Idaho Estate Planning

Recognizing Symptoms of Dementia

We have another installment in our series of favorite blogs from the past. Here is part of a blog from June of 2010. The information is still very valuable.

An online article from FamilyDoctor.org outlines some common symptoms in recognizing dementia.

"Dementia causes many problems for the person who has it and for the person's family. Many of the problems are caused by memory loss. Some common symptoms of dementia are listed below. Not everyone who has dementia will experience all of these symptoms.

• Recent memory loss. All of us forget things for a while and then remember them later. People who have dementia often forget things, but they never remember them. They might ask you the same question over and over, each time forgetting that you've already given them the answer. They won't even remember that they already asked the question.
• Difficulty performing familiar tasks. People who have dementia might cook a meal but forget to serve it. They might even forget that they cooked it. 
  Problems with language. People who have dementia may forget simple words or use the wrong words. This makes it hard to understand what they want.
• Time and place disorientation. People who have dementia may get lost on their own street. They may forget how they got to a certain place and how to get back home. 
  Poor judgment. Even a person who doesn't have dementia might get distracted. But people who have dementia can forget simple things, like forgetting to put on a coat before going out in cold weather.
• Problems with abstract thinking. Anybody might have trouble balancing a checkbook, but people who have dementia may forget what the numbers are and what has to be done with them.
• Misplacing things. People who have dementia may put things in the wrong places. They might put an iron in the freezer or a wristwatch in the sugar bowl. Then they can't find these things later.
• Changes in mood. Everyone is moody at times, but people who have dementia may have fast mood swings, going from calm to tears to anger in a few minutes. 
  Personality changes. People who have dementia may have drastic changes in personality. They might become irritable, suspicious or fearful.
• Loss of initiative. People who have dementia may become passive. They might not want to go places or see other people."

Dementia is caused by change or destruction of brain cells. Often this change is a result of small strokes or blockage of blood cells, severe hypothyroidism or Alzheimer’s disease. There is a continuous decline in ability to perform normal daily activities. Personal care including dressing, bathing, preparing meals and even eating a meal eventually becomes impossible.

The Alzheimer’s Organization reports that 5.3 million Americans suffer from Alzheimer’s disease, the most common cause of dementia. They also report that there are 10.9 million unpaid caregivers helping those afflicted by the disease. In 2000, there were an estimated 411,000 new (incident) cases of Alzheimer’s disease. For 2010, that number is projected to be 454,000 new cases; by 2030, 615,000; and by 2050, 959,000. To read the full report, visit www.alz.org.

In the beginning, family members find part time caregivers for their loved one. At first, loved ones need only a little help with remembering to do daily activities or prepare meals. As dementia progresses, caregiving demands often progress to 24 hour care. Night and day become confused and normal routines of sleeping, eating and functioning become more difficult for the patient. The demented person feels frustrated and may lash out in anger or fear. It is not uncommon for a child or spouse giving the care to quickly become overwhelmed and discouraged.

For more information on dealing with Alzheimer's and other forms of dementia, contact Idaho Estate Planning and schedule a consultation. Remember, good planning is no accident.

Maintaining Healthcare Options in Boise Idaho

Here is another in our "Greatest Hits" series of blogs. This one was first published in June of 2010.

Being In Control
Perhaps the most important goal of any estate plan is to allow the client to maintain control. Most of our clients here at Idaho Estate Planning are very intent on “being in control” as long as possible. They want to make their own decisions about whether to go into a “facility” or stay in their house. (Usually the choice is to stay at home as long as possible.) However, the ability to be in control and stay at home is challenged constantly.

Some of the challenges to being in control consist of those disabilities we all fear:  Alzheimer’s disease, dementia, other mental challenges and numerous physical disabilities. The biggest question becomes, “How do I maintain control if I suffer one of these disabilities?” While these situations are varied (and extremely difficult), there are some basics that will allow you to exercise control, that is, allow you to voice your opinion is such a situation.

Durable Power of Attorney for Health Care
First and foremost, you need to execute a Durable Power of Attorney for Health Care. This is a legal document that allows you to personally choose who will make decisions or give instructions if you are not able to, whether from mental or physical disability. This is an extremely important document to have in your estate plan. It is, therefore, extremely important to carefully consider who you want giving instructions to health care providers on your behalf. Typically, this is a spouse.

But, if the spouse is unable to fulfill this responsibility, who will take over? This requires great thought and consideration. Who has the skill set to take on this responsibility? Who understands what you want to have happen? These are not easy decisions and should not be undertaken lightly.

Living Will
A Living Will is a form created by statute that allows you to express a preference if it is determined by two doctors that you are in a terminal state and being kept alive by artificial life support measures. The Living Will also applies if you are determined to be in a persistent vegetative state (some call this being “brain dead”). The Living Will allows you three basic choices: 1) to forego all life preserving efforts being applied whether artificial or natural; 2) to forego any life preserving efforts applied; or 3) only natural efforts applied including food or water or both. In reality, while these situations do occur, they are rare.

The POST
The Physician Orders for Scope of Treatment or “POST” is a more detailed legal document that allows you be very specific in how treatment, whether artificial or natural is applied to you. You can choose to forego intravenous feeding or the use of a feeding tube. You can choose to forego intubation to keep you breathing. You can choose to forego “aggressive methods” to preserve your life. Each of these is an option that you choose.

HIPAA
If your Living Will or POST is needed, it is your Health Care Agent as established in your Power of Attorney for Health Care who gives the instructions to the health care professionals. These documents, then, work together to help you maintain control of your own situation. One more document that makes all the others work better is the HIPAA release. This is an informational release in which you give the health care professionals permission to provide your health information to your Health Care Agent or other family members. In essence, the Power of Attorney allows your Health Care Agent to talk to the doctor. The HIPAA release allows your doctor to talk to your Health Care Agent.

These, then, are the minimum documents you need to make sure your wishes for health and medical care and end of life decisions are honored. Now is the time to address these concerns and plan for the most difficult of times. Once it starts raining (or hailing as it did yesterday), it’s a little late to start fixing the roof. Once you are incapacitated, it’s too late to do this planning.

At Idaho Estate Planning, we understand the challenges faced by elder Americans. We have the experience and expertise to help you maintain your options and protect yourself as well as your loved ones now and into the future. Remember, good planning is no accident.

  

Alzheimer's - Be Prepared Boise

Here is another in our "Greatest Hits" series of blogs. This one was first published in November of 2011.

While medical research and advocacy are vital causes to uphold, Alzheimer’s is a disease that you and your loved ones might have to face directly, if you have not already. With the reality of Alzheimer’s or dementia striking close to home, 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 needs to be addressed, to include securing government benefits such as Medicaid 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. Thorough estate planning should include durable powers of attorney and advance health care directives. These documents create a plan for your future when you may no longer be able to manage your finances or make decisions regarding your health or personal care due to mental incapacity. With these documents, you identify a trusted person to act on your behalf and in your best interests to make financial and health care decisions for you.

Establishing durable powers of attorney and advance health care directives while you are in good mental and physical health will allow you to avoid the prospects of a court-supervised and expensive conservatorship.

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. At Idaho Estate Planning we have the experience and expertise to help you maintain your options and protect yourself as well as your loved ones now and into the future. We have a network of resources throughout the Treasure Valley ready to help us meet your needs. Remember, good planning is no accident!

Holding On To Our Memories

I wanted to share another blog from a few years ago that is just as valid today as it was then.

With our current economic conditions and a host of other pressures an increasing number of American’s are considering staying in the workforce beyond their planned retirement age. Many will have no choice after the great losses to their retirement accounts. As the average age of the workforce increases so too does the concern for their well-being, especially in reference to dementia and more specifically Alzheimer’s. Right now there are more than 5 million American’s with Alzheimer’s and that is expected to quadruple by 2050. That could be very problematic for businesses, those affected by the disease as well as their co-workers.

If we have a family history of dementia we would be well served to know the early warning signs of the disease. The warnings can be hard to notice as they are revealed rather slowly.

Another way to combat dementia is to be proactive throughout our lives. In the article “How to Age-Proof Your Memory” health.com lists some interesting ideas.

In Our 30’s

Avoid stress, “Stress is toxic to the brain,” says Denise Park, PhD, a cognitive neuroscientist at the Center for Brain Health at the University of Texas at Dallas. The body’s stress response floods the brain with powerful hormones. In the short-term, that helps you focus and cram to meet a deadline, but over time it kills neurons and damages memory centers.

In Our 40’s

Try to maintain focus. “The first step to remembering is paying attention in the first place,” says Gary Small, MD, director of the University of California, Los Angeles, Center on Aging and author of The Memory Bible: An Innovative Strategy for Keeping Your Brain Young. At work, set aside daily chunks of time to unplug from email, instant messages, and workplace chatter. When parking in a big lot, check and recheck landmarks.

In Our 50’s

Maintain close relationships. Ten minutes of talking actually boosts memory and thinking speed afterward, according to new research. “It takes a lot of mental work—you’re paying attention, trying to figure out where somebody is coming from, and sometimes biting your tongue,” says study author Oscar Ybarra, PhD, a psychologist and researcher at the University of Michigan’s Institute for Social Research. This kind of interaction may be as useful as doing crossword puzzles or taking reading-comprehension tests. “Socializing,” Ybarra says, “helps you navigate the real world.”

Plan and Act Now

Taking the right steps now can affect our future well-being. Similarly planning now for the future can positively affect our financial well being. We all want to stay in control of our lives as long as possible and for that we must plan. When it comes to planning for the future, the sad fact is that every year we fail to plan we lose options. Wait long enough and the only options left are those made for us out of desperation. Remember, timing is everything. In order to maintain control as long as possible and have an effect on your own quality of life decisions you must choose to act now. Your decisions need to be made known and documented correctly. Good planning is no accident!

  

Alzheimer's in Idaho & America On The Rise

The latest numbers are in from the Alzheimer’s Association, and reports show one in three seniors dies with Alzheimer’s or other dementia. That is a rather disconcerting statistic, so it only makes sense to make your health care and legal plans now before it’s too late.

This new statistic – hardly alone in a field of such startling stats – comes from a new report by the Alzheimer’s Association. This was discussed in a recent article in The Washington Post titled “Beyond memory loss, report finds 1 in 3 seniors dies with dementia that can impede other care.” Beyond these statistics is the realization that these conditions have a likelihood to impede other care and render a loved one vulnerable to further conditions. For example, pneumonia can be caused by poor motor skills (difficulty swallowing), complications to medication, and even the inability to understand and communicate regarding one’s health care matters.

All told, Alzheimer’s is the sixth leading cause of death, given that it is listed as the underlying condition on death certificates.

So, what should you do now? Realize that Alzheimer’s and dementia are very real and insidious threats to the health and well-being of yourself or your senior loved ones. Get your ducks in a row now, especially when it comes to advance health directives and estate plans.

When planning for this sensitive area of your health care and estate, make sure you contact Idaho Estate Planning to help you navigate the applicable laws. 

For information on other critical subjects visit our website where you'll find a wealth of information including our blog and instructional videos from our You Tube Channel. Remember, good planning is no accident.

Awareness of "Mild Cognitive Disorder" On The Increase in Idaho

When you have an elderly loved one, it’s wise to keep abreast on the ever-evolving medical world and all the new findings for mental health as a person ages. One committee with which you should become most familiar is the American Psychiatric Association and their upcoming best-seller, the DSM5. The book may usher in new ways of approaching elders and depression, and some are apprehensive about the book’s impact.

The concern over the DSM5 has come to a slow boil. The conversation about DSM5 has begun seeping out from the academic literature and into the public square with articles like a recent piece in The New York Times titled “Time to Recognize Mild Cognitive Disorder?”

The DSM5 will be the sequel to the Diagnostic and Statistical Manual of Mental Disorder IV (DSM-IV), the utterly necessary reference book and dust-gatherer of psychologists, doctors, insurance companies, bureaucrats, and lawyers alike. DSM-IV chronicles known and diagnosable psychological disorders.

For seniors, the new disorder making the rounds is “mild cognitive disorder.” This diagnosis is an attempt to bring to psychiatry the same awareness to levels of cognitive senility that medical doctors know all too well and yet still understand too little. If the DSM5 is published as is, and becomes the go-to reference, then we’re likely to see many more elderly diagnosed into categories that have only just now been created.

It’s useful to understand the basis for any diagnosis made by doctors when it comes to our elderly loved ones or even ourselves as we age. Don’t forget – proper planning now can give you peace of mind for any future diagnosis concerning your healthcare needs. At Idaho Estate Planning, we understand the challenges faced by elder Americans. We have the experience and expertise to help you maintain your options and protect yourself as well as your loved ones now and into the future. Remember, good planning is no accident.

Long Term Care for Wartime Veterans

We have spoken many times about the non-service related benefit offered by the Veterans Administration knows as "Pension". Pension has many levels and many names. You may have heard it referred to as Aid & Attendance, Housebound Benefit or Pension Benefit. It is always nice to find someone else talking about this under utilized benefit for our vets. I recommend reading "VA Benefits For Long-Term Care of Veterans and Their Surviving Spouses"  on the estateplanning.com website.

The Pension Benefit could pay as much as $2,020 a month in disability income to a qualifying veteran household. A study commissioned by VA in 2001 estimated that, over the next 14 years, only about 30% of eligible veterans would apply for Pension. This is likely due to the fact that most veterans simply don't know about it. In fact, about a third of all seniors in this country, age 65 and older, could become eligible for pension under the right circumstances. That's how many elderly war veterans or their surviving spouses there are.

At Idaho Estate Planning we understand how to maximize the benefit or avoid a denial. We can also provide guidance for meeting the asset test. We provide the best strategies for reallocating assets through trusts or income conversions to allow for the best possible accommodation of assets for beneficiaries thus avoiding or reducing: taxes; family disputes; and, Medicaid penalties.

We are VA Accredited and we know how to help you get the benefits you earned through your greatly appreciated service to our country. Good planning is no accident. To secure your peace of mind as well as your family's future, get started now. Remember, good planning is no accident.

Overnight Care For Dementia Sufferers

We have often discussed the challenges of dealing with Dementia. Such challenges are faced by the inflicted as well as by the family, especially if they have entered into the role of caregiver. One difficulty few caregivers expect is that many dementia sufferers sleep at night for only an hour or two and many do not sleep at all. Being awakened by a confused family member in the middle of the night quickly effects the health of everyone in the house through loss of sleep and a high stress level that comes with trying to maintain a "normal" environment that is more likely than not an impossibility.

In New Jersey an innovative approach is finding great success. Basically it is an overnight dementia "camp". Although this appears to be the only one in existence we can only assume more will sprout up across the country as their benefits are recognized. You can read the article from the Idaho Statesman written by Jim Fitzgerald here.

If you are the one providing daily care for a loved one, you owe it to yourself to seek help; to take care of yourself and your needs, both physically and mentally. You owe it to those you care for to be your most efficient and effective; often that means a little help from the outside. Seek out professional help that will ease your burden. Look for community service organizations that offer respite help. If you don't know where to start call us. Remember, good planning is no accident.

 

Appeal Rights for Hospice Care Patients

Medicare, and really any kind of health program from private insurance to public entitlement, is always disappointing when it fails patients due to bureaucratic dead ends. It’s even worse when the patient is a hospice patient.

Much can be learned through the unfortunate case of Howard and Emily Back. Emily, now deceased, was a California hospice patient covered by Medicare. Howard appealed his wife’s lack of treatment through the court process. However, the court was quick to point out that there is an administrative appeals process through Medicare regarding its hospice care decisions.

The entire case is detailed in a recent post in The New Old Age a blog through the New York Times, titled “Court: You Can Appeal Medicare Decisions About Hospice Services.” As this blog post notes, Emily was denied coverage for a pain medication while in hospice and in the last stages of life. Consequently, Howard paid for them out of pocket and later (after Emily’s passing) appealed to Medicare to cover the expenses for doctor-ordered medication. While initially told there was no such Medicare appeals process and was turned away, Howard learned otherwise.

As Howard sought to set a precedent so future couples would not face the same roadblocks, the court has finally found and verified that a Medicare appeals process exists. In fact, one can appeal a Medicare decision regarding hospice services with a form labeled “CMS-1490S,” if the beneficiary believes they have been inappropriately denied services.

This case is illustrative of the inherent problems that can occur when the competing interests of patient care and governmental bureaucracy collide.

Trying to keep up to date on Medicaid, Medicare or any other issues faced by America's Elderly can be a daunting task. At Idaho Estate Planning, we understand these challenges. We have the experience and expertise to help you maintain your options and protect yourself as well as your loved ones now and into the future. Remember, good planning is no accident.

 

Avoiding the Hospital - Nursing Home Revolving Door

Elders and their families are well aware of the dangerous roundtrip between the hospital to the nursing home and back again. It has been noted that as many as 60% of those roundtrips are preventable. Forbes recently covered this topic, the article can be found here. 

Idaho Estate Planning is part of the Senior Resource Network of Idaho, a non-profit network of elder care professionals available to provide information on what we discussed above and much more. Let us know your concerns and we will help you find the resources you need.

In addition to caring for your parents or other family members, it is also important to consider your own concerns for the future. How will you maintain your independence as you grow older? What effect would a costly health issue have on your quality of life? The more planning you do now the less difficulty there will be later. Remember, good planning is no accident.