Category: Alzheimer’s Disease

protect loved ones from financial elder abuse

Protect Loved Ones from Financial Elder Abuse

In 2021, more than 6.2 million people in America live with some form of Alzheimer’s disease and need some type of memory care. At the same time, financial abuse and scams, especially those targeting people 65 and older, are on the rise, says the Better Business Bureau. It is important to protect loved ones from financial elder abuse.

Individuals suffering from Alzheimer’s and other forms of dementia face unique challenges when it comes to financial elder abuse and scams, according to a recent report “Protecting you or a loved one from financial elder abuse and scams” from Idaho News 6. The increasing number of Alzheimer’s diagnoses increases chances of needing in-home, memory care or skilled nursing care at some point, making it increasingly important to plan ahead. When there is no advance planning, financial devastation and the potential for financial elder abuse occurs.

Planning starts with an experienced estate planning attorney who can help the family prepare these four basic documents:

  • Last Will and Testament
  • Financial Power of Attorney
  • Health Care Power of Attorney
  • Living Will/Advanced Directive

There are additional documents, depending upon the individual’s situation, including a Durable Power of Attorney, used to give another person the ability to make decisions for property, business and financial matters. In cases of future incapacity, this is extremely important.

Power of Attorney: This appoints an “agent” who can make financial decisions on behalf of the “principal.” The POA creates a fiduciary relationship between the agent and their principal, wherein the agent must act in the best interest of the principal, above their own interest. The selection of a POA is very important, since it is a big responsibility.

The Principal should also name a successor agent, in case the primary agent is not able or willing to take on their role. Understand the possibility of abuse of power by the agent before finalizing any documents. An agent who abuses their powers or reaches beyond their powers can be prosecuted.  However, it is best to make a good choice from the start and try to avoid problems.

Most of us get all the right protection in place for our homes, cars and have health insurance in place. However, the chances of needing long-term care for a dementia are actually higher than having your house burn down.

Planning for incapacity and protecting loved ones from financial elder abuse can be accomplished with the help of an estate planning attorney. Have the conversations with your attorney and your family early and get going.

If you would like to learn more about elder abuse, please visit our previous posts.

Reference: Idaho News 6 (Sep. 14, 2021) “Protecting you or a loved one from financial elder abuse and scams”

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What should women know about long-term care

What Should Women Know about Long-Term Care?

A longer retirement increases the odds of needing long-term care. An AARP study found more than 70% of nursing home residents were women, says Kiplinger’s recent article entitled “A Woman’s Guide to Long-Term Care.”  What should women know about long-term care?

Living longer also increases the chances of living it alone because living longer may mean outliving a spouse. According to the Joint Center for Housing Studies of Harvard University, “In 2018, women comprised 74% of solo households age 80 and over.”

The first step is to review your retirement projections. It’s wise to look at “what-if” scenarios: What-if the husband passes early? How does that impact their retirement? What if a female client lives to 100? Will she have enough to live on? What if a single woman needs long-term care for dementia? Alzheimer’s and dementia can last for years, eating up a retiree’s nest egg.

Medicare and Medicaid. Government programs, such as Medicare and Medicaid, are complicated. For instance, Medicare may cover some long-term care expenses, but only for the first 100 days. Medicare doesn’t pay for custodial care (at home long-term care). Medicaid pays for long-term care. However, you must qualify financially.

Planning for long-term care. If a woman has a high retirement success rate, she may want to self-insure her future long-term care expenses. This can mean setting up a designated long-term care investment account solely to be used for future long-term care expenses. If a woman has a modest degree of retirement success, she may want to lower her current expenses to save more for the future. She may also want to look at long-term care insurance.

Social Security. Women can also think about waiting to claim Social Security until age 70. If women live longer, the extra benefits accrued by waiting can help with long-term care. Women with a higher-earning husband may want to ask the higher-earning spouse to delay until age 70, if possible. When the higher-earning spouse dies, the widow can step into the higher benefit. The average break-even age is generally around 77-83 for Social Security. If an individual can live longer than 83, the more dollars and sense it makes to delay collecting until age 70.

Estate Planning. Having a comprehensive estate plan is a must. Women (and men) should have a power of attorney (POA). A POA gives a trusted agent the ability to write checks and send money to pay for long-term care.

When it comes to long-term care, women should know their own health and the potential drain on the retirement savings. Work with a financial advisor and estate planning attorney to make sure your later years are secure.

If you would like to learn more about long-term care, please visit our previous posts.

Reference: Kiplinger (July 11, 2021) “A Woman’s Guide to Long-Term Care”

 

choosing between assisted living or memory care

Choosing between Assisted Living or Memory Care

When considering a long-term care facility, it can be difficult choosing between assisted living or memory care options. Forbes’ recent article entitled “Assisted Living vs. Memory Care: Which Is Right for You?” explains that assisted living is a long-term care facility that lets seniors remain independent, while providing help with daily tasks. It often provides a small apartment, housekeeping, community meals and activities.

It’s critical to thoroughly review the support needs and challenges facing the person you’re supporting and to try to look honestly at what’s working and what’s not.

The best candidate for assisted living is a person who needs assistance with their activities of daily living but still has their reasoning skills intact. Residents can enjoy socialization and activities with people their own age. This helps with isolation after spouses and friends are no longer with them.

Assisted living residents frequently require personal care support. However, these seniors are able to communicate their needs. Residents may receive help with taking medicine, bathing, toileting and other activities of daily living, or ADLs.

Memory care facilities are secured facilities that serve the needs of those with some form of dementia. These facilities typically have smaller bedrooms but more available, open and inviting common spaces. Research shows the way memory care facilities are designed can be helpful in easing the stressful transition from home to a long-term care community. This includes softer colors, a lack of clutter and clear signage.

Confusion and memory loss can cause anxiety. That’s why having a predictable routine can help. As dementia progresses, a patient may forget how to do normal activities of daily living, such as brushing their teeth, eating, showering and dressing. Memory care facilities ensure that these needs are met.

A memory care facility typically has a smaller staff-to-patient ratio than assisted living because an individual suffering from dementia has greater care needs. Staff will frequently undergo additional training in dementia care.

A memory care facility isn’t always a standalone community. Assisted living or skilled nursing homes may have a separate memory care wing where seniors get the same socialization and activities but with 24/7 protection.

Rather than choosing between assisted living and memory care facilities, having both options in one place can be a plus. The person can start in a less restrictive type of setting in assisted living with the option to transition to memory care as needs, abilities and interests are changed by the condition.

Both types of care have some autonomy but help with hygiene and medication management. However, staff in a memory care unit is specifically trained to work with people with cognitive impairments.

If you would like to learn more about long term care options, please visit our previous posts. 

Reference: Forbes (Aug. 16, 2021) “Assisted Living vs. Memory Care: Which Is Right for You?”

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New Installment of The Estate of The Union Podcast

 

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women should plan for long-term care

Women should plan for Long-Term Care

Women face some unique challenges as they get older. The Population Reference Bureau, a Washington based think tank, says women live about seven years longer than men. This living longer means planning for a longer retirement. While that may sound nice, a longer retirement increases the chances of needing long-term care. Thus, women should consider how to plan for long-term care.

Kiplinger’s recent article entitled “A Woman’s Guide to Long-Term Care” explains that living longer also increases the chances of going it alone and outliving your spouse. According to the Joint Center for Housing Studies of Harvard University, in 2018 women made up nearly three-quarters (74%) of solo households age 80 and over.

Ability to pay. Long-term care is costly. For example, the average private room at a long-term care facility is more than $13,000/month in Connecticut and about $11,000/month in Naples, Florida. There are some ways to keep the cost down, such as paying for care at home. Home health care is about $5,000/month in Naples, Florida. Multiply these numbers by 1.44 years, which is the average duration of care for women. These numbers can get big fast.

Medicare and Medicaid. Medicare may cover some long-term care expenses, but only for the first 100 days. Medicare does not pay for custodial care (at home long-term care). Medicaid pays for long-term care, but you have to qualify financially. Spending down an estate to qualify for Medicaid is one way to pay for long-term care but ask an experienced Medicaid Attorney about how to do this.

Make Some Retirement Projections. First, consider an ideal scenario where perhaps both spouses live long happy lives, and no long-term care is needed. Then, ask yourself “what-if” questions, such as What if my husband passes early and how does that affect retirement? What if a single woman needs long-term care for dementia?

Planning for Long-Term Care. If a female client has a modest degree of retirement success, she may want to decrease current expenses to save more for the future. Moreover, she may want to look into long-term care insurance.

Waiting to Take Social Security. Women can also consider waiting to claim Social Security until age 70. If women live longer, the extra benefits accrued by waiting can help with long-term care. Women with a higher-earning husband may want to encourage the higher-earning spouse to delay until age 70, if that makes sense. When the higher-earning spouse dies, the surviving spouse can step into the higher benefit. The average break-even age is generally around age 77-83 for Social Security. If an individual can live longer than 83, the more dollars and sense it makes to delay claiming benefits until age 70.

Estate Planning. Having the right estate documents is a must. Both women and men should have a power of attorney (POA). This legal document gives a trusted person the authority to write checks and send money to pay for long-term care.

Living longer means women should plan for long-term care. Work with your estate planning attorney and financial advisor to craft a plan that ensures you are well cared for should long-term care be needed.

If you would like to learn more about long-term care, and other related issues, please visit our previous posts.

Reference: Kiplinger (July 11, 2021) “A Woman’s Guide to Long-Term Care”

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Episode 6 of The Estate of The Union podcast is out now

 

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what is the process of conservatorship

What Is the Process of Conservatorship?

The headlines surrounding Britney Spears’ fight against her father’s conservatorship have kept the issue in the public eye. It has prompted many to ask what is the process of conservatorship? It’s how her father controls her finances and her life, dating back to 2008 when she suffered a very public mental health crisis. Her $60 million fortune is controlled by her father Jamie Spears, according to the article “Britney Spears Is Under Conservatorship. Here’s How That’s Supposed to Work” from npr.com. In this case, only her father has the ability to negotiate business opportunities and other financial arrangements.

Britney made a passionate plea before a Los Angeles Superior Court judge to end the conservatorship, saying she is exploited, unable to sleep, depressed and cries daily.

Her process of her conservatorship was set up because of the court’s agreement in 2008 with her father that she was no longer able to manage her own affairs. The judge appointed Jamie Spears, known as the “conservator” to care for another adult (the “conservatee”), who is deemed to be unable to care for themselves.

The conservatee does not lose all rights. They may still take part in important decisions affecting their property and way of life. They have a right to be treated with understanding and respect, and they have basic human rights. However, the court is saying that decisions about where to live and how to support the person need to be made by someone else. This is an extreme situation and is usually done only as a last resort. Once the court has appointed a conservatorship, only a court can lift it.

Conservatorships are usually used for people with a severe cognitive impairment or older people with severe dementia. Guardianships are also appointed for individuals with severe developmental disabilities. Spears is not the typical person under conservatorship. In the last 13 years, she has released albums, judged on The X Factor and earned an estimated $148 million performing in Las Vegas. Spears told the court she should not be in a conservatorship, if she can work and provide money and pay other people.

Many reforms to guardianship laws have taken place, including one principle that guardianship should only extend to the areas of the person’s life they are not able to manage. However, the Spears’ conservatorship includes every aspect of her personal affairs, as well as her property management.

Individuals under guardianship don’t select their guardian, but they may in some instances make recommendations and requests. The court is supposed to give serious consideration to their requests. The court does not seem to be recognizing this or other changes in Britney Spears’ case. She has been asking since 2014 for her father to be removed from his prime role in the conservatorship, and in 2020 she asked the court to suspend her father from his role entirely.

Family members are usually named as guardians, but there can be bankers, or professional guardians named. A wealth management company was added to Spears’ conservatorship in recent months as a co-conservator, but her father remains in charge of all aspects of her life.

Ending a guardianship is difficult, unless the guardianship has been set up for a specific length of time. If there’s a lot of money involved, things can get complicated. The guardian may not agree to steps to modify the guardianship because they will lose income. There’s a real conflict of interest in this case, as Spears’ father is also her business manager. The process of conservatorship is complicated.

There is a trend towards avoiding guardianship and having a person or a handful of people who can help with decision making, while permitting the person to be involved in some way. However, the Britney Spears case is unlike any conservatorship case.

If you would like to learn more about conservatorship and elder law, please visit our previous posts. 

Reference: npr.com (June 24, 2021) “Britney Spears Is Under Conservatorship. Here’s How That’s Supposed to Work”

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What are the early signs of dementia?

What are the Early Signs of Dementia?

Many adult children are finally seeing their parents in person for the first time since the beginning of the COVID crisis. While it is a comfort to spend time together, you might notice changes in a parent’s behavior that was not apparent on the phone or Zoom. Could this be a sign of cognitive decline? What are the early signs of dementia?

Dementia can diminish focus, the ability to pay attention, language skills, problem-solving and visual perception. It can make it hard for a senior to control his or her emotions and lead to personality changes, says AARP’s recent article entitled “7 Early Warning Signs of Dementia You Shouldn’t Ignore.”

The article provides some of the warning signs identified by dementia experts and mental health organizations:

  • Difficulty with everyday tasks. Those with dementia may find it increasingly tough to do things, like keep track of monthly bills or follow a recipe while cooking. They also may find it hard to concentrate on tasks, take much longer to do them, or have difficulty completing them.
  • Repetition. Asking a question, hearing the answer, then repeating the same question a few minutes later, or telling the same story about a recent event multiple times, are causes for concern.
  • Communication issues. See if a senior has trouble joining in conversations or following along with them, stops abruptly in the middle of a thought, or struggles to think of words or the name of objects.
  • Getting lost. Those with dementia may have difficulty with visual and spatial abilities.
  • Changes in personality. A senior who starts acting unusually anxious, confused, fearful or suspicious; becomes upset easily; or loses interest in activities and appears depressed is cause for concern.
  • Confusion about time and place. Those who forget where they are or can’t remember how they got there should raise a red flag. You should also be concerned if a person becomes disoriented about time (asking on a Friday if it is Monday or Tuesday).
  • Troubling behavior. If a senior appears to have greater poor judgment when handling money or neglects grooming and cleanliness, it’s a concern.

Here are some of the methods that doctors use to diagnose early signs of dementia:

  • Cognitive and neuropsychological tests assess language and math skills, memory, problem-solving and other kinds of mental functioning.
  • Lab tests can help rule out non-dementia causes for the symptoms.
  • Brain scans like a CT, MRI, or PET imaging can detect changes in brain structure and function. They can identify strokes, tumors and other problems that can cause dementia.
  • Psychiatric evaluation can determine if a mental health condition is causing or impacting symptoms.
  • Genetic tests are critical, especially if someone is showing symptoms before age 60. The early onset form of Alzheimer’s is strongly associated with a person’s genes.

Stay aware of these early signs of dementia and make a plan for addressing your parent’s needs as they decline. Work with an Elder Law attorney to learn what you can do to ensure your loved ones are cared for in their later years.

If you would like to learn more about dementia and other cognitive issues, please visit our previous posts. 

Reference: AARP (May 4, 2021) “7 Early Warning Signs of Dementia You Shouldn’t Ignore”

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Address Finances if Diagnosed with Alzheimer’s

Address Finances if Diagnosed with Alzheimer’s

Learning you have Alzheimer’s or other types of dementia can be overwhelming.  There are many aspects of life that you will need to address. One of the first things you should do is address your finances if you are diagnosed with Alzheimer’s. Because of the debilitating nature of Alzheimer’s and related forms of dementia on a loved one’s ability to make sound financial decisions, the sooner you can get financial matters in order the better. The Statesville Record & Landmark’s recent article entitled “Steps to take when dealing with Alzheimer’s” lists four important steps to take:

Keep an eye out for signs of unusual financial activity. Early signs of cognitive challenges for a senior include difficulty paying a proper amount for an item, leaving bills unpaid, or making strange purchases. If you see signs of a loss in judgment related to financial matters, additional action may be required.

Identify and name a power of attorney. Many people diagnosed with Alzheimer’s are hesitant to cede control of their personal finances to another. Therefore, have an honest discussion with your loved ones and help them appreciate the importance of having a trusted person in a position to look out for their interests. One person should be designated as financial power-of-attorney, who is authorized to sign checks, pay bills and help keep an eye on the finances of the affected persons.

Ask an experienced estate planning attorney about helping you draft this important document.

Examine the costs of care and how it will be covered. A primary concern is to determine a strategy for how your loved one will be cared for, especially if their cognitive abilities deteriorate.

You will need to be able to determine whether specialized care will be needed, either in the home or in a nursing or assisted living facility. If the answer is yes, you’ll need to determine if there are resources or long-term care insurance policies in place to help deal with those costs, which will impact decisions on a care strategy. Ask an elder law attorney about trusts that can be established to provide for care for the disabled loved one, while still protecting the family’s assets.

Be proactive. Don’t delay too long in addressing financial issues after an Alzheimer’s diagnosis. This can compound an already stressful and emotional time.

Be prepared to take action to get on top of the situation as soon as you’re aware that it could be a problem. Even establishing a plan for addressing these issues before a form of dementia is firmly diagnosed can be helpful.

Do not wait – address your finances early if diagnosed with Alzheimer’s. Ask an experienced elder law attorney for guidance on how to manage these challenging times.

If you would like to learn more about Alzheimer’s and how it can effect estate planning, please visit our previous posts. 

Reference: Statesville Record & Landmark (April 11, 2021) “Steps to take when dealing with Alzheimer’s”

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deduct expenses for long-term care

Deduct Expenses for Long-Term Care

The skyrocketing costs of long-term care (LTC) can ruin your retirement savings. The U.S. Department of Health and Human Services found that 27% of Americans turning 65 this year will have at least $100,000 in long-term-care costs, and 18% will require care costing more than $250,000. However, you may be able to deduct expenses for long-term care.

Kiplinger’s recent article entitled “Tax Breaks may be available for Long-Term Care” says that if you need LTC, you may be able to deduct a portion of the costs on your tax return. If you purchased a long-term-care insurance (LTCI) policy to cover the costs, you may also be able to deduct some of your premium payments. Since retirement planning includes long-term care, it’s important to know how these tax deductions can help to offset overall costs.

Long-Term-Care Costs

The IRS allows you to deduct unreimbursed costs for long-term care as a medical expense, if certain requirements are met. This includes eligible expenses for in-home, assisted living and nursing-home services. The long-term care must be medically necessary and may include preventive, therapeutic, treating, rehabilitative, personal care, or other services. The cost of meals and lodging at an assisted-living facility or nursing home is also included, if the primary reason for being there is to receive qualified medical care.

The care must also be for a chronically ill person and provided under a care plan prescribed by a doctor. The IRS says that a person is “chronically ill,” if he or she can’t perform at least two activities of daily living. These are things like eating, bathing, or dressing. They must be unable to do these without help for at least 90 days. This condition must be certified in writing within the last year. A person with a severe cognitive impairment, like dementia, is also considered chronically ill, if supervision is needed to protect his or her health and safety.

To get the deduction, you have to itemize deductions on your tax return. However, itemized deductions for medical expenses are only allowed to the extent they exceed 7.5% of your adjusted gross income.

An adult child can claim a medical expense deduction on his own tax return for the cost of a parent’s care, if he can claim the parent as a dependent.

Insurance Premiums

The IRS also allows a limited deduction for certain LTCI premiums. Similar to the deduction for long-term-care services, this has to be an itemized deduction for medical expenses. Again, only premiums exceeding the 7.5% of AGI threshold are deductible. (Note that self-employed individuals may be able to deduct premiums paid for LTCI as an adjustment to income without having to itemize.)

In addition, the LTCI policy is required to satisfy certain requirements for the premiums to be deductible. The policy can only cover long-term-care services, so the deduction only applies to traditional LTCI policies, not “hybrid” policies that combine life insurance with long-term-care benefits. This deduction also has an age-related cap. For 2021, the cap is $5,640 if you’re older than 70, $4,520 if you’re 61 to 70 and $1,690 if you’re 51 to 60. (For those 41 to 50, it’s $850, and for 40 or younger, it’s $450.)

Make sure to educate yourself on what types of expenses you can deduct for long-term care. These deductions can be valuable for people in their seventies and older.

If you are interested in learning more about long-term care, please visit our previous posts.

Reference: Kiplinger (March 23, 2021) “Tax Breaks may be available for Long-Term Care”

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What are the early signs of dementia?

When a Guardianship is Needed to Protect a Senior

We would like to think that all of our very responsible parents and relatives have their legal documents in order. However, that is not always the case. It might be difficult to gauge when a guardianship is needed to protect a senior.

Florida Today’s recent article entitled “One Senior Place: What is guardianship and should I seek it?” explains that we need to have a serious discussion with our loved ones and determine if, in fact, “their affairs are in order.” If not, a guardianship may be in their futures.

That is because a guardianship is really a last step.

Guardianship is a legal process that is used to protect a senior who is no longer able to care for his or herself due to incapacity or disability. A court will appoint a legal guardian to care for a senior, who’s called a ward. A legal guardian has the legal authority to make decisions for the ward and represent his or her personal and financial interests. A court-appointed guardian can also be authorized to make healthcare decisions. In a guardianship, the senior relinquishes all rights to self-determination, so you can see how this is the choice of last resort.

If a suitable guardian isn’t found, the court can appoint a publicly financed agency that serves this role.

A doctor will examine a senior and determine if he or she is incompetent to make his or her own decisions. The judge will review the senior’s medical reports and listen to testimony to determine the extent of the alleged incapacity and whether the person seeking guardianship is qualified and responsible.

A guardian can be any competent adult, such as the ward’s spouse, another family member, a friend, or a neighbor. There are even professional guardians. The guardian will usually consider the known wishes of the person under guardianship.

Guardianship can be very costly and can involve a profound loss of freedom and dignity. As a result, speaking with an experienced elder law attorney is essential.

While it might be hard to know when a guardianship is needed to protect a senior, there are things that any competent adult can do to decrease the chances of ever needing guardianship. This includes:

  • Drafting a power of attorney for finances; and
  • Drafting an advance healthcare directive, which names a surrogate decision maker for your healthcare decisions, including the right to refuse or terminate life-sustaining medical care based on your wishes.

Moreover, talk about your wishes and all your estate planning documents with your family. That way they’ll know how to put your plan into action, if required in the future.

If you are interested in learning more about guardianship, please read our previous posts. 

Reference: Florida Today (March 23, 2021) “One Senior Place: What is guardianship and should I seek it?”

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steps to take when diagnosed with Alzheimer's?

Steps to Take when Diagnosed with Alzheimer’s

A diagnosis of Alzheimer’s or any serious progressive disease takes some time to absorb. What are the steps to take when diagnosed with Alzheimer’s? During the days and weeks after the diagnosis, it is important to take quick steps to protect the person’s health as well as their legal and financial lives, advises the recent article “What to do after an Alzheimer’s disease diagnosis?” from The Indiana Lawyer.

Here are the legal steps that need to be taken when diagnosed with Alzheimer’s, before the person is too incapacitated to legally conduct their own affairs:

General Durable Power of Attorney—A person needs to be appointed to perform legal and financial duties when the time comes. This can be a family member, trusted friend or a professional.

Health Care Power of Attorney—A person must be entrusted with making health care decisions, when the patient is no longer able to communicate their wishes.

HIPAA Authorization—Without this document, medical care providers will not be able to discuss the person’s illness or share reports and test results. An authorized person will be able to speak with doctors, pick up prescriptions and obtain medical reports. It is not a decision-making authorization, however.

Living Will—The living will explains wishes for end-of-life medical care, including whether to prolong life using artificial means.

Funeral Plans—Some states permit the creation of a legally enforceable document stating wishes for funerals, burials or cremation and memorial services. If a legal document is not permitted, then it is a kindness to survivors to state wishes, and be as specific as possible, to alleviate the family’s stress about what their loved one would have wanted.

Medicaid Planning—Care for Alzheimer’s and other dementias becomes extremely costly in the late stages. A meeting with an elder law attorney is important to see if the family’s assets can be protected, while obtaining benefits to pay for long-term and dementia care.

After the patient dies, there may be a claim against it from the state to recover Medicaid costs. By law, states must recover assets for long-term care and related drug and hospital benefits. All assets in the recipient’s probate estate are subject to recovery, except if surviving spouse, minor children, blind or disabled child is living or where recovery would cause hardship.

These are just a few steps to take when diagnosed with Alzheimer’s. With good planning and the help of an experienced elder law attorney, the family may be able to mitigate claims by the government against the estate.

If you would like to learn more about Alzheimer’s disease, and other forms of dementia, please visit our previous posts.

Reference: The Indiana Lawyer (Jan. 6, 2020) “What to do after an Alzheimer’s disease diagnosis?”

 

Information in our blogs is very general in nature and should not be acted upon without first consulting with an attorney. Please feel free to contact The Wiewel Law Firm to schedule a complimentary consultation.
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