Gene Role May Be a Link between Dementia and the Coronavirus

Dementia and the Coronavirus – The study in Great Britain is the latest to suggest that genetics may play a part in why some people are more vulnerable to COVID-19 than others. It may also help to explain why people with dementia have been hard hit.

“It is not just age: this is an example of a specific gene variant causing vulnerability in some people,” said David Melzer, a professor of epidemiology and public health at Exeter University and a co-author of the study.

The Guardian’s recent article entitled “Research reveals gene role in both dementia and severe Covid-19” explains that the study published in the Journal of Gerontology: Medical Sciences reports how researchers analyzed data from the UK Biobank, where genetic and health data on 500,000 volunteers aged between 48 and 86 has been collected.

The researchers focused on a gene called ApoE which gives rise to proteins involved in carrying fats around the body and can exist in several forms. One such variant, called “e4”, is known to impact cholesterol levels and processes involved in inflammation, as well as increasing the risk of heart disease and dementia.

They found 9,022 of almost 383,000 Biobank participants of European ancestry studied had two copies of the e4 variant, while more than 223,000 had two copies of a variant called “e3”. The former have a risk of Dementia and the Coronavirus are up to 14 times greater than the latter.

The researchers then studied positive tests for COVID-19 between March 16 and April 26, when testing for the coronavirus was primarily done in hospitals, suggesting the cases were severe.

The results showed that 37 people who tested positive for COVID-19 had two copies of the e4 variant of ApoE, while 401 had two copies of the e3 variant. After considering factors such as age and sex, the researchers say people with two e4 variants had more than twice the risk of severe Covid-19 than those with two e3 variants.

One professor observed that it is possible that the role of ApoE in the immune system is important in the disease. Future research on Dementia and the Coronavirus may be able to harness this to develop effective treatments.

Reference: The Guardian (May 26, 2020) “Research reveals gene role in both dementia and severe Covid-19”

 

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Increasing Medicare Scams in the COVID-19 Pandemic ?

Medicare scams in the COVID-19 pandemic. Motley Fool’s recent article entitled “Seniors, Be Wary of These Medicare Scams During COVID-19” discusses some red flags you should look out for to avoid being a victim.

  1. Callers requesting your Medicare number. Medicare typically won’t call beneficiaries and randomly ask them to verify their benefits. If someone calls you and requests your Medicare ID number, don’t give them your information.
  2. Callers requesting your Social Security number. If a bad guy gets your Social Security number, he can do a number of things with that information, any of which will create headaches for you. This includes opening a credit card in your name and charging a lot of expenses on it. If you get a caller who says he’s a Medicare representative who needs your Social Security number to process a health claim, don’t give it to him.
  3. Email or phone calls asking you to send money. Medicare doesn’t sell prescriptions over the phone or ask seniors to pre-pay for services. If someone calls asking you to send money or give out credit card information, it’s a bogus caller.
  4. A promise for early access to a COVID-19 treatment or vaccine. Right now, there is no COVID-19 vaccine. There is also no mail-order treatment that you can stock up on to protect yourself in case you’re struck with the virus. Therefore, don’t believe a caller who says he’s from Medicare and is offering you a chance to get in on a groundbreaking medication. Don’t pay him or share your Medicare ID number during that conversation. When an effective vaccine is available, Medicare will pay for it and let you know how to get it.
  5. Someone at your door claiming to be from Medicare. Medicare doesn’t have sales reps. Therefore, if someone says they’re from Medicare, lock the door and demand that that person leave immediately. Call the police, if you need help.

When a lot of seniors are worried, isolated, and in financial straits, they don’t need to fall victim to Medicare Scams in the COVID-19 Pandemic. Be prepared and be aware of what common fraud attempts look like. That way, you’ll be in a good position to protect yourself.

If you receive a suspicious email or phone call, report it at 1-800-MEDICARE. This might prevent another senior from falling victim to Medicare Scams in the COVID-19 Pandemic in what could be an extremely dangerous trap.

Reference: Motley Fool (May 25, 2020) “Seniors, Be Wary of These Medicare Scams During COVID-19”

 

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Why Is Blue Cross and Blue Shield Waiving Cost-Sharing Fees ?

Blue Cross announced that it is waiving cost-sharing fees for in-network primary care, mental health, and substance-use office visits.

Star Tribune’s recent article entitled “Blue Cross waives more fees for Medicare Advantage customers” reports this change will impact roughly 100,000 Minnesotans who access Medicare through the company’s Medicare Advantage products. Blue Cross is Minnesota’s largest health insurer and a leading provider of Medicare services in the state.

The elderly are especially at risk to the worst effects of COVID-19. Of the more than 700 deaths from the virus in Minnesota, about 80% have been residents of long-term care facilities, mostly nursing homes and senior apartments. These numbers are similar in other states.

“In the midst of this crisis, seniors have been greatly impacted and are at disproportionate risk,” Dr. Craig Samitt, chief executive of Blue Cross, said in a statement. “With our hope to keep our senior members safe and assure that they receive the preventive care they need, Blue Cross is both expanding coverage and proactively reaching out to help them navigate options to get the care they need.”

Blue Cross and Blue Shield announced that it will begin calling its Medicare Advantage customers next month to make them aware of new benefits and to ask about other medical needs.

Blue Cross previously said it was waiving cost-sharing fees such as all in-network fees to customers who were checking on COVID-19 symptoms or seeking treatment for the illness.

Blue Cross and Blue Shield also waived limits on early refills of medications.

The insurance company also bolstered its coverage for telemedicine services, including the use of video chat apps for patients to interact with doctors.

Medical offices have experienced a big decrease in patient visits of all kinds. In response, many are promoting more telemedicine to continue providing care and treatment.

Two weeks ago, Minnetonka-based UnitedHealth waived copays and other fees through September for Medicare Advantage beneficiaries. This change was partially to recognize that many seniors are delaying certain treatments and procedures to help prevent the spread of coronavirus.

Reference: Star Tribune (May 18, 2020) “Blue Cross waives more fees for Medicare Advantage customers”

Suggested Key Terms: Elder Law Attorney, Medicare, Long-Term Care

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Tax Haven – Divorce Reveals How Trusts are Used by the Ultra-Wealthy

South Dakota has become a domestic mini-Switzerland for wealthy people who want to shield their assets with a tax haven. Texas billionaire Ed and Marie Borsage’s divorce is shining an unwanted spotlight on both his finances and the use of trusts in the state, according to CNBC’s recent article “Billionaire Divorce uncovers secretive world of trusts in South Dakota.”

Married for three decades, the Borsage’s accumulated 12 homes and an unusual collection of high- priced items, like an Egyptian mummy and Marilyn Monroe’s personal effects. It was quite a lifestyle. However, when Ted filed for divorce, Marie discovered that everything had been put into a special trust that shielded assets from any claims. After paying her legal fees, she may end up with nothing from the 30-year marriage.

Ed’s attorneys are making the claim that all of the assets are controlled by the trust, so they are not marital assets. The total value of the couple’s marital property, which would be subject to division in a divorce, is about $12 million. Marie’s legal bills are already in the millions.

The unpleasant nature of the divorce offers a rare look into the highly secretive world of asset trusts and tax haven in South Dakota. The protective trust laws of the state make it a protection and tax haven for wealthy families from the U.S. and around the world. Experts say that about $250 to $900 billion is now being held by South Dakota trusts, from Chinese billionaires, Europeans seeking to avoid taxes and Americans looking to shield wealth from spouses.

When the two married in 1989, they had no wealth. Ed began a commodities trading business and Marie was one of the first employees. They became wealthy. However, in 2012, according the lawsuit, Ed began an affair and filed for divorce in 2017. That was when Marie learned that he had been transferring their business and personal assets into a complicated series of trusts, first in Bermuda and then in South Dakota. Marie was originally a beneficiary of the trust, but then before the divorce, Ed started transferring assets and she was removed as a beneficiary.

According to South Dakota law, he was not required to notify her of the changes. Trusts in South Dakota are also perpetual. Therefore, a wealthy family can put assets into a trust that are held in perpetuity, rather than a limited period of time. The state also gives trusts sweeping privacy and asset-protection against creditors, business partners, lawsuits—and ex-spouses. South Dakota has no inheritance, capital gains or income taxes. It’s an extremely attractive state for people who want to keep their business private and protected.

The state also has strict information protections, so there are nondisclosure orders on all of the attorneys and all of the filings in the divorce case.

Reference: CNBC (May 6, 2020) “Billionaire Divorce uncovers secretive world of trusts in South Dakota.”

 

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Rules for the HIPAA Waiver Relaxed?

The United States Department of Health and Human Services has announced that it won’t enforce penalties for HIPAA Waiver violations of certain provisions of the HIPAA privacy rule against healthcare providers or their business associates for good-faith disclosures of protected health information (PHI) for public health purposes during the COVID-19 emergency.

The HHS Office for Civil Rights said that it was exercising its “enforcement discrimination” in announcing its change in policy during the coronavirus pandemic, a declared emergency period, reports Modern Healthcare in its article “HHS eases HIPAA enforcement on data releases during COVID-19.”

A HIPAA waiver of authorization is a legal document that permits an individual’s protected health information (PHI) to be used or disclosed to a third party. This waiver is part of a series of patient-privacy measures set forth in the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

PHI covered under HIPAA is information that can be connected to a specific individual and is held by a covered entity, like a healthcare provider. HIPAA has set out 18 specific identifiers that create PHI, when linked to health information.

The notification was issued to support federal and state agencies, including the CMS and the Centers for Disease Control and Prevention, that require access to COVID-19 related data, including protected health information.

“The CDC, CMS, and state and local health departments need quick access to COVID-19 related health data to fight this pandemic,” OCR director Roger Severino said in a statement. “Granting HIPAA business associates greater freedom to cooperate and exchange information with public health and oversight agencies, can help flatten the curve and potentially save lives.”

HIPAA’s privacy rule only permits business associates of HIPAA-covered entities to disclose protected health information for certain purposes, under explicit terms of a written agreement.

The moratorium enforcement doesn’t extend to other requirements or prohibitions under the privacy rule, nor to any obligations under the HIPAA security and breach notification rules, OCR said.

Reference: Modern Healthcare (April 2, 2020) “HHS eases HIPAA enforcement on data releases during COVID-19”

Suggested Key Terms: Estate Planning Lawyer, HIPAA Waiver, Probate Attorney

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C19 UPDATE: Will Insurance Help Business Owners Recover Lost Income ?

The economic disruption from the COVID-19 pandemic has led businesses and policymakers to ask whether insurance should Recover Lost Income ?. Most businesses carry Commercial Property insurance, which frequently includes Business Income or Business Interruption coverage. In general, this additional coverage is there to replace lost income due to “covered causes.”

There’s no question that the novel Coronavirus is causing unexpected business losses. But, are the lost profits and other damages covered under these business policies?

Insurers are reluctant to help business recover lost income  in a pandemic, primarily because of the sheer scale of the loss. Insurance industry sources suggest that the cost of covering business income claims resulting from COVID19 could run as high as $290 billion monthly.

While insurers typically exclude coverage for losses due to viruses or bacteria … the final answer may not be as certain. Depending on the exact policy language, a policy review by an attorney may reveal an argument for coverage.

Some lawmakers also are exploring ways to shift some of the economic burden to business insurers.

For example:

  • Some insurance trade groups are considering an option where businesses submit claims as if the losses were covered, and insurers pay claims from a government-funded pool. There is precedent for this approach in the National Flood Insurance Program.
  • A state bill in New Jersey would require insurers retroactively to include virus transmission as a covered peril in BI policies. The bill also includes a provision that would allow liable insurers to petition the state for partial reimbursement collected from other insurers in New Jersey that do not offer BI coverage. This would potentially shift business losses attributable to COVID-19 to all insurers in the state.
  • Massachusetts, New York, and Ohio have also introduced bills on BI coverage.

If you are a business owner and you carry commercial property insurance, the best advice is to promptly review your policies, notify insurers of claims, document losses, and consult qualified legal counsel.

Resources: The National Law Review, Insurance Coverage in the Time of Coronavirus: Business Interruption Coverage May Require Creativity, March 18, 2020; Congressional Research Service, Business Interruption Insurance and COVID-19, March 31, 2020.

 

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C19 UPDATE: Coronavirus and the Elderly Care – Plans for Both Older Adults and Caregivers

Coronavirus and the Elderly Quick. You or your senior loved one is running a fever, coughing and struggling to breathe. You suspect COVID-19 and a full-blown medical emergency starts to unfold. Medical professionals will need to quickly know the patient’s health conditions, medications, healthcare providers and emergency contacts.

Are you ready?

The Centers for Disease (CDC) recommends developing a Care Plan now as part of your emergency preparedness.

What is a Care Plan?

A care plan is a document that summarizes a person’s health conditions and current treatments for their care. The CDC offers a handy form you can use, Complete Care Plan. This is a fill-able form you can complete on your computer or print and complete by hand.

How Do You Develop a Care Plan?

The CDC offers these tips

  • Start a conversation about care planning with the person you take care of.
  • Talk to the doctor of the person you care for or another health care provider.
  • Ask about what care options are relevant to the person you care for.
  • Discuss any needs you have as a caregiver.

And remember, Coronavirus and the Elderly Care care plans can reduce emergency room visits, hospitalizations, and improve overall medical management, especially during a medical emergency.

Resource: Centers for Disease Control, Coronavirus Disease 2019, https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/older-adults.html

 

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What Common Prescription Drugs Might Increase Dementia Risk ?

Anticholinergics are a type of medication that blocks the action of acetylcholine, a chemical messenger in the brain that help drive breathing, digestion, urination and other functions, explains Considerable’s recent article entitled “These common prescription drugs might boost your dementia risk .”

They include drugs for depression (like Paxil), psychosis (like Thorazine), Parkinson’s disease (such as Cogentin) and bladder disorders (such as Ditropan).

The study found a nearly 50% increase in chances of dementia risk among people who received more than 1,095 daily doses of these drugs within a 10-year period— equivalent to a senior taking a strong anticholinergic medication daily for at least three years.

The research, which was published in JAMA Internal Medicine, the University of Nottingham study tracked 284,343 patients age 55 and older between 2004 and 2016.

The researchers analyzed total standardized daily doses (TSDDs) of anticholinergic drugs during that time period.

The University of Nottingham researchers identified each adult’s anticholinergic exposure and saw that the most frequently prescribed anticholinergic drugs were antidepressants, drugs to treat vertigo, motion sickness or vomiting and an overactive bladder.

However, there were some other anticholinergic antihistamines, and gastrointestinal drugs that did not show a connection to a higher incidence of dementia, the researchers said.

While the study shows a correlation between these specific anticholinergic drugs and increased dementia odds, the researchers cautioned that seniors should not discontinue taking any medications without talking with their physician.

Reference: Considerable (Feb. 21, 2020) “These common prescription drugs might boost your dementia risk”

 

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How Risky Is the Coronavirus for Seniors ?

MarketWatch’s recent article entitled “America’s growing elderly population is at risk — here’s what we can learn from Italy” says that we need to keep as many people at home to avoid Coronavirus for Seniors , especially considering not everyone shows signs of the coronavirus but could still be carriers, and protect all citizens, especially the most vulnerable, including the elderly and those with heart and lung diseases.

“What you’re now hearing repeatedly, is that people over 60 and people who have chronic conditions are most at risk of coronavirus,” said Paul Irving, chairman of the Milken Institute Center for the Future of Aging. “That does create serious concerns for older Americans.”

The United States has more than 4,000 confirmed cases of the coronavirus, and 69 deaths.

Italy is to date the hardest hit country in Europe and has the second highest number of confirmed cases and deaths from the coronavirus. China started spreading the infectious disease in December. Italy experienced its highest number of cases within a 24-hour period last weekend — an increase of 3,590 cases and 398 deaths, officials said.

The State of Washington has had the most deaths in the U.S.—many of which were linked to an outbreak at a nursing home in Kirkland in February. There were 26 patients at the Life Care Center of Kirkland who have died between February 19 and March 13, the center said. More than 50% of its residents had been moved to hospitals. New York City, which just shut the nation’s largest public school system for a month, has had five cases as of Sunday night, including two people in their 50s, two people in their late 70s and one woman in her 80s.

The average age of those who passed away in Italy was 81, and many suffered from pre-existing health issues, the BBC said. In China, the death rate among those 80 and older was about 15%, according to a Chinese CCDC report last updated in the middle of February, when there were approximately 72,000 confirmed cases. Those between 70 and 79 years old had a death rate of 8%. By comparison, those in their 20s and 30s each had a death rate of 0.2%, according to Worldometers, which aggregated global reports related to coronavirus.

“There’s also a risk to the broader population, but we really need to focus on protecting our elders,” Irving said. “The older a disease-sufferer, the higher the risk.”

Although just 14.50% of the United States’ population is 65 and older, that number is anticipated to increase in the next decade. Since the start of 2011, about 10,000 people have turned 65 years old each day, and they will continue to do so until 2030, according to nonprofit think tank Pew Research Center. At that point, roughly 18% of the country will be 65 or older.

Government responses to the coronavirus include closing large gatherings of people. like sporting events, universities, and restaurants, which may be important in slowing down the spread of the virus. The CDC recommends all Americans, especially older people, to stay indoors, stock up on necessary food and medications, and reduce contact with others. The CDC also strongly urges everyone to wash their hands with soap and water for 20 seconds, avoid touching their faces and use hand sanitizer with at least 60% alcohol when soap is not available.

Reference: MarketWatch (March 16, 2020) “America’s growing elderly population is at risk — here’s what we can learn from Italy”

 

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S. Martin Gordon has retired. David Parker has taken over.

From the Desk of S. Martin Gordon attorney at law

I wanted to share some recent news with you, my dear client. I have decided to merge my practice, S. Martin Gordon with my colleague, David Parker of the Parker Law Firm. The website address gordontrustlaw will shut down.

As I considered the future, I looked long and hard to find an attorney who I could trust with my clients. As of April 1, 2014, I will become counsel to David’s law firm, the Parker Law Firm.

Many of you have likely seen David at my office these many years. We have done many seminars together and over the years I have referred many cases to him. He is very knowledgeable about my practice and shares my philosophy of the proper way to plan your estate.

David Parker practices exclusively in the areas of estate planning and elder law and is not only extremely knowledgeable in these areas but also provides expertise in Medicaid and Veterans benefits. He will continue the high standards that I insist upon in my own practice.

The phone numbers will remain the same, but we can also be reached at the additional phone numbers listed above. In Westchester, David will be working out of his White Plains office which is located right across from Bloomingdale’s and has free parking. The Westchester phone number will also be the same.

I know that you will be in good hands. Click here to contact David Parker

S. Martin Gordon

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