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IL Estate Planning Blog

Friday, June 24, 2016

"I Needed to Find Care for my Elderly Aunt. What I Found was an Eldercare Crisis"


The call came right after lunchtime.

“I’ve fallen again.”

My great-aunt Emma sounded frustrated and frail. Her arm hurt too much to move, she said, let alone pick up the bag of groceries she’d just bought. It might be broken.
Read more . . .


Friday, June 10, 2016

Downsizing the Family Home


Book Review:  ''Downsizing the Family Home" by Marni Jameson

"I wanted to be respectful of my parents' belongings, honor their lives, be a good steward of their assets, and preserve their past and mine.  At the same time, I didn't want to be weighed down by more stuff, even if it meant something -- and it almost all did."

 

It's a rite of passage almost no one will escape; the difficult, emotional journey of downsizing your or your aging parents' home.  In this book, nationally syndicated home design columnist Marni Jameson sensitively guides readers through the process, from opening that first closet, to sorting through a lifetime's worth of possessions, to selling the homestead itself.  Using her own personal journey as a basis, she chronicles the clearing out of her parents' home of nearly fifty years, from the moment she stood paralyzed on the threshold to the day it sold to another family -- and reveals her strategies for accomplishing the task quickly, respectfully, and rewardingly.
Read more . . .


Tuesday, May 10, 2016

How to Deal with Digital Assets in Estate Planning

Taken from Huff Post Canada, March 25, 2016 

 

Due to recent technological advancements, one's digital presence has become an important part of every day life.  As a result, it is increasingly important to consider how this may impact traditional estate planning. With increasing frequency, individuals are creating complex lives online, which may include a social media presence, electronic banking, reward point balances, online investments, and many other possibilities.

 

Many people also now store digital assets that can have strong sentimental value, such as family photos or favourite playlists, online. As the types of assets that we store in digital formats continues to expand, important issues, such as how they will be accessed post-death, should be a consideration during estate planning involving our more traditional assets.

It is important to note that the issue of digital assets and estate planning does not concern only the younger generation. The conveniences and increased accessibility of technology have also attracted a large portion of the older population, including many who may already have estate plans in place. As it is always recommended that an estate plan be periodically revisited, especially when there are any significant life changes, the organization and implementation of digital assets should also be considered at these junctures.

Unfortunately, it is all too common to see these types of assets overlooked in a will. First and foremost, it is essential for advisers to be asking the right questions about the nature of a testator's assets. This may require probing beyond the consideration of traditional assets, such as real property and bank accounts. In many cases, a digital asset may have no monetary value and it may be overlooked for this exact reason. Asking pointed questions regarding digital assets and having the testator prepare a list of information he or she stores online can help determine how these assets should be distributed or managed.

Another important aspect to address is how digital assets will be accessed after death. Digital assets and accounts are typically accessed by way of a username and password. If the executors of an estate are not provided with this information, they may encounter difficulties when trying to determine what these assets encompass and in obtaining access in order to effectively administer them.

The rules surrounding executor access to online accounts following the death of an account holder vary significantly. It is prudent to provide your executors with a list of online accounts and the corresponding access information rather than risk future inaccessibility as a result of different access requirements. Many sites are based outside of Canada, which means that the executor may encounter conflict of laws issues in the event that the executor’s authority is not recognized in the relevant jurisdiction. This can result in unexpected costs and delays in the administration of the estate.

In order to address this, it is highly recommended that testators give careful consideration to providing a detailed list of any virtual accounts and to an appropriate method of storage for the  username and passwords, to be used after death. There are multiple ways in which this can be accomplished. For instance, it could be in as simple a format as a list that is given to your executors prior to death or attached as a memorandum to the will itself. It is not recommended that the password list form part of the will itself, as it may be made public if the will is probated. However, it is important to bear in mind that this list should be updated periodically. Passwords are sometimes changed (voluntarily or mandatorily) and accounts may be added or deleted. A static list that is created at one point in time will not necessarily be an accurate reflection of the virtual accounts and access information at the time of death.

Another storage method is to make use of online password storage services. There are multiple sites that have been established to provide this service. They are designed to store usernames and passwords to all virtual accounts in a safe and secure format which can be accessed by one master password. In this way, the list can be updated easily and an executor only needs to be provided with one password in order to access all of the necessary information.

As for social media, special concerns may arise with respect to personal preferences surrounding how these accounts should be dealt with post-death. Some may prefer to have these accounts shut down altogether, whereas others opt to have them memorialized in such a way that friends and family have a place to share memories of the deceased. Given these different approaches, it can be useful to provide some direction to your executors regarding your specific preference on the issue. Leaving a social media account open without any planning may seem harmless, but can inadvertently cause unnecessary pain to loved ones. For instance, if the account is not memorialized or deleted, photos of the loved one may appear in Facebook’s “Year in Review” and friends and family will continue to receive annual reminders and prompts to wish the deceased a happy birthday.

In 2016 and beyond, it is impossible to ignore the fact that technology has changed the way we live. Our lives are increasingly intertwined with the virtual world and, accordingly, plans should be made so that assets and information stored digitally are appropriately dealt with at death. 


Tuesday, April 19, 2016

Avoiding Risky Drug Interactions

Taken from Chicago Tribune 2/14/16

Experts say there are important steps patients can take to help protect themselves from a harmful mix of medications.

  • With every new prescription, ask your doctor and pharmacist about what other medications you should avoid, including over-the-counter drugs, foods and dietary supplements.
  • Carry a list of all current medications and bring it to any medical appointments.  The list should include drugs taken only occasionally, over-the-counter medications, patches, tablets, inhalers, drops, liquids, ointments and injections, as well as herbal, vitamin and dietary supplements.
  • Read the complete package insert for all medications you're taking.
  • Use one pharmacy for all your prescriptions.
  • Educate yourself about potential drug interactions for any medications you are taking.
  • If a doctor provides you with a new drug sample, ask if it interacts with the medications you're currently taking.  Routine computer safety checks may have been skipped.
  • Take as few medications as possible.
  • Do not take medications prescribed to someone else.

--Karisa King
 
 

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Tuesday, March 29, 2016

IRS to ask about Health Insurance Coverage on Tax Forms this Year

 

Be prepared for the tax man to get even more personal this year — with questions about your health insurance.

For the first time, you'll have to state whether you had health insurance, through an employer, one of the exchanges or purchased privately. And if you didn't, you could face a penalty.

Also, if you got advance payments of the premium tax credit under the Affordable Care Act, even for only part of the year, there's a new form to file. You'll have to file it even if you only got tax credits for part of the year. And tax filers accustomed to using a 1040EZ will no longer be able to do that if they got a tax credit.

There's more. If you had life changes — a new job with a higher salary, for example — from the time those tax credits were approved, you could end up having to pay some or all of the money back. Conversely, if you lost your job and faced a long period of unemployment, you might now be eligible for the credit.

"I see deer-in-the-headlights looks," said Dave Duval, TaxAudit.com's vice president of consumer advocacy. "These are new items. ACA has been on the books since 2010. We've ignored it, not looked at it, not paid attention to it. It's on the tax return that we're going to be doing for 2014."

INSURANCE REQUIRED FOR MOST

The law requires individuals to have what the government calls minimum essential coverage unless they qualify for one of more than 30 exemptions. For those without insurance — or an exemption — there's a penalty stemming from the law's premise that health care coverage is a shared responsibility among federal and state governments, insurers, employers and individuals.

For 2014, the penalty is the greater of 1 percent of your household income above the threshold for filing taxes or what the Internal Revenue Service calls "your family's flat dollar amount" — $95 per adult and $47.50 per child, with a family maximum of $285 in 2014.

However, the average penalty for the 2014 tax year is expected to be higher — $301, according to Sacha Adam, health care team leader at Intuit, maker of TurboTax. Under the law, those fines will go up for people who remain uninsured in 2015, to about $590 on average.

"Getting health insurance is a big decision for some folks," Adam said. "When it comes to reporting your health insurance on your taxes, it's going to be very straightforward."

A BOX TO CHECK ON FORM 1040

Reporting your health insurance coverage begins on line 61 of Form 1040.

"For the vast majority of Americans, tax filing under the Affordable Care Act will be as simple as checking a box to show they had health coverage all year," Treasury Secretary Jacob Lew said in a statement.

The Department of Health and Human Services estimated that more than three-quarters of taxpayers will need to do no more that.

"If you have it and you have the ability to demonstrate you had it, that should be it and you're not going to be subject to having the additional penalty assessed," said Greg Rosica, a taxpartner at Ernst & Young.

People insured through the exchanges will get Form 1095a in the mail attesting to their coverage and how much of an advance premium tax credit they received. Employers are not required to provide proof of coverage for 2014.

NEW FORMS TO FILE

"A fraction of taxpayers will take different steps, like claiming an exemption if they could not afford insurance or ensuring they received the correct amount of financial assistance," Lew said. "A smaller fraction of taxpayers will pay a fee if they made a choice to not obtain coverage they could afford."

If you received a premium tax credit or might be entitled one, file Form 8962. That will determine whether you got too much of an advance credit payment and have to repay some of it, or if you didn't apply and might be eligible for the premium tax credit on your return.

For those who didn't have health insurance, there's yet another form — Form 8965 — which lists the possible exemptions and lets you claim the one that might apply. It's also where you figure out your penalty if you didn't have coverage for all or part of 2014.

"There's a lot to look for. It is kind of complicated," said Barbara Weltman, contributing editor to the tax guide "J.K. Lasser's Your Income Tax 2015."

The good news, she said, is most people use a paid preparer or software to do their taxes, and they'll be walked through the questions that have to be answered for the health insurance section of the tax return.

"In the tax preparation process, they're not really exposed to forms until the very last moment," Adam said. "At TurboTax, we'll figure out what forms need to be provided."

WHERE TO GO FOR HELP

The IRS has a page on its website devoted to the Affordable Care Act. There, you can access videos featuring the IRS Commissioner, John Koskinen, as well as a number of new publications that provide information about health care and taxes.

Because of the complexity of the requirements, Koskinen told Congress last fall that he expects an increase in calls to IRS toll-free help lines about ACA and taxes. "Our ability to meet this demand may be strained due to ongoing budget constraints and the possibility of an additional increase in call volume related to the impact of tax extender legislation that may be passed later this year," he said.

TurboTax and H&R Block are among the companies that provide guides to taxes and ACA on their websites, and the Tax Policy Center can help you estimate your penalty.

 

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Tuesday, March 8, 2016

Get Ready for FAFSA by Terry Savage

 

Get Ready for FAFSA - Huffington Post December 9, 2015

Copyright Terry Savage Productions, Ltd.; Distributed by Huffington Post
 
Every January millions of high school seniors, and college students, and parents sit down together to fill out the dreaded FAFSA form -- the Free Application for Federal Student Aid. The form is more intrusive than the Federal tax forms, because it asks not only about income but assets of parents and students.

 

The FAFSA is the basis for almost all student aid, loans and grants -- whether aid that is based on financial need or merit-based aid. You'll find it explained thoroughly at www.fafsa.ed.gov. There you can fill out the forms, save your information, and then click to file online. Financial aid is often given out on a first-come, first-served basis -- so don't delay.
 
And according to Susie Bauer, head of 529 and college planning for Baird, the Midwest-based international financial services firm, you should get ready for some big changes in FAFSA for the 2017-2018 school year -- including some moves you should make now -- even if your child is only a high school sophomore.
 
Here are five key things to know about FAFSA, financial aid, and 529 plans:
 
1. Financial Aid is income-driven, but assets count, too. The FAFSA form asks for all income, substantiated by the parents' tax return (both parents, if divorced). Capital gains count as income, so selling stocks and taking gain in the year before filing can impact aid. Similarly, harvesting up to $3,000 of capital losses can reduce parental income. If the student has income, it reduces financial aid on a dollar for dollar basis - creating a disincentive for students to work and contribute to their education.
 
2. 529 College Savings Plans can impact financial aid. A 529 plan owned by the parent is treated as any parental asset for FAFSA and has minimal impact on financial aid. When a grandparent or other person is owner of the 529, it does not show up as an asset on FAFSA. BUT, when you start withdrawing from a grandparent-owned 529, it is counted as direct income to the child - with a much larger impact on financial aid. If grandparents hold such an account, don't start withdrawing until the junior year of college - after you have filed the FAFSA for that year.
 
3. Assets owned by a child weigh heavily against the family in the aid formula. UTMA (custodial) accounts should be spent for the benefit of the child in advance of the FAFSA filing year - or rolled into an UTMA 529 account, where they will be treated as a parental asset.
 
4. You can't use a 529 to pay student loans. Careful planning to use 529 money is essential. No, you can't withdraw to pay down student loans. You can withdraw 529 money tax and penalty-free only to pay for "qualified expenses" such as tuition, room, board, books and certain other fees. If used for something else, there is a 10 percent penalty and taxes must be paid on any earnings over the years. (The exceptions to the penalty occur when a student gets a scholarship, or dies, or is disabled.)
 
5. Timing is everything. Not only should you file early, but you should be aware of two important FAFSA changes coming in 2017.  
First, instead of waiting to file your tax return, or estimating income, you will be able to use the FAFSA IRS Retrieval Tool to verify income from your 2015 return, the prior-prior year. Thus, the income you report for your 2015 return, which you file next April, will impact financial aid for the 2017-2018 college year.  
The other big changes is that the starting date for filing the 2017-18 FAFSA will begin on October 1, 2016, instead of January 1, 2017. So there won't be a last minute rush - if you get started early!
 
Procrastination on FAFSA penalizes the family and the student. Get started now to accumulate as much financial aid as you can. It's a good investment of your time. And that's The Savage Truth.

 

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Monday, February 8, 2016

IRA's and Charities

     On December 18, 2015 Congress passed the PATH Act, which renews and makes permanent the Charitable IRA provision of 2006, making it easier for Americans to give to causes about which they care.  This provision has the power to help local charities strengthen their communities allowing individuals to roll over up to $100,000 annually from an Individual Retirement Account (IRA) to charity without being federally taxed.

     Millions of Americans continue to save pre-tax dollars in their IRAs. The law allows taxpayers 70 ½ and older to share their wealth by giving retirement savings directly to charity-and bypassing income tax.
      This law is important to local charities operating as agents of philanthropy in order to continue to build community and improve social service programs that benefit people every day.

 

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Monday, January 11, 2016

Caregiving News

One Quarter of America’s Caregivers Are Millennials
Caring for older relatives is usually a task associated with Baby Boomers, the 50- and 60-somethings who find their aging parents need assistance. But almost a quarter of the adults who take care of older people — on top of their regular jobs and responsibilities — are between the ages of 18 and 34, according to research by the AARP Policy Institute and the National Alliance for Caregiving. As millions of Americans are expected to live longer than they used to — often losing the ability to do so independently — their families and communities are grappling with how best way to take care of them. Kaiser Health News focused on the problem in a Dec. 2 webinar with advocates and policymakers. About 40 million Americans considered themselves caregivers in 2013, according to an AARP report, said Susan Reinhard, senior vice president at the AARP and one of the webinar’s panelists. Those people are typically women, and their median age is 49. The work they do caring for older relatives — usually parents and grandparents — was estimated that same year to be worth about $470 billion.

Source/more:Kaiser Health News


Monday, December 28, 2015

Donor beware: Giving Season is a time for Scams

Donor Beware:  Giving Season is a Time for Scams

 Jill Schlesinger and Tribune Content Agency Jill on Money

 


As the year comes to a close, charities are stepping up their fundraising efforts. While philanthropy is a wonderful way to promote the causes you care deeply about, cases of fraud continue to be associated with the giving season.

The IRS has raised the red flag about charitable scams, especially those that use recent disasters and tragedies to try and steal money or extract private information from well-intentioned people. "Their schemes include contacting people by phone, social media, email or in person and pretending to be from a charity that helps disaster victims," the agency warned.

The increase in fraud means that you need to do a little work before you give. That is why I want to review and update some of the steps that I outlined last year.

Start by confirming the group's name to determine that it's legitimate. Even if it is a genuine non-profit, there could be a case of mistaken identity. There are hundreds of organizations devoted to children or cancer, so go to the group's website to see how it spends its money. You can also see what others say about the organization by going to the Better Business Bureau's (BBB) Wise Giving AllianceCharity Navigator, Charity Watch and Guidestar.

The Federal Trade Commission recommends that you just say no to any solicitation if the representative asks for money but refuses to give you full details about the group's identity, mission or costs and how it will use your donation. Also say no if it: uses high-pressure tactics, like trying to get you to donate immediately, before you can do research or think it over; asks you to send cash or use a money transfer; offers to send a courier or overnight delivery service to collect the donation immediately; promises to enter you in a sweepstakes or give you a prize for donating; won't provide proof that a contribution is tax deductible; uses a name that closely resembles that of a better-known, reputable organization; or thanks you for a pledge you don't remember making.

To ensure that you are donating to a qualified charity, which is entitled to a tax deduction, you can use the Exempt Organizations Select Check tool at IRS.gov. You can also find legitimate charities at Fema.gov. Officials note that you should never provide your Social Security number, credit card or bank account numbers or passwords to anyone who solicits a contribution from you. If you think you've been the victim of a charity scam or if a fundraiser has violated Do Not Call rules, file a complaint with the Federal Trade Commission.

Once you have determined that the organization is legitimate, you will want to know that its finances are healthy and that it is efficient, ethical and effective. Charity Navigator provides a zero- to 4-star rating system, which includes a review of each charity's fiscal performance. The site also helps you understand what portion of your donation goes to support overhead vs. to the cause itself.

If the donation qualifies and if you itemize your tax deductions, charitable contributions made to qualified organizations may help lower your tax bill. Procrastinators take note: To qualify for write-offs of charitable contributions, your payments must be postmarked by midnight December 31 -- just dating the check "December 31" does not automatically qualify you for a deduction; and pledges aren't deductible until paid. Donations made with a credit card are deductible as of the date the account is charged.

You should maintain a bank record or written communication from the organization containing its name, the date and amount of the contribution. For text message donations, flag the telephone bill with the name of the receiving organization, the date of the contribution and the amount given.


Monday, December 21, 2015

Leaving Nursing Home During Medicare-Covered Stay

Leaving Nursing Home During Medicare-Covered Stay

Nursing home residents often want to participate in holiday gatherings but may worry they will lose Medicare coverage if they leave the facility to do so. Residents and their families and friends can put their minds at ease. According to Medicare law, nursing home residents may leave their facility for family events without losing their Medicare coverage. However, depending on the length of their absence, beneficiaries may be charged a "bed hold" fee by their skilled nursing facility (SNF). The Medicare Benefit Policy Manual recognizes that although most beneficiaries are unable to leave their facility, "an outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or for a trial visit home, is not, by itself evidence that the individual no longer needs to be in a SNF for the receipt of required skilled care...Decisions in these cases should be based on information reflecting the care needed and received by the patient while in the SNF and on the arrangements needed for the provision, if any, of this care during any absences."

Source/more: Center for Medicare Advocacy


Monday, December 14, 2015

Is Hospice Right for You or a Loved One?

Is hospice care the right option for you or a loved one?

by Paula Spencer Scott, AARP Bulletin, November 2015
 
An interesting thing happens when Dawn Gross brings up hospice to patients or their families:
 
"Oh, no, we don't want that!" they often say.
 
"OK," says Gross, a hospice and palliative care physician in San Francisco. "Tell me exactly what you don't want, so we're sure not to give you that."
 
Going off to some facility, they tell her. Losing control of care. Being knocked out by morphine. Or — the clincher — giving up. When Gross assures them that hospice isn't at all like that — that two-thirds of hospice care takes place in the person's home or a long-term care facility, that the patient can still receive medical care, and that Medicare and most private health insurers pay for it in full — they often change their minds.
 
In 2011, about a million people died in hospice — about 42 percent of all those who died, according to the National Hospice and Palliative Care Organization in Alexandria, Va. — and its use is growing.
 
Still, misconceptions about this end-of-life service abound. As a result, many who might benefit from hospice don't sign up until the very end: About a third of hospice users enroll for less than a week, and the median time is 18 days.
 
So how can you tell whether hospice is the right choice for you or your loved one? The answer depends on what you believe hospice is, your current goals, and what you think it can — or can't — do for you.
 
Here's what you need to know.
Hospice is a philosophy of care, not a brick-and-mortar location. Most people say they want to die at home, but only about 1 in 4 end up doing so. One big reason: It's often just too hard. "Trying to care for someone with a serious illness, especially at home, without hospice is like trying to have surgery without anesthesia," says Ira Byock, the executive director of the Providence Institute for Human Caring.
 
Hospices bring everything you might need to the home — hospital bed, bedside commode, medications, bandages, expert consults — tailored to your needs.
 
But if you're daunted by home care, or simply don't want a loved one to die in your home, hospice care also is available in facilities and hospitals.
 
Signing up doesn't mean giving up all medical care. Transitioning to hospice means shifting from one set of goals (how to get longer life through a cure) to another (how to get the best quality of life out of whatever time is left).
 
"When people say, 'I don't want to give up,' the key is to understand what they think they're giving up," Gross says. Even when a cure is no longer viable, therapies that improve symptoms and raise comfort can continue. "I deliver very aggressive care in hospice," she adds.
 
If, however, you feel that you have not exhausted all of your treatment options in search of a cure, hospice may not be for you. Medicare hospice rules require forgoing curative treatments.
 
That may soon change, though. In July, Medicare announced the expansion of a five-year pilot program to 141 hospices in 40 states to allow patients to continue pursuing curative treatments while under hospice care.
 
You have to qualify for hospice, but you can opt out at any time. To qualify for hospice benefits, either through Medicare or private insurance, two physicians must certify that you have a life-altering condition with an expected prognosis of six months or less. This time frame is arbitrary, however; there's no biological or scientific basis for knowing how long you have left, Gross says.
 
If you start hospice and realize it's not for you, you can quit. 
 
 
How can you know when to try hospice? This should be part of ongoing discussions with your health care team, Byock says — "ongoing" because goals and needs evolve.
 
You may live longer during the time you have left. Hospice recipients live longer, on average, than those receiving standard care, research shows. A 2010 study of lung cancer patients found they lived nearly three months longer; another study, looking at the most common terminal diagnoses, found the same, ranging from an average of 20 more days (gallbladder cancer) to 69 days (breast cancer).
 
You can still see your regular doctor. Multidisciplinary by intention, a basic hospice team consists of a physician and nurse (both on call 24 hours a day); a social worker, counselor or chaplain; and a volunteer. Many hospices offer added services: psychologists, psychiatrists, home health aides, art or pet therapists, nutritionists, and occupational, speech, massage or physical therapists. You may also continue to see your regular doctor. And you remain in charge of your medical decisions.
 
The goal of pain management in hospice is to enable you to live well — not sedate you. "People often mistakenly think pain medicine will make the person sleepy to the point where they can't interact," says Karen Whitley Bell, a hospice nurse for 20 years and author of Living at the End of Life. "To the contrary, if you live with pain unnecessarily, it makes you more tired and irritable, and robs you of quality of life."
 
When drugs like morphine are used, it's to treat anxiety and to lessen pain, which has been shown to be undertreated at the end of life — not hasten death, as many people mistakenly believe.
 
Hospice can enrich, and sometimes salvage, the last stage of life. Almost a third of those with a terminal illness die in the hospital, hooked up to machines that do little to halt the process of dying. Hospice is designed to support the more personal aspects of this life stage: reflecting on one's legacy and life meaning, focusing on relationships in a deeper and more intentional way, achieving a sense of closure, and realizing any end-of-life goals, such as attending a grandchild's graduation or getting financial affairs in order.
 
Hospice is for the entire family. It's not always easy to witness the hallucinations of delirium or understand the body language of someone who can no longer speak, for example. A hospice nurse can help interpret what's happening, or explain the signs of imminent death. And when families need a break, the sick person can spend up to five days at a time in inpatient respite care, such as in a nursing home or hospice facility.
 
Hospice continues after death. Many people don't realize that optional follow-up grief support for 12 months is included under Medicare rules. "For many of our families, their journey with hospice is only beginning once their loved one dies," says bereavement counselor Anne Alesch. She runs separate support groups for surviving spouses and adult children.
 
Ultimately, hospice makes space for "the spirit, the love and the quieting of the mind" that tend to take precedence as the body prepares to shut down, says Nina Angela McKissock, author of From Sun to Sun: A Hospice Nurse Reflects on the Art of Dying. Adds Ira Byock: "We make a mistake in assuming that serious illness and dying are mostly medical. They're fundamentally personal."

Paula Spencer Scott is the author of Surviving Alzheimer’s: Practical Tips and Soul-Saving Wisdom for Caregivers.

More on Hospices

As hospice has evolved from a grassroots movement to a booming industry, a few bad apples have inevitably emerged. What should you look for when evaluating a hospice? "There's no easy shortcut to evaluating quality care," says Joe Rotella, M.D., chief medical director of the American Academy of Hospice and Palliative Medicine. But here are some questions to ask.
 
  • Is the hospice accredited? "Hospices aren't required to be certified or accredited, but those that seek outside accreditation are making a special commitment to quality care," Rotella says. The Joint Commission, Community Health Accreditation Partner, the National Hospice and Palliative Care Organization and other groups have created standards of excellence that participating hospices must meet. Some state agencies also certify hospices.
  • Has the hospice been surveyed by a state or federal oversight organization? If so, when? What were the results? The Affordable Care Act now requires hospices that accept Medicare — almost all of them — to complete surveys and provide data about several quality measures, including how well they manage patients' pain. Eventually the results will be publicly available online. For now, ask if a survey has been done and what the results show.
  • Is the medical director board-certified? Board certification is not a requisite, "but having a medical director who is certified by a medical board as a palliative medicine specialist offers one more assurance of training, experience and overall quality," Rotella says.
  • How many patients does the hospice program care for? Hospices come in many sizes. Although smaller ones may provide more personalized care, larger ones (those serving at least 100 patients) have more resources.
  • What is the typical caseload? Ideally, a hospice nurse or nurse practitioner should manage a caseload with no more than 12 patients. — Peter Jaret


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With two offices in Oak Lawn and Oak Brook, Stephen M. Sutera assists clients throughout Cook County, DuPage County and Will County IL including Chicago, Hometown, Barrington, Burbank, Burr Ridge, Chicago Ridge, Darien, Downers Grove, Evergreen Park, Geneva, Worth, Bridgeview, Palos Park, Palos Hills, Palos Heights, Hickory Hills, Midlothian, Willow Springs, Oak Forest, Orland Park, La Grange, Brookfield, Berwyn, Tinley Park, Hinsdale, Villa Park, Clarendon Hills, Westchester, Westmont, Lombard, Elmhurst, Western Springs, Berkeley, Downers Grove, Fox Valley, Glen Ellyn, Willowbrook, Aurora, Addison, Lisle, Forest Park, Bensenville, Wheaton, River Forest, Itasca, Shorewood, Frankfort, Mokena, Naperville, Crest Hill, Homer Glen, New Lenox, Bollingbrook, Schaumburg, Channahon and Woodridge.



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