Health Care Law and Dementia Testing

How many times have you walked into a room this month, only to wonder why you were there?  Have you misplaced your cell phone or car keys lately?

Well you are not alone.  But that is probably no reason to worry, or seek out an evaluation for dementia, just yet.

But you should know that screening for cognitive impairments can be covered, under Medicare, and some other insurances, and if done as part of the annual wellness check, under Medicare rules, there should be no deductible.

Is screening appropriate for everyone?  Most professionals say no.  If you or your loved one have few signs of trouble, the utility of the testing has been debated, and some think it is unwarranted.

That is not quite the same though, if, as you or a loved one ages, you start to see signs of trouble.

Then such a screening might help in three ways.  First one can establish a sort of “baseline.” And, second, IF the screening indicates a problem, more testing can be done, and perhaps even medicines can be prescribed–medicine for Alzheimer’s are most effective when used early on. Third, before capacity is entirely gone, you can attend to your legal affairs.

For more information see this article from Kaiser Health News:

Perhaps too, you have heard of the “mini-mental state” examinations.  Ever wonder what sort of questions might be asked?  You’re in luck–here is an example:

As you help others or think about helping yourself, remember it is important to take care of most all legal documents before your capacity, or the capacity of a loved one, is seriously questioned.

Don’t Go It Alone

If you are facing a disease process that is likely to greatly alter your ability to help yourself, or your life in general, don’t go it alone.  Sure, sure, in the final analysis, whatever happens, is happening to YOU.

But more likely than not there is a constellation of folks who care and who would or will help. You should take advantage of that, in order to not feel overwhelmed.

The trick is to avoid “burn out” by caregivers, and to get knowledge and perspective for yourself. The road ahead may well be pretty rocky.  So finding even a little guidance from those who have tread the path may make the road ahead seem less rocky.

Virtually every major condition or disease has a “group” or organization.  While such groups may be heavy-handed at times in seeking donations, most give decent information, offer tips, sponsor support groups, talk about treatments, and so on. If you are at all worried about a group, you can pretty readily check out their background and standing with various rating agencies, the Attorney General in your state, or others.

As an attorney, I can often help with some aspects of what you will or your loved ones may face.  But the law only helps so much.  Make an appointment with me of course, early on–but take advantage of what others can offer too.

In early May we will list a number of groups and organizations as part of our web links and resources.

Stay tuned.

End of Life Care–Is Cost In the Mind of the Patient or Doctor?

Do you suspect that the costs of end of life care enters the minds of patients and doctors?  What’s your guess? Most folks would say you guessed right — if you thought costs did enter the mind of patients or doctors.

No one wants to be  “cheap” when it comes to the care of our loved ones.  And we have every right and incentive, to make sure end of life care is appropriate, and paid for, if covered by insurances.  Many of us would gladly reach into our own pocket to add vitality to our life or to preserve the life of a loved one.

But not all medical spending is equal, it seems, and some expensive treatments and approaches, haven’t really proven themselves, yet they do persist. See this article from the NY Times, for instance:

And some writers and studies hint that doctors are less likely to choose as many end of life treatments as the average patient.  An interesting write up can be found here:

This is not to say, that treatment for those who wish treatment, isn’t still the order of the day.  And some advocates have been very wary of any legislation that might hasten death or make anything akin to an assisted suicide commonplace.  See this website:

From a public health perspective an analysis of effective spending of monies for health outcomes, is not unwarranted.  And in the past few years, more analysis is likely to emerge, in part because of some federal initiatives from 4 or 5 years ago, and because one goal of the the Affordable Care Act, is to bend the cost curve downward.  This is so because in the last decade or so, medical care costs have increased far far above the rates of inflation. Taming those costs may help us all down the road.  So expect to see more analysis of public health dollar spending effectiveness, and expect to see as well, more focus on treatments and approaches for individual patients.  For instance see: and also:

It’s all fascinating stuff, and fodder for great discussions.  When we take it down to the individual level, the personal level, the tragedy isn’t what choice we ultimately make, if we make it ourselves.  The tragedy is when we leave substitute decision makers in the lurch when or if we can no longer speak for ourselves.

My parents, now dead, were born in the early 1920’s.  They grew up during the Depression, served in World War II and went on to have children, buy homes, work, etc.  Their medical history was relatively unremarkable, when younger–but the ravages of time did make the last two to five years at the end of their life more challenging.  They availed themselves of many treatments and saw some specialists, as need be.

But they both also made clear that some treatments or some conditions were simply not tolerable…and they let their children know that too.

And my own folks at least, especially my mother, wondered about the wisdom of spending thousands and thousands of “taxpayer” money (meaning, she said, Medicare) with an uncertain prognosis, and for perhaps just a few weeks of life. Of course that was easier for her to say in her mid 80’s since, as she put it, she already had “a good long run,” and pain issues often intruded on her daily life.

But my folks had discussion which helped the children. Knowing how they felt made it “easier” on us, the children, when tough calls near the end of life needed to be made.  Have you been as thoughtful?

Medicare and Insurance Advocacy

In a perfect world, I suppose, Medicare would be easy to understand, everyone would understand their coverages, and claims would always be processed so as to benefit the elderly fairly and fully and promptly.

And for many many people covered by Medicare, the system actually does work fairly well.

But Medicare has been getting more complicated. Changes are happening often, and for several years now, between the optional Medicare drug coverage programs, Medicare supplemental programs, the changes in the Blue Cross of Michigan structure, and the so-called Medicare Advantage plans, the landscape has changed. And this is also true for coverage under health insurance and long term coverage plans as well.

People need to spend more time reading and learning about their coverage and their options.  And I think folks might need to start asking more questions about their coverage, and even challenging claims if they are told a service isn’t covered.

Perhaps now, even more so than in the past, Medicare and other insurance advocacy and planning will be the order of the day for seniors and their families and anyone with Medicare coverage of any kind.

Feel free to set up an appointment with me if you’d care to review your options or if you think you are trapped in some sort of Medicare or insurance snafu.  I may be able to help.

And check out some of the “Useful Resources” on our website.  We’ve gathered and then listed a good deal of decent and credible websites as a way to help our clients and readers and potential clients.

Under Useful Resources, in the Federal/Nationwide section we have links to the Medicare website and the Center for Medicare Advocacy websites.

And in the Michigan list under our Useful Resources, we have links to the Michigan Medicare and Medicaid Assistance Program (MMMAP) and the Michigan Peer Review Organization (MPRO).   There is also a link to the Michigan Department of insurance and Financial Services.

Any or all of the above resources and the information found, will help you better use or understand Medicare and sometimes other insurances too.  And with knowledge comes power.

And remember that The Place for Good Counsel, the office of attorney Brad Vauter, can sometimes help too.  Insurance and Medicare advocacy can help assure you are able to obtain services and benefits you need and that ought to be covered.  And good Medicare and insurance planning, can help you put together a plan that best meets your needs and budget.

Sharing Favorite Songs–of Aging or Getting Older

There must be hundreds and hundreds of songs that conjure up the passage of time, and a few handfuls, at least, that speak to aging and growing older. Can you think of any? Have any favorites?

We probably all know some. Songs with lyrics that veer to the saccharine or the sardonic; gloomy or gay; trendy or traditional.

In my legal calling, such songs cross my mind now and then.  They don’t drill into my brain or ears like an Ohrwurm or anything, but they do bubble up to the surface of my consciousness every so often.

At the risk of creating a monster, I’d invite you, my many readers (o.k. o.k., my two very smart dogs, the guy who helped me create this web site and the two other faithful readers, one of whom is a unable to sleep nights and prowls the web reading everything) to nominate a song you think fits in this category.

Consider it a contest of sorts–albeit without a prize.*

Some rules:

Submit your entry by May 3rd.

Submit up to two entries only, with a brief explanation. For instance: why you like it or where did you first hear it, or why does it mean anything to you or why did it make your list?  And it has to be just one song or two–we’re not trying to create an encyclopedic list, after all.

Submit  only a song you really like–one that you might actually share with others you love or like. Or songs you might share or discuss if  you were waxing philosophic, or sentimental or eloquent.

Let me hear from you–all you need do is respond to this post or email us (subject matter should be “my favorite song on aging”) at

Without trying to push the nominations in any direction, let me list three examples that come to my mind when thinking of such songs or lyrics:

Hello in There by John Prine (Bette Midler has covered this too)

When I’m 64 by The Beatles

This ‘Ol House  (traditional) covered by many including Stuart Hamblen, Rosemary Clooney, Dolly Parton and others

But I’d really love to read about, and listen to your suggestions!

* heck this is a law office–we like a disclaimer every now and then.

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