The prevalence of autism is on the rise in the US. Because the condition first manifests itself before the age of 3, the majority of people receiving new diagnoses are under the age of 6. Autism spectrum disorder (ASD) refers to a broad range of behavioral conditions that include challenges with social skills, speech, and nonverbal communication as well as repetitive behaviors. The Centers for Disease Control and Prevention (CDC) now estimate that autism affects 1 in 59 children in the United States. That number has been steadily increasing in the past decade.

Autism is a very plural condition as there are many subtypes, primarily influenced by the environmental and genetic factors and has varying degrees of severity. Individuals coping with autism have distinct sets of strengths and challenges. That is why people are characterized as being on an autism spectrum because the individual scale of learning, thinking and problem-solving skills can range from highly skilled to severely challenged. Some who are diagnosed with autism spectrum disorder (ASD) may be able to live entirely independently while others may require some to significant support in their daily lives.

Federal and state programs help assist families with children and young adults who have ASD. The Individuals with Disabilities Education Act (IDEA) federal law outlines rights and regulations for US students who require special education. The US Department of Education website outlines the basics of IDEA in simple terms. Are these services available until the young adult reaches the age of 22 and then what? There is a vast continuum of diagnosed and undiagnosed adults who are struggling to make sense of life while living with ASD.

Autism Speaks is an organization that calls on legislators and public health agencies like the National Institute of Health to promote research and advancements in understanding the increased prevalence of and complex medical needs that often accompany a person with autism. There has recently been a call to double the budget to advance research and create policies that better provide individual support and services as autistic children transition to adulthood and need employment and residential options.

For people afflicted, autism is a lifelong condition and there is an unacceptable gap in our awareness of their needs particularly as children age out of federal school programs at 22 and are left to struggle with areas of basic life skills such as employment, housing, and social inclusion. Children with autism eventually become adults with autism. While some autistic adults become very successful, even famous for their success in arts and sciences (Albert Einstein, Dan Aykroyd, and others) others languish in their inability to navigate a complex world.

Wherever an adult finds themselves in the autism spectrum, there are specific basic needs which mirror those adults without the challenge of ASD, and they are friendship, support, and opportunity. The mechanisms and interpretation of communication may differ but the human need is the same. Reliance on tax-funded programs is not always the best way to approach the needs to sustain them as funding and programs come and go. The real solution to meet the needs of adults with autism is essentially the same as the needs of children with autism. People in their families and communities must help their autistic loved one to make sense of and live in a complex world. The collective belief that they have abilities and strengths are can help reduce their anxieties. Accommodating support in ASD sufferer’s efforts to meet challenges and their own special needs can go a long way in assisting them to live more independent and successful lives.

Are federal and state programs available? Are there community outreach programs that help young adults transition to independent living past the age of 22? Adults with autism differ from one another just as it is for children on the spectrum.

If you have questions or would like to discuss your particular situation, please don’t hesitate to reach out. You can contact Elville & Associates in Columbia, Maryland by sending us a message here or by dialing us at (443) 393-7696.

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Your senior years should not be plagued with money woes. The stress that money problems bring not only ruins your aging experience but can also be disastrous to your health. Rising health care costs and your increased need for health care can add up to big bills that can further tax your health. To age well, you must use sound financial judgment as well as make healthy choices for your body and mind. The goal is to remain as healthy as you can for as long as you can and have a healthy bank account to support those goals. Beyond the obvious, such as choosing the right insurance plan and saving money for retirement, there are other strategies you can implement to further a successful and happy retirement.

Chronic stress is known to worsen health problems and can also accelerate the aging process. Though everyone experiences and handles stress differently, it is important to identify the specific stresses in your life and hone in on its source to be able to address it adequately. Relationship stress, family stress, and work stress can be treated through meditation and gentle yoga. The more you practice, the more significant the mental and physical benefits you experience.

In the case of financial stress, meditation will not save you. You need a concrete plan to approach your problem. Develop a budget that will address which debts you need to pay off first and stick to the program. Learn to avoid excessive spending that puts you in a debt cycle. Once you are as debt-free as reasonably possible, learn ways to increase your savings.

An easy way to lower your expenditures and increase your savings is to view the world as your gym. Thirty minutes of brisk walking five days a week in your neighborhood is excellent for your body and your mind. Bring your cell phone, but only use it in the event of an emergency. Take in the outdoors around you and let your mind be free. You can be active doing leg extensions or squats in your own home. You can do several ballet plies while cooking a meal and toe raises while brushing your teeth. Before you get out of bed in the morning move your pillow out of the way and stretch out your spine; arms overhead and extending through your toes. The idea is to connect your daily routine activities to a specific exercise and do it every time you enter into that everyday behavior. If you have physical limitations, talk to your doctor before implementing at-home exercises or neighborhood walks.

Learn to limit the portions of food you eat. We are a nation of overeaters. In many countries around the world, it is unheard of to have a “to go” box from a lunch or dinner that is too big for consumption in one sitting. The Dietary Guidelines for Americans 2015-2020 recommend active men over 65 need 2,600 calories daily, while sedentary men require just 2,000; for women, it’s 2,000 if active, and 1,600 daily calories if sedentary. Pass on the heaping helping and pass on a second helping. By limiting the amount of food you eat, you can maintain a more healthy weight, which in turn can improve your health and longevity, as well as save money.

If you have room in your yard, start a vegetable garden, plant some fruit trees, and involve your friends to share in the workload and the resulting produce. If you don’t have a yard, join a community garden. Growing your food is an excellent way to increase the number of fruits and vegetables you eat and has the added benefits of making you physically active and socially engaged. By making a garden a group effort, you can prevent isolation which for many older adults is a risk factor for everything from depression to hypertension. If you have problems kneeling or being down on the ground, try using raised garden beds or even try gutter gardening. Gutter gardens are a simple way to grow vegetables that have minimal roots in gutters that are affixed to an outside wall at a height that is comfortable for you. Gutter gardens also remove the problem of bugs in the soil. A fruit and vegetable garden will lower your grocery bill and shift your eating habits to a more healthful plant-based diet.  Learn how to can or freeze your produce if you have a short growing season where you live.

Make a small investment to solve a significant problem. A grab bar in the shower or lowering the height of your bed can help you prevent a range of serious injuries from a fall. Fractures and head traumas often result in a rapid health decline and even death. Improve your balance with gentle tai chi exercises. Be sure you have adequate lighting in your home. Fix uneven floorboards and get rid of throw rugs. By being mindful of how you move through your home you can avoid an unnecessary fall which will save you money by avoiding medical treatment and might even save your life.

Kick bad habits and start with smoking. Just because you have not already developed lung cancer after decades of smoking does not mean you won’t, nor will it help prevent other lung problems like emphysema or chronic obstructive pulmonary disease (COPD). Replace a bad habit with a good one as proposed above. If you drink alcohol on a daily basis or sometimes to excess, consider cutting back or quitting altogether. Alcohol contributes to unsteadiness on your feet and can precipitate you to fall. Do not take more than the prescribed dosage of painkillers or anti-anxiety medications and never mix them with alcohol. It is easy to become addicted to these drugs as you age because often they are used in the treatment of chronic conditions. You can build a tolerance to them and need progressively stronger doses. Try to find alternative ways to address your pain or anxiety. Cut back on sugar and fatty foods.

If your day is not structured, create a schedule. Try to eat at regular times as well as have a predictable bedtime and wake up call. Your body will appreciate the regularity of life. Kicking bad habits to the curb can help you enjoy your retirement years with greater energy and health as well as save you a lot of money on bad habits that are expensive. Don’t tax your wallet and your well being.

There are many techniques for aging well and preserving your bank account. Some methods are simple while others require guidance by trusted counsel. Reduce the financial stresses of your retirement and contact our office today and schedule an appointment to discuss how we can help you with your planning.

Get in touch with Elville & Associates in our main office in Columbia, Maryland by sending us a message here or by dialing us at (443) 393-7696.

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Authored by:  Stephen R. Elville, Esq. – Elville and Associates, P.C. – 443-393-7696, steve@elvilleassociates.com, @elvilleassoc

When a parent of a child with special needs retires and begins receiving Social Security retirement benefits, the child may qualify for Social Security Disability Insurance (SSDI) based on the parent’s work record if the child’s disability manifested itself before the child attained 22 years of age. But a little-known provision in the Social Security regulations allows the spouse of a retiree to also receive Social Security benefits, even if he or she has not yet reached retirement age, so long as he or she is caring for a child with disabilities at home.

Here’s an actual example. Father retires and begins receiving Social Security. Because his daughter developed a disability prior to attaining 22 years of age, the daughter will begin receiving SSDI benefits at the time of father’s retirement. Furthermore, because mother (age 58) is caring for the couple’s daughter at home, she may also begin receiving spousal Social Security benefits, even though she hasn’t reached the minimum retirement age. Of course, there is a catch. Because the combination of the mother’s and daughter’s benefits exceeds Social Security’s limit on family benefits, the result is that daughter’s benefit is reduced. But the combined benefit still exceeds the daughter’s benefit alone by more than $500 per month. Over the four years from when father begins taking Social Security benefits until the mother reaches age 62, the family receives more than $30,000 in extra benefits, which makes a large difference in their ability to care for their daughter.

To paraphrase the Social Security Administration’s (SSA) website, in order for a parent to receive benefits in this situation, the parent must exercise parental control and responsibility for a mentally disabled child. The benefits can also be received if the parent performs personal services for a child who is physically disabled. In many cases, the SSA will inform the parent of this opportunity, so long as the parent is already receiving spousal benefits before the child turns 16. But if the parent is not receiving these benefits, it is important to explain the situation to the SSA when the retiring parent applies for Social Security. #elvilleeducation

Tags: Elville, Retired Parent, Social Security Benefit Regulations, Special Needs
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The Centers for Medicare and Medicaid Services are looking to the future of the US health care system, and it is projected to be overloaded with seniors needing medical care. In 2010 the US elderly population accounted for about 13 percent of the US population yet accounted for 34 percent of the total health care expenditure. That percentage will continue to increase because of increasing longevity in the growing senior community. Depending on the region, estimates about the future costs of elderly health care may more than double between the ages of 70 and 90.

Government medical programs and services, insurers and manufacturers are tasked with finding ways to reduce the enormity of health care costs in particular as it pertains to senior care needs solutions. Lower costs and increasing efficiencies are the mandates to address the looming potential expenditure crisis. Enter the Internet of Medical Things (IoMT).

Digital technologies and their application to senior medical needs offer the best hope to address existing and future needs. You may have already read about the Internet of Things (IoT) which is a network of devices such as home appliances, software actuators, and vehicles including wheelchairs, not traditionally extended to internet connectivity. The IoMT is similar but reserved for a collection of medical devices and their applications that connect to healthcare information technology systems through online computer networks. The medical devices are digitally linked to Wi-Fi that allows machine-to-machine communication and throughputs of data collection. The captured data can be stored and analyzed all the way from individual to metadata levels. The importance of controlling senior medical costs now and in the future cannot be understated.

Vitals-tracking wearables are already well-known medical devices. These devices monitor everything from daily physical activity levels, hypertension, cardiac ailments, diabetic levels and more. The devices send vital signs over the internet to medical monitoring staff who can alert health care providers when vital signs are out of the patient’s range of normal. Vitals-tracking wearables are also used in assisted living facilities, nursing homes and hospitals to help nurses and off-site physicians continuously monitor seniors’ vital signs passively.

Medication adherence tools are an electronic reminder system for proper consumption of prescription and other medications.  These tools reduce the chances of missing or overdosing on medications. Medical adherence tools can decrease the number of hospitalizations or 911 calls prompted by the potentially serious consequences of improper dosing of medications thus saving costs on unintended medical attention.

Virtual home assistants are increasingly found in senior homes providing daily assistance such as environmental controls, medical advice, calendar reminders, as well as social connections to family and friends which reduces the risk of isolation and therefore can reduce depression. All of the benefits that a virtual home assistant can provide considerably reduce unnecessary life stresses and health problems which reduce costs.

Biomarker portable diagnostic devices are a staple in the senior age group as they need to be tested more frequently than most segments of the population. Rather than a trip to a pathology lab for blood testing et al., these smart and portable diagnostic devices can allow the senior to perform testing in the comfort of their own homes and get results that are formatted to be instantly shareable with medical care providers. The convenience factor and proactive nature of these devices allow for more frequent testing which can lead to early disease detection and its treatment which lowers the costs of health care.

Emergency assistance, fall detection, and “navigation guidance” back to their residence for dementia patients are all part of the personal emergency response systems available to seniors. Some of the fall detection systems are now equipping seniors with sensor belts that can identify a change in gait and can even deploy airbags to prevent injuries due to unintended falls.

Fall-related health care costs can be staggering as it can include hospitalization in the event bones are broken, or a severe head injury occurs. These fall detection systems will trigger alerts to designated emergency contacts in the event of fall, emergency medical need, or re-homing of dementia or Alzheimer patient.

Seniors with disabilities including sensory and cognitive impairment can use disability assistance tools to control selection and volumes of streaming music, on-off switch programs for televisions, lights and thermostat controls. Many of these systems are being developed for voice recognition to reduce the need to interact with screens and buttons. Some of the existing tools include customizable colored buttons installed in the residence of the senior that alerts them to perform daily tasks like brushing their teeth. Upon completion of the task, the senior presses the button and the device activates the next task in the customized sequence. When a senior can manage their environment without the constant need for supervision, it lowers health care costs.

Nearly everyone is familiar with the concept of the smart implant known as the pacemaker that controls the heart rhythm of the wearer and can communicate patient data via smartphone apps to their physician. Now there are newer smart implants. These include glucose sensors, dedicated readers, smart knee, shoulder and spine implants, and orthopedic implants which can communicate post-surgery performance. These implants provide real-time data of patient condition to medical professionals who quickly assess if early intervention is required when a problem arises thus lowering medical costs.

Smart home senior facilities have arrived. Residences receive wrist-worn wearables that can free up care providing staff as the devices are tied into machine learning and predictive analytics determining insights into deviations from the senior’s daily routine. Some are designated into three types of color-coded alerts such as red for night wandering or potential fall, orange for changes in the routine of daily living such as irregular eating, and yellow for environmental issues such as leaving a stove on or a refrigerator open. This technology allows health care professionals to monitor patients while multi-tasking other facility operational tasks saving health care costs. Similarly, family caregivers can use remote monitoring tools that enable oversight without having direct contact with their loved one. Alerts are sent when daily routines are detected to deviate from the norm allowing the family member to contact their senior to ensure all is well. Remote monitoring tools can help family caregivers remain at work and on-task in their own lives while still adequately watching over their loved one.

While the internet of medical things holds great promise to curb excessive increases in senior health care costs, there are some cautionary tales. What if an internet service provider “goes down” and no Wi-Fi is available to maintain connectivity to health care professionals? Lately, the number of natural disasters in this country calls attention to what will happen to senior digital monitoring when the lights go out during a fire, flood, hurricane or tornado. Will there be a backup generator to keep the devices online? Will there be anyone in the affected disaster zone online to interpret the medical data a vital tracking wearable uploads? What if the medical device fails for mechanical reasons? Can all aging seniors cope with this level of technology?

While these remain potential disaster scenarios the more massive disaster is not addressing the overwhelming costs of senior health care for an increasingly elderly population. The internet of medical things is the logical, efficient, and effective solution for now.

If you have questions about what you have read or would like to speak with us about you or a loved one’s legal needs, please don’t hesitate to reach out. You can reach Elville & Associates at our Columbia, Maryland office by dialing us at (443) 393-7696 or by clicking here to send us a message.

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Authored by: Stephen R. Elville, Esq. — 443-393-7696, steve@elvilleassociates.com, @elvilleassoc

Individual Retirement Accounts, 401(k)s, and other qualified plans allow an employee to shelter his or her retirement savings, tax-free, until retirement. When an employee withdraws funds from his IRA or 401(k), the amount withdrawn is considered taxable income. Because of this favorable tax treatment, the government does not want people to remove the funds from a retirement account until they reach retirement age, so it imposes an additional 10 percent tax on any funds that are taken out of an IRA or 401(k) before the owner of the account is 59 1/2 years old.

The early withdrawal penalty has been very effective at forcing retirement plan owners to keep money in their retirement accounts, but it could be unnecessarily punitive if an employee suddenly becomes disabled and needs to access the funds in his retirement account to pay for medical expenses or for the daily cost of living. The IRS has taken this problem into account and offers people with disabilities, or people who incur sudden medical expenses, a break. If a retirement account owner becomes disabled, the IRS will waive the 10 percent early withdrawal penalty so long as she can show that he or she is unable to perform any substantial gainful activity and that the condition causing the disability is expected to result in death or last for a long time.

These requirements just so happen to mirror some of the major requirements for a person to qualify for Social Security Disability Insurance (SSDI). If someone does not meet the disability requirement, there are still several other exceptions to the early-withdrawal penalty that may be useful for a person with a disability, even if his condition does not rise to a level where it completely prevents him from performing substantial gainful activity. If someone is unemployed and needs to take money out of a retirement plan to pay privately for health insurance (often very important for people with disabilities or for the parents of children with disabilities), the IRS will waive the early withdrawal penalty. Likewise, if an account owner has significant unreimbursed medical expenses that are more than 7.5 percent of his gross income, then the retirement funds can be utilized to pay for those bills without penalty.     #elvilleeducation

Tags: 401(k)s, Early Withdrawal Penalty for IRAs, Exceptions, Other Qualified Plans
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By:  Jeffrey D. Stauffer — Community Relations Director — jeff@elvilleassociates.com, 443-393-7696, @elvilleassoc

Columbia, MD – In the first-of-its-kind partnership in the country, Elville and Associates, P.C., an estate planning, elder law, and special needs planning law firm based in Columbia, Maryland, and the Institute on Healthcare Directives have partnered to offer MIDEO® (My Informed Decision On VidEO) to the firm’s Client Care Program members.  The MIDEO® card is a personalized card with individuals’ critical healthcare information on the front that also hosts by video, accessible by a QR code scan, their prerecorded wishes for resuscitation and other healthcare choices.  By providing an accurate, up-to-date, easy to review video of the individual speaking, their personal MIDEO® will accurately allow their wishes and choices to be carried out correctly by medical professionals. 

“Elville and Associates is privileged to partner with Dr. Ferdinando Mirarchi and MIDEO® to provide our Client Care Program members with the leading-edge technical tools they need to stay ahead of the curve in healthcare decision-making,” remarked Stephen R. Elville, principal and lead attorney of Elville and Associates.  “Clients are assured and gratified to know they can implement advanced measures, remain proactive in making their health-related wishes known, and protect themselves to the greatest extent possible in an uncertain world.”

Some of the benefits of MIDEO® are:

ü MIDEO^® prevents medical errors related to medical strangers misinterpreting your documents

ü MIDEO^® ensures the right care at the right time

ü MIDEO^® is personalized and individualized for you

ü MIDEO^® is easy to complete and Dr. Mirarchi will guide you through every step

ü MIDEO^® protects your family from having to make difficult, uninformed decisions that may cause family disruption

ü MIDEO^® is protection for you and your family that is retrievable anywhere in the country and internationally

The Institute on Healthcare Directives and MIDEO® are spearheaded by Dr. Ferdinando Mirarchi, Chief Medical & Scientific Officer of the Institute on HealthCare Directives and the Founder of MIDEO®.  From institutehcd.com, he is “the Principal Investigator of the TRIAD (The Realistic Interpretation of Advance Directives) Research Series which has been featured by the New York Times & Wall Street Journal. His research reveals there is a new Nationwide patient safety risk affecting patients who have living wills, Physicians Orders for Life-Sustaining Treatment orders and those who are critically ill.  His TRIAD VIII study, released by the Journal of Patient Safety, is groundbreaking and reveals patient treatment is much more effective if video testimony is incorporated into their advance care plans.  Dr. Mirarchi is also a practicing Emergency Medicine Physician and Medical Director of the Department of Emergency Medicine at UPMC-Hamot in Erie PA.”

At Elville and Associates, it has and always will be the firm’s mission to offer the very best legal-technical knowledge and service to our clients and communities we serve.  We trust this added benefit will prove valuable to our clients and advisor community with whom we partner as a benefit to their clients.

To learn more about MIDEO® and the Institute on Healthcare Directives or to set an appointment, please visit MIDEOcard.com and institutehcd.com.  For more information about Elville and Associates, please visit elvilleassociates.com.

Tags: elville and associates, HealthCare Directives, MIDEO®
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Olivia Holcombe-Volke began volunteering with MVLS in 2015, and since then has helped 39 clients with 51 legal issues including estate administration and planning, deeds, and tax.

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Tags: MVLS, Olivia Holcombe Volke
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Authored by: Stephen R. Elville, Esq. — Elville and Associates, P.C.– 443-393-7696, steve@elvilleassociates.com, @elvilleassoc

Trustees of special needs trusts are often approached by family members of trust beneficiaries who would like to be paid as caregivers for the beneficiaries. While the Social Security Administration (SSA) currently does not explicitly prohibit payment of family caregivers from special needs trusts that support Supplemental Security Income (SSI) recipients, there are other reasons why trustees should be cautious about doing so. Many states have laws that require parents to care for their children. In those cases, it is inappropriate for trustees to compensate parents for services that they are legally required to provide to their children. These duties of support often survive past the age of majority in cases where children have lifelong special needs. Secondly, there is trustee liability to consider. Caregivers are employees of the trust and must be treated as such, even if they are family members. When employing caregivers, including family caregivers, trustees must follow all state and federal wage and hour guidelines and must properly withhold the appropriate taxes from the caregiver’s paychecks. In many cases, trustees, especially non-professional trustees, are not equipped to do this job, so they must work through agencies that actually hire the family members and are paid a premium by the trust to administer their benefits. Also, when trustees are serving as employers, there is always a risk that family members will be injured on the job, resulting in workers’ compensation claims. While there are many reasons why family members might make the best paid caregivers, careful consideration to all of the factors surrounding the employment of family members should be taken into account. #elvilleeducation

Tags: Caregivers, Special Needs, Trust Funds, trusts
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At Elville and Associates, P.C., we couldn’t be more proud of Partner Olivia Holcombe-Volke for her tireless pro bono estate planning work with the Maryland Volunteer Lawyers Service. Olivia is a true advocate for those in need of assistance, and the link to the article below captures the essence of the need for more people like Olivia and the important work she does. #probono #advocate #elvilleeducation #estateplanning #mvls

Click here for Article

Tags: Estate Planning Work, Olivia R. Holcombe-Volke, Pro Bono
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Authored by: Stephen R. Elville, Esq. — Elville and Associates, P.C. — 443-393-7696, steve@elvilleassociates.com, @elvilleassoc

Many people 65 years of age and over are subconsciously aware of the vulnerability of their assets, including retirement plan assets (IRAs, 401(k)s, 403(b)s, and other Qualified Plans) to Medicaid (long-term care) spend down and dissipation. This awareness carries over into the estate planning process, ultimately leading to the question(s): do I engage in “regular” conventional estate planning without consideration of lifetime long-term care asset protection considerations; or do I engage in a long-term care asset protection strategy that incorporates my overall dispositive plan; or a combination of both? For the majority of people, if these questions are not addressed during the estate planning process, the planning may be one-dimensional and opportunities could be missed. Who can afford that? To steer clear of this danger, all planning should be goal driven. With client goals being identified up front, the planning outcome should be a foregone conclusion and the opportunity to “hit two or three birds with one stone” will not be lost.

To discuss If you would like to know more about the estate planning options for your family or you, or simply have your existing estate planning documents reviewed, please contact me at the following: steve@elvilleassociates.com; or mary@elvilleassociates.com; or via telephone at 443-393-7696.

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Tags: Elville, elville and associates, estate planning, family
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