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Category: Alzheimer’s Disease

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”

 

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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”

 

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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?”

 

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Probate versus Trust Administration

Probate versus trust administration. What are differences? Are they the same? Many people get these two things confused. A recent article, “Appreciating the differences between probate and trust administration,” from Lake County News clarifies the distinctions.

Let’s start with probate, which is a court-supervised process. To begin the probate process, a legal notice must be published in a newspaper and court appearances are needed. However, to start trust administration, a letter of notice is mailed to the decedent’s heirs and beneficiaries. Trust administration is far more private, which is why many people chose this path.

In the probate process, the last will and testament and any documents in the court file are available to the public. While the general public may not have any specific interest in your will, estranged relatives, relatives you never knew you had, creditors and scammers have easy and completely legal access to this information.

If there is no will, the court documents that are created in intestacy (the heirs inherit according to state law), are also available to anyone who wants to see them.

In trust administration, the only people who can see trust documents are the heirs and beneficiaries.

There are cost differences between probate and trust administration. In probate, a court filing fee must be paid for each petition. There are also at least two petitions from start to finish in probate, plus the newspaper publication fee. The fees vary, depending upon the jurisdiction. Add to that the attorney’s and personal representative’s fees, which also vary by jurisdiction. Some are on an hourly basis, while others are computed as a sliding scale percentage of the value of the estate under management. For example, each may be paid 4% of the first $100,000, 3% of the next $100,000 and 2% of any excess value of the estate under management. The court also has the discretion to add fees, if the estate is more time consuming and complex than the average estate.

For trust administration, the trustee and the estate planning attorney are typically paid on an hourly basis, or however the attorney sets their fee structure. Expenses are likely to be far lower, since there is no court involvement.

There are similarities between probate and trust administration. Both require that the decedent’s assets be collected, safeguarded, inventoried and appraised for tax and/or distribution purposes. Both also require that the decedent’s creditors be notified, and debts be paid. Tax obligations must be fulfilled, and the debts and administration expenses must be paid. Finally, the decedent’s beneficiaries must be informed about the estate and its administration.

The use of trusts in estate planning can be a means of minimizing taxes and planning for family assets to be passed to future generations in a private and controlled fashion. This is the reason for the popularity of trusts in estate planning.

It should be noted that a higher level of competency—mental comprehension—must be possessed by an individual to execute a trust than to execute a will. A person whose capacity may be questionable because of Alzheimer’s or another illness may not be legally competent enough to execute a trust. Their heirs may face challenges to the estate plan in that case.

Reference: Lake County News (July 4, 2020) “Appreciating the differences between probate and trust administration”

 

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Alzheimer’s and other Brain Diseases Require Special Estate Planning Steps

There are certain steps that can be taken by individuals, loved ones and family members to make this challenging time safer and smarter, advises an article “Financial And Estate Planning Steps To Take Now: Special Considerations For Those With Brain Disease” from Forbes.

Anyone living with a neurologic condition needs to be sure their planning reflects not only their condition but their personal experience of the condition. The variability of each person’s experience of a brain disease, from symptoms and severity to the progression rate and future prognosis to the possibility of any recovery, affects how they need to plan.

For an Alzheimer’s patient, in early stages there may be no problems in signing legal documents and putting legal safeguards in place to protect finances. Most people are not aware that the degree of competency to sign legal documents varies, depending upon the complexity of the documents to be signed and the circumstances. A relatively low level of competency is required to sign a will. This is known as “testamentary capacity.” A higher level of competency is required to sign something like a revocable trust, investment policy statement, etc. Therefore, a person who may be legally able to sign a will may not have the legal capacity to sign other documents. Alzheimer’s patients need to get their entire estate plan in order, as soon as a diagnosis is received. Safeguards are extremely important, including having an independent person, like a CPA or trusted family member, receive copies of all monthly bank and brokerage statements, in case abilities decline faster than anticipated.

Patients living with peripheral neuropathy may experience issues with balance, burning sensations, dizziness, hypersensitive skin and pain that make wearing socks or shoes impossible. If the condition becomes so severe that the person becomes homebound, they need to make changes: set up accounts, so bills can be paid online, have income streams set to automatic deposit and simplify and consolidate accounts. It is important to have a Power of Attorney (POA) that is effective immediately or a revocable living trust with a co-trustee. In this way, you do not have to leave home to conduct your business.

Parkinson’s disease may not be well understood by professional advisors. You’ll need to explain that your facial expression—Parkinsonian masked face—does not mean that you are not responding to a conversation. They need to know that your handwriting may change, becoming small and cramped. This can result in a bank or other financial institution refusing to accept your signature on documents. Your attorney can prepare a document that confirms you are living with Parkinson’s disease and that micrographia is one of your symptoms. The document should include three or four different signatures to reflect the variations. Have each signature witnessed and notarized.

People living with MS (multiple sclerosis) face the possibility of an exacerbation that could leave them incapacitated at any time. A revocable trust to coordinate financial management, with trusted individuals as co-trustees should be in place.

For people with these and other brain illnesses, an emergency financial and legal road map needs to be prepared. It should include monthly recurring bills, non-recurring bills like life insurance, property taxes, etc. Contact information for key advisors, your estate planning attorney, CPA, financial advisor, banker, insurance agent, etc., needs to be shared. Your estate plan should be updated, if you haven’t reviewed it in three or four years. If you don’t have an estate plan in place, now is the time to have one created.

Reference: Forbes (May 17, 2020) “Financial And Estate Planning Steps To Take Now: Special Considerations For Those With Brain Disease”

 

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Retirement Planning and Declining Abilities

Whether the reason is Alzheimer’s, Parkinson’s or any of a number of illnesses that lead to dementia, it’s hard for families to think about legal or financial concerns, when a diagnosis is first made. This can lead to serious problems in the near future, warns the article “Cognitive Decline Shouldn’t Derail Retirement Planning. Here are Some Tips to Prepare Your Finances” from Barron’s. The time to act is as soon as the family realizes their loved one is having a problem—even before the diagnosis is official.

Here are some useful tips for navigating cognitive decline:

Take an inventory. Families should create a detailed list of assets and liabilities, including information on who has access to each of the accounts. Don’t leave out assets that have gone paperless, like online checking, savings, credit card and investment accounts. Without a paper trail, it may be impossible to identify assets. Try to do this while the person still has some ability to be actively involved. This can be difficult, especially when adult children have not been involved with their parent’s finances. Ask about insurance policies, veterans’ benefits, retirement accounts and other assets. One person in the family should be the point person.

Get an idea of what future costs will be. This is the one that everyone wants to avoid but knowing what care costs will be is critical. Will the person need adult day care or in-home care at first, then full-time medical care or admission to a nursing facility? Costs vary widely, and many families are completely in the dark about the numbers. Out-of-pocket medications or uncovered expenses are often a surprise. The family needs to review any insurance policy documents and find out if there are options to add or amend coverage to suit the person’s current and future needs.

Consider bringing in a professional to help. An elder law estate planning attorney, financial planner, or both, may be needed to help put the person’s legal and financial affairs in order. There are many details that must be considered, from how assets are titled, trusts, financial powers of attorney, advance health care directives and more. If Medicaid planning was not done previously, there may be some tools available to protect the spouse, but this must be done with an experienced attorney.

Automate any finances if possible. Even if the person might be able to stay in their own home, advancing decline may make tasks, like bill paying, increasingly difficult. If the person can sign up for online banking, with an adult child granted permission to access the account, it may be easier as time goes by. Some monthly bills, such as insurance premiums, can be set up for automatic payment to minimize the chances of their being unpaid and coverage being lost. Social Security or Supplemental Security Income benefits are now required to be sent via direct deposit or prepaid debit card. If a family member is still receiving a paper check, then now is the time to sign up for direct deposit, so that checks are not lost. Pension checks, if any, should also be made direct deposit.

Have the correct estate planning documents been prepared? A health care representative and a general durable power of attorney should be created, if they don’t already exist. The durable power of attorney needs to include the ability to take action in “what if” cases, such as the need to enroll in Medicaid, access digital assets and set up any trusts. A durable power of attorney should be prepared before the person loses cognitive capacity. Once that occurs, they are not legally able to sign any documents, and the family will have to go through the guardianship process to become a legal guardian of the family member.

Reference: Barron’s (Jan. 11, 2020) “Cognitive Decline Shouldn’t Derail Retirement Planning. Here are Some Tips to Prepare Your Finances”

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What I Need to Know about Caring for a Loved One with Dementia

Family caregivers of dementia patients must be more prepared for immediate changes in temperament. They need more support and respite care, and they need a better idea of what to expect in the days and months ahead.

Forbes’s recent article entitled “When Your Loved One Has Dementia: 3 Questions For Family Caregivers” provided three important questions to ask if your aging parent or family member has been diagnosed with a form of dementia.

What training must I have? When a parent, friend, or other loved one in your care is has dementia, you should look to local healthcare resources for education and training.

The temperament of people suffering from a form of dementia can change swiftly. It can rapidly turn hurtful or even violent. However, there are things a caregiver can do to interact with them to help keep them calm. Ask their healthcare provider for suggestions or referrals.

As a caregiver, do I have the legal standing to take care of this person? You should determine if your loved one has a will or living will in place, along with a healthcare power of attorney. These are documents that must be drafted and signed, before their dementia progresses to the point where it totally distorts your loved one’s thought process.

The documents provide instructions as how to care for them, according to their original wishes and avoid stress in the family, if disagreements arise. Contact an elder law attorney as soon as possible to create these documents.

How do I get help when I need it? Caring for an aging loved one can be a very tiring task. Tending to the needs of an aging loved one with a form of dementia is an even greater challenge. Begin planning now for self-care.

You can’t take care of a loved one with dementia, if your physical and mental health is wiped out and you are exhausted. Look at respite care options to give yourself the rest you’re going to need.

Getting these measures ready now can ensure that you are prepared for the tough future.

Reference:  Forbes (March 23, 2020) “When Your Loved One Has Dementia: 3 Questions For Family Caregivers”