The Senior List Guest Articles

Reminiscing- Is it Helpful? A Look at Brain Fitness and Overall Wellness

2009-10-02T10:47:00.000-07:00

Could remembering that story about riding bikes with your best friend actually be good for your health?

Could memories of your neighborhood and favorite games and toys assist in your overall well being?

Could coming to terms with difficult remembrances help you move on and live life to the fullest?

Indeed, it appears to be so. Over 100 studies over the last 10 years have found that reminiscing lowers depression, alleviates physical symptoms (arthritis, asthma), and stimulates the hippocampus where memories are stored in the brain.

In fact, Dr. Gene Cohen, a noted authority on creativity and aging, says autobiography is like chocolate for the brain--especially in older adults. So one very affordable and easy way to work that brain is to think back and consider the details in your memories and experiences.

Here are 4 fun ideas to test your memory:

Can you actually remember a conversation that happened 20 years ago? Who was it with? What was it about? Did anything happen as a result of it?
Remember a picnic from the past (maybe at a family reunion). Can you recall what you heard, smelled, tasted, touched, or saw at that event? Try to write it down.
Walk yourself down the street of your neighborhood when you were a kid—even take out a piece of paper and jot down boxes for each neighbors house. Who lived in the houses? Who were your favorite and least favorite neighbors? What were some of the funny things that happened on your street?
Try to describe one of your grandparents or parents to a friend. Can you recall their mannerisms, their appearance, and what they liked to do with their time? Think about what life lessons you learned from them.

In addition to the creative benefits of remembering, Dr. Andrew Weil, author of Healthy Aging, recommends that everyone compose an ethical will (this is simply a heartfelt letter to your loved ones). This type of letter of love can help people say what matters most to their family and friends. Just write it from your heart and tell them how you really feel.

Life review has also been found to touch all seven dimensions of wellness--especially helping people socially, emotionally, and intellectually. People at ALL stages of life can benefit from a look back at the past. That’s because, when we look to the past, it can help us come to terms with things, learn from our mistakes, see the joy in our lives, and discover what’s next.

Beth Sanders is the founder of LifeBio.com and author of the Memory Journal. In 1993, she interviewed her own grandmother and realized that she never knew her as well as she could or should until that day. Her passion for family history and stories has helped thousands to preserve relationships and create a lasting legacy. Life Bio has appeared in the Wall Street Journal, Associated Press stories, the Chicago Tribune, and she has appeared on numerous radio programs including Satellite Sisters, Life Online with Bob Parsons, and Coping with Caregiving. For more information visit www.lifebio.com.

Funding Cuts for Seniors- Could the Timing be any Worse?

2009-10-02T10:20:00.000-07:00

As more residents are forced to pay for their own way in long term care, the timing for Medicare and Medicaid cuts could not be worse.

66% of residents in an assisted living facility in 2009 reported being the primary source of payment for the costs of housing and care. The impact of the economic recession has hit seniors and their families hard with an almost 60% drop in the number of families able to contribute to a loved ones care. The trend of more seniors being solely responsible for the costs of housing and care will only be made worse as the combination of a slow economic recovery and additional cuts to programs such as Medicare and Medicaid are being contemplated as part of President Obama’s health reform plans.

Over the coming years these economic and political realities will be exacerbated by the baby boomers reaching retirement age and then their “senior living” years (shifting to use of home healthcare, assisted living and skilled nursing home care). Cuts to programs such as Medicare and Medicaid may be shortsighted. During a recent interview with healthcare policy expert Gail Wilensky on PBS’ News Hour (Aug. 10), her insight into the impact of these cuts was very specific:

GAIL WILENSKY: The notion that you can cut $500 billion to $600 billion dollars out of the Medicare and Medicaid program and think that you don't risk affecting access for groups of seniors is simply incorrect. That is a whole different story. What most of the ways to get money quickly, which is what you want if you want to use that money to expand insurance coverage for people don't have it, are sure ways that Congress will score as being a real saving, and that means whacking reimbursement. They're going to lower reimbursements for a nursing home. They're going to lower reimbursements...

JUDY WOODRUFF: For nursing homes?

GAIL WILENSKY: ... for nursing homes, for home care. They're going to reduce the amount hospitals who have high re-admissions for certain illnesses have. Now, do you want to go after some of these in reforming the delivery system? You do in careful and slow ways, but just whacking reimbursement, which is the only way to get quick savings upfront, is a whole different matter.

There is no doubt that our nation’s healthcare system needs reform, but before cutting real dollars to provide care to our nation’s most vulnerable population, areas to concentrate on first are administrative waste, unnecessary medical testing, frivolous law suits, and excessive drug and medical equipment costs. Regardless of the outcome of this latest attempt to reform healthcare, seniors and their families must prepare themselves to shoulder more and more of the burden of the costs for senior housing and care. Private funding sources are going to continue to become the rule and not the exception as time moves along.

If you want to add your voice to the healthcare reform debate, click here (http://www.ahcancal.org/advocacy/Pages/SaveOurSeniors.aspx) to learn how on the American Health Care Association (AHCA) website.

Chris Orestis
Lifecare Funding Group

Is 87 Too Old To Travel?

2009-10-01T10:41:00.000-07:00

Alice, a seasoned traveler who is now a widow and has mobility issues, wasn’t sure. She loved to go on cruises, which she had been doing for some 50 years. However, she had always gone with her husband, who was also an adventurer. Without him, she felt so lost. She had the money. She had the desire. Could she do it physically? Knee problems and leg pain were getting her down. She could no longer walk or stand for long periods. She had serious doubts. (read more).

When a family member suggested getting a wheelchair for the trip, Alice balked. She could stand, exercise, walk, drive her car, live independently and take care of herself for the most part. A wheelchair?? Isn’t that for OLD people?

She booked the trip, invited to treat her adult children to the cruise, and then nearly canceled. She’d been to Europe before. The hills, the walking, the stamina needed just might be beyond her capabilities. But, when her family talked her into getting the wheelchair, ordered it for her, and it arrived, she changed her mind. This might be ok.

Twelve days in beautiful ports with the excitement, the services of a cruise ship, and her familiarity with this kind of travel was enough to entice her to go ahead. One of her kids accompanied her on the flight to the port of departure. That helped. So did the wheelchair escort in the airports. She learned that wheelchair customers go to the front of the line. The other kids met her at the rendezvous point, and it all worked out well.

The lightweight, portable wheelchair was a godsend. (Cost: $150.00). It weighed just under 15 pounds and collapsed easily. It had to be pushed by one of her kids, but that was fine. She used it often during the exploration of the ports of call, always accompanied by a family member. She could sit in the shade and wait awhile if they wanted to go ahead for a bit and see something in a place that was too steep for her.

With the use of a well engineered assistive device and some help from her family, Alice was able to enjoy the trip from start to finish. She walked freely around the ship without the chair, only taking it to go ashore. This is a success story for an 87 year old who had never traveled without her husband, and was brave enough to take the risks and adapt to her limited mobility. Last we heard, Alice is planning the next cruise, looking ahead to savoring life as much as possible.

By Carolyn L. Rosenblatt, R.N., B.S.N., Attorney

AgingParents.com

When Driving a Car is a Perilous Proposition for Your Parents: The Signs to Look for and What You Should Do

2009-08-14T11:27:00.000-07:00

I floored the gas pedal. My head whiplashed. How fast the car was going I'm uncertain, but it must have been at least 50 MPH in less than 10 seconds. It required a bit of effort, but I took my foot off the gas, momentarily coasted, then jammed on the brake pedal as hard as I could and swerved hard to the right attempting to avoid an oncoming car. A pretty harrowing experience!

Impaired vision, diminished flexibility and reduced reaction time—a deadly recipe for many Elderly Drivers.

If only my reaction time had been a split-second quicker. And, if only my neck, legs and arms had the range of motion they once had when I was younger. Not to mention my eyesight. I couldn't see the traffic signal very well.

Fortunately, I was driving on a closed-course track at Rentschler Field in East Hartford CT and, at all times, was in the comforting presence of a professional defensive driver from Liberty Mutual and was following his instructions.

But the scenario I just described is not unlike what many elderly drivers may experience when they are operating a motor vehicle. Impaired vision, diminished flexibility and reduced reaction time is a deadly recipe for any driver no matter what age he or she may be.

My ordeal that day at the closed-course track opened my eyes, literally, to the perils of driving that many seniors may experience. I was a fitted with a specially-designed "senior simulator" suit and special vision-impairing glasses to help simulate the effects of aging on my driving ability.

At 61, I am in reasonably good health. My range of motion is average for my age. My reaction time, although slowed from what it used to be when I was 28 years old, remains good. And my eyesight is 20-20 with glasses. The notion that someday I might have to surrender permanently the driver seat for the passenger seat is not on my radar screen.

The issue of when a person should stop driving can be filled with emotion and, if not handled properly, can lead to a dispute among family members that can unravel a relationship to its very core.

My father-in-law was in his late seventies when it became abundantly evident that driving a car would not only place him in peril, but other nearby drivers and pedestrians. We think he sensed it himself that the days of tooling around town were nearing an end. It was only after my wife and her brother sat down and talked with him that he agreed to give up the car keys. Interestingly, though, he refused to give up the car. For two years the car remained in the garage before it was finally sold.

My uncle was 83 at the time when he was not longer able to safely drive a car. Despite pleadings from his adult children, he strongly resisted turning over the keys. Finally, he relented, but only when his wife refused to be a passenger anymore if he was behind the wheel. Tough lady, my aunt. Good for her.

Friends in Michigan are, right now, dealing with the same issue with their 80-year-old father. I know the man. He's a terrific guy, although more stubborn than a mule when it comes to heeding the warning signs about driving. Here's a guy who routinely falls, had a hip replacement, and has the range of motion of a stale pretzel.

These three examples can be repeated unfortunately thousands of times across the nation.

For example, I received this email from Marie (last name omitted for privacy), who faced a very similar, yet familiar, situation. Marie writes:

"Yes this can be a very difficult step to take with your elderly parents. I am one of five children; our mother turned 79 in January of 09. About 5 years ago she was diagnosed with "pre-Alzheimer's." She was having mishaps with driving just prior to this time, knocking off the side mirrors, running into things taking a corner into a driveway to sharp, etc.

So she fought long and hard to keep the freedom to drive, especially since she was mostly self sufficient and lived alone. Other family drama and circumstances occurred to create the need to finally take the keys for good. Then, we worked in coordination as a family, with her primary care doctor, and, at that time, part-time care givers, to encourage her to not drive. We only allowed her to drive with one of us in the car. This was oftentimes a nerve racking experience. Then, unbeknownst to her, because we notified the Dept. of Motor Vehicles, in our state, and sent a letter from her doctor which stated she should no longer drive, they revoked her license, but it stated she could get it back upon passing a driving test. Well, that was over 6 months ago and she no longer talks about re-taking her test, much less studying for it.

My suggestion is that the family members, as well as close friends, must work together and continue to communicate to the person the safety of the situation, AND work out other options, public transportation, care givers, friends to take them to church, etc. It is a tough thing to take away this "right," but I feel that the responsibility lies with those closest to the elderly driver, (even if this means close friends), as in our experience, the elderly person themselves is usually NOT willing to stop driving. You have to be willing to create a bad effect on them in order to save their life and the lives of others on the road."

The Warning Signs
If you have noticed any of these warning signs in your parents driving, perhaps it's time to start the conversation with them about driving safety:

> Running red lights or stop signs
> Performing jerky stops or starts
> Problems seeing road signs or traffic signals
> Hitting curbs
> Straying into other lanes
> Reacting slowly Riding the brake
> Easily distracted while driving

The purpose of the event I attended in CT was for the introduction of the Driver Seat Game by Liberty Mutual.

The Driver Seat Game is a comprehensive program to provide families with resources that address the emotionally charged issue of determining when it’s time for elder parents to transition from driver’s seat to passenger seat.

The web-based game is an innovative digital approach to tackling the highly sensitive subject of senior driving. A series of mini-games actively portray the challenges many senior drivers face by dramatizing visual decline, reduced mobility and poor reaction time in three impairment stages that act as the game's difficulty settings. Players must navigate different driving scenarios: busy traffic, going to the grocery store, finding parking in crowded lots, and even evading wildlife on winding country roads. Additionally, trivia challenges throughout the game educate the player and reinforce the underlying campaign goals of awareness and empathy in the active game experience. The Driver Seat Game will empower adult children to work with their parents to find a transportation solution that makes sense for their family.

I played the game and really think it is the best way for Baby Boomers – and, frankly, people from all age groups – to understand the problems faced by older drivers.

While presented as an online game, it is compellingly realistic for the aging population and addresses some very serious issues. Most importantly, it sensitizes adult children to the very emotional changing needs of their parents.

A what a Conversation Starter!
The Driver Seat Game is a great conversation starter, too. Most families are simply not addressing the very important issue of senior mobility, perhaps because they feel ill-equipped on how to approach it.

According to a recent national survey of Baby Boomers and senior drivers by Liberty Mutual, the vast majority (75 percent) of adult children say neither they nor anyone to their knowledge has ever spoken to their parents about driving safety issues. An even greater percentage of seniors (88 percent) say no one has had these conversations with them.

The survey sheds light on a possible reason why Boomers and their aging parents don’t discuss driving safety. More than half of Boomers (58 percent) think their parents would find a conversation about changing their driving habits “uncomfortable,” and more than one in three (38 percent) believe their parents would “be angered” by such a discussion.

Encouragingly, revealed the Liberty Mutual report, this isn’t the case. Only one-quarter (24 percent) say they would find the conversation “uncomfortable,” and 9 percent say they would “be angered.” Further, 92 percent of seniors say their adult children “have a right” to raise this issue with them.

The Driver Seat Game and other comprehensive online resources can be found HERE at the Liberty Mutual senior driving resource center.

Note:
If you would like to share a story about how you handled this issue with your parents, join the dialogue. Email me at MartinDiano@Gmail.com.

by Martin Diano—Publisher, BB[KC]

About Martin Diano
Martin is publisher of the Baby Boomer [Knowledge Center]™ and Founder of Boomer Authority™. You can follow him on Twitter @MartinDiano, friend him on Facebook, and connect with him on LinkedIn.

Will My Loved One Need An Income Cap Trust to Get Medicaid Benefits?

2009-08-13T17:05:00.000-07:00

Applying for Medicaid assistance to help pay for the cost of long-term nursing home care has always been a confusing process. It is pretty rare for a person to be able to apply for Medicaid and be eligible right away. There is almost always some advance planning required. For many Medicaid applicants, that planning includes the creation of something called an Income Cap Trust.

Many states, including Oregon, have something called an “Income Cap.” The Income Cap rule states that if your monthly income is over a certain amount (currently $2,022 per month), you do not qualify for Medicaid long-term care assistance. This is true even if you have care costs that far exceed your income. For example, if your monthly Social Security and pension income is $2,200 per month, and your care costs are $6,000 per month, you do not qualify for Medicaid since your income is higher than the Income Cap.

This used to be a real problem for people, and many years ago, the only answer was to move to another state that did not have an Income Cap rule. Fortunately, the laws have changed, and a person whose income is over the Income Cap can now become qualified for Medicaid assistance by setting up a special type of trust known as an Income Cap Trust.

An Income Cap Trust is designed to hold the Medicaid applicant’s pension and Social Security income. A bank account is set up in the name of the Income Cap Trust. Each month, all of the ill person’s income is deposited into the Income Cap Trust account. So long as the trustee of the Income Cap Trust (usually a spouse, partner or adult child) agrees to spend the income in a manner approved by Medicaid, the ill person will not be disqualified from receiving Medicaid assistance, even though his or her income is over the Income Cap.

An experienced elder law attorney can be of tremendous help in this process. Most importantly, the elder law attorney prepares a plan for the spending of the ill person’s monthly income in accordance with the Medicaid rules, and submits the plan to Medicaid for approval. There are ways to design the “spending plan” in a way that provides the maximum benefit to the ill person and a healthy spouse. An experienced elder law attorney can make sure you don’t miss out on these opportunities. Remember that an Income Cap Trust takes some time to set up. You don’t want to get all of the way through a Medicaid application and be told “your application would be approved, but where is your Income Cap Trust?” Having your Income Cap Trust established at the right time can prevent long delays in Medicaid eligibility. At an average nursing home cost of $6,500 per month, a delay in your Medicaid application can prove very costly.

Do you know someone with a loved one who is in long-term care, or may need it in the future? Please pass this article along to them, so they will know about the need to plan in advance. You may save them from a stumble upon the Elder Care Path.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on
his firm and on Medicaid issues, please visit his website at www.elderlawpdx.com.

Is Dad Okay?

2009-06-12T08:57:00.000-07:00

Depression is the most common of mental conditions which can be treated, but among the elderly, it is one of the most overlooked. Sometimes, it’s because physicians don’t recognize the signs and symptoms. Sometimes it’s because of an overall attitude of society that perhaps feeling low is just part of getting old. The danger in overlooking depression is twofold. First, quality of life that could be improved isn’t, and unnecessary suffering goes on. Second, the alarming fact of elder suicide looms. Depression is both an emotional occurrence and a physical event. The physical component is triggered by brain chemistry, and can be helped.

Feeling low doesn’t have to be a permanent part of getting older. There are many elders who are able to take aging in stride, and accept the many limitations that accompany getting along in years. Aging is frequently marked by losses. Loss of spouses, siblings and friends, as well as losses of physical strength and abilities can lead to sadness. The sadness associated with loss can often be lessened with time. But what if Dad, who lost his wife last year, just doesn’t seem to care about anything anymore? If more than a year has passed since loss of a spouse, and an aging parent still seems unable to move forward, it may to be time to see the doctor for a checkup.

If you are able to accompany Dad to the doctor, mention the problem specifically. Loss of enjoyment of things one normally likes is one of the symptoms of depression. Other symptoms include feeling sad for extended periods, loss of appetite, sleeping too much or not enough, eating too much, difficulty making decisions, steady weight loss, or unusual weight gain, irritability, outbursts of temper which are not normal, and withdrawal from friends and family.

Depression is one of the most treatable of all mental health problems. Many excellent medications can make a great difference in one’s mood and ability to participate in life. Counseling or talk therapy can also be a great help in managing feelings of loss and grief and in helping an aging parent to get through the grieving process.

If Dad is just not getting back to the way he was, and has an alarmingly long, ongoing period of sad mood and other symptoms, encourage him to see his doctor. Plan to go with him to be sure he doesn’t gloss over the problem. Many elders are unaccustomed to talking about their feelings. They may lack the basic vocabulary to describe them. The adult child can offer gentle assistance with this difficult area. If unchecked, depression can become a downward spiral with no end. It can become worse and more miserable for the depressed person as time passes.

Addressing depression in an aging parent can lead to relief, and improved quality of life. It is a loving act to suggest that the problem can be improved. It may take the initiative of a son or daughter to get help for Dad, but the effect of help if well worth your effort.

By Carolyn L. Rosenblatt, R. N., Attorney at Law and Dr. Mikol S. Davis, Psychologist, AgingParents.com
Carolyn L. Rosenblatt, R. N., Attorney
Dr. Mikol S. Davis, Ed.D., Psychologist

Ms. Rosenblatt is a registered nurse, who practiced nursing for 10 years, working mostly with elders, before becoming a lawyer. She has practiced law for 30 years, as an advocate for individual rights. In 2006, she and her psychologist husband, Dr. Mikol Davis, founded AgingParents.com, a consulting and mediation service for families with aging loved ones in San Rafael, CA. Dr. Davis’s practice of 35 years has focused on anxiety and depression. Together, they form a team to assist with legal, health care and mental health aspects of aging. Ms. Rosenblatt is the author of The Boomer’s Guide to Aging Parents, available at AgingParents.com.

© 2009, Carolyn L. Rosenblatt, R. N., Attorney at Law and Dr. Mikol S. Davis, Psychologist

Sitters Make Hospital Stays Safer and Less Lonely

2009-06-11T09:17:00.000-07:00

You would think hospitals, where you are surrounded by nurses, doctors and medical staff, are one of the safest places to be. However this is sadly not the case. With one or two busy nurses working 12-hour shifts and handling many patients with critical needs, it can be a long wait before anyone comes to check on you. Plus, it only takes an instant for a dangerous fall to occur. 10% of fatal falls for older adults occur in hospitals. Dementia, disorientation and medication are the leading factors that contribute to falls in hospitals.

The best safety precaution is a specialized caregiver known as a “hospital sitter.” Hospital sitters provide round-the-clock companionship and make observations of any health problems. Sitters can monitor and keep patients company, converse and read or even run necessary errands. However, sitters cannot aid or participate in any patient care or physical contact and must stay out of the way of hospital staff.

Sitters are under the direction of the hospital’s registered nurses. In the event of an urgent need, fall or medical emergency, the sitter will be there to immediately summon the nurse in charge. One of the most helpful tasks that sitters can do is to keep a journal. Sitters can record every doctor visit/outcome that occurs during their shift and describe any procedures done and the expected and actual outcomes. Sitters can also maintain emergency contact information for the patient’s family, as well as essential legal documents—including a copy of the patient’s Advanced Directives, in case a relative is unable to be contacted for a critical decision.

Hospital sitters provide peace of mind for the patient’s family. They supply vigilance that ensures safety and companionship and reduce a patient’s boredom and depression. They also enable the patient’s family to go home and rest, knowing their loved one will never be alone.

Dr. Kathy Johnson, PhD, CMC
Home Care Assistance, Inc.
www.homecareassistance.com
__________________________________________________________________________
Kathy N. Johnson, PhD, CMC is a Certified Care Manager and the Co-Founder of Home Care Assistance, Inc. She holds a Doctorate in Psychology from the Illinois Institute of Technology. Kathy is committed to serving the needs of seniors nationwide.

Do Flexible Long Term Care Insurance Policies Exist?

2009-06-08T21:45:00.000-07:00

Many of the long term care insurance policies I am researching require me to make permanent choices about the policy benefits. Are there any types of policies that allow me to change my policy benefits in the future?

The Problem – Inflexible Policies
Most long term care insurance policies require you to make permanent decisions about the benefits of your policy upon purchasing the policy. This presents a host of problems, including:
1. insufficient coverage for the future if you chose coverage that is too modest
2. unmanageable premiums today if you choose higher coverage than you can afford
3. inability to change policy benefits and features if your health deteriorates

The Solution – Flexible Policies
Some long term care insurance policies allow you to make changes to your policy after the policy has been purchased. This can be a tremendous benefit if you are interested in obtaining a policy today, but are working within a budget.

Some insurance companies offer flexible policies that allow you to increase your coverage without additional underwriting. Imagine you purchase your policy when you are 55 years old and are in perfect health. After 10 years, you are now 65 years old, are interested in increasing your coverage, but now you suffer from a number of health conditions. A flexible policy would allow you to increase your benefit without any medical underwriting whatsoever. Despite the deterioration in your health the insurance company is legally obligated to increase your coverage upon your request.

Pay close attention to what conditions are associated with your flexibility options. Some insurance companies will allow you to exercise changes throughout the life of the policy. Others will discontinue your ability to make changes if your decline the option to change two times in a row.

Some insurance companies allow you to enhance you coverage as follows:
1. increase your daily benefit based on inflation
2. increase your benefit period
3. decrease your elimination period

Pay close attention to how the insurance company prices their flexible policy. Ideally, you should only pay for the additional benefits you add to the policy, while the premium for the initial coverage purchased at the inception of the policy remains unchanged. In the example above, you are able to save money during the first 10 years of the policy and are then able to enhance your coverage at a more affordable price than most long term care insurance polices would offer.

Action Step – Do Your Research
Before purchasing a policy, be sure to research the features of your policy. Understanding if your policy is a flexible or inflexible policy before you purchase it can avoid unnecessary aggravation and financial hardship in the future.

Aaron Skloff, Accredited Investment Fiduciary (AIF), Chartered Financial Analyst (CFA), Master of Business Administration (MBA), is the Chief Executive Officer of Skloff Financial Group, a NJ based Registered Investment Advisory firm. The firm specializes in financial planning and investment management services for high net worth individuals and benefits for small to middle sized companies. He can be contacted at www.skloff.com or 908-464-3060.

Have You Been Told Your Loved One Needs a Guardianship?

2009-05-13T16:06:00.000-07:00

We often receive calls from potential clients who have been told that their loved
one needs the assistance of a legal guardian. In the most common situation, the person has been living independently, but is showing signs of dementia, and has been doing things that put themselves or others at risk of harm. Examples include leaving the stove burners on, locking themselves out of their home, wandering out of their home and getting lost, and mixing-up their medications. Other times a senior will have a behavioral disturbance, such as striking out at care center staff and fellow residents, and a guardian is needed to consent to psychiatric medical treatment and consent to placement in a secure care facility.

A guardian is person who is appointed by a court to make health care and placement decisions for another person. We start the guardianship process by filing a court petition, explaining the circumstances to the court, and asking the court to appoint a legal guardian. We send out notices to interested persons, including close family members and people serving as trustee, power of attorney, and health care representative. A copy of the legal notice is personally delivered to the person in need of a guardianship (called a “respondent”). The respondent and interested parties have 15 days to object to the appointment of a legal guardian.

During the 15-day waiting period, a trained psychologist or nurse, known as the “court visitor”, is appointed by the Judge to interview the respondent and all persons who are knowledgeable about the respondent’s circumstances. The court visitor reports his or her findings to the Judge, including the visitor’s opinion about whether a guardian should be appointed.

From our first contact, it normally takes 20 to 25 days to obtain a guardianship. Sometimes there is an emergency situation requiring immediate action. The most common example is a respondent with a behavioral disturbance requiring immediate psychiatric treatment. In these situations, we can request a temporary emergency guardianship, which we can normally obtain within 5 or 6 days.

Sometimes the decision to file for guardianship is easy – the respondent’s behavior is creating an immediate and serious risk of harm. Other times it is more difficult. For example, we often meet with adult children of aging parents concerned about the parent’s ability to live independently, but the parent has “not yet” done anything risky or suffered harm. Filing for guardianship can create real animosity between adult children and aging parents. It is not a decision to be taken lightly. Sometimes the best decision is not to file for guardianship. An experienced elder law
attorney can be of tremendous help in weighing the pros and cons, and the timing, of a guardianship petition.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on
his firm and on guardianships, please visit his website at www.elderlawpdx.com.

Adult Care Homes: The BEST Alternative to Nursing Homes

2009-05-13T15:58:00.000-07:00

Alva is a petite, quick and witty ninety-three year old woman. Her dark eyes sparkle with mischief when she sees her caregiver’s four-year old daughter enter the sunlit bedroom. The two of them are great friends. In her southern drawl, Alva beckons the little one over onto her lap and takes a chocolate kiss out of her pocket. The little one shyly glances at me before she settles her head on Alva’s shoulder, unwraps the candy and pops it into her little mouth.

Alva loves it here. She repeats it over and over, patting the little one on the head. She’s been here for the last 8 years, ever since her husband died and her children realized that she couldn’t live on her own anymore. The caregivers are wonderful: respectful of her privacy, yet concerned over her wellbeing every minute of the day. And the food, everything homemade, including the bread, absolutely delicious.

I met Alva’s daughter over a cup of coffee later on that afternoon. She was happy to see me, she said, mainly because she was so satisfied with her mother’s living conditions and comfortable with the knowledge that her mother was in the best place possible. She wanted to get the word out. Together with her brother, they had spent weeks looking at possible options, yet in the end they decided on what had been their gut feeling to begin with: living in a homelike setting where the care ratio was one caregiver to only 5 residents would be more conducive to their mother’s wellbeing and to their state of mind.

The following morning I met with a group of adult home providers who, due to their trailblazing efforts in making this option visible, continue to set the standards high in the competitive field of geriatric living alternatives. I wanted to get their input on what sets them apart from the rest. Ana, Teddy, Melanie, and Lidia are stunning, articulate and passionate about being recognized and respected for what they do. Savvy businesswomen that they are, they realize the importance of community, and continually strive to market their businesses as well as the industry.

Based in West Linn and Lake Oswego, Oregon, the four of them together with three others, have combined their efforts in educating their communities about the benefits of adult care homes versus nursing homes. I asked them to tell me a little bit about themselves and the following is an excerpt of our talk:

What are adult foster care homes and how do they differentiate from nursing homes?
Ana: Adult care homes are home based businesses in which an individual is licensed to provide 24-hour care for senior citizens. The providers and caregivers are able to offer individualized, one-on-one care, manage medications, diseases, and/or behavioral issues within a comfortable, peaceful setting, while all along promoting independence.
Melanie: They are also more affordable than nursing homes where the overhead is often higher.
Teddy: In an adult care home there is a consistency in care and a routine developed which gives a greater sense of comfort to the resident. They know what to expect and when to expect it.
Lidia: The elderly need that home-like environment and familiar faces opposed to the confusion of a nursing home where there is a high turnover rate.

What are your reasons for opening such a business?
Lidia: It was a natural decision for me. I come from a culture where the frail older members of a family are taken in by the younger ones.
Melanie: The same applies to me as well. It’s second nature.
Ana: I grew up around it. My parents had a business in their home. My 6 other siblings currently have businesses in theirs as well.
Teddy: I’d have to add that it is an ideal business if you have young children and want to work from home.

What are the biggest misconceptions about adult foster care?
Ana: That they are under-regulated and the caregivers do not have the experience necessary. The actuality is that we are closely monitored and have to keep detailed documentation and maintain the required continuing education classes.
Lidia: Some people believe that since we do not have an RN on staff, medical care is lacking, therefore we are not as professional as a nursing home. The truth is that each of our residents’ doctors and visiting nurses are just a phone call away, 24 hours of the day.
Teddy: That anyone can do it. It actually takes patience, composure and a willingness to continually push yourself through education and motivation to be the best home out there.
Melanie: That we’re in it for the money. Yes, it pays, but so does any other business. People forget that our responsibilities stay with us 24 hours a day, 7 days a week. And that’s year after year. Even while we’re on vacation.

By: Angie Muresan

Caregiving Agreements – Fairness for the Caregiver Child

2009-03-09T18:10:00.000-07:00

A recent article in US News & World Report states that “more than 50 million family members provide more than $300 billion a year in uncompensated care to family members.” The care is frequently provided by an adult child who has moved back into the family home to take care of mom or dad. In elder law, we call this child the “caregiver child.”

The caregiver child has often left the work force to take care of an aging parent. He or she has lost an income, and also loses health insurance, Social Security and IRA contributions, and the chance to advance in his or her prior employment. A caregiver child makes many personal sacrifices in the course of caring for a parent.

At our law firm, we always ask if an adult child is providing care for an aging parent, and raise the issue of compensation for the caregiver child. The parent will often suggest leaving an additional bequest in his or her will to the caregiver child, in recognition of the care services provided. There are several problems with this approach. With the high cost of long-term care, there is no guarantee that the parent will have any assets to pass to the caregiver child. An unequal bequest in a will can also create friction between the caregiver child and the other children, who will receive less.

The best strategy involves setting up a caregiver agreement between the ill parent and the caregiver child. The agreement details the services the child will be providing and the method of payment. The agreement serves many useful functions. First, it is evidence that the payments from parent to child are not gifts that would trigger a Medicaid waiting period. Instead, the payments are compensation for services provided, not subject to any penalty. Second, the agreement reduces friction between the caregiver child and other children, since the parent clearly states his or her intent that the care be compensated.

It is very important to establish the care agreement early in the caregiving relationship. Medicaid will normally approve a written care agreement that provides for payments concurrent with services provided, so long as the amount of payment is reasonable in relation to the service provided. Medicaid is far more suspicious of caregiver agreements that purport to pay a lump sum for past services provided, and may seek to treat these payments as gifts, subject to a transfer penalty waiting period.

In our experience, parents recognize that they are asking a lot of a child who becomes a caregiver. They want to give the child the tools to do the job well. A caregiver agreement prepared by an experienced elder law attorney can be an important part of the plan. Do you know an adult child caring for an aging parent? Or a parent receiving care, who wants to make sure a caregiver child is treated fairly? Please give him or her a copy of this article.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on his firm and on elder law planning, please visit his website at www.elderlawpdx.com.

How to Protect Your Benefits When Leaving an Employer

2009-03-01T14:55:00.000-08:00

Taking the extra time to address your benefits before leaving or shortly after you leave your employer can save you from grief for years to come. Without any action, you could forego valuable benefits or jeopardize your health.

Listed below are the top four benefits that should be addressed as soon as possible.

1. Flexible Spending Account (FSA). Be sure to submit all your un-reimbursed medical expenses before leaving your employer. FSAs work on a use it or lose it basis – you must spend your balance before the end the year while you are still employed or your old employer keeps the balance.

2. Retirement Plan. Whether you have a 401(k), 403(b), or 457(b), be sure any profit sharing and matching has been credited to your account before leaving your employer. Rollover your retirement plan to an IRA. This tax-free transfer avails you to thousands of investment choices most retirement plans do not offer. Consider a tax advantaged transfer of company stock inside your 401(k) plan, using the Net Unrealized Appreciation (NUA) rule.

3. Life Insurance. Many employers offer group life insurance as a paid benefit to employees. If continuation is offered, it may be inappropriate and/or too expensive. Consider replacing it with an individual life insurance policy, which is a critical financial planning and estate panning tool.

4. Health Insurance. Less than 10% of eligible workers establish COBRA benefits during the normal 60 day window. Many decline COBRA because they must pay the entire premium (plus a 2% administrative fee) their employer was paying, which can easily cost a family $13,000 a year. The new American Recovery and Reinvestment Act of 2009, which the president signed into law on Feb. 17, includes a 65% subsidy on the cost of COBRA premiums for up to nine months.

Addressing your benefits before leaving and soon after leaving your employer can protect you and your family. Delay action and you could permanently lose benefits. Be sure to speak with an RIA obligated by law to act in your best interest when making key financial decisions.

Aaron Skloff, Accredited Investment Fiduciary (AIF), Chartered Financial Analyst (CFA), Master of Business Administration (MBA) is CEO of Skloff Financial Group, a Registered Investment Advisory firm in Berkeley Heights. He can be contacted at www.skloff.com or 908- 464-3060.

For Financial Independence, Make Long Term Care Insurance Part of Your Financial Strategy

2009-01-24T11:28:00.000-08:00

If you’d rather write your will than have a discussion about planning for long term care (LTC) needs, you’re not alone. Results from a John Hancock Life Insurance Company Long Term Care Survey revealed that more than half of the respondents opted for the will. In addition, a slightly less percentage said that going to a nursing home is worse than becoming bankrupt and half said they consider it worse than dying.

It’s clear that the emotions surrounding the very thought of losing our independence can paralyze us from taking action. But it doesn’t have to be that way. Once people understand the facts about long term care, the planning process is much easier and offers peace of mind about preserving savings, protecting family members from the burden of caregiving, and retaining independence.

Caregiving and Its Impact
Long term care is the assistance needed by someone who can no longer independently perform daily activities such as eating, bathing or dressing. This care can be received at home, in an assisted living facility, adult day care center or nursing home.It’s important to understand that long term care does not necessarily have to mean nursing home care, which seems to be the biggest fear and misconception associated with LTC.In fact, 80 percent of older adults who receive LTC do so in their own homes or community settings.That’s good news.

Yet, with the majority of LTC services provided at home, more Americans today have first-hand experience with caregiving and how it affects their personal lives, family, financial security and work situation.A portion of the John Hancock LTC survey focused on the impact of caregiving, and over half of the respondents said that a family member or friend needed care.

Knowledge is Power
While it is true that the vast majority of Americans recognize the importance of planning ahead, there is a lack of knowledge about LTC as well as the pros and cons of funding alternatives. With the national average cost for nursing home care at more than $72,000 and the expenses of at-home care or services provided in a community setting on the rise – these costs really add up. Many rely on the hope that government programs like Medicare and Medicaid will pay for LTC services — but these programs pay for very little long-term care and only in limited situations.

Long Term Care Insurance Is the Best Funding Solution
Fortunately, there is an easy way to prepare for long term care and its costs. Long term care insurance (LTCI) was identified by 42 percent of the survey respondents as the best solution for funding long term care costs. It’s important to note that LTCI premiums are based on your age and health when you apply, so it makes sense to buy when you are young, in your 40s or 50s.

When you think about it, planning for long term care is important to your overall financial and a LTC insurance policy can help:

Protect your retirement savings

Give yourself control over where you receive care– as most policies cover care in all settings these days (home, assisted living facilities, adult day care and nursing homes)

Give you the means to pay for higher quality care

Relieve your family and friends from heavy caregiving responsibilities

Qualify you for tax advantages and credits

Receive not only financial support, but professional advice, additional resources and service provider discounts.

It is true that knowledge is power. The more you know about long term care planning, the more you realize that it is no different from planning for your retirement or other key financial goals. Taking it one step at a time is the key. Do some of your own research or contact me at 503-758-5725, info@beckyltc.com, or http://www.beckyltc.com to learn how we can work together to develop a strategy that fits your needs and budget.

In Down Times, Life Insurance Offers a New Option to Fund Senior Housing

2009-01-19T17:08:00.000-08:00

If you haven’t just returned from a desert island, you know the news. The

U.S.

economy is hurting and big-ticket assets such as homes and stocks have lost value—in some cases, lots of value. While experts debate how long it will take for the economy to find its footing, seniors looking to cash in some of their assets to fund retirement living or long-term care are looking for smart options now.

Seniors typically sell their homes first when looking to fund retirement living or long-term care. But today, values are down, so selling could translate into a loss-- or more money later if you wait. On top of that, selling a home is taking much longer now, sometimes more than a year.

This is sobering news for seniors trying to ride out the bad times and regain that value later. But waiting is not always possible, especially when assistance with activities of daily living is needed now, not three years from now.

“We continue to talk to seniors who would like to move in, but they are a little hesitant, hoping the market will turn around,” said one national provider of senior housing and long term care.

A second common option to fund senior housing and health care is tapping into stocks and bonds. Like housing, stock values are well below what they were just a few years ago. In most cases, selling now would result in big losses. Reverse mortgages also became more common, but this option presents problems for seniors who want or need to move now without taking a serious loss or pay back the loan immediately.

So what is someone to do if they want or need to move into assisted living, independent living or even a long-term care situation soon?

Senior living provider offers new option

Many companies are now offering an option that is quick, easy, and helps families preserve many of their primary assets as part of the family estate. This option is called a Life Settlement, and very quickly it is becoming a financial tool for retirement living and skilled nursing care costs.

The definition of a Life Settlement is simply this: It’s the sale of a life insurance policy by the policy holder while still alive to an institutional investor that will pay a lot more for the policy than the cash “surrender” value. And, because life insurance values are guaranteed and disconnected from the economy, there is no fluctuation, as is the case with real estate and stocks.

“In the face of falling home and stock values, rising inflation, and depleted savings, many people we are meeting with are taking a close look at the Life Settlement option because it helps a family preserve long-held assets, such as a home, until it is more convenient to sell. It is not complicated with transactions often completed in 30 to 60 days,” explains Chris Orestis, principal, Life Care Funding Group, a firm that specializes in insurance matters and Life Settlements.

A Life Settlement is an alternative way for seniors to tap into an existing asset to generate liquidity to cover immediate needs. The seller of the life insurance policy gets a lump sum payment—and since it is not a loan, the funds are unrestricted and require no repayment. The gains of a Life Settlement option are tax deductible if applied to retirement living or skilled nursing care.

For those intimidated by the thought of selling their home or liquidating other assets to secure the funds they will need, a Life Settlement is a welcome alternative source of funds to access, according to Orestis.

“With billions of dollars worth of life insurance owned by people older than 65 today—tapping into Life Settlements as an alternative funding option for senior housing and care is gaining serious interest,” he said.

Life Care Funding Group can be reached at www.lifecarefunding.com

Money Managers to the Rescue!

2008-12-12T12:44:00.000-08:00

Can’t keep the checkbook balanced? Don't like or forget to pay bills? These professionals can help. Many older Americans struggle with money management, specifically paying their monthly bills. For some, physical conditions such as poor eyesight or arthritis can make simple tasks of writing checks and opening the mail difficult. Others are confused, forgetful and/or disorganized all potentially leading to past due notices, late fees, services fees, canceled policies, and lost documents.

Today, almost all of us are drowning in official-looking solicitations for credit cards, insurance, fraud protection and financial assistance from every institution in which we have an account. In the past, having several bank accounts was once considered prudent, but now has turned into a junk-mail nightmare. Junk mail can look so official it begs a reply often unknowingly opening another checking account. Charities of our world, even the ones near and dear to our hearts, continue to solicit contributions on a weekly basis. Selling mail lists has become a huge revenue generator for many companies including banks, credit cards companies, mortgage companies, telephone companies and others.

Now, we can hire a Daily Money Manager to provide assistance to people who have difficulty managing their personal monetary affairs. This service offers a cost-effective way for clients to get assistance with organizing, bill paying, balancing checkbooks, and reviewing statements, from a trusted source. A Daily Money Manager does not replace the services of other professionals, such as CPAs, banks, financial planners, and attorneys, but assists clients with daily affairs and helps maintain records and information that is essential for these professionals.

Services that may be provided:

Bill paying, preparation of checks, deposits
Balancing checkbooks and organizing bank records
Organizing files for tax and other purposes; general organization
Phone calls concerning incorrect bills, or to ascertain relevant information
Deciphering insurance information and assistance with claims
Setting up automated accounts or other means to efficiently handle household finances
Getting a handle on junk mail
Referrals to needed professionals, such as CPAs, attorneys, financial professionals

A Daily Money Manager begins with an informational interview, so you can get to know us, and we can understand the client’s needs. Together, we determine an effective plan to meet the individual needs. Typically, the DMM will visit monthly or weekly to review bills, mail, insurance papers, and help the client write the checks, balance the check book, organize and file papers.

How do you find a daily money manager? Follow this advice:

One of the best places to start your search is with the Web site of the American Association of Daily Money Managers, where you can find a list of money managers by state of residence. WWW.aadmm.com.
Before meeting face-to-face with someone, ask if they charge for the first session. Some money managers offer a free consultation, which lets you make a more informed choice about whether daily money management is for you.
Ask for references from people who have used their services before, and check those references out. After all, you're entrusting your financial health to that individual. Make sure that trust is warranted.
Make certain the DMM you're considering is insured and is willing to work with another individual such as a lawyer or an accountant on your behalf.
Get a referral from someone in the financial services field, such as your tax adviser or accountant.
Go with your gut -- it may be the most important thing to do, Make sure you like and instinctively trust this individual. If it doesn't feel right, it isn't. It's got to be a good fit.

Laura Miller can be reached at 503-654-9200
e-mail: laura_sapphiredmm@comcast.net
Website: www.sapphireDMM.com to download a brochure.

The How, When and What-If's of Talking to your Parents About Aging Issues

2008-11-03T06:24:00.000-08:00

If you're reading this you've probably reached a point where your parents have gotten old. You see them struggling to do day-to-day things like cooking or cleaning. You start to wonder about talking with them because you worry about their health and wellbeing. Yet you also wonder what to say to them and whether they'll listen.

In the following pages, I've provided some tips and tools for talking with your aging parents about concerns you have for them. There's also information to help you determine if your parent's safety is at issue. In the event your mother or father doesn't want to talk about the safety issues you see, there are several ideas for ways to handle the situation. Finally, there is a list of the many care options available to your parents along with a brief description and the pros and cons of each option in my opinion.

HOW TO TALK WITH YOUR AGING PARENTS ABOUT CONCERNS YOU HAVE FOR THEM
Give some thought to the emotional response your concerns may bring up. Often, when
adult children with aging parents are scared or worried they begin to make demands. They tell their parents what to do.

I encourage you to step back from your emotions and identify your concerns. This increases the chance of a having a successful conversation with your parent(s). I suggest you write down what's going through your head when you think about the situation and what you think needs to be done. Then write these reasons down, starting with the word, "because."
My concern Because...
You can't live alone anymore.
I'm afraid you're going to start a fire because you can't see as well as you used once did.
I'd never forgive myself if you got hurt.
I worry that you'll fall and won't be found for days.
You can't drive anymore. I'm afraid you'll get in a wreck and be seriously hurt or die.
I'm worried you'll hurt yourself or someone else.

The "because" column is how you want to start the conversation with your parent(s). Notice the language in the first column compared to the second column. You vs. I. Generally the reaction to the word "you" is defensiveness. When that happens conversations turn into a battle of wills. So speaking from your own perspective, using "I," reduces defensiveness. It also comes from a place of caring and concern. Your parent is more likely to respond when they know you're concerned and care about them. Parents usually don't want their kids to suffer. Ask for their input. Do they worry about falling? Have they thought about getting into a car accident? Older adults are painfully aware of how aging is affecting their bodies though they may not talk about it. So chances are that they've given some thought to what might need to change.

Ask them how they'd solve the problem. Include your parents in the solution. Too often, as people age, they are ignored or overlooked. It's a societal problem. It's also extremely frustrating and if your parent(s) think they don't have a choice, or their opinions don't matter, they're more likely to dig in their heels. But, more importantly, it is their life you're talking about. They should have the power to choose their destiny and will be more likely to be happier with the decisions.
Be aware that your parent is afraid of losing their independence. Chances are, you're both on the same page where their independence is concerned. Discussing your concerns sooner rather than later decreases the chances they'll harm themselves or come to any harm. By recognizing that they may be afraid of losing their rights, their ability to choose and control over their own lives, you'll better understand why they may say or react they way they do. You'll be better able to talk with them and relate to what they're going through and more likely to be successful in talking with them.

WHAT IF I THINK MY PARENT IS UNSAFE AT HOME?
If you feel your parents may be putting themselves or someone else at risk it's important to address it as soon as possible. Most older adults have one primary fear: that their independence will be taken away. Contrary to how they often see it, reducing their chances of getting hurt is the best way to maintain their independence. An obvious safety concern is driving. If you suspect, or know, your parents are unsafe behind the wheel then it's probably necessary to intervene. You may have noticed how often there's news coverage of an older motorist hitting someone or something. Some of these accidents have injured, or even killed, the older adult or other people. Admittedly, this is a tricky area to discuss with your parents, which I'll explain later, so it's a common issue that children with aging parents avoid. Doing so, however, keeps your parent and others at risk. Another concern is safety in the home. Poor balance, strokes that affect your parents ability to get around, overmedication, and the need to go up and down stairs daily are some common things that increase a person's risk for falls. Poor eyesight or an inability to think clearly or react quickly [due to a stroke, reduced oxygen to the brain, overmedication, or the beginning stages of dementia] can create a situation where your mother or father aren't able to prevent a fire from starting if a hot pad falls onto a burner or a candle tips over, for example.

H*#@ NO, I WON'T GO
Even though you feel you feel your parents are unsafe, they may not agree. I suggest to clients that they give their parents several choices and a deadline for deciding. A script for this:
"I know you don't want to discuss leaving your home; however, the reality is you can't stay here unless you accept in-home help or, you have the option of moving to assisted living. You'll have to decide by [give them a specific deadline]. I know this isn't easy for you and I'm sorry about that."

Your parent may continue to object and you may need to continue repeating some version of what I've outlined above. Showing compassion yet being firm can move many parents who dig their heels in, but not all. Despite all your efforts your parent may continue to live in an unsafe environment until something serious happens that makes it impossible for them to return home. Depending on the issue that prevents them from moving home, they may have few options.
It's not unusual for assisted living facilities to have waiting lists. Depending on your parent's health situation he/she may have to skip assisted living entirely and go to a skilled nursing facility. The best you may be able to do is talk with facilities near you, or near your parent's home, and ask to be put on a waiting list. This gives you some control over circumstances if you have to make quick decisions about your parent's living situation later on. Facilities will check with you if your name is getting near the top of their move-in list as apartments become available. If circumstances haven't changed for you, most facilities will move your name to the
end of the list.

CARE OPTIONS
There are many types of care options and each has its pros and cons.

Living with Adult Children
This option is not for everyone. I ask clients who are considering this if they've sat down and discussed it with their parents. It's not uncommon for adult children to feel it's their duty to move their parents into their home and care for them. However, when they talk with their mother or father about this they're often surprised their parent doesn't want this. Likewise, some elderly parents expect their kids to make a place for them in their home when they can no longer care for themselves. This often isn't realistic. Adult children may literally not have space for their mother or father to move in; money to pay for things their parent needs as
they age [or to move to a bigger home]; be able to afford to work less hours or take time off to provide the help their parent needs or, may not have the fortitude to be with their parents that much. Unless adult children and their mother or father have established a relationship as adults that allows for each other's differences, throwing parents and children together after years of being apart can create a lot of stress for both parties. Even if the parent/child relationship is strong and both sides are respectful of each other's time, space and lifestyle, adding a parent to your household can be hard on significant others and grandchildren. This decision takes careful consideration for everyone involved, you, your parent, your kids, your significant other, your siblings, because it impacts all of them in some way.
Pros...

an opportunity to give back to your mother or father for all they've done for you

Cons...

if the above benefit sounds rosey it's because it usually is. Rarely does the dream match reality.
high stress simply because your parent's needs will increase the older they get.

In-Home Care
There are companies that provide caregivers that will come to your parent's home. Services vary but generally they provide light housekeeping, prepare meals, write letters, provide socialization (visit with your family member), transport to appointments, help bathing and dressing and medication reminders. These companies may, or may not, provide nursing services (described below).
Pros...

your parent can continue to live in their home
may be less expensive than assisted living
covered by long-term care insurance

Cons...

Depending on the cost your parent may still be home alone much of the time. Having a device like Lifeline is one solution. You might remember the ads on television, "Help, I've fallen and I can't get up." Your parent wears a device around his/her neck and if something happens and they need help they push this button. When your mom or dad activates the device, several things may happen: some devices allow your parent to talk to a person who assesses what's needed and/or talks to your parent until help arrives; other types of devices alert a dispatcher at the company who works from a list of contacts provided by the family, if they are unable to reach anyone or, after a certain period of time, 911 is called. The main challenge with these types of devices is getting your parent to wear it ALL the time.
Your mom or dad may be limited in where they can go, or when they can schedule appointments if they have to be within the hours the caregiver is present. This is one of the biggest obstacles older adults face if they stay in their home. It's one of the main reasons they continue to drive when they shouldn't. Imagine what it would be like to always have to rely on someone else to take you where you want to go. Most U.S. lack a good public transportation system so there are many places, besides rural areas, where public transportation is not available.
Parents can be uncomfortable having caregivers do things for them so they may use the time for visiting or encourage them to leave before they've completed their chores. Asking the staff of the home care company how they address these issues before you hire them is one way to deal with this problem. Continuing to ask the company for caregiver feedback is another. Asking your parent what things the caregiver is doing for them may also give you a feel for what's being done, or not being done.

In-Home Skilled Nursing
Companies that offer this service may provide many of the same services in-home care providers do but they also provide nursing services such as: giving medications, reporting conditions and changes to your parent's doctor, taking vitals, drawing blood, giving injections, setting up medications and physical and occupational therapy.
Pros & Cons are similar to those of in home care above.

Retirement Communities
Generally these are independent living communities of people 55 and older. The living quarters can be homes or apartments, depending on the community, and residents may have the option to buy or to rent. Retirement communities are much like independent living but some services may be provided and residents are usually 55 years of age and above.
Pros:

Less upkeep than a home- Generally the dues or rent include services for grounds keeping; house cleaning services may be offered; a dining room or other type of meal service may be available and other amenities may be offered.
Less likelihood your parents will be isolated. There are often activities, excursions, etc. offered in these communities and residents tend to reach out to one another.

Cons:

Potential for narrowed thinking- While your parent may not be isolated from others, residents are primarily spending time with their own age group. Their experiences outside of the community may also be limited. These factors create the potential for them to view the world more narrowly.

Assisted Living
These facilities have apartments with kitchenettes. Generally they provide three meals a day that are part of the monthly rent. Most only serve meals in the facility's dining room. There is a nurse on staff and nursing aides who administer medications (some facilities will let residents who are cognitively able manage their own medications). Most facilities offer outings throughout the month for residents. Housekeeping is provided.
Pros:

Your parent will be less isolated
They can get their care needs met less expensively than with in-home care

Cons:

Facilities can be fairly regimented- It's less expensive and more convenient for the facility to provide meals and some services to residents on a schedule. This can be fairly frustrating since this is another area older adults lose control over basic things: when to eat; bathe, etc.
Your parents daily needs may not be met quickly- A focus on turning a profit and a lack of employee commitment to the work (usually due to low wages) often means facilities are understaffed

Skilled nursing facility (a.k.a. nursing homes)
This is the type of facility that was available for your parents' parents. Most confuse assisted living with this type of facility. Nursing homes have become skilled nursing facilities (SNF pronounced like sniff) because medical insurers can save costs by moving patients here who need rehabilitation or a longer recovery period after their hospital procedure. It is not true, as your parents may believe, that you never get out of a SNF. It depends on why someone is there. Usually people stay long term if their needs are more than an assisted living facility can provide. (This would be similar to in-home skilled nursing services; the needs are greater than "basic" service: wheelchair bound; need helping getting in and out of bed, chairs, etc. can't walk without assistance, etc.) Some people on Medicaid may be in a SNF because they can't find an assisted living facility that will take Medicaid. Some people may not have enough money for assisted living but have too much for Medicaid. There may be a unique reason a person would stay in a nursing home long term besides those I've mentioned.
Pros:

Staff have the training to take care of extensive medical needs
It is less expensive than in-home care

Cons:

Facilities are often understaffed and employees are usually overworked
Privacy is often at a minimum
Your parent has little control over their environment

Continuing Care Retirement Communities (Three in One)
Some senior housing options have a retirement community, assisted living and skilled nursing (or only the last two) all in the same place.
Pros:

Your parent can get the level of care they need without having to leave familiar surroundings and friends

Cons

Any of the cons I've mentioned above

I hope this report helps you feel more confident in dealing with the issues that come up as your parent's age, in talking with them about your concerns and in helping them make the right decisions for their health and wellbeing.

Lynne Coon, MS
Counseling and Resources for Adults with Aging Parents
www.lynnecooncounseling.com

Understanding Compulsive Hoarding

2008-11-02T06:25:00.000-08:00

We have all heard stories about compulsive hoarders. Maybe you have been to someone's house and had to navigate via "goat trails" in and out of the person's accumulated possessions. I have always thought of this as simply an eccentric behavior. But recently I read a story that caused me to think more deeply about this problem.

A man had been married to his wife for over 50 years. She was a compulsive hoarder. They had separate rooms in their home. His was meticulously clean; hers was absolutely jam-packed with junk. He took care of his wife when her health went into decline. As she was dying, her last words were not something like "I love you", instead, her last words were "please don't touch my stuff".

Hoarding is defined as the acquisition of, and inability to discard items, even though they appear to others to have no value. People with compulsive hoarding syndrome have immense difficultly throwing things away, even items of little or no value such as old newspapers, bits of string, worn-out clothes, and junk mail.

A person who is a compulsive hoarder has a variety of thoughts going through his or her mind. Items may be perceived to have sentimental value, and "If I throw it away, I am throwing away part of myself." Hoarders have a difficult time making decisions. They fear making the wrong decision, so they will save an item to avoid making a "bad choice" of getting rid of it. Hoarders may feel responsible for those around them, so they will save items "just in case I or my loved ones need them".

Hoarders also have control issues. They may feel that the moment they throw something away, they are no longer in control, and what happens to this item is in the hands of others. Hoarders are also afraid of forgetting what something looked like, or its content, and fear that "once the item is gone, it's gone forever." There is also a fear of "letting go." For example, a hoarder may fear that once she has thrown something away, that part of her life, no matter how insignificant, is gone forever.

Hoarding also creates safety issues. Excessive clutter causes fire and tripping/fall hazards. People have trapped themselves in homes and apartments, and floors have collapsed due to the weight of hoarded materials.

Hoarding also creates a stress for family members, who may feel embarrassed, frustrated, or resentful of the hoarding behavior. They are ashamed of the clutter, but are forced to live amidst chaos. Family members often resort to "self-help" methods by attempting to clean or organize without the consent of the hoarder, which leads to arguments and fights.

Compulsive hoarding is considered to be a form of obsessive-compulsive disorder (OCD). There are two forms of treatment: medications and behavioral techniques. People working with compulsive hoarders should encourage them to find a psychiatrist or therapist who is experienced in the treatment of OCD who can prescribe appropriate medications and help teach the person to gradually begin to discard items.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on elder law issues, check out his website at www.elderlawpdx.com.

Forget Me Not: November is National Alzheimer's Awareness Month

2008-11-01T14:42:00.000-07:00

Dementia is a major issue for older people and their families. According to the Centers for Disease Control and Prevention, 47% of people age 85 and older have some kind of dementia. In my elder law practice, I find it helpful to have a working knowledge of the different types of dementia affecting our clients and their families. The major categories of dementia are as follows:

Mild Cognitive Impairment. This exists when a person has a complaint about memory loss that is corroborated by someone else. Neuropsychological testing will show that these patients have an objective memory impairment when compared to peers of similar age and educational background. At this stage, the person appears to have normal general cognitive function and can perform activities of daily living. Mild cognitive impairment is not in itself a diagnosis of dementia. However, many people diagnosed with mild cognitive impairment will progress to a diagnosis of Alzheimer's Disease.

Alzheimer's Disease. This may start with a loss of short-term memory. As it progresses, the patient will experience an impairment in executive function (the ability to make and carry out a plan) and judgment. He or she will have difficulty making appropriate choices. Social skills may be lost. Next, the patient may experience aphasia, or language impairment. Initially, this manifests as difficulty making word choices. As the illness progresses, the patient's verbal communication is very difficult to understand, and in late stages, the patient may not speak at all. Another symptom is called apraxia, which is motor memory impairment. This is where the person has difficulty with activities of daily living, such as bathing and dressing. The person may easily become disoriented as to time and place, and is at risk of getting lost. Finally, the person may experience symptoms of agnosia, which is the inability to recognize the purpose of an object. He or she may not know what to do with a toothbrush, or may take a cup of coffee and pour it on the floor. Approximately 10% of Alzheimer's Disease cases are so-called "early onset," with diagnosis prior to age 65. These cases tend to progress faster than "late onset" Alzheimer's Disease.

Vascular Dementia. This is a decline in cognitive ability that is usually the result of a stroke. It is the second leading cause of dementia. It occurs when brain tissue is damaged because of reduced flow of blood to the brain. The brain cells have difficulty working together to process information. Executive function is often affected, but memory impairment may be less severe than with Alzheimer's Disease.

Lewy Body Dementia. This is a progressive dementia characterized by a significant fluctuation in the person's cognitive impairment. There will be periods of acute confusion, and recurrent, detailed visual hallucinations. The person may show motor symptoms similar to Parkinson's Disease, such as changes in gait. He or she may shuffle or walk stiffly. There may be frequent falls. People with Lewy Body dementia are very sensitive to anti-psychotic medications, which can worsen cognition and motor control issues, and increase hallucinations. For this reason, it is very important that proper diagnosis is made and health care providers are educated about this form of dementia.

Frontal-Temporal Dementias. These are dementias of behavior rather than memory. The onset is more rapid than with Alzheimer's Disease. Symptoms include early and severe changes in personality, judgment, planning, and social function. Pick's Disease is an example of a frontal-temporal dementia.

One of the most important things a person with mild cognitive impairment or early
dementia/Alzheimer's can do is to develop a plan to insure good care and quality of life, and to make sure their legal affairs are in order. Alzheimer's Disease and Dementia Planning is one of our specialties. If you know someone affected by Alzheimer's Disease, please give him or her a copy of this article.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on
his firm and on Medicaid planning, please see his website at www.elderlawpdx.com.

Understanding Life Sustaining Measures

2008-09-17T06:21:00.000-07:00

You have decided to follow your doctor's advice and complete an Advance Directive for Health Care thus providing a clear understanding of your wishes as they relate to life sustaining measures. You understand the significance of having an Advance Directive, but as you research the process, you are confronted with a lack of understanding regarding what life sustaining measures encompass.

Life sustaining measures can be defined as, "Any medical treatment in which the primary goal is to prolong life rather than treat the underlying condition." In such cases an individual's own body is not capable of sustaining proper functioning on its own without medical intervention. Some examples of life sustaining measures are:

Artificial nutrition and hydration are utilized when an individual is not receiving the nutrients necessary for health and well being. Artificial nutrition (tube feeding) requires a tube be placed into the stomach or the upper intestine. Hydration (fluid replacement) involves tube placement intravenously (IV) via a needle.

Cardiopulmonary resuscitation (CPR) is used when an individual's heart beat and/or breathing has stopped. CPR includes treatments such as mouth-to-mouth resuscitation, chest compressions, electric shock and/or drugs to restart the heart. CPR can be life saving, however, there is a risk of broken or cracked ribs, punctured lungs and death.

Mechanical ventilation supports a person's breathing when they can no longer breath on their own. In this situation a machine called a ventilator forces air into the lungs via tubing in the mouth or nose.

Dialysis is the artificial process by which waste products and excess water are removed from the blood. It is used when the kidneys are no longer able to do this adequately.

These examples of life sustaining treatments are just a few of the more common measures taken to continue life when one or more body systems are not working properly. Deciding what, if any, treatments are right for you should depend on several factors:

Does the treatment relieve suffering, restore functioning, or enhance the quality of life? If so, these would be some of the benefits of treatment. Conversely, a treatment may be considered problematic if it is painful, prolongs the dying process or negatively effects the quality of life. Other questions to ask yourself might be: What are my values as they relate to life prolonging measures? Who will carry out my wishes should I become incapacitated? If I start treatment and it does not improve my status will I want to continue that treatment? If so, when? (It should be noted that it is ethically and legally acceptable to discontinue a treatment that is no longer of benefit. It is the disease not the withdrawal of treatment that causes death.)

How you choose to complete your Advance Directive and what measures you choose to take are up to you. Talk to your doctor and don't be afraid to ask questions if you find the terminology confusing or you simply don't understand. Ultimately understanding your Advance Directive and the medical terminology associated with it will enable you to communicate your wishes to those providing your health care and increase the likelihood that your wishes will be honored.

Finally, understand that completing an Advance Directive for Health Care is a gift to your loved ones. Instead of guessing about what your wishes might be, they have a clear, written, and legally binding expression of your wishes, enabling them to serve as your advocate.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on his firm and on Medicaid planning, please see his website at www.elderlawpdx.com.

Salute our Veterans with Quality Care!

2008-07-04T06:18:00.000-07:00

When families come to see me regarding the long-term care needs of a loved one, we always identify two goals. The first, and most important goal is good quality care. The second is to obtain that care in a manner that does not completely impoverish the older person and his or her spouse. In developing a plan to pay for good care, we have to identify all sources of funds to help pay for that care. The most overlooked source of help with long-term care costs is a Veteran's Administration (VA) benefit that pays monthly income to veterans and their spouses, and to the surviving spouses of deceased veterans. This benefit is commonly known as "Aid and Attendance Benefits."

In 2008, an unmarried veteran can receive a cash payment of as much as $1,554 per month. A widow or widower of a deceased veteran can receive up to $998 per month. Married veterans can receive up to $1,842 per month. While this is not enough to pay for 24-hour care, it can be of great help for the senior who is still living at home or in community-based care, and needs to bring in some extra help to remain independent.

Like Medicaid, the VA Aid and Attendance benefit is a means-tested program. Generally speaking, assets have to be reduced to approximately $80,000, plus the home and one car, in order to qualify. The applicant must have limited income, however, high medical and care costs can be used to offset the applicant's income.

In addition, the Aid and Attendance benefit is limited to wartime veterans and their spouses. The veteran does not have to have a service connected injury or have served in combat; military service during wartime for even one day is sufficient. The veteran or his or her spouse must need assistance with activities of daily living. Even if the veteran has assets exceeding $80,000, it is possible to plan to obtain Veteran's Aid and Attendance benefits.

Unlike Medicaid, there is no five-year "penalty period" if the applicant has transferred assets out of his or her name. The eligibility rules regarding planning are not as restrictive as the Medicaid eligibility rules. By doing planning to obtain Veteran's Benefits, it is sometimes possible to pay for care while staying out of the Medicaid system. Still, Veteran's Benefit planning should always be done by an experienced elder law attorney who understands the Medicaid rules, just in case the veteran may someday need to qualify for Medicaid assistance.

Do you know a military veteran who served our country during wartime, and who could use some extra money to pay for care costs? If so, please give him or her a copy of this article. Planning for Veteran's Benefits is an excellent way to provide extra income to help the veteran and his or her spouse receive the care they need, while staying independent as long as possible.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on
his firm and on Elder Law planning, please see his website at www.elderlawpdx.com.

Dad's Odd Behaviors Don't Mean He Has Alzheimer's-He's Just Getting Older, Right?

2008-06-24T06:16:00.000-07:00

For eleven years I pleaded with my elderly father to allow a caregiver to help him with my ailing mother, but after 55 years of loving each other--he adamantly insisted on taking care of her himself. Every caregiver I hired to help him sighed in exasperation, "Jacqueline, I just can't work with your father--his temper is impossible to handle. I don't think you'll be able to get him to accept help until he's on his knees himself."

My father had always been 90% great, but boy-oh-boy that temper was a doozy. He'd never turned it on me before, but then again--I'd never gone against his wishes either. When my mother nearly died from an infection caused by his inability to continue to care for her, I immediately flew from Southern California to San Francisco to save her life--having no idea that in the process it would nearly cost me my own.

EARLY SIGNS OF DEMENTIA?
I spent three months nursing my 82-pound mother back to relative health, while my father said he loved me one minute but then get furious over some trivial little thing and call me horrible names and throw me out of the house the next. I was stunned to see him get so upset, even running the washing machine could cause a tizzy, and there was no way to reason with him. It was so heart wrenching to have my once-adoring father turn against me.

I immediately had the doctor evaluate my father, only to be flabbergasted that he could act completely normal when he needed to! I could not believe it when the doctor looked at me as if I was crazy. She didn't even take me seriously when I reported that my father had left the gas stove on without it lighting, or that he had nearly electrocuted my mother. Luckily, I walked into the bathroom just three seconds before he plugged in a huge power strip, which was in a tub of water--along with my mother's soaking feet!

Much later, I was furious to find out that my father had instructed his doctor (and everyone he came into contact with) not to listen to anything I said because I was "just a (bleep bleep) liar"--and all I wanted was his money! (Boy, I wish he had some.)

Then things got serious. My father had never laid a hand on me my whole life, but one day he nearly choked me to death for adding HBO to his television--even though he had eagerly consented to it just a few days before. Terrified and shaking, I dialed 911 for the first time in my life. The police came and took him to a psychiatric hospital for evaluation, but I just could not believe it when they released him saying they couldn't find anything wrong with him. What is even more astonishing is that similar horrifying incidents occurred three more times.

CAREGIVER CATCH 22
I was trapped. I couldn't fly home and leave my mother alone with my father--because she'd surely die from his inability to care for her. I couldn't get healthcare professionals to believe me--because my father was always so darling and sane in front of them. I couldn't get medication to calm him, and even when I finally did--he refused to take it, threw it in my face, or flushed it down the toilet. I couldn't get him to accept a caregiver in their home, and even when I did--no one would put up with him for very long. I couldn't place my mother in a nursing home--he'd just take her out. I couldn't put him in a home--he didn't qualify. They both refused any mention of Assisted Living--and legally I couldn't force them. I became a prisoner in my parents' home for nearly a year trying to solve crisis after crisis, crying rivers daily, and infuriated with an unsympathetic medical system that wasn't helping me appropriately.

GERIATRIC DEMENTIA SPECIALIST MAKES RIGHT DIAGNOSIS
You don't need a doctorate degree to know something is wrong, but you do need the right doctor who can diagnose and treat properly. Finally, I stumbled upon a compassionate neurologist specialized in dementia, who performed a battery of blood, neurological and memory tests, along with CT and P.E.T. scans. He reviewed all of my parents' many medications and also ruled out all the many reversible dementias. And then, you should have seen my face drop when he diagnosed Stage One Alzheimer's in both of my parents--something that all of their other doctors had missed entirely.

TRAPPED IN OLD HABITS
What I'd been coping with was the beginning of Alzheimer's, which starts intermittently and appears to come and go. I didn't understand that my father was addicted and trapped in his own bad behavior of a lifetime and that his habit of yelling and pounding the table to get his way was now coming out over things that were illogical and irrational... at times. I also didn't understand that demented does not mean dumb (a concept that is not widely appreciated) and that he was still socially adjusted never to show his "Hyde" side to anyone outside the family. Even with the onset of dementia, it was amazing he could be so manipulative and crafty. On the other hand, my mother was as sweet and lovely as she'd always been.

BALANCING BRAIN CHEMISTRY
I learned that Alzheimer's is just one type of dementia (making up 65% of all dementias) and there's no stopping the progression nor is there yet a cure. However, if identified early there are medications that in most people can mask/slow the progression of the disease, keeping a person in the early independent stage longer--delaying full-time supervision and nursing home care. (Ask a Dementia Specialist about the FDA approved medications: Aricept, Exelon, Razadyne and Namenda.)

After the neurologist treated the dementia and then the depression (often-present in dementia patients) in both of my parents, he prescribed a small dose of anti-aggression medication for my father, which helped smooth out his volatile temper without making him sleep all day. (Boy I wish we'd had that fifty years ago!) It wasn't easy to get the dosages right and not perfect, but at least we didn't have to have police intervention anymore! And once my parents' brain chemistries were better balanced, I was able to optimize nutrition, fluid intake, and all their medications with much less resistance.

CREATIVE BEHAVIORAL TECHNIQUES
As soon as the medications started working, I was finally able to implement some creative behavioral techniques to cope with all the bizarre behaviors. Instead of logic and reason--I learned to use distraction, redirection and reminiscence. Instead of arguing the facts--I simply agreed, validated their frustrated feelings, and lived in their reality of the moment. I finally learned to just "go with the flow". And, if none of that worked, a bribe of vanilla ice cream worked the best to get my obstinate father into the shower, even as he swore a blue streak at me that he'd just taken one yesterday (over a week ago)!

Then finally, I was able to get my father to accept a caregiver in their home (he'd only alienated 40 that year-most only there for about ten minutes), and with the tremendous help of Adult Day Health Care five days a week for them, and a weekly support group for me, everything started to fall into place. It was so wonderful to hear my father say once again, "We love you so much, sweetheart."

ALZHEIMER'S / DEMENTIA OFTEN OVERLOOKED
What is so shocking is that no one ever discussed the possibility of Alzheimer's with me that first year. I was told their "senior moments" and intermittently odd behaviors were just old age, senility, stress, and a "normal part of aging". Since one out of every eight persons by the age of 65, and nearly half by the age of 85, get Alzheimer's Disease--I should have been alerted to the possibility. Had I simply been shown the "Ten Warning Signs of Alzheimer's", I would have realized a year sooner what was happening and known how to get my parents the help they so desperately needed.

If any of this rings true for you or someone you love, I urge you to seek early evaluation from a Dementia Specialist-immediately!

TEN WARNING SIGNS OF ALZHEIMER'S
(Reprinted with permission of the Alzheimer's Association)

1. Memory loss
2. Difficulty performing familiar tasks
3. Problems with language
4. Disorientation of time and place
5. Poor or decreased judgment
6. Problems with abstract thinking
7. Misplacing things
8. Changes in mood or behavior
9. Changes in personality
10. Loss of initiative

Expanded Descriptions: http://www.elderrage.com/alzheimers.asp

Jacqueline Marcell is a former television executive whose caregiving experience resulted in her first (bestselling) book "Elder Rage", a Book-of-the-Month Club selection being considered for a film. Over fifty endorsements include: Hugh Downs, Regis Philbin, John Hopkins Memory Clinic, and the National Adult Day Services Association who bestowed on her their Media Award. She also hosts the "Coping With Caregiving" radio program www.wsRadio.com/CopingWithCaregiving. Jacqueline is also an International speaker who has delivered over 150 keynotes, including to the Florida House of Representatives. She also writes a Q&A column for AgingCare.com, and Blogs for HealthCentral.com and ThirdAge.com. Jacqueline is also a breast cancer survivor who advocates that everyone (especially caregivers), closely monitor their own health.

Power of Attorney for Finances: An Essential Tool for Elder Care Planning

2008-06-12T06:12:00.000-07:00

Most people understand the need to have a will, so that when they pass away, assets will go to their chosen beneficiaries. Most people do not realize that they also need to appoint a power of attorney to make financial decisions and manage assets for them, if they become incapacitated.

If you think about it, most any financial decision we make requires a signature. Selling a house, writing a check, entering into agreements, etc., all require that we be able to sign documents. A signature itself is not even enough; the law imposes a requirement that the person signing the document have sufficient mental capacity to understand what they are signing.

As we age, there is a greater possibility that a time will come when we are not able to sign important legal documents. Or, even if we can sign our name, we may not understand what we are signing. At that point, assets are frozen unless someone has been given the legal authority to make financial decisions for you. The best way to do this is through a power of attorney for finances.

A power of attorney for finances is a document you can sign to appoint another person to make important financial decisions for you in the event you become incapacitated. The person you appoint is called your "agent". It is a good idea to name one or more alternate agents, in the event your first choice is unable or unwilling to serve in that role.

As an Elder Law attorney, one of the most common phone calls we receive is "I need to get power of attorney for my Mom." My answer is always, "that's great, we'd love to help your Mom. Let's schedule a time for her to come in and discuss it." "Well, that's a problem," replies the caller "because Mom has Alzheimer's Disease, and she won't understand what you are talking about."

In this situation, it may be too late to get a power of attorney. A power of attorney must be signed by a person who is legally competent. This means the signer must have the ability to understand the nature and importance of the document. If someone already has Alzheimer's Disease, or dementia, or has suffered a stroke, it may be too late to sign a power of attorney. Therefore, it is important to sign a power of attorney while a person has mental capacity to understand the document.

When deciding who should be your agent, remember that the most important qualities are honesty and good financial management skills. The main disadvantage to having a power of attorney is, a dishonest agent could use the power of attorney to misappropriate your assets. Therefore, only appoint the most trustworthy people to serve in this role. There are also professional trust companies that may agree to serve as your agent.

A power of attorney should always be prepared by an experienced elder law attorney. It is possible to obtain a generic power of attorney from a legal stationery store. However, this form will not give the agent the ability to make many types of important decisions for a disabled person. An experienced elder law attorney can provide a power of attorney that will give your agent flexibility to make important financial decisions if you are not able to make them yourself, such as disability planning, creating trusts, long-term care cost planning and tax planning.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on his firm and on Medicaid planning, please see his website at www.elderlawpdx.com.

How an Elder Law Attorney can Help with Long-Term Care Planning

2008-06-11T06:08:00.000-07:00

Elder Law attorneys help older people and their families with all of the legal consequences of aging. These consequences tend to fall into three categories: surrogate decision making for finances and health care; estate planning; and long-term care cost planning. We use powers of attorney for finances and advance directives for health care, wills and trusts, and a variety of strategies to help people get and pay for good care. When an older person lacks the ability to pay for care over their life expectancy using private savings or long-term care insurance, an elder law attorney will advise him or her on qualifying for long-term care assistance through the Medicaid program.

It is appropriate to refer an older person and his or her family to an elder law attorney for possible Medicaid planning in most cases where there is a need for long-term care. The elder law attorney will meet with the elder and his or her supportive family members. We will look at the income and resources available to the elder, and try to assess the level of care needed. We will also consider the needs of other family members, such as a healthy spouse or a disabled child, who may be dependent on the same income and resources for support. We can then advise the elder and his or her family whether the private resources are sufficient to pay for the care of the elder and to support the healthy spouse and any disabled children. If there is any chance the private resources will be insufficient for these purposes, the elder law attorney will suggest Medicaid planning.

Medicaid planning involves the restructuring of an elder's finances in order to qualify for Medicaid long-term care assistance without losing everything. Medicaid is a means-tested program, and the elder's assets often have to be spent down to very low levels before he or she will qualify. In the case of an unmarried person, his or her assets have to be spent down to $2,000. If the ill person is married, the healthy spouse can keep a portion of the assets, however, this portion is usually insufficient to pay for the spouse's care for his or her life expectancy. Through the process of Medicaid planning, an elder law attorney can get a much better result for the ill person, a healthy spouse, and any disabled children.

The bottom line for this type of planning is good care and personal dignity for the elder. In our system of health care, money is often necessary to insure a good quality of life for the elder. Protected funds can be used to support a healthy spouse in the community, pay for a geriatric care manager for the ill spouse, and provide for special needs items for a disabled child. An elder law attorney is an important part of the long-term care team and can make a tremendous, positive difference in the dignity and quality of life for elders facing serious health issues.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on his firm and on Medicaid planning, please see his website at www.elderlawpdx.com.