36 THE QUEENS COURIER • HEALTH • APRIL 4, 2019 FOR BREAKING NEWS VISIT WWW.QNS.COM
health
Elder Law Minute TM
Understanding Hospice, Palliative Care and Medicare Coverage
BY RONALD A. FATOULLAH, ESQ.
Medicare’s hospice benefi t is one of
Medicare’s most comprehensive benefi
ELDER LAW
ts and can be extremely helpful to both
a terminally ill individual and his or
her family. However, this benefi t can be
misunderstood and underutilized. Being
knowledgeable about this benefi t ahead
of time can help ease the burden of
choosing hospice care should it become
necessary.
Hospice and palliative care both off er
compassionate care to patients with
life-limiting illnesses. Hospice care is
reserved for terminally ill patients when
treatment is no longer curative during
the last six months of life, assuming the
disease takes its normal course. In contrast,
Resistance-Exercise and Aging
For the aging individual, exercise is
associated with an array of benefi ts that
support a longer life span. A recent
study supports its connection to protecting
and enhancing brain function. In
2016 scientists released their fi ndings of
a controlled trial study that investigated
the eff ects of resistance training on cognitive
function in older adults.
Resistance training, also called
strength training, is exercise that
employs weights, machines, bands or
other devices that work key muscle
groups. Th e researchers wanted to determine
whether cognitive improvement
occurred as a result of either increased
aerobic capacity or increased muscle
strengthening.
Although both programs improved
whole body muscle strength and aerobic
capacity as well, the study team
found, however, that only the enhanced
strength scores, but not the enhanced
aerobic scores, were signifi cantly associated
with improvements in cognition.
While the exact reason for these benefi -
cial eff ects remain unknown, it is clear
that it is strength-related gains from
resistance exercise that cause cognitive
benefi ts.
Most medical professionals continue
recommending aerobic exercise, yet
fail to understand the value and benefi ts
of resistance exercise, especially for the
aging population.
Th is trial showing the superior cognitive
benefi ts of strength training adds
to a wealth of past evidence that supports
the value of strength exercise in
inhibiting a condition known as sarcopenia
(i.e.: a degenerative, progressive
loss of skeletal muscle mass usually 0.5-
1.0% loss per year aft er age fi ft y), and
also cognitive decline and the onset of
various neurodegenerative diseases (i.e.:
conditions/diseases resulting in a degeneration
within the nervous system which
includes the brain).
Unfortunately, despite the many
known benefi ts of exercise for the older
adult, the majority of them do not exercise
regularly.
Th e fi rst step, therefore, to motivating
older adults to exercise is educating
them about the benefi ts of exercise
with a strong emphasis on the outcomes
that can be expected if exercise occurs
regularly.
When prescribing an exercise program,
it is important to consider the
elderly person’s medical history, his
functional status in terms of cardiovascular
and musculoskeletal fi tness and
body composition. For example, if the
individual has knee pain, performing
weight bearing activities, with weights,
may not be appropriate.
Finally, there is strong evidence indicating
older adults can exercise safely
and that regular exercise has both physical
and mental health benefi ts.
Incidentally, a defi nition of aerobic
is a form of exercise that does not use
weight bearing devices, but rather free
movement such as jumping jacks, pushups,
arm twirls, etc.
Quotable Quote: “Strike a balance
between confi dence and humility –
enough confi dence to know that you
can make a real diff erence, and enough
humility to ask for help." (anonymous)
Sheldon Ornstein Ed.D, RN, LNHA
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
post-graduate 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.
palliative care can be used as a separate
area of medical practice while the
patient is receiving treatment through
diff erent phases of his/her life limiting
condition. Hospice care and palliative
care treat the whole patient and the family,
off ering physical, intellectual, emotional,
social and spiritual counseling
and support. Hospice care also supports
the terminally ill individual’s independence,
access to information and his/her
ability to make choices about healthcare.
Hospice can help with such daily activities
as administering medications, bathing,
and dressing, but hospice does not
provide full time caregivers. Hospice
requires that a willing and able caregiver
be available in the patient’s home setting.
Th is setting may be a house, apartment,
skilled nursing facility, assisted living
facility or other location. Some hospices
off er inpatient services in hospitals
and hospice facilities as well.
To qualify for Medicare’s hospice benefi
t, a benefi ciary (individual entitled to
Medicare benefi ts) must be entitled to
Medicare Part A. Th e patient’s physician
must attest that the benefi ciary has a life
expectancy of six months or less; however,
if the patient lives longer than six
months, the doctor can continue to certify
the patient for hospice care indefi nitely.
Th e benefi ciary must also agree to give
up any treatment to cure his/her illness
and agree to receive only palliative care.
It is very important to note that a benefi
ciary can change his or her mind at any
time and it is possible to revoke the benefi
t and reelect it later. Th is can be done
as oft en as needed.
Medicare will cover any care that is
reasonable and necessary for easing the
course of a terminal illness and care that
is aimed at improving the quality of the
benefi ciary’s life and making him or
her more comfortable. Medicare hospice
benefi ts provide for physician and nurse
practitioner services, nursing care, medical
appliances and supplies, drugs for
symptom management and pain relief,
short-term inpatient and respite care,
homemaker and home health aide services,
counseling, social work service,
spiritual care, and bereavement services.
Because the individual is electing palliative
care over treatment, hospice benefi
ts do not include treatment to cure the
benefi ciary’s illness, prescription drugs
other than those for symptom control or
pain relief, care from a provider that was
not set up by the hospice team, room and
board, care from a hospital (either inpatient
or outpatient), or ambulance transportation
unless it is arranged by the hospice
team. Th e benefi ciary can choose
to have his or her regular doctor be the
attending medical professional, and if the
hospice team determines that the benefi -
ciary needs short-term inpatient care or
respite care services, Medicare will cover
a stay in the respective facility.
Hospice care is paid for in full by
the Medicare Hospice Benefi t and by
Medicaid Hospice Benefi t. Most insurances
and the Veteran’s Administration
also cover hospice services in full or with
minimal co-payments. In addition, the
Center for Hospice Care is committed to
providing hospice and palliative care to
anyone in the community who needs it
and meets the qualifi cations, even if they
are un-insured, under-insured or unable
to pay.
Palliative care is paid for by Medicare,
Medicaid and most private insurances if
the patient meets the criteria.
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. Th e law fi rm
can be reached at 718-261-1700, 516-
466-4422, or toll-free at 1-877-ELDERLAW
or 1-877-ESTATES. Mr. Fatoullah
is also a partner with Advice Period, a
wealth management fi rm that provides
a continuum of fi nancial and investment
advice for individuals and businesses,
and he can be reached at 424-256-7273.
RONALD FATOULLAH
ESQ, CELA*
/WWW.QNS.COM
