Pick’s Disease

Recently, I’ve had the opportunity to represent multiple clients that have been diagnosed with Pick’s Disease. Pick’s Disease is a rare and permanent form of dementia that has serious and lasting effects on the person. Those who suffer from Pick’s Disease have behavioral and personality changes which will eventually make it impossible for them to hold down a job or live independently. It is extremely important that anyone diagnosed with this disease meet with an elder law attorney to discuss asset protection and life care planning. Caring for someone with dementia can bankrupt a family unless proper planning is put in place.

If you are diagnosed with Pick’s disease, you should have a power of attorney and advance medical directive prepared, as well discuss whether a special needs trust or asset protection trust would be appropriate for your situation. Don’t delay in making sure your family is protected. Prior planning makes all the difference.

Estate Planning

Why Plan Your Estate?
The process of estate planning means that you have a plan prepared for the management of your affairs during your life and for the disposition of your property upon your death or disability.  No one likes to dwell on the prospect of his or her own death or disability. The failure to plan may cause you or your family to incur unnecessary expenses, taxes, delays, and stress when you die or be become disabled. You run the risk that your loved ones may not receive what you would want them to receive after your death due to conflicts and disagreements, taxes, or administrative costs after death. Failure to plan may also cause you to run out of money during your lifetime if you are to need long-term care. This means that there may be no inheritance left for your spouse or children. This can all be avoided by proper estate planning.    A complete estate plan should consider the needs of your spouse, children, and other beneficiaries.
A comprehensive estate plan will address the following questions:
Whom do I want to make financial or health care decisions for me if I am incapacitated?
Whom do I want to manage my estate after my death?
Where do I want my property to go after my death?
What if my I want to leave property to a beneficiary who is disabled, has a substance abuse problem, or may become divorced?
What happens if my spouse or I become disabled?
How can I minimize or avoid probate taxes and fees after my death?
How can I leave an inheritance for my children?
All estate plans should include the two important estate planning instruments: a durable power of attorney and an advance medical directive.  The first is for managing your property during your life, in case you are ever unable to do so yourself.  The second is for the management of your health care decisions in case you are unable to do so yourself.  Also, an estate plan should include a will and possibly a revocable trust.  Many Americans are using revocable (or “living”) trusts to avoid probate and to manage their estates both during their lives and after they’re gone, but that doesn’t mean it’s the best option for your family.
A complete estate plan will address your needs, as well as the needs of your spouse, children and other family members or business partners.  A good estate planning attorney will discuss your specific family situation with you to determine the best estate plan for your family, whether you need a will and/or a trust and to ensure that you are take care of in the event of a disability.
Don’t delay in getting a proper estate plan put into place. Not having the proper estate plan could have disastrous results for your family. Prior planning makes all the difference.

Caregiver Burnout

While the caregiving role can be enormously rewarding, it also means a lot of sacrifice on the part of the caregiver and their family.  Caregivers generally start taking on a few tasks at a time, however the need generally expands and with each increase, caregivers forfeit more of their personal lives.  The average family caregiver provides nearly 18 to 20 hours of care a week in addition to holding down a job and managing a family. It is not unusual for caregivers to be forced to leave the workforce as needs escalate.  Caregiving can last from less than a year to several decades
Just as overwhelming for a caregiver is the never-ending to-do  list.  Most caregivers face a landscape of too little support at too high a cost.
Caregivers who don’t get the help they need can wind up doing more than they are able to (emotionally, financially or physically) and end up with caregiver burnout. Caregivers who are “burned out” may experience fatigue, stress, anxiety, and depression. Many caregivers also feel guilty if they spend time on themselves rather than on their ill or elderly loved ones.
The symptom of caregiver burnout include:
Feeling blue, irritable, hopeless, and helpless
Changes in appetite, weight, or both
Changes in sleep patterns
Withdrawal from friends, family, and other loved ones
Loss of interest in activities previously enjoyed
Getting sick more often
Feelings of wanting to hurt yourself or the person for whom you are caring
Emotional and physical exhaustion

How can I prevent burnout?
Here are some steps you can take to help prevent caregiver burnout:
Find someone you trust — such as a friend, co-worker, or neighbor — to talk to about your feelings and frustrations.
Take advantage of respite care services. Respite care provides a temporary break for caregivers. This can range from a few hours of in-home care to a short stay in a nursing home or assisted living facility.
Be realistic about your loved one’s disease, especially if it is a progressive disease such as Parkinson’s or Alzheimer’s. Acknowledge that there may come a time when the patient requires nursing services or assisted living outside the family home.
Don’t forget about yourself because you’re too busy caring for someone else.
Talk to a professional elder law attorney to ensure that your loved one is getting any benefits they may be entitled to and that they have a long-term care plan in place.
Stay healthy by eating right and getting plenty of exercise and sleep.
Accept your feelings. Having negative feelings — such as frustration or anger — about your responsibilities or the person for whom you are caring is normal. It does not mean you are a bad person or a bad caregiver.
Join a caregiver support group. Sharing your feelings and experiences with others in the same situation can help you manage stress, locate helpful resources, and reduce feelings of frustration and isolation.
Where can I turn for help for caregiver burnout?
If you are already suffering from stress and depression, seek medical attention. Stress and depression are treatable disorders. If you want to prevent burnout, consider turning to the following resources for help with your caregiving:
Geriatric Care Managers – Geriatric Care Managers assist families with creating and putting into place a long-term care plan.  They can help the family with all aspects of that plan, including finding home health care or nursing home placement.
Home health services — These agencies provide home health aids and nurses for short-term care, if your loved one is acutely ill. Some agencies provide short-term respite care.
Adult day care — These programs offer a place for seniors to socialize, engage in a variety of activities, and receive needed medical care and other services.
Nursing homes or assisted living facilities — These institutions sometimes offer short-term respite stays to provide caregivers a break from their caregiving responsibilities.
Caregiver support services — These include support groups and other programs that can help caregivers recharge their batteries, meet others coping with similar issues, find more information, and locate additional resources.
Some content from: The Cleveland Clinic Foundation.

Veteran's Benefits – Aid and Attendance

Many seniors are unaware that they may be eligible for the VA aid and attendance benefit.  This benefit is available to veterans over the age of 65, who served at least 90 days of active duty, with one day during a period of wartime.   They must have received a better than dishonorable discharge.  If a veteran, or his spouse, has recurring out of pocket medical expenses or needs assistance with daily living tasks (such as meal preparation, dressing, bathing, shopping, taking medications, etc.) he or she should consult an elder law attorney to determine whether they might qualify for the Aid and Attendance benefit.
This benefit pays the veteran or spouse a monthly tax-free  pension amount.  A veteran is eligible for up to $1949 per month and a widowed spouse is eligible for up to $1056 per month in tax-free income.
In order to qualify, the veteran or widowed spouse must have recurring medical expenses or require personal assistance.  Medical expenses can include in-home care (including a child who is taking care of a parent either part-time or full-time), assisted living community costs, nursing home costs, prescription drugs, medical equipment, adult day care, insurance premiums, etc.
There are asset and income qualifications as well.  An experienced elder law attorney can assist the veteran or his widowed spouse in creating a plan for veteran’s benefits and determining the best method for preparing the application.  The elder law attorney will also discuss with the family how any application for VA benefits might affect future eligibility for Medicaid or other government benefits. It is imperative that steps be taken to adequately preserve the senior’s assets and to preserve eligibility for any other benefits the senior may require in the future.
Finally, the process of applying to the VA for this benefit can be very lengthy and difficult.  It is best to work with someone knowledgeable who can assist you in preparing your claim so that it is approved as quickly as possible.
The VA also requires that anyone giving advice to veterans about this benefit be accredited through the VA.  Before choosing a professional to assist you, make sure to ask if they are accredited and if they will help your family prepare a Medicaid or other long-term care plan at the time they are preparing the plan for VA benefits.
Angela N. Manz is an elder law attorney licensed in the Commonwealth of Virginia.  She is accredited through Department of Veterans Affairs to assist veterans and their families in the preparation of claims for veterans benefits.
This blog post is not intended to provide legal counsel or to be a substitute for legal counsel. We assume no responsibility for any errors, omissions or any damage resulting from the use of this information.

Seminar Event!

The Law Office of Angela N. Manz and Care Connect of Hampton Roads will be hosting a free information session to answer your Senior Care Questions. Registration is free!
Seminar dates:  July 28th, August 25th, September 29th
2:30 pm – Virginia Beach Central Library
To register, call Angela at 757-271-6275.  Don’t miss this great opportunity to have all your questions answered!

Geriatric Care Management

Many seniors and their families have found tremendous joy and relief while working with a geriatric care manager.  A geriatric care manager assists clients with all aspects of aging, answering such questions such as:

  • Should I move into assisted living?
  • Does my loved one have to go into a nursing home?
  • How can I get my loved one into a quality assisted living or nursing care home?
  • How can I get the correct Medicare benefits?
  • What if I need in home care?
  • How can I help take care of my parent when I live in another state?
  • What if I want to move my parent closer to me?
  • What if my loved one isn’t taking their medications properly?
  • What if I don’t think my loved one is ready to leave the hospital or rehabilitation center?
  • And much more . . .

If you need help for your senior loved ones, consider working with a geriatric care manager to help your family navigate through these difficult decisions.
This blog post is not intended to provide legal counsel or to be a substitute for legal counsel. We assume no responsibility for any errors, omissions or any damage resulting from the use of this information.

Will Medicaid Take My Home?

Medicaid and Medicare are two government programs available to seniors that can be very confusing.  Medicaid is a federal government program, administered through the states, that will cover almost every expense associated with nursing care for those who qualify. Medicare is a health insurance program for people over age 65 or for people under age 65 with certain disabilities.
Medicaid is frequently used for people who require full-time or skilled nursing care. In Virginia, Medicaid will provide benefits for a nursing home or for some limited in-home care service
The eligibility requirements for Medicaid are very strict and there can be significant penalties imposed for not following the rules. In Virginia, a single person can have no more than $2,000 in countable assets. For a married couple, the spouse applying for Medicaid may have no more than $2,000 and the spouse still living in the community may keep up to $109,560 in countable assets. This doesn’t mean that every community spouse may keep $109,560. It means that this is the maximum in countable resources that the community spouse is allowed. The rules on how to calculate the amount that a community spouse may keep depend on what assets the couple has when the institutionalized spouse enters the hospital or nursing home. Also, not every asset is countable for Medicaid purposes. For instance, an individual applying for Medicaid is allowed to have one personal vehicle as an exempt asset.
The biggest question I get is whether Medicaid will take your home. I frequently find that there is a lot of misinformation on this subject as well, so we will clear that up here today. In Virginia, Medicaid does not “take” anything from anyone. What happens is that the assets of the couple (or individual, if not married) are looked at as of the date that the ill spouse (or single individual) first entered the hospital or nursing home for a period of thirty days or longer. This is called the “snapshot date”. If the couple (or single individual) has too much in countable resources, they will be required to spend those excess resources before becoming eligible for Medicaid. This is called “spending down”.  Once those extra assets are spent down, they can then apply for Medicaid. The good news is that, for a married couple, as long as the community spouse remains in the home, it is NOT a countable resource and is not counted for Medicaid purposes. For a single person, the home is exempt for the first six months, but after that a “good faith effort to sell” must be made. This does not mean that the person must actually sell their home before getting Medicaid.  This is where people can get themselves into trouble, so it would wise to seek counsel from an elder law attorney before attempting this on your own.
Each week I hear stories from my clients about advice and ideas that they get from others. Most of the time the information is either incorrect or is not correct for that person’s situation. It is imperative that you discuss your individual situation with an elder law attorney. You need someone who can look at all pieces of the puzzle and give you accurate advice to create a long-term care plan that works for your family. Don’t rely on third-hand information. Going straight to a professional will save you time, money and heartache in the future.
This blog post is not intended to provide legal counsel or to be a substitute for legal counsel. We assume no responsibility for any errors, omissions or any damage resulting from the use of this information.