Saturday, February 04, 2012 Want Advice From Those in the Last 1/3 of Their Lives?
By: Susan M Graham, Certified Elder Law Attorney, Senior Edge Legal, Boise, Idaho 83702
Cornell University (my alma mater) created a Legacy Project to find out from those in the last third of their lives, what life experiences, both positive and negative, have taught them about living effectively. There is a new book called "30 Lessons for Living", Hudson Street Press, by Dr. Karl Pillemer which gathers advice from more than 1,000 elders.1
Here are some highlights:
1. Marriage: "A satisfying marriage that lasts a lifetime is more likely to result when partners are fundamentally similar and share the same basic values and goals."
2. Careers: Be involved in work that you absolutely love and look forward to doing every day.
3. Parenting: Spend more time with your kids. Share in their interests and activities.
4. Aging: "Embrace it. Don't fight it." Most of the 1,000 people found old age had more opportunity than they thought. If you are worrying about dying, then plan for it. "Get things organized, let others know your wishes, tidy up to minimize the burden on your heirs."
5. Regrets: Take advantage of opportunities. Say "yes" more. Fill out your Bucket List and start checking off items once they are done.
6. Happiness: Happiness is a choice, not what life deals you.
"Even if their lives were nine decades long, the elders saw life as too short to waste on pessimism, boredom and disillusionment."
If you want to share your own wisdom and need help in getting started, on the web go to "New York Times." Type in "Questions for Your Own Circle of Experts." I bet your family and friends would be delighted to hear from you.
__________________________
1"Advice From Life's Graying Edge on Finishing with No Regrets" by Jane E. Brody, The New York Times, January 10, 2012, page D7.
Friday, December 02, 2011 Yesterday, I Spent 3 Hours in the Emergency Room [E.R.] With a Friend. Who Will Go With You When You Need Help?
By: Susan M. Graham, Certified Elder Law Attorney, Senior Edge Legal, Boise, Idaho
Sam had a cough that started about 10 days ago, and he became so uncomfortable it was difficult to breathe. We ended up spending 7 hours in the doctor's office and E.R. until they decided what to do.
Did you know there are 4 drugs that cause two-thirds of the E.R. visits for people 65 and older?1 What are they?
1. Warfarin, also known as Coumadin, a blood thinner, accounts for 33% of emergency visits.
2. Insulin injections account for 14% of the visits.
3. Aspirin, clopidogrel and other anti-platelet drugs that help prevent blood clotting result in 13% of visits.
4. Lastly, diabetes drugs taken by mouth [oral hypoglycemic agents] accounts for 11% of the hospitalizations.
Why are these drugs a problem? One reason mentioned in the New York Times article is these drugs have a narrow window between an effective and a dangerous amount to be taken. Another problem is these drugs are not considered "high risk" drugs, so less attention is paid to the actual dosage.
What is the answer so you don't end up in the E.R. because of prescribed drugs? Be proactive. Talk to your doctor about all the medications you are taking (prescribed or not) and take the appropriate dosage.
What plans do you have if you are too ill to care for yourself?
______________________
1The New York Times, Tuesday, November 29, 2011, p. D6, "4 Drugs Cause Most E.R. Visits in Elderly."
Saturday, October 22, 2011 Would You Want Your Enemy As Your Guardian?
By Susan M. Graham, Certified Elder Law Attorney, Senior Edge Legal, Boise, Idaho
This happened for the heiress of L'Oreal, a French cosmetics company. Liliane Bettencourt is 89. She and her daughter, Francoise Bettencourt-Meyers, have been suing one another for years. A French Court found the mother to have failing mental health and to be showing signs of dementia. The Court then appointed the daughter as her mother's guardian. Now, the daughter can control when her mother can travel and how her money will be managed.1
Could this happen to you?
A simple way to avoid this is to sign a financial power of attorney and health power of attorney stating who you want to make financial and health decisions for you if you are not able to care for yourself. That will be a great first step.
If you have not signed these documents, go to our website (www.graham-lawoffice.com) and download the forms for free. The forms come with instructions to make them easy to fill out.
______________________
1Heiress Loses L'Oreal Family Fight, The Wall Street Journal, page B8, October 18, 2011.
Friday, October 14, 2011 A MacArthur Genius Grant is Awarded to An Elder Abuse Lawyer. Yeah!
By Susan M. Graham, Certified Elder Law Attorney, Senior Edge Legal, Boise, Idaho
Caregivers of the elderly have a legal as well as a moral obligation to provide proper care for their charge. Allowing your 84-year-old mother to rot to death is considered illegal.
Attorney, Marie-Therese Connolly, received the MacArthur Fellowship, the so-called "genius" grant, and was awarded $50,000 in recognition of a career that focused on many forms of elder abuse, including physical and psychological abuse, as well as the financial exploitation and wrongful deprivation of rights of the elderly.
One example of a case handled by Ms. Connolly involved Chris Wise, a caregiver for his mother who was sentenced to three years in prison. Why? Even though his mother said she did not want to go to a nursing home and wanted to die at home with dignity, there is nothing dignified about dying in a filthy bed, emaciated and covered in sores so deep that bone was visible. In her last days he ignored her calls for help, and just turned up the sound of his music so he could more easily ignore her.
Of course this is unpleasant to imagine, but thankfully it is called to our attention so that we can be more vigilant in protecting our seniors. Perhaps this will help move some state Legislatures, including Idaho, to strengthen their laws to protect the elderly.
Congratulations and thank you, Ms. Connolly, for your work to protect seniors.
Sunday, September 25, 2011 Ten Warning Signs of Alzheimer's
By Susan M. Graham, Certified Elder Law Attorney, Boise, Idaho
Did you know September 21, 2011 was Alzheimer's Action Day? Many companies have taken action by educating their employees and customers about the 10 warning signs of Alzheimer's1 disease. I want to share that information with you too so you can help others in your world.
1. Memory loss that disrupts daily life. One of the most common signs of Alzheimer's is memory loss, especially forgetting recently learned information. Others include forgetting important dates or events; asking for the same information over and over; relying on memory aids [e.g., reminder notes or electronic devices] or family members for things they used to handle on their own.
What's a typical age-related change? Sometimes forgetting names or appointments, but remembering them later.
2. Challenges in planning or solving problems. Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before.
What's a typical age-related change? Making occasional errors when balancing a checkbook.
3. Difficulty completing familiar tasks at home, at work or at leisure. People with Alzheimer's often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favorite game.
What's a typical age-related change? Occasionally needing help to use the setting on a microwave or to record a television show.
4. Confusion with time and place. People with Alzheimer's can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there.
What's a typical age-related change? Getting confused about the day of the week but figuring it out later.
5. Trouble understanding visual images and spatial relationships. For some people, having vision problems is a sign of Alzheimer's. They may have difficulty reading, judging distance and determining color or contrast. In terms of perception, they may pass a mirror and think someone else is in the room. They may not realize they are the person in the mirror.
What's a typical age-related change? Vision changes related to cataracts.
6. New problems with words in speaking or writing. People with Alzheimer's may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name [e.g., calling a "watch" a "hand-clock."
What's a typical age-related change? Sometimes having trouble finding the right word.
7. Misplacing things and losing the ability to retrace steps. A person with Alzheimer's disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time.
What's a typical age-related change? Misplacing things from time to time, such as a pair of glasses or the remote control.
8. Decreased or poor judgment. People with Alzheimer's may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean.
What's a typical age-related change? Making a bad decision once in a while.
9. Withdrawal from work or social activities. A person with Alzheimer's may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced.
What's a typical age-related change? Sometimes feeling wary of work, family and social obligations.
10. Changes in mood and personality. The mood and personalities of people with Alzheimer's can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone.
What's a typical age-related change? Developing very specific ways of doing things and becoming irritable when a routine is disrupted.
_________________
1Source: The Alzheimer's Association [alz.org] Friday, September 23, 2011 Caregivers Reminder
By: Anonymous and Susan M. Graham
When I spill some food on my nice clean dress or maybe forget to tie my shoe, please be patient and perhaps reminisce about the many hours I spent with you. When I taught you how to eat with care, plus tying laces, dressing yourself and combing your hair.
Those were precious hours spent with you so when I forget what I was about to say, just give me a minute. Or, maybe too it probably wasn't important anyway. I would much rather you just listen if I tell a story once more even if you know the ending through and through. Remember your first nursery rhymes when I rehearsed it a hundred times.
When my legs are tired and it's hard to stand or walk the steady pace that I would like to do, please take me carefully by my hand, and guide me now as I so often did for you.
I don't know who wrote this [I modified it some], but I love the sentiment to remind us of both the earlier and later steps in life's journey.
Saturday, September 10, 2011 10 Steps to Take After the Death of a Loved One
By: Susan M. Graham, Certified Elder Law Attorney
This checklist includes important steps to help manage the estate of someone who has died.
1. Follow the specific funeral and burial instructions left by the decedent. Contact your local funeral home or mortuary for assistance in making or following through with any prearranged funeral plan.
2. Arrange for the care of any persons who are dependent on the decedent, such as minor or disabled children, an elderly spouse or the decedent's elderly relatives.
3. Arrange for the care of any pets of the decedent.
4. Secure the residence. You may want to have some trusted friend stay at the house. Change the locks.
5. Arrange to receive several copies of the death certificate - ten is not too many in most cases.
6. Keep track of your time. Get receipts for all out-of-pocket expenses you pay related to the estate administration so you can be reimbursed.
7. Notify the decedent's friends, family members and work associates of the death.
8. Call the attorney who set up the estate plan to make an appointment and learn how to administer the decedent's estate. The attorney can tell you who is legally responsible under a Last Will and Testament, Trust, or even if no documents were prepared. Locate the original Last Will and Testament or Trust to take to the attorney if these doucments exist. It is important to talk with an attorney prior to making any decisions relating to the administration of the estate. Sometimes the wrong decision, taken hastily, can be costly.
9. Do not distribute any personal property items such as rings, guns, china and other household things until you speak to an attorney. If you distribute such items and you did not have the legal authority to do so, you may be personally liable to others.
10. Update your own estate plan to be certain you and your family are protected. It is important that a surviving spouse make changes now that their spouse has died. In most situations, it will be necessary to prepare a new financial power of attorney, new health power of attorney, and new Last Will and Testament or Trust to reflect any changes to your plan. Saturday, July 30, 2011 Some Day You May Be Miss [or Mr.] Daisy. Are you ready?
By: Susan M. Graham, Certified Elder Law Attorney, The Graham Law Office, P.A., Boise, Idaho 83702
Driving in this country is important. You can elect when and where you are going out. Losing driving privileges can be distressing as it represents a milestone in life that a person is no longer physically able to drive and they lose some of their independence.
But, there may come a time for each of us when it is no longer safe to drive, and we may not notice (or don't want to notice) when that day arrives.
I don't want to be like my client who drove down the street, scrapped 15 parked cars and clipped off every car's mirror. He denied it was his fault. "They all parked wrong."
What steps can we take to protect us from hurting ourselves or hitting some innocent person?
Plan ahead!
Authorize a trusted agent, perhaps your health care agent, to help make the decision that you are no longer capable of driving. Here is some suggested language to add to your health power of attorney.
My agent is authorized to tell my doctor that in my agent's opinion, I am a danger to others when I drive. I realize that this might result in the loss of my driving license and driving privileges. I also realize that I may not agree with my agent when my agent comes to this conclusion. However, I do not want to endanger myself and I do not want to endanger others. Therefore, I put this decision in my agent's hands, as I have the utmost trust and confidence in my agent.1
____________________
1Driving Miss Daisy, by Ruth A. Phelps, Trusts & Estates, July, 2011, pages 18-20. Friday, June 03, 2011 New Report Reveals Over-Use of Anti-Psychotics in Nursing Homes
This spring, a family reported to me that a loved one in a nursing home had trouble getting her medications in balance. She was placed in a hospital to help sort the problem out and after her stay, she was even worse and never spoke again. What a tragedy.
This summary of a national report reflects the same experience is happening all over.
"When a loved one moves into a nursing home, the support of family and friends is particularly important. This is especially true when the nursing home patient has dementia and can't adequately advocate on his or her own behalf. A newly released report from the Office of the Inspector General for the Department of Health and Human Services makes clear just how crucial it is for families to monitor and ask questions about medications that such patients receive."
Source: CNN Opinion (May 31, 2011) and the National Academy of Elder Law Attorneys
Full OIG report Friday, May 06, 2011 Veteran's Benefits - Prescription Drug Program
If you are a Veteran and are "in the VA system" you can obtain your prescriptions from the V for free or for a modest charge. The veteran can get a prescription filled by the VA clinic if the prescription is issued by either a VA physician or a private doctor. The co-payment ranges from $0.00 to $9.00 for a 30 day supply per prescription. The determing factor for the level of co-pay is the veteran's annual household income which is reviewed annually.
How do you get "in the system"?
To get into the VA health system you need to contact the loca VA Health Care Administration. You will need to provide them with your discharge papers/ Then fill out their application form. Part of the form asks for financial information. If you don't fill in the financial information you can still get prescription drug coverage but you will pay the maximum of $9 per monthly supply of each drug. To get enrolled in the system it is necessary to have a physical exam with a VA doctor. Start early, because it may be months before you can schedule an appointment.
Once you are enrolled in the prescription drug program you can have your prescriptions filled. The VA will mail the prescriptions to you.
Annually you will receive more paperwork to fill out. To stay enrolled you need to complete and mail in the forms, otherwise you will be dropped from the program.
The Prescription Drug Program is a benefit you earned as a Veteran.
Prepared by Susan M. Graham
Attorney Accreditied with the Veterans Administration
The Graham Law Office, P.A., 1009 W. Fort Street, Boise, Idaho 83702
208-344-0375 Friday, March 04, 2011 Watch Out for Elder Abuse-(Here is a Common Example)
Actor Mickey Rooney has been the alleged victim of elder abuse at the hands of his own stepkids, according to the restraining orders filed Monday. The 90-year-old actor, who, born in vaudeville has had one of the longest careers of any actor, was granted court protection from stepson Chris Aber and his stepdaughter Christina Aber, after he filed a case against them charging verbal, emotional and financial abuse, and for denying him such basic necessities as food and medicine. The court documents say that both Chris and Christina Aber have been keeping Rooney as “effectively a prisoner in his own home: through the use of threats, intimidation and harassment. Chris Aber has also been accused of taking control over Rooney’s finances, blocking access to his mail and forcing the actor into performances he does not whish to do. With the assistance of attorneys Bruce Roth and Vivian Thoreen of Holland & Knight LLP, Rooney sought and was granted temporary protection for not only himself but for his wife, Jan Rooney, and his stepson, Mark Rooney, who lives with the actor. Rooney fears for their safety and is worried Chris and Christina Aber might retaliate in a physically abusive way, or try to kidnap the actor now that the case has been filed, court documents say. “All I want to do is live a peaceful life, to regain my life and be happy,” Rooney wrote in a statement to his fans. “I pray to God each day to protect us, help us endure and guide those other senior citizens who are also suffering.”
Friday, January 07, 2011 How to Pay a Relative to Care for Dad Without Stepping on a Land Mine.
Landmines? What are they?
• What is the right amount to pay?
• Should there be a written agreement?
• What about taxes?
• Full discloser to all the family?
• How will this impact getting Veterans Benefits and Medicaid?
“According to a report by the National Alliance for Caregiving and AARP, 43.5 million Americans looked after a friend or relative age 50 or older in 2009, 28% more than in 2004.” [Source: Should You Pay A Relative to Take Care of Mom? by Anne Tergesen, The Wall Street Journal, December 11, 2010]
If care is required, many families prefer to pay a relative rather than hire a complete stranger. It is only fair to pay someone if they are working part-time or full-time to provide quality care.
What is the right amount to pay? That depends on how many hours, the skill level of the provider and the pay rates in the local area.
Should there be a written agreement? Yes, this will be required if the elder ever should need to apply for Medicaid and the future can’t be predicted. To make sure the legal standards for the agreement meet the Idaho Department of Health and Welfare requirements, contact an attorney who is knowledgeable in this area to assist in drafting this contract. Another advantage of the contract is the terms of employment are spelled out so there are no misunderstandings in the future. If you ignore creating a written agreement and pay the relative caregiver, this will create problems in the future for qualifying for Medicaid.
What about taxes? The provider will pay income tax on the wages received, and the elder may have to pay employer taxes. It is recommended that a Certified Public Accountant be contacted to be certain this is done properly.
Why provide full disclosure to the family? If the other family members are aware of the formal arrangement to provide care for an elder, there is less chance of family disputes about who is being hired and how much they are being paid.
How will this impact getting Veterans Benefits and Medicaid? The Veterans Non-service Connected Pension benefits and the Medicaid rules are complex and are not coordinated. That means you can provide care in a way that works for the Veterans Administration but that may not work to qualify for Medicaid.
So what is the bottom line? To make sure everyone is treated fairly and to get the maximum benefit for the elder, the caregiver and the family, get a written agreement that meets the needs of everyone and also meets the legal requirements for the government benefit programs if they should ever be needed. Paying for the preparation of a “Personal Service Contract” will save lots of heartache and money in the future.
P.S. If you need help with a “Personal Service Contract” or your estate plan contact us through our website (www.graham-lawoffice.com) or call 208-344-0375. Friday, December 17, 2010 Give The Greatest Gift-Peace of Mind
The greatest gift you can give the special people in your life is to make certain your affairs are in order. Then, they can help you if you are too ill to help yourself or deal with the issues the day you die. What a grim topic to talk about during the Holiday Season. But, in fact, what a grand gift to give your family, friends and you - the “Peace of Mind” that you and your family are covered if unexpected events happen such as serious illness or death.
How can you provide that “Peace of Mind”? Set up or review your estate planning documents. At a minimum everyone needs the following documents:
a. A Health Power of Attorney to indicate who could talk to the medical professionals if you are unable to communicate.
b. A Living Will which indicates your wishes about end of life treatment you want.
c. A Financial Power of Attorney which identifies who you want to handle modest financial decisions if you are not able to take care of your money.
d. A “Last Will and Testament” or a “Revocable Trust” to set forth who you want to handle your affairs when you die and who will receive your property.
If you have no estate plan in place, go to our website ( www.graham-lawoffice.com) and down load the FREE forms we have available to get you started.
Happy Holidays to you and may 2011 be a healthy and fun filled year for you!
P.S. Thank goodness starting next week the days will be getting longer, even though winter has not started, I’m ready for Spring. Friday, November 05, 2010 Medicare Plan Review-Limited Time Only-Don't Wait!!!
Medicare open enrollment is between November 15 and December 31. This is your opportunity to switch Medicare drug or health care plans. It is the perfect time to review your coverage and is extra important this year because of the new federal health law.
AARP and the State of Idaho Senior Health Insurance Benefits Advisors (SHIBA) have scheduled statewide meetings to help people select the right prescription drug program. The meeting in the Boise Valley is scheduled for Monday November 15. There will be free on-site consultation with advisors, and no sales or marketing will occur. The location is at the AARP Idaho office, 3080 E. Gentry Way, Suite 100, Meridian, Idaho 83642 from 9:30 to 3:30 p.m. on a first-come, first- serve basis. No appointments are necessary. The publicity on the AARP website states “Confused by Medicare Rx? What you don’t know could cost you money! What is the best way to save money on prescription drugs? Do you know how to protect yourself against Medicare Fraud? Do you have the right prescription drug plan for your needs?”
Five reasons why you will want to review your plan.
1. You have a limited time period to change plans running from November 15 to December 31, 2010.
2. Your prescription drug plan can change their premiums, deductions and available list of drugs they cover, so your current plan may not be the best for you.
3. The cost of the prescription drug “donut hole” should decrease for most seniors in 2011 because Medicare participants will receive a 50% discount on brand-name drugs and a 7% discount on generic drugs. Unfortunately, it will take until the year 2020 before the donut hole is eliminated.
4. Under the new law, Medicare will now pay 100% of preventative care, such as annual wellness exams.
5. If you find you want to change plans, in 2011 you have between January 1 and February 15, which is 30 days shorter than in 2010.
Here are three steps you can take to help yourself:
1) Contact your Medicare supplemental insurance agent;
2) Attend the AARP meeting on November 15 to get more information that applies to you;
Insurance agents will be sending their clients a letter with an authorization for the agent to work with clients, which must be signed and returned to the agent. After November 15, the agent can then set an appointment to talk with the client about his or her Medicare and supplemental insurance needs. Friday, October 15, 2010 The Elder Justice Act Passed. Why You Should Care?
Elder abuse is a serious and widespread problem. The National Center on Elder Abuse (NCEA) estimates that one to two million elders are exploited or mistreated by someone they depend on for care. As an example in 2005, people 65 and older lost $1.3 billion in personal property crimes. Elder justice is about elder abuse prevention whether it occurs in the home or in a facility.
What is the Elder Justice Act? It became law on March 23, 2010, as part of the national Health Care Reform Bill. The most important parts provide for funding for Adult Protection Services for states and establishes an Elder Justice Coordinating Counsel to start the process to coordinate the activities of federal, state, local and private agencies and entities relating to elder abuse, neglect and exploitation.
What are the types of elder abuse?
• Physical abuse – use of force to threaten or physically injure a vulnerable elder.
• Emotional abuse – verbal attacks, threats, rejection, isolation, or belittling acts that cause or could cause mental anguish, pain or distress to a senior.
• Sexual abuse.
• Exploitation – theft, fraud, misuse or neglect of authority, and use of undue influence as a lever to gain control over an older person’s money or property.
• Neglect - a caregiver’s failure or refusal to provide for a vulnerable elder’s safety, physical or emotional needs.
• Abandonment - desertion of a frail or vulnerable elder by anyone with a duty of care.
• Self-neglect - an elder becomes unable to understand the consequences of one’s own actions or inactions, which leads to or may lead to harm or endangerment.
As people age often there is a conflict between the rights of the elderly senior to make independent decisions and the need to protect that senior from making or failing to make decisions that put them in danger.
This is a difficult balancing act between permitting the senior to have full control of their life and protecting them when necessary. Just being aware of the problem is a start to help eliminate elder abuse.
So the good news is the Elder Justice Act is now law, and has started the process to protect the elderly from abuse. The bad news is Congress failed to provide funding to implement the act. What can you do? Contact Senators Crapo and Risch, and Congressmen Simpson and Minich and ask that they support the funding for the Elder Justice Act1.
P.S. I’ve missed the past few weeks because I have been out of town. I attended a statewide meeting in McCall where we shared information and ideas on how to more effectively represent our clients to help them obtain Medicaid benefits. Then I went to Las Vegas to help grade exams for a national test to be Certified Elder Law Attorneys (CELA). I am one of approximately 400 CELAs. Unfortunately it appears only 6 of 16 passed the test. I came home with a cold and that put me out of commission for a week. Happy Fall to you!
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1The Elder Justice Act: Where We Are Today, September 8, 2010, Bob Blancato, National Coordinator, Elder Justice Coalition, www.elderjusticecoalition.com Friday, September 10, 2010 WHEN DO YOU NEED A CONSERVATOR OR A GUARDIAN?
What happens if you fall down or are in a car accident and you can no longer handle your affairs due to mental or physical limitations? Who will handle your affairs?
Of course, this will never happen to you, but what if? Recently I had a client fall in the shower, ending up in the hospital and then a nursing home. The family called and wanted to know what to do. No planning had been done. So it was necessary for some one to petition the Court and request to be appointed the conservator (the one who handles the money) and the guardian (the one who makes the health and housing decisions) for the incapacitated person.
To start this process the petitioner hires an attorney. The Court appoints a second attorney to represent the incapacitated person, a doctor to evaluate that person and a “visitor”. The “visitor” acts as the Judge’s eyes and ears and talks to interested persons so the Judge can decide the best arrangement for the management of the incapacitated person’s affairs. The “visitor” is often someone with a Master’s Degree in Social Work or a third attorney.
The time required for this process is easily three months before a permanent Conservator and Guardian are appointed, assuming this matter is not contested. Once someone is appointed, the Court will require at least an annual accounting and status report to be filed with the Court. In addition, the Judge may require Court approval before any unusual distributions or actions are taken.
A step in the right direction to help avoid this expensive and lengthy process is to sign financial and health powers of attorney and a living will. That way the people you trust will be in a stronger position to help you. You can also give them the specific powers to help protect and rearrange your assets to qualify for Medicaid or Veterans Benefits if necessary.
Estate planning with a Will or Trust and asset protection planning in advance of a crisis helps make it easier for your loved ones to assist you avoid a Court probate at your death or a Conservatorship and Guardianship proceeding if you become unable to handle your affairs.
. . . .
The information provided in this article is general information and not intended as legal advice. Friday, September 03, 2010 "Frank Talk About Care at Life's End"
“Last week, over the objections of New York State’s medical society, Gov. David A. Paterson signed into law a bill – the New York Palliative Care Information Act – requiring physicians who treat patients with a terminal illness or condition to offer them or their representatives information about prognosis and options for end-of-life care, including aggressive pain management and hospice care as well as the possibilities for further life-sustaining treatment.”1
Similar legislation was proposed in the National Health Bill that was passed this year, but that language was removed in the final version.
There are difficult choices concerning “what to do?” when you or a loved one has an illness that is identified as terminal. Having complete information about all the options seems the optimal beginning point for figuring out what is best for each individual.
__________________
1“Frank Talk About Care At Life’s End” by Jane E. Brody, The New York Times, page D1, August 24, 2010 Friday, June 25, 2010 The Conveyor Belt of Aging - As People Age They Usually Fall Apart
We all want to just die some day in the distant future. No one wants to be dependent and require caregivers for any extended period before we die. The reality is obvious - as we age we probably fall apart. Just like an older car, the tires get flat or bald, the fender rusts and falls off, the battery dies. What is the progression for people?
Hopefully you started on the conveyor belt of life for seniors as a healthy retired person. As the belt moves along have you found yourself;
• Taking medications
• Having health issues
• In the hospital for a crisis (pneumonia or a fall)
• Experiencing memory loss
• Less mobile
• Signing up for Medicare and supplemental insurance to help pay for all of this.
At this point care becomes an issue, care in the home is needed and a new concern becomes how to pay for that care. Is the care paid for “out of pocket," with long-term care insurance, Veterans Administration benefits, or Medicare? As the conveyor belt keeps moving, staying in the home may no longer be possible, so you move to an assisted living facility (where you can do a few things for yourself) or you become a fragile senior and need to be in a skilled nursing home. Again, the concern is what funds you will use to pay for that care – your own money, VA non-service connected pension benefits, Medicare, Medicaid or long-term care insurance.
What is the average length of care in facilities?
Assisted Living stays range from 2.5-3 years.1 To qualify to stay in an assisted living facility, the residents need some help with what are called “activities of daily living.” These six activities include: medications, bathing, dressing, toileting, transferring and eating.
Skilled Nursing Care (nursing home) stays average 2.4 years. Of course, the average is based on residents who stay for only a few days, and others who stay for a decade or more.
What does it cost for care in southwestern Idaho?
Assisted Living $2,000 to 5,000/month
Nursing Home $6,000 to $8,000/month
At Home $20/hr for a bath aide in the home to
$15,000/month for 24-hour care.
Once the conveyor belt has stopped, after death, are there care needs for the surviving spouse or dependent disabled children?
The issues become frightening when considering this progression. Start planning NOW.
1 Public Policy Institute, Assisted Living in the United States Fact Sheet, AARP, FS62R Friday, June 18, 2010 Elder Abuse - Do You Know What That Is?
We have clients who are doing their best to help elderly family members, but are inadvertently harming their loved ones by leaving them isolated and alone. There just are not enough hours in a week to do the shopping, preparing meals, visiting, cleaning and the other large and small endless chores required for fragile or demented elders. So many people just do the best they can. But that really may not be enough or right in the big picture. How do you know when there is “Elder Abuse”? This brief article by Dr. Mor highlights the subtle and overt forms of abuse. It is my hope that being aware of even unintentional forms of abuse will help prevent this from happening and move caregivers to seek help in providing care for our seniors.
PREVENTION OF ELDER ABUSE
Eva Mor PhD
Author of "Making the Golden Years Golden"
The numbers reflecting incidents of abuse in the senior population vary depending on the source that is reporting them. Definitions of what constitutes as "abuse" are also diverse: some sources define elder abuse as only physical abuse, while other sources include emotional abuse, sexual abuse and financial abuse. Accurate numbers are also extremely difficult to compile since many incidents of abuse go unreported. Many elderly are afraid or ashamed to report incidents of abuse, especially if the perpetrator is a family member. Seniors at times are emotionally or physically abused by a familiar person, and are often unable to recognize it as abuse or rationalize it.
What can be done to eliminate incidences of abuse? Society should shoulder the responsibility to protect the elderly, but it begins with the family of the senior. Many of the children and other relatives of the elderly feel that once they have a care giver to care for the elderly their work is done. Far from it, they need to remain vigilant in directing and overseeing that good care is in fact what is provided.
When visiting an elder loved one, you should be alert to the warning signs of abuse:
Emotional or Psychological Abuse:
Are there insults or threats directed at the elder? Are they living in social isolation? The elder may be extremely upset, withdrawn, unresponsive, or exhibiting other unusual behavior. He or she may have a vacant look in their eyes or exhibit fear; they may not always express those verbally, so look for signs in their face or behavior.
Physical and Sexual Abuse:
Look for suspicious bruises or other injuries. Look for signs of restraints, such as a rope burns. See if he or she shows sudden changes of behavior, such as unexplained anger, fear, withdrawal, or has become very quiet. Note if a worker or caregiver refuses to let you visit the elder, making all kind of excuses.
Neglect:
Look for signs of malnutrition, if there is noticeable weight loss, dehydration, bed sores, or if personal hygiene is noticeable neglected. Note if the elder is sitting in soiled clothing, unshaven, unkempt, without dentures, or with long or dirty nails, are they walking around at midday still wearing pajamas? Listen to complaints from the senior as to whether or not their aide is listening to them or following their wishes and follow up on them.
Financial Abuse:
Keep an eye out for unexplained bank withdrawals, unauthorized use of bank and credit cards, reports of stolen or missing checkbooks and bank cards, or if your parent or elder writes checks as a loan or gift to the aide. Be on the lookout for valuables suddenly disappearing. Monitor any sudden changes in the will or banking documents, and be alert if assets are suddenly transferred to a family member or to someone outside the family.
If you discover any of the above warning signals, you should correct them and/or notify the police. The above warning signs should be looked for not only in the home of the elderly, but also if they reside in a nursing home, assisted living facility or a residential care facility. If the elder does not have a family member to protect him or her, the responsibility falls on the society, all of us – doctors, social workers, friends, neighbors and local clergy. For more info: www.goldenyearsgolden.com Friday, April 09, 2010 The Use of Health Powers of Attorney/Advance Directive for Decision Making Before Death
What type of heath care do the elderly receive when they near the end of their life? Are the wishes they described in a Living Will or Health Power of Attorney actually followed?
Information was gathered from a number of sources, including the Veterans Affairs Center for Clinical Management Research that concluded patients who signed the health care documents usually received the care that was associated with their preferences. The following a summary of an article published Aril 10, 2010 in the New England Journal of Medicine[1].
Background: Recent discussions about health care reform have raised questions regarding the value of advance directives.
Method: We used data from survey proxies in the Health and Retirement Study involving adults 60 years of age or older who had diedbetween 2000 and 2006 to determine the prevalence of the need for decision making and lost decision-making capacity and totest the association between preferences documented in advance directives and outcomes of surrogate decision making.
Results: Of 3746 subjects, 42.5% required decision-making, of whom 70.3% lacked decision-making capacity and 67.6% of those subjects, in turn, had advance directives. Subjects who had living wills were more likely to want limited care (92.7%) or comfort care (96.2%) than all care possible (1.9%); 83.2% of subjects who requested limited care and 97.1% of subjects who requested comfort care received care consistent with their preferences. Among the 10 subjects who requested all care possible, only 5 received it; however, subjects who requested all care possible were far more likely to receive aggressive care as compared with those who did not request it (adjusted odds ratio, 22.62;95% confidence interval [CI], 4.45 to 115.00). Subjects with living wills were less likely to receive all care possible (adjusted odds ratio, 0.33; 95% CI, 0.19 to 0.56) than were subjects without living wills. Subjects who had assigned a durable power of attorney for health care were less likely to die in a hospital (adjusted odds ratio, 0.72; 95% CI, 0.55 to 0.93) or receive all care possible (adjusted odds ratio, 0.54; 95% CI, 0.34 to 0.86) than were subjects who had not assigned a durable power of attorney for health care.
Conclusions: Between 2000 and 2006, many elderly Americans needed decision making near the end of life at a time when most lacked the capacity to make decisions. Patients who had prepared advance directives received care that was strongly associated with their preferences. These findings support the continued use of advance directives.
[1] Advance Directives and Outcomes of Surrogate Decision Making Before Death. The New England Journal of Medicine, April 1, 2010. Authors are Maria J. Silveira, M.D., M.P.H., Scott Y.H. Kim, M.D., Ph.D., and Kenneth M. Langa, M.D., Ph.D Monday, January 04, 2010 Do You Know The Signs of a Stroke?George was at a Barbeque last Saturday afternoon and fell down. Then got up and said he was fine. He died at 6:30 pm from a stroke.
If you know the signs of a stroke, you can save a life. How? If a stroke victim is medically cared for within 3 hours it may be possible to totally reverse the stroke effects.
Seniors lack knowledge of the signs of stroke. Older people poorly understand most of the important warning signs of stroke and factors that increase risk for this medical emergency, researchers from Dublin, Ireland, have found. Among 2033 older men and women, fewer than half knew that dizziness, numbness, weakness, and headache are common warning signs of stroke, report Dr. Anne Hickey, of Royal College of Surgeons in Ireland and colleagues. Source: Reuters Health (17 August 2009)
So how can you, just a bystander, recognize a stroke? Ask four simple questions.
1. Ask the individual to smile. Does one side of the face droop?
2. Ask the person to talk and speak a simple sentence, such as “It is raining today.” Are their words slurred? Can they repeat the sentence correctly?
3. Ask the person to raise both arms. Does one arm drift downward?
4. Ask them to stick out their tongue. If the tongue goes to one side or the other that too is an indication of stroke.
If the person has trouble with any one of these tasks, call 911 or get to the hospital fast. Brain cells are dying. |