Kansas Senior Press Service Weekly Newsletters Kansas Senior Press Service Weekly Newsletters By: Dave Farson
Allegra was her formal name. She had six toes on each foot. We called her Leggy.
She came to live at our house when she was about 1 year old and lived here for 16 years. Leggy was an independent cat. She came around only when she wanted to, and she allowed only certain people to touch her.
Leggy was a chow-hound and “Persistence” should have been her middle name. When she was hungry, which was almost all the time, she would find me and proceed to make an unworldly noise until I went to feed her.
In her 16th year in our house, Leggy’s health began to fade. Having six toes did not help when arthritis attacked her joints. When she became less interested in food, I knew we had a problem. In her final days, Leggy could not even get into the litter box.
Finally I took Leggy to the vet, who gave her a muscle relaxant and then a shot that stopped her heart. We didn’t want Leggy to be in pain, nor did we want her to have a life of little quality. What kind of life would be hers if she couldn’t yell at me for food or eat like a hungry horse?
At the same time, two other events were taking place.
My wife’s father (and my friend) was in his final days, too. Hospice came into Bill’s life.
Part of his care was a big hospital bed that went up and down. One day, when Bill and I were talking, I asked him, “Are you in that bed to get well or to die?” He said, “Dave, I ask that question every single day. And I ask myself what ‘well’ means to a guy 86 years old.”
Bill’s health deteriorated rapidly. He needed adult diapers. He couldn’t walk. He slept more and was less interested in the comings and goings around him. The world’s problems would have to solve themselves.
In the end, Bill’s passing was peaceful. He was breathing and then he was not. One of his daughters is a nurse, and even she did not fully recognize his last breath.
Bill died as he lived. He was a gentle, kind, unobtrusive man. He would never draw attention to himself as Leggy did daily in her hunt for food.
The other event that coincided with the deaths of Bill and Leggy was the release of Jack Kevorkian from prison. As he stood outside before the media, he promised not to break any laws. He said he would work within the system.
Some years ago, Kevorkian assisted those in pain, with no hope for recovery, in quickening their days. After signing that they were of sound mind, his patients received a muscle relaxant and then a medicine that stopped their heart. Kevorkian helped people end their own lives.
Leggy suffered in her last days. Bill, to my knowledge, did not like the life he lived in bed. Life can be nasty and brutish. I should have taken Leggy to the vet a week or two earlier. Bill, if given the choice, might have chosen to pass sooner.
Death is usually not an answer to our questions, but a source of more questions. Among them are these: Do we treat our animals more humanely than we treat ourselves? Is our confusion about death so profound that we are left in the position of cherishing all life, no matter its quality? In what ways do our religious beliefs and philosophies help us live the end of our lives? In a society where individual control is important, can we allow individuals to have control in their end days?
The questions are innumerable and important. No matter how we answer, it is the spirit in which we live the days given to us that ultimately counts.
Let us consider the end, but let us rejoice in our beginnings and middles. Let us share ideas about our end days, but before they arrive, let’s live as hard and as well as we can. Let’s scream for more food, as Leggy did. Let’s travel, if that gives us pleasure, as far and as smart as we can. Let’s play when we can. Let’s give what we can to whomever we can. Then, if we live fully and effectively, some will gather at the time of our death to celebrate how we lived. In our end days, we will not be alone.
Dave Farson, of Overland Park, taught at Shawnee Mission North High School for 33 years. He is now a freelance writer.
By: Malissa Walden
Medicaid is the largest source of funding for medical and health-related services for people with limited incomes. This nationwide health care program is operated and administered by the states, with federal financial participation. Within certain broad federal guidelines, states decide who is eligible; the amount, duration, and scope of services covered; rates of payment for providers; and methods of administering the program.
The Spousal Impoverishment Law, often referred to as Division of Assets, essentially changes the Medicaid eligibility requirement for couples when only one spouse needs nursing home care, allowing the spouse at home to protect a portion of his/her income and resources. The couple may seek a division of resources, income, or both. If this is not done, certain resources and income will be considered available to the person needing care, who may not gain eligibility as quickly. The goal of the law is that the spouse needing care receives Medicaid sooner, without the spouse at home being reduced to poverty.
If your spouse requires long-term nursing home care, Medicaid assistance will be available if:
To determine eligibility, contact your local Social and Rehabilitation Services (SRS) office. You will be asked to list all of your assets on a Resource Assessment and Allowance Determination form. Ask SRS to review your eligibility for Medicaid and possible Division of Assets if your spouse is already in a nursing home and if your income, as an at-home spouse, is less than $1,650 monthly.
After reporting your assets to SRS, if you acquire additional resources before your spouse is actually receiving Medicaid coverage, the resources are usually considered a part of your spouse’s share of assets and must be depleted before eligibility begins. Because the Community Spouse Resource Allowance is determined at the month of entrance into long-term care, resources that were not owned by either spouse in that month cannot be considered for division purposes. Generally, additional resources received by the at-home spouse may be held without affecting the other spouse’s eligibility for Medicaid.
If it is necessary to transfer resources to the at-home spouse, you may need to complete a form called a Notice of Intent to Transfer Resources, which will give you extra time to make such transfers. Never make any transfers until all of the paperwork has been completed and the amount of income and resources that the at-home spouse can keep is determined. Transfers made before you visit SRS may jeopardize Medicaid eligibility. Always seek prior approval from SRS before transferring resources or income.
The amount of resources that can be protected is determined by the amount of total exempt and non-exempt resources owned by you when your spouse first enters an institution. This figure is determined from the information you reported and verified on the Resource Assessment form. Items that do not count toward Medicaid eligibility include the home and its contents, one car per family, one burial plot and casket per person, a funeral plan, the share of property allowed to the at-home spouse by the Spousal Impoverishment Law, personal possessions such as wedding rings and clothes, and, in some situations, property used in an on-going business.
As the at-home spouse, your share of property will be the greater of these two elements: the first $20,328 of total non-exempt resources, or half of the total non-exempt resources owned at the time your spouse entered nursing home care.
The maximum share you may keep is $101,640. You will also be allowed to keep all of your own income and a portion of your spouse’s income, up to $1,650 per month total. In addition, if there are shelter expenses (rent, mortgage, taxes, or insurance) in excess of $213 per month, you may be entitled to an allowance of up to $2,541 per month.
The remaining amount of combined resources and income is considered available to the institutionalized spouse. Medicaid benefits will not be paid until the spouse applying for assistance is able to meet the Medicaid eligibility requirements. This means the spouse needing care must deplete his or her share of the divided resources to the Medicaid eligibility level (currently $2,000). When the spouse is approved for Medicaid, his or her monthly income determines patient liability. After deducting a personal needs allowance of $60 and unpaid medical expenses, the remainder of income, if any, is paid to the nursing facility toward the cost of care.
Keep in mind that SRS will have a first-class claim against an estate for benefits paid to the recipient, under estate recovery laws, despite any division or transfers. This claim arises only after the death of the recipient and the surviving spouse. If the at-home spouse dies first, s/he should receive at least half of the estate, based on state inheritance laws. These newly acquired resources by an institutionalized spouse will be countable toward the $2,000 limit. Receipt of resources in excess of this amount could result in a loss of Medicaid coverage until financial eligibility can again be established.
Medicaid is an income-based program, and as such, is not for everyone. You have to decide what is in your best interest. This can be difficult as you try to plot a course through all possible scenarios. Although Medicaid is ever-evolving, you can navigate your way through the system. Your local SRS office can provide the proper application forms, the latest allowance figures, and general assistance. Asking for advice early may save you from future complications.
Malissa L. Walden, Esq., is an elder law project manager with Kansas Legal Services, Inc.
By: Matt Bunch
Beware, pampas, maiden, and fountain grass—the natives are getting restless. Too long have these three grasses been the accent in the perennial garden or the screen for the utility box. Too long have they been used in the big-box store parking lot, the corporate landscape, and, to my horror, along highway interchanges.
Beware, because the bluestem is coming home to roost, and it has brought friends! The bulldozer and road grader of development have destroyed many of our native prairies and grasslands, but their species are finding a new residential home.
Grasses serve many functions in the landscape. They bring form, movement, color, and winter interest, and serve as companion plantings, screens, and borders. Big bluestem, Andropogon gerardii, the tallest of our native grasses at a mature height of six to eight feet, has wonderful blue-purple stems with blue-green foliage. The inflorescence looks similar to a turkey foot (one of the common names for this grass). Fall color is red to bronze after a frost. Big bluestem works great as a screen or in the background of a perennial bed.
Another tall native grass is switch grass, Panicum virgatum. Besides being touted as an alternative fuel source, switch grass has been used in the landscape for years. Many cultivars are available, most of them featuring a variety of foliage colors during the growing season and fall. As a rule, switch grass will get four to six feet tall, with an airy inflorescence that captures the wind. The fall color is typically bronze to yellow.
When asked to name my favorite ornamental grass, I may respond differently, depending on the season—but more often than not I choose little bluestem, Schizachyrium scoparium. It is little bluestem that colors the Flint Hills crimson, auburn, and yellow in the fall. During the growing season it has a distinct blue-purple/blue-green cast at a mature height of three feet. Little bluestem looks great in mass plantings where it is allowed move about in the wind. It also serves as a companion plant to keep taller perennials from falling over.
Prairie dropseed, Sporobolus heterolepis, lines the front entrance sidewalk of the Discovery Center. During the growing season it is rather unassuming, but beautiful tufts of thin green foliage capture the wind nicely. In late summer it sends up an airy inflorescence to three feet tall. The seed heads are brownish-tan to nearly white and have an uncanny scent, somewhere between cilantro and burnt popcorn. Prairie dropseed makes a nice border plant, as well as a taller groundcover when planted en masse.
Sideoats grama, Bouteloua curtipendula, and blue grama, Bouteloua gracilis, are also wonderful grasses for a border planting or as a groundcover, the blue grama growing to just a foot tall. Other native grasses to try are sand love grass, Eragrostis tricoides, and pink muhly grass, Muhlenbergia capillaris, both having beautiful airy seed displays.
While it’s nice to enjoy the movement, color, and form of grasses in the fall and winter, most do not like to be transplanted from October to March. All ornamental grasses should be planted and divided in the spring, unless they are being grown from seed. For more information on grasses in the landscape and how to use them, consult The Color Encyclopedia of Ornamental Grasses, by Rick Darke. Then you can start planning what you’ll put into the ground next spring.
Matt Bunch is a Kansas-certified arborist employed by Powell Gardens as a horticulturist for the Discovery Center.
These articles are also available electronically at the Center on Aging Website: http://www2.kumc.edu/coa/Senior_Press_Article/Topic_Index.htm