Michigan Estate Planning Blog

A National Alzheimer’s Agenda

With budget plans just now coming to a head, it’s good news for many of us that Alzheimer’s has become one of the “we can’t wait” initiatives in President Obama’s plan. Such measures still need to be passed through Congress, and positive advances may not be immediately forthcoming. However, it is heartening to see fiscal support for an issue that affects so many of us and our loved ones. If all goes to plan and the approach makes it through Congress – a politically trepidatious journey these days even for the most common-sense and appealing legislation – then the budget will earmark an infusion of $156 million for Alzheimer’s research and care. In many ways it’s the flesh and bones to an earlier announcement from the administration regarding a national plan toward treating Alzheimer’s that came out to some guffaws due it’s lack of a clear source of funding. The full details on allocation are still forthcoming, but at least a small portion of that infusion, some $26 million, is intended for immediate use and care of Alzheimer’s patients. The rest is to go toward research and the hope of improving future care, and also perhaps systematic prevention. How this news will affect us, and whether it will weather violent political and economic seas is yet to be seen, but it’s a powerful promise for many.

Reference: The Kaiser Health News (February 7, 2012) “Alzheimer’s Research Gets Funding Boost

ALZHEIMER’S: BE PREPARED!

It’s important not to forget about Alzheimer’s. Medical research and advocacy are vital causes to uphold. Nevertheless, it is a disease that you and your loved ones might have to face directly, if you have not already. The reality of Alzheimer’s or dementia striking close to home, then some understanding and prior planning can help you in terms of the extensive economic toll and the unique legal ramifications. According to a recent Forbes article, Alzheimer’s is as widespread as it is demanding. Consider this: Another American citizen will develop Alzheimer’s every 69 seconds. The symptoms are oftentimes subtle, at least initially. Some estimate that more than 13 million Americans will have the disease by 2050 and run up as much as $1 trillion in costs. Because of the progressive nature of the disease, most of the costs and problems won’t develop until later on. Nevertheless, significant planning must take place at the time of diagnosis, if not anticipated beforehand. So, what is the scope of this “significant planning”? First, you will need to secure medical care, both for now and for the future. That means fundamental financial planning need to be addressed, to include securing government benefits like Medicare and Social Security Disability Insurance. Second, because of Alzheimer’s progressive cognitive degeneration, estate planning must occur early in the process to secure and protect family assets. Fundamentally, it’s important to understand that Alzheimer’s is not the same as other diseases. Through it all, competent counsel will be necessary to properly assess the needs and possibilities, as well as to ensure that everything is in place when needed most

Reference: Forbes (September 21, 2011) “September Marks World Alzheimer's Month as Advocates Push for Early Diagnosis and Health Care Planning”

ELDER LAW / DEMENTIA

Do you have a loved one with dementia? If the statistics hold, many more of us will have loved ones with dementia in the future. Unfortunately, with workers (who still have employment) staying on the job well into retirement, that means we will have many co-workers with dementia, too. A recent story out of DeKalb County (i.e., Atlanta) illustrates this coming trend. Meet Linda Carter, the Superior Court clerk of DeKalb County. At age 59, Linda suffers from early onset Alzheimer’s. Her condition was a secret held between Linda and a helpful confidant in the court office. This confidant helped Linda perform her duties and remain employed. Obviously, such an effort is not sustainable. Recently, their secret was revealed when Linda was offered a routine form to sign. In reality, the form was a letter of resignation prepared for her. She signed it. Linda wants her job back. She sued the court to reinstate her post, once it became clear what had transpired. Now, a quagmire has developed as other employees have deemed her mentally unfit to return to her post. While this is a rather novel case (especially arising in the context of a courthouse), it is illustrative of a growing problem in the workplace – employees who have Alzheimer’s or dementia. Alzheimer’s patients oftentimes will go to great lengths to hide their condition. This, in turn, puts an undue burden on others to recognize and properly deal with the situation. After all, those afflicted with the impairment aren’t without rights and “reasonable accommodations” ought to be made. As an employee, it’s important to know your abilities and how you are performing. Similarly, as a fellow employee it’s important to understand your co-workers and deal with the situation honestly. Regardless, these types of cases will only increase as statistics rarely lie.

Reference: The Atlanta Journal-Constitution (October 1, 2011) “Challenges of an aging workforce”

Charitable Giving – Ways And Means

Giving to charity over your lifetime can be powerful. Not only can you make an impact on the charities you care about, but you enjoy personal satisfaction and even charitable deductions. Still, since the tax laws are in a state of flux (and we can only expect them to become more uncertain as the politics in Washington continues to boil over), making substantial lifetime gifts may become more dicey, especially given the fragile economy. As a result, giving at your death may be more attractive and practical. As the Wall Street Journal points out, there is always the option of leaving a bequest. One way to make a postmortem bequest is through your Last Will and Testament. While you lose the lifetime charitable deduction, the bequeathed amount is deducted from your estate value. Depending on the size of your estate, that deduction can be significant. It’s true that the estate tax exemption amount is (for most Americans) a safe $5 million, but there’s no guarantee it will stay there (as with the gift tax laws). Nevertheless, a bequest also is a more malleable means to benefit charity, since you can think about your decision over a longer period and can give more types of assets. A classic example is the ability to name a charity as beneficiary to your IRA without the income tax burden of required minimum distributions. Remember: Charities do not have to pay income taxes on your IRA like your heirs would. Indeed, there are many powerful tools to use when making a bequest, depending on the type of asset. Be sure to read the original Wall Street Journal article for more ideas.

Reference: The Wall Street Journal (October 1, 2011) “The Quest for the Right Bequest”

Drug-Managed Dementia Dilemma

Dementia and Alzheimer’s can prove to be huge challenges for the healthcare institutions we trust to care for our affected loved ones. Unfortunately, these are challenges many institutions meet with the over-use, abuse or improper use of drugs. The good news is that this problematic trend is being identified and resolved for many families. As recently reported by the Associated Press, the turn to drugs for nursing home patients with dementia is nothing new. Dementia has a nasty tendency to disorient patients who may grow paranoid or lash out as a result. The safest way to protect them and others has been through medication to calm them. Of course, under-funded institutions also have a tendency to use drugs to a fault, and many use the wrong drugs, like antipsychotics. These drugs (like Risperdal, Zyprexa, Seroquel, Geodon, Abilify, Invega, and older medications) are designed to help people suffering from schizophrenia or bipolar disorder… and are not approved for dementia patients. Since 2005, these drugs have been under an FDA warning that they can cause an increased rate of death in dementia patients (due to heart attacks and pneumonia). Nevertheless, as of 2007 (according to a recently released government audit), about one in seven nursing home patients aged 65 or older was prescribed at least one of the drugs and, in about 83% of these cases, the prescription was for off-label use, like treating dementia. Ironically, the use of these drugs can create further confusion for the dementia patient and impair his or her ability to interact normally. Not surprisingly, many dementia patients actually have improved dispositions when they are taken off of these drugs. It’s hard to estimate how widespread the problem is today, but at least it has been recognized and many institutions are correcting the trend. While the use of drugs is not bad in all cases (since there are patients who are severely disoriented), but certainly not every patient needs them or needs them at full strength. This is just one more concern to bear in mind when you visit your elderly loved one and when choosing the right nursing home for them.

Reference: The Associated Press via ABC News (September 14, 2011) “Push Underway to Cut Drugs for Dementia Patients

ALZHEIMER’S: BE PREPARED!

You may not have known but September is World Alzheimer’s Month. As the month comes to a close, it’s important not to forget about Alzheimer’s. Medical research and advocacy are vital causes to uphold. Nevertheless, it is a disease that you and your loved ones might have to face directly, if you have not already. The reality of Alzheimer’s or dementia striking close to home, then some understanding and prior planning can help you in terms of the extensive economic toll and the unique legal ramifications. According to a recent Forbes article, Alzheimer’s is as widespread as it is demanding. Consider this: Another American citizen will develop Alzheimer’s every 69 seconds. The symptoms are oftentimes subtle, at least initially. Some estimate that more than 13 million Americans will have the disease by 2050 and run up as much as $1 trillion in costs. Because of the progressive nature of the disease, most of the costs and problems won’t develop until later on. Nevertheless, significant planning must take place at the time of diagnosis, if not anticipated beforehand. So, what is the scope of this “significant planning”? First, you will need to secure medical care, both for now and for the future. That means fundamental financial planning need to be addressed, to include securing government benefits like Medicare and Social Security Disability Insurance. Second, because of Alzheimer’s progressive cognitive degeneration, estate planning must occur early in the process to secure and protect family assets. Fundamentally, it’s important to understand that Alzheimer’s is not the same as other diseases. Through it all, competent counsel will be necessary to properly assess the needs and possibilities, as well as to ensure that everything is in place when needed most.

Reference: Forbes (September 21, 2011) “September Marks World Alzheimer's Month as Advocates Push for Early Diagnosis and Health Care Planning”

Uncovering Dementia/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.

Reference: Forbes (August 11, 2011) “The Danger of Your Aging Parent Covering Up Dementia”

Long-Term Care Insurance Comes Of Age

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, people who will need long-term care insurance protection later, unfortunately have not purchased 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.

Reference: Reuters (August 16, 2011) “Long-Term Care Insurance Gets a Makeover”

ELDER LAW/ ALZHEIMER’S

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 Academy of Elder Law Attorneys (NAELA). An elder law attorney can help 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. An elder law attorney also can 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 can learn more about Alzheimer’s disease, at the Alzheimer’s Association online.

Reference: Reuters (July 20, 2011) “Alzheimer’s: early planning critical to financial health”