Category: Alzheimer’s Disease

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”

Photo by Andrea Piacquadio from Pexels

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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?”

 

steps to take when diagnosed with Alzheimer's?

Ways to Recognize Signs of Dementia

More than 50 million people around the world have dementia, and 10 million more are diagnosed each year, according to the World Health Organization. In fact, one in 10 Americans 65 and older has Alzheimer’s dementia, according to the Alzheimer’s Association. There are ways to recognize signs of dementia.

KSL.com’s recent article titled “11 signs of dementia everyone should know” says that with numbers like these, the odds are good someone you know will be impacted by dementia at some point in your life. Let’s look at 11 signs of dementia you should look for in your aging loved ones:

  1. Memory loss that impacts daily life. The most commonly recognized sign of dementia is memory loss. However, this is more than mere forgetfulness. It is the type of memory loss that makes it hard to learn new information or remember important dates or events. Those with dementia-related memory loss will remember items they’ve previously forgotten, and it will disrupt their daily life in many ways.
  2. Issues with planning or solving problems. Deficits in executive functioning is a recognized sign of dementia. This can include a wide range of things, such as planning and problem-solving. People who have dementia might experience trouble with regular work tasks, trouble problem solving with minor issues, or difficulty planning a schedule. Some memory loss is expected in old age. However, impairment in problem-solving or with planning isn’t.
  3. Difficulty completing familiar tasks. A person may have trouble doing tasks they ordinarily do, like using the computer, making coffee, or following their normal work routine.
  4. New problems with words in speaking or writing. At first, it might be amusing to hear your loved one call a banana a donut or something else, but continued incidents of this behavior is worrisome and may be a symptom of dementia.
  5. Confusion as to time or place. Forgetting their location or how to get to or from familiar places is another common early signal of dementia. These can lead to danger for someone with dementia to run an errand or live on their own.
  6. Trouble with visual images and spatial relationships. Visuospatial abilities are the ability to understand what we see around us and interpret spatial relationships. Dementia can bring on a decline in visuospatial abilities, such as reading, judging distance, or trouble with depth perception.
  7. Misplacing things and losing the ability to retrace steps. People with dementia increasingly put things in strange locations and can’t find them. In fact, they may accuse others of stealing the items.
  8. Changing moods, personality, and judgment. These changes are due to damage in vital areas of the brain which can lead to depression, manic-like behaviors and frequent changes in emotions called emotional lability. Dementia causes damage to the frontal lobe systems, and it can result in a loss in the ability to make sound judgments about insignificant or substantial issues.
  9. Social withdrawal. While we all like some quiet time, with dementia, it’s important to recognize if there’s a change of behavior and withdrawal from social activities they’re enjoyed in the past.
  10. Difficulty concentrating. Background noise and loud environments can make it difficult for a person suffering from dementia to concentrate. It makes them frustrated and makes conversations difficult. There’s not much you can do about the concentration problems, but you can help make their environment less stimulating. Reducing distractions and using the person’s name often as you speak to him or her.
  11. Hallucinations. Finally, hallucinations are a symptom worth discussing with a healthcare provider. If you notice your loved one becoming upset about events that didn’t happen, talk with their doctor.

These are just a few ways to recognize signs of dementia in a loved one. It is vitally important to stay in close contact with your primary care physician. Take the time to consult with your family and an elder law attorney to ensure you have provided for your loved one as they decline.

If you would like to learn more about dementia and other forms of mental decline, please visit our previous posts.

Reference: KSL.com (Dec. 29, 2020) “11 signs of dementia everyone should know”

 

when mom refuses to get an Estate Plan

Serving as a Caregiver for the Elderly

Not everyone is cut out for assisting older people because the job requires a unique skillset and, more importantly, empathy. There are things you need to know before serving as a caregiver for the elderly.

Big Easy’s recent article entitled “6 Things to Consider as a Caregiver for the Elderly” says it can be hard to understand that a senior has become dependent on others, and being assisted in everyday tasks may even lead to compromises in their privacy. This can put a senior in stressful conditions that lead to anxiety. In that case, hiring a professional caregiver for the elderly may be the best option.

However, no matter your training, serving as a caregiver for an older person can still be challenging. Consider these six things to develop the best possible relationship with the elderly and to provide the best care.

Compassion. Being compassionate helps develop a better connection to the elderly person. This can frequently solve many behavioral problems and can make for a pleasant caregiving environment. Most older people have some physical or mental disability that keeps them from being independent. In some situations, being abandoned by their loved ones creates even more emotional damage. To help, be empathetic and kind to them in these difficult times. This can significantly help to decrease the emotional pain that accompanies old age and illness. Being compassionate is one of the most effective ways of delivering the best care possible in these situations.

Communication. If you have the ability to have natural and comfortable conversations with elderly patients, you can develop a tighter emotional bond with them. Healthy communication and conversations also can distract a senior from things that may be troubling them, which will not only benefit the patient but will also help you carry out your tasks more easily. You may also be called upon to interact with other family members or doctors, so good communication skills are required.

Safety. Safety is vital for the elderly, and the slightest negligence can become a matter of life and death for them. The most common types of injuries for older people are attributed to falls. It is also even more dangerous because their bones are weak and don’t heal quickly. Use extreme care when assisting seniors in slippery areas, like the bathroom. Take precautions, such as de-cluttering the house and eliminating tripping hazards. Most importantly, keep them under constant observation, especially those with mental illnesses.

Hygiene. Maintaining quality hygiene can be a challenge, especially if people are shy or want their privacy. Take bathing as an example: it’s not surprising that the elderly are embarrassed, when caregivers have to bathe them. Even so, you are tasked with maintaining their hygiene. If you don’t, it can lead to more health-related issues.

Medications. Most seniors take medication, some of which produce side effects, such as nausea or dizziness. As a caregiver, you should make certain that they are taking their medicines on time and watch for side-effects in the case of an emergency. Review their medications and administer the prescribed dosage at the right times yourself. This will also help those who forget to take their medicines without prompting.

You may have several challenging times serving as a caregiver for the elderly, but empathy and compassion will help you considerably. You will create a better job experience and help the elderly with a very difficult phase of their life.

If you would like to learn more about serving as a caregiver, please visit our previous posts. 

Reference: Big Easy (Dec. 10, 2020) “6 Things to Consider as a Caregiver for the Elderly”

 

when mom refuses to get an Estate Plan

There is a Difference Between Alzheimer’s and Dementia

Many people see dementia and Alzheimer’s as the same thing. However, there is a difference between Alzheimer’s and dementia. Dementia is an umbrella term used to describe a group of symptoms that affect memory, communication abilities and activities of daily activities. Alzheimer’s is the most common cause of dementia. It affects roughly 60-80% of the people with dementia.

Alzheimer’s is a specific disease, and dementia is a syndrome or category, explains The Advocate in its recent article “Alzheimer’s Q&A: What’s the difference between Alzheimer’s and dementia?”

It usually is seen in those persons age 65 and older.

Dementia symptoms can result from other causes that develop earlier in life, like Huntington’s disease, Parkinson’s disease and Creutzfeldt-Jakob disease, which can show up in middle age or earlier.

Both dementia and Alzheimer’s can cause memory impairment, language difficulties, as well as cognitive decline.

Common symptoms linked to Alzheimer’s include the following:

  • Difficulty remembering recent events and conversations
  • Depression
  • Personality and behavioral changes
  • Impaired judgment
  • Trouble speaking; and
  • Confusion and disorientation.

Some causes of dementia will share these symptoms. However, they include or exclude other symptoms, which can help in making a differential diagnosis.

Alzheimer’s disease is degenerative, incurable and irreversible. This illness is the only one of the top 10 causes of death that has no prevention, maintenance, or cure.

Approximately 20% of the causes of dementia can be reversed with the proper diagnosis and treatment. These reversible conditions include the following:

  • Vitamin deficiency or metabolic disorder
  • Normal pressure hydrocephalus
  • Alcohol or drug abuse
  • Brain tumors; or
  • HIV-associated neurocognitive disorders.

The process and assessments to land on a diagnosis of Alzheimer’s disease are typically more complex than other forms of dementia. A detailed medical history is taken, and other conditions are ruled out as causes for the symptoms.

Brain imaging scans may indicate pronounced brain cell death that’s associated with Alzheimer’s disease.

Alzheimer’s disease can only be completely confirmed after a person passes away. An autopsy will show the plaques and tangles associated with the disease. This will also exclude other causes.

If you would like to learn how dementia and other disorders impact estate planning, please visit our previous posts. 

Reference: The Advocate (Nov. 16, 2020) “Alzheimer’s Q&A: What’s the difference between Alzheimer’s and dementia?”

 

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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