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Alzheimer's

Monday, June 26, 2017

The Four Most Important Legal Documents You Will Need to Manage Your Aging Parent's Affairs

To help your parents get their affairs in order, you should first make sure that you or someone trustworthy has the legal ability to manage your parent’s affairs.  This article is a guide to the four fundamental legal documents you and your parent may need in order to get financial affairs in order.



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Thursday, June 22, 2017

How Safe is My Mother from Financial Exploitation?


 

Jennifer’s 80-year-old mother seemed to be running low on funds every month.  By the end of the month, she had no money for groceries.  Jennifer had helped her mother with a budget, so she thought her mother had plenty of money to make it through each month.  When she asked her mother to allow her to look at her bank statements, though, Jennifer discovered a series of automatic debits to several companies she did not recognize.  It turns out, her mother had signed up for monthly book delivery clubs, as well as recurring magazine subscriptions for magazines Jennifer knew her mother did not read.
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Thursday, June 1, 2017

Important Things You Should Know Before Deciding to Seek Guardianship or Conservatorship of an Adult


What exactly is a guardian, what is a conservator and when should you become the guardian or conservator of an adult?

Aunt Mary is 86 years old and has always been a little eccentric, but lately she’s been giving money to John, a much younger man that she calls her special friend.  Aunt Mary says that she knows her family doesn’t approve of her giving him money and gifts, but she has plenty of money, John has been her friend for many years, he has always helped her with her home and yard, and she doesn’t have anyone else she would rather spend her money on.  Does she need a guardian or conservator?

What is a guardian and conservator?

A guardian is a person who is legally responsible for someone who is not able to manage his or her own affairs. Guardians and conservators are appointed by the judge of the probate court in the county in which the person in need of a guardian/conservator, called a ward, resides or can be found.

In Georgia, a guardian is the term that is used for the person responsible for managing affairs related to the health and safety of the ward, while a conservator is responsible for the financial affairs of the ward.


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Monday, January 23, 2017

Help, I’m Lost in the Medicare Alphabet Maze!


 

Recently, I had to help a relative reinstate her Medicare Part D insurance coverage after she forgot to pay the premiums for several months.  The insurance company sent many notices advising that they would terminate coverage if the past-due premiums were not paid, but she either ignored the notices or could not comprehend what they said and eventually lost coverage.

After spending hours on the phone first with the insurance company and then with Medicare, I realized that Medicare is somewhat of a mystery to me.  Medicare is not yet my health insurance provider, so other than knowing that most of my clients are covered by Medicare and pay a monthly premium for the health insurance, I really had little idea of how Medicare works.  This blog post is a general guide to Medicare, while the next four posts will explore the alphabet of Medicare in more depth.
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Thursday, July 16, 2015

The Zen of a Family Meeting: The Five Things You Must Cover When Planning for Your Aging Parents’ Care

 

 

July is Sandwich Generation Awareness Month.  The Sandwich Generation refers to those people, mostly in their mid-40’s to late 50’s, who are caring for aging parents as well as caring for young children or dependent young adult children.  If you are the meat or peanut butter in that sandwich, you might be looking for help from your siblings or other family members.  One of the best ways to plan the care for an aging or disabled family member is by holding a family meeting.  The meeting is designed to do many things:  get information from the aging or disabled person about their needs, figure out what kind of care is needed and brainstorm about ways to find that care, gauge the financial resources available for care, and assign duties to various family members so that one caregiver does not get burned out.

Who should attend the meeting?  I recommend that all of the parents and siblings attend a meeting, preferably where they can meet face to face to talk about the issues facing the aging parent now, and those issues that may come up in the future.  If grandchildren, aunts and uncles or friends will be responsible for some of the care, invite them along.    The parent or person with a disability should be in attendance so long as they are physically able to be there. 

It is usually best to hold the meeting in a neutral place, such as a meeting room in a hotel or community center.  I also recommend there be a fairly impartial facilitator to keep the meeting on track, if possible.  And, there should be plenty of snacks and drinks so people won’t want to leave before you’ve discussed all the important points.

With so many families spread out over the world, it can be difficult to get everyone together.  If the family has a regular family reunion, perhaps the reunion time can be extended to allow the family to get together for this meeting.  If there is no regularly scheduled reunion, you can use scheduling programs such as www.doodle.com to find out when the most attendees will be available. If some family members absolutely cannot meet in person, you can use tools such as Skype www.skype.com or Google Hangouts www.google.com/hangouts‎ to bring those other family members in by video.

Once you have set the time and place, have everyone agree to an agenda.  Appoint someone to come up with a proposed agenda in advance of the meeting, and then circulate that proposed agenda for comments, additions and changes.

Here are the five basic items that should be covered in the meeting:

 

  1. The Health and Safety of the aging parent or person with a disability

     

    How do they feel about their own healthcare and safety and what are they concerned about?

    Are there any disease or illness diagnoses?

    Are they paying attention to personal hygiene?

    Have there been any instances where the safety of the parent has been compromised, such as falling, leaving the stove on, wandering, etc.?

    Who are their physicians, dentists, therapists, professional and volunteer caregivers?

    What medications are they taking and are they remembering to take them regularly? 

     

    What health insurance do they have?  If they are on Medicare, is there supplemental insurance or prescription medication coverage?

    How are the premiums paid and is there someone who will be informed if the premiums are not paid?

     

    How are their finances? 

    What financial resources do they have? 

    What are their regular bills and how do those bills get paid?  How will you know if they forget to pay the bills?

     

  2. The current living and care arrangements, whether those arrangements are working, and a plan for future living arrangements

 

 If the parent’s condition is changing, what living and care arrangements will be necessary in the future?

How will you find appropriate housing and care?

 

  1. The legal documents do they have and the legal documents they need

     

    Who is their lawyer and when was the last time they saw a lawyer?  Where are the legal documents stored?

    Who is named as Agent, Personal Representative, etc. in those documents?

    Who are their beneficiaries on their IRA’s, 401(k)’s, life insurance policies and annuities?

     

  2. A plan to pay for long-term care

    Is there long-term insurance available?  If so, what are the terms?  Where is the policy and how are the premiums paid for? 

    If there is no long-term care insurance, can the parent or person with disability afford to pay for care by him or herself?  Are there any government programs, such as Veterans benefits or Medicaid, that can help pay for long-term care?

     

  3. The family caregivers – who will do what and when

Sometimes family members volunteer to perform the tasks for which they have talent.  The brother who is a nurse may be the natural fit for the person to oversee the parent’s healthcare and the sister who is the CPA will take over the finances.  What if it isn’t so clear or if no one wants to take on the tasks?  Can people be hired to perform some of the tasks such as paying the bills? 

Can the family agree that it may not be fair to one of the children to take on all of the responsibility for care?

If one family member is taking on the bulk of the care, can the others agree to take a turn to provide relief to the primary caregiver? 

 

The topics may vary from family to family, and for those families who may find it especially hard to discuss these items you might consider having a professional or a mediator to assist in these discussions.

 

 

 

 


Wednesday, November 27, 2013

Nursing Home Care for Veterans

Nursing Home Care for Veterans

The VA provides “Community Living Centers”, or what used to be called Nursing Homes.  These are operated by the VA, and are usually in a Veterans Administration Hospital.  These Community Living Centers (CLC’s) provide rehabilitation for veterans recovering from injury and illness in the short-term, but also provide long-term skilled nursing care for veterans who need care for long periods of time for a service-connected injury.

For veterans rated at 70% service-connected or higher, or for those who need nursing home care for their service-connected injuries, the VA pays for their nursing home placement as part of their package of healthcare benefits.

The CLC’s are available for non-service connected veterans who are enrolled in VHA healthcare, and need short term services such as rehabilitation, hospice, respite, and for those waiting for placement in the community.

VA provides care to veterans based on a priority system.  There are currently 8 categories of veterans based on service- connection and financial need.  For example, a veteran who is 50% service-connected or higher is in category 1.  A non-service connected veteran with significant assets and income is most likely going to be enrolled in category 8.

Veterans in category 1 will be eligible for placement in a CLC, and will not have a co-pay, but those in category 8 will be placed in a CLC only if there is availability and no one in a higher category needs the bed.  The veteran in category 8 will pay a daily co-pay for services in the CLC.

In Atlanta, the CLC is located in the VA hospital on Clairmont Road, and is almost always full to capacity with a waiting list.  For those veterans for whom nursing home care is not part of the package of medical benefits, they may be able to find placement in one of the two Georgia War Veterans Homes.

The two Georgia War Veterans Homes in Georgia are not run by the national VA, but are available to veterans.  The Georgia Department of Veterans Services and the Georgia Health Sciences University operate the Georgia War Veterans Nursing Home in Augusta.   The Georgia War Veterans Home in Milledgeville is operated by United Veteran Services of Georgia, Inc., which operates the home for the Georgia Department of Veterans Services. 

In order to be eligible for admission to a Georgia War Veterans Home, the person must be domiciled in Georgia, and must have resided in Georgia for the five years immediately preceding admission.  He or she must have been a “war veteran”, defined as any veteran who served on active duty in the Armed Forces of the U.S. during wartime or during the period between January 31, 1955 and May 7, 1975.  In addition, the U.S. Department of Veterans Affairs must approve them as “eligible for care and treatment”.  Veterans accepted into the Georgia War Veterans Homes will be required to pay some expenses such as Medicare or health-care insurance deductibles and co-pays.  The forms to apply for admission to the Georgia War Veterans Homes are found at veterans.georgia.gov/gwvh-forms.


Wednesday, February 20, 2013

Caregiver Appreciation

Expressing appreciation for the assistance received from caregivers is something that not many think about, but is certainly needed. Now some may say, “Why should I be grateful for help from someone I am paying?” Or in the case of family caregivers, “Aren’t family members supposed to take care of each other?” Research shows, however, that not only does expressing appreciation make the caregiver feel better about what they do, but also that the people expressing gratitude have a greater sense of well-being.

Expressing appreciation for something your caregiver has done for you does not require the eloquence of a public speaker, only a few words are all that it takes. Examples of some things to say thank you for are : “Your gentleness when helping me change positions really minimizes my pain. Thank you.” “The way you talk to me as a person, rather than a patient, really makes me feel good.”  By giving sincere words of affirmation  will not only allow the caregiver to feel appreciated, but will help them to have a know how you liked to be cared for.

Expressing gratitude is a choice. This month, show some appreciation to someone who helps care for those in need.


Wednesday, January 23, 2013

The Importance in making the right choice in Assisted Living

When families and seniors are looking at assisted living communities, it’s a momentous, life changing time. With so many options out there, it is important to get it right the first time.

It can be such an intimidating choice that many families come down with “analysis paralysis” and indefinitely postpone a decision out of fear of making the wrong choice.

Fortunately, the decision becomes easier as you expand your knowledge and visit several places. A Place for Mom has a video, How to Find the Best Assisted Living, that outlines the things to look for when researching assisted living, but it can be equally helpful to know exactly what not to do when searching for assisted living.

Along with the video, A Place For Mom has listed the top 8 mistakes people make when looking into assitied living. There are a lot of decisions you will have to make when it comes to choosing the perfect assisted living, so be sure to do your research and ask questions!!! Feel free to ask us for help! As an Elder Law attorney, we work closely with many assisted livings in the area and can provide some helpful information.

Click here for more information


Tuesday, December 20, 2011

Holiday Traditions: Really Check in With Your Neighbors and Relatives

On Friday night, we gathered with neighbors old and new to celebrate a cherished tradition – our annual progressive dinner.  Traditionally, we begin the year.  We find out about the new babies, weddings and graduations to come.  We learn what colleges the children will attend, and where soon-to-be college graduates will start their careers.  We also check in on aging neighbors to find out about their health scares, their difficulties, the loss of their loved ones.  After moving from house to house for salads, and main courses, we end up with more wine and sweet treats to reminisce about dinners past.  How many have we had?  No one can remember.  But by the end of the evening, we’re looking forward to next year’s dinner, and assigning tasks to make it happen.

Continuing this tradition is important to my family and my neighborhood because it allows us to connect with our neighbors, to get to know them when times are good so that we can help each other when times are not so good.  Without our traditional yearly gathering, we might not realize when our neighbors need our help.

In my practice, I see many people who see their aging or ill family members and friends at the holidays and realize that all is not well.  Sometimes, all has not been well for so long that those family members are now in crisis.

If you are visiting family members who are aging or ill, take the time to talk with them to find out about their health.  Are they seeing a doctor?  What medications are they taking?  How do they keep track of their medications on a daily basis?  Ask them if they have a healthcare proxy or advance directive for healthcare?  Who will make healthcare decisions for them if they are not able?

Although it can be difficult to have a conversation with parents about their finances, ask them if they have appointed someone to make financial decisions for them if they are not able.  Look around the house and see if there are stacks of unopened bills.  Find out if they have long-term care insurance.  Ask where their important financial and legal documents can be found.  If they haven’t appointed anyone to make decisions for them, urge them to do that while they still can.

If your aging family members are still driving, ride with them to see if they are still able to drive safely.  Are they stopping at the stop signs?  Do they forget to look before making a turn?  Do they still remember how to get to places they have been to many times before or do they forget where they are going?  If they are having trouble driving, would a driving school help?  Or, can you help them find transportation so they won’t need to drive anymore?

With married couples, try to talk with each one alone.  Sometimes couples get so good at covering for each other, you don’t realize that one of them might be suffering from dementia.  If one of the couple is ailing, find out how the well spouse is coping.  Is he or she eating and sleeping right?  Is he or she getting help in the home so he or she can get out to see friends, or just get some time to rest and recharge?

Look in the refrigerator, freezer and cupboard.  Is the food in the refrigerator or cupboards moldy or out of date?  Are they going to the grocery store on a regular basis?  If you suspect that they are not eating right, is there a meals-on-wheels program that they might qualify for?

I hope that you will enjoy holiday traditions with family, friends, and neighbors this year.  Will you take time to talk with your family and friends to see whether they might need help in the coming year?

Happy Holidays!

Patti Elrod-Hill

 

 

 

 


Sunday, July 3, 2011

When Bridget Came To Visit: On Being Prepared

 When Bridget came to visit, she wanted to take my blue and white teacups home with her.  They were shiny and pretty, and fit in her hand just perfectly.  Dick promised they would go to the mall and buy some teacups just like them.

Bridget was in the mid to late stages of Alzheimer’s disease when she and Dick first visited my office.  Dick, a wonderful, patient husband and caregiver to Bridget, was determined to be prepared for whatever legal and financial zingers might hit the couple.  Years before, after Bridget was first diagnosed with Cognitive Memory Impairment, Dick and Bridget had prepared living trusts, powers of attorneys, and healthcare directives.  They came to me to make a few changes to Dick’s living trust and financial power of attorney.   I always recommend that clients update advance directives and powers of attorney to avoid having someone decide that the documents are “stale” and, therefore, not valid.  We prepared new advance directives for Bridget and Dick.  On the day Bridget came to sign, she could not remember that the children whom she had nominated as agents were adults.  In fact, I’m really not sure she could remember who her children were.

With sadness, I told Dick that Bridget could not sign any documents that day.  We agreed to try another day, since those with dementia often have times when they are very alert, and other times when they are not.  Bridget never was able to sign her new advance directive, and soon went to stay in a wonderful memory care facility.   The health care and financial proxies she had already signed worked fine for her, and Dick was able to make her healthcare and financial decisions without any challenges.

Susan, on the other hand, had never executed advance directives for healthcare, financial powers of attorney, or any wills or trusts.  She didn’t think she needed to, since her husband made most of the financial decisions for the couple.  Her family did not push her to do any planning, since they thought it would upset her.  When I visited Susan at the nursing home after her husband died, she told me the nurses were stealing her underwear, she no longer recognized her family members, and she wondered why I was visiting her at work.   Susan swore like a sailor, and insisted that she would not sign “any g. . d. . . papers”, believing that I was trying to steal from her, too.

As a result, her family had to spend months and thousands of dollars to seek guardianship and conservatorship of Susan, a court proceeding which is expensive financially and emotionally for all involved. 

Many folks with Alzheimer’s and other dementias become paranoid and distrustful.  When they hit that stage, it is extremely difficult to get them to agree to do advance directives, financial powers of attorney, or wills.  Why would they agree to sign something that they believe allows folks to steal from them?

As an attorney, I preach that every adult needs to have an advance directive for healthcare, a financial power of attorney, and at least a basic will.   In Susan’s case, her fear of planning led to heartache and hardship for her family.   Could all of this expense and difficulty have been avoided by visiting an attorney’s office while Susan was able to plan for her and her family’s future?

As a footnote, I want to tell you all about Dick, Richard J. Farrell, whom I mentioned above.  Dick has written a book Alzheimer’s Caregiving about his life with Bridget, joys and trials of caregiving, and about his grief when Bridget died after living with Alzheimer’s for nearly 20 years.  Check out his website at www.alzheimerscaregivingbook.com to see how you can order a copy.

 


Wednesday, May 13, 2009

The Alzheimer's Project - Review of The Memory Loss Tapes

The Alzheimer’s Project
A Review of The Memory Loss Tapes

 
Like most Baby Boomers, I have a fear of developing Alzheimer’s Disease. As an Elder Law attorney, I witness the struggles of the adult children of parents who have Alzheimer’s Disease (AD) as they try to understand what is happening to their parent and wrestle with the best way to care for their parent as the parent slowly fades away.
 
The Alzheimer’s Project is intended to open a dialogue about Alzheimer’s Disease, to show the disease from several perspectives – that of the person who has AD, the children and young teenagers who have relatives with the disease, the scientists and doctors struggling to find treatments and a cure, and from the caregivers.
 
The Memory Loss Tapes, the first episode in the documentary series airing on HBO this week, is viewed from the perspective of those who have been diagnosed with AD. Each segment shows someone in varying stages of the disease, starting with Bessie who is in the very early stages of the disease and ending with Cliff’s death from complications from the disease.
 
Although much of this episode is frightening, much of it is happy, sad, and hopeful – often all at the same time.
 
We are first introduced to Bessie, an 87-year-old widow living in a small town in Wisconsin who was diagnosed with AD two months before her part of the documentary was filmed. Bessie is still living her normal life – for the most part. She lives by herself with her dog, Skipper, and still drives, cooks and performs with a singing group. She struggles to remember the words to songs and forgets the names of people she has known for years. Bessie is aware that she is forgetting things, but she is determined to continue the activities she has enjoyed for years. Although she understands there is no cure for the disease, she hopes for a couple more good years with donepezil, (known by the brand name, Aricept) a medication prescribed by her doctor.
 
Fannie, an 82-year-old widow in St. Louis, represents the second phase of the disease. Fannie’s segment is probably the most familiar and the most disturbing to those who must care for a loved one with AD, because Fannie has little awareness that she is suffering from AD and is irritated with those who try to keep her safe. When we first meet Fannie, it is three months since her diagnosis. Fannie’s doctor told her to quit driving, which she says makes her feel “inadequate” and “completely dependent on someone else.” Fannie takes an assessment test to determine whether she must stop driving. When asked to rate her driving ability, Fannie chooses Above Average. As part of the assessment, Fannie must take a driving test. It is frightening to watch as we see that Fannie cannot remember how to put the car in reverse, sees traffic signs in places where there are none and cannot figure out a right turn from a left turn. After the test, Fannie believes that she will be able to continue to drive. When Fannie is told that she can no longer drive, she is very upset and says that “they” are taking away her independence.
 
The Joe’s Blog part of the documentary was very difficult to watch. Joe, just 63 years old, was diagnosed with AD two years before the documentary was filmed. He writes a blog he calls Living with Alzheimer’s. Before developing AD, Joe was involved in the computer industry. He describes himself as having been a genius, involved in helping some of the computer companies become the largest in the world. Now, Joe gets lost in his own backyard and is afraid to go out of the house because he may not be able to find his way home. Indeed, when he takes his young granddaughter to the park, he forgets how to get out of the park. Thankfully, his granddaughter remembers how to get home.
 
Joe very candidly tells the camera that the medication he takes for AD killed his sexual appetite. During a visit to his psychologist, Joe describes the disease as being like someone shaving slices of him – like at the deli when they shave the meat and little scrapings and pieces come off. The most difficult part for the viewer is to see Joe talk about taking his own life when he gets too far along. Joe feels that he will soon reach the point when he will end his life and he buys a wooden box – presumably for his ashes – and shows it to his family.
 
Yolanda Santomartino, age 75, represents AD in the later stages. Yolanda slumps in her wheelchair, no longer able to walk or to sit up straight. She talks to herself in the mirror, believing that she is talking to someone else named Ruth. Yolanda gets tired of talking to Ruth through the “window” because Ruth does not talk back to her. Yolanda is frightened by a ribbon on her chair, which she believes is an animal, and becomes agitated when she thinks snakes are in her wheelchair. Her caregivers struggle to calm her, and often play along with her fears by trying to mash the snakes in her chair. Family members will feel the pain that Yolanda’s son feels when his mother does not recognize him when he is sitting next to her. As Yolanda cries, “This is no life.”
 
Woody Geist, Age 81, was diagnosed 14 years before this documentary was filmed. He lives in a Sunrise assisted living memory care facility, and spends most of his day wandering around, whistling, and trying to figure out where he is going. Despite the fact that he is married, he has a “girlfriend” at the assisted living. She refers to Woody as her husband.  Old home movies show Woody hamming it up in front of the camera, singing with a men’s acapella singing group. We rejoice with Woody when he appears at a performance of his old singing group, and, although he cannot remember any of the members of the group, he does remember the words to the songs. Woody’s favorite phrase is “We’re lucky. I am glad we can be together.”
 
Josephine Mickow, age 77, does not talk much anymore. She makes sounds and whistles, but we barely hear her speak.  She lives with her daughter in a small house in a rural area.  Her daughter’s spinning group put a fence around the perimeter of the yard and now Josephine wanders aimlessly in her yard fiddling with the fence, as though trying to get out of the yard. Her daughter gave up her job in the city to care for Josephine, and now just gets by making yarn from the llamas and alpacas she raises and selling her goods at shops in her area. The most difficult part of Josephine’s piece is when Josephine puts a pebble in her mouth and her daughter has to stick her fingers in Josephine’s mouth to pry the pebble out. Josephine was an artist, and still leaves little vignettes of vegetables, glasses, and other found objects around the house. Her daughter preserves these vignettes through photographs.
 
The final segment features Cliff Holman, age 79, who was diagnosed 6 years before the documentary. We meet Cliff in the last stages of AD, being cared for at home by his wife with help from hospice nurses. Cliff was a children’s entertainer called “Cousin Cliff”, and had a daily children’s television show. He gets agitated because he believes he has to get to the television station to do a show. His wife struggles knowing that in his living will he asked that his life not be prolonged by artificial means, but feeling that she does not want to lose him. In the end, Cliff is taken to a hospice facility and we watch his family say their last goodbyes and grieve with them when the hospice nurse nods her head and says “he’s gone.”
 
 
The last scene shows Bessie searching for her car, and the viewer knows that she has just begun this incredibly difficult and painful journey, with Bessie just slipping away until her life end like Cliff’s.
 
Although some people may find this part of the documentary series difficult to watch, I found some hope here. The families of those suffering with AD, though stressed and grieving, also found joy and happiness in taking care of their loved ones. Though they often described their loved one as slipping away, I found that each person retained some part of their personality throughout the stages of the disease. Even as Cliff is in the final stages, he is waving to the camera and saying “I’ll see you on smellivision.”


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