The Rare Walking Corpse Syndrome

— How Could Someone Feel Dead?

The mind is truly an amazing — and strange — contraption, and few things demonstrate that better than Cotard’s syndrome. Learn about the bizarre condition of walking corpse syndrome.

By Avery Hurt

Cotard’s syndrome, or Cotard’s delusion as it is often called, is a rare neuropsychiatric disorder in which a person believes they are dead, that they do not even exist, or sometimes that the world itself does not exist.

The condition was described in 1880 by Jules Cotard, a French neurologist and psychiatrist. In a presentation to the Société Médico-Psychologique, Cotard ;reported the case of a 43-year-old patient who believed she had “no brain, nerves, chest or entrails, and was just skin and bone.” She claimed to need no food because she was “eternal and would live forever.”

What Is Cotard’s Syndrome?

Not all patients with Cotard’s syndrome expect to live forever in some Zombie-like state. In fact, most believe that they’re already dead or very close to death. Individuals with Cotard’s Syndrome experience a profound distortion of reality and beliefs about their existence.

They may adamantly assert that they do not possess a physical body or have lost their internal organs. This perception of self can lead to extreme apathy, self-neglect and detachment from the world around them.

A 2018 study analyzed the cases of 12 people who had been diagnosed with this disorder and found that eight of the 12 believed they had died. The other four believed they were in the process of dying. Three of the four who claimed to be dying said worms, viruses or bugs were eating their internal organs.

Patients with Cotard’s Syndrome Symptoms

The patient’s belief that they’re dead or dying is often accompanied by other delusions as well. A 44-year-old man diagnosed with Cotard’s also hallucinated spiders in the walls, rats running along the baseboards and people’s faces melting.

A 74-year-old patient reported that he had been stabbed while in his nursing home and referred to his hospital bed as his casket. This man also believed that his wife had been replaced by an imposter, a separate delusion known as Capgras syndrome.

A 35-year-old woman with Cotard’s believed that her brain was rotting and reported that she could feel worms crawling around in her brain. A 50-year-old male who believed he was dying insisted that his arm had been cut off and his fingers were being ground up. None of this, of course, was true.

Nevertheless, the patients were thoroughly convinced and could not be persuaded otherwise, even when the evidence (the arm was still attached to the body; no worms could be detected on brain scans) or logic (how can you talk with me if you have no brain?) seemed convincing to everyone else. The patients often used a logic of their own. When caregivers urged one Cotard’s patient to eat, she asked, “Why do I need to eat when I’m already dead?”

Causes of Cotard Delusion

Though very rare, Cotard delusion can be a symptom of schizophrenia; two of the 12 patients in the 2018 study also had schizophrenia. (Other studies have shown that fewer than one percent of schizophrenia patients also have Cotard’s.) However, the study also found that various neurological and psychiatric disorders were associated with the syndrome.

Three patients had been diagnosed with depression, and four had a history of addiction to opiates and benzodiazepines. Seizures, cluster headaches, evidence of stroke, lesions in the brain and loss of brain volume have also been found in various combinations in Cotard’s patients.

However, whether or not any of these conditions cause Cotard delusion is unknown. It seems that this bizarre constellation of delusions can result when any number of things go wrong in the brain.

Unsurprisingly, there is no specific criteria for a diagnosis, and there is no entry for Cotard’s in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the book psychiatrists and other mental health professionals use to guide them in diagnosing and treating mental illnesses.

How Is Cotard’s Syndrome Treated?

Devastating as these symptoms are, Cotard’s can be treated. Typically by treating any underlying neurological or psychiatric disorders with psychotherapy, pharmaceuticals or a combination of the two approaches. Electroconvulsive therapy (ECT), a treatment that involves electrical stimulation of the brain, has been shown to be effective in some patients as well.

Cotard’s syndrome is one of many neurological conditions that remind us just how little we understand how and why our brains do what they do. While treatment is available, researchers are still working on finding out more about Cotard’s syndrome.

Complete Article HERE!

What is a death rattle?

— What to expect when expecting the end of life

By Julie Power

What is a good death? What is a death rattle?

No question is off limits for palliative care nurse specialist Rachael Zielinski, who tells families and relatives that death and dying are not something to whisper about.

To make her point, she raises her voice. “As a community we need to reclaim the experience of death and dying. It is OK to talk about it,” she tells a workshop called Last Days attended by 20 people in Sydney’s south.

A palliative care nurse with 20 years of experience, Zielinski also wants to bring back the D words: death, dying and dead. Euphemisms like “passing” or “gone” can be confusing, she said, recounting the confusion of a woman who didn’t realise her death was imminent.

About 160,000 people die in Australia each year. Zielinski has seen hundreds die.

Every Christmas Day she remembers the first death she saw: Mrs Merriweather’s nearly 40 years ago.

Then only 18 and living in Sandgate, England, Zielinski sat with the older woman in her final moments and then kept vigil next to the woman’s body.

Last Days was developed by aged and community care provider HammondCare to demystify death and help people navigate death and dying. More sessions across Sydney have been funded by NSW Government’s Sydney North Health Network.

HammondCare’s Dr Andrew Montague said carers, family members and friends were often unprepared for what may be confronting at end of life.

“There is a need to help those who care for people at end of life to equip them to navigate their journey,” said Montague, the general manager health and hospitals. “It will also seek to encourage more openness in making and documenting end-of-life choices.”

According to a survey of 1000 Australians last year by Palliative Care Australia, 88 per cent of respondents agreed it was important to start thinking and talking about their wishes and preferences for care (if they were to become seriously or terminally ill). Despite that, only 56 per cent of those surveyed had talked about or recorded their end-of-life wishes.

Katrina Pearson was at the session to discuss how to manage the palliative care of her mother Robyn, now 72, who was diagnosed with a degenerative disease 11 years ago.

Pearson spoke with her mother about her wishes – before she agreed to go into an aged care facility when she could no longer walk. “It is important to talk about it, and it was good that we talked when she was able to do so.”

Research from Western Australia’s palliative care experts found many people thought palliative care was for the last days of life, thinking their doctor or specialist had given up. Yet research from the United Kingdom found people who receive palliative care earlier live longer and have a better quality of life.

Zielinski said: “We love early referrals. When we get people who are in the terminal phase, we get upset. We could have done so much more.”

Palliative care’s practical aspects include writing a will, delegating someone to make decisions about care, managing symptoms and pain, and identifying what is important in the final days and where and how someone wants to live and die.

Often the wishes of the dying are far from grandiose, such as a desire to eat at a local restaurant once more, look out on a garden, have grandchildren visit or have their dog on the bed.

“Many want to stay at home, in their same bed, but may change their opinion,” Zielinski said. “Dying in a hospital is not a failure.”

But dying at home takes a village.

Zielinski hopes the Last Day’s three-hour workshop and workbook will provide a place to ask questions and challenge preconceptions that caring for someone at the end of their life is something technical, private and hidden.

“Death and dying are the last taboo. We are all going to die, and many of us will care for someone who is dying.”

Death was a process like birth, with recognisable stages and progression, said Zielinski. Unlike birth, though, there are few workshops for families, and no books on “what to expect when you are expecting [to die]” or film adaptations.

The person dying usually sleeps more and eats and drinks little or nothing, which can upset families used to making food to demonstrate love and affection.

“Someone in their last days may only want a tiny spoonful of yoghurt,” she said.

The dying person may attempt to eat to show their love, too.

She recalled a woman who made her husband a grazing plate of a tiny piece of “posh chocolate”, a minuscule bit of sandwich, and fruit.

“He took a little nibble from the sandwich and put it back,” Zielinski said.

That upset his wife.

“I said [to her], ‘That is just the most beautiful thing I’ve seen. It’s a pure gift of love. Look at that, he actually doesn’t need or want it.’ So it’s about education. It’s about understanding those changes.”

Families frequently find “the death rattle” – experts call them terminal secretions – distressing because they think the person dying may be in pain or anguished.

“It is like a snore, which you are not aware you are doing,” she said.

It is caused by uncleared mucus at the back of a throat, she told the workshop. “That gurgly sound you hear, well, that person is so deeply unconscious, they’re not aware that that saliva is sitting there – that they are not trying to cough or swallow to get rid of it. But the sound will distress you. So remember that Rachael said this might happen. It’s not distressing Mum or whomever that is.”

Many deaths are gentle but a few are traumatic. In those cases it is often the words of a carer or a family member, even a prayer or a kind word, that make more of a difference than any medicine.

That was the case with a deeply religious woman who couldn’t be calmed until a pastoral care worker kneeled with her and prayed. She died soon after.

“I have never seen anything like that,” said Zielinski. “We [health professionals] can’t do what [family and friends] can do. We are empowering people to think they have a place.”

A pilot of the program over the past two years found 73.9 per cent of participants strongly agreed that they know more about how to support a person in their last months, weeks and days of life, while nearly 70 per cent understood what to do to relieve physical symptoms.

Complete Article HERE!

Tough choices

— When it’s time to move from home to assisted living

While 8 in 10 Americans ages 65 and older say they want to age in their homes, it’s not always possible when health declines.

Knowing when a loved one needs a more supportive environment, such as assisted living, continuing care retirement community or a nursing home, can be challenging. Though “aging in place” remains a cherished goal, seniors are fretting less about it these days, a recent Associated Press/NORC Center for Public Affairs poll found.

An expert in geriatric mental health offers some guidelines for knowing if is still realistic or if someone needs more care, whether through moving or a home visitation service.

Dr. Molly Camp is an associate professor of psychiatry at University of Texas Southwestern Medical Center in Dallas. In a center news release, she said there are five domains to consider:

Personal needs and hygiene: Basic self-care activities, including bathing, dressing and toileting, must be met. A person’s ability to get in and out of tubs and showers and their risk of falling should be considered.

Home environment: Consider the ability to handle basic maintenance and repairs, as well as access to electricity and water, a sufficiently sanitary living environment and how to avoid safety hazards, such as structural deficiencies.

Necessary activities: Assess whether your loved one can complete complex, essential tasks such as transportation, shopping, meal preparation, cleaning and using technology.

Medical self-care: Your loved one should be able to manage their medications, care for minor wounds and self-monitor for illness.

Financial affairs: Evaluate whether the person has the ability to pay bills on time, track other finances, avoid exploitation, and enter into binding contracts when needed.

Of course, Camp noted, may be able to help manage finances and home visitation programs may be able to help with chores such as cleaning and cooking.

Complete Article HERE!

We asked two experts to watch The Father and Supernova.

These new films show the fear and loss that come with dementia

BY Fran McInerney

Two new films explore the fear of forgetting, loss of control, and other complexities that accompany a dementia diagnosis. The Father and Supernova , both released this month, grapple with the challenges confronting people living with dementia and those who love them.

Dementia is the seventh leading cause of death worldwide , and the second leading cause of death in Australia . The media has an important role in shaping public understanding of poorly understood conditions such as dementia , and it is pleasing to see it considered thoughtfully in both films.

We watched these films through our lenses as a clinician and a neuroscientist. The different causes and conditions that make up the umbrella term of dementia mean the experiences of people living with it — and their loved ones — can differ widely. These films illustrate this well.

Marching through the brain

Because different parts of the brain control different functions, the type of dementia is defined by its pathology, origin in the brain and progression .

In Supernova, directed by British filmmaker Harry Macqueen and starring Colin Firth and Stanley Tucci, we see a fairly accurate representation of frontotemporal dementia. Specifically, this is the type where certain language skills are impaired, known as semantic dementia.

The Father, meanwhile, directed by French playwright Florian Zeller and based on his play of the same name, centres on a protagonist, Anthony (played by Anthony Hopkins), with Alzheimer’s disease, the most common cause of dementia.

Owing to the neurodegenerative nature of dementia, people with this diagnosis experience a progressive deterioration of memory, thinking and behaviour, and gradually lose the ability to perform daily tasks and other physical functions, ultimately leading to death.

‘I don’t need her or anyone else. I can manage very well on my own.’

Both films accurately reflect many of the key early features of these forms of dementia and provide insight into the varied presentations and issues associated with the conditions.

Whereas The Father focuses more heavily on the experience of the individual living with dementia, Supernova gives more attention to shared grief and loss.

Caring and sharing

In Supernova, Tusker (Tucci) and Sam (Firth) take a roadtrip through stunning northern England. We soon learn the journey is as much an adventure to visit Sam’s family, as it is an exploration of their own mortality.

‘You’re still the same person, Tusker,’ says Sam. ‘No I’m not, I just look like him,’ his partner responds.

Unlike many other illnesses, those living with dementia frequently show no outward physical signs of their condition until late in its course, and Tusker appears in good physical health.

We witness Sam’s panic when Tusker and their dog Ruby go missing. Impulsivity and spatial disorientation are common phenomena experienced in dementia. Later, Sam masks his distress (as carers often do), attributing his tears to cutting an onion while preparing dinner.

‘Can you tell? That it’s gotten worse?’

Dementia is a condition that affects the person progressively and globally; we initially only see subtle symptoms of Tusker’s language loss, for example, when he can’t find the word ‘triangle’. Later we note his loss of instrumental function: needing two hands to guide a glass to his mouth, negotiating which arm goes into which sleeve while dressing. Sam tenderly maintains Tusker’s dignity while helping him dress.

When Sam finds Tusker’s notebook, the writing in it has deteriorated across the pages to an indecipherable scrawl. The last pages are blank.

Tusker declares he is dying — dementia is a terminal illness — but how long he has left is unknown. The median time from dementia diagnosis to death is five years. For a previously high-achieving person like Tusker, the loss of his cognitive ability feels more profound to the viewer.

Frightening experience

While The Father may appear to be an imagined horror story, it masterfully presents the disorientating and frightening reality for a person living with dementia.

Anthony is a powerful and compelling character who draws us into his internal chaos – unaware that he is losing his sense of self in place and time. We learn he has been an engineer and father of two daughters, and lives in a comfortable dwelling in a leafy London suburb. He is by turns irascible and charming. Like Tusker, he appears physically fit, well-groomed and fed.

The early narrative tension revolves around Anthony refusing home help. He denies verbally abusing a recent carer and accuses her of stealing his watch; when this is shown to be false he shows no insight or remorse. Those living with dementia may strive to make sense of things they cannot remember by imaginatively filling in the gaps .

People with dementia are altered by the disease, but it’s important to remember that who they are as a person still endures. IMDB

Seeing the world through Anthony’s eyes is a masterful plot device as we the viewers are not quite sure of what is ‘real’. At some early points we wonder if Anthony is being abused or gaslighted as we are drawn into his perceptions; later we learn that the lens through which we see Anthony’s world is distorted, but a terrifying reality to him.

Like all of us, Anthony is capable of harshness and tenderness, of charm and cruelty. Those experiencing dementia often have diminished control over their emotions and behaviours and this can be exacerbated by stress.

A small weakness of the film is that we gain no real sense of Anthony’s earlier life. Anthony’s temper may indeed be an enduring part of his personality, though it’s more likely a consequence of his serious disease. This is an important point for carers to understand. When his son-in-law challenges him to stop ‘getting on everyone’s tits’ we have some sympathy for Anthony, who we begin to realise is behaving fearfully rather than deliberately.

Eventually Anthony is reduced to sobs: ‘Lost all my leaves. Branches. Wind. Rain’. As he moves from the moderate to advanced stage of dementia , the need for tender and humane care is clear.

Still inside

A key theme with many films exploring dementia, is the end — not just the end of the story, but the end of life.

In The Father we are drawn into Anthony’s agonising reality, the quiet chaos of tomorrow. In Supernova, we understand that Tusker chooses to write the end of his own story. Individuals living with dementia may be altered by the disease process, but it’s important to remember that who they are as a person endures.

The nihilistic vision of these films, while powerful and thought-provoking, is not the only possible construction of dementia. Though we must come to terms with the fact that dementia is a terminal disease, the end point does not negate the imperative to respond to the needs of the person; indeed, it highlights the need for empathy.

Complete Article HERE!

Kathy Brandt, A Hospice Expert Who Invited The World Into Her Own Last Days With Cancer, Dies

In January, Kathy Brandt (right) was diagnosed with stage 3 ovarian clear cell carcinoma and learned she had mere months to live. She is pursuing aggressive palliative care, forgoing treatments such as chemotherapy or radiation.

by JoNel Aleccia

Kathy Brandt, a hospice industry leader who turned her own terminal cancer diagnosis into a public conversation about choices at the end of life, died Aug. 4. She was 54.

Brandt’s death was announced on social media by her wife and partner of 18 years, Kimberly Acquaviva, 47, a professor of nursing and author of a book about hospice care for LGBTQ patients and families.

“I wanted all of you to know that Kathy had a peaceful death and your love and support is what made that possible,” Acquaviva wrote in comments posted to Facebook. “Our family has felt your love and we can’t begin to tell you how much it’s meant to us.”

Brandt died at the Charlottesville, Va., home she shared with her wife, their 19-year-old son, Greyson Acquaviva, and their dogs, Dizzy and Mitzi. She was diagnosed in January with stage 3 ovarian clear cell carcinoma, a rare and aggressive cancer.

For the past several months, Brandt and Acquaviva chronicled the day-to-day drama of dying in a series of frank, intimate posts on Facebook and Twitter aimed at demystifying the process and empowering other patients.

After researching her disease, which has a median prognosis of less than 13 months and often fails to respond to chemotherapy, Brandt refused drug treatment, declining what she regarded as “futile” medicine. Instead, she chose aggressive palliative care to manage her symptoms, to the dismay of some friends and family — and even her oncologist.

“If it’s not going to save my life, then why would I go through trying to get an extra month, when that month leading up to it would be terrible?” Brandt told Kaiser Health News in April.

The couple’s posts were followed by hundreds of well-wishers who donated more than $80,000 to help defray living expenses and medical costs. The essays and tweets were an unusually intimate window into the physical, emotional and psychological process of dying.

In April, Brandt described herself as a “dead woman walking” on the sidewalks of Washington, D.C., where they lived until June.

“It’s surreal trying to go about a ‘normal’ life when you know you aren’t going to be around in a few months,” she wrote.

During the last weeks of Brandt’s illness, Acquaviva tweeted about her partner’s bowels, posted photos of her sleeping and shared that Brandt was distressed about what would happen to her and to her family when she died. The frank posts prompted concern from people who asked whether Brandt had consented to have her death live-tweeted for the world. Acquaviva replied:

“My wife @Kathy_Brandt is a hospice and palliative care professional, as am I. She decided early on that she wanted us to share her dying process — all of it — publicly so that she could keep educating people about death and dying until her last breath.”

A well-known hospice industry leader and consultant, Brandt spent three decades in the field and was most recently tapped to write and edit the latest version of clinical guidelines for quality palliative care.

The willingness of Brandt and Acquaviva to share an unflinching account of terminal cancer drew praise from fellow hospice and palliative care experts, said Jon Radulovic, a spokesman for the National Hospice and Palliative Care Organization and their longtime friend.

“As she did throughout her professional career, Kathy has continued to teach the field about compassionate care and patient self-determination,” he wrote in an email before her death.

Elena Prendergast, an assistant professor of nursing at Augusta University in Georgia, wrote that she was moved by their experience.

“I have gone through this with family and with patients, but somehow you both have found a way. With your humor and raw transparency, you both make me feel like I am learning about this process for the first time,” Prendergast tweeted last month.

Brandt remained passionate about encouraging patients to consider the full range of choices when confronting terminal illness.

“If you’re ever diagnosed with a disease that will ultimately kill you no matter what you do, think through what you want the rest of your life to look like,” she wrote in a July 11 email. “Then seek out care that will help you make that version a reality.”

Acquaviva said they had worried that Brandt would not receive the care they’d hoped for in a hospice setting — despite their long efforts to advocate for better conditions for LGBTQ people.

In a post on their gofundme page, Acquaviva urged: “Do whatever you can to ensure that ALL LGBTQ+ people — not just those who know who to call or what to ask for — have access to hospice care provided by professionals who will treat them with dignity, respect, and clinical competence.”

Brandt asked that her obituary appear in The New York Times. It is scheduled to run next weekend, Acquaviva said, and it includes a final request that nods to the activism that characterized Brandt’s work on behalf of LGBTQ people and others who need end-of-life care.

“From the time that Kathy was diagnosed with clear cell ovarian cancer six months ago, she was clear with her family that the cause of death should be listed as the Trump Presidency in her obituary. In lieu of flowers, the family asks that donations be sent to whichever candidate secures the Democratic nomination, even if you really wish someone better were running.”

A memorial for Brandt will be held at 2 p.m. Oct. 26 at Friends Meeting of Washington, 2111 Florida Ave. NW, Washington, D.C. 20008.

Complete Article HERE!

Declining Sense of Smell May Foretell Death

By Stephanie Pappas

Elderly people with a poor sense of smell have a higher likelihood of dying in the 10 years after testing than those whose sniffers stay sharp.

In a new study, elderly people with a poor sense of smell had a 46% higher risk of death 10 years after olfactory abilities were tested, compared to those who passed the smell test. The study also reported that 28% of the increased risk of death could be attributed to Parkinson’s, dementia and unintentional weight loss, all of which predict death in their own right and can also affect a person’s sense of smell. [7 Ways the Mind and Body Change With Age]

But the remaining 72% of the risk linking poor sense of smell and death is unexplained and may be due to subtle health conditions that eventually worsen, the authors wrote in the study, published today (April 29) in the journal Annals of Internal Medicine.

According to the paper, about a quarter of older Americans experience a decline in sense of smell, but this is more likely to go unnoticed compared to loss of sight or hearing. Some studies have linked the decline in sense of smell to risk of death within five years of the decline’s onset, but that research didn’t control for demographics such as sex and race, or health characteristics that might explain the links between sensory loss and death.

n the new study, Michigan State University epidemiologist Honglei Chen and his colleagues used data from the Health ABC study, a long-running study of elderly individuals. (One of the co-authors of the new study, Dr. Jayant Pinto, has received money unrelated to the current study from pharmaceutical companies involved with respiratory allergies and nasal drug delivery.)

Between 1997 and 1998, scientists had recruited about 3,000 older adults, ages 70 to 79, living in Pittsburgh or Memphis, Tennessee for the Health ABC study. Of those individuals, nearly 2,300 completed a smell test at the beginning of the study. In this test, they were asked to identify 12 common smells, and they remained in the study until their deaths or until 2014, whichever came first.

During the total follow-up period of 13 years, about 1,200 study participants died. The researchers found that those with a poor score on the olfaction test had a 46% higher risk of dying by year 10 and a 30% higher risk of dying by year 13, compared with those who had a good score. (The stronger association at year 10 compared to year 13 was likely because the participants were already into their 70s and nearing the end of their life spans, the researchers wrote. By year 13, many were dying regardless of their sense of smell or health status early in the study.)

Sense of smell seemed to be a particularly powerful predictor of earlier death for those who were in good health, the researchers wrote. Among participants who said at the beginning of the study that their health was good, poor olfaction was linked to a 62% increase in the chance of dying by year 10 compared to good olfaction; it was linked to a 40% increase in the chance of dying by year 13.

It’s known that the neurological damage from Parkinson’s disease and dementia can affect a person’s sense of smell, so Chen and his colleagues investigated whether those conditions could explain the link between the nose and death. They also checked the role of weight loss, which could indicate malnutrition.

Even taking those conditions into account, a poor sense of smell explained 70% of the differences in timing of death. The association held across race and gender, which could make it a powerful tool for quantifying health, the researchers wrote.

“[P]oor olfaction among older adults with excellent to good health may be an early warning sign for insidious adverse health conditions that eventually lead to death,” the researchers wrote.

Complete Article HERE!

This might be the most egregious tax proposal of them all

Business Insider explains one of the Republicans’ most egregious proposed changes in the tax code:

The Republican tax plan repeals an itemized deduction that applies to healthcare expenses. That’s key for families with high medical costs, like those dealing with chronic conditions that require medical devices and other expensive equipment. Right now, those expenses can be deducted from their taxes, but under the Republican tax plan, they wouldn’t be able to.

Under current law, individuals who spend over 10% of their income on medical expenses are allowed to deduct part of those costs from their taxes. The proposed new bill would remove that deduction. According to the Internal Revenue Service, for 2016 taxes, individuals were able to deduct in an itemized way “only the amount of your unreimbursed allowable medical and dental expenses that is more than 10 percent of your adjusted gross income [AGI].”

Who spends more than 10 percent of his or her AGI on medical expenses? Generally people at the end of life in nursing-care facilities, where many expenses are not covered by Medicaid or Medicare. CNBC reports:

“This would be a joke if the consequences weren’t so serious,” said Brad Woodhouse, campaign director of health-care advocacy group Protect Our Care, in a statement. “Republican leaders are determined to raise health-care costs for middle-class families who need it most — in this case people with high medical costs or those paying for long-term care.”

While it’s not a widely used tax deduction — about 5 percent of tax filers claim it — for the old and sick it can be significant.

It tends to be mostly … older people who do not have long-term care insurance, and end up in a nursing home,” said Richard Kaplan, a professor who specializes in tax policy and elder law at the University of Illinois College of Law.

The cost of living in a nursing home can easily run up to tens of thousands of dollars per year and wipe out the savings of elderly residents who are paying out of pocket. The deduction can be an important offset to taxes those Americans would owe on their retirement savings distributions.

“For people who are receiving long-term care and are paying for it themselves, this is going to be a huge deal,” said Kaplan.

Andy Slavitt, former head of the Centers for Medicare and Medicaid Services, tells me, “The medical deduction is one of the most popular and important tax credits, particularly for all of us as we age.” He adds, “It keeps many seniors and families out of bankruptcy when in need of end of life care. Ask anyone with chronically ill kids, parents, or spouses.” These are not only very sick, old people but very sick, old and non-rich people. (“AARP has calculated that about three-quarters of those who claim the medical expense deduction are 50 or older, and more than 70 percent have incomes $75,000 or below. Many of those expenses are for long-term care, which is typically not covered by health insurance. Long-term care can cost thousands or tens of thousands of dollars a year.”)

This move doesn’t recoup much revenue in the grand scheme of things. (“It will cost the government about $10 billion a year in lost tax revenues in 2018 and about $144 billion over the next 10 years.”) So why do it? Well, Republicans have given so many tax breaks to the rich and corporations that they are scrounging for ways to take benefits away from others.

Consider this: The giveaway to rich heirs by removing the estate tax and allowing heirs the “stepped-up basis” adjustment in assets comes to $300 billion. They are literally taking money from nursing home residents so that rich heirs won’t have to pay a dime of inheritance taxes on estates exceeding $11 million (for a couple).

Or think about elimination of the alternative minimum tax, something that costs President Trump and other very rich individuals millions or tens of millions. Repealing it would cost $695.5 billion. Literally, they are taking money from people in nursing homes so that Trump and people like him can pay less in taxes.

There’s only one word to describe this sort of trade-off: obscene.

Complete Article HERE!