Category Archives: Senior Tips

Family Caregivers

Make sure your own needs are met as well as your loved ones.

As family caregivers, often our primary focus is on doing everything we can to help our loved ones remain as happy, healthy, and comfortable as possible. However, we often do this at the expense of our own well-being. We become so overwhelmed by our multiple tasks and roles that our ability to cope and care for ourselves becomes diminished. The negative effects of this increased level of stress can include:

sleep deprivation
poor eating habits
failure to exercise
failure to stay in bed when ill, and
postponement of or failure to make medical appointments.

We’ve all heard of the rule on an airplane: If the oxygen mask drops down in front of you, you should put yours on first and then help others with their oxygen masks. What is the reason for this? It is because we are better able to help others when we first take care of ourselves. This remains true in the context of care-giving. We are better able to help our loved ones, when we first make sure that we are caring for ourselves. The Family-Caregiver Alliance has provided a list of tips for self-care for caregivers. These tips include:

Learning stress reduction techniques, including: knowing the warning signs, identifying the sources, identifying what you can and cannot change, and taking action.
Attend to your own healthcare needs.
Get proper rest and nutrition.
Exercise regularly.
Take time off without feeling guilty.
Participate in pleasant, nurturing activities.
Seek and accept the support of others.
Seek supportive counseling when you need it, or talk to a trusted counselor or friend.
Identify and acknowledge your feelings.
Change the negative way you may view some situations.
Set personal goals.

Remember, it’s not selfish to make sure that your own needs are being met. Your health and well-being are just as important as the health and well-being of your loved one.

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a senior’s legal, financial or healthcare needs, please call us.

National Alzheimer’s Disease Awareness Month

Using the 6 R’s to help a loved one with Alzheimer’s.

This month is National Alzheimer’s Disease Awareness Month. As a result, I thought it might be appropriate to discuss a situation that many of us caring for a family member with Alzheimer’s might encounter. We know that there will be difficult days for our loved one, and many of us may become overwhelmed when we don’t understand how to work through behaviors that are problematic for our loved one, ourselves, and others. In the book called, “The 36-Hour Day,” the Johns Hopkins University Press discusses the six R’s of behavior management, which may prove helpful when difficult situations present themselves.

Restrict. Use this R sparingly and with a lot of care. Often times when we try to force our loved one with Alzheimer’s to stop a behavior, it will actually upset him or her more. If the behavior is dangerous and could cause harm to our loved one or others, then restriction of that behavior becomes necessary. If the behavior does not pose a significant threat, however, instead try to redirect your loved one to a more positive behavior as opposed to immediately restricting the behavior.
Reassess. Mentally step back from the situation for a minute and really think about what might be causing this problematic behavior. Is there something in his or her environment that is causing annoyance or unrest, and can that factor be removed? Is there something physically wrong with your loved one that might be causing this behavior? Try to think of every possible reason for why this behavior is happening.
Reconsider. It is important to think about the situation from our loved ones’ point of view. This is as much a transition into the unknown for them as it is for us. Think about how their stress and anxiety may go up in certain situations, and try to understand why that might be the case. Empathy toward our loved ones can go a long way.
Re-channel. This is where that redirection that we talked about earlier really comes into play. Look for a way to change the problematic behavior into one that is safer and non-destructive. Find a hobby of your loved one that he or she is still able to complete. This can help change a problematic situation into a more positive one.
Reassure. In these strained situations it is important to make sure that our loved ones still know that we care. Reassure him or her that everything is alright and that you are still there and care. Give your loved one a hug or some other gesture that may provide reassurance. Even if your loved one doesn’t remember these reassurances, he or she may still retain the positive feelings from it.
Review. After the situation is over, take time to think through what happened. Did you handle the situation well and what would you do differently next time? Think about what things led to the behavior in the first place and how those things may better be prevented. This process may help you to better and more easily handle these situations in the future.

Source: http://www.nursevirginiablog.com/2011/01/the-six-r%E2%80%99s-of-behavior-management/

Dispelling Medicaid Myths

Correct information helps avoid mistakes.

We have found that there is a lot of misinformation about social welfare programs, their recipients, and what it costs to participate in the programs. The following are some myths about Medicaid for the Aged, Blind and Disabled and facts to consider:

Myth: Medicaid is a handout or a free ride. Once someone is eligible for Medicaid, the government pays for everything for the participant.

Fact: When a person is deemed eligible for Medicaid, they are required to share in the cost of their medical care. Depending on income level, some participants could pay as much as $2,100.00 per month to participate in the Medicaid program – hardly a free ride. Why would someone pay such a hefty sum to be on Medicaid? The cost of care without Medicaid would be considerably higher and leave them unable to pay for necessary medical care.

Myth: People on welfare programs, like Medicaid, are free loaders who are working the system.

Fact: People on Medicaid for the Aged, Blind and Disabled are retired school teachers who were once sharp as a tack, but have succumbed to the mind devastating effects of Alzheimer’s. They are farmers who once made a living off the sweat of their brow, who are now enfeebled by Parkinson’s disease. They are Veterans of our wars who once loaded torpedoes onto gunships in the South Pacific who are now themselves loaded from a gurney into an ambulance.

Myth: Once you are on Medicaid, the government takes over all of your money.

Fact: Medicaid participants remain in direct control of their income. Continued eligibility in the program requires the participant to make the aforementioned “share of cost” payment.

Myth: If your spouse needs to go on Medicaid, you have to spend down all your money in order for him or her to qualify.

Fact: The community spouse can retain the following property even if his or her spouse goes into a facility and receives Medicaid:

The parties home and adjacent land
One vehicle
Prepaid burial plans
½ of the parties’ funds in bank accounts and cash value in insurance policies up to $117,240.00

In conclusion, the best way to avoid costly mistakes in qualifying for Medicaid is to have the correct information, which can be provided by an elder law attorney.

Advance Directives

Take control of your healthcare by expressing your desires in written documents.

By completing Healthcare Directives in advance and expressing what kind of medical treatment and healthcare you want to receive if you are unable to communicate, you take control of this important part of your life. The Idaho Medical Consent and Natural Death Act, “The Act,” endorses two documents for this purpose: a Living Will / Durable Power of Attorney for Health Care and a Physician’s Order for Scope of Treatment. These documents have far reaching implications, so you should understand how they work and when they go into effect.

A Living Will takes effect when

you are unable to communicate, and
you have an irreversible injury, disease or illness, and
a medical doctor has certified all of these:
- your condition is terminal
- life-sustaining procedures would only artificially prolong your life
- your death is imminent
Or you have been diagnosed as being in a persistent vegetative state.

A Living Will only goes into effect under the above limited circumstances, but what about other times in your life when you need medical treatment and you cannot communicate your desires? The Act provides that if you are unable to consent to medical treatment, a surrogate-decision maker may make the decision for you. Individuals that can act for you, in the order of their priority, are: a court-appointed guardian or the person named as your Durable Power of Attorney for Health Care. If no one has been designated, a spouse or other family member may make decisions for you. This can lead to a conflict between family members who have differing opinions on the medical treatment or care that you should receive.

In Idaho, the Living Will and Durable Power of Attorney for Health Care are combined into one document. The Durable Power of Attorney for Health Care will go into effect if for any reason you are unable to communicate your desires concerning your care. Giving your agent authority to make decisions for you is necessary for individuals who have a chronic illness, such as Alzheimer’s, and need someone to make day-to-day healthcare decisions for them.

In the Durable Power of Attorney for Health Care you may give your healthcare agent directions as to the kind of medical treatment and healthcare that you want to receive. You should also have a conversation with your designated agent to make sure he or she is willing to act on your behalf and follow your directives.

This leads us to the third document, the Physician’s Order for Scope of Treatment (POST). The POST is a one-page document that you fill out with your doctor. Section A functions as a “Do Not Resuscitate Order.” If you do not want to be resuscitated if your heart and breathing have stopped, you would indicate this.

Sections B and C indicate your desires for medical interventions and for artificial fluids and nutrition; however, unlike a Living Will, these sections do not specify under what circumstances your desires would take effect. To avoid conflict between your Living Will and your POST, you should fill out the “Other Instructions,” (in Sections B and C) indicating under what circumstances your directives apply. For example, you might say “My directive applies if I have a terminal illness and death is imminent or if I am in a persistent vegetative state.” An alternative way to handle this issue is to defer decisions concerning your medical interventions and artificial fluids and nutrition to your agent named in your Durable Power of Attorney for Health Care.

These documents ensure that your desires will be followed. It is your life; your wishes matter.

Nursing Home / Resident’s Rights

How to receive the best care possible guaranteed by the law.

The National Senior Citizen’s Law Center (NSCLC) has written an article called, “20 Common Nursing Home Problems – and How to Resolve Them.” (June 2010) This is a valuable resource in choosing a nursing home or in understanding and asserting your rights as a nursing home resident. Residents’ rights are derived from The Nursing Home Reform Law, which is a federal law that applies to all states.

The following are a few of the more common problems discussed in the article. We encourage you to visit the website below for more information.

Residents and their family members have a right to participate in developing a care plan.
Nursing homes must make reasonable adjustments in meeting the residents’ needs and preferences. For example, residents should not be told that they must wake up early or take a bath at certain times. Residents’ preferences must be taken into consideration.
Medication may not be used to make residents more manageable; it may be used only when the behavior is caused by a diagnosed illness.
One important right to be aware of is that a resident’s family member may visit any time, day or night.
Therapy, when medically appropriate, should be provided regardless of the resident’s source of payment.
Evictions from nursing homes are allowed for only six limited reasons, and a 30-day advance notice is generally required.

Because of consumers’ unfamiliarity with nursing homes and the protections provided, residents and family members are often reluctant to speak up. For example, a resident or family member shouldn’t feel sheepish to ask that necessary therapy be provided, or that a resident be allowed to sleep longer in the morning. At times a resident or resident’s family may benefit from the assistance of an attorney or other advocate to help them. Being knowledgeable about the protections in the Nursing Home Reform Law will enable residents to have the high-quality care they deserve.

The complete article can be found at the NSCLC’s website at:
http://www.nsclc.org/wp-content/uploads/2011/02/20-Common-Problems-Nov-2010-Final.pdf

Third-Party Special Needs Trust

Providing for a disabled child.

Sometimes parents will raise a developmentlly disabled child and continue to care for the child into adulthood. If one of the parents develops a chronic-health problem, the parent may not have the resources to care for the disabled child and to provide for his or her own needs. In such a case, the parent will frequently turn to Medicaid to help pay for care. This raises the question of how does the parent qualify for Medicaid and still provide for the disabled child?

The answer is for the parent to set up a Special-Needs Trust (SNT) for the child. A transfer of assets into a SNT for a disabled child is an allowable transfer under Medicaid rules. By making the transfer, the parent’s assets can be reduced below $2,000.00, thereby, meeting Medicaid’s asset elibility requirements.

What if the child is receiving Medicaid? Does transfering assets into a SNT make the child ineligilbe for government benefits? A third-party SNT is established with the assets of someone other than the disabled child. Therefore, if the trust is set up and administered properly, it is used to supplement not supplant public benefits. The resources available in the trust can be used to improve the quality of life of the disabled child. Once the trust is created and funded by the trustmaker, other relatives of the disabled child, for example the child’s sibliings, can direct assets to the trust. Finally, the parent can choose who the assets in the trust will go to when the disabled child passes away.

With proper planning, a parent with a chronic-health problem can qualify for Medicaid and still provide for a disabled child without disqualifing the child from government benefits.

Virtual Dementia Tour

Your Window into Their World

The Virtual Dementia Tour® is an immersion experience simulation of dementia created to teach people about the physical and mental challenges facing those living with dementia. The VDT® both helps people caring for those with dementia provide better care and offers hope to caregivers, providing tips and tools necessary to create an environment that supports the needs of those with the disease.

Over 500,000 people from elder care communities, corporations, caregivers, first responders, healthcare providers, municipal employees and nonprofit organizations in 14 countries have experienced the Virtual Dementia Tour®. Of those, 94 percent said they felt it was crucial and necessary to undergo the training in order to provide good care to those with dementia.

The Virtual Dementia Tour was created by award-winning geriatric specialist PK. Beville, M.S., founder and CEO of Second Wind Dreams®, an organization changing society’s perception of aging through the granting of dreams for elders. Proceeds from the sale of VDT products are used to support the dreams programs around the world.

If you are interested in gaining a greater understanding of the impact of Alzheimer’s disease and dementia on someone you love or care for, you are invited to participate in a sensitivity training session offered by Packer Elder Care Law. If you would like to learn more, please call 208-785-5600 or 208-542-0400.

Testamentary Special Needs Trust

A way to provide for a spouse with Alzheimer’s in your will.

When one member of a couple is diagnosed with Alzheimer’s, the other spouse is often still healthy. The healthy spouse frequently becomes the care provider for the spouse with Alzheimer’s allowing him or her to remain in their home. Being a caregiver, however, can be an exhausting and stressful responsibility and can take its toll on the healthy spouse. Consequently, it is not unusual for the healthy spouse to predecease the spouse diagnosed with Alzheimer’s. This may create a problem if the estate of the healthy spouse goes to the spouse with Alzheimer’s, since it may disqualify the spouse with Alzheimer’s from receiving Medicaid.

Fortunately, federal law allows the healthy spouse to create a testamentary Special Need’s Trust (SNT) that prevents his or her estate from passing to the spouse. Since the assets of the SNT are not available to the spouse with Alzheimer’s, they are not counted toward Medicaid eligibility. The Trust can then be used to provide for the supplemental needs of the spouse with Alzheimer’s, that are not covered by Medicaid. Money from the trust can be used for many things including medical equipment, trips or other special events which increase the dignity and quality of life of the spouse.

The following case study gives an example of how this works. Ron and Sheri had been married for several years, when Sheri was diagnosed with Alzheimer’s. Ron told Sheri that he would care for her in their home for as long as he was able. After a year of providing care, Ron is diagnosed with inoperable lung cancer and will most likely predecease Sheri. Ron changes his estate plan and writes a new will setting up a testamentary SNT for Sheri. When Ron passes away and Sheri moves into an assisted-living facility, her children can file an application for Medicaid to pay for the cost of her care. The money in the SNT will not be counted towards her eligibility for Medicaid and can be used to provide for Sheri’s supplemental needs and enhance her quality of life.

A healthy spouse, concerned about the well-being of a spouse diagnosed with Alzheimer’s, can continue to provide for that spouse even after he or she passes away by establishing a testamentary SNT.

Powerful Power of Attorney

When applying for Medicaid you need a Powerful Power of Attorney.

Kerry Peck and Rick L. Law in their book “Alzheimer’s and the Law” refer to what they call a powerful power of attorney. A powerful financial power of attorney is one that includes the power to do Medicaid-related asset protection. It might include the following provisions:

the Power to make gifts to specified loved ones such as a spouse or disabled child
the power to create a trust, or if the person has a trust the power to add or remove assets from the trust.
The power to apply for public entitlements like Medicaid

Why are these provisions important in a financial power of attorney for a person who has Alzheimer’s? Here’s an example of a situation we recently encountered.

A son hired us to file an application for Medicaid for his father. The father had no assets, however his income exceeded Medicaid’s maximum allowed monthly income of approximately $2022.00. In order to qualify the father, we suggested an approved strategy of preparing a Qualified Income Trust (Miller Trust) to reduce the father’s income below the maximum monthly income allowed.

Since the father was no longer competent to sign the trust documents, the son provided us with the copy of a standard power of attorney naming the son as the father’s agent. However, the power of attorney failed to state that the son had authority create a trust.

Several banks advised us that without this authority they would not set up a checking account for the Trust. The son was faced with the prospect of having to go to court and apply for a conservatorship, with its additional cost and reporting requirements to get the authority he needed to set up the Trust.

This situation could have been avoided by creating a powerful not powerless power of attorney. If filing for Medicaid is a possibility for an older adult, remember to include in the financial power of attorney the authority to complete the necessary transactions to qualify for Medicaid.

Hospital Stays

Two Words You Must Understand: “Observation Status.”

If you are on Medicare, there are two words you need to understand that will save you unneeded stress and money. They are: “Observation Status.” When you or a loved one are taken to the Emergency Room, you can save yourself thousands of dollars by clarifying if you are on observation status or not.

Medicare pays for inpatient and outpatient services very differently. If you are on observation status, you have not been admitted to the hospital and are considered to be outpatient, even if you sleep in a bed over night. Confused yet?

So, why should you clarify if you are on observation status? Medicare Part A will only pay for a hospital stay if you have been admitted to the hospital with a doctor’s order; it will not pay if you are on observation status. In addition, observation status does not qualify you for the 3-day stay in the hospital that is required for Medicare Part A to pay for a skilled-nursing facility.

Let me give you an example. Sally was taken to the Emergency Room by her daughter. Sally received care, treatment and ate and slept at the hospital for 4 days. Upon discharge the doctor ordered rehabilitation to a skilled-nursing facility to help her recover strength and mobility prior to going home. Sally and her daughter were under the assumption that Medicare would pay the bill. They were shocked when Sally received a bill for close to $15,000.00 after she returned home from the nursing facility. Unfortunately, Sally found out after it was too late that she had never been officially admitted to the hospital, but was only on “Observation Status”, and therefore Medicare would not cover her stay.

Next time you find yourself at the hospital, make sure you clarify your status. Simply ask your doctor or the hospital staff, “Am I admitted Inpatient”, or “Am I on Observation Status?” You will be glad you did.