June 14, 2010
Recognizing Symptoms of Dementia
The Brown family reunion has always been an event everyone looks forward to. Family visits, games, stories and everyone’s favorite foods are always on the agenda. On the top of the menu is Grandmas Lemon Coconut Cake. Grandma always makes the traditional cake from her old family recipe. This year, however, the cake tasted a little on the salty side, perhaps a half cup full of salty.
Though the family was disappointed over the cake, of more concern was Grandma’s confusion with the recipe and her similar confusion about the loved ones around her. Could something be wrong with grandma’s mental state?
One might say that for an elder person a little forgetfulness or confusion is normal, but when do you know if there is a serious problem, such as dementia?
An online article from FamilyDoctor.org outlines some common symptoms in recognizing dementia.
“Dementia causes many problems for the person who has it and for the person’s family. Many of the problems are caused by memory loss. Some common symptoms of dementia are listed below. Not everyone who has dementia will experience all of these symptoms.
- Recent memory loss. All of us forget things for a while and then remember them later. People who have dementia often forget things, but they never remember them. They might ask you the same question over and over, each time forgetting that you’ve already given them the answer. They won’t even remember that they already asked the question.
- Difficulty performing familiar tasks. People who have dementia might cook a meal but forget to serve it. They might even forget that they cooked it.
Problems with language. People who have dementia may forget simple words or use the wrong words. This makes it hard to understand what they want. - Time and place disorientation. People who have dementia may get lost on their own street. They may forget how they got to a certain place and how to get back home.
Poor judgment. Even a person who doesn’t have dementia might get distracted. But people who have dementia can forget simple things, like forgetting to put on a coat before going out in cold weather. - Problems with abstract thinking. Anybody might have trouble balancing a checkbook, but people who have dementia may forget what the numbers are and what has to be done with them.
- Misplacing things. People who have dementia may put things in the wrong places. They might put an iron in the freezer or a wristwatch in the sugar bowl. Then they can’t find these things later.
- Changes in mood. Everyone is moody at times, but people who have dementia may have fast mood swings, going from calm to tears to anger in a few minutes.
Personality changes. People who have dementia may have drastic changes in personality. They might become irritable, suspicious or fearful. - Loss of initiative. People who have dementia may become passive. They might not want to go places or see other people.”
Dementia is caused by change or destruction of brain cells. Often this change is a result of small strokes or blockage of blood cells, severe hypothyroidism or Alzheimer’s disease. There is a continuous decline in ability to perform normal daily activities. Personal care including dressing, bathing, preparing meals and even eating a meal eventually becomes impossible.
What can family members do if they suspect dementia? An appointment with the doctor or geriatric clinic is the first step to take. Depending on the cause and severity of the problem there are some medications that may help slow the process. Your doctor may recommend a care facility that specializes in dementia and Alzheimer’s. These facilities offer a variety of care options from day care with stimulating activities to part or full-time live-in options. Sometimes if patients tend to wander off, a locked facility is needed.
In the beginning family members find part time caregivers for their loved one. At first, loved ones need only a little help with remembering to do daily activities or prepare meals. As dementia progresses, caregiving demands often progress to 24 hour care. Night and day become confused and normal routines of sleeping, eating and functioning become more difficult for the patient. The demented person feels frustrated and may lash out in anger or fear. It is not uncommon for a child or spouse giving the care to quickly become overwhelmed and discouraged.
Family gatherings provide an excellent opportunity to discuss caregiving plans and whole family support. It is most helpful if everyone in the family is united in supporting a family caregiver in some meaningful way.
“The first step to holding a family meeting, and perhaps the most difficult one, is to get all interested persons together in one place at one time. If it’s a family gathering, perhaps a birthday, an anniversary or another special event could be used as a way to get all to meet. Or maybe even a special dinner might be an incentive.
The end of the meeting should consist of asking everyone present to make his or her commitment to support the plan. This might just simply be moral support and agreement to abide by the provisions or it is hoped that those attending will volunteer to do something constructive. This might mean commitments to providing care, transportation, financial support, making legal arrangements or some other tangible support.” The Four Steps of Long Term Care Planning
Professional home care services are an option to help families in the home. These providers are trained and skilled to help with dementia patients. Don’t forget care facilities as well. It may be the best loving care a family member can give is to place their loved one in a facility where that person is safely monitored and cared for.
Angela N. Manz is an estate planning and elder law attorney licensed in VA and NC.
April 8, 2010
Angela N. Manz is now licensed to practice law in NC
The Law Office of Angela N. Manz is pleased to announce that Angela Manz is now licensed to practice law in the state of North Carolina. Angela took the February, 2010 NC bar exam and will be sworn in at the end of April.
A personal note from Angela: I want to extend my heartfelt thanks to all those who helped and supported me while I studied for the bar exam. It was difficult, but definitely worth it. Your kind thoughts and prayers were much appreciated and I couldn’t have done it without your support. I will be expanding my practice to cover Elizabeth City and the surrounding areas, as well as Charlotte, NC where I have many wonderful friends and family members.
-Angela
March 21, 2010
Planning for Your Elder Years
If we were to ask an older person what his or her most important concerns for aging are, we would probably get a variety of different answers. According to surveys frequently conducted among the elderly, the most likely answers we would receive would include the following three principal concerns or life wishes:
1. Remaining independent in the home without intervention
from others2. Maintaining good health and receiving adequate health care
3. Having enough money for everyday needs and not outliving
assets and income
To address these concerns or wishes and maintain the quality of life wanted in the elder years, it simply takes a little preplanning.
Few people do this kind of planning.
It is human nature not to worry about an event until it happens. We may prepare financially for unexpected financial disasters by covering our homes, automobiles and health with insurance policies.
However, no other life event can be as devastating to an elderly person’s lifestyle, finances and security as needing long term care. It drastically alters or completely eliminates the three principal lifestyle wishes listed above.
The majority of the American public does not plan for this crisis of needing eldercare. The lack of planning also has an adverse effect on the older person’s family, with sacrifices made in time, money, and family lifestyles.
Because of changing demographics and potential changes in government funding, the current generation needs to plan for long term care before the elder years are upon them.
Let us look at some facts.
- The population of the “very old,”–older than age 85–is the
fastest growing group in America. This population is at
highest risk for needing care. (Statistical abstract of the United States,
2008, population) - Medical science is preventing early sudden deaths, which
means living longer with impaired health and greater risk of
needing long term care. - The Alzheimer’s Association estimates the risk of
Alzheimer’s or dementia beyond age 85 to be about 46% of
that population. - It is estimated that 6 out of 10 people will need long term
care sometime during their lifetime. - Children are moving far away from parents or parents move
away during retirement making long distance care giving
difficult or impossible. - Government programs–already stretched thin for long term
care services–will experience even greater stress on
available funds in the future.
One of the important things for planning is how to maintain your lifestyle as you age. You may be healthy enough to stay in your own home with help provided for the following activities of daily living:
maintaining a home,
providing meals,
supervision,
companionship,
transportation and
shopping services.
This type of care at home is non-medical and must be provided free of charge by family, friends, or volunteers or the care must be paid for out-of-pocket by the family.
Government programs, in most cases, will not pay for this kind of care. It is estimated that 80% of all long term care is non-medical, with 90% of that care provided in the home. It is most likely that your long term care will begin with home care.
It is wise to plan now how you will pay for care when it is needed. In evaluating your future income you may find it necessary to add some resources such as long term care Insurance to pay for assisted living or nursing home costs. Long term care insurance must be purchased while you are younger and healthy. Failing health, stroke or other aging issues will not allow you to qualify for this insurance.
A reverse mortgage will also help pay for home care if staying in your home is an option.
Consider where you may want to live in your elder years. Many assisted living facilities offer complete care alternatives with a nursing home wing if needed. Senior retirement communities also offer many amenities with some including home care options.
Now is the time to do estate planning. A professional estate planner will give you direction on how best to protect your assets for future needs and for Medicaid planning.
Do your paper work. Now is the time to create your trusts, will, medical directives in a living will and any other documents you want noted for future use. Gather Insurance policies and bank records where they can be found by family members in case you are not able to get them yourself.
We don’t like to think of our elder years in terms of health problems, but a sudden stroke, heart failure or onset of dementia could make it impossible to carry out our own wishes if preparation was not made ahead of time.
Make sure that you and your loved ones have a plan for long term care. Remember – prior planning makes all the difference.
March 12, 2010
Elder Law Attorneys Specialize in Helping the Elderly
Many elderly persons rely entirely on their children, family members or other trusted individuals to help them. This dependence upon caregivers or family members makes an older person more vulnerable to abuse and financial exploitation. Legal arrangements and protective actions by family may be necessary to shield loved ones from making bad decisions or from being taken advantage of.
Though you wouldn’t think a child could take advantage of his or her mother or father, there is no way to know what someone will do who is desperate for money or who feels entitled to an inheritance. For example:
David’s parents’ health was failing and living alone in their home was becoming a concern. His sister Jill wanted to look into assisted living for them. David immediately became upset at Jill for wanting to spend their money. He packed up his parents and brought them to his home. Being single and working, he was not available to them during the day, but left food and water on the table to sustain them until he returned home in the evening. Jill lived over 300 miles from David and when she could get to his house to visit; she found her parents’ care was not acceptable. They could not remember if they took their medications or if they had even eaten a meal that day. David was also draining their savings account and when confronted about it, became angry and complained that he needed their money to pay expenses for their care. Clearly Jill felt her brother’s care of their parents was abusive, but David’s defense was he provided a home for his parents in which he could care for them. This family needs a professional advisor to help them understand and clarify the issues concerning their parents’ care.
Making legal decisions about property, finances, power of attorney, and final wishes are important tasks to complete for the final years of life. Having legal documentation for a will, for medical treatment and for the person designated to be responsible for parents’ welfare can avoid family disputes and financial abuse, and help to conserve assets that are needed for care.
Elder law attorneys specialize in legal issues affecting the elderly. They are knowledgeable about Medicare and Medicaid programs. They work with the elderly in assisting them and their families with all aspects of estate planning and implementing necessary legal documents for the final years of life. In addition, they help individuals to apply for and possibly accelerate coverage from Medicaid. An elder law attorney can also help with disputes with Medicaid. Below is a partial list of what an elder law attorney might do:
- Preservation or transfer of assets seeking to avoid spousal impoverishment when a spouse enters a nursing home
- Medicaid qualification and application and Medicaid planning strategies
- Medicare claims and appeals
- Veterans Benefits claims
- Social security and disability claims and appeals
- Disability planning, including use of durable powers of attorney, living trusts and living wills
- Help with financial management and health care decisions; and other means of delegating management and decision-making to another in case of incompetence or incapacity
Probate - Administration and management of trusts and estates
- Long term care placements in nursing homes and assisted living
- Nursing home issues with patients’ rights and nursing home quality
- Elder abuse and fraud recovery cases
Most elder law attorneys do not specialize in all of the areas iterated above. When considering an attorney you will want to find one who has experience in the area you need help.
According to The National Academy of Elder Law Attorneys — http://www.naela.org/:
“Ask lots of questions before selecting an elder law attorney. You don’t want to end up in the office of an attorney who can’t help you. Start with the initial phone call. It is not unusual to speak only to a secretary, receptionist or office manager during an initial call or before actually meeting with the attorney. If so, ask this person your questions.
- How long has the attorney been in practice?
- Does his/her practice emphasize a particular area of law?
- How long has he/she been in this field?
- What percentage of his/her practice is devoted to elder law?
- Is there a fee for the first consultation and if so, how much is it?
- Given the nature of your problem, what information should you bring with you to the initial consultation?”
A good way to choose an attorney is by referral from friends, family, clergy or other associations. Before you meet for your initial consultation, prepare the items you want discussed and taken care of. Bring pertinent documents and questions. Be sure you get clear answers and that you understand what your attorney is proposing.
Two-way communication is the best way your attorney can understand your needs and concerns. Does the attorney listen to what you say, appear to really care about your concerns or return your phone calls? If not find another attorney. Most Elder law Attorneys sincerely want to help make you or your parent’s elder years a well planned for, peaceful experience for all involved.
There are a number of ways attorneys charge for their services. They may charge a flat hourly rate. Or they may charge hourly for some services and add on additional expense for out-of-pocket costs such as paperwork, stamps, phone calls, etc. Or they may charge a single fee for a mutually agreed-upon course of action or plan.
Angela N. Manz is an estate planning and elder law attorney licensed in the Commonwealth of Virginia.
March 10, 2010
Employer Support for Care Giving Employees
“There are only four kinds of people in this world. Those who have been caregivers, those who are caregivers, those who will be caregivers, and those who will need caregivers.” Rosalynn Carter, Former First Lady
The U.S. Department of Labor estimates that in the year 2010, 54% of workforce employees will provide eldercare for a parent or parents and that nearly two-thirds of caregivers will experience conflict between demands at home and demands from employers.
Today’s employed Baby Boomers are the caregiver generation for their parents. They are finding themselves juggling care responsibilities around their employment obligations. Sometimes employees find they have no option but to take leave from work or use sick time to meet their caregiving demands.
Employers also feel the toll it is taking on their employees. A report by the AARP describes the cost to employers:
“Companies are also seeing the emotional and physical toll that caregiving takes on their workers. In one study, 75% of employees caring for adults reported negative health consequences, including depression, stress, panic attacks, headaches, loss of energy and sleep, weight loss, and physical pain. Businesses suffer, too, by having to pay high health insurance costs and in lost productivity. That doesn’t count the promotions or assignments workers turn down that require travel or relocation away from aging relatives.”
Businesses that don’t offer benefits or address eldercare wind up paying for them. A recent study by the MetLife Market Mature Institute and the National Alliance for Caregiving states that U.S. companies pay between $17.1 billion and $33.6 billion annually, depending on the level of caregiving involved, on lost productivity. That equals $2,110 for every full-time worker who cares for an adult.
Eldercare cost businesses:
- $6.6 billion to replace employees (9% left work either to take early retirement or quit)
- Nearly $7 billion in workday interruptions (coming in late, leaving early, taking time off during the day, or spending work time on eldercare matters)
- $4.3 billion in absenteeism” AARP
Typically, human resource departments work with employees on many issues that may affect their work productivity. There are programs for drug and alcohol abuse, domestic violence, illness, absenteeism and child care; but, help with eldercare issues is not normally provided.
A growing number of companies are directing their HR departments to provide resources, education and group help for caregiving issues. Once such resouce is Care Connect at Work, an employee benefits company providing hands-on assistance to employees to help them better balance their caregiving and work responsibilities. Care Connect at Work has care coordinators who assist in the following ways:
- Identify and address the problems and concerns related to their loved one’s care needs and their role as a caregiver
- Provide home and safety assessments to determine the on-going care needs of the employee’s senior loved ones
- Create a customized long-term care plan for the senior loved one to address current and future needs, such as health care, finances, insurance and legal documents
- Work hands-on with the employee caregiver to implement the long-term care plan, including filing for Veteran’s benefits, Medicaid, finding placement in assisted living or nursing homes and addressing family concerns and conflicts and coordinating other services as needed
- Assist directly with the demands and dilemmas of caregiving and planning in order to alleviate and reduce the amount of time that the caregiver would typically spend coordinating for themselves while on the job.
- Provide support and/or counseling to help the employee caregiver and their family work through physical and emotional concerns
- Offer employer approved caregiver and retirement support services will help to improve employee morale and loyalty.
- Care Connect coordinators will also work around the employee caregiver’s schedule to further reduce time away from work.
Employers, employees and eldercare service providers working together can make parent or senior caregiving a workable solution for all.
March 3, 2010
Pfizer Alzheimer’s Disease Drug Fails in Study
Pfizer Inc. said Wednesday that its Alzheimer’s drug candidate Dimebon did not meet its goal in a late stage clinical study, as the drug was no better than a placebo at treating the disease.
The compound Dimebon did not meet any of its main or secondary goals in the study, which involved 598 patients with mild to moderate Alzheimer’s disease. Dimebon is considered one of Pfizer’s key drug candidates and the company is running four other late stage trials of the drug.
November 22, 2009
What Is the Veterans Aid and Attendance Pension Benefit?
”Aid and attendance” is a commonly used term for a little-known veterans’ disability income. The official title of this benefit is “Pension.” The reason for using “aid and attendance” to refer to Pension is that many veterans or their single surviving spouses can become eligible if they have a regular need for the aid and attendance of a caregiver or if they are housebound. Evidence of this need for care must be certified by VA as a “rating.” With a rating, certain veterans or their surviving spouses can now qualify for Pension.
The purpose of this benefit is to provide supplemental income to disabled or older veterans who have a low income or high medical costs. Pension is for war veterans who have disabilities that are not connected to their active-duty service. Pension is primarily intended for very low income veterans, but a special provision in how Pension is calculated can allow veterans or single surviving spouses with high income to also receive the benefit which may be as much as $1, 949 a month. This special provision kicks in for veterans who have ongoing and expensive long term care costs.
Aid and Attendance Pension benefit can pay up to $1,949 a month for qualifying long term care needs such as:
- Family members who provide home care
- Professional home care providers to come into your home
- Assisted Living or Adult Day services
- Nursing Home long term care
- Home renovations for disability
- Prescription drug costs
- Insurance premiums
- Diabetic or incontinence supplies
- Other un-reimbursed medical expenses
If the veteran’s income exceeds the Pension amount, there is usually no award given, however, income can be adjusted for unreimbursed medical expenses, and this allows veterans with household incomes larger than the Pension amount to qualify for a monthly benefit. There is also an asset test to qualify for Pension.
If you have assets and a sizable income, you will most likely need and benefit from the services of a Veterans Benefits Consultant concerning what you need to do before you submit to the VA for an award. It is extremely important that assets that might be gifted or converted to income also meet Medicaid gifting rules in case the veteran or the surviving spouse may have to apply for Medicaid. The consultant can help avoid Medicaid penalties associated with reallocating assets.
Angela N. Manz is a veteran’s benefits consultant who understands the aid and attendance benefit as well as Medicaid rules. Angela N. Manz can be reached at 757-271-6275 or by going to www.manzlawfirm.com
November 15, 2009
Average Cost of a Nursing Home Inches Closer to $80,000 a Year
Although the US economy has seen price rollbacks during the last year, long-term care providers have actually been raising rates, according to the 2009 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs. Private room nursing home rates rose 3.3 percent to an average of $79,935 a year or $219 a day, while assisted living also climbed 3.3 percent on average to $37,572 a year or $3,131 a month.
Home health care aides now cost an average of $21 per hour, which represents a 5 percent jump, and adult day care services now average $67 per day, a 4.7 percent increase over 2008.
The MetLife survey also reports on the cost of a semi-private room in a nursing home, which increased 4 percent to $198 a day, or $72,270 a year. The cost of a semi-private room in an Alzheimer’s or Memory-Care wing averages $75,920 annually.
Once again, the highest rates for a private nursing home room in 2009 were found in Alaska, where the cost is $584 a day on average. The lowest rates were found in Louisiana (with the exception of Baton Rouge and the Shreveport area), at $132 a day.
The cost of assisted living was the highest in Wilmington, Delaware, at $5,219 a month and the lowest in North Dakota at $2,014 a month. Home health care aide services ranged from a high of $30 an hour in Rochester, Minnesota, to $13 and hour in the Shreveport area. Adult day care services were highest in Vermont at an average $150 a day and lowest in the Montgomery, Alabama, area, at $27 a day.
For the full MetLife 2009 survey report, including the average long-term care costs for selected cities, please follow this link:
October 21, 2009
Nursing Home Crisis
The nursing homes in the United States are facing massive layoffs and possible closings due to the recession and government cuts for Medicare and Medicaid reimbursement. The funding crisis comes as more and more seniors are facing health care issues that require nursing care. What can you and your family do to make sure that you are protected from the nursing home crisis? Meeting with an elder law attorney is the first step in creating a plan that will take care of your family in a crisis. Don’t wait until it’s too late. Prior planning makes all the difference.
August 21, 2009
Probate and Estate Administration
When a loved one passes away, his or her estate may needto go through a court-managed process called probate or estate administration where the assets of the deceased are managed and distributed. If your loved-one owned his or her assets through a well drafted and properly funded living trust, it is likely that no estate administration is necessary, though the successor trustee needs to attend to the distribution of the deceased’s trust assets. The length of time needed to complete the probate of an estate depends on the size and complexity of the estate and the local rules and schedule of the probate court. In Virginia, it generally takes at least a year to finalize the administration of an estate.
If you or your loved-one wants to avoid probate, you can do so with a properly drafted and funded revocable living trust. For more information, you should consult your local elder law attorney.
