Monthly Archives: March 2013

Lessons in Dementia

brain tag cloud pictogram

A large part of my elder law practice consists of advising family caregivers dealing with dementia.

When I saw that a free program was being offered today at the Dorothy Benson Senior Center in Sandy Springs, I signed up right away.  The more resources and information regarding dementia that I have in my toolbox, the more I can help my clients and their families.

Dementia expert Teepa Snow presented the program, and it was excellent.  In preparation for my next post, which involves planning for dementia and long-term care, I wanted to share some of the tidbits I learned from Teepa today:

On dementia in general:

The term “dementia” does not mean the same thing as “Alzheimer’s” and neither “dementia” nor “Alzheimer’s” mean the same thing as memory loss.

There are 85 – 90 types of dementia. Every type has these things in common:
1.     At least two parts of the brain are actively dying.
2.    Each dementia will destroy at least 2/3 of the brain.
3.    All types of dementia are progressive (i.e. they all get worse over time);  however, each is progressive in its own unique way.
4.   Nothing can slow, stop or turn around dementia.
5.   All forms of dementia are terminal.

Because dementia affects several parts of the brain, it causes more than memory problems. Dementia affects thought, language, behavior, personality, and feeling/affect, among other things.

“Dementia” itself is not a diagnosis. Instead, it describes a collection of symptoms. It is vital that patients receive a good evaluation from a qualified physician, so that the patient and caregivers know what kind of dementia they are dealing with.

Medical issues are often misdiagnosed as dementia because of the resulting cognitive issues. Medical problems causing cognitive impairment can include depression, thyroid imbalance, lack of Vitamin B12, long-term alcoholism, diabetes, hypertension, and infection, just to name a few.

A dementia “diagnosis” is very scary to patients.  There is a huge stigma surrounding dementia.

On dealing with dementia and patient resistance:

Patients often act illogically, and caregivers may respond with resistance.  This response is entirely natural, but counterproductive.

Resistance in the caregiver is often met with resistance in the patient, and caregivers’ efforts to explain or correct illogical or resistant behaviors are not helpful.  Instead, caregivers should try to discover the underlying cause (that is, the unmet need) of the behavior (which is often not what it initially seems).

Key: do not correct. Let it go.  Join the journey. If Mother said she saw Aunt Eunice last night, don’t correct her, even though Aunt Eunice has been dead for thirty years.  Tell her you think it’s nice Aunt Eunice visited, and ask her whether Aunt Eunice still has that terrible perm.

Be aware that sudden changes in behavior often have underlying medical causes, including lack of sleep, lack of nutrition, dehydration, lack of sunlight… Remember, investigate and try to find the underlying cause.

Most important: I asked Teepa to name some resources for family caregivers, and she provided the following:

1.   Alzheimer’s Foundation of America

2.   Alzheimer’s Association

3.   More resources listed on Teepa’s website, including free videos

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What’s Going On With the Estate Tax?



Remember back in December when there was all that talk about the fiscal cliff?  Since that headline was so quickly replaced with debt ceiling concerns, and followed most recently by the sequestration issues (who comes up with these terms???) you might have already forgotten about the fiscal cliff.

As esteemed Georgia State College of Law professor Samuel Donaldson put it during a recent Atlanta Estate Planning Council talk where I was a guest, we did like Wile E. Coyote, running off the cliff and hovering in the air for a few seconds.  However, unlike Wiley, we turned around and made it safely back onto the cliff before plunging to our demise (okay, maybe that is a little dramatic).

For estate planning purposes, this means that Congress implemented a permanent (that is, until Congress changes it) unified Gift and Estate Tax Exemption of $5 million for each individual, indexed for inflation.  This means that as of 2013, an individual can transfer up to $5,250,000 million during life or at death before being subject to gift or estate tax.

As I tell many clients, most of us are not lucky enough to have an estate tax problem.  For those who are, many options still exist, which may include:

1.   Use of Family Limited Partnerships and other Family-Owned Business Entities to distribute wealth

2.   Acquisition of Life Insurance (and use of Life Insurance Trusts) to cover potential estate tax liability

3.  Sales to Grantor Trusts

4.  Use of Grantor Retained Annuity Trusts

5.  Use of Credit Shelter Trusts

6.  Charitable Bequests

7.  Transferring the home to a Qualified Personal Residence Trust

8.   Making annual gifts under the Annual Exclusion amount ($14,000 in 2013)

As you can see (and although this might as well be in Greek to many) there are a number of options available to reduce the hit.  If you are lucky enough to have an estate tax problem but have not completed an estate plan, call your attorney today!

CAVEAT:  This web site and the information contained herein have been prepared for educational purposes only.  The information on this blog does not constitute legal advice, which would be dependent upon the specific circumstances of a particular case.  In addition, because the law can vary from state to state some information on this site may not be applicable to you.

Image © Valerie Potapova –

Stop Senate Bill 202

Stop Senate Bill 202
Readers:  A bill is pending in the Georgia Senate that would solidify the enforceability of binding arbitration clauses in nursing home admission agreements.   (Thank you to the Georgia Trial Lawyers Association;  attorney Ira Leff;  and attorney Paul Black of the National Association of Elder Law Attorneys (NAELA), Georgia Chapter, for helping spread the word about this bill.)
SB 202 would require seniors and their families to waive the resident’s right to a trial by jury – granted by the 7th Amendment to the U.S. Constitution – in a case against the nursing home.  
You can contact your local senator by clicking here, to voice your opinion on the pending bill.  The bill is up for vote early next week.
The Georgia Trial Lawyers Association recommended the following language:  SB 202 would allow nursing homes to force my loved ones and our family to sign away our constitutional right to trial by jury just so we can get our loved one into a nursing home. At a time when their profits are soaring and the quality of care they are providing is among the worst in the country, Georgia nursing homes do not deserve – or need – this accountability bailout. Please stop SB202 from getting out of committee or from passing the State Senate.