Florida Stateand president of the University, he hadgained a keen understanding of what wasgoing on with the freshmen in their sec-ond or third month of their first year ofcollege—probably away from home forthe first time for more than a month ortwo, and a month or two away from theThanksgiving holidays when they wouldreturn home. When he observed thatmost of us were probably writing homewith more frequency and longing, themurmur of the audience confirmed that itwas more than probable. Campbell askedhow many of the students in the roomwho were freshmen had been able to gethome since the fall semester began. Theresponse was unanimous that none ofus had yet been home. Campbell asked ifwe were calling home more often. We

agreed we were. Campbell asked if weever believed we would be writing thatmany letters home and writing the kindsof things we were writing to our familymembers, even to our younger brothersand sisters, if we had any. The buzz fromthe response in the audience was clear;

we understoodwhat he was say-ing. Campbellthen explainedthat those werethe best ex-amples of nostal-gia that he couldgive: that each ofus was longingfor “going homeagain!” Each ofus was realizing

one of the most important changes in lifehad just occurred. The change to inde-pendence and autonomy had us grap-pling with the freedoms that come withit.

As President Emeritus Campbell con-cluded his remarks, he left us with thewisdom of his years, and the experienceof his professional life. He shared withus how understandable it was to be home-sick. He invited us to embrace those feel-ings because those feelings are the deep-est part of what it means to live, to knowlife—longing for the love of family.

Nooks of nostalgia. The elder citi-zens that we serve have countless nooksof nostalgia that they bring with them totheir elder law conferences. As our eldercounselors make clear to us at every turn,it is mandatory that we listen to themshare their histories with us, and allowtime for nostalgia. This is true in any pro-fession where older Americans are beingserved. A literal example of how suchcounseling occurs is found in MaryPipher’s book Another Country: Navi-gating the Emotional Terrain of Our El-ders. At my request, Dan Kellogg andhis 2000 Symposium Committee have ar-ranged to bring Dr. Pipher to the 2000Symposium as one of NAELA’s keynotespeakers. Mary Pipher does for the eld-erly in Another Country, what she didfor teenage girls in her New York Timesbestseller Reviving Ophelia. Pipher art-fully describes the elder patients that she

counsels, at times sharing with us thefamily care giving that she provided tomembers of her own family. She adds cre-ative, perceptive opinion about all thingssurrounding the elder citizens that weserve. Deliciously inviting, Pipherweaves stories of her patients weavingstories. Nostalgia is the order of the dayas they describe the events and thememories that gave them identitythrough life, give them identity still.

We are privileged to receive nooksof nostalgia from the clients we serve.Take for example, Bob and Mary. In theirmid 70’s, Bob and Mary are doing well.Life is comfortable for them, as it is forthe three children that they have raised.A functional family, as elder law attor-neys would tend to describe them forpurposes of unitary or family identity asthe client we serve.5 A recent medicalscare landed Mary in the hospital. Shewas out and doing well within days, butthey were hearing from friends and neigh-bors that there were all kinds of thingsgoing on in Medicaid and in Medicarethat they just didn’t understand andthey wanted some advice from a lawyer.

As I eased them into a review of theElder Law Questionnaire, a standard formfor most of us, I asked if each of themwould share with me a bit of their his-tory so that I could have an understand-ing of just who I was speaking with. Bobstarted first, allowing as how he was oneof ten children, with five brothers andsisters still living. Bob explained howthey actually started from nothing, noth-ing but scratch. But they scratched theirway working when times were bad in the‘30s. Times were even worse for Bob andhis family because his daddy died at theage of 41 in 1937, leaving his mama toraise ten “youngins.” Bob surmised thatif it had not been for good neighborsand the Legionaries they might not havemade it. Volunteering for World War II,Bob thought he was joining the Navywhen he actually ended up in the Ma-rines, serving in the Pacific from 1942 to1945. Bob made mention of Guadal Ca-nal, but not much of it. Given the oppor-tunity, Bob probably hasn’t made muchmention of it ever since. And then atwinkle came to Bob’s eye and he was in

The elder citizens thatwe serve have countless

nooks of nostalgia that theybring with them to theirelder law conferences.


7


P A I D A D V E R T I S E M E N T

one of those nooks of nostalgia. He said,“But you know I came home on leaveone time and kidnapped Mary and hauledher off to South Carolina and got mar-ried over a weekend.” I turned and lookedat Mary, an understated, rather stoic char-acter who for the first time in the confer-ence beamed a big grin, her eyes glisten-ing. She started in on Bob, and beforeshe could get any words out of hermouth, I said, ”Now wait a minute, Mary,this is Bob’s side of the history. Let’s lethim finish.” Bob finished with what wassort of ordinary in his estimation. I turnedto Mary and said, “Okay Mary, now it’syour turn!”

Living up to my first impression ofher, Mary described herself as a reallydull person. “I haven’t done much ofnothing. Bob and I made it through jun-ior high, but not much further.” I inter-rupted, asking if Bob actually kidnappedher? Without the miss of a beat, Maryshot back, “No way, it was the other wayaround, he just didn’t know it!” Mary’s

grin stretched from one ear to the otheras those remarks landed in the room. Bobshook his head, admitting that he hadbeen eyeing Mary every since they werein first grade and if the truth be told, hewould do whatever she wanted, and he’sstill doing it now.

Nooks of nostalgia. NAELA has itsown nooks of nostalgia. If you let them,those 35 or so members, honored as thefounding members, will tell you storiesat the drop of a pin about how and whereNAELA started in San Francisco, Chi-cago, San Diego or Tucson, dependingupon the one speaking. Other NAELAnooks of nostalgia abound. ConsiderGarey Eakes. Many members may notknow Garey, NAELA president 1991-92.Many of us know Garey all too well. Ieven made reference to Garey in theNAELA Quarterly after the Institute inChicago.6 It was the infamous lun-cheon—the one where the panel at thedais included Peter Strauss, and moreimportantly, Professors Luther Averyand Jeffrey Pennell discussing ethicsand elder law. While Professor Pennell

was more careful with his words aboutwhat elder law attorneys do that moveto the very bounds of the practice of law,Luther Avery did not mince any words.He declared that for elder law attorneysto do Medicaid planning was tantamountto unethical. Garey couldn’t take it any-more. He found himself on his feet in themiddle of the room yelling at the top ofhis lungs with his neck about as red as itcould get, articulating a rebuttal in loudand boisterous terms. Garey got that offhis shoulders, venting with passion whatmany in the room felt, although theNAELA leadership at the time was notso sure it landed well in that forum. Theheat and passion that Garey expressedwas representative of the tenor of thetimes, generating from the offensive ac-cusations and political attacks by acouple of long term care insurance huck-sters and pitchmen directed at NAELAmembers for providing as a legal serviceasset preservation techniques by whichclients gain Medicaid eligibility, oftencircumventing the need for long term care



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8


insurance.Another NAELA nook of nostal-

gia. Most of you know Vincent Russo,who has not been away from us as muchsince his term as president. El Presidenteserved from 1992-93, and continues tobe visible and involved in many ofNAELA’s on goingprojects. Do youremember the lun-cheon that distin-guished Vincent?In 1993, NAELAheld its annualsymposium in At-lanta. Noteworthywere GeraldineChampion andVincent Russo be-ing interviewedlive on CNN, andthe first stage pre-sentation of TheGame of Aging, acreative and funnyluncheon presen-tation created byVincent.

Vincent tookthe subjects of ag-ing and the historyof NAELA as thecontent of a Jeop-ardy-like game forthe Saturday luncheon. While there is avideotape somewhere (Vincent couldn’tfind it), Vincent nostalgically volunteeredsome of what he remembered in a recentlywritten memo. With regard to the con-testants, he had invited a number ofNAELA leaders (i.e., NAELA Fellows)to participate in the Game of Aging. Hewas surprised that a number of those heasked did not want to participate be-cause they were concerned that theymight be embarrassed during the game.Ultimately, the individuals participatingin the program were Allan Bogutz ofTucson, AZ and Victoria, British Colum-bia (NAELA Fellow and 1988-89 NAELAPresident); Scott Severns of Indianapo-lis, IN (NAELA Fellow and 1989-90 and1990-91 NAELA President); CynthiaBarrett of Portland, OR (NAELA Fellow

and 1993-94 NAELA President); DanFish of New York, NY (NAELA Fellowand 1994-95 NAELA President); andRon Landsman of Bethesda, MD(NAELA Fellow). Vincent rememberedthat there was a special guest who didnot know that he would be asked to par-ticipate—Harley Gordon of Boston,MA.

Having cho-sen the partici-pants and con-firmed their accep-tance, Vincent ex-plained how heorganized TheGame of Aging.There were fivecategories, withfive questions ineach category, in-cluding bothsingle and doublejeopardy. Vincentremembers that inthe two gamesthat were playedthe categories in-cluded topic areassuch as Medicaid,The Code By Sec-tion, Health CareDecisions and ad-vance directives,etc. There weresixteen categories

that Vincent utilized for the game. Asthe categories were displayed onoverheads, Vincent scripted how overtwo hundred questions with answerswould be asked of the participants asthe program progressed.

Vincent asked Ira Wiesner(NAELA Fellow and 1996-97 NAELAPresident) to act as the judge. To add tothe authenticity, Vincent played theJeopardy game theme as backgroundmusic; piped in “applause” when appro-priate; arranged for prizes to be givenout, including cash (not real); organizedthe Management Plus staff, includingexecutive director Laury Adsit, to marchout during the final jeopardy questionplaying the Jeopardy game theme songon kazoos. Vincent involuntarily enlistedhis family as well, having Dante and

Elizabeth handing out the prizes andElizabeth announcing the change overfrom one jeopardy game to the next withplacards (Vincent wrote that Elizabethwas truly embarrassed.)

Vincent remembered one memorable,nostalgic moment when Dan Fish ques-tioned an answer given by another par-ticipant because it was not in the form ofa question. Vincent distinctly rememberswhen the audience turned on him, grow-ing hostile when he started asking diffi-cult questions, such as the tax questionsin The Code By Section category. Thecrowd even hissed when he asked a spe-cific “state” question and the only par-ticipant easily answering the questionwas the one residing in the state of thequestion (a New York question answeredby Dan Fish.). Vincent did not rememberwhich participant ultimately won TheGame of Aging. When he called Ira andDan, they did not remember the winnereither (three of our past presidents expe-riencing a senior moment). Vincent be-lieves history will judge The Game ofAging as a hit with all who were there.Vincent’s lasting impression was thatevery one had a good time and it was alot of fun. An epilog: Vincent never imag-ined what a grueling experience it wouldbe standing up there keeping the momen-tum going for that length of time. TheGame of Aging was a hoot, providingthe second generation of NAELAians(like me) a better understanding of agingand of NAELA’s history.

At my request, during the NAELASymposium in San Diego, Allan Bogutzagain shared with us the sensitivity“brown bag” luncheon where we had todon those things from the lunch bags onthe tables that made us walk, talk, feeland act like our elders suffering throughdisabling situations at the end of life’sprocess. It might be time for Vincent toscript the second run of The Game ofAging. Send him cards and letters.

Each of you has your own nooks ofnostalgia. Some of them about NAELA. Iinvite you to share them with the editorsof the NAELA News so that NAELAmight be able to chronicle its past, allow-ing members to longingly remember thehistory of their organization, never for-getting how it all began.


Each of you hasyour own nooks of

nostalgia. Some of themabout NAELA. I inviteyou to share them with

the editors of theNAELA News so that

NAELA might be able tochronicle its past,

allowing members tolongingly remember the

history of theirorganization, never

forgetting how itall began.

9


Thoughts on NAELAand Caring

by Harley Gordon, Esq.

I went to visit my dad in the hospi-tal last summer. I peaked my head in theroom and quickly left thinking the staffhad moved him. Surely this man lyingcradled by tubes and tethered to life sup-port systems could not be my father. Itwas.

Lewis Gordon, the tough, opinion-ated no-nonsense patriarch of our fam-ily had suffered a stroke 10 years earlier.The health care system did exactly whatwe all have come to expect: it kept himalive. Unfortunately, it also created thenatural result we all will face because ofthat success - chronic illness.

As elder law attorneys we see andhear these life dramas daily. If heroism isdefined as being able to bear the un-bearable for one more minute, we seeheroes everyday. We are privileged tohelp families as they struggle to makethe right decisions for loved ones suf-fering from chronic debilitating illnesses.Often there is no right answer and itseems that whatever they do is wrong.We can’t take away the heartache butwe can offer the counseling, the minis-tering people need as they bear the un-bearable.

Speaking for myself and I believemany other practitioners, who deal withlong-term care issues, my practice is fo-cused on crisis situations. Most peopledo not plan for the possibility of inca-pacitation. Rather they believe it will nothappen or if it does someone will takecare of them. It is supported by the be-lief that Medicare or Medicaid will payfor that care.

We all know that is not the case.We all know that the housing and ser-vices our clients need to enable them toremain independent and at home are notcovered in the long term by Medicare orMedicaid.

Unfortunately, NAELA has beenperceived by its critics both in and outof Congress as an organization that fo-cuses on using Medicaid as an entitle-

ment program for the middle class. Rightor wrong it is the perception that countsand in the arena of public policy we havetaken more than our share of bodypunches.

One effect is that our role in the de-bate on how long-term care will be de-livered and paid for is diminished whenwe are viewed with suspicion by stateand federal policy makers. NAELA hastoo many good ideas promoted by toomany dedicated members to be left onthe sidelines.

NAELA also has a responsibilityto its members to promote programs thatboth enhance knowledge and opportu-nities to increase business. Both thisand our commitment to contribute to thenational debate about the future of long-term care are key elements in our mis-sion statement.

Approximately 18 months ago, theNAELA Board of Directors voted to en-ter into a relationship with a company Ifounded. The Corporation for Long-TermCare Certification was created to offerthe long-term care insurance industryits first professional designation CLTC(Certified in Long-Term Care). The pro-gram has the support of major insurancecarriers, rank and file agents and bro-kers and state regulators in the form ofcontinuing education credits.

The goal is two-fold. The board be-lieves that involvement with the indus-try gives it the opportunity to influenceboth the content of policies and howthey are marketed to consumers. Sec-ond, it believes that the arrangement willlead to increased business for membersbecause agents and brokers will be morewilling to refer clients to lawyers whosupport the sale of insurance if appro-priate.

Long-term care is a profession.Agents and brokers who make a com-mitment to understand the complexitiesof this field are far more likely to makean appropriate sale. That is exactly the

purpose of the CLTC designation. The 8part multidisciplinary course is the re-sult of collaboration with NAELA mem-bers and other professionals in the field.NAELA has agreed to both create andgive the mandatory test at locationsthroughout the country.

The board hopes that NAELAmembers will be more likely to supportthe sale of long-term care insurance if itis done so by professionals with the cre-dentials to help solve the long-term careneeds of clients. Part of the solution isreaching out to elder law attorneys forassistance in the planning process.

The life insurance and legal profes-sion have always been natural allies inthe field of estate planning. The sameshould also be the case with long-termcare representatives and elder law attor-neys. It is time to move from suspicionon both sides, often fostered by outsid-ers who relish dissent and use it for theirown ends, to one of cooperation andinclusion.

NAELA members have the oppor-tunity to “do well by doing good” byreaching out to those agents and bro-kers who make the commitment to getcertified. Both the Board and I encour-age you to work closely with these indi-viduals who want to do the right thingby their clients.

I understand first hand the impor-tance of long-term care insurance. I hadpurchased a policy for my dad. My momturned to me in his hospital room to askif the policy was still in force. All shewanted to do was take her husbandhome. My dad died August 13 at theage of 77.

He never used the policy but to mymother it scarcely mattered. She told melater that just the thought of it beingavailable comforted her.

I’m honored that the Board of Di-rectors has decided to join forces in pro-moting the responsible sale of a prod-uct that offers the financial resourcesthat allows people to keep their commit-ments to their families and those samefamilies to keep their commitments totheir loved ones.

I look forward to working with theboard and all of you in the future.

10


Non-lawyersare sometimessurprised whenlawyers acknowl-edge that the le-gal system is notwell-suited tosome kinds ofproblems. Thatsurprise willprobably turn toastonishment atthe suggestionof two elder lawpractitioners in anew book pub-lished this week:

“We begin,however, withthis short cau-tionary chapter,with a warning ofthe dangers of using lawyers and the lawto solve family problems. Mediation andcounseling promise much better resultsfor you and for your family.

“The law isn’t good at resolving fam-ily conflicts. Lawyers work best in aworld of strangers, where they can snarlquestions, point fingers, and stamp feet.When the dust settles, strangers pay upand go home. Scars mend or are forgot-ten.

“Kin never walk away; kin are forthe long haul.”

This short excerpt from Fifty andBeyond: The Law You and Your ParentsNeed to Know is typical. The new bookon elder law is lively, entertaining, infor-mative, thought-provoking and filledwith a surprising amount of detail aboutthe legal issues faced by the rapidly

growing commu-nity of olderAmericans.

Written byUniversity of Ari-zona law profes-sor KenneyHegland and Tuc-son elder law at-torney Allan D.Bogutz, CELA,(founding mem-ber and pastpresident of the

National Academy of Elder Law Attor-neys), Fifty and Beyond neatly avoids oneof the problems so often faced in legalwriting for a general audience. Althoughmuch depends on local or state laws, muchis also common among different statesHegland and Bogutz have generalizedwhere necessary, but never at the expenseof useful and detailed information.

The range of topics covered is alsoimpressive. From pension plans and So-cial Security, through grandparents’ visi-tation rights and age discrimination, andall the way to estate planning, nursinghomes and the “right to die,” the authorshave managed to provide details on awide range of legal issues.

Most importantly, however, Fifty andBeyond is fun to read. The lively sense ofhumor never condescends or trivializes,but always contributes to understandingof the legal issue under discussion. Forexample, while discussing age discrimi-nation the authors note that it is unlikelythat an employer will call an older em-ployee an “old goat” just before firing

Book ReviewFifty and Beyond : The Law You and Your

Parents Will Need to Knowby Kenney F. Hegland, Esq., Allan D. Bogutz, CELA.

Carolina Academic Press (Paperback, October 1999); 238 pages;$22.95 at Barnes & Noble and Amazon.com.

Can be ordered fromAmazon.com at this address:www.amazon.com/exec/obidos/ASIN/0890897840/flecurplctucarie

Reviewed by Robert Fleming, CELA

What NAELAMembers Have to Say

About The BookCharles P. Sabatino, Esq. NAELA Board Member

“If you could cross an encyclopedic legal reference with the down-homephilosophy and wit of a Will Rogers you might come up with a book like Fiftyand Beyond. Astoundingly exhaustive in its range of subjects, Fifty providesaccurate, to-the-point legal advice wryly enriched by poetry, humor, and exis-tential musings aimed directly at the baby boomer generation. It might wellhave been titled Zen and the Art of Legal Planning.

Rebecca C. Morgan, Esq., NAELA ImmediatePast President

“Fifty and Beyond: The Law is a book for everyone, even those youngerthan 50! The authors comprehensively cover the subjects about which all of usneed to know as we plan for our futures. The subjects are clearly discussed ina straight-forward way. The authors approach these important subjects withcompassion and wit, making the book entertaining as well as informative. Thereaders will find that the real world examples clearly illustrate the points made,and allow the reader to use these illustrations to easily answer her own ques-tions. The book, at 238 pages, is complete, but reads quickly and understand-ably. This is one book you want to read.”


I didn’t knowphoto size... Ican adjust it ifthis is wrong.

11


NAELA Public PolicyCommittee Opens New

Advocacy FrontierBy Brian W. Lindberg

N A E L A P U B L I C P O L I C Y C O N S U L T A N T

The NAELA Public Policy Commit-tee Chairs Ron Fatoullah, CELA and StuZimring, Esq., recently announced thata new tool to communicate with federalelected officials will soon be available toNAELA members on the NAELAwebsite (www.naela.org). By the end ofFebruary 2000, NAELA members will beable to go to the website and find a num-ber of new capabilities that will enablemembers to:

● Access a guide to Congress,find out who represents you in

Congress, read biographies ofHouse and Senate members,identify staff, researchcommittee assignments andmuch more.

● Write to Congress, thePresident, and other govern-ment officials. You will be ableto use NAELA drafted letters,personalize these letters, andsend e-mails to Congress andothers or print them out formailing.

● Keep up-to-date on hotNAELA issues thoughlegislative alerts.

● Track the status of legislation,committee hearings, and flooraction important to NAELAand you.

● Follow the voting records ofmembers of Congress.

The NAELA Board and the PublicPolicy Committee have been building afoundation for NAELA member advo-cacy activities for several years withtraining and public policy speakers atNAELA symposiums and institutes.We have become active leaders in vari-ous coalitions in Washington, DC andhave written to and met with numerousmembers of Congress on behalf of ourclients interests. We are hopeful thatoffering these additional advocacytools and opportunities will expand theinvolvement of NAELA members in thelegislative and regulatory processes.The new area of our web site will offereducational opportunities to NAELAmembers and will empower us to advo-cate for our public policy agendas. Wewill provide further updates as this newservice evolves.

him; they then manage to work in aninteresting reference to a WinstonChurchill speech, and finish with: “Alas,most lawyers are historical illiterates andmost employers are too cagey to callyou an old goat. (This awkward con-struction in no way suggests that weare calling you an old goat.)”

In 34 chapters and less than 300pages, Hegland and Bogutz have pro-vided truly useful and understandableinformation. Here you can find adviceon living trusts (don’t buy them fromtraveling salespersons-see a lawyer),nursing home admissions (don’t signas “responsible party” for your familymember’s nursing home admission), di-vorce (it’s usually appropriate for oldercouples only if one spouse wants toremarry, or if one spouse is institution-alized and thec o m m u n i t yspouse’s assetsneed to be pro-tected from nurs-ing home costs).You can learnabout door-to-door sales (thethree-day “cool-ing off” periodonly applies to in-home sales), theimportance (anddanger) of durablepowers of attor-ney and how tomake decisions foran incapacitatedspouse or parent.And you can ac-tually enjoy theprocess of learn-ing about all ofthese issues,thanks to thelively writing, thewry sense of hu-mor and the easy-going approach toproblems of greatmagnitude.

Book Review(continued from page 10)


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For more information contact Joanne Bass of the Elder Law Practiceof Timothy L. Takacs at (615) 824-2571 or [email protected];or visit http://www.tn-elderlaw.com/workshop.html.

12


Medicare Appeals UpdateBy Vicki Gottlich, Esq.

N A T I O N A L S E N I O R C I T I Z E N S L A W C E N T E R *

Beneficiaries and their advocatescontinue to grapple with a number of is-sues involving Medicare appeals. Thefollowing article summarizes 1999’s de-velopments.

Grijalva v. ShalalaIn August 1998, the Ninth Circuit

affirmed the lower court ruling in a na-tionwide class action that the Health CareFinancing Administration (HCFA) failedto implement and enforce an adequateappeals process for Medicare managedcare appeals. Grijalva v. Shalala. 152F.3d 1115 (9th Cir. 1998). The govern-ment filed a petition for certiorari whichwas granted in a summary dispositionon May 3, 1999. The Supreme Court, invacating the judgment and remandingthe case, did not indicate that thelower court decisions were wrong,but rather that the lower courtshould analyze the case in light ofits decision in American Manu-facturers Mutual Insurance Co.v. Sullivan, 119 S. Ct. 977(1999)concerning what constitutesstate action, and the changesto the managed care appealsprocess made by the BalancedBudget Act of 1997 and its implementingregulations. Shalala v. Grijalva,119 S.Ct.1573 (1999).

The case is now back before the dis-trict court, and the parties have had pre-liminary settlement discussions. None-theless, advocates continue to reportproblems with the Medicare managedcare appeals process.

New Medicare NationalCoverage DecisionsProcedure

HCFA published a new procedurefor making Medicare national coveragedecisions in April. 64 Fed. Reg. 22619(April 27, 1999). HCFA may initiate itsnew process if there are conflicting car-rier or intermediary policies; medical ex-perts debate the effectiveness of the ser-

vice; a covered service is widely con-sidered ineffective or obsolete; or HCFAreceives an external formal request foran NCD. Formal requests must be writ-ten and must include supporting docu-mentation. When the request is madeby a beneficiary or other member of thepublic, HCFA may gather and preparethe necessary information itself. HCFAwill post on its web site, www.hcfa.gov,any formal request that it accepts for re-

view. HCFA intends to process requestswithin 90 days.

The new procedure, while makingsome improvements, does not addresstwo major concerns. The process stillinvolves a substantial amount of delay.HCFA acknowledges that its 90 daydeadline may not be met where the issueis complex or controversial. If it involvesa technology assessment, the requestmay be referred to the Medicare Cover-age Advisory Committee, which meetsonly twice a year. The 90-day period willrestart if additional information is sub-

mitted, and it does not even commenceuntil after a request is designated a for-mal request. The request can remain in-definitely in the informal stage while evi-dence needed for a formal request iscollected.

HCFA also does not address thelack of an adequate appeals processwhen Medicare coverage is deniedbased on an out-of-date NCD or be-cause HCFA has not yet determinedwhether Medicare will cover a new ser-vice or technology. The Medicare Act,42 U.S.C. § 1395ff (b) (3), prevents con-sideration of the validity of an NCD atthe administrative level. A federal judgewho determines that the record is in-sufficient to support the validity of theNCD must remand the case for supple-mentation of the record and may onlydetermine that an item or service is cov-ered after review of the supplementedrecord.

Because HCFA did not create ameaningful opportunity for benefi-

ciaries to question NCDs in the newNCD procedures, beneficiaries are leftwith virtually no recourse other thanto request a formal determination byHCFA. The onerous NCD processmakes it unlikely that many ben-eficiaries who need a particularservice or technology will sub-mit a formal request and that, ifa request is submitted, it willbe processed in a timelyenough manner to benefitthe requesting beneficiary.

Part B Carriers WillStart Taking Requestsfor Review by Telephone

In September, HCFA issued a finalrule with comment period allowing fortelephone requests for review of aMedicare carrier’s initial determinationof a Medicare Part B claim. 64 Fed. Reg.52665 (Sept. 30, 1999). The regulation,which goes into effect on February 1,2000, implements a proposed rule thatwas issued in July1995.

Previous regulations required a re-quest for review to be made in writingwithin six months of the carrier’s initialdetermination. HCFA justif ies the


13


Medicare Appeals Update(continued from page 12)

change to allow telephone requests be-cause doctors and beneficiaries oftencall the carrier to dispute or protest adetermination orto ask for a clarifi-cation, and sub-mission of a writ-ten request cantake considerabletime and effort.The new rule re-quires a carrier todesignate a tele-phone number asthe appropriatenumber to call torequest review ofan initial determi-nation. HCFAguidance will re-quire all carriers toensure that theyhave sufficientstaff to handle thecalls. AlthoughHCFA determinedthat technical cir-cumstances pre-vent it from allow-ing electronic re-quests for review of initial determina-tions, the agency is still considering thefeasibility of providing this option.

Details concerning how to monitorcalls, the percentage of calls monitored,and other contractor performanceevaluation standards will be issued in aforthcoming Medicare Carriers Manualinstruction. HCFA states in the preambleto the regulations that a carrier mayrecord telephone requests for review ina manual log or in a computer database.Carriers will be required to train tele-phone reviewers to meet the require-ments of the Privacy Act, to seek anappointment of representative form fromsomeone purporting to represent thebeneficiary, and to verify the identifica-tion of a beneficiary or provider whorequests a telephone review. Telephonereview generally will not be available toproviders and suppliers who do not ac-cept assignment unless they have asigned appointment of representativeform.

CongratulationsCertified Elder Law Attorneys

The following individuals have recently completed therequirements to become a Certified Elder Law Attorney by the

National Elder Law Foundation. Congratulations!

Eric R. VargasYakima, WA

Janice D. PasculliNewton, NJ

For more information on how to be come a Certified Elder Law Attorney,contact Brittany Betz at (520) 881-1076, ext. 116, e-mail:

[email protected].

Calendar of EventsCalendar of Events

May 25-26, 2000Continuing medical education conference,“Challenging Dementia in the NewMillennium.” Wyndham Emerald PlazaHotel, San Diego, CA. For moreinformation and brochure contact JoyceZillner or Sue Johnson at (619) 622-5800.

July 9-18, 2000World Alzheimer’s Congress 2000,Washington Hilton and Towers,Washington, DC. For more informationcontact the Alzheimer’s Association at(312) 335-5813 or visitwww.alzheimer2000.org.

Medicare advocates

can expect further

changes to Medicare

appeals procedures in

the coming year.

HCFA continues to

work on additional

regulations to

implement the

Medicare+Choice

grievance and appeals

procedures.

HCFA states that, to avoid confu-sion, the Explanation of Medicare Ben-efits/Medicare Summary Notice (EOMB/MSN) or Remittance Advice forms willnot include details about the telephone

review process.The forms will onlycontain a generalstatement that thebeneficiary maytelephone the car-rier to request re-view. HCFA ex-pects to providethe information“by other means,such as in newslet-ters, seminars, andenvelope stuffers.”

FutureDevelopments

Medicare ad-vocates can expectfurther changes toMedicare appealsprocedures in thecoming year. HCFAcontinues to workon additional regu-lations to imple-ment the Medicare+Choice grievance

and appeals procedures. The DistrictCourt for the District of Connecticut haspending before it cross motions for sum-mary judgment in Healey v. Shalala, a na-

tionwide class action concerning due pro-cess rights when home health benefits aredenied, reduced or terminated. HCFA with-drew on the eve of its effective date a pro-gram memorandum issued in August thatwould have required home health agen-cies to use a mandatory model noticewhen denying, terminating or reducingservices. HCFA claims a new notice willalso be issued shortly.*Vicki Gottlich, Esq.is now employed atthe Center for Medicare Advocacy.

(continued from page 5)

14


Advocates shouldremember these impor-tant coverage rules and

the administration’scommentary whenseeking benefits for

skilled nursing facilitypatients in order to

insure that they obtainthe Medicare coverageto which they are en-

titled.

Medicare Advocacy Corner Important Provisions Reinstated in

Medicare Skilled Nursing Facility RegulationsBy Judith A. Stein, Esq.

C E N T E R F O R M E D I C A R E A D V O C A C Y , I N C .

In July,1998 revisions were made tothe federal regulations which made sig-nificant changes to the Medicare skillednursing facility level-of-care require-ments. The revisions created a lack ofclarity about what constitutes skillednursing and, therefore, about abeneficiary’s ability to receive Medicarecoverage for skilled nursing facility care.This confusionwas resolved oneyear later when im-portant provisionsdefining skillednursing were rein-stated into the fed-eral regulations. 64FR 41670 (July 30,1999).

The 1998changes had elimi-nated “overallmanagement andevaluation of apatient’s care plan,observation andassessment of thepatient’s changingcondition, and pa-tient educationservices” from thelist of examples ofskilled nursing ser-vices which, if de-livered on a dailybasis, qualify a patient for Medicareskilled nursing facility (SNF) coverage.42 CFR §409.33(a)(1)-(3). These servicesare fundamental to basic nursing prac-tice and should, therefore, remain as abasis for determining a skilled nursingfacility level of care. (See 42 CFR Sec-tion 409.32; The Lippincott Manual ofNursing Practice, 1996, page 5.) Thechanges resulted in the identification ofonly certain specific examples of nurs-ing care, such as foley catheter changesand intravenous or intramuscular injec-

tions, as skilled services which couldtrigger Medicare coverage for SNF care.

On April 28, 1999 HCFA Adminis-trator Nancy-Ann Min DeParle re-sponded to an inquiry regarding thisissue from the Center for Medicare Ad-vocacy. Administrator DeParle con-firmed that HCFA continues to considerthese services skilled nursing care. In

her letter, which isavailable from theCenter, Ms.DeParle wrote:

...we did notintend that ourdeletion of careplan manage-ment/evaluation,observation/as-sessment, and pa-tient educationwould indicatethat we no longerregard these ser-vices as appro-priate examplesof skilled care.Rather, we madethis revision inthe belief thatsuch servicesneed no longer beseparately identi-fied in the admin-istrative criteria

since they are already effectively cap-tured by the clinical proxies utilized inthe [new] Resource Utilization Groups[RUGS], version III [payment] systemof resident classification used underSNF PPS.

Fortunately for beneficiaries, theseprovisions were reinstated in the fed-eral regulations issued in July, 1999. Inreinstating the provisions the Secretarynoted:

Our reason for deleting the explicit

references in the regulations to manage-ment and evaluation, observation andassessment, and patient education wasnot that they no longer represented ap-propriate examples of skilled care, butrather, because we believed that theseseparate references were no longer nec-essary in view of the clinical indicatorsthat have been incorporated into the up-per 26 RUG-III groups. However, in or-der to avoid possible confusion on thispoint, we are accepting the commenters’suggestion to reinstate these categoriesas specific examples in the SNF level ofcare regulations. 64 FR 41670 (July 30,1999).

The three reinstated regulation pro-visions incorporate some of the most criti-cal nursing activities for invoking Medi-care coverage. They are as follows:

1. Overall management and evalua-tion of an individual’s care plan (42CFR 409.33(a)(1));

2. Observation and assessment ofthe patient’s changing condition.(This includes identifying andevaluating the patient’s need formodification of treatment or foradditional medical procedures untilthe condition stabilizes.) (42 CFR409.33(a)(2));

3. Patient education services (42 CFR409.33(a)(3 ) ).

Advocates should remember theseimportant coverage rules and theadministration’s commentary when seek-ing benefits for skilled nursing facilitypatients in order to insure that they ob-tain the Medicare coverage to which theyare entitled. The regulations and relatedcommentary, quoted above, should bebrought to the attention of hospital dis-charge planners, SNF providers, fiscalintermediaries, administrative law judges,and others interested in Medicare skillednursing facility determinations. This isparticularly true when advocating onbehalf of patients whose need for dailyskilled nursing services may not be iden-tified through the process of establish-ing a RUGS classification.

15


Member NewsNAELA wasmentioned as aresource in thefollowing:

● BESTWEEK, in theNovember 15, 1999issue, in “LTC-Certifica-tion Program Launched.”

● Catskill Mail, in the Novem-ber 16, 1999 issue, in “EstatePlanning Basics Explained forSenior Citizens.”

● The Christian Science Monitor, inthe January 3, 2000 issue, in“Coming to Terms with Long-TermCare.”

● The Fresno Bee, in the October 9,1999 issue, in “Surfing Notes’column.

● The Gazette, in the September 25,1999 issue, in “Proceed Cautiouslyon Long-Term Care.”

● The Keene Sentinel, in the Septem-ber 26, 1999 issue, in “Be Cautious;Medicaid Annuities Have Pitfalls.”

● The Long Island Business News, inthe October 28, 1999 issue, in“Elder Law: More Than JustDrafting Wills.”

● The News Journal, in the October24, 1999 issue, in “Finding the VeryBest Assisted Living.”

● The Queens Courier, in the October19, 1999 issue, in “Elder Law Q &A.”

● Physicians Financial News, in theOctober 15, 1999 issue, in “HelpingAging Parents Cope with Money,Health, and Stress.”

● Smartmoney, in the November 1999issue, in “The Gray Charade.”

● Suburban News, in the September29, 1999 issue, in “Americans LookForward to Longer Life Expectan-cies.”

● Today’s Dallas Woman, in theNovember 1999 issye, in “In Caseof Emergency – Crisis CareOptions.”

Jeffrey Abrandtwas quoted in the October

24, 1999 issue of The New YorkTimes Magazine, “The Ethicist – BeMedicareful.”

Martha Brown was featured in theDecember 6, 1999 issue of the St. LouisBusiness Journal, in “Elder Law Spe-cialty Offers Expertise on Aging Is-sues.”

Geraldine Champion was quotedin the October 31, 1999 issue ofNewsday, in “Struggling with Elder Care,Inheritance.”

Randall K. Craig addressed the So-ciety of Financial Service Professionalson November 5, 1999 in Evansville, In-diana on the subject of “Practical AssetPreservation and Medicaid PlanningTechniques.” Randall was also electedto the Board of Directors of theVanderburgh County Area Agency onAging and the Board of Directors of theSouthwestern Indiana Regional Coun-cil on Aging, Inc.

Edward Dale and CherylFeuerman’s article, “An Introduction toMedicare,” was published in the Winter1999 edition of Elder’s Advisor; the Jour-nal of Elder Law and Post-retirementPlanning published by Marquette Uni-versity Law School.

Janna Dutton, CELA, Frank Johns,CELA, and Steven Perlis, CELA, werefeatured in the December 24, 1999 issueof the Chicago Tribune, in “Senior Part-ners.”

Ronald A. Fatoullah= wrote “TheABCs of Elder Law,” for the November2, 1999 issue of The Queens Courier and

The Forest Hills Courier. In addition,Ronald wrote “Elder Law & Estate Plan-ning” for the November 16, 1999 issueof The Southeast Queens. Mr. Fatoullahwas also quoted in the November 13,1999 issue of Newsday, in “The DarkLong View Elderly Face Grim FutureUnder Current Rules” and in the Novem-ber 20, 1999 issue of Newsday, in “Love’sMore Complicated the Second TimeAround.”

Jason A. Frank was quoted in theNovember 13, 1999 issue of The DailyRecord, in “Who’s Minding Our Eld-erly.” Jason was also featured in the No-vember 15, 1999 issue of The DailyRecord, in “Elder Laws = Confusion”and the November 18, 1999 issue of TheDaily Record, in “All or Nothing:Keswick Appeals After Talks With Uni-versity Fail.”

Connie Glass was quoted in the Oc-tober 25, 1999 issue of The HuntsvilleTimes, in “’Tis Better to Give (Than tobe Taxed.”

Susan G. Haines co-wrote “DueProcess in Protective Proceedings: TheCase for Strict Safeguards” with John J.Campbell for the December 1999 issueof the ElderLaw Report.

Michael C. Hodes was featured inthe October 23, 1999 issue of The DailyRecord, in “The Law of Getting Old.”

On January 3, 2000 the Board ofGovenors of the Washington State BarAssociation appointed Preston L.Johnson to a five-year term as a Hear-ing Officer in the lawyer discipline sys-tem.

Linnea Levine was quoted in theOctober 15, 1999 issue of The JournalRecord, in “Transferring a Home to Chil-dren.”

Harry S. Margolis wrote “FutureTrends in the Field of Elder Law” for theDecember 6, 1999 issue of the Massa-chusetts Lawyers Weekly.

Brenda McElnea, Esq. and Mary E.WanderPolo, Esq. were featured in theDecember 1, 1999 issue of the The SouthBergenite, in “Is Someone You Love atRisk?”


16



P E R I P A T E T I C E S S A Y I S T

For a While I Guess I WasDead

by Clifton B. Kruse, Jr., Esq.© Clifton B. Kruse, Jr.

Clifton B. Kruse, Jr.

Irma losther husband af-ter nearly six de-cades of mar-riage. She ar-ranged for hisburial, and pur-chased twograve sites andan eolith-likestone on whichhis name and hers were carved. Their re-spective birth dates were shown, and hiswas to evince his date of death as well.

It was difficult for Irma to visit thememorial garden in which her familialcompanion was now buried, but one dayseveral months after his entombment,she did. And there neatly inscribed onthe stone was the year of death, just asshe had ordered: 1913 - 1998 - but thecarved-on date was beside her name, nothis!

An embarrassed stone cutter tookcare of the error moments after Irma’s fran-tic call. The problem was solved, andIrma was telling me about it. The stone-cutter had been graciously forgiven. “Forawhile I guess I was dead,” she rea-soned. She sounded serious, and I wastoo timid to invite further discourse onthis theme.

Irma’s home is a small apartment onthe eighth floor of a high-rise in our city.Her living room faces west and from thisvista she can see her mountains, theRockies. “Stylishly rococo,” is her de-scription of them. Stylishly rococo, in-deed! They stream by her balcony deco-rating her Western horizon as far northand south as she can see. At an earliertime Irma and her mate had often pic-nicked among these granite peaks, butthat was long ago. Irma, now, only imag-ines their wildflower meadows and theirclear as crystal high mountain streams,but that’s enough; she accepts the limi-

tations that age introduces to us all. Inthe Fall she can still see large yellowpuncta, dots of color from the Rockies’Aspened forests. And she never tires ofviewing their grandiose peaks, sometipped with snow most of the year.

● ● ●

I keep falling,” Irma admitted. “Ithink I stumble over my rug edges.” Shepaused. “And I fell in the bath, too.”Following a long introduction, admiringher unique view of our earth’s great art,the purpose of this day’s meeting wasdisclosed. “I’ve lost my husband. Am Ito lose my home as well?”

Irma fell in the bath. No rugs there.She’s declining -and she knows it.This is why I wascalled by Irma - notabout the error onthe tombstones;that, she had re-paired, but thedeath date is eerilymetaphoric, cer-tainly disturbingbecause she mustnow be consideringthe reality of theend of her life.

I looked intoher eyes, magnifiedby her thick-lensglasses. Her eyeswere tearing. Shespoke in quick,short staccato-like sentences, accentu-ating the emotion: “This is my home. Ican’t leave. You’ve got to help me. Themanager knows you’re coming. She toldme I have to leave because I keep falling.I told her that she’d have to deal withmy lawyer!” She spoke this final sen-tence with emphasis.

“Where is John Wayne when I needhim?” I thought. I imagined the big guy,

all 6’6", coming through a Western bar’sswinging doors, hatted with a dirty butone time white wide-brim nearly touch-ing the transom, six-shooters on bothhips, a grim “don’t mess with me,” de-meanor emphasized with narrowed eyesand compelling frown. I imagined thevisigoths scrambling, getting out of hisway. But I knew the landlady here atMountainview. She’s taller than I, andtougher - not about to run from me oranyone, except, perhaps the cowboy.

This is a critical moment in the lifeof my 89-year-old client. For her leavingher home, forced to leave, is like deathitself, the end of her life. And she facesthis alone now, without her life’s mate.

● ● ●

“Why weren’t you here this morn-ing?”

This was the greeting I received re-cently from a remarkable sculptor, anartist who was facing the end of his life’s

work. Surroundedby his magnificentart, in coverallsstained with theresidue of the me-dia in which heworked, the grimethat steel leaves inthe process ofmolding it into dra-matic, mobilesculpture. He wassullen, scowlingas he spoke.

“I never comeby in the morning.Didn’t I tell you I’dstop by afterwork? That’s whenI always come -about 6:00 o’clock.

It’s 6:00 now.”He didn’t answer, morose, troubled

by the woeful spirits that ruled his mindand body. He was nearing his fourscoreand ten, the time when he would be ac-companied from his home, too. He hadoutlived the energy he needs to main-tain his large, beautifully ornate self-crafted home, and the strength requiredto continue creating his grand art. His

“Why weren’t youhere this morning?”This was the greeting

I received recentlyfrom a remarkablesculptor, an artist

who was facing theend of his life’s

work.

17


Peripatetic Essayist(continued from page 16)

life as a sculptor is ending, and he is indespair. He ambled to his workshop stu-dio; I followed. He shook his head,paced about the room, angry at thegods, his fate, his woe. He talked, ravedreally. I listened, but his anguish wasnot quieted. As 7:00 o’clock ap-proached, I readied to leave, and wewalked through his workshop, towardsits exit that led into the roadway. Hestopped by a large anvil mounted nearthe doorway. “Good-bye, my goodfriend,” I voiced. He was silent. I drovedown the foothills roadway, and perhapsthe engine noise of my old Subarumuffled the sound of the .38, but its mis-sile ended the life of my friend. Some-one heard it, though, and a call waswaiting for me as I edged into my home’sdriveway. It was the coroner. I headedback, met with the police, told themwhat I knew, and tried to comfort myfriend’s wife who arrived at the homeshortly after I’d first left. She met thepolice there and was shown his corpseby them. His body was slumped on theconcrete floor where we had said ourfinal good-bye - mine vocal, his said insilence, and then, after I departed, withthe sound a gun makes.

● ● ●

“Hi, Pat.” I’d knocked on themanager’s office door, the tough one I’dmet before, the one who’d just told Irmashe’d have to move.

“Where can I take Irma, Pat?” Iasked. “She says she’s got to leave.”

“She falls all the time.”“That’s what she tells me.” She said

you’d been wonderful to her, and checkon her every day, eight floors up on aslow elevator. ‘I wouldn’t be alive to-day without Pat,’ she told me,” carefulnot to overdo the praise. “Any idea whyshe’s falling?”

“It could be the rugs.”“Really?” I answered, quite sur-

prised by this response. “Her toes mightget caught under the edges,” she of-fered, sounding to me like she’s work-ing on a solution.

“Would she let us take them up, soshe’d just have the hardwood?”

“I’ll ask her,” Pat replied.What’s all this talk about having to

move, I wondered. Irma’s imagination?Wanting attention? Is it a way to get asympathetic visit from her lawyer? Thesubject of Irma’s having to move to asafer site, whatever that might be, wasnever suggested in my conversation withthe building’s “tough” manager. This an-nouncement came only from Irma, per-haps a verbalization of her fear - antici-pation of what she fears Pat may one dayhave to say.

Irma experienced several falls result-ing in bruises but no breaks, even afterthe rugs were taken up, so she must havestrong bones. In one incident she struckher head on the floor and told me thatshe felt like someone was in the roomwith her hitting her cranium with a baseball bat; so she was hurting. But she re-covered from this and the other falls also.She dutifully used her lifeline, the alertfor Pat, the tough landlady, so she couldbe rescued, and, in addition, Pat unfail-ingly and cheerfully stops by Irma’splace several times a day to check onwhat has become her charge, and nowher special friend. Irma knows she’s com-ing and leaves her door open for easyentry. Knowing each other for manyyears as, respectively, apartment man-ager and resident, they’ve now bonded,and care about each other.

For now, Irma’s problem is solved.She falls but she gets up and if she can’t,she has her lifeline. And “isn’t this bet-ter,” she asks, “than living in the ‘dyingplace’?” the nursing home she dreads.Irma has stashed much of her wealth. Sheknows that she can get twenty-four hourcare in her small home, eight floors upwith a mountain view, when the timecomes - if it does - when she’ll need this.She also knows that her bed can bemoved in by the window if full bedrest isneeded, so she can continue to look outat her mountains, watch their seasons,and still be moved by the inspirationwhich their beauty brings to her. Pat hasconfirmed this. It’s a promise made pos-sible by this new friendship. Pat is Irma’sdefender. For them, now, there will be nogoodbye.

Thomas L. McKenzie andGeraldine E. Champion, CELA, wrote“Double Duty,” for the November 15,1999 issue of The Los Angeles DailyJournal.

In the October 10, 1999 issue ofThe Spokesman – Review, in “Closewatch on guardians,” Cheryl Mitchellwas quoted.

Amelia Pohl was quoted in theSeptember 26, 1999 issue of The PalmBeach Post, in “Estate Planning 101.”

Virginia Rice was featured in theDecember 6, 1999 issue of the St. LouisBusiness Journal, in “Elder Law Spe-cialty Offers Expertise on Aging Is-sues.”

Avram L. Sacks was quoted in theOctober 20, 1999 issue of The WallStreet Journal, in “A Special Summaryand Forecast Of Federal and State TaxDevelopments”

Jane Seymour received the 1999Professionalism award from the Wash-ington State Bar Association.

Cynthia Sharp has been elected toserve a second term as president of theSouth Jersey Chapter of the Alzheimer’sAssociation.

Daniel Taylor wrote several ar-ticles which include: “All About Willsand Why You Need One” for the Sep-tember 1999 issue of the GrandparentsGuide; “All About General DurablePowers Of Attorney, Durable HealthCare Powers of Attorney, and LivingWills and Why You Need One” for theSeptember 1999 edition of Senior Di-rections; “Recognizing, Reporting, andSolving Elder Abuse, Neglect, and Ex-ploitation” for the Summer issue SeniorVoice. Daniel also presented “Long-Term Care Planning For The Elderly” ata seminar at The Laurels Assisted Liv-ing Community.

Neal Winston wrote “Social Secu-rity Retirement Benefits: An Overview,”for the October 1999 issue of TheElderLaw Report.

Member News(continued from page 15)

18


If you haven’t done solately, you should examine ifyou are making the most ofyour NAELA membership. TheNAELA Boards of Directorshave placed an emphasis ondeveloping member servicesover the last ten years. Whilewe are good about publicizingeach program or service ini-tially, I sometimes think wetend to forget about them un-less there is an urgent need.

As you enter the new millennium,you should be scrutinizing what will makeyour work a little easier and what will al-low you to work a little wiser. Here aresome of the NAELA products and ser-vices that you may or may not currentlybe utilizing:

1. NAELA Conferences – Begin theNew Year with the 2000UnProgram, to be held February11-13, 2000 in Dallas, Texas. Thisprogram has developed a veryloyal following of members andoffers an opportunity to talkinformally with other membersabout building, maintaining andeven selling practices. Those whohave attended in the past,wouldn’t miss it! We just say: Tryit, you’ll like it!

The 2000 Symposium will be heldMay 4 – 7, 2000 at the WarwickHotel in Philadelphia, PA. Thecommittee has broadened itshorizons and gone after nationally-known speakers. If you want thelatest on elder law, aging and lawpractice trends, you won’t want tomiss it! There’s also time to enjoythis marvelous city!

The 2000 Institute will be held

November 17 – 19, 2000 atthe Broadmoor Hotel andSpa in Colorado Springs,CO. This program isNAELA’s premier substan-tive program offeringadvanced sessions onevery topic. Perhaps youshould consider bringingthe family for Thanksgivingat the Broadmoor!

2. NAELA Tapes and Manuals –With the exception of theUnPrograms, NAELA has tapesand manuals available from eachof its programs for the past 10years. Complete manuals belongin every elder law library. Indi-vidual sections may also bepurchased ata nominalprice.

3. NAELABrochures –NAELA has11 substan-tive bro-chures thatare written forthe elder lawclient. Thetopics rangefrom LongTerm CareFinancing toAdvanceDirectors toHealth CareDecisionMaking.Thesebrochures aredone veryattractivelyand would

make a terrific addition to yourreception area or may be used ashandouts at seminars. There’seven a place for you to insert astamp or a sticker with youroffice information. All ofthese brochures were written forelder law clients by elder lawattorneys. Call NAELA for yourfree sample set today!

4. National Elder Law Month –May is the month, Elder Law isthe theme! NAELA provides apacket of materials to memberswho are interested in presentingseminars, meeting with the pressor talking to legislators. This isyour opportunity to highlight theprofession and your prominencein it!

5. Special Interest Groups –NAELA now has six SpecialInterest Groups: Health CareDecision Making, Guardianship,Trusts, Tax, Litigation andAdvocacy, and Practice Manage-ment and Development. Each SIGhas its own library of materials,

its own page onthe NAELAwebsite, its ownnewsletter, andmeetings at eachsymposium andinstitute. If youhaven’t signedup, you can doso on your duesinvoice or bycalling theNAELA officeand requesting aSIG applicationform.

6. NAELAMembershipDirectory –NAELA mem-bers have foundthe membershipdirectory to beextremely helpful

(continuedon page 19)

Laury L. Adsit

Make theMost of Your NAELAMembership in 2000!

By Laury L. AdsitE X E C U T I V E D I R E C T O R

As you enter the

new millennium,

you should be

scrutinizing what

will make your

work a little easier

and what will

allow you to work

a little wiser.

19


in making referrals to attorneysin other areas. There are twosmall nuances of the directorywhich you should be aware of: ifyou have more than one officelocation, for a $45 fee, you canobtain a second or third listing.This allows you to be listed inmultiple cities or states. TheExperience Registry listingsappear in the directory afterapproximately 15 percent of ourmember names. These membershave attested to having handleda minimum number of cases ineach area that they list.Manymembers tell us that they go tomembers with those listing firstwhen making a referral. If youaren’t registered, call JeniferMowery at (520) 881-4005 ext.114, or email her [email protected] and requestan Experience Registry Applica-tion.

7. NAELA Consumer Directory –NAELA also publishes and sellsa Consumer Directory by regionof the country. The sameinformation that is listed in theMembership Directory alsoappears in the ConsumerDirectory. This information isalso available on the NAELAwebsite.

8. NAELA News and NAELAQuarterly – These are the BESTelder law publications around.The News highlights trends andassociation events and theQuarterly is a scholarly journal.Be sure to read them as soon asthey hit your desk!

9. NAELA Chapters – NAELAcurrently has 13 active chapters:Arizona, Northern and SouthernCalifornia, Carolinas, Colorado,Florida, Illinois, Kansas, Massa-chusetts, Missouri, New Jersey,Texas and Washington. If youare in an area with a chapter: you

should be active! If a chapterdoesn’t exist, consider startingone! Call Janice Phillips at(520) 881-4005 ext. 121 for achapter start-up kit.

10. NAELA Fellows – NAELAcurrently has 45 Fellows. Thesefolks have displayed an involve-ment in elder law, both nationallyand locally, that exemplifies theirdedication to the profession.Fellows are elected annually andthe cut off date for applicationsis February 1st of each year.

11. CELAs – Elder law attorneys arecertified by the National ElderLaw Foundation. A lengthyapplication process and an allday exam must be successfullycompleted to become a CELA.There are currently 120 CELAsacross the country. You could beone of the most elite in thecountry?

12. Public Policy/LegislativeActions – Part of NAELA’smission is to advocate for qualitylegal services for the elderly.

Make the Most of YourNAELA Membership in 2000!(continued from page 18)

Technology & PracticeManagement Consulting

Wondering how to use technologyto better manage your elder law practice?

GET ADVICE FROM PRACTICING ELDER LAW ATTORNEYS!

Services include on-site evaluation of your technology needs,management structure, and recommendations that will resultin a more productive practice. See results instantly.

Don’t delay – contact us today!Robert B. Fleming, CELA ● 520/622-0400

[email protected]

Timothy L. Takacs, CELA ● 615/[email protected]


NAELA works with BrianLindberg, our Washington DCPublic Policy Consultant, toidentify issues that are relevantto elder law clients and topractices. The newest edition willbe access to a state-by-statetracking system as part ofNAELA’s website. Members willnow be able to see what ishappening in their state andotherstates on an as-needed basis.

13. Skip #13 – We’re not supersti-tious, but lots of folks are…..sogo on to #14!

14. Give to Get – Like most associa-tions, those who get the mostusually give the most! NAELA isa volunteer directed, staff drivenassociation. We are governed bya board of directors composedofsix officers and 15 directors.We have 32 active committeesand subcommittes, three activetask forces, six Special InterestGroups and 13 local chapters.There is certainly enough workfor everyone! So, speak up andvolunteer now!

20



The Foster CareIndependence Act of1999, H.R. 3443, was

signed into law byPresident Clinton on

December 14, 1999. Itcontains the former SSIFraud Prevention Actof 1999, which did not

pass Congress. Twoprimary changes in the

new law will have asignificant effect ondisability, elder law,

and estate planning forthose persons and theirspouses who are or will

become eligible forSupplemental Security

Income (SSI).

The Foster Care Independence Actof 1999, H.R. 3443, was signed into lawby President Clinton on December 14,1999. It contains the former SSI FraudPrevention Act of 1999, which did notpass Congress. Two primary changes inthe new law will have a significant effecton disability, elder law, and estate plan-ning for those persons and their spouseswho are or will be-come eligible forSupplemental Se-curity Income(SSI).

Among otherchanges, transferof assets for lessthan market valuemay create a periodof ineligibility, andthe assets and in-come of certainself-settled trustswill now count asa resource and in-come to the recipi-ent for SSI pur-poses. Penaltieshave also beenadded excludingrepresentat ives(including attor-neys) and healthcare providers fromparticipation in theOASDI and SSIprograms who pro-vide or assist inproviding false in-formation for indi-viduals to obtainbenefits. Thetransfer penalty became effective thedate of enactment, and the self-settledtrust preclusion is effective as of Janu-ary 1, 2000. This summary describes onlythe SSI portion of the law.

In the laws’ original form in 1998,which did not pass, the sections of the

bill involving trusts and transfers weresubstantially harsher than the presentversion. Efforts by Becky Morgan andNAELA Public Policy Committee per-sons, Emily Starr, Ron Fatoullah, andRene’ Reixach, and legislative consult-ant Brian Lindberg, resulted in allow-able non-countable transfer options simi-lar to institutional Medicaid finding their

way into this year’sversion of the Billwhen it was re-in-troduced in Janu-ary 1999. Virtuallyno changes weremade in these sec-tions when the Sen-ate later consid-ered it.

Brian Lindbergand I, in conjunc-tion with other ad-vocacy groups,continued to workwith the HouseS u b c o m m i t t e estaff. The final ver-sion of the Bill wasamended to includea higher monthlydisqualif icationcalculation ratebased upon thestate supplement inaddition to the Fed-eral benefit rate, amaximum disqualifi-cation period ofthirty-six months re-gardless of theamount transferred,and other positive

changes. The Bill also amended Title XIXand disallowed states who use SSI crite-ria for determining non-categorical Med-icaid from using the new SSI trust rulesto determine eligibility for Medicaid forthose individuals not receiving SSI.

Despite serious efforts, we were not

successful in convincing legislators toamend the Bill to allow for an individualor their spouse, or for those age 65 andover, to make transfers to a d4A or d4Ctrust or similar device. In effect, theOBRA ‘93 preclusion and disqualifica-tion period for self-settled trusts for in-stitutional Medicaid benefits has beencarried over to the SSI program.

Our argument for inclusion of sucha provision had been that use of a trustor similar self-settled device is necessaryfor the elderly to retain enough assets toafford services to remain in the commu-nity. By providing eligibility for a combi-nation of public benefits from SSI andMedicaid, and other state programs aswell as supplemental payments from thetrust, individuals could avoid prematureinstitutionalization. In many states, thisform of low income elderly estate plan-ning was used to prevent the extremeremedy of requiring entrance to a nurs-ing home when the individual’s limitedsavings were quickly exhausted due tounassisted private pay status and therewas no source other than Medicaid cov-ered nursing home care to provide ben-efits at the level necessary to sustain theindividual.

For example, some states havesupplemental SSI benefits and Medicaidwaivers that allow limited benefit pay-ments to an individual in certain levelsof assisted living facilities (ALF) and resthomes in the community. SSI only allowscountable assets of $2,000 for an indi-vidual or $3,000 for a couple. If allowedto continue to transfer assets to a trustthat would not disqualify the elderly in-dividual for SSI, the assets in the trustcould be used to supplement public ben-efits and the individual’s income to makeup the difference of the cost of an ALF.It is also much less costly to the indi-vidual and the government benefit pro-grams to remain at home or in a commu-nity residence than in a nursing home.

This self planned and administeredstretching of resources provides a moremeaningful and less restrictive livingenvironment for the individual and agreat savings compared to the cost ofnursing home care to the Medicaid pro-gram. Unfortunately, the Congressional

New Law Penalizes SSITransfers and Trusts

By Neal Winston, Esq.N A E L A S S I A N D D I S A B I L I T Y P U B L I C P O L I C Y S U B C O M M I T T E E

21


Budget Office, in responding to Housecongressional staff inquiries initiated byNAELA about the savings claimed in ourproposed plan, could only base its analy-sis on a first level “guesstimate” with-out any study or actual facts, i.e., “if lesspeople are eligible for SSI, then of coursethe program will save money”. The addi-tional burden put on other programsfunded by the states and the federal gov-ernment by quick depletion of resourcesand pushing the individual into a moreexpensive level of care under Medicaidwas never analyzed or considered.

Transfer Penalty The Medicare Catastrophic Cover-

age Act of 1988 (MCCA) removed anydisqualification period or other penaltyfor transfers of assets for less than mar-ket value in order to establish resourceeligibility for SSI. The new law returns apenalty of up to a 36 month maximumdisqualification period for certain trans-fers by the recipient or spouse. Thelength of the disqualification period is

determined by dividing the amountof the transfer by the recipient’s com-bined monthly federal and maximum statesupplement benefit payment.

Similar to institutional Medicaid, the“look back period” is 36 months. How-ever, unlike Medicaid, the transfer dis-qualification period can’t exceed 36months, even if application is made dur-ing the look back period of a very largeasset transfer or the transfer is made to atrust. Partial months are rounded to thenearest whole month.

The transfer penalty in the new lawseems to track similar provisions forMedicaid in OBRA ‘93. Transfers be-tween spouses and to another for thesole benefit of the recipient or spouseare allowed without penalty, as are trans-fers to a minor or disabled adult child ofthe recipient. Also allowed are transfersto certain self-settled trusts if the assetstransferred are considered as an avail-able resource for SSI purposes. Trans-fers to so-called Medicaid or OBRA ‘93trusts (42 U.S.C. s. 1382b(e)(5)(d)(4)(A)and (C)) for the benefit of the recipient,

spouse, or disabled child, are allowed,except that the recipient cannot be age 65or older. This last clause seems to be in-consistent with and disqualify the OBRA‘93 allowance of (d)(4)(C) trusts for per-sons age 65 and older.

Transfer of a home is also similar toOBRA ‘93. It can be transferred to aspouse, a minor or disabled child of therecipient, a sibling who has an equity in-terest and has lived in the home for “atleast 1 year immediately before the datethe transferor becomes an institutional-ized individual”, and a child who residedfor 2 years in the home before the recipi-ent became institutionalized and whosecare allowed the recipient to remain athome.

Regardless of the transfer condi-tions, the penalty may be waived “in ac-cordance with regulations promulgated bythe Commissioner”. Waiver exceptionsinclude situations in which the recipientintended to dispose of the assets at fairmarket value, the transfer was made “ex-clusively” for a purpose other than toqualify for SSI benefits, “all” assets trans-ferred for less than fair market value havebeen returned, and the denial of eligibilitywould work an undue hardship on the re-cipient.

If a recipient owns an asset in com-mon or jointly with another person or per-sons, any action taken by the recipient or“by any other person” that reduces oreliminates the recipient’s ownership orcontrol of the resource constitutes a dis-qualifying transfer of the asset. If thespouse of the recipient makes a disquali-fying transfer, the disqualification periodshall be apportioned between the recipi-ent and spouse if the spouse should be-come eligible for SSI benefits. The trans-fer penalty is effective as of December 14,1999.

Trusts The new law also requires that the

assets and income of certain self-settledtrusts be counted for SSI eligibility pur-poses. Under the former law, assets of anyself-settled irrevocable trust of which therecipient was a beneficiary, were excludedas a countable resource to the SSI recipi-ent (at least under the federal portion ofthe program), as long as the individual did

not have the authority to control distri-butions. Coupled with the former abilityof the recipient to transfer assets with-out penalty, the recipient could establishand fund a trust that might assist the re-cipient in meeting living expenses and stillbecome or remain eligible for SSI ben-efits.

Now, certain trusts established bythe recipient or spouse that allow distri-bution of assets or income to the recipi-ent or spouse will be countable for SSIpurposes. Consideration may not begiven to trust terms regarding purpose,trustee discretion, or distribution restric-tions, although clauses of the legislationappear to have an inconsistency overcountability of assets as related to distri-bution restrictions.

Resources and income in OBRA ‘93trusts, found at 42 U.S.C. s. 1382b(e)(5)d(4)(A) and (C), are specifically not count-able under the new legislation. Trustscreated under d(4)(A) by definition can-not be created by recipients age 65 orolder, and the new legislation also pre-cludes those age 65 and older from trans-ferring assets to a (d)(4)(C) trust withoutpenalty. If the recipient or spouse (or anyperson or other entity acting on behalf ofthe recipient), including a court, takes anyaction to divert countable assets or in-come from the recipient, those assets orincome shall be counted as available tothe recipient for SSI purposes.

This legislation only applies to self-settled trusts established on or after Janu-ary 1, 2000. All prior existing trusts, andthe treatment of existing trust assets andincome, will be grandfathered under cur-rent regulations. Transfers by will are alsoexcluded under the new law. Under newregulations to be established by the SSA,the new trust limitations may also bewaived on an individual basis if theywould cause an “undue hardship” to arecipient. States that use SSI eligibilitycriteria to establish community Medicaideligibility for individuals not receiving SSImay not use the new trust legislation tootherwise limit the Medicaid eligibility.

Ironically, even though the federalSSI program now only allows a recipientto make transfers to an OBRA ‘93 trustwithout a transfer penalty, asset recov-

New Law Penalizes SSITransfers and Trusts(continued from page 20)


22


ery from the trust upon the death of therecipient is made only to the state Med-icaid program. If an SSI recipient createssuch a trust and doesn’t use a substan-tial amount of Medicaid, after Medicaidis paid, the trust remainder will go towhomever the recipient designates. Fi-nally, even though a transfer of a re-source will create a period of ineligibilityfor SSI, no transfer of a resource will cur-rently disqualify an individual for com-munity level Medicaid in most states.

Need For Regulations H.R. 3443 has left open many ques-

tions of application that may be ad-dressed in regulations. Most inconsis-tencies arise from the legislative attemptto apply Medicaid and OBRA ‘93 princi-pals to SSI. Medicaid has previously leg-islated the coordination of the incomeand assets of a community spouse withthose of the institutionalized spouse.

The new SSI legislation, while retain-ing the exemptions of interspousal trans-fers, does not reflect on current SSI lawthat “deems” the entire income and re-sources from one spouse to the otherfor countability purposes. It also doesnot consider the SSI rule that separationof living arrangements for spouses be-yond a “temporary absence” also sepa-rates the countability of income and as-sets between spouses. Medicaid has al-lowed a partial cure of asset transfers,while the SSI legislation notes that “all”resources have to be returned.

“Income” and “resources” are spe-cialized terms defined in Title XVI of theSocial Security Act. The month that anasset is received, it is considered onlyas “income” during that month. The fol-lowing month, if still in the possessionof the recipient or spouse, it becomes a“resource”. Several NAELA membershave noted that H.R. 3443 only providesa transfer penalty for transfer of a “re-source”. Does that mean that if an assetis transferred in the month that it is re-ceived, there is no transfer penalty?

Penalties for FraudRepresentatives (including attor-

neys) and health care providers who areconvicted of or administratively deter-mined by the SSA to have committed anyfraud type offense as described in vari-ous sections of the Social Security Actshall be excluded assuch from partici-pation in any SocialSecurity Insuranceor SSI program.Upon conviction orsuch finding by theSSA, the minimumperiod of exclusionshall be 5 years. Thesecond offenseshall be for not lessthan 10 years, andthe third perma-nently. The of-fenses may haveoccurred prior toenactment of thenew law. It wouldappear that attor-neys and health care providers who rep-resent or write reports for disability ben-eficiaries and recipients are particularlysusceptible to running afoul of thisclause.

The law further requires that statedisability determination agencies andstate licensing agencies must be notifiedof the exclusion to participate, appropri-ate investigations be made and sanctionsinvoked, and the Inspector General andSSA informed of such actions taken bythe agencies. Accused individuals andother entities shall be given due processthrough notice, hearing, and judicial re-view. Under certain circumstances, theSSA may suspend the exclusion. Anyrepresentative or health care providermay be required to certify that no priorconviction of a violation causing an ex-clusion has occurred in order to partici-pate.

Other ChangesH.R. 3443 also contains many other

changes attempting to affect the fiscalintegrity of the program. If any overpay-ment is made to a Representative Payeeafter a recipient’s death, the Representa-tive Payee will become personally liablefor repayment of the overpayment, in-

cluding recovery from the Representa-tive Payee’s own benefits. SSI overpay-ments may be recovered from lump sumpayments of SSI benefits to the individualor couple in an amount not less than the

lesser of the over-payment or 50 per-cent of the lumpsum payment.

The SSA mayuse collectionpractices for SSI(such as privatedebt collectionagencies and inter-ception of govern-ment related pay-ments) formerlyonly used for col-lection of Social Se-curity InsuranceBenefits as al-lowed by the DebtCollection Im-provement Act of

1996. Collection activities may continueafter SSI eligibility ends. If a person makesa false or misleading statement or repre-sentation of fact that is known or shouldbe known as such to obtain Social Secu-rity Insurance or SSI benefits, aside fromother penalties, benefits may be sus-pended. The penalty period is six monthsfor the first offense, 12 months for thesecond, and 24 months for the third andsubsequent offenses. The penalty periodwould not preclude eligibility for and re-ceipt of Medicare or Medicaid.

Any SSI applicant or recipient mustprovide the SSA with authorization to ob-tain from any financial institution any fi-nancial information or records involvingthe recipient or any other person whoseresources or income are material to theeligibility of the recipient. The authoriza-tion shall remain effective until the appli-cation is denied, benefits end, or the re-cipient withdraws the authorization. Theauthorization shall be considered as meet-ing the requirements of the Right To Fi-nancial Privacy Act. If any recipient re-fuses to provide the authorization, ben-efits may be denied or terminated.

States are required to provide stateprisoner information to federal and fed-


“Income” and

“resources” are

specialized terms defined

in Title XVI of the Social

Security Act. The month

that an asset is received, it

is considered only as

“income” during that

month.


23


erally assisted programs. In requestinginformation from any state in determin-ing eligibility or continuing eligibility forOASDI or SSI benefits, the SSA shall bedeemed to meet any use, safeguarding,or disclosure standards required by thestate in order for the SSA to receive theinformation.

The SSA shall conduct a study onpossible measures to improve fraud pre-vention and administrative processingfor disability benefits, all SSI benefits,and timely processing of reported incomechanges by recipients. A report shall besubmitted within one year of enactmentwith recommendations for improvements.The SSA must include in its annual bud-get an itemized report of how much fundsare expended to “combat fraud commit-ted by applicants and beneficiaries”.

Finally, a new benefits program simi-

lar to SSI, called Title VIII, has been cre-ated for World War II veterans who areage 65 or older, resides outside of theUnited States, District of Columbia, andNorthern Mariana Islands, have other in-come less than 75 percent of the SSI fed-eral benefit level, and would otherwise beeligible for SSI. The SSA must also con-duct a study to determine why family farm-ers with assets of under $100,000 are de-nied SSI benefits, and whether deeming isa cause of discrimination against familyfarmers. Family farmers who have beendenied SSI benefits in the past 10 yearswould be included and the study must becompleted within 1 year.

Name/Telephone Extension E Mail Address

Address Changes ................................. Jenifer Mowery, ext. 114 ................. [email protected] ............................................ Kimberly Ehmke, ext. 106 .............. [email protected] Questions .................................. Janet Tite, ext. 119 ......................... [email protected] Action ......................................... Laury Adsit, ext. 113 ....................... [email protected] ............................................. Becky Notestine, ext. 107 ............... [email protected] .......................................... Brittany Betz, ext. 116 ..................... [email protected] ................................................ Janice Phillips, ext. 121 .................. [email protected] Placement .......................... Janice Phillips, ext. 121 .................. [email protected] Director ................................ Laury Adsit, ext. 113 ....................... [email protected] Registry ............................. Jenifer Mowery, ext. 114 ................. [email protected] .................................................. Debbie Barnett. ext. 117 ................. [email protected] ................................................ Debbie Barnett, ext. 117 ................. [email protected] Questions ................................. Jami Morris, ext. 118

or Becky Notestine, ext. 107 ........... [email protected] Relations .................................... Jihane Rohrbacker, ext. 115 ........... [email protected] .......................................... Jenifer Mowery, ext. 114 ................. [email protected] Directory .......................... Jenifer Mowery, ext. 114 ................. [email protected] News /Quarterly Articles .......... Jihane Rohrbacker, ext. 115 ........... [email protected] Policy ......................................... Laury Adsit, ext. 113 ....................... [email protected] Interest Groups ....................... Jane Coppalla, ext. 109 ................. [email protected] Coordinators ............................... Jenifer Mowery, ext. 114 ................. [email protected]/Institute Information

CLE ................................................ Brittany Betz, ext. 116 ..................... [email protected] ...................................... Pam Carlson, ext. 108 ................... [email protected] ........................................ Jihane Rohrbacker, ext. 115 ........... [email protected] .................................. Jenifer Mowery, ext. 114 ................. [email protected] ....................................... Pam Carlson, ext. 108 ................... [email protected]

Tapes/Manuals ...................................... Jami Morris, ext. 118 ...................... [email protected]

There are often questions as towho is who on the NAELA staff.As you know, we have a staff of15 people working for us, andeveryone is responsible for veryspecific things. Our offices arelocated at 1604 North CountryClub Road, Tucson, Arizona85716 and are open from 8:00am.to 5:00pm., Mountain Time,Monday through Friday, exceptholidays. The telephone numberis (520) 881-4005. The faxnumber is (520) 325-7925. Wealso have voice mail andtherefore, you may leavemessages 24 hours a day, sevendays a week! To help you in yourendeavor to get through themaze, we are listing who youshould contact for what things:

Who’sWho

on theNAELAStaff ?


2 Cranny is defined as a small break or slit;crevice or chink. See The Merriam-WebsterDictionary, 122 (Home & Office ed., MerriamWebster, Inc., 1998)(However, I don’t recallever seeing, reading or hearing about a nookwithout a cranny.)

3 Nostalgia is defined as a wistful or exces-sively sentimental, sometimes abnormalyearning for return to or of some past periodor irrevocable condition. See The Merriam-Webster Dictionary, 357 (Home & Officeed., Merriam Webster, Inc., 1998).

4 Now I will know just how many Gators arereading (or have stopped reading) thisPresident’s Message, especially CharlieRobinson.

5 Consider the ethical pieces here that are atthe center of some of the issues of ethicsswirling around our profession and mirroredin the current deliberations and recommen-dations of the E2K 2000 Commission of theABA. See also Russell G. Pierce, “For-ward to Symposium on ‘Should the FamilyBe Represented as an Entity?’ Reexamin-ing the Family Values of Legal Ethics,” 26Seattle L. Rev. 10 (1998)(Section specifi-cally addressing the Communitarian Con-structions of the Legal Ethics Codes).

6 See A. Frank Johns, “Editor’s Comment,”VI NAELA Quarterly 15 (Summer, 1993).

E N D N O T E S1 Nook is defined as a right-angled corner; an

interior angle formed by two meeting walls;a secluded or sheltered place or part. SeeThe Merriam-Webster Dictionary, 356(Home & Office ed., Merriam Webster, Inc.,1998).

24


AvailableResources

● The National Senior Citizens’Law Center is about to beginpublishing a monthly mailing onNursing Home Enforcement.The mailing will focus on state-level enforcement activity andwill include a narrative overviewand copies of primary docu-ments, such as administrativeand court decisions, officialreports and media reports. Anoverview of relevant federalactivities will also be included.Annual Subscriptions for themailing will be$120.00. For moreinformation,contact theNational SeniorCitizens’ LawCenter, 1101 14th St.,N.W., Suite 400Washington, DC 20005,(202) 289-6976.

● Thompson PublishingGroup Inc is publish-ing The Americanswith Disabilities ActCompliance Guide. This guideis a comprehensive looseleafhandbook that has been writtenin easy-to-understand language.The guide covers key questionsthe law has presented to provid-ers, including:

● Who must comply with theact?

● Who is protected by the act?

● What constitutesdiscrimination?

● What is reasonableaccommodation?

● How can communicationbarriers be overcome?

● What sanctions do non-compliant providers face?

Cost for the guide and monthlybulletins is $287.00. For moreinformation, call (800) 677-3789.

● The American Association ofHomes and Services for the Aginghas published The Consumers’Directory of Continuing CareRetirement Communities. Thisdirectory profiles more than 500facilities. Centers are organizedalphabetically by state. Listingsalso include services, agreementoptions and costs. “This resourcehelps seniors better understandthe benefits that continuing careretirement communities offerresidents,” said David Cole, the

of readers regardless of theirprofessional background. Forexample, Miles points out thatmedical and social needs ofminority elders will catch somecommunities unprepared to meetthe challenge. The book isavailable for $10.00 for members($15.00 for non-members). Formore information, contact theGerontological Society ofAmerica, 1275 K Street N.W.,Suite 500, Washington, DC20005-4006, (202) 842-1275

● AARP presents Persons WithDementia: Can They MeetMedicaid Level-of-Care

Criteria for Admission toNursing Homes andHome and Commu-nity-Based WaiverPrograms? Thereport uses thefunctionaleligibility criteriarecommended bythe congression-

ally mandatedAdvisory Panel on

Alzheimer’s Diseaseto analyze whether states

incorporate the recommendedeligibility criteria for personswith dementia in their Medicaidlevel-of-care criteria, and whethermeeting those criteria is suffi-cient to meet states’ level-of-carecriteria. The study provides abaseline for tracking changesthat states make in their level-of-care criteria. For more informa-tion, contact AARP, 601 E. St.,N.W., Washington, DC 20049, orvisit its website: www.aarp.org.

● The American Medical Associa-tion, Chicago, has releasedDiagnosis, Management andTreatment of Dementia: APractical Guide for PrimaryCare Physicians. The 47-pagebooklet includes tests forgauging dementia and examines

association’s director of continu-ing care. Cost is $25.00 formembers and $35.00 for non-members. For more information,call (800) 508-9442.

● The Gerontological Society ofAmerica has published TheRealities of Minority Aging inAmerica. The book examines thewide spectrum of social andmedical issues facing America’sminority elder population. EditorToni Miles, M.D., Ph.D., of theUniversity of Texas HealthScience Center in San Antonio,noted in her preface that thisbook “holds surprises” for a lot (continued on page 25)

25


legal problems, dealing withfamily members, elder abuse andthe handling of patient pain andanxiety. For more information,visit the American MedicalAssociation’s web site:www.ama-assn.org.

● The International LongevityCenter USA Ltd., an affiliate ofthe Mount Sinai School ofMedicine, has released TheAging Factor in Health andDisease: The Promise of BasicResearch on Aging. The reportis the outcome of a two-daymultidisciplinary workshopwhere scientists discussed thecurrent status of biomedicalaging research. It calls for anincrease in funding to helppeople lead longer, healthier livesand reduce health care costs.The report also identifiesresearch areas that could be thefoundation for medical advancesthat would prevent, delay, orreverse the adverse effects ofaging. For more information, callthe International LongevityCenter-USA Ltd., (212) 288-1468,email: info@ilcusa,org or visit itsweb site: www.ilcuas.org.

● Health Professions Presspresents Aging, Rights andQuality of Life: Prospects forOlder People with Developmen-tal Disabilities, edited by StanleyS. Herr and Germain Weber.The book presents internationalresearch on advances made inhuman rights and qualityassurance in health care delivery.Topics covered include legal andfinancial considerations, qualityof life and quality standards, self-determination, developments inpublic policy, managed care,models for support, principles ofgood practice and human-rightsrequirements. For more informa-

tion, call Health ProfessionalPress, (888) 337-8808, fax (410)337-8539, e-mail:[email protected] visit its web site:www.healthpropress.com.

● The Health care FinancingAdministration is now allowingproviders to test their ownbilling systems with Medicare’ssystems. The Medicare systemshave been certified as year-2000ready to process and ready topay all Medicare claims submit-ted on and after Jan. 1, 2000.During the pre-2000 testingperiod, providers and theirbilling agents or clearinghousewill have an advance opportu-nity to test their billing systems,identify any problems withMedicare claims submissionsand remedy their software andhardware as necessary.

To avoid having paymentproblems in 2000, HCFA isurging each submitter to takethree steps:

· Schedule future-date testingwith the appropriateMedicare carrier or fiscalintermediary so that thesubmitter’s own system canbe assessed.

· Consult HCFA’s website(www.hcfa.gov.y2y) or callthe toll-free year-2000information line ((800) 958-HCFA) for helpful informa-tion, telephone numbers ofMedicare contractorcontacts and other resources on becoming ready.

· Make a plan, or alternative –operating plan, in case of anoffice or billing systemfailure.

For more information, call (202)690-6145

● The Brookdale Center on Aging

recently published “TheBrookdale Senior RightsReport.” By combining thewidely read Senior RightsReporter with the highlyacclaimed Entitlement Bulletinsand adding new feature articlesin each issue, “The BrookdaleSenior Rights Report” hasbecome required reading forsocial workers, attorneys,elected officials and their staffand other professionals workingwith older persons. The new“Brookdale Senior RightsReport,” published six timeseach year, costs $100 forhospitals, nursing homes, homecare agencies, professionalassociations, universities,libraries, professionals in privatepractice, social service agencieswith 10 or more employees; and$50 for senior centers, legalservice organizations, countyoffices for aging, county socialservice departments, and socialservice agencies with less than10 employees. Order forms for“The Brookdale Senior RightsReport” or other Brookdalepublications can be obtained bycalling the Brookdale Center onAging at 212-481-4433 or 518-433-9011, faxing a request to212-481-5069, sending an emailto [email protected] or visiting ourwebsite at: www.brookdale.org.

Available Resources(continued from page 24)

26



27


Name ______________________________________

Nickname for Badge ___________________________

Firm/Agency _________________________________

Address _____________________________________

City ________________________________________

State ______________________________________ Zip _____________________

Telephone ___________________________________________________________

Fax ________________________________________________________________

Guest/Spouse ________________________________________________________

Special Needs/Disabilities _______________________________________________

Dietary Needs ❏ Vegetarian ❏ Kosher

Are you a SIG member? If so, please check all that apply.

❏ Advocate Litigation ❏ Guardianship/Capacity ❏ Health Care Decision Making

❏ Practice Development/Practice Management ❏ Trusts ❏ Tax

Will this be your first time at a NAELA program? ❏ Yes

Please list any additional state that you need CLE credits:___________________________________________________________________

Registration Fees Before/On AfterSymposium: May 4-7, 2000 4/03/00 4/03/00

NAELA Member $435 $485 $ ________________

LSC/Title III Attorney $335 $385 $ ________________

Non NAELA Member $795 $895 $ ________________

Wednesday, May 3, 2000Pre-Session:Basics of Elder Law Day $125 $150 $ _______________

Certification Review Course $175 $175 $ _______________

Additional Meal Tickets for Guests:Breakfast Tickets @ $20.00 each ............................................ $ ________________❏ Thursday ___________ ❏ Friday __________❏ Saturday ___________ ❏ Sunday __________

Lunch Tickets @ $20.00 each ................................................. $ ________________❏ Wednesday __________ ❏ Thursday __________❏ Saturday ___________

Thursday Opening Reception @ $25.00 each ....................... $ ________________

Optional Event - TBASaturday, May 6, 2000Everyone who would like to attend must purchase tickets.

TOTAL AMOUNT ENCLOSED .................................................. $ ________________

RegistrationForm

One per person (Please type or print)

Please complete the registration formand return with a check payable toNAELA or charge below to:

VISA/MC

# _______________________________

Exp. _____________________________

Signature

________________________________

Mail to:NAELA Symposium 2000

1604 N. Country Club RoadTucson, AZ 85716

(520) 881-4005 Phone(520) 325-7925 Fax

Refund Policy: No refunds will be issuedafter April 14, 2000. Cancellations beforethat date will receive a full refund less a$50 administration fee. Changes orcancellations must be made in writing toJenifer Mowery at the NAELA office.Substitutions are welcomed.

For OfficeUse Only

Registration Fee

$ ______________

Type ___________

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1 6 0 4 N . C O U N T R Y C L U B R O A DT U C S O N , A Z 8 5 7 1 6 - 3 1 0 2

BULK RATEU.S. POSTAGE

PAIDTucson, ArizonaPermit No. 3178

National Academy ofElder Law Attorneys, Inc. TM

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Documents

Responding to the Grieving Client · author of Another Country: Navigating the Emotional Terrain of our Elders, will be a featured keynote speaker at this year’s NAELA Symposium,