Heart Attacks: A Plan
for Survival
Facts About a Woman's Heart Attack
From The Director
Planning With
the New Federal Tax Law
Mature
Driving and Mature Wisdom
Local News Available
to Visually Handicapped
Attorney's Fees
Must Be Approved
Heart Attacks: A Plan for Survival
Heart attacks don't always have to be fatal.
Medical science now offers treatments that can stop heart attacks in their
tracks, if given quickly enough after the attack begins. In many
cases, damage to the heart can be avoided altogether, and that means a
return to a normal life after a heart attack strikes.
Why don't more people take advantage of these lifesaving
treatments? The answer is, they wait too long before seeking medical
care. These new treatments work best if given within an hour of the
start of symptoms. They work less well as time goes on. It's
common for heart attack victims to wait hours, even days, without asking
for help. While they wait, heart damage is occurring. Whey
do people wait so long? There are several reasons:
The heart attack signs are not well known.
A person having a heart attack doesn't always experience chest pain; there
are other signs. Also, the kind of discomfort associated with heart
attacks can be mild. It might feel like pressure or squeezing, rather
than pain. The feeling of discomfort may come and go, as well.
People deny to themselves that they're having
a heart attack. No one wants to be having a heart attack.
They may hope they're only having heartburn, or simple muscle strain.
They may decide to "wait and see" if they feel worse before calling anyone,
slowing down the arrival of help.
Many people balk at calling 9-1-1.
There are a hundred reasons why people don't call 9-1-1. Some people
are embarrassed. Others worry if their insurance company will cover.
It is always better to be safe than sorry. Anyone who has warning
signs for more than 15 minutes should call 9-1-1 or have someone drive
them to a hospital right away.
People have not prepared to cope with this kind
of emergency. When a heart attack begins, the first response
for many people is fear. A state of fear is not the best stance from
which to make life-and-death decisions about that to do, whom to call,
and how to respond right away.
Just as you plan what to do in case of fire, you
can prepare for a medical emergency such as a heart attack -- just in case.
Planning now could save lives. Here are the steps to follow:
1. Learn the heart attack warning signs:
Chest discomfort. Most
heart attacks involve discomfort in the center of the chest. It can
feel like pressure, squeezing, or pain.
Shortness of breath. Some
people find it hard to breathe. This feeling often comes with chest
discomfort, but also can come before it.
Discomfort in other areas of the
body. Discomfort can also occur in the jaw, neck, arms, shoulders,
or back.
Other signs. People having
a heart attack may also feel sick to their stomach, break out in a "cold
sweat" or feel weak, light-headed or faint.
Other things to consider: If you're concerned about
your insurance coverage, call your insurance company now and check your
plan. Most insurance companies cover emergency care for a possible
heart attack. Think through ahead of time what you would do if you
have heart attack warning signs at home, at work, in the middle of the
night, on vacation, or any other place or situation that may require advance
planning. Know where the nearest emergency departments are.
Talk with family and friends about the heart attack warning signs.
Stress the importance of acting fast. Explain the benefits of calling
9-1-1 instead of getting to the hospital by car. Talk to your doctor
about your risk for a heart attack and about what you should do if you
experience any of the heart attack warning signs. Gather important
information to take along with you to the hospital, such as the name and
phone number of a contact person/persons who should be informed in case
of emergency, a list of medications you are now taking, a list of health
problems you now have, any allergies to medicines or foods, and your insurance
policy name and phone number. Keep this paper handy and remember
to take it with you if you have to go to the hospital.
These simple steps can be a real comfort if a heart
attack happens. You'll know exactly what to do.
"Heart Attack REACT" provided this information.
A Woman's Heart Attack
A woman's heart attack is not always the same as a man's.
Compared to men, women less often report strong
chest pain. A woman may first feel jaw, neck, arm, back or shoulder
pain. She may feel short of breath, break out in a cold sweat, feel
sick to her stomach or light-headed. All these warning signs can
signal a heart attack in progress.
Delay time in women is longer than in men. Delay costs lives.
New treatments, if given quickly, can stop a heart
attack in progress. These treatments work best if given within an
hour of the first warning signs. However, women having such warning
signs wait longer than men to call for help, perhaps because many people
wrongly think of heart attacks as a "man's problem."
Heart attack is the number one cause of death among women.
Women are more likely to die of heart attack than
of any other cause, three times more likely to die of heart attack than
breast cancer. At older ages, women are twice as likely as men to
die from heart attacks within a few weeks of the attack.
Women have heart attacks, on average, when they're older.
Some 85 percent of all heart attack deaths in women
occur over the age of 65.
Older age makes diagnosis more difficult, contributing to delay.
Since women tend to be older, they may have other
health problems - arthritis, osteoporosis or diabetes, for example.
Such complications make it harder to diagnose a heart attack and treat
it quickly. Women should talk with their doctors about these complications
before a heart attack occurs.
Or they "don't want to bother anybody."
They may not call 9-1-1 for fear of embarrassing
themselves or bothering their neighbors. Yet the very best thing
a woman can do for her family is to take care of herself.
A woman's heart attack should be treated just like a man's.
A woman should watch for the heart attack warning
signs. If she experiences warning signs for more than 15 minutes,
she should act fast, call 9-1-1 or get to a hospital right away.
This information was provided by "Heart Attack React."
The Medicine Squeeze
The 44 million Americans who have no health care
coverage view those 65 and older, with Medicare coverage, as well positioned
to receive the health care they need.
Increasingly, however, Medicare consumers are finding
their health care access limited, their choices narrowed, and their services
numbered.
The Balanced Budget Act of 1997 brought a major
change in how home health services are reimbursed, and the effects of this
change are already being felt in Berkshire County.
The Balanced Budget Act established an interim Payment
System (IPS) which rolls back Medicare home health payments to 1993-1994
levels, minus 2%. Agencies which were big spenders in ‘93 and ‘94
fare best under this scenario; frugal entities such as most of those in
Massachusetts are penalized. According to a 1/7/98 Wall Street Journal
article, the New England and Mountain states are losers under the Interim
Payment System, winners (big spenders in 1993/1994) are largely in the
South. The Massachusetts Congressional delegation, including Representative
John Olver, hopes to change the IPS system. Rep. Olver wants to hear
from individuals or their families who can tell their story about the loss
of Medicare paid home health services and the impact of this loss on their
lives.
In the 1980s, Medicare's soaring costs led to the
creation of Diagnostic Related Groups (DRGs) by which acute (hospital)
care was limited. Episodes of illness generate a specific payment
to cover all in-hospital costs of that particular DRG; hospitals lose money
if a person stays longer or has more tests and services than her/his DRG
provides. The DRGs of the 1980s, still in effect, led to Medicare
patients being discharged sooner and more in need of care than they were
before DRGs. To help those who needed much post hospital care, and
also to serve some with chronic health care needs, the rapid expansion
of in home health care began in the late 80s.
Medicare home health services continued to grow
in numbers of people served and number of visits per patient largely unabated
until recently. Now Medicare spending is to be reined in, much as
hospital costs were earlier.
Summer of 1997 saw reports of massive fraud and
waste in Medicare, at the same time Congress was seeking ways to lower
Medicare spending; the Interim Payment System was in place by 10/1/97.
Next (10/99) will come a prospective payment system; similar to DRGs, which
will pay a flat rate based on diagnosis.
All of this has home health agencies in an uproar,
with some patients who have literally had home health services for years
losing their service, and quite possibly being propelled into institutional
care.
Squeezing Medicare first in hospital payments, and
now in home health services will help bring spending down; what this fragmented
and willy nilly kind of health care policy making does to the health care
consumer is already being felt by Berkshire elders.
Medicare consumers who seek to receive all they
need can become their own advocates. If services are not allowed,
contact one of the numbers listed on page ?
under Phone Numbers for Beneficiaries . Appeal denials of service,
take stories of denials that get reversed to your Congressional delegation.
Medicare is in a mess. Consumers and their
families and advocates can work to make things better; paying attention
is a good first step; contacting Medicare and Congress is the necessary
next step.
Planning With the New Federal Tax Law By David C. Katz and Susan Wissler
Several months have passed since President Clinton
signed the Taxpayer Relief Act of 1997, again with Congressional and Executive
ballyhoo and claims (bordering on the fraudulent) that the latest law "simplified"
the tax code, when the law in many respects is even more complex, with
some provisions that will keep lawyers and accountants scratching their
heads.
Regarding estate and tax planning, the new law has
kept some valuable features and has improved some others.
Estate Tax - For example, the new law increases the state tax
exemption equivalent (i.e., that amount of an individual's estate that
is exempt from estate tax) from $600,000 to $1,000,000 over a 10 year period.
However, the increases are not indexed for inflation, so that depending
on the inflation rate over the next 10 years, the increases in real dollars
may be relatively minimal. Moreover, with the phase-in most increases
do not occur until the 8th through the 10th year. Thus, while Congress
takes all of the credit for the increase now, there is no guarantee that
the law will not be amended before the most significant increases have
even taken effect.
If you believe that your assets will grow at a rate
relatively equal to the growth in the exemption equivalent, then your planning
based on the old $600,000 equivalent will probably be fine. But if
you have set up a credit shelter trust with a formula calling for the maximum
estate tax shelter, the amounts disposed of by your trust will be the higher
amounts specified under the new statute. This may not be consistent
with your overall estate planning strategy.
Annual Gift Tax Exclusion: The law has retained the substantial
benefit of the annual gift tax exclusion of $10,000, which can be doubled
with the consent of the donor's spouse. In addition, the new law
"indexes" the $10,000 gifts to inflation, but only if inflation increases
by increments of 10%.
The important thing to remember is that over a period
of years this exemption may be used to move substantial amounts of one's
taxable estate, including appreciating assets, to any other persons, relatives
or not. For example, a couple making joint gifts to three children
and five grandchildren could together give $20,000 each to eight people
each year, for a total annual asset transfer of $160,000. If the
couple gave to spouses as well, the amount could be increased by $20,000
per spouse per year. If you do not have children and grandchildren,
or if they have substantial assets already, do not overlook other relatives
such as nieces and nephews, or any other person you wish to benefit.
This exemption can be used every year to make gifts to unlimited numbers
of people. This is a simple and effective but often overlooked planning
technique.
Many ask if you should file gift tax returns even
if you are gifting amounts below the $10,000 annual exclusion. It
is always important to keep accurate records, and if you are gifting non-monetary
assets (such as interests in land) where a fair market value must be ascertained,
we strongly recommend that you file a gift tax return. As a result
of the new law, the IRS has only three years from the date of receipt of
the return to review and challenge the value of the gift.
IRAs - The new law creates the so called "Roth" IRA. This
is touted by many as superior to the old IRA, also retained by the law,
for the reason that all appreciation and buildup of interest and dividends
will not be taxed when ultimately distributed, provided that the Roth IRA
has been open for at least five years.
This is an advantage, but great care must be taken
in converting an existing IRA to a Roth IRA. Generally, the untaxed
growth will be taxed in the year of the conversion, but if the conversion
is done before January 1, 1999, the tax may be paid over a four-year period.
Most people interested in the Roth IRA will be better served by starting
them from scratch and leave the converting to those special situations
where it is warranted.
Capital Gains - We have heard much fussing about this in Congress
for many years. Congress has reduced the maximum capital gains tax
from 28% to 20% for most people selling appreciated property. The
reduction in the capital gains tax is even greater for individuals in the
lowest tax bracket. Be careful, however, since there are some tricky
holding requirements.
These are just a few of the items of interest in
the new tax law, but keep in mind that taxes should never be the sole driving
force behind your plan for the disposition of your assets to those you
wish to benefit at your death. In addition, the rules are sufficiently
complex that you should always consult with your advisors about your specific
family circumstances.
In the coming months, we will address various methods
of estate planning. In addition to wills and trusts, we will discuss
joint property, gifts to minors, life insurance, various types of IRAs
and other ways to benefit your family members, as well as some planned
giving techniques to benefit charities and yourselves at the same time.
David C. Katz and Susan Wissler are with Katz, Murphy and Greenwald, A Professional Corporation.
On
Growing Older: Mature Driving and Mature Wisdom
By Dr. Robert V. Hamilton
Senior citizens, according to the common stereotype,
are incompetent drivers.
Statistics show that drivers age 55 and older make
up 25 percent of the driving population, yet are involved in only 18 percent
of accidents. Mature drivers have fewer and less severe accidents than
younger drivers.
Some advocates demand that "high risk" drivers (16-18
and over 55 years of age) need stricter requirements to drive. A number
of states have adopted these practices.
Psychological and physical effects of growing older
As we grow older, we face the question of our ability
to drive.
Aging can and does affect driving skills.
Age-related factors of vision, perception, reaction time, hearing, physical
health, and wisdom contribute to driving skills.
Visual acuity diminishes with age. Most of
us think about glasses at about age 40. Traffic signs and road hazards
get dimmer and fuzzier. We become more sensitive to bright sunlight and
oncoming headlights at night.
As depth perception diminishes, our ability to back
the car or to parallel park is increasingly difficult. We may have
trouble in judging the speed of traffic at intersections.
Normal aging delays reaction time. This is
the interval between the point we first see the road hazard to the time
we apply the brake. In older people, the neural processes necessary to
activate the leg and foot to press the brake pedal is slowed.
Impaired hearing, occurring less frequently than
visual loss, is an important factor in driving. A mature motorist
must be alert to sounds of nearby vehicles, horns, sirens, screeching tires,
and other signals.
Mature wisdom in driving
Wisdom, endowed to seniors, gives a decided advantage
over younger drivers. the mature driver uses wisdom to counteract
age related changes.
To this end, I highly recommend the AARP 55 Alive/Mature
Driving Program. This eight hour instructional course reviews and
reminds the older driver of proper driving practices. It offers self-assessment
and an examination of age related changes which affect driving ability
with ways to deal with these changes. Contact Elder Services of Berkshire
County for information.
Dr. Hamilton is President of Elder Services' Board of Directors.
He retired from
North Adams State College where he was a Professor of Psychology.
Local News Available to Visually Handicapped
The Berkshire Talking Chronicle, located in Dalton,
is the radio reading service providing current printed information to Berkshirites
with reading handicaps. A reading handicap is caused by blindness,
visual impairments, or the inability to hold or turn the pages of printed
materials. The signal is transmitted with the help of WBEC-FM facilities
on a sub-carrier to special receivers which are loaned at no charge.
The Chronicle has listeners in central and south Berkshire County.
At the present time, there is no reception in north county.
The Chronicle's mission is to keep the print handicapped
of Berkshire County continuously informed of what is occurring in the community.
Our volunteers read the Berkshire Eagle twice daily, morning and evening.
The Berkshire Record and Pittsfield Gazette are also read. In addition,
specialty programs such as health, humor, literature and history programs
are scheduled on a weekly basis. Guest speakers from Tanglewood's
Talks and Walks program and Jacob's Pillow are aired seasonally, as well
as certain courses from the Berkshire Institute for Lifetime Learning.
For further information, or to learn how you can
become a volunteer reader at the Berkshire Talking Chronicle, call 684-0880.
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