Posted in the senior resource series by Everbrook Senior Living 

VA Aid & Attendance, “A&A”, is a monthly long-term care benefit available to low-income veterans age 65 or older or disabled if younger (and/or surviving spouses as that term is further defined by VA rules) who served active duty for at least 90 days during a period of war, having been discharged other than dishonorably and who show a need for assistance or supervision with activities of daily living due to physical disability, cognitive impairment or both. Once an applicant is medically and financially qualified, he or she receives a monthly check. A&A has long been an important means to fund assisted living. The Maximum Annual Pension rate, MAPR, available to eligible veterans or spouses is*: 

2019 Basic A&A Maximum Annual Pension Rate

Veteran with no dependents: $22,577

Veteran with spouse: $26,765

Surviving Spouse: $14,529

*Dependent children are also part of the calculation but not discussed here.

Recently, the Department of Veteran’s Affairs (VA), has amended regulations governing financial eligibility for A&A, imposing for example a bright-line net-worth requirement as well as spend-down penalties for veterans who transfer assets for less than fair market value looking-back 3-years from date of application. Critics of the rule revamp warn that many needy veterans will be denied benefits and while technically accurate, the tightening of financial means testing will reduce the numbers of veterans who becomes eligible for the VA long-term care benefits but overall will help more middle-class veterans who are receiving long-term services become eligible for A&A benefits.

This month we’ll be focusing on exercise and brain health. This is a topic that usually doesn’t get a lot of attention but is very important as far as one’s mental health is concerned. When we talk about exercise were always referring to the physical part of exercise and tend to leave out the mental part, so we wanted to share some awesome news on this topic!

Let’s talk about an overview of the brain first. The brain is one of, if not the most complex, organs in our body. The human body cannot physically and mentally run without a brain. The brain produces our every thought, action, memory, feeling and experience of our lifetime. It weighs about 3 pounds containing millions of neurons (nerve cells) working hard each day so what better way to treat your brain than to exercise it with physical activity and nutrition!

Posted in the Senior Care Topics Series by Everbrook Senior Living

Seniors reading or watching the news are informed that Medicare, through its parent agency, Centers for Medicare and Medicaid, CMS, is now covering some essential non-medical services such as in-home care, transportation, and soon phone consultations with the doctor. In brief, Medicare following passage of the CHRONIC Care Act of 2017 and through reinterpretation of its own rules, has empowered only Medicare Advantage Plans, “MA”, to offer a broader array of supplemental benefits including vision/hearing screens to name a few and now non-skilled home-health to beneficiaries who demonstrate a medical need for such services. A supplemental benefit under Medicare is defined as: 

• A service or benefit not covered by traditional Medicare 
• A service or benefit that is primarily health-related, and
• A service or benefit in which the MA plan incurs a non-zero direct-medical cost.

Although seen universally as a positive step toward the continuing trend to reform coverage rules so medical providers can be paid to treat longer term chronic illness, in reality, seniors in need of home-health aides to support disabilities or who hope to talk to their doctor over the phone instead of having to travel their office will likely have to wait several years to receive those benefits in manners which make real improvements to their quality of health and life. Yet, for seniors with complex chronic illness which includes many senior living residents, MA plans appear to be the best option to get the most comprehensive coverage including essential supplemental benefits not available in traditional Medicare like in-home care or telehealth benefits, although with some uncertainties to work through. Medicare Part D amendments and other payment models being tried at CMS are not discussed here.

Nutritional fads come and go. But one fad which seems to have elevated to a gold-standard of credibility has been the so-called "Mediterranean Diet". The Mediterranean diet recommends eating lots of plant-based foods mainly fruits, vegetables, and legumes and foods infused with monounsaturated fat such as olive oil. This popular diet acquired high acclaim in the US as a nutritional best-practice in preventing heart disease after a five-year study by a group of Spanish nutrition scientists caused the New England Journal of Medicine, NEJM, to publish its conclusions suggesting that the Mediterranean diet can decrease risk of heart attack and strokes. The study concluded: prolonged exposure to the Mediterranean diet produced a substantial reduction in risk of major heart disease among high-risk people.

Recently, a statistical sleuth named John Carlisle exposed many flaws in the study namely its claim to have assigned people randomly to the study and other anomalies. Carlisle’s analysis refuted the study’s findings thus discrediting it, causing the NEJM in the summer of 2018, to retract the original publication. This turn of events has re-ignited the debate on what is optimal diet for seniors in later life and whether nutrition can have a positive impact on the health and wellness of very old adults? Ironically, much the Mediterranean diet compares agreeably to nutritional best-practice recommendations of public health organizations and other accredited bodies but without all the feigned notoriety. Yet, to deliver nutritional best-practices in later stages of life requires that special accommodation be made to address health-status changes.