Lessons in Dementia

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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?

 

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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 – Fotolia.com

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.

But You’re Not Old Enough to Practice Elder Law!

But You’re Not Old Enough to Practice Elder Law!

You  may know that the term “Elder Law” does not indicate the age of the attorney – although I promise, many people think that this is a HILARIOUS joke.  But really – what IS Elder Law?

Backing up a bit, I went to law school at Wake Forest University School of Law.  During my first semester, in the fall of 2005, I met a classmate who told me she had decided to go to law school because she wanted to practice Elder Law.  I had no idea what that meant.  I even thought it was weird that she wanted to practice in an area devoted to “old people.”

Fast forward two years – I was finishing up my second year of law school and I had decided that estate planning was my path.  I enjoyed the analytic and intellectual aspects of developing a written plan that ensured the appropriate transfer of assets during life and at death, all while avoiding legal and tax pitfalls.  I also knew that I would find helping people fulfilling.  So, when I learned that Wake Forest had an Elder Law Clinic – where students could represent elderly clients under the supervision of the managing attorney/professor – I jumped at the chance, knowing estate planning would be involved.

During my time at the clinic, I learned that Elder Law encompassed those things that I enjoyed in estate planning, and more.  So, when I graduated from law school, I set out to practice in an area that three years before, I had found a bit strange.

Fast forward again, five years this time.  I am in my fifth year of practice, and several weeks ago I attended the Atlanta Bar Association fair presented for first year law students at John Marshall Law School here in Atlanta.  The first student who approached my table asked “what is Elder Law?”, as did the second, and the third, and the fourth…

To explain to the students what Elder Law is, I described the kind of help I provide.  I told them that my practice consists largely of estate planning, that is, drafting wills and trusts and powers of attorney and health care directives, which direct how clients’ assets are distributed at their death, provide for control of the same during life, and direct health care decisions if someone else has to make them.   My clients tell me what their desires and concerns are, and I help execute a written plan that will see their wishes through.  Or, when a loved one dies, I assist the family in establishing an estate and distributing the assets.  When adult children call because mom or dad is not doing so well at home, I counsel regarding their options, talking about the differences between Assisted Living Facilities and Nursing Homes, and the option of in-home care for those who do not want to leave home at all.  I summarize the costs and the financial options for paying for care, reviewing the rules of the Medicaid program and the Veterans Administration pension program, hopeful that those benefits might help.  When someone is trying to take advantage of my client financially, I try to use the legal remedies available to bring the injustice to a halt.  When my clients need someone appointed for mom or dad (or aunt or uncle or husband or wife) to handle their affairs because the mental capacity is gone, I represent them in the probate court to have a guardian and conservator appointed.

When my clients are discouraged, I try to comfort them.  When they cry, I give them a tissue and tell them that it is going to be alright, but that it is alright to be sad.  When they are angry or when they are scared, I listen. When they are confused, I educate them.  And when they are lost, I try to show them that the path does not seem so treacherous once someone turns the lights on.  As far as I am concerned, that is what “Elder Law” is.

Welcome to the Elder Law Update!

Welcome!  I am thrilled to have you visit this site, and I hope that you learn a little more about elder law while you are here!

The mission of the Elder Law Update is to provide reliable, useful, and easy to read information about dealing with aging from a legal perspective.   In discussions about my career with others, I have found that many people have no idea what “Elder Law” is.  However, when I begin talking about the issues my clients commonly face,  heads start nodding and every person seems to have a personal story of how that issue affected his or her family. We are all affected by the same types of problems, but we are not equally educated regarding all of the solutions available through planning and preparation.  I hope that the articles on this blog can help seniors and their family members learn about the legal issues often faced by the elderly, and the many ways in which an elder law attorney can help guide aging family members through that period of transition.

Please stay tuned for monthly posts in areas ranging from estate planning with wills and trusts, probate of wills, administering trusts after the documents are signed, dealing with dementia and Alzheimer’s disease, planning and paying for long term care, powers of attorney and advance directives for healthcare, and more.