Alzheimer's

Recently, our former president, Jimmy Carter, decided to stop his own life-sustaining treatments to receive at-home hospice care so he can spend his final days surrounded by family and friends. When I was serving as my father’s healthcare surrogate, I had to make the decision to enroll him in hospice services at the end of his life.Whether or not to enroll a family member in hospice care is an issue that many families face and it can be very confusing. Here is an article outlining what hospice is, how to find one, and also how to spot a hospice company that might be practicing some Medicare fraud:

When faced with a terminal illness or condition, more people than ever are choosing hospice care over starting or continuing expensive medical treatments. Hospice care is for patients who choose not to undergo specific treatments or when they are no longer effective.
Read more . . .

Last month, we discussed the most important documents you need to prepare yourself for a potential disability that impairs your ability to make financial or healthcare decisions for yourself.  This month we will discuss what to do if you are responsible for making healthcare or financial decisions for someone with a disability.

A few years ago, my father started to show signs that he was suffering from dementia.  He was always a very intelligent man and had good social skills, so the dementia was most likely hidden for a number of  years. 

At some point, he began paying his bills twice or not paying them at all, and he and his girlfriend got lost while driving to familiar places.

 Is It Time to Have a Conversation About Long-term Care with an Aging Parent?

Like many families, mine is scattered all over the United States.  Work and other commitments make it difficult to visit distant loved ones more than a few times a year.  When visiting, it is hard to gauge the health and safety of family members because they are often not going about their normal daily activities. 

A few years ago, while visiting my dad in Oregon, I noticed that there was something not quite right with him.  He was repeating himself and telling stories about his history that I was pretty sure were not true.

There are not enough hours in the day – a familiar phrase I mutter to myself while trying to accomplish the items on my ever-expanding to-do list.  That phrase may really be true for those caring for a family member with disabilities. 

Although I haven’t found a way to add hours to my day, I have found ways to extend the time available for learning new things.  I’ve discovered that I can listen to podcasts and books while doing tasks that require my physical -but not necessarily my mental – presence. 

I listen to podcasts when I’m running, doing laundry or cooking, or while I’m wandering around Trader Joe’s picking up groceries.

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.

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.

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.

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.

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.

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

 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.