According to the Centers for Disease Control and Prevention, the National Institutes of Health and the American Heart Association, coronary heart disease is the number one killer of women and men in the United States. A 2009 survey by the American Heart Association indicates that a woman in the United States suffers a heart attack every minute.

In fact, women are twice as likely as men to experience nausea, vomiting, or indigestion during their heart attack. Because many women are unaware of the symptoms of a heart attack, they do not react properly and seek immediate help. Women are also more likely than men to have other conditions such as diabetes, high blood pressure and congestive heart failure and, therefore, the need for timely medical response becomes even more crucial.

The U.S. Department of Health and Human Services on Women’s Health has created a national public education campaign, “Make the Call. Don’t Miss a Beat” to educate women and their families about heart attack symptoms.

Symptoms include:

• Unusually heavy pressure on the chest
• Sharp upper body pain in the neck, back, and jaw
• Severe shortness of breath
• Cold sweats
• Unusual or unexplained fatigue (tiredness)
• Unfamiliar dizziness or light-headedness
• Unexplained nausea (feeling sick to the stomach) or vomiting

For more information about womens health, visit www.womenshealth.gov/heartattack.

Littman Krooks LLP offers legal services in several areas of law, including elder law, estate planning, veterans’ benefits, special needs planning, special education advocacy, and corporate and securities. The firm’s offices are located at 399 Knollwood Road, White Plains, New York; 655 Third Avenue, New York, New York; and 300 Westage Business Center Drive, Fishkill, New York. For more information about Littman Krooks LLP, visit www.littmankrooks.com.

Are you having difficulty getting the pension or 401(k) plan funds you worked years to earn? Five pension counseling projects, funded through the U. S. Administration on Aging and serving plan participants and their beneficiaries in 22 states, can help.

The retirement system’s complexity and unresponsiveness can overwhelm the most tenacious retirees when they try to obtain the pensions they have earned. Companies change their names, merge or go bankrupt. They terminate, freeze and under-fund pensions. In some instances companies deny that employees worked for them, or they miscalculate pension benefits. Death or divorce can add difficulty in securing pension benefits. Solving these problems is the work of the pension counseling projects.

Since their inception in 1992, the pension counseling projects have obtained pension benefits valued at more than $75 million for workers and retirees who have earned them.

In most cases pension counseling projects confront a seemingly never-ending succession of brick walls to obtain what a retiree clearly appears to be entitled to. For example, a 62-year-old man from Connecticut worked for a large communications company for nearly 21 years, more than enough time to meet the legal requirements for vesting. He called the Pension Action Center at the University of Massachusetts Boston, utterly frustrated that after trying for more than a year, he was unable to get his pension.

First, company officials told him that they had no record of his employment. After he provided proof of his employment, they told him he must have worked in a position that was not covered by the pension plan. When he asked what that position was and why it was not covered, they said that they didn’t know because they had no records. The same baffling statements were initially repeated to the Pension Action Center.

Obtaining the legal documents that governed the plan proved that there was no basis for the statements. The documents specifically provided that “all employees” were pension plan participants and would accrue benefits under the plan. The Action Center filed a formal claim on the man’s behalf, pointing out the plan provisions and documenting his lengthy employment. After months of follow-up phone calls and letters, a favorable decision was received. The man received a monthly pension of more than $600 for his lifetime with an estimated value of more than $144,000.

Helping this man to get the benefits he had earned was gratifying, but the effort it took would anger and frustrate anyone who did not have the knowledge and persistence to finally win. That is what the pension counseling projects provide.

The pension counseling projects offer a unique and confidential service that is free of charge for individuals who need help. If either you, your company or pension plan is within a project’s service area, you may contact your project for help. Here are the pension counseling projects and the states they cover:

Mid-Atlantic Pension Rights Project
New York Pension Rights Office — (800) 355-7714

Serving New York and New Jersey
New England Pension Rights Project
Pension Action Center — (888) 425-6067

Serving Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont

Upper Mid-West Pension Rights Project
Minnesota Pension Rights Office — (866) 783-5021

Serving Minnesota, Wisconsin, North Dakota and South Dakota

Iowa Pension Rights Office — (800) 992-8161

Serving Iowa

Western States Pension Rights Project
California Pension Rights Project — (916) 551-2140

Serving California, Nevada, Arizona and Hawaii

Mid-America Pension Rights Project
Michigan Pension Rights Office — (866) 735-7737

Serving Michigan, Tennessee and parts of Pennsylvania

Ohio Pension Rights Office — (866) 735-7737

Serving Ohio, Kentucky and parts of Pennsylvania

I recently spoke to Helene Bergman, the founder and director of Elder Care Alternatives, about the challenges faced by seniors and their caregivers.  Helene is a certified geriatric care manager and is on the board of directors of the National Association of Professional Geriatric Care Managers.

Q: You have said that with “consistent and superior care and support” any senior can remain at home throughout life.  Please explain.

A: I have managed the care of seniors with significant health issues who successfully remained at home for over a decade. However, to do so requires quality direct caregiving and other factors like adequate financial and social supports.

To design an appropriate care plan tailored to the senior’s unique care needs, we initially provide an assessment to better understand the senior’s medical and/or cognitive disabilities and to identify the supportive systems available to them. If there are family and/or friends, their roles are maximized to improve the senior’s quality of life. We link those with substantial finances to community resources, and we help others with limited finances secure Medicaid for home care. The seniors who fall in the middle class, with just adequate finances to cover their expenses, face greater challenges to remaining at home. Fortunately, in recent years, I’ve seen more situations in which long-term care insurance has eased the way for them.

There are other considerations, especially if the senior applies for Medicaid or even uses a private agency for home care. Does the senior’s residence lend itself to home-based care?  Is there a separate sleeping area for the hired caregiver? Can the senior ambulate adequately or is a lifting device (Hoyer lift) necessary.  These factors can negate eligibility and precipitate premature placement in a facility. However, if the senior can afford to pay privately for home care, even a studio apartment in New York City can be made adaptable, and the senior’s wish to remain at home can always be accommodated.

Q: Please talk about quality of life when an individual is faced with acute health problems.

A: Quality of life is a significant ethical issue for the senior and family caregivers. The question is whether to adhere to  a “wellness” regimen vs. experiencing “pleasure.” I know of an instance where a senior was recently diagnosed with diabetes, yet gourmet food and wine had long been central to his lifestyle.  Enforcing a strict dietary regimen would make him miserable, and his loved ones are struggling to balance medical advice with his way of life.

These decisions are very subjective and there is no right or wrong.  If the senior is cognitively intact, the decision should be his or hers. If the family must make executive decisions for a senior with dementia, they need to ensure that they don’t unconsciously project their own preferences when trying to envision what their loved one would want.

Q: What other tips can you offer family caregivers?

A: Be proactive—don’t wait for a crisis.  Have open discussions with your family members about how you will handle the possibility that parents will require significant care sometime in the future.

Become knowledgeable concerning your loved one’s medical and financial affairs.  Know the names of doctors and have your name placed on the third party notification list for various insurance policies.  Be in contact with your family member’s financial planner, broker and accountant so that they know who you are and will be willing to speak with you in the future, if necessary.

Finally, use this experience to begin planning for your own senior years.

Thanks, Helene.  These are issues that most families will face at some point.  I hope that your insights will be reassuring to individuals who are planning for, or currently experiencing, the changes that accompany the aging of a loved one.

Following are observations by Amy C. O’Hara, Esq., a Littman Krooks attorney who focuses on estate planning, estate administration, trust administration, guardianships, special needs planning, and elder law.

Uncertainty concerning the federal estate tax continues. Allowed to lapse entirely at the end of 2009, it’s scheduled to jump to 55 percent on January 1, 2011, on estates valued at $1 million or more.  This means that the number of estates subject to federal tax will increase by a factor of eight from 2009, when the exemption was $3.5 million.

No one envisioned this scenario.  In 2001, after dropping the estate tax from 55 percent to 45 percent, a contentious Congress gave itself an eight-year window to work through its differences. It was thought that the “threat” of a 2010 expiration would spur compromise.  But not so. Since then, the exemption has steadily grown from $675,000 to $3.5 million per individual.

All year, observers have expected that some middle ground, and possibly retroactive measures, would be legislated. All year, individuals and their estate planners have struggled with an ambiguous tax environment. Election years, though, are unpopular times for tax-related action. Regardless of one’s vote, a public official is likely to anger some constituent, and Congress has recessed without taking decisive action.

The question is whether anything will change when Congress convenes following the November elections. Assuming that our representatives and senators take action, will the new rate be 35, 45, or 55 percent?  What will be the exemption amount?

Many observers think that no action at all will be taken this year because the congressional agenda is packed and there are so few working days left in 2010. In the meantime, the best that can be done is to factor flexibility into your estate plan while you wait.

We interviewed David Leven, executive director of Compassion  & Choices of New York, about the state’s recently passed Palliative Care Information Act.  That legislation requires physicians to offer terminally ill patients information on their prognosis and their full array of end-of-life care options, including hospice and other palliative care, in addition to life-extending interventions.  Compassion  & Choices of New York works to improve end-of-life care and to expand available options in order to ensure a humane and peaceful death with dignity.

Q: Why was it necessary to enact this law? It seems like common sense for doctors to share this information with their patients.

A: Even though patients are entitled to receive details concerning diagnosis, prognosis, treatment options, and accompanying benefits and risks, many doctors are not having these discussions with the terminally ill.  Many physicians haven’t been adequately trained to have these difficult conversations, and they’re uncomfortable having them.

Q: Why did the Medical Society of the State of New York (MSSNY) oppose this legislation?

A: Although many physicians supported the bill, it’s true that the MSSNY did not support it.  I believe that was an unfortunate knee jerk reaction to having the legislative process mandate their professional behavior. The fact is that they were already under both an ethical and legal obligation to provide this information.  This legislation simply clarifies previously existing law to include the specific right to receive this critically important information, including options available for those who are terminally ill.

Q: Studies have shown that candid end-of-life discussions benefit patients.  Please explain.

A: First of all, most patients—83 percent, according to one study—want to hear the truth about their health, even if they’re terminally ill. After these discussions, they are more likely to accept their diagnosis.  As a result, most of them–85 percent–opt for palliative treatment rather than life-extending regimens.  Sixty-three percent put in place “do not resuscitate” orders, twice as many as those who have them when end-of-life discussions do not occur. End-of-life discussion patients are less likely to choose to use mechanical ventilators or to spend time in the intensive care unit. They are also more likely to be enrolled in hospice and for a longer time.

It’s been found that patients with aggressive interventions had a worse quality of life during their last week than those focused on palliative care. There are also significant cost savings, but the real issue is that a person has the right to be informed of the options and to have their wishes concerning this most personal of decisions respected.

Thank you, David; I know that Compassion & Choices New York worked diligently to have this legislation passed.  We appreciate your sharing this information concerning the rights of terminally ill individuals and the benefits that accrue when they are empowered to direct their end-of-life care.