Hospital–Induced Delirium

When the elderly visit the hospital it’s simply not the same as when they were younger. No, everything is more dangerous.

The New Old Age Blog at the New York Times recently discussed a danger that is all too common, but still under the radar screens of medical and the everyday worlds alike. It’s the problem of elderly delirium.

Usually, when we talk about an elderly person no longer being themselves, we think of dementia. Nevertheless, another dramatic neurological problem is delirium and it is often, ironically, brought on by hospital visits. Here’s what happens: When the elderly are put under such heavy medication it can generate a neurological imbalance that results in dramatic disorientation, sudden confusion, and loss of attention. The list of medications that can have this affect is fairly long, including sedatives, sleeping pills, narcotic painkillers and some allergy, blood pressure and incontinence drugs. As a result, it’s not a surprise that delirium is common.

Each year 20 percent of the 11.8 million elderly patients in hospitals develop delirium. This includes some 60 percent to 85 percent of those in intensive care on ventilation and more than half of postoperative surgical patients.

The problem is that delirium also can have long-term effects, according to recent research. In the end, many hospitals may be doing long-term damage to their patients. For more information and a stirring example, read the original story here. Be sure to take a look at the checklist to help determine the difference between dementia and delirium.

If you are elderly do yourself a favor and forward this message on to those who would be your support should you end up in the hospital. The members or your Disability Panel are a good place to start. If you don’t have a Disability Panel call 208-939-7658 and we’ll help you set up your estate plan to include this critical option. Remember, good planning is no accident.

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New Advances in Long-Term Care Insurance

It is an unfortunate fact that healthcare costs are steadily rising and will only continue to rise in the foreseeable future. Accordingly, healthcare inflation must be considered when planning to protect your health, your family, and your financial well-being. One of the greatest threats is long-term care, especially as we age. For many, long-term care insurance is the best protection against long-term care poverty. Thankfully, as reported in a recent Reuters article, the long-term care insurance market is growing to accommodate the growing need and several new options are becoming available.

Granted, we don’t like thinking about growing old and frail, perhaps with dementia or Alzheimer’s to boot. It is easy to procrastinate. Besides, who wants to pay policy premiums? As a result, many of those who will need long-term care insurance protection in the future are not purchasing policy protection now.

According to Matthew Sharpe of Genworth, “Long-term care is definitely under-penetrated, there’s no doubt about it. About 4 percent of the population that is eligible actually has a policy.” Because of this, Genworth and other companies are developing newer and easier tools for consumers to use, and that just might translate into newer and better policies for you to consider.

Whether any policy option is the right option for you depends on your unique circumstances. As pointed out in the original article, the strongest reason to secure a policy may be the possibility of dementia or Alzheimer’s. While there are many ideas presented in the Reuters article for your consideration, nothing can replace the advice and counsel of an experienced long-term care insurance agent to help you navigate your options.

At Idaho Estate Planning, we can help you find the resources you need to put your estate plan together. We have the experience and expertise to help you maintain your options and protect yourself as well as your loved ones now and into the future. Remember, good planning is no accident!

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Power of Attorney

Some people who thought they had covered all their bases and acted responsibly to care for loved ones in the event of a debilitating illness or incapacity are finding their plans un-done by strict banking policies. Bank of America recently updated their online security procedures, and no longer accepts a power of attorney for online banking.

As Bernard Krooks wrote last week for Forbes, this strict policy came to light when Chicago resident Eva Kripke was blocked from accessing her husband’s Bank of America account. According to Krooks, Mrs. Kripke had been handling her husband Sidney’s bank accounts as agent under a power of attorney ever since he was diagnosed with Lewy body dementia four years ago. Suddenly now, however, she is denied access under the bank’s updated security procedures.

The bank suggested she go to her local branch and get a printout of her husband’s account information. Unfortunately, Mrs. Kripke felt this was unacceptable because her husband’s health status requires close financial oversight. Kripke’s options in this situation are limited because her husband’s illness has rendered him incompetent. Opening a new bank account for her husband elsewhere would require executing a new document, a near impossible task when the grantor is incompetent.

Rules such as these are becoming increasingly prevalent and significant as more people are called upon to care for an aging population and their attendant disabilities.

Understanding Powers of Attorney is just a part of successful estate planning. To ensure a successful plan, we at Idaho Estate Planning will: 1) educate you and your helpers; 2) take the time to get to know you, your family, your desires, your concerns, your goals, and your potential problems; 3) gladly and patiently answer questions until you understand the concept or issue; and, 4) based on experience with the problems and results caused by poor planning, help you design and implement the plan that fits your concerns and goals. Remember, good planning is no accident.

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Alzheimer’s & Estate Planning

A diagnosis of Alzheimer’s disease can be devastating for everyone involved, including the patient and all of their family members. Should you be facing this diagnosis, there are probably a million thoughts racing through your mind, from keeping your loved one safe to caring for them as the disease progresses. One thing you might not think about is the need for estate planning. As a recent article by Reuter’s explains, if you or someone you love has a family history of dementia, is showing symptoms of Alzheimer’s or is concerned about later-life planning, it’s time to get to work.

You’ll want to assemble a team that specializes in long-term planning and elder care issues. A good place to start is the National Care Planning Council (NCPC). The NCPC and their website www.longtermcarelink.net are a very comprehensive resource for Eldercare (Senior Care) and Long Term Care Planning. Idaho Estate Planning is a founding member of the Idaho Care Planning Council and the Treasure Valley Care Planning Council. Both are a part of the NCPC network.

At Idaho Estate Planning we can help you navigate the elective transfer of decision-making authority through a power of attorney or trust and can help you qualify for needs-based programs like Medicaid and Veterans Pension Benefits if necessary. We set up a legal framework through which the client and his or her family can transfer assets and decision-making responsibilities.

Alzheimer’s is the sixth leading cause of death in the U.S., with 5.4 million Americans suffering from the disease. So, health care proxies will be another important aspect of your legal plan.

You may want to read 2 previously posted blogs titled Maintaining Control of Your Healthcare Options and Recognizing the Signs of Dementia. When dealing with Alzheimer’s and other forms of dementia it is critical to start NOW. At Idaho Estate Planning, we can help you find the resources you need to put your long-term care plan together. We have the experience and expertise to help you maintain your options and protect yourself as well as your loved ones now and into the future. Remember, good planning is no accident!

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Negotiating Long-Term Care Costs

There are some things you just don’t haggle about but, perhaps contrary to what you would guess, it turns out that long-term care isn’t one of those things. Long-term care is expensive, to say the least, but as explained in a recent article in SmartMoney, there are some expenses that may be negotiable.

Nursing homes usually will not negotiate fees, but you may be able to negotiate with assisted-living facilities and home health care agencies.

Start by arming yourself with information. You can look up local costs at Genworth.com/costofcare on a map prepared by Genworth Financial, one of the country’s largest long-term care insurers. This can help you compare costs for various types of care in your area. MetLife offers another source of area-specific information at MatureMarketInstitute.com (click on “Research” then “2010 Market Survey of Long-Term Care Costs.”)

Other resources include “Medicare and Home Health Care” which describes the home health benefits that Medicare covers (available at Medicare.gov) and the United Hospital fund’s “Next Step in Care” website for family caregivers.

Other bargaining strategies to keep in mind:

• Ask if there is a waiting list at the facility. If not, you may have more room to negotiate.
• While nursing homes generally do not discount rates, you may be able to negotiate for extra amenities.
• If a home-care agency has rates at the higher end of your local market, you may be able to get a lower rate if you let them know you are interviewing several agencies and taking cost into consideration.
• If you hire a home-care agency for a significant number of weekday hours, that agency may be willing to discount any extra fees they charge for weekend work.

At Idaho Estate Planning, we can help you find the resources you need to put your long-term care plan together. We have the experience and expertise to help you maintain your options and protect yourself as well as your loved ones now and into the future. Remember, good planning is no accident!

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Hold On to Those Memories

With our current economic conditions and a host of other pressures an increasing number of American’s are considering staying in the workforce beyond their planned retirement age. Many will have no choice after the great losses to their retirement accounts. As the average age of the workforce increases so too does the concern for their well-being, especially in reference to dementia and more specifically Alzheimer’s. Right now there are more than 5 million American’s with Alzheimer’s and that is expected to quadruple by 2050. That could be very problematic for businesses, those affected by the disease as well as their co-workers.

If we have a family history of dementia we would be well served to know the early warning signs of the disease. The warnings can be hard to notice as they are revealed rather slowly.

Another way to combat dementia is to be proactive throughout our lives. In the article “How to Age-Proof Your Memory” health.com lists some interesting ideas.

In Our 30’s

Avoid stress, “Stress is toxic to the brain,” says Denise Park, PhD, a cognitive neuroscientist at the Center for Brain Health at the University of Texas at Dallas. The body’s stress response floods the brain with powerful hormones. In the short-term, that helps you focus and cram to meet a deadline, but over time it kills neurons and damages memory centers.

In Our 40’s

Try to maintain focus. “The first step to remembering is paying attention in the first place,” says Gary Small, MD, director of the University of California, Los Angeles, Center on Aging and author of The Memory Bible: An Innovative Strategy for Keeping Your Brain Young. At work, set aside daily chunks of time to unplug from email, instant messages, and workplace chatter. When parking in a big lot, check and recheck landmarks.

In Our 50’s

Maintain close relationships. Ten minutes of talking actually boosts memory and thinking speed afterward, according to new research. “It takes a lot of mental work—you’re paying attention, trying to figure out where somebody is coming from, and sometimes biting your tongue,” says study author Oscar Ybarra, PhD, a psychologist and researcher at the University of Michigan’s Institute for Social Research. This kind of interaction may be as useful as doing crossword puzzles or taking reading-comprehension tests. “Socializing,” Ybarra says, “helps you navigate the real world.”

Plan and Act Now

Taking the right steps now can affect our future well-being. Similarly planning now for the future can positively affect our financial well being. We all want to stay in control of our lives as long as possible and for that we must plan. When it comes to planning for the future, the sad fact is that every year we fail to plan we lose options. Wait long enough and the only options left are those made for us out of desperation. Remember, timing is everything. In order to maintain control as long as possible and have an effect on your own quality of life decisions you must choose to act now. Your decisions need to be made known and documented correctly. Good planning is no accident!

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Family Caregivers of Veterans May Qualify for Compensation

Looking for a way to help Mom and Dad pay for home care or assisted living? Perhaps you are their caregiver. Wouldn’t it be nice to receive some compensation to help you provide their care? There is financial help available for senior veterans and their spouses.

For veterans who served during a time of war or for their surviving spouses, veterans benefits such as the Veterans Aid & Attendance Pension will pay additional income to cover long term care costs. The great news about this program is that VA will allow veterans’ households to include the annual cost of paying any person such as family members, friends or hired help for care when calculating the Pension benefit.

Pension can provide an additional monthly income of up to $1,949 a month for a couple, $1,644 a month for a single veteran or $1,056 a month for a single surviving spouse of a veteran. This money can be used to help pay the cost of home care, adult day services, assisted living or nursing home services.

A family member can be considered an in-home attendant, but that family member has to be paid for services duly rendered. There is potential for fraud here where a family member may move into the home and ostensibly receive payment as a caregiver but not actually provide the level of care paid for. Documentation for this care must be provided to VA, and it is reasonable for VA to question whether the services being purchased from a family member living in the household are legitimate. Such arrangements should be extensively documented and completely arm’s-length.

The care arrangements and payment for home care must be made prior to application and there must be evidence that this care is needed on an ongoing and regular basis. We recommend a formal care contract and monthly invoice billing for services. Money must exchange hands and there must be evidence of this. All of this documentation must be provided as proof to VA when making application for the pension benefit. Costs for these services must be unreimbursed; meaning these costs are not paid by insurance, by contributions from the family or from other sources. Even though the family member being paid for services cannot reimburse the veteran household directly, the family may pay the bills for the veteran household. This indirect form of support is allowed.

In 2007 the AARP released a study on Caregivers in America in which they reported, “Many caregivers make direct out-of pocket expenditures to help support a family member or friend with a disability. Non-spousal caregivers were asked how much money they spend in a typical month for groceries, medicines, or other kinds of cash support for the care recipient. About half of caregivers contributed financially, spending an average of $200 per month ($2,400 per year). Caregivers who had the greatest level of caregiving burden reported spending $324 per month ($3,888per year) out of pocket.”

The study went on to say, “In addition to direct out-of-pocket expenditures made by caregivers, many caregivers experience other significant economic losses. The majority of caregivers in the United States (59 percent) are employed either full or part time. The financial impact of caregiving on caregivers in the workforce can involve multiple aspects of their income security, including their wages, job security and career paths, and employment benefits such as health insurance and retirement savings.

Those family members acting as caregivers for America’s veterans and/or their spouses can help reduce the stress on their own and their families emotional, social and financial well being by making use of the VA Pension Benefit.

The secret for receiving a successful award from the VA 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, accredited 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 veterans get the benefits they have earned through their  greatly appreciated service to our country. Remember, good planning in no accident.

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Helping Our Parents Prepare for Their Future

There is a very good chance that you or someone you know is taking care of elderly parents now or looking at that possibility in the near future. In 2008 a USA TODAY/ABC News/Gallup Poll of baby boomers found that 41% who had a living parent were providing care for them — either financial help, personal care or both — and 8% of boomers said their parents had moved in with them.

Of those who were not caring for an aging parent, 37% said they expected to do so in the future. About half said they were concerned about being able to provide such care.

If financial planning and long term care planning have not been done previous to the need for care, the burden falls on the caregiving family member. Decisions about how care will be paid for, who will be responsible for managing the estate as well as how the long term care will be given can cause stress and contention among family members.

It is best for parents and all family members to be involved in planning for future financial needs. The financial resources being used today could change drastically with the occurrence of a stroke, illness or onset of dementia. In order to plan financially for long term care, you need to know what the costs are now and what they will be in the future.

Every year MetLife does a survey of long term care costs. Their 2010 survey shows that the average daily rate for private nursing home is $229 which is up from $219 in 2009. Assisted living monthly base rate cost rose to $3,293 in 2010 from $3131 in 2009. Home health aides average $21 an hour.

Planning financial needs can be very difficult, considering you do not know when long term care will be required or how long it will be needed. Staying in the home for care will require professional home care assistance, travel accommodations to doctor appointments, help with shopping, meals, medical supplies and medication and possibly a 24-hour attendant. Even if a family member is doing most of the care, in most cases professional care will eventually be required or a move to a nursing home facility will be necessary.

When evaluating present income and assets consider how they would work for future needs. Consider the following:

• Care options
• Long Term Care Costs
• Long Term Care Insurance
• Home Care Costs
• Medicaid Planning
• VA Benefits & Planning
• Legal Documents – Estate Planning

Idaho Estate Planning is part of the Treasure Valley Care Planning Council, a non-profit network of elder care professionals available to provide information for and 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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Getting Your Affairs in Order

Recently I had someone in my office wanting to know what his options were for taking care of his In-laws. In 2004, when the first signs of medical troubles appeared, he had, with his wife and her siblings, tried to convince the parents that they needed to get their affairs in order. They needed to do some planning, but as is all too common, no planning was done. Where there could have been many choices and options, now there are few. Where there could have been comfort in their final years, now hard choices must be made that would never have been considered before.

The National Institute on Aging gives three simple, but important steps to putting your affairs in order:

• “Put your important papers and copies of legal documents in one place. You could set up a file, put everything in a desk or dresser drawer, or just list the information and location of papers in a notebook. If your papers are in a bank safe deposit box, keep copies in a file at home. Check each year to see if there’s anything new to add.
• Tell a trusted family member or friend where you put all your important papers. You don’t need to tell this friend or family member about your personal affairs, but someone should know where you keep your papers in case of emergency. If you don’t have a relative or friend you trust, ask a lawyer to help.
• Give consent in advance for your doctor or lawyer to talk with your caregiver as needed. There may be questions about your care, a bill, or a health insurance claim. Without your consent, your caregiver may not be able to get needed information. You can give your okay in advance to Medicare, a credit card company, your bank, or your doctor. You may need to sign and return a form.”

When it comes to planning for the future, the sad fact is that every year we fail to plan we lose options. Wait long enough and the only options left are those made for us out of desperation. Remember, timing is everything. In order to maintain control as long as possible and have an effect on your own quality of life decisions you must choose to act now. Your decisions need to be made known and documented correctly. Good planning is no accident!

Call us today and let us help.

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Legal Issues with Veterans Benefits

Accreditation

The VA Pension Benefit helps veterans and surviving spouses pay for assisted living care in the home, nursing home, or assisted living facility. It pays up to $1,949 per month to provide care for single or married veterans, or their surviving spouses. Applicants must meet certain medical and financial thresholds. Many find the application process complicated and seek help preparing the forms. It is important to understand federal law dictates that no one may help a veteran in the preparation, presentation and prosecution of an initial claim for VA benefits unless that person is accredited by the VA. The only exception to this law is that any one person can help any veteran – one-time only – with a claim. To help any veteran a second time requires accreditation.

VA recognizes 3 types of individuals for purposes of accreditation.

1. Accredited attorneys
2. Accredited agents and
3. Accredited representatives of service organizations. (Veterans Service Officers)

In order to be accredited to help veterans with new claims, an individual desiring this certification from VA must submit a formal application, must meet certain character requirements and work history requirements and – except for attorneys – must pass a comprehensive test relating to veterans claims and benefits. There are also requirements for ongoing continuing education.

What Does It Mean to Help a Veteran with a Claim?

VA interprets its prohibition on preparing, presenting and prosecuting a claim to mean that talking to a veteran or a veteran’s qualifying spouse or dependent after that person has indicated an intent to file a specific claim for benefits requires accreditation. Anyone can talk about veterans benefits in general with any veteran and need not be accredited. The point at which discussion narrows down to specific information about the veteran’s service record, medical conditions, financial situation including income and assets and other issues relating to a claim specific to a veteran or dependent triggers accreditation. According to VA, discussing the specifics of the claim means that the veteran has expressed an intent to file an application for veterans benefits, and at this point, the consultant helping the veteran must be accredited.

This bears repeating: An individual cannot advise a veteran or other eligible beneficiary about that person’s specific claim for VA benefits unless that individual is accredited.

Using an Accredited Agent

The secret for receiving a successful award from the VA 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, accredited 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. Remember, good planning in no accident.

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