Are You Ready for the “Holiday Reality Check”?

The Holidays bring families together, which is a great thing, especially for those family members separated by geography. But since the holidays also mean spending time with your parents and elderly loved ones, it can be a shock. The New Old Age Blog at the New York Times recently referred to this shock as the “Holiday Reality Check”.

All those months of checking in over the phone or getting reports from a sibling might have led you to believe that all was well with your elderly loved ones. Now, when you actually see them face to face, all is not well on the home front.

It hits in greater and lesser degrees: Finding a loved one to be fairly forgetful, much more than before. Perhaps it’s finding stacks of unpaid bills and old food filling the fridge, or discovering that the nursing home selected was the wrong choice. No doubt many readers already have encountered their own Reality Check during a Thanksgiving visit, but the important thing is that the holidays aren’t over yet. No, they are just ramping up.

As we venture deeper into the holiday season, you may seize the opportunity to pay more attention and begin to right some wrongs sooner rather than later. For many, this might mean an up-front and realistic discussion about what needs to happen, whether that be planning for the estate, writing advanced directives, or pursuing care.

However, there also are more gentle steps that can be taken and some pragmatic ones as well. Fixes that you can offer from afar might mean hiring helpers or even professional geriatric care managers to work in your stead.

The important thing is what the holidays mean about and for your family. Consider this a clarion call to be proactive while there still is time to plan, rather to be reactive when time to plan is past.

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!

Idaho Estate Planning is part of the Senior Resource Network of Idaho, a non-profit network of elder care professionals available to provide information on what we 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. Remember, good planning is no accident.

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Impoverished Seniors Rate Nearly Doubles

It’s been fairly clear that medical expenses were becoming an immense financial drain on the elderly. If you are elderly or have an elderly loved one, then this is a given, as supported by recent census data.

As reported in Reuters, the number of poor persons hit a record high in 2010, and poverty rates among the elderly have had the steepest gain.

In fact, according to the census, a record 49 million Americans (i.e., 16 percent of the population) qualify as impoverished. When it comes to the elderly, the poverty level jumped to 15.9 percent, or roughly 1 in 6, from the previous year’s nine percent.

It’s true that the census study and methods have become a political flashpoint. However, the new analysis takes a broader look at life and includes government benefits. Previous studies used older methods that failed to account for how people maintained their standard of living.

Politics aside, these are still sobering data. If government benefits have become that much more of the equation, then it goes a long way towards showing what’s at stake in the present and upcoming political storms.

For many of America’s elderly that find themselves struggling to meet growing health costs a solution comes in the form of an underutilized VA benefit. For veterans who served during a time of war or for their surviving spouses, the Veterans Aid & Attendance Pension will pay additional income to cover long term care costs. Pension can provide an additional monthly income of up to $2,019 a month for a couple, $1,703 a month for a single veteran or $1,093 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.

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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Medicaid Asset Transfer Woes

Oftentimes, Medicaid and Medicare can be entirely necessary programs. They also can be pretty tricky to navigate, especially if you, or a loved one, fall just above the income limits. That said, Medicare and Medicaid don’t like it when they feel you are “gaming” the system. Elder Law Answers highlights yet another case in which an elderly person was denied benefits because of improper planning.

The case in question is Hedlund v. Wisconsin Dept. of Health Services (Wis. Ct. App., No. 2010AP3070, Oct. 13, 2011). Lucille Hedlund was a Medicaid applicant who was denied benefits because she also was a beneficiary to an irrevocable trust that qualifies as an available asset, bringing her above the income threshold. It didn’t matter that the trust has been set up 17 years ago, especially because of the circumstances.

Mrs. Hedlund transferred all of her assets to her children in June 1991, with the exception of a checking account. And, on the very same day, her children put those very same assets into an irrevocable trust and named her as beneficiary. While this was pretty sneaky, it was not enough to give Medicaid the slip.

Medicaid ruled that there was reason to infer that Mrs. Hedlund had directed her children to create and fund the irrevocable trust because the plan was effected on the same day. Note: It didn’t even matter that the assets weren’t hers at the time the trust was created, since they were still “available assets” in the eyes of the court … some 17 years later when Mrs. Hedlund entered a nursing home in 2008.

Applications for Medicare and Medicaid are important and should not be taken lightly. If you, or a loved one, need to make plans for long-term care, then you need to schedule a consultation with us right away, before you take any actions. Remember, good planning is no accident.

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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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Medicare Enrollment Window Opens Earlier

It’s Medicare season once again, but it’s early this time. Unfortunately, many seniors just haven’t gotten the message. The open enrollment period is now from October 15 to December 7. And that’s a whole month earlier than in the past.

According to a recent survey in Florida and reported through the Kaiser Health News, nearly two-thirds of seniors are unaware that Medicare enrollment is earlier this year. So, why the change? The Affordable Care Act.

Along with the accelerated enrollment period, it is hoped that beneficiaries will have their Medicare cards by the start of the New Year. Customarily, late enrollees find themselves in a bit of a pickle (i.e., without their Medicare cards) come January 1. While the start date this year is hard to remember (October 15), the deadline won’t be for most Americans of Medicare eligibility age (December 7).

Of course, the enrollment period isn’t the only change afoot with Medicare. Like last Medicare season, the sheer number of plans has been pared down in an effort to make selection easier.

Planning pointer: Review your anticipated medical needs (or those of your senior loved ones) to determine whether a change in plan is warranted. As a result, you could stand to save hundreds – or even thousands – of dollars. Many seniors don’t make plan changes out of habit. Accordingly, some diligent (and gentle) prodding may be in order.

If you are unsure of your options you may wish to attend our upcoming seminar regarding Medicare options on November 8^th. If you are interested, call to reserve a spot by speaking with Kathy at 208-939-7658. Remember, good planning is no accident.

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Housing Slump Effects Senior Care Options

After four years or so the housing market is still idling at terribly low levels, but even if we’re all feeling it, it’s our nation’s seniors that seem to be uniquely hurt. The problem has been growing over those years, but the Kaiser Health News recently put out an article taking stock of the situation and new reactions from assisted-living and nursing home facilities.

With housing prices and market demand so low, seniors simply can’t get up and enter into a facility, even if they need it. For many seniors, the plan had always been to use the equity in their home as the investment to keep them afloat in retirement but the value in those homes simply dropped in 2008. Even if you can forget how much the house was worth in 2007, before the crash, it’s simply not easy to sell a house these days and they tend to just sit on the market for years, or fetch too little money to make the sale possible. It’s causing seniors to wait that much longer before they can enter into a facility, and that’s time on top of however long it took them to finally make the decision to give up the home in the first place. It isn’t good for finances, and it is especially bad for health.

The facilities themselves aren’t happy with the trend and some are working to help ease the transition. In certain facilities across the parts of the country that were hit hardest by the housing bubble the occupancy rate has dropped as much as 10%, with nursing homes and continuing care facilities hit the hardest and assisted-living only slightly better.

For you or a loved one it means that there are a number of possibilities to plan for. Those that can’t quite get out of their homes might consider bringing the care to them through in-home care services or perhaps living with loved ones. Still, if a facility is necessary then there may be options out there, it might be possible to work with the administration; chances are you’re not the only one with the problem and they may offer a solution.

At Idaho Estate Planning, we can help you find the resources you need to put a 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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Uncovering Alzheimer’s Cover-Ups

Dementia and Alzheimer’s are becoming increasingly common, but even if we are beginning to become more and more aware of how to spot them, it doesn’t make it any easier. Many a reader will be familiar with the terrible uncertainty and concern over their elderly parent’s thinking. Fortunately, Carolyn Rosenblatt of Forbes has more advice to give in her recent article.

Among the many dangers to keep in mind when an elderly loved one starts “slipping” it that they may begin “hiding” it. For one thing, it is not something with which any senior looks forward to acknowledging, even if they are aware of some telltale symptoms. It is human nature.

We all compensate or distract when there is something to hide, both from ourselves and from others. But when something like Alzheimer’s is at stake, it can be all the more difficult to get past and harmful to hide. Indeed, since there is no actual test for dementia or Alzheimer’s, it is possible that a doctor will be unable to diagnose those conditions.

It is important, therefore, to observe how your loved one functions. Keep a keen eye on them and know what you are seeing, for their own sake. The original article has more advice and anecdotes to offer, but Ms. Rosenblatt sums up the steps in four points. As soon as you begin to worry you must, first, persuade your loved one to visit a doctor, and a specialist if possible, to detect it early. Second, you must secure their estate planning documents while they have legal capacity to know and understand what they are doing. Third, you must secure proper care for them. Fourth and last, you have to discuss the circumstances openly with all family members, so all may be aware of the circumstances and can work together to protect your loved one.

Last year we published two blogs, Aging Parents: Warning Signs of Failing Health, and Recognizing Symptoms of Dementia. You may also find these articles useful if you are concerned that a loved one may be showing signs of dementia or other health issues related to aging.

Timing is critical in these situations. The best time to begin addressing your concerns is now. At Idaho Estate Planning, we can help you find the resources you need to protect yourself and your family. 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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Get Out of Bed & Get Better

As we and our loved ones age, we put a lot of effort (and resources) into making sure a hospital bed is available when needed. New research shows that while that hospital bed may sometimes be necessary, getting up and out of it as quickly as possible is key to recovery. As it turns out, the hospital bed is a huge contributor to old-age infirmity, as studies prove that bed-rest and immobility slow healing and stunt recuperation.

A recent New York Times column, “The New Old Age” covered the results of a study conducted by University of Texas physician, Dr. Steve Fisher. Using a step activity monitor (a fancy pedometer), the Texas team found that just an extra 600 steps a day, or about 12 total minutes of slow walking, could significantly shorten hospital stays. Although Dr. Fisher calls for further study, he still offered his optimism, “It’s encouraging to think that small changes can be of broad benefit.”

Though physicians may have advised nursing staff to help the patient ambulate, nurses and aides frequently have little time for these tasks and the patient may not get up and walk enough. Dr. Fisher recommends that family members take the initiative and ask about getting a physical therapist involved early on and about whether the family is permitted to help the patient walk.

One obstacle to an aggressive mobility plan is the risk of falls. Not only are they a valid concern for you and your loved one, but also for the hospital. Since 2008, a fall is grounds for Medicare to refuse to reimburse a hospital for a patient’s care. So, it’s understandable that the hospital might be overly cautious about families helping elderly patients walk. Nonetheless, Dr. Fisher still encourages families to look for safe ways to help elderly patients get up and walk. While falls can indeed be dangerous, the consequences of prolonged immobility may be worse.

Put together a detailed plan for your future long-term care by calling Idaho Estate Planning today. Remember, good planning is no accident.

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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