March 2019 newsletter

March 2019 newsletter Image

How Much Will the Hospital Charge?

Under new federal regulations hospitals are now required to post how much they charge for their services but consumers may continue to be confused about how much they can expect to pay. Here’s why. Delaware hospitals are complying with this mandate but looking at the price list (called charge master) may not satisfy your “How much?” question. Christiana Care offers an explanation of why the price lists are confusing saying charges are based upon the amount of time that specific services like the operating room are needed; supplies, medication and other services specific to your care; and that not all of the physicians who care for you are employees, so they will send a separate bill.  

A video provided by Nanticoke Health Services explains that charges in the charge master are the maximum the hospital can charge, but most patients pay less due to negotiated rates by an insurer or other discounts. The video also warns that charge masters are difficult to understand because they use medical codes. The website states that the charge master “… is not a helpful tool for patients to comparison shop between hospitals or to estimate what health care services are going to cost them out of their own pocket.”

A quick look at Delaware hospitals confirms that comparison shopping is difficult. We tried to find out the price to replace a hip. Christiana Care lists a “Major joint replacement or reattachment of lower extremity w/o MCC” as $31,256.84. (Keep in mind the caveat above about physician charges, room charges, etc.) St. Francis pricing shows a number of “Implant Joint” charges for items distinguished by letters such as AA or Z and the charges range from $630 to $38,719. St. Francis also lists “ortho hip rev first 30 min” as $14,094.00.

If you want to know more, here are links to pricing pages for Delaware’s hospitals.

Beebe Healthcare provides three spreadsheets with charges by medical code at

Bayhealth Hospital provides access to spreadsheets which list pricing for about 3,000 procedures by medical code at

Christiana Care is by far the easiest to understand. It hosts a website with prices in consumer-friendly language at

St. Francis Hospital allows you to download a spreadsheet of more than 5,000 procedures by medical code at

Naticoke Health Services has a link to a spreadsheet with more than 8,500 procedures by medical code at This link also provides access to the video which is very short and very helpful.


Our founding attorney, Bill Erhart who is a Certified Elder Law Attorney, will be speaking at Rockland Place on Wednesday, March 27 on the topic of “How to Be a Wise and Generous Grandparent.” This Lunch & Learn, from noon – 1 pm, is open to the public. If you would like to attend, call Rockland Place at 302-777-3099.


Technology Update

In Japan, several technology innovations are showing promise for nursing homes and assisted living facilities.

  1. An ultrasonic bladder sensor taped to the patient’s abdomen can alert staff that the resident may need to use the bathroom.
  2. An under-the-bed Doppler radar sensor can monitor heartbeat and breathing which may give staff time to prepare family before a person dies.
  3. A similar device can alert staff of a potential fall if a person is taking too long to return to bed from the toilet.
  4. Finally, a gamer is working on a system like Pokemon-Go where stroke patients wearing virtual-reality goggles catch balls or move objects that appear to pop up in front of them. These actions can be part of repetitive rehab exercise.

Here in the U.S., Electronic Caregiver is launching a virtual caregiver called Addison Care to help healthcare professionals monitor people in their homes. The service uses 15-inch monitors located throughout the house along with visual sensors, Bluetooth biometric devices, etc. An Avatar-like image which appears on the monitors can carry on two-way conversations. The service is programmed to the houseowner’s needs and can monitor medications, provide warnings if it sees problems and send alerts to caregivers if the person changes her routine – leaves the house at 3 am, for example.

Three Steps to Make Retirement Work

Studies show that not everyone is ready to retire – they don’t know what to do or are concerned about spending their precious savings.  If you are longing to quit the 9- to- 5 or already have, here are steps you can take to make this new phase in life work.  

1-Have a reason to get up and get going on day-one of retirement. If you think you want to paint or write a book, take classes now so when you retire, you’ll be ready to dig in. If you want to volunteer or mentor, begin researching those opportunities early so when you are retired, you can get started.  

2-Set a budget and give yourself an allowance, as if you still were getting a paycheck. You’ve saved and saved for retirement, now you have to change your mindset from save to spend – that can be scary.  If you know how much you need each month, you can simulate a paycheck by setting up regular transfers from your savings instruments to your checking account as if you still had a monthly paycheck. With a budget, you’ll know how much you can spend on groceries and haircuts as well as gifts for the grandkids, dinner out and travel. 

3-Talk with your spouse or partner about how you plan to spend your time. You don’t have to be together 24/7! You may also want to revisit household chores and change responsibilities for some.

As with almost everything in life, careful planning can help you enjoy the retirement you’ve earned.

Careful planning is the root of an Estate Plan. Let us help you plan for the future, protect your assets and pass your estate on to your loved ones.  

Tiny Homes Help Seniors Get Closer to Their Kids

If you don’t have an extra bedroom for Dad to move into, you may want to consider adding an extra house or Accessory Dwelling Unit in the backyard. These tiny homes, some as small as 350 square feet, are being constructed in backyards and over garages around the country. They typically have a kitchen, bedroom, bath and living area.

ADUs are allowed in Delaware but some communities forbid them and each county has its own rules. In New Castle County, a detached ADU must be on two acres of land; in Sussex County an ADU cannot have a kitchen.

Across the country, folks build them so an aging parent can live close by or to generate income by renting them on Airbnb, for example. Some have both goals in mind.

Read Next Avenue’s story on this trend by clicking here.

Surgery does not Always Help with Knee Pain

An article published by Kaiser Health News says that up to one-third of patients who undergo knee replacements continue to experience pain – sometimes chronic pain -- and one in five are dissatisfied with the results.

While the number of knee replacement surgeries has doubled from 1999 to 2008, with 3.5 million projected by 2030, about 33 percent of patients who undergo knee replacement may not even be appropriate candidates for the procedure, because their arthritis symptoms aren’t severe enough to merit aggressive intervention, according to a 2014 study in Arthritis & Rheumatology.

Why so many surgeries? Two reasons:

  • Americans are aging and getting heavier.
  • Doctors’ greater willingness to operate on younger people, such as those in their 50s and early 60s because new implants can last longer — perhaps 20 years — before wearing out and because of a higher rate of injuries in young people.

According to the article, surgery is not the only solution to arthritis and often is not the most effective treatment. Even patients with severe arthritis can benefit from over-the-counter pain relievers, dietary advice, physical therapy and education about their condition.

A study comparing surgical and non-surgical treatments in 100 older patients eligible for knee replacement found that all patients improved whether they had surgery or a combination of non-surgical therapies. Further, patients treated with non-surgical therapies were satisfied with their progress and decided not to have surgery when it was offered.

In addition, surgical patients developed four times as many complications including infections, blood clots or knee stiffness severe enough to require another medical procedure under anesthesia.

If you are considering knee replacement surgery, it may pay to ask your doctor about all of your treatment options.

Follow this link to read the entire article.

If you want to know more about how Estate Planning can work for you, join us for a free public seminar Thursday, April 4. The seminar will be in the community room of the Artisan’s Bank Building at 2961 Centerville Road, Wilmington, DE 19808 from 10 a.m. – 12 p.m. Our founding attorney, Bill Erhart who is a Certified Elder Law Attorney, will be the presenter. To register yourself and your spouse/partner/guests visit the events page on our calendar at


Is Aging a Disease?

The short answer to the question is ‘no’ according to researchers who are studying ways to address illness and chronic conditions brought on by old age like heart disease, cancer, stroke, neurological conditions, diabetes. They all increase radically with advancing years but by looking at the aging process, researchers think there are ways to address all of those illnesses at once.

There are four broad categories of the aging process: chronic inflammation, cell dysfunction, stem cells that fail to regenerate tissue and an accumulation in tissue of aging cells that accompanies disease. A number of studies are underway to tackle one or more of these categories.

  • A combination of two drugs seems to slow how older cells affect aging. Mice treated with the drugs had improved cardiac function and exercise capacity. Symptoms of osteoporosis were delayed and the mice were healthier in old age.
  • Other drugs are being developed to kill old cells.
  • Another drug would restore a co-enzyme that assists in cell respiration but dries up in old cells. Human clinical trials are underway with this drug.  

Scientists point out that the fact that more people have Alzheimer’s disease, dementia, joint and hip problems etc. is largely because people are living longer. The challenge is to extend the ‘health span’ instead of the ‘age span.’ Dozens of clinical trials are in the works already with just that aim.

(Based on an article New York Times article, How Long Can People Live? and republished by AFAR, The American Federation for Aging Research.)

Massachusetts Court Case: Medicaid Denials Must Include Reasons to Deny

A Massachusetts Superior Court judge overturned a Medicaid application denial because the Medicaid examiner did not state reasons for the denial. The court said, “... if transfers during the look-back period are declared non-qualifying there must be evidence in the record and an explanation from the examiner as to why the proffered explanations are not credible.” In this case, the examiner apparently denied the explanations because she did not believe them.

The case involved an 88-year-old, homebound woman (Coko) and a daughter who cared for Coko and lived in her home. Coko made two bank transfers totally approximately $45,000, transferred a life insurance policy worth about $23,5000 to her daughter and gave her granddaughter her car, valued at about $1,300.  The bank transfers were used to cover the Coko’s living expenses and the granddaughter used the car to take her to appointments.

MassHealth, the Medicaid program in Massachusetts, challenged the four transfers. The court found that the MassHealth hearing examiner “ … acted arbitrarily, capriciously and abused her discretion … because she thought the proffered evidence was insufficient, or not credible, she thought she could ignore it and deny the appeal.” The count found that, “All the facts necessary to meet Coko’s burden to establish entitlement to the child-caretaker exception were in the record, and they should have been accepted as meeting the claimant’s burden … She was spending her money in order to stay out of a nursing home with the hope of never needing admission … The examiner made no factual finding that Coko was being untruthful …”

Finally, the court stated, “MassHealth cannot presume that all look-back transfers were intended to speed up eligibility for MassHealth.”

Other court rulings:

  • In New Jersey, the courts have ruled that Medicaid is not required to assist applicants in getting bank statements which are required for eligibility.
  • In another court case, a woman transferred funds to her sons before applying for Medicaid and she was penalized for the transfer. She appealed, her sons paid her attorney fees and she paid them back. The Supreme court said that reimbursement of attorney fees was a return of assets and her penalty period should be reduced.

We can help you apply for Medicaid to pay nursing home fees and protect your savings. Give us a call to learn more.