The law of later-life healthcare and decision making

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Where to find it

Law Library — 2nd Floor Collection (2nd floor)

Call Number
KF3608.A4 F76 2017
Status
Available

Authors, etc.

Names:

Summary

Whether you need an explanation of the intricacies of Medicare and Medicaid, alternatives to guardianship, or healthcare decision making for an incapacitated person, The Law of Later-Life Healthcare and Decision Making, Second Edition offers perspective and guidance in making difficult decisions. The book provides a comprehensive description of the manner in which the law regulates and reacts to healthcare and personal decision making for the elderly. The book answers to important and complex questions about healthcare decision making. And for those difficult questions that have no answers, this book outlines the legal issues and the doctrines that are at play.

Contents

  • About the Author p. v
  • Preface p. vii
  • Chapter 1 Paying for Health Care p. 1
  • 1.1 Medicare p. 1
  • 1.2 Medicare Part A Eligibility and Enrollment p. 2
  • 1 Individuals Age 65 or Older p. 2
  • 2 Individuals under Age 65 p. 4
  • 3 Enrollment p. 4
  • 4 Voluntary Enrollment p. 5
  • 5 Medicare Part A Benefits p. 7
  • a Hospital Insurance Benefits p. 7
  • b Spell of Illness and 90-Day-Coverage Period p. 8
  • c Lifetime Reserve 60-Day Coverage p. 9
  • d Skilled Nursing Facility (SNF) Care p. 10
  • e Home Health Care p. 11
  • 6 Hospice Care p. 14
  • 7 Medicare Savings Programs p. 16
  • 1.3 Medicare Part B p. 17
  • 1 Eligibility p. 17
  • 2 Medicare Part B Benefits p. 18
  • 3 Part B Deductible and Co-payment p. 20
  • 4 Services Not Covered by Part B p. 22
  • 1.4 Medicare Advantage (Ma) (Formerly Medicare Part C or Medicare + Choice) p. 22
  • 1 Eligibility p. 22
  • 2 Enrollment p. 23
  • 3 Benefits p. 24
  • 1.5 Medicare Part D Eligibility and Benefits p. 25
  • 1 Eligibility, Premiums, and Co-pays p. 25
  • 2 Coverage and Formularies p. 28
  • 3 Tax-Free Subsidies for Employer-Sponsored Retiree Prescription Drug Plans p. 29
  • 1.6 Medicare Payment Procedures p. 30
  • 1.7 Appeals from Medicare Denial of Coverage p. 31
  • 1.8 Appeals for Beneficiaries in Medicare Advantage (Medicare Part C) p. 32
  • 1.9 Medicare Reimbursement and Workers' Compensation and Insurance p. 33
  • 1.10 Medigap Insurance Policies p. 33
  • 1.11 Program of All-Inclusive Care for the Elderly (Pace) p. 35
  • 1.12 Employer Health Insurance for Employees Age 65 and Older p. 36
  • 1.13 Employer-Provided Retiree Health Care Benefits p. 37
  • 1.14 Veterans Health Care Benefits p. 38
  • Chapter 2 Long-Term Care Housing Options p. 41
  • 2.1 Introduction p. 41
  • 2.2 Aging in Place p. 41
  • 1 Advantages and Disadvantages p. 41
  • 2 Meeting the Challenges of Aging in Place p. 43
  • a Is Aging in Place Affordable? p. 43
  • b House-Sharing with a Relative p. 45
  • c House Sharing with a Nonrelative p. 46
  • 3 Medicare- and Medicaid-Financed Home Health Care p. 47
  • 4 Adult Day Care p. 49
  • 2.3 Age-Restricted Housing p. 50
  • 1 Federal and State Fair Housing Laws p. 50
  • 2 Types of Age-Restricted Housing p. 53
  • a Rental Property p. 54
  • b Ownership p. 55
  • 2.4 Retirement Housing Options p. 56
  • 1 Planned Communities p. 56
  • 2 Condominiums p. 58
  • 3 Cooperative Ownership p. 60
  • 4 Mobile and Manufactured Homes p. 60
  • 2.5 Supportive Housing p. 62
  • 1 Congregate Housing p. 62
  • 2 Assisted Living Facilities p. 63
  • 3 Board and Care Homes p. 68
  • 4 Continuing Care Retirement Communities (CCRCs) p. 69
  • a What Is A CCRC? p. 69
  • b Admission Contract and Fees p. 71
  • c Eviction p. 74
  • 2.6 Nursing Homes p. 74
  • 1 Services p. 75
  • 2 Governmental Regulation p. 77
  • 3 Contracts of Admission p. 78
  • a Responsible Party Provisions p. 79
  • b Binding Arbitration Clauses p. 80
  • 4 Transfers and Discharges p. 82
  • 5 Federal Nursing Home Reform Act (NHRA) p. 83
  • 6 State Ombudsman p. 87
  • 7 Statutory Private Rights of Action p. 87
  • 8 Common Law Tort Rights p. 89
  • a Intentional Torts p. 89
  • b Medical Malpractice p. 90
  • c Negligence p. 91
  • d Contract p. 94
  • 2.7 Hospice Care p. 95
  • 1 Medicare Eligibility for Hospice Care p. 95
  • 2 Hospice Services p. 96
  • Chapter 3 Paying For Long-Term Care p. 99
  • 3.1 Introduction p. 99
  • 3.2 Sources of Private Pay p. 100
  • 1 Personal Savings and Family Assistance p. 100
  • 2 Annuities p. 102
  • a Retirement Savings and Annuities p. 103
  • b Variable and Fixed Annuities p. 105
  • c Deferred Annuities p. 107
  • d Income Taxation of Annuities p. 108
  • 3.3 Refinancing the House p. 108
  • 3.4 Reverse Mortgages p. 109
  • 1 Description p. 109
  • 2 The Home Equity Conversion Mortgage p. 111
  • 3.5 Sale of House and Leaseback p. 113
  • 1 What Is a Sale and Leaseback? p. 113
  • 2 The Lease p. 114
  • 3 Federal Income Tax Consequences p. 115
  • a Statutory Exclusion of Gain p. 115
  • b Calculation of Gain p. 117
  • 4 Tax Consequences to the Parties p. 118
  • 5 Advantages and Disadvantages p. 119
  • 3.6 Sale of Remainder Interest p. 120
  • 3.7 Continuing Care Retirement Communities (CCRCs) p. 121
  • 1 Admission Policies and Fees p. 122
  • 2 Federal Income Tax Deductions of Fees p. 125
  • 3 Levels of Care and Personal Security p. 125
  • 4 Regulation p. 126
  • 3.8 Long-Term Care Insurance p. 127
  • 1 Benefits p. 128
  • 2 Insurability, Cost Considerations, and Lapsing of Policies p. 130
  • 3 Federal Income Tax Consequences p. 132
  • 4 State Partnership Policies p. 133
  • 5 Hybrid Long-Term Care Insurance Policies p. 133
  • 3.9 Medicare p. 136
  • 3.10 Medicaid p. 137
  • 1 Introduction p. 137
  • 2 Paying for Nursing Home Care p. 138
  • 3 Eligibility Requirements for Single Individuals p. 138
  • a Residency p. 138
  • b Categorically Needy p. 139
  • c Optional Categorically Needy p. 140
  • d Medically Needy p. 141
  • e Resource Eligibility Requirements p. 142
  • 4 Eligibility Requirements for Married Individuals p. 144
  • a Income p. 144
  • b Resources p. 145
  • 5 Community Spouse Resource and Income Rights p. 146
  • a Spousal Resource Allowance p. 147
  • b Income for the Community Spouse: Minimum Monthly Maintenance Needs Allowance (MMMNA) p. 147
  • c Use of Institutionalized Spouse's Income for the Benefit of the Community Spouse p. 149
  • 6 Transfer of Assets p. 150
  • a Look-Back Period and Period of Ineligibility p. 150
  • b Transfers for Fair Consideration: Personal Services Contract p. 153
  • c Exempt Gifts p. 155
  • d Transfer of Home p. 156
  • e Gifts in Trust p. 157
  • 7 Planning Techniques for Married Couples p. 158
  • a Repayment of Debts by Institutionalized Spouse p. 158
  • b Conversion of Countable Resources into Exempt Assets p. 159
  • c Conversion of Countable Resources into Income for Community Spouse p. 160
  • d Changing Beneficiaries p. 161
  • 8 Statutorily Approved Trusts That Create Eligibility p. 162
  • a "Miller Trusts" p. 162
  • b Payback Trusts p. 162
  • c Pooled Trusts p. 163
  • 9 Estate Recovery p. 164
  • 3.11 Paying for Adult Day Care p. 164
  • 3.12 Life Insurance as a Source of Long-Term Care Financing p. 165
  • 1 Accelerated Benefits p. 165
  • 2 Viatical Settlements p. 166
  • Chapter 4 Legal Implications of Mental Incapacity: Guardianship, Conservatorship, and Powers of Attorney p. 167
  • 4.1 Introduction p. 167
  • 4.2 Guardianship Terminology p. 172
  • 4.3 For Whom May a Guardian be Appointed? p. 172
  • 4.4 For Whom May a Conservator be Appointed? p. 174
  • 4.5 The Relationship between the Need for a Guardian and the Individual's Medical Condition p. 175
  • 4.6 The Requirement of a Demonstrated Need for a Guardian p. 176
  • 4.7 Types of Guardianships p. 178
  • 1 Guardian of the Estate p. 179
  • a Limits on the Authority of the Guardianship of the Estate p. 179
  • b Expenditure of Principal p. 181
  • c Control of the Person p. 182
  • d Voluntary Conservatorship or Guardianship p. 184
  • 2 Guardian of the Person p. 185
  • a General Authority p. 185
  • b Mental Health Treatment p. 185
  • c Termination of Life-Sustaining Treatment p. 186
  • d Proof of the Incapacitated Person's Desires p. 189
  • 3 Plenary Guardianship p. 192
  • 4 Limited Guardianship p. 194
  • a The Concept of Mental Capacity p. 194
  • b The Purpose of Limited Guardianship p. 196
  • c Reluctance to Use Limited Guardianship p. 197
  • 5 Temporary or Emergency Guardians p. 201
  • a Procedures p. 202
  • b Reasons for Temporary Guardianship p. 203
  • 6 Uniform Veterans' Guardianship Act p. 206
  • 4.8 Guardianship Procedures p. 206
  • 1 The Petition p. 206
  • a Content p. 207
  • b Nomination of the Guardian p. 211
  • c Where to File the Petition p. 213
  • d Changing the Residence or Domicile of the Ward p. 213
  • e In Rem Jurisdiction p. 216
  • 2 Notice p. 217
  • 3 The Hearing p. 219
  • a Presence of the Allegedly Incapacitated Person p. 219
  • b Right to a Jury p. 220
  • c Court Visitors p. 220
  • d Right to Counsel p. 221
  • e Guardian Ad Litem p. 223
  • f Evidentiary Standards p. 224
  • 4.9 Selection of the Guardian p. 226
  • 1 Guardian Nominated by the Petitioner p. 227
  • 2 Nomination of Guardian by the Incapacitated Person p. 228
  • 3 Statutory Priorities p. 229
  • 4 Family Discord and the Selection of the Guardian p. 231
  • 5 Nonprofit Corporations as Guardian p. 232
  • 6 Public Guardians p. 232
  • 4.10 Paying for the Costs of Guardianship p. 233
  • 1 Attorneys' Fees p. 234
  • 2 Guardians' Fee p. 235
  • 4.11 Reporting Requirements and Court Supervision of the Guardian p. 236
  • 1 Annual and Final Reports to the Court p. 236
  • 2 Removal of Guardian p. 238
  • 4.12 Termination of Guardianship p. 238
  • Chapter 5 End-of-Life Decision Malting p. 241
  • 5.1 The Right of a Competent Patient to Forego Life-Sustaining Medical Treatment p. 242
  • 1 Informed Consent p. 242
  • 2 Who Is Competent? p. 244
  • 5.2 Health Care Decision Making Absent Judicial Proceedings for the Mentally Incapacitated Patient p. 245
  • 1 Informal Reliance upon Spouse or Family p. 245
  • 2 Statutorily Designated Surrogate Decision Maker p. 247
  • a General Description p. 247
  • b Selection of the Surrogate p. 248
  • c When Surrogates Disagree p. 249
  • d The Authority of the Surrogate p. 249
  • 5.3 Health Care Decision Making for the Incapacitated Patient: Guardianship and Judicial Oversight p. 253
  • 1 Cruzan: The U.S. Supreme Court Sets the Framework p. 253
  • 2 Clear and Convincing Standard p. 254
  • 3 Substituted Judgment Standard p. 255
  • 4 Termination of Treatment under Best Interest Standard p. 256
  • 5.4 Living Wills p. 257
  • 1 Procedural Requirements p. 258
  • 2 State Forms and Substantive Requirements p. 259
  • a Permanently Unconscious p. 260
  • b Terminal Illness p. 261
  • c Artificial Nutrition and Hydration p. 262
  • 3 When Living Wills Take Effect p. 263
  • 5.5 Health Care Powers of Attorney p. 264
  • 1 Procedural Requirements p. 266
  • 2 Statutory Forms and Customized Documents p. 268
  • 3 Execution of the Document in a Health Care Facility p. 271
  • 4 Selection of the Surrogate: Who, How Many, and Successors p. 271
  • 5 When Does the Surrogate's Right to Act Begin? p. 273
  • 6 The Extent of the Surrogate's Decision-Making Authority p. 273
  • 7 Relation of Surrogate and Guardian of the Person p. 274
  • 8 HIPAA p. 275
  • 5.6 DNR Orders p. 276
  • 1 CPR p. 276
  • 2 State DNR Statutes p. 277
  • 3 Emergency Personnel and DNR Orders p. 278
  • 4 Treating Physicians and DNR Orders p. 279
  • 5.7 POLST p. 280
  • 5.8 Palliative Care at the End of Life p. 282
  • 1 The "Double Effect" Doctrine p. 282
  • 2 Terminal Sedation p. 283
  • 3 Impediments to Adequate Pain Management p. 284
  • a Use of Opioids for Acute or Chronic Pain p. 286
  • b Federal Barriers to Use of Opioids p. 287
  • c State Barriers to Adequate Pain Relief p. 289
  • d Liability for Failure to Adequately Treat Pain p. 290
  • 5.9 Hospice Care p. 291
  • 1 Medicare Payment for Hospice Care p. 291
  • 2 Hospice Care Services p. 293
  • 3 The Hospice Interdisciplinary Team p. 295
  • 4 Paying for the Cost of Hospice Care p. 296
  • 5 Hospice Patients' Rights p. 298
  • 5.10 Disposition of the Decedent's Physical Remains p. 300
  • 1 Common Law p. 301
  • 2 Statutory Law p. 302
  • 3 Other Evidence of the Decedent's Intent p. 304
  • 4 Re-interment and Payment p. 305
  • 5.11 Organ Donation p. 306
  • Table of Cases p. 000
  • Index p. 000

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