38 THE QUEENS COURIER • HEALTH • APRIL 1, 2021 FOR BREAKING NEWS VISIT WWW.QNS.COM
health
Elder Law Minute TM
What to do with your stimulus check if you are in a nursing home
ELDER LAW
Chronic illness and aging
Chronic illness is the hallmark of aging. For many
years, elderly individuals with intractable pain from
arthritis were advised repeatedly, by their primary physicians,
“You must learn to live with it.” But fi nally, chronic
disorders are now being taken seriously as we confront
the social and economic costs of impairment. Arthritis is
almost universal, but more trouble for some than for
others. However, a state of wellness may be achieved if
the individual feels capable and motivated to manage
the problem with or without assistance.
According to social scientists, “The aged, with one or
more chronic conditions who are supported by those
concerned, can result in a healthy satisfaction with life
and improved self-esteem that can follow.”
Chronic illness requires a reorganization of how society
thinks about the physical needs of the aged. The
numerous manifestations of a chronic illness should
never be the sole determative factor in understanding
the elderly’s state of health nor continued wellness.
Several years ago I was a moderator at a lively discussion
with a group of nursing home residents regarding
chronic illness and their idea of what was “wellness” and
what it can off er them. They questioned how it applied,
for instance, to the daily struggles they were experiencing
and the medications they were taking for the pain
that gave only temporary relief. There were several comments
such as, “Let’s get real. Wc’re too old and nothing
we do, whether it be daily meds or exercise, etc., alleviates
our permanent pain.”
Another resident replied, “My arthritis is severe and
comes on like a fast moving locomotive, but never stops.
I consider myself a perpetual passenger.” He continued,
“When will it ever stop?” The anguish in his voice was
real, his attitude, desperate.
The elderly don’t graciously accept their chronically
painful disorders. They rather tend to mourn their loss.
The researchers Strauss and Glaser, visualized chronic
illness as “a trajectory model that is aided by innumerable
health care providers toward a clearer understanding
of the restrictions that arises from chronic illnesses.”
The researchers Corbin and Strauss, off er their view
of chronic illness as “a trajectory that traces a course
of illness through several phases which may be either
upward, downward or plateaued. In its entirety, a chronic
illness may periodically include a preventive phase, a
defi nitive crisis and acute phase, and a comeback phase.”
Chronic illness is diffi cult to always identify as so
many acute disorders have chronic results.
Many of the more commonly identifi ed disorders
tend to fl are up and subside once again into remission
before the next fl are up occurs.
There is a growing recognition that chronic illnesses
are a major concern for health practitioners.
Unfortunately, health professionals and the lay public
have as yet been unable to fully demonstrate an adequate
understanding of the problem. The prevalence
of a multiple of chronic illnesses continues to rise in
the general population along with the lengthening of
the aged individual’s life span. Here are several relevant
statistics regarding chronic conditions in the United
States, particularly for those over seventy-fi ve and who
are female.
• Arthritis: 55% incidence, nearly twice as common
in females;
• Hearing impairment: 38% incidence, slightly more
common in females;
• Hypertension: 37% incidence and more common in
females;
• Cataracts: 25% incidence and nearly twice as common
in females.
Until the late 1930s, prevailing illnesses were predominantly
caused by either bacterial infections or parasites.
With the advent of antibiotics and immunizations,
these diseases have decreased markedly in the industrialized
nations. Instead, cancer, arthritis, and cardiovascular
conditions have become the more prevalent of
public health problems. According to Strauss and Corbin,
“Much of the acute care seen in hospitals is in response
to episodes from a chronic illness.” This growing awareness
of chronic illness is a catalyst for change.
According to the Foundation for Rehabilitation
Nursing, “Most persons with chronic impairments need
physiologic and psychologic treatment to achieve a reasonable
level of physical functioning.” There is recent literature
on the subject of chronic illness that emphasizes
the need for immediate and intense rehabilitation even
during an acute illness. No longer is it appropriate to
withhold treatment until the patient is diagnosed medically
stable. The aged with long standing disabilities,
have the potential for becoming chronic and insolvable
and may therefore welcome the opportunity of participating
in a rehabilitation experience with all of its longterm
benefi ts.
The value of enjoying a sense of well-being can begin
with a carefully crafted rehab program. However, if you
ask the average aged individual with a painful chronic
outcome to describe what they believe is physical rehabilitation
and what it can off er them they will reply,
walking on a treadmill and/or lifting a few weights.
Nothing could be further from the truth! What then
can rehabilitation off er? Here are but a few examples of
what the process involves:
• strengthening of weakened muscles (quadriceps,
hamstrings)
• improving physical endurance (lung capacity)
• increasing range of motion (arms/legs)
• improving coordination of movement (walking on
level and unlevel surfaces)
• improving functional gait (avoiding unnecessary falls)
• expanding those activities of daily living practices.
Successful physical rehabilitation can be viewed as
full restoration of one’s physical functioning. In other circumstances,
the individual may not always fully recover
but still achieve a reasonable control over their lives.
The elderly individual with an unremitting and painful
chronic problem will, with time, eff ort and specific
exercises, secure most, if not all of his resources and
capacities.
The wrongful image of the poor, sick and old is continuously
advanced by the media as a progressive decline in
physical and mental health, despite the fact it is a false
assumption fraught with endless negative stereotyping
of the aged and fi lled with potential setbacks to their
pride and convictions, but most of all, their progress.
According to one social scientist, “This kind of wrongheaded
thinking can be thought of as a false fi xed belief
and not of the real world regarding the current status
of aging.”
The aged have become increasingly cognizant about
chronic illness and its long-term consequences that may
very well lead to physical and mental dependence with
all of its numerous ramifi cations. Recent documentation
however, has shown that the aging population has
begun to “break out” of the mold, that chronic illness is
equated with decline and endless dependency.
It bears repeating, once again, the aged have an inexhaustible
level of energy that can be utilized for calling
upon a caring caregiver whenever assistance may
be needed.
Final Comment: Jennie, an 89-year-old nursing home
patient was asked how she would interpret the concept
of wellness as it relates to a current chronic illness she is
living with. She replied, “For me wellness means doing
my very best with the energy I have left and the situation
I fi nd myself in. And when I don’t feel like I am doing
my best, I take a nap and pick up again later. Look, let’s
face it, there will always be another sunrise for me to
awaken to.” You go, Jennie!
Sheldon Ornstein Ed.D, RN, LNHA
BY RONALD A. FATOULLAH, ESQ.
AND EVA SCHWECHTER, ESQ.
While stimulus checks come as a benefi t to many,
for Medicaid recipients the additional funds can be a
source of concern. Nursing home residents who are in
receipt of institutional Medicaid benefi ts are careful to
keep their total resources below the Medicaid resource
limit of $15,950. Additionally, Medicaid recipients pay
a majority of their income outright to the nursing
home. As the third round of stimulus checks are being
distributed, nursing home residents should know their
rights and responsibilities with regard to their stimulus
checks.
In December 2020, Congress approved $600 stimulus
checks for individuals making less than $75,000 a
year. In March 2021, Congress approved another round
of $1,400 stimulus checks. These checks are being sent
to everyone eligible, including individuals on Medicaid
and in a nursing home or assisted living facility.
It is important for nursing home residents to be
aware that they are not required to turn their checks
over to their nursing home. To ensure that the stimulus
checks are being used for their intended purpose,
the Federal Trade Commission (FTC) is reminding
nursing home and assisted living residents that
their stimulus checks are for them, not their facility.
With the fi rst round of stimulus checks, there were
reports that facilities were taking the checks without
the residents’ permission. The FTC announced
that if nursing homes ask for a resident’s check, the
resident should contact the state attorney general
and the FTC.
However, Medicaid recipients should also know
that, while they can keep the stimulus funds in their
own accounts, there are certain restrictions that apply
if the additional funds put the Medicaid recipient over
Medicaid’s resource limit. Medicaid recipients who
receive a stimulus check that puts them above this
limit will need to spend down the money within a year
or risk losing benefi ts.
The Social Security Administration has said that it
will not consider stimulus payments as income, and
that the payments will be excluded from a Medicaid
recipient’s resources for 12 months. The following are
examples of what a Medicaid recipient may be able
to spend the money on without aff ecting his or her
eligibility:
Making a payment toward paying off debt.
• Making small repairs around the house.
• Updating personal eff ects. Buying household goods
or personal comfort objects. Buying a new wardrobe,
electronics, or furniture.
• Buying needed medical equipment, seeing a dentist,
or having one’s eyes checked if those items are
not covered by insurance.
If you have questions about how you or a family
member in a nursing home can spend his or her stimulus
money, it is advisable to contact an elder law attorney
to assist in appropriate planning.
Ronald A. Fatoullah, Esq. is the founder of Ronald
Fatoullah & Associates, a law fi rm that concentrates in
elder law, estate planning, Medicaid planning, guardianships,
estate administration, trusts, wills, and real
estate. Eva Schwechter is an elder law attorney with
the fi rm. The law fi rm can be reached at 718-261-
1700, 516-466-4422, or toll free at 1-877-ELDER-LAW
or 1-877-ESTATES. Mr. Fatoullah is also a partner with
Brightside Advisors, a wealth management fi rm with
offi ces in New York and Los Angeles.
This summary is not legal advice and does not create
any attorney-client relationship. This summary does
not provide a defi nitive legal opinion for any factual situation.
Before the fi rm can provide legal advice or opinion
to any person or entity, the specifi c facts at issue
must be reviewed by the fi rm. Before an attorney-client
relationship is formed, the fi rm must have a signed
engagement letter with a client setting forth the Firm’s
scope and terms of representation.
RONALD FATOULLAH
ESQ, CELA*
Dr. Sheldon
Ornstein is a
registered professional
nurse
with a doctoral
degree in nursing
organization.
He has specialized in the
care of older adults and has
published many articles on
the subject. He has done postgraduate
work in gerontology
and has taught at several
universities. In 2013, he was
inducted into the Nursing Hall
of Fame at Teachers College,
Columbia University.
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