A U.S. district court dismisses a lawsuit by a Kentucky nursing home to obtain retroactive Medicaid benefits for a deceased resident because the nursing home does not have standing to pursue a claim on behalf of the resident’s estate. Diversicare v. Glisson (U.S. Dist. Ct., E.D. Ky., No. 16-141-HRW, October 27, 2017).

Wilma Fryer entered a nursing home, and the nursing home applied for Medicaid benefits on her behalf. The application was still pending when Ms. Fryer died. The state eventually denied the application due to missing information about Ms. Fryer’s finances.

At the hearing, the nursing home produced the previously missing information, but the state denied the application because the information was not produced before the application was processed. The nursing home filed a claim in federal court, arguing that the state wrongfully denied Ms. Fryer benefits.

The U.S. District Court, Eastern District of Kentucky, dismisses the claim, holding that the nursing home does not have standing to sue on Ms. Fryer’s behalf. The court notes that the nursing home is not the administrator of Ms. Fryer’s estate. According to the court, the nursing home “is, at best, a creditor” and there “are no Kentucky statutes that allow a creditor of an estate to sue directly on behalf of a deceased debtor.”

Seniors tighten their belts in retirement, and that may not always be a good thing.

Most seniors aren’t living large in retirement. However, that’s not necessarily because they lack the money to do so.

“Those who have higher incomes are generally living too frugally,” says Matt Fellowes, founder and CEO of United Income. Seniors trim an average of 2.5 percent off their spending each year, according to a white paper he drafted examining data from the government and University of Michigan. Meanwhile, estate values grew 130 percent between 2000-2002 and 2010-2012.

While it may seem as though there can be no harm in living frugally, Fellowes and other finance experts say both seniors and the economy can suffer when spending declines.

Shift of income in retirement. For workers who have earned a paycheck for decades, the shift to using income from retirement accounts can be difficult. “When people start paying themselves, they get scared,” says Dolph Janis, founder and owner of Clear Income Strategies Group in Charlotte, North Carolina.

After spending a lifetime saving money, it can feel unsettling to begin pulling cash from accounts that were previously off-limits. “It’s a psychological issue,” says Nancy Skeans, CEO of Schneider Downs Wealth Management Advisors in Pittsburgh. It’s something even her more affluent clients experience. “They are really apprehensive about spending $30,000 or $40,000 for a new car,” she says, even when they can clearly afford it.

Health care, economic concerns stifle spending. Health care costs and the economy also rank high as motivation to cut spending. In particular, today’s longer lifespans breed uncertainty about if and when retirement money will run out.

“The good news is you get to live a long life,” says Stephen Daney, investment advisor at Better Money Decisions and founder of The Life Money Center in Albuquerque, New Mexico. “The bad news is that you may have only planned for [age] 75 or 80.”

Skeans says her clients are particularly concerned with how to pay for health care. “[They worry] about the unknown cost of what it’s going to cost to take care of me when I’m 85 years old,” she says. Some people are also concerned about market fluctuations and worry about a future recession wiping out savings. “People continue to refer back to 2008,” Skeans says. “What if it happens again?”

Television might be partly to blame. The Bureau of Labor Statistics reports seniors watch significantly more television than younger age groups. While people 35 to 44 years old watched an average of two hours of TV programming each day in 2016, the number jumps to four hours for those 65 to 74 years old. “As people follow news more closely, they may become more susceptible to a negative viewpoint,” Fellowes says. News tends to sensationalize changes in the market, which can result in people holding on to their money too tightly.

Dangers of extreme frugality. Being frugal may seem like a virtue, but it doesn’t come without faults. The most obvious problem is that it’s difficult for seniors to enjoy retirement if they refuse to spend any of their money. “If you become obsessed with penny-pinching, that’s a problem,” Daney says.

Fellowes says the problems go deeper than that. According to his research, seniors may delay preventive care or withdraw from social activities in order to save money. Both can have a negative effect on senior health and well-being.

There is also a larger economic issue at play. In 2012, consumer insights firm Nielsen predicted baby boomers would hold 70 percent of disposable income in the U.S. by 2017. “You have this population that has stockpiled assets and isn’t putting [them] back into the economy,” Fellowes says. Although hard to quantify, that could have an economic effect at the national level.

How to find the proper balance. Janis says there is a relatively simple way for seniors to avoid hoarding money they could be spending to enjoy their retirement years. “Too many people are worried about how much money they have and not enough about how much income they have coming in,” he says.

Instead of lumping all retirement funds into one bucket, Janis divides them into guaranteed and non-guaranteed sources of income. Periodic payments from Social Security, traditional pension plans and annuities can all be considered guaranteed, and seniors should be sure their fixed expenses can be covered by these sources.

“When I’m doing a [financial] plan, Social Security should take care of medical needs and living expenses,” Janis says, assuming his client doesn’t have an annuity or pension. “It shouldn’t cover your lifestyle.” Lifestyle expenses such as travel and dining can be taken out of 401(k)s, IRAs or other savings.

Being too frugal in retirement doesn’t seem like the worst problem to have, but there is no reason to hold onto your cash when you could be using it to enjoy your golden years more fully.

By:

How to find the proper balance. Janis says there is a relatively simple way for seniors to avoid hoarding money they could be spending to enjoy their retirement years. “Too many people are worried about how much money they have and not enough about how much income they have coming in,” he says.

Instead of lumping all retirement funds into one bucket, Janis divides them into guaranteed and non-guaranteed sources of income. Periodic payments from Social Security, traditional pension plans and annuities can all be considered guaranteed, and seniors should be sure their fixed expenses can be covered by these sources.

“When I’m doing a [financial] plan, Social Security should take care of medical needs and living expenses,” Janis says, assuming his client doesn’t have an annuity or pension. “It shouldn’t cover your lifestyle.” Lifestyle expenses such as travel and dining can be taken out of 401(k)s, IRAs or other savings.

Being too frugal in retirement doesn’t seem like the worst problem to have, but there is no reason to hold onto your cash when you could be using it to enjoy your golden years more fully.

By: Maryalene LaPonsie – USNews.com

WASHINGTON (Reuters) – The largest U.S. veterans service organization on Thursday urged President Donald Trump to veto recent legislation allowing financial companies to block customers from banding together to sue, saying it would hurt members of the armed forces.

The American Legion, which rarely speaks out on bank policy or politics, said in a statement it would “not be silent while banks and payday loan shops rip off servicemembers and veterans”. But it will likely have a hard time convincing Trump to veto the resolution to roll back the Obama-era policy.

The Consumer Financial Protection Bureau, an independent federal regulator, finalized a rule this summer that barred banks, credit card issuers and other financial companies from requiring customers to agree not to join group lawsuits and only take any potential disputes to closed-door arbitration.

In a vote of 51 to 50, the Senate on Tuesday passed a resolution killing the rule and prohibiting regulators from enacting a similar one in the future. The House of Representatives approved the resolution earlier, and now all that is needed to erase the rule is for Trump to sign it into law.

”Our membership has stated unequivocally that we are opposed to situations where our military and veterans’ financial protections are chipped away to increase the profits of the big banks,” said American Legion National Commander Denise Rohan. “Repealing the CFPB arbitration rule takes away consumers’ most effective tool to protect themselves against predatory lenders.”

Servicemembers can struggle to sue companies individually because they cannot afford legal costs, move frequently for work, or are deployed overseas, the Legion said.

In class actions, individuals with the same complaint band together to lower lawsuit costs.

Many veteran organizations tried for months to stop the Republican-led Congress from passing the resolution, and other advocacy groups have also pressed for a veto.

That is a long-shot.

The White House issued a statement shortly after Tuesday’s vote applauding the resolution, saying the CFPB rule would have given consumers “fewer options for quickly and efficiently resolving financial disputes” and opened “the door to frivolous lawsuits by special interest trial lawyers.”

The rule’s supporters say arbitration is rigged against consumers because it is secretive, does not set legal precedent, and is controlled by the companies. They also say the right to sue is enshrined in the U.S. Constitution.

Reporting by Lisa Lambert; Editing by Andrew Hay

On February 16, 2017, the Jimmo v. Sebelius court approved a Corrective Statement to be used by the Centers for Medicare and Medicaid Services (CMS) to affirmatively disavow the use of an “Improvement Standard” for Medicare coverage. The government will use the statement as part of its Corrective Action Plan, which was ordered by the Court last month to remedy noncompliance with the Jimmo Settlement.

The court-approved CMS Corrective Statement follows:

The Centers for Medicare & Medicaid Services (CMS) reminds the Medicare community of the Jimmo Settlement Agreement (January 2014), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met). Specifically, the Jimmo Settlement required manual revisions to restate a “maintenance coverage standard” for both skilled nursing and therapy services under these benefits:

Skilled nursing services would be covered where such skilled nursing services are necessary to maintain the patient’s current condition or prevent or slow further deterioration so long as the beneficiary requires skilled care for the services to be safely and effectively provided.

Skilled therapy services are covered when an individualized assessment of the patient’s clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist (“skilled care”) are necessary for the performance of a safe and effective maintenance program. Such a maintenance program to maintain the patient’s current condition or to prevent or slow further deterioration is covered so long as the beneficiary requires skilled care for the safe and effective performance of the program.

The Jimmo Settlement may reflect a change in practice for those providers, adjudicators, and contractors who may have erroneously believed that the Medicare program covers nursing and therapy services under these benefits only when a beneficiary is expected to improve. The Settlement is consistent with the Medicare program’s regulations governing maintenance nursing and therapy in skilled nursing facilities, home health services, and outpatient therapy (physical, occupational, and speech) and nursing and therapy in inpatient rehabilitation hospitals for beneficiaries who need the level of care that such hospitals provide.

Attorneys for the Jimmo plaintiffs are pleased that the statement emphasizes the availability of coverage for maintenance nursing and therapy when it is skilled. Many older adults and people with disabilities require skilled therapy or nursing to maintain current functioning or prevent deterioration. This is particularly true for people with chronic and progressive conditions, such as Parkinson’s disease, multiple sclerosis, or ALS. Medicare beneficiaries and their advocates should point to the CMS Corrective Statement if confusion about the Improvement Standard among medical providers or Medicare decision-makers persists.

“The CMS Corrective Statement is intended to make it absolutely clear that Medicare coverage can be available for skilled therapy and nursing that is needed to maintain an individual’s condition or slow deterioration,” says Judith Stein, Executive Director of the Center for Medicare Advocacy and a counsel for the plaintiffs. “We are hopeful this will truly advance access to Medicare and necessary care for people with long-term and debilitating conditions.”

CMS will be publishing the Corrective Statement on a new webpage dedicated to Jimmo. The webpage will also include Frequently Asked Questions and Jimmo-related documents and resources. The Corrective Action Plan also includes additional training for Medicare contractors and adjudicators. The Plan must be fully implemented by September 4, 2017.

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The Center for Medicare Advocacy, Inc., established in 1986, is a national nonprofit, nonpartisan law organization that provides education, advocacy and legal assistance to help older people and people with disabilities obtain fair access to Medicare and quality health care. The Center is headquartered in Connecticut and Washington, DC with offices throughout the country.

Vermont Legal Aid is a non-profit law firm established in 1968 to provide civil legal services for those living in poverty, with a disability, or over age 60. We also serve anyone who is discriminated against in housing decisions and all who face challenges related to health care insurance or services.

The days are long past when the only career doors that readily opened to young women were those marked teacher, secretary or nurse. Yet young adults who are part of the millennial generation are nearly twice as likely as baby boomers were to choose the nursing profession, according to a recent study.

These young people, born between 1982 and 2000, are also 60 percent more likely to become registered nurses than the Gen X’ers who were born between 1965 and 1981.

What gives?

“There’s no perfect answer,” said David Auerbach, an external adjunct faculty member at Montana State University’s College of Nursing and the lead author of the study, which was published this month in Health Affairs. The trend could be associated with economic factors, he said. Millennials came of age during a period of deep economic uncertainty with the Great Recession, which began in 2007, and the nursing profession generally offers stable earnings and low unemployment.

In addition, researchers have teased out generational characteristics that might make nursing more attractive to millennials.

“These people are looking for more meaningful work and work that they care about,” Auerbach said.

One thing that hasn’t changed since the 1950s: Nursing is still dominated by women. In 2017, women made up at least 83 percent of registered nurses and licensed practical nurses, according to data from the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

For the study, researchers analyzed Census Bureau data on 429,585 registered nurses from 1979 to 2015. The study excluded data on advanced practice nurses.

The study found that the number of new entrants into the field has plateaued in recent years. Still, the millennial generation’s embrace of the nursing profession should nearly compensate for the retirement of baby boomer nurses over the next dozen years and may help avert shortages, according to the researchers.

Many factors will influence whether the supply of nurses is adequate in coming years. The health care needs of an aging population is only one of them.

“The growth in accountable care organizations and alternative payment models is probably the biggest factor,” Auerbach said. For example, as hospitals move away from fee-for-service medicine toward models that pay based on quality and cost effectiveness, nurses’ roles may shift, and fewer of them may be needed in hospital settings as inpatient care declines.

By Michelle Andrews

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