Awareness Planning & Preparation
To eliminate Alzheimerâ€™s Disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health.
Planning & Preparation Shining a light on
PLANNING AND PREPARATION
2 | June 2019 | Alzheimers Awareness Guide | Lee Central Coast Newspapers
This June, Alzheimer’s & Brain Awareness Month, the Alzheimer’s Association is highlighting the critical importance of planning and preparation for caregivers so that they are ready in case of a disaster. Safety is important for everyone, but the need for a comprehensive safety plan becomes vital as dementia progresses. Taking measures to improve safety can prevent injuries and help the person with Alzheimer’s feel more relaxed, less overwhelmed and maintain his or her independence longer. Taking safety precautions is important when caring for those with Alzheimer’s disease or dementia. Our safety center at alz.org/safety provides important tips and guidance to help you better take care of those with Alzheimer’s. Some of the general topic areas available in the safety center include: Wandering Home Safety Driving Medication Safety
MedicAlert + Safe Return Technology 101 Traveling In a Disaster Abuse We included many of these topics in this issue as well. Please enjoy this publication, refer to it often, or pass it on to a neighbor or loved one in need. Feel free to call us with questions. We are here to help. Spread the word about Alzheimer’s by using #ENDALZ on social media this June! Visit alz.org/ abam to get started. Sincerely, Donna Beal, MPH, MCHES Vice President, Program Services Alzheimer’s Association California Central Coast Chapter www.alz.org/cacentralcoast 24 Hour Hotline: 1-800-272-3900
Alzheimer’s Association California Central Coast Chapter 2019 Events ALZHEIMER’S & BRAIN AWARENESS MONTH® The Longest Day® Friday, June 21
RivALZ: BLONDES VS. BRUNETTES® Santa Barbara— Garden Street Academy Saturday, July 20
WALK TO END ALZHEIMER’S®
ALZHEIMER’S WOMEN’S INITIATIVE
Santa Maria—Waller Park Saturday, September 28 Oxnard—The Collection at RiverPark Saturday, September 28 San Luis Obispo— Mission Plaza Saturday, October 26 Westlake Village— Westlake Commons Saturday, October 26 Santa Barbara—Hilton Santa Babara Beachfront Resort Saturday, November 2
‘Your Brain Matters’ Luncheon—Santa Barbara TBD
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Lee Central Coast Newspapers | Alzheimers Awareness Guide | June 2019 | 3
Whatever your individual needs, The Oaks at Nipomo offers thoughtful, personalized choices to optimize your lifestyle. Independent Living at The Oaks at Nipomo is ideal for residents who enjoy a more active life, but who appreciate all the little things we can handle for them. In your own private apartment, housekeeping and laundry are available — and, you can enjoy dining in one of our dining venues. Enjoy events and activities within the community or relax in one of our many lounge areas. Amenities include a movie theater, beauty salon, fitness center, recreation areas and our Saratoga Room where you can unwind and enjoy a glass of wine or converse with friends. Assisted Living at The Oaks at Nipomo provides additional personalized services and care. In the comfort of your own private apartment, you’ll have peace of mind with extra help with medication management, bathing, dressing and more which make living at The Oaks at Nipomo a life enriching experience. Our dedicated and caring staff works closely with residents and their families to achieve the highest level of health and independence. No matter what your preference, The Oaks at Nipomo offers inviting options perfectly designed to help you make the most of the good life ahead. Memory Care at The Oaks at Nipomo is an individualized program, catering to each resident’s specific needs and focusing on their unique skills and abilities to promote and maintain a richer, more fulfilling life. The environment is friendly and comfortably secure, with experienced 24-hour staff and a dedicated Resident Service Director. Services include assistance with activities of daily living, routine wellness assessments, comprehensive activities and life enrichment programs.
Planning & Preparation Financial Planning for Dementia Care By BRAD TISDALE, MS, CES, CLTC
4 | June 2019 | Alzheimers Awareness Guide | Lee Central Coast Newspapers
Caring for people with Alzheimer’s disease continues to be a reality for many American families. Unpaid family caregivers provide an estimated 18.5 billion hours of care per year valued at nearly $234 billion. Caring for over 5.8 million Americans living with Alzheimer’s costs the nation a whopping $290 billion. Age is the highest risk factor for Alzheimer’s. Nearly 50% of people in their 80s develop Alzheimer’s or some other form of dementia. Every 65
seconds, another American will develop Alzheimer’s. By 2050, the rate will go up to every 33 seconds, and the cost of care will skyrocket to $1.2 trillion. These large and almost incomprehensible numbers do have consequences. Unless we find a cure or a way of preventing it, Alzheimer’s will take an even heavier toll on our health care and financial systems. But the impact will hit the hardest on everyday American homes. Today, more than 16 million people
are already caregiving for a loved one with dementia. One in 3 seniors dies with Alzheimer’s or another dementia. The cost of care for seniors with dementia is on average 3 times higher than for seniors without dementia. Are you prepared for the financial and physical impact? When planning for retirement, many envision more time to do the things they love such as traveling, spending time with family, enjoying a favorite sport/ hobby or finally getting to the things on their bucket list. Rarely do we consider or plan for needing care in the longterm. Who wants to think about that? However, the numbers indicate that most families will be affected by dementia in one form or another. Should this be the case for your family, do you have a plan in place to handle it? A longterm care plan should address where care will be provided, who will provide care, who will coordinate all the services, and most importantly, what financial resources are available to pay for care. Most families have “sticker shock” when it comes to the extra expenses associated with dementia care. Some of the costs to consider include personal care and safety items, home modifications, prescriptions drugs, adult day services, in-home care, custodial care or assisted living and nursing home care. Costs for in-home care may add up to $16,000 per month and according to the MetLife Mature Market Study, assisted living for dementia patients costs nationally an average of $5,000 per month. In our Central and South Coast communities, assisted living averages about $7,500 per month. Costs related to dementia and other long-term care needs are paid mostly out-of-pocket. Without a strategy in place, these ongoing expenses can adversely affect income, assets, retirement and estate plans. Medicare and health insurance don’t pay for custodial care; and Medicaid (MediCal in CA), the state-administered assistance program, is only available to those with low income and limited assets and does not pay for assisted living or home care. Long-term care insurance is a strategy for those who don’t want to self-fund their care. A policy pays benefits when someone needs supervision due to a cognitive impairment or when they need help with two or more activities of daily living; this can be a result of normal aging, frailty, and dementia, or because
of an accident or illness. Benefits are paid for care provided in the home or in a facility such as assisted living. There are two approaches to long-term care insurance. One is a stand-alone policy that pays for care when needed; the other is an asset-based or “hybrid” policy. Built into a life insurance or annuity contract, hybrid policies pay for care when needed, or they pay a death benefit to the policy beneficiary if care is not needed. Annuities can be used to pay for long-term care expenses. The Pension Protection Act (PPA) of 2006 allows funds to be withdrawn income tax free from certain non-qualified annuities when used to pay for qualified longterm care expenses. There are different ways to fund a long-term care annuity. For example, someone who has an existing annuity with a low basis and a large amount of tax deferred gain could transfer (via 1035 exchange) all or a portion of the cash value in their annuity into a PPA compliant annuity with long-term care benefits. When care is needed, they can take tax-free monthly withdrawals to reimburse their long-term care expenses. Upon their death, any cash value balance goes to their beneficiary. There are options to extend long-term care benefits beyond the value of the annuity. It is easier to health-qualify for a long-term care annuity than a stand-alone policy which also makes this an attractive option for those with more health issues. An existing life insurance policy can be converted into a long-term care benefit to help pay for the care someone is already receiving. Instead of surrendering a policy for only its cash value or ceasing to pay a premium that has become unaffordable, consider converting the death benefit into a living benefit that can pay for care and other expenses. Paying for dementia and other extended care needs is about having enough cash available each month to cover those costs. When monthly income alone is not enough, savings, investments and other assets are used fill in the gap. Over time, this can significantly erode assets and reduce the amount of interest those assets can generate. It can also adversely affect the lifestyle of a spouse or family member who needs those assets to live on. Longterm care is a prudent part of financial and estate planning, and the earlier you address it, the more options you have.
Planning & Preparation
Lee Central Coast Newspapers | Alzheimers Awareness Guide | June 2019 | 5
Planning & Preparation Thank You Monique Limón for AB 388 By Leigh Cashman, Vice Chair of the Board for the Alzheimer’s Association, California Central Coast Chapter
After losing my father to Alzheimer’s disease more than two years ago, I vowed to do everything in my power to help other families facing this growing public health crisis. As a volunteer advocate with the Alzheimer’s Association, it is my mission to raise public awareness and urge my legislators to make ending Alzheimer’s disease a priority. While it is no small feat, I am eternally grateful that Assemblymember Monique Limón and Senator Hannah Beth Jackson of Santa Barbara have answered the call in the state legislature. Alzheimer’s disease has reached epidemic proportions and is on the rise. The number of Alzheimer’s deaths in California has increased by 268 percent between 2000 and 2017, making it the 4th leading cause of death in in the state. In the absence of an effective treatment or cure, just 45 percent of people affected nationally have been formally diagnosed by a clinician, leaving too many families and caregivers without adequate answers,
planning and support. AB 388, introduced by Assemblymember Limón and
co-authored by Senator Jackson, would initiate local efforts to build a statewide public health infrastructure to
address Alzheimer’s disease through the implementation of the CDC Public Health Roadmap (known as the Healthy Brain Initiative). Alongside a $10 million onetime budget investment, the bill would launch a statewide public awareness campaign to reduce stigma associated with Alzheimer’s, and it would fund eight county pilot projects to improve early detection and diagnosis. It is a modest investment of millions that would save billions as California’s Alzheimer’srelated Medi-Cal costs are projected to jump 32 percent by 2025 to nearly $5 billion annually. The budget proposal will be heard in Budget Subcommittee 1 of the Assembly on May 6th while the bill has until midMay to pass out of the Appropriations Committee and on to the Senate. I send Assemblymember Limón a heartfelt thank you for being a champion in the fight against Alzheimer’s and for her bold vision to improve public awareness and early detection and diagnosis.
Research Breakthroughs 6 | June 2019 | Alzheimers Awareness Guide | Lee Central Coast Newspapers
By Donna Beal, MPH, MCHES
Alzheimer’s disease, the only leading cause of death that has yet to be cured, continues to grow in the number of individuals afflicted, with an estimated 5.7 million currently living with the disease. This is a steady increase of 14 percent from 2017, during which the total national cost reached an astounding $259 billion. In 2018, this cost also rose to an estimated $277 billion, and at its current rate of increase, is expected to reach an astounding $1.1 trillion by the year 2050. The financial cost, however, cannot compare to the in-home care provided by family members, friends, and other unpaid caregivers, who make up eightythree percent of the total help provided. As the world’s largest nonprofit funder of Alzheimer’s research, the Alzheimer’s Association is committed to accelerating the global effort to eliminate Alzheimer’s. We have undertaken a multitude of diverse research initiatives working toward methods of treatment, prevention and, ultimately, a cure. This is a very exciting time in Alzheimer’s disease research. Tremendous gains have been made in understanding the basic biology underlying Alzheimer’s disease — including how brain cells work and what goes wrong in Alzheimer’s. Additionally, we are making great strides in developing new technologies to detect Alzheimer’s earlier. For example, using advanced
imaging — such as PET scans — we can now see Alzheimer’s-related changes in living people up to 20 years before clinical symptoms of cognitive decline. Emerging diagnostics such as cerebrospinal fluid analysis, blood tests, saliva analysis, and optical evaluation are in development as tools for early Alzheimer’s detection. Why is this important? Early and accurate diagnosis is critical to ensuring that people receive high quality care, and can plan for the future. It also enables enrollment in clinical trials at the earliest stages of disease — when effective treatment and prevention may still be possible. The Alzheimer’s Association is leading the U.S. POINTER study — a two-year clinical trial to evaluate whether lifestyle interventions that target many risk factors such as heart health and nutrition can protect cognitive function in older adults at increased risk for cognitive decline. U.S. POINTER is the first such study to be conducted in a large group of Americans across the United States. The study is currently recruiting participants. Research is the primary force that will one day find a cure or prevention to this disease, and the most successful way to continue this advance is through advocacy and public policy. These successful milestones in funding and awareness are essential to achieving our goal of a world without Alzheimer’s.
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Planning & Preparation
Avoid Family Conflicts By Marcy Maler, MA, Care and Education Specialist
When a family member is diagnosed with dementia, the effect it can have on the entire family can be overwhelming. The diagnosis can trigger a range of emotions—denial, anger, fear, frustration, sadness, or depression. There also are many decisions to make, ranging from treatment, care needs, living arrangements, finances, to end-of-life care. As a result, family conflicts commonly arise. Each family has its own history of relationships, roles, and life challenges that can affect how individuals will react to a diagnosis of dementia. The task at hand is to get everyone on the same team to care for someone who is ill. Consider strategies that will promote cooperation and lessen the potential for family conflicts. How do we navigate these? Educate yourself. Learn as much as you can about the disease and the challenges that you will be facing. Share this knowledge and the resources you used to obtain it with your family members. Communication is key. Initiate family meetings. Find a space that is comfortable and convenient with few distractions. Be honest and informative, giving everyone a chance to express themselves. Consider holding your first meeting without the diagnosed person present, so family members can openly share thoughts
and feelings that might be painful for him to hear; then hold a second meeting with the diagnosed person present, so he too can express his reactions. Cooperation. Identify and make a list of current and anticipated caregiving needs and then designate supportive roles that each family member can take. Share responsibilities. Assigning realistic supportive roles to family members will definitely reduce caregiver stress. It is unlikely that you will be able to divide caregiving evenly, but try to match each relative’s abilities, resources, and emotional capacity to the appropriate task. While one might provide hands-on or live-in care, others might be responsible for respite care, household chores, or perhaps researching care facilities. Hopefully, your loved one will have designated someone to handle financial or legal issues, but if not, designate your most capable relative. Use a centralized calendar or LotsaHelpingHands.com to keep responsibilities straight. Document problems and progress. Keep a journal to share with your relatives. This will help clarify misperceptions and avoid arguments. Ask for help when you need it. A caregiver should never worry about being “selfish” if she asks for help. Caregiving is a
major undertaking. Most of your friends and family want to help, but do not know how. If a friend enjoys cooking, ask him to help with meal preparation. Identify and express your needs. The physical and emotional demands that are placed upon caregivers impact their general health and increases risk for chronic disease, health-related physiological changes, and even death. If you can’t get enough help from family and friends, there are agencies who can provide care in your home or watch your loved-one at a respite center in your area. Caring for a person with dementia poses special challenges. Maintain your supportive system. Once you have an infrastructure for cooperative care in your family, continue to hold family meetings to discuss care and other relevant issues. Meet regular, avoid long meetings, welcome each other’s input, and be prepared for any necessary changes in care. Technology can help. A conference call, Skype, a video, an audio recording, and emailing or texting can help even the longdistance relatives keep up to date. Create an agenda and share it before you meet. Make it clear that the goal of a meeting is to evaluate care and needs, identify problems, and consider solutions. Be open
to compromise and possibilities you hadn’t considered on your own. Be inclusive. It is important to include everyone who is part of the caregiving team, including family, friends, neighbors, paid caregivers, or social workers. Talk about your feelings in an open, constructive manner. Express your feelings without blaming or shaming anyone else by using “I” statements. For example, you might say, “I’m feeling overwhelmed with juggling my own schedule and dad’s appointments,” rather than, “You don’t understand what it’s like to manage dad’s schedule.” Listen to and acknowledge other family members’ feelings too. Learn the beauty of compromise. Since you are part of a collaborative team, it is important to acknowledge that there are multiple ways of attaining a goal. Respecting each person’s individuality and her particular situation, helps to create acceptance and allows for creative solutions. Do not criticize. Be especially supportive of family members who are responsible for daily, hands-on care. Keep in mind the desires and wishes of the person with dementia. There is more than one way to provide care. Be respectful of each caregiver’s abilities and values. There are many “right” ways to provide care.
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This project was supported, in part by grant number 90SAPG0052-01-00, from the U.S. Administration for Community Living, Department of Health and Human Services, D.C. 20201. projects under government encouraged to express freely their findings Living. and This publication wasWashington, supported by the Central CoastGrantees Commissionundertaking for Senior Citizens with the financial assistance, sponsorship in whole or part,are through a grant from the Administration for Community conclusions. Points of view or opinions do not, therefore necessarily represent official Administration for Community Living Policy.
Lee Central Coast Newspapers | Alzheimers Awareness Guide | June 2019 | 7
Planning & Preparation
Disaster Situation: Are you Prepared?
8 | June 2019 | Alzheimers Awareness Guide | Lee Central Coast Newspapers
By Molly Kehoe, MSW
A home-based social worker, I recently visited with a woman who is caring for her husband. While discussing her husband’s current health needs, she talked about how much he has declined physically and that she is not strong enough to move him. She described how she uses a transfer pole and a gait belt and verbal step by step instructions to help him transfer. She uses her own body to brace him and prevent a fall until she can maneuver him into his wheelchair. Sometimes they laugh and sometimes they cry, but they are managing. We reviewed her emergency evacuation plan and she was stunned that she hadn’t thought about how she could get him out of the house and into the car by herself in a time of emergency. Panicked, she wanted to know what our community had in place for her. Being new to the area, I wasn’t familiar with a countywide emergency plan. I was hoping she had some ideas of help from family or friends. She said she had no family in the area and that her neighbors weren’t actual friends. I did some research regarding local and countywide responses to folks such as this couple, provided her information on the county plan, how to prepare her home and who to contact at her mobile home park to see what type of plan they had in place. We then discussed how she can rally her neighbors and distant family members for assistance. She is not outgoing and is so busy caring for her husband that she seldom visits with her neighbors. The possibility of needing immediate assistance moved her from inactivity to stepping outside her comfort zone. To date, she has met a few neighbors, signed up for local emergency alerts and continues to work on an evacuation plan. For individuals, an emergency evacuation plan can seem insurmountable. Asking for help, connecting to what is already in place and reaching out to the community are first steps to getting your plan in place. Californians are not unfamiliar with natural disasters like earthquakes, fires and mudslides. Most of our households have evacuation plans and well-stocked emergency kits. But how prepared
are you to assist your loved one with dementia in a disaster situation? If you have to evacuate your loved one in minutes, do you know what to take with you? How are you going to keep him calm and reassured? Here are some considerations that every caregiver should know before a disaster occurs:
If your loved one lives in a residential facility, find out about its disaster and evacuation plans. Ask if you will be responsible for evacuating your loved one. Whether your loved one lives with you or you are a long-distance caregiver, make sure evacuation plans include her specific needs. Check your local Alzheimer’s Association and other organizations that provide services for the elderly to see if help is available. Enroll in MedicAlert® + Alzheimer’s Association Safe Return®, a 24-hour nationwide emergency response service for individuals with Alzheimer’s or related dementia who wander or who have a medical emergency. Call toll-free at 1(888)5728566 or visit www.alz.org. If you are already enrolled in MedicAlert + Safe Return, make sure your information is up to date. If you know a pending disaster is about to occur: Get yourself and the person with Alzheimer’s to a safe place. If the need to leave quickly is likely, do not delay. Try to leave as early as possible to minimize long delays in heavy traffic. Alert others (family, friends, medical personnel, etc.) that you are changing locations, and give them your contact information. Contact them regularly as you move. Be sure there are people other than the primary caregiver who have copies of the person’s medical history, medications, physician information and family contacts. Purchase extra medications. If your loved one uses oxygen, be sure to obtain portable tanks.
accessible location. Your emergency kit might include: Easy on/off clothes (a couple of sets). Medication (or minimally, a list of medications with dosages). Velcro shoes/sneakers. A spare pair of eyeglasses. Incontinence products. Extra identification items for the person, such as an ID bracelet and clothing tags. Copies of legal documents such as a power of attorney. Copies of medical documents that indicate the individual’s condition and current medications. Copies of insurance and Social Security cards. Waterproof bags to hold medications and documents. Physician’s name, address and phone numbers (including cell phone). Recent picture of the person with dementia. Hand lotion or other items to provide comfort. Bottled water. Favorite items or foods, liquid meals. Pillow, toy or something else to hug. Alzheimer’s Association and MedicAlert + Safe Return phone numbers.
During an evacuation
People with dementia are especially vulnerable to chaos and emotional trauma. They have a limited ability to understand what is happening, and they may forget what they have been told about the disaster. Be alert to potential reactions that may result from changes in routine, traveling or new environments.
When appropriate, inform others (hotel or shelter staff, family members, airline attendants) that your loved one has dementia and may not understand what is happening. Do not leave the person alone. It only takes a few minutes to wander away and get lost. Changes in routine, traveling and new environments can cause: Agitation Wandering Increase in behavioral symptoms, including hallucinations, delusions and sleep disturbance. Do your best to remain calm. The person with dementia will respond to the emotional tone you set. Tips for preventing agitation Reassure the person. Hold hands or put your arm on his or her shoulder. Say things are going to be fine. Find outlets for anxious energy. Take a walk together or engage the person in simple tasks. Redirect the person’s attention if he or she becomes upset. Move the person to a safer or quieter place, if possible. Limit stimulation. Make sure the person takes medications as scheduled. Try to schedule regular meals and maintain a regular sleep schedule. Avoid elaborate or detailed explanations. Provide information using concrete terms. Follow brief explanations with reassurance. Be prepared to provide additional assistance with all activities of daily living. Pay attention to cues that the person may be overwhelmed (fidgeting, pacing). Remind the person that he or she is in the right place.
The Rona Barrett Foundation Supports Raising Awareness Of & Finding A Cure For Alzheimer’s
Consider preparing an emergency kit in advance. Keep it in a watertight container and store it in an easily
Planning & Preparation
Legal Planning for Alzheimer’s Disease By Nathaniel Hannaford, Attorney at Law
trust, called a “settlor” or “trustor,” that transfers property to another person, the “trustee.” The trustee holds the property for the benefit of another person, called the “beneficiary.” The same person can actually serve in each of these roles. For instance, an individual can create a trust and transfer his or her assets to the trust. While alive, that same individual can manage the trust assets for his or her own benefit. If the individual becomes unable to handle his or her own financial affairs, a new individual named in the trust may take over the role as trustee and manage the trust assets for the benefit of the person that created the trust. Upon the trust creator’s death, the trustee may distribute the trust assets to the named beneficiaries in the trust. One of the primary purposes for creating a living trust is to avoid probate. Probate is a court-supervised procedure for collecting the assets of a deceased person, paying debts, creditor’s and taxes, and following approval from the court distributing those assets to the deceased person’s beneficiaries. In California, the probate process takes approximately 7 to 12 months, but can be significantly longer in complicated cases or in larger counties where the number of court case filings is greater. While the cost to create a living trust may be more than a simple will, the after-death savings to administer a trust and avoid probate can be substantial. The costs for handling a probate are based, in large part, on the statutory fees that may have to be paid to a personal representative and the attorney for the estate. The personal representative’s commission and the attorney fees are paid out of the estate and are computed as a percentage of the gross value of the estate pursuant to California Probate Code §§ 10800 and 10810. For example, the combined statutory commission and attorney fees for a $500,000 estate can be as much as $26,000, and that amount does not include any potential claim for extraordinary fees from the court. There are also court costs for filing pleadings in the estate and fees paid to a court-appointed probate referee charged with appraising certain assets of the decedent. As real estate values in California have increased over the years and the size of estates has grown, the costs to administer an estate in probate have sharply increased. A second benefit of a living trust is that assets are transferred into the living trust before death. A will becomes operative only upon death and requires a decedent’s assets to go through probate. Since a living trust requires a person to transfer property into the trust while still alive, those assets
are managed by a trustee both before and after death. This can be important when the person creating the living trust is diagnosed with dementia or Alzheimer’s disease. While capable, this person can continue to serve as trustee and manage his or her own assets. Should the time come when that person is no longer able to manage his or her own financial affairs, a successor trustee can step in and manage the assets for his or her benefit. At his or her death, the successor trustee can distribute the assets just as the trust creator wishes and avoid probate. This gives the creator of the living trust much more flexibility in managing his or her estate compared to having just a simple will. As such, a living trust can be an important legal and financial planning tool for all persons, but especially those dealing with a diagnosis of dementia or Alzheimer’s disease. In addition to the ability to avoid probate, potential after-death cost savings, and flexibility in managing one’s estate, the living trust comes with the added benefit of privacy versus a will that requires probate and a court-supervised estate that is open to public viewing. (3) If a living trust does not fit our
needs, what do you recommend a person should have prepared when dealing with a diagnosis of early on-set dementia or Alzheimer’s disease? While a living trust is an important legal document that can designate a person to manage the assets and finances of the trust’s creator, another document that is equally important and much easier to prepare is a Durable Power of Attorney for Asset Management. In fact, two of the most important documents that any person should have prepared no matter the age is a Durable Power of Attorney for Asset Management and Durable Power of Attorney for Health Care (advanced health care directive). These Durable Powers of Attorney are important when a person with dementia no longer has the legal capacity to make financial or health care decisions, as the documents will appoint a third-party known as an “attorney-in-fact” to make decisions on them. In some instances, dependent upon a person’s given situation and the make-up of their estate, a simple will and Durable Powers of Attorney for Asset Management and Health Care are all that is needed.
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Lee Central Coast Newspapers | Alzheimers Awareness Guide | June 2019 | 9
Legal planning or “estate planning” following an early diagnosis of dementia or Alzheimer’s disease is an important step to take and should not be delayed. While it is prudent for all individuals to make an estate plan, it is especially important for anyone receiving such a diagnosis in order to articulate decisions to be made for you before it’s too late. When a caregiver, spouse, domestic partner or client in general is requesting guidance on what type of an estate plan will best fit their needs, the following three questions are often asked: (1) What if someone has been diagnosed with early on-set dementia or Alzheimer’s disease? Can that person still create and sign estate planning documents? The short answer: it depends. The level of judgment and decision-making ability for an individual to create and sign estate planning documents is referred to as legal capacity. In California, the requisite legal capacity necessary depends on the subject matter being addressed. For testamentary capacity to create a living trust or will, the legal capacity standard is extremely low. See Marriage of Greenway (2013) 217 Cal.App.4th 628, 642. Under California Probate Code § 6100.5, a person lacks general testamentary capacity if he or she is unable to: Understand the nature of the testamentary act; Understand and recollect the nature of the individual’s property; or Remember and understand the relationship to family members and those whose interests are affected by the will. Alternatively, a person also lacks testamentary capacity if he or she suffers from a mental disorder with symptoms of delusions or hallucinations, and the delusions or hallucinations cause the individual to devise property in a way that they would not do normally. While the legal capacity required for testamentary acts is lower than that required for other matters, it is important to not delay in creating an estate plan. A diagnosis of early on-set dementia or Alzheimer’s disease heightens the need to act promptly. (2) What is a living trust and how do I know whether one is needed? Most people have very little experience in dealing with trusts or how they work. While trusts have been around for centuries, their rise in popularity can be attributed to an increased interest in estate planning and avoiding probate. In its most basic form, a trust is simply a written document that creates a legal relationship between the creator of the
Planning & Preparation
What Are Placement Agencies? By Lori Gross
10 | June 2019 | Alzheimers Awareness Guide | Lee Central Coast Newspapers
What are placement agencies? Placement agencies are both locally owned and nationally for-profit agencies that work with seniors age 50 years or older to find independent, assisted living, residential care, memory care, and skilled nursing facilities. Some facilities have respite care for short term stays. Placement agencies are free for the seniors they work with and receive a one-time commission from the facilities they are contracted with. The commissions range from 50% to 120% depending on the agency. This is important because facilities do not work with all agencies. Ask the senior advisor you are working with what their commission rate is. A respectable agency will answer your question. It is more beneficial to use a local agency over that of a national one. The local agencies in this area have been operating for many years. Because they are local, they are in and out of the facilities they are contracted with weekly. They have built relationships with the facility owners and staff. Many of the local agencies will meet with you
personally at your home, the hospital or rehabilitation facility. They will conduct an in-depth assessment and ask what your monthly budget, and accompany you personally or a family member or friend to look at facilities that meet your requirements and within your budget range. It is important to give your senior advisor a budget to work with, because facilities charge between $2,500 to $12,000 per month depending on the location and type of facility. Local agencies will work with your primary care physician to get the necessary documentation completed for placement. You will also need a tuberculosis test or a recent clear chest X-Ray showing no signs of tuberculosis for placement. The physician report is the directive from your doctor to the facility stating the type of care that you will need. Some agencies are in contact with Community Care Licensing and will provide you with the state reports from the facilities you are touring. It is important to select a facility that offers hospice care. Some facilities do not have hospice waivers and then you will
have to look for another facility when that time comes. Some agencies do not charge for follow-up visits to check in on you or your loved one. You may want to stay in your home for as long as you can. On average, a licensed and bonded home care agency will charge $25 per hour with a twohour minimum. So, two hours in the morning and two hours in the evening will cost $3,000 per month. If you need more than four hours of care in a day, it would be beneficial to move into a licensed facility. For a person needing 24-hour care, the cost could be as high as $20,000 per month. Unfortunately, Medi-Cal does not pay for independent, assisted living or memory care. California considers them housing options and they are private pay. If you are on Medi-Cal, then you may not be able to afford the minimum monthly cost of $2,500 per month. Skilled nursing facilities do take MediCal for their long-term care options, but you will have to meet their requirements to be there. Call your local skilled nursing facility to see if you qualify for
long term care. Long-term care insurance could defray the cost of assisted living, memory care, skilled nursing or licensed home care. If you have a long-term care insurance policy, the terms will be spelled out within the first three pages. You will also find their per diem rate as well as the term of the contract. If you are a veteran or widow of a veteran, you could receive up to $1,700 per month for the veteran and up to $1,000 for the widow from the Veteran’s Association. This amount will go toward the cost of licensed care in your home or toward the cost of assisted living, memory care, or residential care. The program is called Aid and Attendance. You need to be receiving the care before you can submit the application. It could take from thirty days to one year to receive the reimbursement from the Veteran’s Association. They will also give you retroactive monies from the date the application was filed. Veterans can also apply to live in one of the nine California Veteran Homes. The cost is a portion of your monthly income.
“One day, my mother stopped at a stop sign and didn’t know what to do next. It was very unsettling for her.” Ed, on his mother living with Alzheimer’s
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