Salt Lake City Estate Planning

Obama's Alzheimers Agenda

The Obama administration announced plans Tuesday for a two-year, $156 million cash infusion for Alzheimer’s research and care. The money will help solidify a still-developing national plan to better treat and even prevent the illness by 2025.

With budget plans just now coming to a head, it’s good news for many of us that Alzheimer’s has become one of the “we can’t wait” initiatives in President Obama’s plan.

Such measures still need to be passed through Congress, and positive advances may not be immediately forthcoming. However, it is heartening to see fiscal support for an issue that affects so many of us and our loved ones.

If all goes to plan and the approach makes it through Congress – a politically trepidatious journey these days even for the most common-sense and appealing legislation – then the budget will earmark an infusion of $156 million for Alzheimer’s research and care.

In many ways it’s the flesh and bones to an earlier announcement from the administration regarding a national plan toward treating Alzheimer’s that came out to some guffaws due it’s lack of a clear source of funding.  The full details on allocation are still forthcoming, but at least a small portion of that infusion, some $26 million, is intended for immediate use and care of Alzheimer’s patients. The rest is to go toward research and the hope of improving future care, and also perhaps systematic prevention.

How this news will affect us, and whether it will weather violent political and economic seas is yet to be seen, but it’s a powerful promise for many. 

Reference: The Kaiser Health News (February 7, 2012) “Alzheimer’s Research Gets Funding Boost”

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ELDER LAW

Craig Reaves, past president of the National Academy of Elder Law Attorneys, practices elder law in Kansas City, Mo., and fields occasional questions from New Old Age readers.

On the topic of disclosures, a reader inquired about what to do about her family of eight siblings and one elderly father. Long ago the siblings got together and put two of the sisters in charge of their father, largely because his will and other directives advised as much. As a result, they were granted power-of-attorney and access to his accounts.

Now, the reader has discovered that they aren’t forthcoming with information about their father, his care, and his finances. The reader is worried that she won’t hear anything until there’s a demand for money to care for their elderly father, and, perhaps, that the original funds weren’t adequately used.

The response of Craig Reaves is tailored to the reader’s unique situation, but his advice is applicable for many in this same or similar position. As a preliminary caveat, there are specific state laws (i.e., like those regarding “powers of  attorney”) that govern the authority, responsibility and liability of agents and fiduciaries.

Read Craig Reaves’ enlightening response in his original post.  

Reference: The New York Times – The New Old Age Blog ( January 18, 2012) “Ask the Elder Law Attorney: Disclosures and Loans”

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Hospice: Medicare and Medicaid Profit Center?

A national hospice company improperly cycled patients through nursing homes and hospice with a goal of making as much profit as possible from Medicare, according to a whistleblower lawsuit announced this week.

Healthcare lawsuits involving the various ways that the elderly can be taken advantage of turn up in the news on a daily basis these days. Why? Well, partly for political reasons and partly for the sheer number of egregious situations that have been created.

As an informed citizen/taxpayer, it’s important to think about and understand the big picture. However, as a family member, it’s vitally important to remember them for the sake of your elderly loved ones.

A new legal battle has begun to churn, as recently reported at Kaiser Health News. Yet another healthcare company is being accused of taking advantage of the elderly and their families to draw the greatest yield from Medicare and Medicaid coffers. Here a large company, operating across several states, is accused of actively recruiting and cycling patients through nursing home and hospice services.

Such companies are compensated by Medicare based on the length of time patients receive care. Medicare picks up the entire nursing home tab for the first 20 days (after that the patient has to contribute), and conversely, if a patient spends too much time in hospice care, Medicare demands their money back since the patient was clearly admitted to end-of-life care under false pretenses.

Here’s the rub: If you cycle between nursing home regimens and then jump into hospice care as early as possible (but not too early), Medicare will pick up the entire tab and for the maximum amounts, and that’s the issue.

The legal battles, as well as the politics and economics aside, stories like these also demand a certain amount of attention since they could directly impact your family.

If you have a loved one in need of nursing home and/or hospice care, it’s important that they find and receive that care… and that they not be abused by an uncaring system.

Reference: Kaiser Health News (January 4, 2012) “Lawsuit Accuses Company of Fraudulently Cycling Patients through Nursing Homes, Hospice Care.”

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Decision-Making Declines As Birthdays Increase

We ask older Americans to make complicated financial decisions about Social Security, Medicare, retirement distributions and more—just when they are losing their fastball. Regardless of gender or education level, Americans become considerably less literate about all things money after age 60, according to a new study.

Why do many of the most difficult decisions we face come later in life? I guess it’s just fact of life. Unfortunately, we’re not always at the top of our game when those decisions must be made. Therefore, it’s essential to make proper plans earlier, rather than later.

According to a recent study, reported on here by the Wall Street Journal, the decline starts around age 60. The scores on a test measuring knowledge of investments, insurance, credit and money basics fell about 2% each year starting after age 60. In fact, they fell from about 59% correct for those in their 60s to a dismal 30% for those 80 and older. What’s almost as bad is that these very people actually grew more confident in their decisions and knowledge.

Problem: These are the very same people who are attempting to sift through the messy and confusing programs like Medicare and Social Security, at the very same time they are undergoing this dramatic change in their mental agility. These also are the people who will want to take care of their loved ones in their estate plans in an era of constantly changing laws and regulations.

If you are the adult child of older parents, this is something to bear in mind when seeking to help them, perhaps especially when your assistance is unwanted. Likewise, as a parent, fact of life will necessitate a bit of self-understanding. And for everyone, this means that proper estate planning should be done earlier, rather than later. 

Reference: The Wall Street Journal (October 30, 2011) “Financial Acumen Declines After 60”

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Hospital-Induced Delirium Hits Seniors Hard

What my family didn’t know at the time, because the doctors did not tell us, was that this frightening transformation was a classic case of hospital delirium — a brain dysfunction characterized by sudden confusion and inattention. It’s one of the most common, dangerous and costly complications of hospital stays for the elderly.

When the elderly visit the hospital it’s simply not the same as when they were younger. No, everything is more dangerous.

The New Old Age Blog at the New York Times recently discussed a danger that is all too common, but still under the radar screens of medical and the everyday worlds alike. It’s the problem of elderly delirium.

Usually, when we talk about an elderly person no longer being themselves, we think of dementia. Nevertheless, another dramatic neurological problem is delirium and it is often, ironically, brought on by hospital visits. Here’s what happens: When the elderly are put under such heavy medication it can generate a neurological imbalance that results in dramatic disorientation, sudden confusion, and loss of attention. The list of medications that can have this affect is fairly long, including sedatives, sleeping pills, narcotic painkillers and some allergy, blood pressure and incontinence drugs. As a result, it’s not a surprise that delirium is common.

Each year 20 percent of the 11.8 million elderly patients in hospitals develop delirium. This includes some 60 percent to 85 percent of those in intensive care on ventilation and more than half of postoperative surgical patients.

The problem is that delirium also can have long-term affects, according to recent research. In the end, many hospitals may be doing long-term damage to their patients. For more information and a stirring example, read the original story here. Be sure to take a look at the checklist to help determine the difference between dementia and delirium. 

Reference: The New York Times (November 2, 2011) “Another Hospital Hazard for the Elderly”

 

Myths Vs. Reality – Appointing Guardians For Minors

As it happens, parents would rather talk about pretty much any other part of their personal life than answer this question. But when they finally do start talking, almost everyone has the same misconceptions about the process. In fact, most folks are letting four major myths hold them back from getting the job done and protecting their kid in case the worst happens.

Estate Planning can be a pretty off-putting subject for many people. And, since the subject matter is one’s own death, it’s easy to understand why. Sometimes, however, it may be easier to just think about estate planning in terms of money or assets.

Nevertheless, the issues that are worth planning for are often more immediate. For example, every parent has a good reason to nail down the issue of guardianship for their minor children.

To that end, Jacoba Urist at the Huffington Post recently put together the four dangerous myths about choosing a guardian:

1. The myth of the perfect match. What would the perfect match look like? Someone just like you, presumably (and you personally, in a perfect world.) Nevertheless, it’s a convenient myth for putting off any decision and getting any planning done. Remember: You can always name a new guardian as your child grows or as circumstances change.
2. The myth that someone will step up and solve the issue anyway. While it may be true that your family members will swoop in, that doesn’t mean they will all agree on who ought to do so (or that the family members you would want to will even be able). It can mean a family fight and, in that case, the one who actually chooses is the judge.
3. The myth that you can just leave a letter hidden somewhere. Many parents write a letter asking a loved one to become guardian and then tuck it away so that it can be found if the need should arise. Although that’s better than nothing, it’s not legally binding.
4. The myth that you don’t have to ask. If you don’t ask you’ll never know how your guardian feels about your decision. Deciding this issue in advance can help your family and your children in a difficult time.

Take a look at the original article here, and maybe consider if you’re holding yourself back from making a decision. Often, proper planning begins in one place and spreads out into an entire plan, so perhaps this is how you come to find your plans and your priorities. 

Reference:  The Huffington Post (October 24, 2011) “4 Dangerous Myths About Choosing a Guardian”

 

Drug-Managed Dementia Dilemma

Antipsychotics are meant primarily to help control hallucinations, delusions and other abnormal behavior in people suffering from schizophrenia and bipolar disorder, but they're also given to hundreds of thousands of elderly nursing home patients in the U.S. to pacify aggressive and paranoid behavior related to dementia.

Dementia and Alzheimer’s can prove to be huge challenges for the healthcare institutions we trust to care for our affected loved ones. Unfortunately, these are challenges many institutions meet with the over-use, abuse or improper use of drugs. The good news is that this problematic trend is being identified and resolved for many families.

As recently reported by the Associated Press, the turn to drugs for nursing home patients with dementia is nothing new. Dementia has a nasty tendency to disorient patients who may grow paranoid or lash out as a result. The safest way to protect them and others has been through medication to calm them. Of course, under-funded institutions also have a tendency to use drugs to a fault, and many use the wrong drugs, like antipsychotics. These drugs (like Risperdal, Zyprexa, Seroquel, Geodon, Abilify, Invega, and older medications) are designed to help people suffering from schizophrenia or bipolar disorder… and are not approved for dementia patients.

Since 2005, these drugs have been under an FDA warning that they can cause an increased rate of death in dementia patients (due to heart attacks and pneumonia). Nevertheless, as of 2007 (according to a recently released government audit), about one in seven nursing home patients aged 65 or older was prescribed at least one of the drugs and, in about 83% of these cases, the prescription was for off-label use, like treating dementia. Ironically, the use of these drugs can create further confusion for the dementia patient and impair his or her ability to interact normally. Not surprisingly, many dementia patients actually have improved dispositions when they are taken off of these drugs.

It’s hard to estimate how widespread the problem is today, but at least it has been recognized and many institutions are correcting the trend. While the use of drugs is not bad in all cases (since there are patients who are severely disoriented), but certainly not every patient needs them or needs them at full strength. This is just one more concern to bear in mind when you visit your elderly loved one and when choosing the right nursing home for them.

Reference: The Associated Press via ABC News (September 14, 2011) “Push Underway to Cut Drugs for Dementia Patients”

Alzheimer's: Be Prepared!

Living with Alzheimer’s disease is very difficult for the individuals affected and their loved ones. But by dedicating some time early on in the diagnosis and fighting for the cause during World Alzheimer’s Month and beyond, a family can know they have done everything to support their loved one to live a full life and protect their legacy.

You may not have known but September is World Alzheimer’s Month. As the month comes to a close, it’s important not to forget about Alzheimer’s. Medical research and advocacy are vital causes to uphold. Nevertheless, it is a disease that you and your loved ones might have to face directly, if you have not already. The reality of Alzheimer’s or dementia striking close to home, then some understanding and prior planning can help you in terms of the extensive economic toll and the unique legal ramifications.

According to a recent Forbes article, Alzheimer’s is as widespread as it is demanding. Consider this: Another American citizen will develop Alzheimer’s every 69 seconds. The symptoms are oftentimes subtle, at least initially. Some estimate that more than 13 million Americans will have the disease by 2050 and run up as much as $1 trillion in costs. Because of the progressive nature of the disease, most of the costs and problems won’t develop until later on. Nevertheless, significant planning must take place at the time of diagnosis, if not anticipated beforehand.

So, what is the scope of this “significant planning”? First, you will need to secure medical care, both for now and for the future. That means fundamental financial planning need to be addressed, to include securing government benefits like Medicare and Social Security Disability Insurance. Second, because of Alzheimer’s progressive cognitive degeneration, estate planning must occur early in the process to secure and protect family assets.  

Fundamentally, it’s important to understand that Alzheimer’s is not the same as other diseases. Through it all, competent counsel will be necessary to properly assess the needs and possibilities, as well as to ensure that everything is in place when needed most.

Reference: Forbes (September 21, 2011) “September Marks World Alzheimer's Month as Advocates Push for Early Diagnosis and Health Care Planning”

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Travel Tips for Caregivers of Elderly Loved Ones

Sometimes you travel because you want to, sometimes because you need to. Whatever the reason, planning a trip can be logistical nightmare for caregivers.

Being responsible for an elderly loved one can mean adopting a rather rigid schedule and lifestyle, especially if you are the primary caregiver. How, then, do you travel? It can be a logistical nightmare, whether the travel is elective or necessary. Regardless, understanding some of the challenges and workarounds in advance can make the travel more manageable. The New Old Age blog at The New York Times recently offered some food for thought on this important subject.

The big question is whether your elderly parent is traveling with you. If the travel involves you alone for business or pleasure, then you still may need to replace yourself while away. Perhaps you already have someone who assists with care. If yes, find out whether they can temporarily stay on full-time since they already know your parent and their needs. If no, then contact an in-home care organization, as many offer temporary services. Don’t overlook assisted-living or nursing homes, too. They might offer temporary stay options. Finally, there is the more difficult (but less expensive) option of coordinating a schedule of volunteer (or recruited) family members and friends. Note: Care must be taken since everyone needs to know the schedule and understand the care requirements.

If your elderly loved will be traveling with you – such as for a family vacation or even to a care facility – then there are additional considerations, but at least you will be the one there to run interference. Of course, the first hurdle is whether they can travel. You’ll want to contact their doctor to get their opinion. In addition, this will give you a greater appreciation of challenges you may not have addressed.

While you’re at it, medications ought to be first and foremost on your mind. Running low on a medication mid-trip can be risky at best and deadly at worst. It may be difficult getting a prescription filled, as well. It may be advisable to take extra quantities of virtually everything from pills to Depends.  

In regards to other details, make schedules for everything to maintain consistency from meals to rest breaks to bathroom breaks. Remember: When flying, consider asking for a wheelchair in the terminal, even if it is not expressly needed. Why? The wheelchair can help make transporting your elderly loved one much easier and, on many airlines, it can help you get to the front of the boarding line.

While the original post has even more specific ideas and instructions, the general rule of thumb is to think about the little details and to plan for them, whether you’re leaving your elderly loved on at home or you’re traveling together, it will make a world of difference.

Reference: The New York Times (September 15, 2011) “When It’s Time to Hit the Road”

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Special Needs Planning – A Changing Landscape

Deciding how to leave your assets to your kids is tricky enough. If your adult child has a chronic disability, the task is much more complicated.

Estate planning is never easy, if only because it means thinking about protecting your loved ones when you’re no longer around. It’s bad enough making plans to protect self-sufficient heirs who take care of themselves and an inheritance. However, it can be a real challenge when planning for heirs with special needs for a variety of personal and legal reasons. Unfortunately, as The Wall Street Journal Online recently pointed out, with the economy and politics as they are, there are new concerns to bear in mind as you plan.

Both the State and federal budgets are strapped for cash and the burden is falling on Medicare and Medicaid. It’s up to the Congressional Special Committee to consider the future of Medicare now, but many Medicaid programs already are feeling the squeeze with tighter income restrictions for benefits and services.

Of course, much of the disabled population (12% of the overall population) relies on state and federal services for those services that they couldn’t afford in the private market. To plan for an heir with special needs, then, means planning to provide for them without risking their main sources of care. Now, more than ever, that means a “special needs trust,” tailored to provide the inheritance as a safety net without endangering the continuation of benefits. [Sidebar: Sometimes an older parent can make this move kill two birds with one stone. How? They create the trust now for themselves and a loved one with special needs so that both qualify for government benefits, once the “look back” period has past for eligibility disqualification. As budgets get tighter, expect greater governmental scrutiny of such moves.]

The other major issue, and a related one, is housing. Many Americans with special needs live in group housing programs. These programs are, in turn, subsidized by government agencies, but are increasingly unable to meet demand and are cash-strapped. For one, the same political/economic pressure is keeping those agencies from expanding.

At the same time, there simply are more prospective residents due to lengthening life expectancies. The US would have had to expand its residential-services capacity by 28% to meet the demand as of two years ago. Clearly, housing has been an issue and it will only get worse.

Amidst all of this uncertainty, you still need to plan where your loved one will live. This might mean another form of trust. For example, a “Qualified Personal Residence Trust” (QPRT) would provide that you live in your home until your death, but that your family member with special needs would live there (without disqualifying ownership). Great care would need to be given in the preparation of such an arrangement. Also, it may be possible to provide a home to shelter several persons with special needs. For example, say several families pool resources, or even to leave a home to a non-profit that can convert the home into a new group home. The options are limited by your creativity.

Ultimately, the best plan will depend on your own unique family circumstances, as well as the current state and federal laws governing benefits and services. Unfortunately, according to a recent study by Arc, an advocacy group, only one-third of affected actually has plans to control what happens when the caregiver grows old and after they are gone.

Bottom line: Remember to engage qualified legal counsel to help you navigate the regulatory minefields.

Reference: The Wall Street Journal Online (September 3, 2011) “Taking Care of Disabled Heirs”

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