Another Wake-up Call to Document End of Life Care Decisions

A couple of weeks ago, our extended family came together to celebrate my mother’s 95th birthday.  My mother has always loved a party, so even though she suffers from several chronic conditions, and then had a pretty serious health scare 2 weeks before the party, she had an amazing recovery and was able to (as my husband said) “make the scene” with close to 50 friends and family members.

The next day, after most of us had returned to our own homes, still in the glow of the wonderful family gathering, my mother suffered a heart attack.  Five days later, she was alert, refusing any pain medication and back home with her amazing team of compassionate caregivers.  She has continued to improve every day, and is just about back to  her role as “information central” for all the news related to our far flung family members.

While this story has a happy ending, it was a reminder to all of us of the importance of understanding what our mother would want done – or not done – if extreme measures had been called for.  Fortunately, I did have her Living Will close at hand, and was able to share it with her medical team.  But while it was certainly better to have the document than not, our family found that the words on the page did not answer all of our questions about the specific situation in which we would have found ourselves if our mother had not been able to bounce back with minimal medical intervention.

If there was a silver lining from this challenging experience, it is that it caused us to research palliative care options, and talk to one another about what that might mean to us, and to our mother.  And while we may find at the next crisis that the seemingly logical thought process we developed still doesn’t apply to the current situation,  at least we will have a framework for discussion among our family, and my mother’s medical team, that we started when we had a chance to reflect.

As I say to my clients, every adult should have advance directives in place, and you do not need a  lawyer to accomplish that.  The website of the National Hospice and Palliative Care Organization ( contains state-specific advance directive forms, as well as helpful information and study guides about end of life decision making, and helps you create an advance directive that you can email to doctors and family members.  If you do not have your intentions in writing, check out these sites today.



Hospitals Must Keep Patients Informed About Observation Status

I’ve written before about making sure you have been “admitted” when you have been in the hospital for a night or two. Medicare recipients who have been evaluated in the hospital, received care and perhaps even stayed overnight may have been classified as “observation status,” which is an outpatient category.  This means that their care is covered by Medicare Part B, rather than Part A, which includes much more comprehensive coverage for hospital stays.  This can also affect whether Medicare will cover the cost of skilled nursing care following that stay in the hospital.

Historically, patients have no idea how they have been coded until they are being discharged, or sometimes not until they receive significant bills after returning home.

To begin to address this issue, Congress passed the Notice of Observation Treatment and Implication for Care Eligibility (“NOTICE”) Act, which now requires hospitals to give patients both oral and written notice when they have not been admitted, but are receiving treatment as outpatients.   They must use the written notice that was created by CMS called the Medicare Outpatient Observation Notice (“MOON”).  The MOON requires the signture of the patient or the patient’s authorized representative, which means that any oral notice would only be preliminary.

Receipt of this notice gives the patient, and her physician, the opportunity to advocate that the patient’s condition is such that she should be admitted, so that she can benefit from full Medicare Part A coverage for her care.

VA Acknowledges Presumption of Illness from Camp Lejeune Water Exposure

In the early 1980s, chemicals that are used in dry cleaning and metal  degreasing, along with benzene and vinyl chloride, were discovered in the water supply system at Camp Jejeune and MCAS New River.  The contaminated wells were finally shut down in … [Continue reading]

Centers for Medicare and Medicaid Reconfirms Guidelines for Skilled Care

In a previous post, I have described the 2014 settlement in the case of  Jimmo v. Sebelius, in which the Court confirmed that Medicare is obligated to pay for physical, occupational and/or speech therapy that is necessary to keep a medicare … [Continue reading]

Whose In Charge When You are in the Hospital?

My 94 year old mother was just released from the hospital following a 13-day stay, precipitated by a serious infection. First, the good news - the infection has cleared and she is back home,  thinner (not a good thing) and more easily fatiged, but … [Continue reading]

A New Kind of Employment Discrimination?

More and more employees are finding that they need to take time away from their jobs to care for their elderly loved ones.  It may be for a short time around a medical crisis, or they may need to provide ongoing care services to someone who is unable … [Continue reading]

Keeping Track of Your Pension

Although more and more employers are switching from defined benefit plans to IRA's and  401(k)s, many Baby Boomers did spend part of their careers at companies that offered a pension as part of the compensation package.    Now that they are getting … [Continue reading]

Help for Financial Caregivers

A couple of weeks ago,  my post described some holiday gifts and services that can help relieve stress for physical caregivers. Those of us who are charged with assisting our loved ones with their finances may find that responsibility stressful as … [Continue reading]

Remember the Caregivers During this Holiday Season

Thoughts of the upcoming holidays encourage many of us to anticipate spending time with family and friends to revisit established traditions and enjoy our favorite foods. Unfortunately,  people who serve as caregivers for loved ones with Dementia … [Continue reading]

When Screening Tests are No Longer Called For

The guidelines for when women should have screening mammograms was recently in the news again, when the American Medical Association recommended that regular testing for women with no known risk factors should not start until age 45, rather than the … [Continue reading]

What to do When Dad Shouldn’t Drive

One of the toughest conversations we have - or dread having - when someone we love has been diagnosed with Alzheimer's Disease or other dementia is the discussion about whether that person can continue to drive.  For gentlemen of a certain age, the … [Continue reading]

Arbitration Agreements in Nursing Home Contracts

As anyone who has had to admit a loved one to a nursing home knows, the contracts are long and full of "legalese" and fine print, especially when you consider the stressful situation that has brought you to be reviewing that contract in the first … [Continue reading]

Another way to remind you to prepare your Advance Directives!

Pretty much everyone who works with seniors, not to mention attorneys and medical service providers who work with all adults, at all ages, have written innumerable articles, blog posts and social media messages to get the word out that everyone needs … [Continue reading]

Is Dementia a Service-Connected Injury for Gulf-Region Veterans?

  As an Elder Law attorney, I don't see as many WWII veterans as I used to, since fewer and fewer of them are still with us.  Instead, more and more of my fellow baby-boomers who are Viet Nam veterans are coming to my office for assistance.  … [Continue reading]