How We Benefit from Being Grateful

The Science of Gratitude

Researchers Robert A. Emmons, University of California – Davis, and Michael E. McCullough, University of Miami, have been conducting a study on gratitude. Three groups of participants in the study were asked to keep journals. One group used their journals to record the hassles and problems they had faced. The second group recorded neutral life events while the third group kept “Gratitude Journals” listing the experiences and things they were grateful for each week. Following are highlights from the “Research Project on Gratitude and Thankfulness – Dimensions and Perspectives of Gratitude”.

• In an experimental comparison, those who kept gratitude journals on a weekly basis exercised more regularly, reported fewer physical symptoms, felt better about their lives as a whole, and were more optimistic about the upcoming week compared to those who recorded hassles or neutral life events (Emmons & McCullough, 2003).
• A related benefit was observed in the realm of personal goal attainment: Participants who kept gratitude lists were more likely to have made progress toward important personal goals (academic, interpersonal and health-based) over a two-month period compared to subjects in the other experimental conditions.
• Participants in the daily gratitude condition were more likely to report having helped someone with a personal problem or having offered emotional support to another, relative to the hassles or social comparison condition.
• In a sample of adults with neuromuscular disease, a 21-day gratitude intervention resulted in greater amounts of high energy positive moods, a greater sense of feeling connected to others, more optimistic ratings of one’s life, and better sleep duration and sleep quality, relative to a control group.

The researchers have found that “grateful people report higher levels of positive emotions, life satisfaction, vitality, optimism and lower levels of depression and stress.” One’s thankfulness also has an effect on how others see them. “People with a strong disposition toward gratitude have the capacity to be empathic and to take the perspective of others. They are rated as more generous and more helpful by people in their social networks”

Other traits found to be improved or enhanced by an attitude of gratitude are: well being, sociality, spirituality and a healthier view on possessions and materialism.

The holidays are a great reminder of the importance of gratitude. The challenge then, is can we take that frame of mind and carry it through the rest of our lives. If we do, research tells us we will live a happier, less stressful and more meaningful life.

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Caring for Senior Veterans – VA Long Term Care Benefits

Caring For Our Veterans

The United States has fought many wars throughout the world defending our freedoms and continues to do so. From the beginning, our country has established a program to care for the men and women of our military who fought in those wars.

The Veteran’s Assistance Program goes back to 1636 when Pilgrims of Plymouth Colony fought with the Pequot Indians. The Pilgrims enacted a law from English law that reads, “If any man shall be sent forth as a soldier and shall return maimed, he shall be maintained competently by the colony during his life.” In 1789 U. S. congress passed as law that pensions were to be provided to disabled veterans and their dependents and in 1811 the first domiciliary and medical facility for veterans was completed. Since that time the Department of Veterans Affairs has opened a multitude of care facilities nationwide

Here are some of the benefits provided for Veterans by the Department of Veterans Affairs:

• Hospitals & Health Care Clinics
• Mental Health
• Counseling
• Job training
• Burial and Memorial benefits
• Education
• VA Home Loan
• DIC
• Compensation
• Pension
• Care Management
• Home Renovation for Disability
• Assisted Living
• Prosthetics
• Rehabilitation
• Weight Management
• Nursing Homes
• Prescriptions

“Aid and attendance” is a commonly used term for a little-known veterans’ disability income. The official title of this benefit is “Pension.” The reason for using “aid and attendance” to refer to Pension is that many veterans or their single surviving spouses can become eligible if they have a regular need for the aid and attendance of a caregiver or if they are housebound. Evidence of this need for care must be certified by VA as a “rating.” With a rating, certain veterans or their surviving spouses can now qualify for Pension. Pension is also available to low income veteran households without a rating, but it is a lesser dollar amount.

Pension – The Underused Benefit

There are different income categories for Pension, but the highest could pay as much as $1,949 a month in disability income to a qualifying veteran household. A study commissioned by VA in 2001 estimated that, over the next 14 years, only about 30% of eligible veterans would apply for Pension. This is likely due to the fact that most veterans simply don’t know about it. In fact, about a third of all seniors in this country, age 65 and older, could become eligible for pension under the right circumstances. That’s how many elderly war veterans or their surviving spouses there are.

To receive Pension, a veteran must have served on active duty at least 90 days with at least one of those days during a period of war. There must be a discharge under conditions other than dishonorable. Single surviving spouses of such veterans are also eligible. If younger than 65, the veteran must be totally disabled. If age 65 and older, there is no requirement for disability. There is no age or disability requirement for a single surviving spouse.

There are income requirements, but a special provision does allow household income to be reduced by 12 months worth of future, recurring medical expenses. Normally, income is only reduced by medical expenses incurred in the month of application. Allowable, annualized medical expenses include insurance premiums, ongoing prescription drug costs, out-of-pocket cost of monthly medical equipment rental, the cost of home care, the cost of paying adult children to provide care, the cost of adult day services, the cost of assisted living and the cost of a nursing home facility. These are all considered medical costs and they can be deducted from income to receive this benefit.

The secret for receiving a successful award for aid and attendance or housebound ratings is not in filling out the form but in knowing what documents and evidence must be submitted with the application. Knowing the secrets for a successful award – with the special case of long term care recipients – is 95% of the battle. A knowledgeable consultant can provide information to shorten the VA’s decision window of 6 to 12 months to possibly 3 or 4 months.

At Idaho Estate Planning we understand how to maximize the benefit or avoid a denial. We can also provide guidance for meeting the asset test. We provide the best strategies for reallocating assets through trusts or income conversions to allow for the best possible accommodation of assets for beneficiaries thus avoiding or reducing: taxes; family disputes; and, Medicaid penalties.

We are VA Accredited and we know how to help you get the benefits you earned through your greatly appreciated service to our country. Good planning is no accident. To secure your peace of mind as well as your family’s future, get started now.

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Strategies to Reduce Caregiver Stress Part IV

Understanding Caregiver Stress

A 2003 study of caregivers by a research team at Ohio State University has proven the off-repeated adage “stress can kill you” is true. The focus of the investigation was the effect the stress of caregiving had on caregivers. The team, led by Dr. Janice Kiecolt-Glaser, reports on a 6-year study of elderly people caring for spouses with Alzheimer’s Disease. The study not only found a significant deterioration in the health of caregivers when compared to a similar group of non-caregivers but also found the caregivers had a 63% higher death rate than the control group.

Controlling Stress with Calming Techniques

Music Therapy

Listening to music is a wonderful way to alleviate stress. In doing extensive research on what any given piece of music produces as a physiological response, many unexpected things were found. Many of the so-called Meditation and Relaxation recordings actually produce adverse EEG patterns in the brain–just as bad as Hard Rock and Heavy Metal. A British study involving stress and surgery found “music of a style selected by the patient appeared to be more effective overall in reducing stress.” Another study found that any music performed live and even at moderately loud volumes even if it is somewhat discordant can have a very a beneficial response. Basically, listen to music that makes you feel good, and if you can go listen to it live – all the better.

Pet Therapy

There is a saying that “dog is man’s best friend.” This is certainly true when it comes to dealing with your body’s stress response. Many people feel more relaxed when companion animals are present. Several studies have shown that pets are good for us in numerous ways. For example, petting an animal is known to lower your heart rate, lower your blood pressure and brighten your mood. Another study found that simply watching fish in an aquarium made patients waiting to undergo medical procedures less anxious. In fact, “pet therapy” is frequently used in hospitals and nursing homes to increase socialization and to reduce depression, loneliness, anger, and stress

Secondly, having tender physical contact with your pet is also good for you. Having an animal to hold, cuddle and caress has positive effects on people. Especially those who might have limited means to give or receive physical expressions of affection. Most of us have felt a warm fuzzy feeling inside just by getting your face licked by a puppy. After a hard day at work, this kind of attention can really help you to calm down and relax.

Next, simply talking to your pet can be very therapeutic. People often talk to their pets to share their thoughts, feelings, troubles and worries. Although your pet won’t give you any solutions for your problems, the very act of talking about your concerns with a good listener may help you find your own solutions. And you must admit pets are great listeners.

Finally, if you have a dog for a pet, you get to go for a walk at least 3 or four times a day. This affords you the perfect excuse to take time to yourself away from your stressors. These walks give you time to breathe fresh air, join with nature, collect your thoughts, make plans for the day, or just daydream. The light exercise you get from walking your pet helps you to deal with the physical stress reactions you have acquired in the course of your day. Specifically, walking with your dog helps you to burn up the pent up energy your stressors have caused.

Gardening

Gardening has an important impact on the health of individuals through direct interaction with plants and the natural environment. Horticulture promotes individual health through exercise, stress reduction, social interaction and mental stimulation. Gardening is recommended by such groups as the American Heart Association as a technique to improve general physical health and thus prevent many diseases. In addition, urban agriculture can plan a role in improved health through access to high quality fresh produce either locally produced or self-produced.

Prepare Now to Reduce Stress Later

Idaho Estate Planning is part of the Treasure Valley Care Planning Council, a non-profit network of elder care professionals available to provide information beyond the items discussed above. Let us know your concerns and we will help you find the resources you need.

In addition to caring for your parents or other family members, it is also important to consider your own concerns for the future. How will you maintain your independence as you grow older? What effect would a costly health issue have on your quality of life? The more planning you do now the less difficulty there will be later. Better planning now will reduce the stress placed on you and your future caregivers. Good planning is no accident.

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Strategies to Reduce Caregiver Stress Part III

Understanding Caregiver Stress

A 2003 study of caregivers by a research team at Ohio State University has proven the off-repeated adage “stress can kill you” is true. The focus of the investigation was the effect the stress of caregiving had on caregivers. The team, led by Dr. Janice Kiecolt-Glaser, reports on a 6-year study of elderly people caring for spouses with Alzheimer’s Disease. The study not only found a significant deterioration in the health of caregivers when compared to a similar group of non-caregivers but also found the caregivers had a 63% higher death rate than the control group.

Reduce Stress Through Proper Nutrition

Avoid Over Eating

Many people react to stress by eating. Eating too much for a long period causes obesity. This causes your heart and lungs to work harder, overloads your organs and reduces stamina. Studies show that fat cells excrete IL-6 and that overweight people have high levels of IL-6 in their blood. This in turn leads to the IL-6-associated illnesses such as heart disease, immune disorders and diabetes.

Good Eating Habits

Some people react to stress and stress-induced depression by not eating or eating poorly. If you eat a good, well-balanced diet, your body will be receiving all the nutrients it requires to function properly. On the other hand, if you are eating an unbalanced diet or not eating enough you may be stressing your body and contributing to stress-related complications by depriving yourself of essential nutrients.

Coffee, Tea, Caffeine Soft-Drinks & Chocolate

Caffeine is a stimulant. One of the reasons you probably use it is to raise your level of activity. This chemical actually enhances the stress response and thus increases your existing stress. Small quantities probably do little harm but large quantities over a long period produce excessive stress and lead to many of the physical ailments attributed to chronic stress. Too much caffeine can be dangerous. If you are drinking many cups of caffeine products a day, then you may find you can reduce a lot of stress and save your health by switching to caffeine-free products for a portion of your daily intake.

Alcohol

Some people react to stress by imbibing in alcohol. In small amounts, spirits may help you relax. In larger amounts alcohol may increase stress as it disrupts sleep. Over the long-term, alcohol will damage your body. Alcohol is also a depressant. If you’re prone to depression, alcohol will only make it worse. Studies show that depressed people have eight times the level of IL-6 as compared to the general population. As we have seen, high, prolonged levels of IL-6 are a marker for debilitating illness and early death.

Tobacco

In the short-term tobacco use seems to relax people but the toxic effects of nicotine raise the heart rate and enhance the stress response. If you smoke, try taking your pulse before and after a cigarette, and notice the difference. After the initial period of giving up smoking, most ex-smokers report feeling much more calm.

Sugar and Refined Flour

Sugar can be a stimulant for people experiencing stress and stress-induced depression. Sugar-rich foods (the starch in refined flour is also a form of sugar) can raise your energy level in the short-term. The problem is your body copes with high levels of sugar by secreting large amounts of insulin, which in turn, quickly reduces the excess amount of sugar in your blood stream often causing blood sugar levels to swing too low.

These up and down spikes in blood sugar can cause agitation, mood swings, irritability and fatigue, which in turn can contribute to the creation of additional stress. The ups and downs of sugar spikes also contribute to depression. And of course, excess sugar is readily converted to body fat thus causing obesity. Consuming sugar in the form of complex carbohydrates–whole grains, fruits, vegetables and tubers–forces the digestive tract to release blood sugar more slowly and keeps insulin and blood sugar levels more normal. Avoid fruit drinks, sugar drinks, candy, pastas, white bread and pastries.

Prepare Now to Reduce Stress Later

Idaho Estate Planning is part of the Treasure Valley Care Planning Council, a non-profit network of elder care professionals available to provide information beyond the items discussed above. Let us know your concerns and we will help you find the resources you need.

In addition to caring for your parents or other family members, it is also important to consider your own concerns for the future. How will you maintain your independence as you grow older? What effect would a costly health issue have on your quality of life? The more planning you do now the less difficulty there will be later. Better planning now will reduce the stress placed on you and your future caregivers. Good planning is no accident.

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Strategies to Reduce Caregiver Stress Part II

Understanding Caregiver Stress

A 2003 study of caregivers by a research team at Ohio State University has proven the off-repeated adage “stress can kill you” is true. The focus of the investigation was the effect the stress of caregiving had on caregivers. The team, led by Dr. Janice Kiecolt-Glaser, reports on a 6-year study of elderly people caring for spouses with Alzheimer’s Disease. The study not only found a significant deterioration in the health of caregivers when compared to a similar group of non-caregivers but also found the caregivers had a 63% higher death rate than the control group.

Lifestyle Changes to Reduce Stress

Exercise

Exercise is a powerful and effective way to fight stress. It is recommended you do about 30 minutes of moderate exercise at least 3 days a week. Here are a few reasons why exercise works.

• Distraction–Exercise provides time away from the stresses of the day.
• Endorphins–Endorphins are opiate-like chemicals that the body produces naturally during periods of stress or physical exertion to relieve pain.
• Neurotransmitters–During exercise, the body releases higher levels of dopamine. These hormones improve the thought process by facilitating transfer of information between neurons.
• Self-esteem–Exercise can be a gratifying and fulfilling activity for people. The act of doing something good for self can promote self-esteem.

Support Groups

Participating in a support group can help manage stress. Sharing coping strategies in a group setting lets you help others while helping yourself. It may also help you to realize that some problems have no solutions and that accepting the situation is reality. Social support has a huge impact on reducing stress. Those who suffer alone, suffer a lot.

Get Adequate Sleep

The catch-22 with sleep is that if you are over-stressed, you are likely to experience a disturbed sleeping pattern, and if you are experiencing a disturbed sleeping pattern, you are likely to become over-stressed!

Sleep isn’t a luxury; it’s a necessity. Sleep restores the body and mind and helps us maintain our mental and physical health. Studies have shown that people who get seven to eight hours of sleep each night enjoy better health and live longer than people who get less sleep.

To ensure that you get enough sleep, try some of the following suggestions:

• Develop a sleep schedule and stick to it.
• Get 30 or more minutes of physical activity each day. Avoid working out during the three hours before bedtime.
• Avoid caffeine, nicotine, and alcohol. Quit smoking. An alcoholic beverage (a “night cap”) before bed may make you drowsy but it actually deprives you of deep, restorative sleep.
• Engage in relaxing activities before bed.
• Leave your troubles outside the bedroom door. Make your bedroom a worry-free zone.
• Create a cozy sleep environment free of distractions.

Pursue Diversions, Hobbies and Relaxing Activities

Another simple way to reduce stress is to distract yourself — go to a movie, play a sport, immerse yourself in a hobby, listen to some favorite music or take a walk. It cannot be emphasized enough how important it is as a caregiver you spend some quality time alone every week, doing exactly what it is you like to do.

Prepare Now to Reduce Stress Later

Idaho Estate Planning is part of the Treasure Valley Care Planning Council, a non-profit network of elder care professionals available to provide information beyond the items discussed above. Let us know your concerns and we will help you find the resources you need.

In addition to caring for your parents or other family members, it is also important to consider your own concerns for the future. How will you maintain your independence as you grow older? What effect would a costly health issue have on your quality of life? The more planning you do now the less difficulty there will be later. Better planning now will reduce the stress placed on you and your future caregivers. Good planning is no accident.

Idaho Estate Planning

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Strategies to Reduce Caregiver Stress Part I

Understanding Caregiver Stress

A 2003 study of caregivers by a research team at Ohio State University has proven the off-repeated adage “stress can kill you” is true. The focus of the investigation was the effect the stress of caregiving had on caregivers. The team, led by Dr. Janice Kiecolt-Glaser, reports on a 6-year study of elderly people caring for spouses with Alzheimer’s Disease. The study not only found a significant deterioration in the health of caregivers when compared to a similar group of non-caregivers but also found the caregivers had a 63% higher death rate than the control group.

Ask for Help

Most caregivers are reluctantly thrust into their role without preparation because the need for care usually comes with little warning. Caregivers end up operating in a “crisis” mode–arranging medical care and living arrangements, scheduling care time, providing meals and household chores and so forth. Because they are so stressed and burdened, they rarely take time to find out what resources are available to help them. Ironically, caregivers often sever ties with family, friends and support groups about this time just when help from these people is most needed.

As a caregiver you must ask for help. The stress of going it alone is dangerous to your health. If it’s difficult to ask for yourself, use an advocate–a sibling, friend or professional care manager –to arrange a meeting and get formal, written commitments from those people who are willing to help you. The extra help will give you breathing room to find all those resources that are there to help you.

Assistive Technology

There are a number of technologies to make sure your loved-ones are safe while you’re away. Such things as emergency alert bracelets and pendants, GPS tracking for wandering, remote video surveillance, telehomecare, sensory augmentation and all sorts of assistive devices to help disabled people cope on their own.

Take Time Off

Taking a break from caregiving is just as important as taking a break at work or taking that long-awaited vacation. A care manager may be of help in selecting the best temporary help to give you a break. Or you may make arrangements with family or friends to give you a break from caregiving.

Seek Care Management Advice

A number of organizations and private companies will give you advice and guidance — many for free. If your care recipient has a very low income, you might get free help from your local Area Agency on Aging. A lot depends on available funds.

Idaho Estate Planning is part of the Treasure Valley Care Planning Council, a non-profit network of elder care professionals available to provide information beyond the items discussed above. Let us know your concerns and we will help you find the resources you need.

In addition to caring for your parents or other family members, it is also important to consider your own concerns for the future. How will you maintain your independence as you grow older? What effect would a costly health issue have on your quality of life? The more planning you do now the less difficulty there will be later. Better planning now will reduce the stress placed on you and your future caregivers. Good planning is no accident.

Idaho Estate Planning

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Helping Your Elderly Parent with COPD Related Depression

Experts say that over a million people in the United States have chronic obstructive pulmonary disease (COPD). It is a chronic lung condition that includes bronchitis, emphysema or both.

COPD affects the airways and air sacs within the lungs, which makes breathing difficult and can result in a person becoming less active over time. An elderly person who has COPD will easily become depressed, when dealing not only with breathing difficulties but other age related problems.

One example of COPD related depression is Martin, age 72. Martin had lived a busy lifestyle, playing golf, volunteering at the community center and working in his garden. Diagnosed with COPD six months previous, and uncertain how to manage his breathing difficulty and new medications, Martin stopped all his activities. Giving up the things he loved to do and sitting more at home along with improper diet, he became a victim to depression.

Martin’s son Anthony realized that his father could not handle his new situation and depression alone. A trip together to Martin’s physician began the steps to dissipating the depression and enabling Martin to return to his social life.

Anthony received instructions about his father’s medications from the doctor and how they were to be used and consequently could help his father with medication reminders.

The most common types of daily COPD medicines are:

• Inhaler for daily maintenance – Bronchodilators help relax the muscles around the lungs’ breathing tubes. This reduces shortness of breath and makes breathing easier.
• Steroids – Corticosteroids, taken in pill form or inhaler reduce swelling in breathing tubes to quickly make breathing easier. Not commonly for prolong use.
• Oxygen Treatment – Severe COPD will reduce your lungs’ ability to put oxygen into your blood to be carried throughout your body. Martin’s oxygen level was measured to determine if he would need prescribed oxygen therapy. Oxygen is usually prescribed if the oxygen in the blood is low during sleep, exercise, or while not active. A respiratory therapist from an oxygen supply company or home health service can help with learning how to use oxygen.

An important factor in Martin’s depression and COPD management was his diet.

“A healthy diet can play an important role in the management and treatment of COPD.
Finding the right diet can be tricky for people with chronic obstructive pulmonary disease (COPD), since they need to eat a healthy diet and maintain their optimal weight to keep COPD symptoms in check.”  (Krisha McCoy, MS, Lindsey Marcellin, MD, MPH)

Maintaining the right nutrition and taking vitamins not only keeps the body healthy but heals the mind, providing emotional well being. Fad diets or extreme dieting are not appropriate for COPD patients. Extreme weight loss can be as much a hazard as being overweight. A home care nutritionist can help establish a healthy menu and diet plan.

With medication and diet under control the final steps to overcoming Martin’s depression were to return to his daily activities. With COPD, an elderly person is more hesitant to leave home, especially if that person’s breathing capacity is not as it used to be. There is a lot of available mobility support for the elderly with small portable oxygen units, walkers, electric scooters and other supportive equipment to help these disabled people move about in the community.

With the help of mobile services and his son at his side to start with, Martin returned to the golf course and community activities. His new diet and return to previous activity helped Martin overcome his symptoms of depression.

Studies show that the intervention of family and friends in helping and supporting elderly people with COPD results in a decrease of depression and a healthier outcome for the patient.

The Oxford Journals: Medicine, Age and Ageing states

“It is also worth exploring how family and friends may be involved in supporting the patient and to encourage social interaction. Educating the spouse, family members and friends about depression may help them to understand the consequences of the disease and to develop coping strategies and in turn may reduce the likelihood of isolation. A very recent study that investigated the benefits of emotional support by family and friends and of spiritual beliefs in patients with major depression showed that those with higher perceived emotional support had better outcomes.” (Oxford Journals Medicine Age and Ageing Volume 35, Number 5)

Idaho Estate Planning is part of the Treasure Valley Care Planning Council, a non-profit network of elder care professionals available to provide information on the information discussed above and much more. Let us know your concerns and we will help you find the resources you need.

In addition to caring for your parents or other family members, it is also important to consider your own concerns for the future. How will you maintain your independence as you grow older? What effect would a costly health issue have on your quality of life? The more planning you do now the less difficulty there will be later. Good planning is no accident.

Call us today and let us help.

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Aging Parents: Warning Signs of Failing Health

Aging parents are becoming a concern for a growing number of Idahoans. In an article originally published on www.MayoClinic.com we find some useful tips on monitoring our parent’s well-being while allowing them the independence they desire. Below are 5 items to consider.

1: Are your parents losing weight?

Losing a significant amount of weight without trying can be a sign of trouble. Perhaps they are having difficulty cooking whether because of a lack of energy, difficulty using utensils and appliances, or maybe they’re having difficulty reading or understanding the instructions.

As we age it is normal for our sense of taste to diminish this can also lead to a loss of appetite when foods just don’t taste as good as they used to. Smell is very important to our appetite and a decline in our ability to smell can also lead to problems with proper nutrition.

Of course there is always the concern of deeper issues such as dementia, cancer or even depression.

2: Are your parents taking care of themselves?

A direct quote from the Mayo Clinic article explains this concern:

“Pay attention to your parents’ appearance. Are their clothes clean? Do they appear to be taking good care of themselves? Failure to keep up with daily routines — such as bathing, tooth brushing and other basic grooming — could indicate health problems such as dementia, depression or physical impairments.”

It is also important to monitor the living conditions in the home. Look for big changes from the past. Are lights burnt out? How about the bathrooms, are they kept as clean as they used to be? Scorched cookware may indicate forgetfulness when cooking. Depression or dementia can be a cause of chronic problems in this area as well.

3: Is their home as safe as possible?

Safety around the home is very important. Are hallways and stairs well lit? Are falls becoming a problem? Are they having trouble reading prescriptions or instructions? Is there a concern of falling or slipping when coming in and out of the house? A malfunctioning water heater or furnace can be deadly. Periodic maintenance is critical to keeping the home safe.

4: Are they in good spirits?

Again we want to see consistency in their behavior. Are they as active as they would like to be? Do they need help getting out and participating in activities? Are they still interested in life-long hobbies and activities? If they are religious are they attending worship services?

5: How are they getting around?

We all slow down as we get older. Watch your parents as they are walking. Make sure they can still get where they need to without too much discomfort or pain. Aching joints and lack of energy can lead to difficulties walking and that can lead to depression. Do they need a cane or a walker? Perhaps they would benefit from chairs that are easier to get out of or higher toilets that are easier to use?

What to do?

• First, take care of any safety issues. Replace light bulbs; add bars or grips where necessary. If canes or walkers are needed take care of the issue.
• Talk to your parents, share your concerns with them. Open communication can go a long way towards taking care of these issues. It isn’t always easy to admit you need help. Therefore, be patient and understanding. Remember how important your independence is to you, it is just as important to them. Sometimes just knowing that someone cares and is paying attention can make all the difference.
• Encourage regular visits with health care professionals.
• Consider Home Health services. There are a number of very good services in Idaho that have experience serving the elderly while helping them to maintain their independence.
• Network with local agencies and support groups.

It is important to make sure your parents know of your sincere concerns and that you truly care for them. Quality of life is an important variable and they need to know that you are concerned about the same things they are.

Idaho Estate Planning is part of the Treasure Valley Care Planning Council, a non-profit network of elder care professionals available to provide information on the information discussed above and much more. Let us know your concerns and we will help you find the resources you need.

In addition to caring for your parents, it is also important to consider your own concerns for the future. How will you maintain your independence as you grow older? What effect would a costly health issue have on your quality of life? The more planning you do now the less difficulty there will be later. Good planning is no accident.

Call us today and let us help.

Idaho Estate Planning

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Hospice Care

Hospice Care

It is unfortunate that many people who died in a hospital emergency room or who received heroic treatments to prolong life in a hospital or nursing home may have had the alternative of dying at home in familiar surroundings, with family or other loved ones at their side.

Most often when it becomes apparent that there is really no hope for recovery, a family calls 911 and starts a process which can result in great stress and great emotional discomfort. The loved one who is dying ends up in a hospital or nursing home in a strange environment, frightened and confused and tied to tubes and monitoring devices. Given the option, this is not how most of us would choose to spend our last hours on earth.

Attending to a dying loved one in the peace and quiet of the home with caring family close at hand can be a comforting and even spiritual experience for all involved. Hospice can allow this to happen. Memories of a loved one passing in peace can provide great comfort for family members in years to come.

When there is no longer hope for prolonging life and especially when the decision is made months in advance, hospice is a viable alternative to other medical intervention.

Hospice care is a valuable service and is generally underused except for terminal cancer patients. Most families wait too long to have their doctor prescribe hospice from Medicare. Doctors or families don’t often consider this care alternative for Alzheimer’s, degenerative old age or other debilitating illnesses where a person is going downhill fast. They should.

Good Hospice Care:

• Manages the patient’s pain and symptoms
• Assists the patient with the emotional and psychosocial and spiritual aspects of dying
• Provides needed medications, medical supplies, and equipment
• Coaches the family on how to care for the patient
• Delivers special services like speech and physical therapy when needed
• Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time
• Provides bereavement care and counseling to surviving family and friends.

A person can receive hospice from Medicare if:

1. He or She is eligible for Medicare Part A (Hospital Insurance), and
2. The doctor and the hospice medical director certify that the person is terminally ill and probably has less than six months to live, and
3. The person or a family member signs a statement choosing hospice care instead of routine Medicare covered benefits for the terminal illness, and
4. Care is received from a Medicare-approved hospice program.

A person may continue to receive regular Medicare benefits from his or her customary doctors for conditions not related to the hospice condition.

Good planning is critical. Good planning leads to more options, more control and greater peace of mind. However, good planning is no accident. All of these decisions and options are best discussed well in advance. To secure your peace of mind as well as your family’s future, get started now.

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Medicaid Planning Part III

Introduction

In Medicaid Planning Part II we covered:

• Intent to Return Home
• Medicaid Treatment of a Home
• Special Home Exemption Rule
• Joint Tenancy

Transfer Title of the Property to the Community Spouse

Transfers to a spouse of any assets are exempt from Medicaid eligibility rules. An institutional spouse, anticipating Medicaid, can transfer title in the home to the community spouse and it has no effect on Medicaid eligibility. This can be done either with a quit claim deed or through a trust. With the asset no longer in the name of the care recipient, Medicaid recovery cannot use the house as a basis for recovering its costs. And the community spouse can transfer the house to a member of the family and as long as this is done beyond the five-year look back period, then Medicaid can’t assess a penalty period for a transfer of assets for less than value. It’s important to use a legal adviser to make sure you do this properly.

Trust to Avoid Probate

Common trusts to avoid probate are called “living” or “inter vivos” trusts. A trust never dies, thus it is not subject to probate. Most arrangements make the trust the owner of the property with the original owner(s) as trustee(s) (caretaker as it were) and beneficiaries(s). Thus, the property reverts to the estate at death. Most people initiate these trusts to avoid probate. Assets in these trusts, other than a primary residence, are transparent to Medicaid. These trust assets are subject to Medicaid spend down rules.

The trust can be used in states where Medicaid recovery only uses primary residences passing through probate as being subject to recovery. However, a growing number of states do not recognize these arrangements to avoid probate estate recovery and go after primary residences in revocable trusts regardless of ownership.  Idaho does not ignore the trust, however, Health and Welfare will require that the trustees of the revocable or living trust transfer the primary residence back out of the trust to the beneficiaries.  This, then, allows Health and Welfare to recover the value of benefits paid from the house now destined to go through probate.

To do it right for these states requires an irrevocable trust with no life interest, set up 5 years or more before a Medicaid claim. Very few people are willing to do these kinds of trusts.

Some people also include a so-called “life interest” in property in arrangements where property is gifted or in irrevocable trusts. The life interest gives them use of the property until their death even though they don’t own it. Medicaid in many states does not recognize life interest and the property is considered to be in the ownership of the person who gifted it and subject to look back rules and recovery.

Move Loved One Needing Care to Another State

A person needing Medicaid covered care in one state may not qualify under that state’s rules but might qualify under the rules of a neighboring state. Of particular concern are candidates suffering from dementia or Alzheimer’s. It’s difficult to quantify their need for care and in some states, those people who are cognitively impaired might not get help with Medicaid even though their needs might be greater than the needs of those who are physically disabled.

Families should consider moving loved ones who have been declined in one state, to live with a member of the family in another state and possibly qualifying in that state. In addition the new state may be more lenient with Medicaid recovery procedures.

A second reason may be that the current state of residence has a very tight supply of Medicaid beds and there is a waiting list. Moving the loved one to a state where there are more available Medicaid beds may avoid the family having to temporarily cover the cost of a non-Medicaid nursing home bed while waiting for one to become available.

Give Away Assets

We have already discussed the moral implications of using Medicaid planning strategies for unfairly qualifying for Medicaid and shifting the burden of cost to the taxpayers. New look back rules under the Deficit Reduction Act have effectively done away with gifting strategies used in the past to accelerate eligibility for Medicaid. This does not mean that gifts cannot be used, but planning must be done many years in advance. Under these new circumstances the whole concept of gifting in order to qualify for Medicaid is much more complicated and consulting with a professional familiar with the Medicaid requirements is essential..

Good planning is no accident. All of the issues discussed above are best handled in advance. To secure your future care, get started now.

Idaho Estate Planning

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