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IMPORTANT: THIS ARTICLE HAS BEEN DRASTICALLY REVISED IN 2022. PLEASE SEE THE UP-TO-DATE VERSION HERE.

 

Understanding life estates may be essential if protecting the home (or other real property) is an important goal. Getting the concept down, however, can be a bit confusing. Confusion be gone! Read on!

Falstaff

“Right, then! Another two of these and I’ll be ready!”

Blame the English for our confusing real property law. I am convinced that the concepts involved in this article were invented in 1095 at Ye Whyte Horse on Thames Taverne four hours after closing time and some of the barristers had gotten a bit into their cups.

Lately, many have been asking about so-called “Lady Bird Deeds.” I’ll explain below . . . but you are going to have to read the whole article in order to understand.

First, take a look at other types of ownership . . . it might make understanding life estates easier.

Fee Simple

Most people think of real property ownership as fee simple. Someone with fee simple title completely owns the property. She can sell it, give it away, rent it, use it as security on a loan and do pretty much anything she wants with it (that isn’t otherwise illegal, of course). She is also responsible for paying the taxes on the property and any debts encumbering the property. The property is subject to the claims of her creditors. When the owner dies, the property passes through her estate (as directed by either a will or the state laws of intestacy).

Tenancy in Common

If two or more people own property the property is likely tenancy in common. Think of it something like a partnership among the owners. Each can use the property (unless they have a contract to the contrary). Each can sell his share, give it away, and use it as security for a loan. If one owner dies, his share passes as directed by his will or the laws of intestacy. Creditors can claim against his share. InGeorgia, a married couple is presumed to own property as tenants in common, although they can make other arrangements in a deed.

Joint Tenancy With Rights of Survivorship

This type of ownership might seem similar to tenancy in common, but it isn’t. Initially it looks like a tenancy in common, but if one owner

Lady Bird

“Hey. Bob will discuss Lady Bird deeds directly.”

dies, the other owners take his share (divided among themselves). Sort of a “Last Man Standing” game because the property may end up completely owned (in fee simple) by the last surviving owner. Incidentally, in North Carolina, a married couple is presumed to own property as “tenants by the entireties” . . . which for purposes of this discussion acts the same as a joint tenancy with rights of survivorship (although they can opt out).

Now For Life Estates . . .

If one person owns the right to occupy and use property for her remaining life (she is called the “life tenant”) and the title specifies that the property passes automatically at the instant of the life tenant’s death (these folks are called the remainder interests . . . in the less gentle times of about 15 years ago they were called the remaindermen) the result is a life estate. Many folks call it “life time rights.”

While the life tenant has a right to live on the property or perhaps to collect rent on the property, she also has the responsibility of keeping it up and paying taxes on it.

Although theoretically a life tenant can encumber her life estate or sell her life estate, all she can do is dispose of or restrict whatever it is she owns . . . a life estate. No banker in his right mind will lend against a life estate because when the borrow dies . . . poof! . . . so does the banker’s security. The property passes free to the remainder interests. Same thing happens with respect to the life tenant’s creditors. Poof! Gone. Now don’t get excited . . . if the life tenant owned the property in fee simple and encumbered it before setting up the life estate the creditor isn’t going anywhere until someone pays up!

How To Set Up A Life Estate

Two ways. A fee simple property owner can set up a life estate for himself by conveying a remainder interest in the property to the intended remainder interests. The deed may say something like “I, Falstaff, the Grantor give Blackacre to Prince Hal, but retain a life estate in Blackacre.”

A way to set up a life estate for another person is for a fee simple property owner to convey property to another person as the life tenant and to yet another person as the remainder interest owner.  The deed may look like this: “I, Hotspur, convey Blackacre to Falstaff for life, with a remainder interest to Prince Hal.”

Will Medicaid Count a Life Estate for Eligibility Purposes?

In Georgia a life estate interest is a Medicaid-countable asset unless the property itself is not countable for some other reason (probably because it is the primary residence). In North Carolina a life estate is not countable . . . it simply renders the property regardless of value or size or type as a noncountable asset for Medicaid purposes.

Can the State Collect On Life Estate Property?

No. That is the beauty of a life estate. North Carolina only collects against probate property (and a life estate is not probate property . . . remember, it passes automatically at the life tenant’s death). The Georgia Department of Community Health says they can do it, but they never have and, unless the General Assembly drastically changes the law, they never will (Hint: read above about how a creditor goes “Poof!”).

Are There Other Medicaid Problems?

“They’ll NEVER figure these out!”

Yep. Remember that if you transfer something valuable it will not count as an asset for Medicaid (you don’t own it anymore, after all!). However, the transfer will raise issues of whether a transfer penalty should apply. If Falstaff transfers $100,000 cash it will not count because he does not own it; however . . . in Georgia it will count as a transfer penalty of about 20 months and in North Carolina about 16 months if Falstaff applies for Medicaid within five years of the transfer.

The problem with setting up a life estate is that most of the time something valuable is being conveyed. For example, if Falstaff is 70 years old, Medicaid uses an actuarial chart that shows Falstaff’s life estate to be worth about 70% of the value of the property, and Prince Hal’s remainder interest to be worth 30% of the property value.

If Blackacre is worth $100,000 and Falstaff sets up the life estate by transferring the remainder interest to Prince Hal, then Falstaff has transferred property worth about $30,000 (assuming Blackacre is worth $100,000). If Falstaff applies for Medicaid within five years he has a $30,000 transfer issue to deal with.

On the other hand, Falstaff could have sold Prince Hal the remainder interest and there would be no problem.

One planning strategy that is occasionally used is for Falstaff to buy a life estate. If he pays $70,000 for the life estate in Blackacre, he will pay fair market value so there will be no transfer penalty. Further, in North Carolina the life estate won’t be countable as an asset (it will be in Georgia unless it is his residence).

A Final Life Estate Problem

The last paragraph sounded pretty neat, hunh? Not so fast. The rules slow that up a bit by saying that if the life estate purchased was in property that was “the home of another person” then Falstaff would actually have to live in the property for at least 12 continuous months. If he doesn’t live there 12 months or more, there will be a transfer penalty on the purchase even though he may have paid fair market value. If the property was not the home of another person, Falstaff should be OK.

Flying to the Rescue (From Texas?): Lady Bird Deeds

 

I have no idea why they’re called Lady Bird Deeds or if Lady Bird Johnson used them

“Lyndon tried one of those fancy deeds on the house behind me, but there was some kind of problem.”

(although her husband was one of Medicaid’s Founding Fathers).

A Lady Bird deed looks like a standard life estate deed at first glance, except that the Grantor retains the right to change his mind or give the remainder interest to someone else. “I, Falstaff, give Backacre to Prince Hal, but I retain a life estate in Blackacre and further retain the right to cancel this deed or to give the remainder interest to any other person so named.”

Would you pay Falstaff money for the remainder interest? Of course you wouldn’t. The remainder interest is worthless because Falstaff could always change his mind. On the other hand, if Falstaff dies without changing his mind, Prince Hal will automatically take Blackacre.

In North Carolina, because the remainder interest has no value Falstaff has not made a valuable transfer and there is no penalty. Further, on his death the property should pass free of estate recovery. Lady Bird deeds have worked fine for years. They do make me a bit nervous . . . they seem just . . . too easy. I’ll use them, but only if nothing else will work.

Georgia has an open season on Lady Birds. They don’t work. Period.

A recent Georgia Lady Bird sighting.

 

PLEASE NOTE: I HAVE CLOSED COMMENTS TO THIS ARTICLE. SORRY, BUT AFTER RECEIVING OVER 100 (!) COMMENTS I SIMPLY COULDN’T CONTINUE TO RESPOND AND STILL FIND A BIT OF TIME TO PRACTICE LAW. THANKS FOR YOUR INTEREST, THOUGH.

Filed Under: General, Medicaid, Nursing Homes Tagged With: , , , ,

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Benefits Reform Ahead

You have that uneasy feeling that you ought to be doing something . . . just not sure what. Perhaps Mom or Dad has been exhibiting some troubling health symptoms. As the oldest/only/closest child you know that it will be up to you to come up with a solution.

You’ve also been reading the news.

Once the 2012 elections are over and a new Congress is seated, Medicaid rules may likely tighten. It really will not matter which party comes out on top: It will become ever more difficult to qualify for this program as Congress authorizes and directs the states to revise rules.

The Forecast

Social Security, Medicare, and Medicaid are in trouble. Across the political spectrum, from secretaries Geithner and Sebelius to Mitt Romney and Paul Ryan, the alarm is being raised. The only thing the politicos disagree on is what to do. On April 24 the trustees of the Medicare program released their annual report with 3 different sets of numbers (“bleak, bleaker, and bleakest” according to Medscape Medical News).

So desperate is the government getting for money that cuts in Medicare reimbursements to nursing homes, aggravated by Medicaid cuts, will likely cause as much as 35% of nursing homes to reduce staffing – and North Carolina is the third hardest hit state (according to a study by the Alliance for Quality Nursing Home Care).

The financial crisis has set the stage for the problems, but all social programs directed to older population will feel intense pressure from the Boomers “coming of age” and having the nerve to live longer.

Some states are squeezing now. An excellent Wall Street Journal describes this in some detail.

Although the numbers discussed show the programs becoming insolvent at current levels within 10 to 15 years, do not be lulled into complacency:  Action will need to be taken very soon to begin to turn the tide.

While I have real misgivings about the way long term Medicaid is currently designed and believe that there are rational approaches to saving huge amounts, the current program and rules are all I have to use for the benefit of my clients.

So . . . What To Do?

Plan early. When the rules change, they almost always change prospectively, not retroactively. In other words, harsher rules will likely apply to planning strategies implemented after the new rules become effective.

Failure to adequately plan early runs not only the risk of being hit with higher rules hurdles, but leaving a family with fewer options if a parent’s health suddenly declines. There is a medical analogy here: The longer a bothersome problem is left untreated, the more intensive will be the final remedy (if one is even available).

So where does planning start?

Get educated!

Grumpy Guy

Trying To Figure It Out

First, become familiar with Medicaid. There are all sorts of resources online. I have written a “Plain English” guide to North Carolina Nursing Home Medicaid that is available online (fill out the online request form and I’ll even send you a paper copy – which also contains a valuable planning offer).

Learn about trusts. I have a number of informative articles posted on the Mason Law, PC website. There are also hundreds of articles on the web.

If you’re looking for something more comprehensive with planning guides and forms, tryElderLawUniversity. It is not free, but it is not too expensive either. Fair disclosure:ElderLawUniversityis my brainchild.

In May the Friends of the Asheboro Library and I will be hosting a series of three seminars that might get you started on planning. Click HERE for more details on these three seminars.

Get qualified help. Many of the news outlet articles I mentioned above urge people to get the help of a qualified elder law attorney. I know of at least one! On the other hand, there are other sources to find qualified help.

A good elder law attorney need not be certified, but a certified elder law attorney will be good. Check the North Carolina Board of Legal Specialization for board certified elder law attorneys.

The National Academy of Elder Law Attorneys (NAELA) is an organization representing almost all elder law attorneys in the US. The NAELA website has a geographically searchable directory. In fact, if an attorney is not a member of NAELA, he or she likely is not serious about practicing in the elder law specialty.

To recap:

  • Don’t dither!
  • Get educated!
  • Get help!

Filed Under: General, Medicaid, Medicare, Social Security Tagged With: , , , ,

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Dog Language: WHAT?Updated April 14, 2017

Recent Question: Bob, is it OK for the trustee of a special needs trust to purchase a $2,000 pure bred spaniel for the trust beneficiary, Edwina?

Recent Answer: Only if Edwina is not planning on eating the dog. I’ll explain. First, you’ll need to understand the SSI income rules and what In Kind Support and Maintenance (ISM) is. Distributions from a special needs trust might be income! The trick is in understanding how income is counted and what it does.

What is SSI?

Supplemental Security Income, or SSI, supplements the income of disabled persons or those aged 65 and over who meet certain low asset tests and have countable income from all sources less than $735 monthly (this article uses 2017 factors and rates). SSI will insure that a person’s countable income from all sources, when combined with an SSI benefit, will equal the Federal Benefit Rate or “FBR” (which for a single person is $735). See the complete FBR chart elsewhere on this website. For example, if a single person’s countable income is $500, then SSI will pay $235.

Usually the amount of SSI is not as important as the fact that someone is eligible to receive any SSI. In most states (including North Carolina and Georgia) receiving even $1 SSI will entitle the person to Medicaid (which for a disabled individual can be a life saver).

How Income Counts in SSI

An SSI eligible individual may not have countable income in excess of the FBR. Countable income will reduce the amount, dollar-for-dollar, that SSI pays. Income includes all amounts received from wages, other public benefits, annuities, gifts (in the month of receipt) and other noncash items such as food and shelter (or payments made for those expenses).

When calculating countable income, the first $20 of income from all sources is disregarded. Thereafter, the first $65 of earned income is disregarded, and after that one-half of earned income in excess of $65.

SSI Earned Income: Can Edwina Work A Little?

Maybe a little. For example, if Edwina, a disabled individual, occasionally answers phones at a local charity and earns $1,200, she will be eligible for $92.50 monthly SSI payments. Let’s do the math: Edwina earns (meaning she works for it) $1,200. Subtract $20 from $1,200 to get $1,180. Subtract the first $65 of earned income from $1,180 to arrive at $1,115. One-half of $1,115 will be the income excluded ($557.50). So, in other words, Edwina’s countable income is $642.50 ($1,200 minus $557.50). Accordingly, Edwina’s SSI benefit is $735 (the maximum SSI benefit) less $642.50 (countable income). She will receive a monthly SSI check equal to $92.50.

SSI Unearned Income: Can Edwina Receive Cash?

Maybe a little . . . a VERY little. Instead of working, say Edwina receives a $1,200 cash distribution from a special needs trust (or even from a well-meaning friend or relative). SSI considers this unearned income (after all, she didn’t earn it). That means there are no earned income exclusions. $1,200 cash distribution, less the general $20 disregard yields $1,180. That is Edwina’s countable income. $735 (maximum SSI benefit) less $1,180 yields . . . TOAST. Edwina is toast! No SSI benefit.

What happens if instead of cash, the trust pays for certain items for Edwina?  Say, for example, the trust pays for clothing, food, computer equipment, prescription drugs or therapy, entertainment, travel . . . or even a pet.

In-kind Support and Maintenance (ISM): Can Edwina Receive “Other Stuff”?

Now to the matter at hand: Can the trustee of the special needs trust buy the fancy dog for Edwina? It depends. Is Edwina planning on Fricasse of Fido (er . . . a feast) or is she planning for the emotional comfort that can only come from the unqualified love of a furry companion? The answer to those questions will determine whether Fido is In-Kind Support and Maintenance or ISM.

Sometimes trusts and other people give a disabled beneficiary certain non-cash items, or pay for non-cash items on behalf of the individual. If such an item is classified as ISM it will reduce SSI benefits. The amount of the reduction may not matter . . . or it could result in the beneficiary losing all SSI (and Medicaid). Of course, if the item is not ISM, it doesn’t matter how much it is worth as long as it is a non-countable asset for SSI purposes.

Items related to food and shelter are ISM. For example, rent or mortgage payments (shelter), utility expenses (shelter), groceries (food), restaurant food certificates (food), property taxes (shelter), or a Christmas gift from Omaha steaks (food) are all ISM. (Interesting side note: Cable, phone, and internet are not ISM).

If Edwina is planning on eating Fido, Fido’s value ($2,000) will be ISM. On the other hand, if Edwina does not intend to eat Fido, he is not ISM.

What Does ISM Do To SSI Benefits?

It depends. One of two rules could apply, depending upon the beneficiary’s living arrangement. If the beneficiary is living in the home of another for at least one continuous month and receiving both food and shelter without contributing her pro rata share of those costs, her SSI benefit is lowered by one-third of the FBR (or $245 in 2017). This is called the “value of the one-third reduction” or “VTR” rule (I have no idea where they get “VTR”).

The problem with the VTR rule is it is “all or nothing.” If the rule applies, the beneficiary’s SSI is reduced $245 regardless of the actual value of the food and shelter received. If someone is receiving $735 SSI, the reduction to $490 might be a good deal (especially if the food and shelter is high quality).

Two conditions must be met for the VTR rule even to apply: (1) living in another’s home rent free, and (2) receiving free food. If those conditions aren’t met, the rule doesn’t apply.

If the VTR rule doesn’t apply, then the “presumed maximum value” or “PMV” rule applies. Under this rule, if the beneficiary receives any ISM during the month, the value of the ISM is “presumed” to be $245. “Presumed” means that if the beneficiary can prove that the ISM wasn’t worth $245, the SSI benefit will be reduced only by the actual value of the ISM. On the other hand, if the ISM is worth more, the value is still “presumed” to be $245 and the SSI will be reduced accordingly.

As For Fido . . .

So . . . if Fido (worth $2,000) is meant for the dinner table (gross), he is ISM. If Edwina’s SSI is more than $245 and she doesn’t have other offsetting earned or unearned income, then she’ll be OK (other than, I presume, a bit of indigestion). On the other hand, if Edwina’s SSI is less than $245 and Fido is ISM (food), she is . . . .

 

FOR FURTHER READING ON TYPES OF SPECIAL NEEDS TRUSTS, SEE A GOOD ARTICLE ON THIS WEBSITE.

Filed Under: General, Social Security, Special Needs Planning Tagged With: , , , , , , ,

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Originally published in Course & Scope (January 2012) Newsletter of the Workers’ Compensation Section of the North Carolina Bar Association

Your new client Ralph Kramden, 66, comes to you seeking help. He has a $100,000 Medicare Set-aside Arrangement established after a minor 2005 bus accident at work. The MSA includes approximately $60,000 for a spinal cord stimulator, and Ralph reports that his doctor of the past couple of years says that Ralph is not a candidate for spinal cord stimulation (SCS) on account of the pacemaker that Ralph has had since 2002.

Ralph would really like to access some of the MSA funds. Over the years very little of it has been disbursed, and he has had very little pain and never relied on anything stronger than over-the-counter pain relief.

Upon further research you discover that SCS is indeed contraindicated for patients with pacemakers. In fact, a careful review of the 2007 submissions to CMS shows a significant over-allocation to the MSA. Aside from the issue involving the SCS (or lack thereof) it appears that brand name analgesics (notably Duragesic patches) were used.

Duragesic is a fairly powerful opioid patch that Kramden will likely never use. Further Duragesic use can be addictive, and probably should not be used indefinitely. In keeping with what the initial MSA submitters thought to be acceptable practice, the Duragesic was priced in the MSA over Kramden’s life.  Fortunately, the MSA did reference “Duragesic, or acceptable generic.” You have learned that even if Kramden were using anything stronger than OTC analgesics for pain, a Duragesic generic (fentanyl) is now available at less than two-thirds the price of the Duragesic listed in the MSA prescription drug component.

The entire file leaves you wondering whether the CMS staff are still celebrating over the allocations made to Kramden’s MSA. Maybe hindsight is 20-20. Then you begin to wonder if Ralph has any recourse or right to modify the MSA.

What is galling is that while the entire MSA submission process is voluntary (albeit highly recommended if the case falls within MSA workload review thresholds) Kramden’s case would not even be reviewable had the current review thresholds been in place when CMS reviewed Kramden’s MSA back in 2007.[1] The solution then would have been: Fix it and move on.

The CMS Position: Yes, Yes With Limits, No

CMS takes the position that once an MSA has been reviewed and approved no funds should be released from the MSA for any purpose other than the purpose for which the MSA was established unless CMS approves. Upon discovery of such an unauthorized disbursement, future Medicare reimbursement could be denied until an amount equal to the entire settlement (net of reimbursed conditional payments) has been expended on injury-related expenses. Not pleasant, although a denied claimant would have access to the usual Medicare appeals process.

In an April 22, 2003, policy memo[2] CMS announced that if a treating physician concluded that a beneficiary’s medical condition “substantially improved” a written request together with appropriate supporting documentation could be submitted to the appropriate regional office.

Apparently the April 22, 2003, policy unleashed a workflow avalanche. In Q&A 10 of a July 11, 2005, policy memo CMS backtracked and limited review of revised WCMSA proposals to those submitted five or more years after the initial approval letter and justifying a 25% or more reduction in the then outstanding MSA funds. Ralph would have had a reasonably good chance of submitting a revised MSA proposal, less the SCS, and perhaps less the other analgesics (or at least priced at the generic level).

Unfortunately, effective August 25, 2008, CMS rescinded Q&A 10 of the July 11, 2005, policy memo. In effect, CMS is attempting to “freeze” allocations for future medicals at settlement date levels.

Well . . .Maybe

In spite of the air of finality in the August 25, 2008, memo, there may be a glimmer of hope for Kramden.  Q&A 12 of the July 11, 2005, memo remains in force.

Q&A 12, entitled “Additional Information Submission after WCMSA Case Is Closed” might help Ralph out. The policy reminds readers that “[t]here are no appeal rights stemming from a CMS determination of the appropriate amount of a WCMSA” but that there are “several other options available.”

A submitter who believes that there are “obvious mistakes, such as mathematical errors or failure to recognize” previously paid expenses being included in the allocation is invited to contact the Regional Office issuing the final determination for a correction.

A submitter who believes evidence has been misinterpreted or who disagrees “for some other reason” has a couple of options. If a submitter believes additional evidence not previously considered would warrant a change in the MSA amount, the case may be resubmitted “with the additional evidence” and a request for review to the Coordination of Benefits Contractor (COBC). The request will be treated as a new WCMSA submission.

In the case of Ralph Kramden, it may be worthwhile to consider a re-submission under the foregoing policy. The fact that in 2007 he had a pacemaker that would have medically contraindicated the use of a SCS at the time of the WCMSA submission certainly falls under the heading of “additional evidence not considered at the time of the initial submission.”  Had medical evidence been developed much later that pointed to the avoidance of SCS for pacemaker wearers, though not as strong a case, a submission might still be warranted.

With respect to the Duragesic component, two possible arguments could be advanced. First, Duragesic (or a generic equivalent) should not have been priced for Ralph’s life due to its addictive nature; the correct manner would have been limited to a specific duration (be sure to support this contention with medical records or a physician’s statement). Second (and as an alternative argument), now that a less expensive generic is available, any component remaining for the use of this generic should be repriced. With respect to the latter argument, there is no CMS guidance, but it is certainly worth the attempt.

Finally, CMS acknowledges that a claimant has recourse to the usual Medicare appeals route if payment is denied on the basis that the WCMSA has not been properly exhausted. The rights available to a denied Medicare claim are much more extensive, including eventual recourse to the federal courts. The amount involved, however, would have to be significant in order to justify the loss of Medicare during the appeals process, not to mention the direct costs associated with the appeal.

Summary

Unfortunately, there is no longer a procedure for reducing or eliminating an over-allocated MSA. On the other hand, CMS policy indicates a potential for reconsideration in cases of clear error or the development of new or additional evidence. The likelihood of a successful adjustment, however, is far from certain, and the practitioner and client will be required to consider whether the process is worth the time and effort.


[1] As of April 25, 2006, CMS reviewed MSA submissions involving total settlements in excess of $25,000. This was the policy in effect at the time Kramden’s 2007 was prepared. Effective May 11, 2011, CMS announced it would review only those MSA submissions that either (i) involved current Medicare beneficiaries with total settlements in excess of $25,000, or (ii) involved claimants with a “reasonable expectancy” of Medicare enrollment within 30 months and total settlements in excess of $250,000. Had the current policy been in place in 2007, Kramden’s MSA would not have fallen into the review threshold (at age 61 he did not have a reasonable expectation of Medicare enrollment within 30 months).

[2] CMS usually releases administrative practice, guidance and policy in the form of “Regional Administrator” letters from various national office directors.

Filed Under: Medicare Secondary Payer

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Guest Columnist . . .

Patricia A. Shevlin, MD

Patricia Shevlin, MD

At the beginning of every year, most of us try to get organized, make a few resolutions about what we could do better and start new prescription drug plans. One area that is frequently neglected is the medication list.  In an effort to cut down on medication errors, I offer my recommendations to patients about their medications.

  1. Keep an updated list of your medications with you. Include the prescription and the non-prescription medications. Before your appointments, review the list by comparing it to the bottles that you have at home. If there is a discrepancy, you should adjust your list. If there is an error or suspected error you will be able to get it corrected by calling the office of the physician who wrote the prescription, or ask at the office visit.  At the appointment or when you get home, add any new prescriptions to your list.
  2. Include on the medication list the reason for the medicine, such as diabetes or blood pressure. I think this makes it easier to organize your medications and to realize what to expect if you miss a pill or run out of a medication.
  3. To prevent running out of a medication, I strongly recommend a weekly pill container. When you fill this every Saturday or Sunday, you will know in advance when you need to call for refills. No matter how efficient an office or pharmacy is, delays can occur due to electronic transmission errors, fax machine downtime etc.  The sooner you can request a refill, (within the requirements of your insurance company), the better.
  4. The weekly medication container is NOT an indication of memory impairment.  Most of us are busy and when we have medications we take at the same time day after day, it is easy to think you have taken a medication when you have not. I remind patients all the time that birth control pills have come in packages with the day of the week written on them for this exact reason. It’s not a problem just for the seniors.
  5. Keep the prescription and non prescription medications that you take on an as needed basis separate from the daily medications. The names should be on a separate list or the back of the daily list. The bottles should be in a separate bag. This cuts down on confusion, especially when filling the weekly pill container. It also helps a family member who may be helping you when you are sick and need one of those medications.

You may be asking yourself “Why do I need to do all of this? My doctor has a record of my medications.” First of all, you are the patient and you are responsible for what goes in your body. In addition to your health, it’s also your money that’s at stake here.  Most of us have multiple doctors and all of our medicines are not written in one place. Bringing your list should encourage your physicians to put the entire list into their records. Finally, many patients use multiple drugstores. There are mail order options for daily medications, local drugstores for acute medications and $4 options for some medications.  The possibilities for confusion are endless.  Everybody needs a reliable system.

Dr. Shevlin is a partner in Asheboro Family Physicians of North Carolina, PA

 

 

 

Filed Under: Guest Columns