Friday, February 26, 2010

Easing the Pain of a Parent's Alzheimer's Diagnosis

As Elder Law Attorneys, we meet with clients on a daily basis who are on an emotional roller coaster. Life was rolling merrily along for them, then all of a sudden they received some bad news - Mom or Dad is in the hospital. After a few days, the news is worse - The Diagnosis is Alzheimer's AND Mom or Dad can't go back home - they are having to go to a nursing home. AND the kids have to select a nursing home for Mom or Dad to go to within 24 hours AND the nursing home costs $5,000 per month.

If your other parent is alive and living at home, no doubt all of this has hit them like a freight train. Will they still be able to live at home ALONE without assistance, or will they need assistance? If they do need assistance, what type will they need?

If Mom or Dad is single, some of the questions are: What do we do with the home? Will he get to return home? Should we sell the home? Where are his bank accounts? Are all bills paid? How will we pay for all of this?

We realize that when an adult child walks into our office, they are reeling from all of the above and more. This is where we try to slow down the process, take you by the hand and help!

Medicaid is the program that will pay for your parent's long term care - yes we have to get some information from you to start this process, but after that we will take the ball and run, doing everything necessary to get your parent qualified for Medicaid. This solves the financial part of the problem.

Secondly, our life care planners will meet with you and do everything possible to make sure that your parent gets the best possible care, in the least restrictive environment, without going broke.

The expense of doing all of this is not paid by you, the child, but out of your parent's spend-down - that is out of the money that they would otherwise have had to paid to the nursing home before they received Medicaid assistance.

The BEST PART is that by taking action: (1) We help your parent qualify for Medicaid sooner; (2) We help your parents preserve additional assets; (3) Our Life Care Planners work hard to make sure that your parent is receiving appropriate care.

If you are reading this, it is likely that something unexpectedly bad has happened to your parent. We can't fix that - but give us a call and we'll help to ease the pain.

Saturday, January 2, 2010

Home for the Holidays with Alzheimer's

Home for the Holidays with Alzheimer's! What kind of blog post is that!? If you visited your parents this holiday season and noticed that something wasn't quite right with your parents, you know exactly what I'm talking about.

Our clients usually have very full lives, complete with spouses and children. Needless to say, their plate is full. Then one day when you come home to visit Mom or Dad, you notice that something is not right. Mom or Dad asks the same question about your youngest daughter 10 times in the space of an hour; or maybe they can’t remember your youngest daughter’s name; or maybe they don’t remember something that you did together 2 hours ago. You suspect the worst. You suspect Alzheimer’s.

Several thoughts may race through your mind. Is it really that bad, or was it just my imagination? Can Mom or Dad get by for a while longer without assistance? What type of assistance is available? Do they have enough money to pay for this? Do I have enough money to pay for this?? Do I need to quit my job and move back home? If you have other siblings, can they handle things? If your other parent is living, can they handle it?

Depending upon the severity of the experience, you may have had these and other thoughts race through your mind. Often it is not readily apparent what course of action needs to be taken. However, to get you started, here are three things that need to be done to best help Mom or Dad:

1. Help them get the best possible care. Of course, this is assuming that they actually need care. In fact you may have overreacted. However your gut feeling is a powerful thing so if you suspected something, it definitely pays to take immediate action. The first step is to get Mom or Dad evaluated by a Gerontologist, which is a doctor that specialized in problems associated with aging. There is probably one in your area. After an evaluation, they can determine what actions need to be taken. Sometimes, something as simple as change in medication may be what’s needed. In more severe cases, a stay in a geriatric-psychiatric (geri-psy) facility may be needed to optimize their medications and treatment regimen.

2. In the least restrictive environment. Obviously, the least restrictive environment is at home. If the Alzheimer’s is at an early stage, and their Gerontologist feels that, with proper medication, it would be safe for them to live at home for a while longer, then this should be considered. Another big factor is who is available to help. If your other (well) parent is still living, they will no doubt want to help and want to keep your parent with Alzheimer’s at home. Consider however, the physical, mental and emotional toll that this takes on the health of your well parent - it is often substantial. Do other siblings live close by that could help? If the situation is a little more severe, you may need to consider home health care, an Assisted Living Facility or a Skilled Care Nursing Home. Again, their Gerontologist should be able to make a proper recommendation.

3. Without going broke. All of this care is expensive. Medicare and their Medicare supplement, should pay for doctors, hospitals and up to 100 days in a skilled care nursing facility (see article on this blog about Medicare). After that it’s probably private pay (until they have spent a portion of their money), then Medicaid (see article on this blog about Medicaid).

Most people of this generation are very private regarding their finances – especially with their children. If the situation is severe, it is probably time to “meddle”. If you have siblings, then all of you may need to have the discussion with your parents together (see article on this blog about Saving the Farm). If the planning process is begun early enough, they can protect many of their assets. However, even in a crisis situation, where time is not on your side, an Elder Law attorney will be able to take many actions to preserve and protect many of their assets for their benefit.

There is no doubt that you love your parents and want the best for them. In a situation like we have discussed above, now is the time to enlist the help of professionals and take action immediately – your parents health depends on it.

Tuesday, December 1, 2009

Biggest Razorback Fan Contest

If you have received this month's newsletter, you may have seen an article on the back page called the "Biggest Razorback Fan Contest". If you would like to enter a picture in that contest, just send your wildest picture of you displaying your Razorback pride. You can send it to me at We will post the winning entry's in our next newsletter and on this blog next month.

Friday, November 27, 2009

I'm Thankful for Alzheimer's Caregivers

Today I visited my brother and his wife in Hot Springs. This was not your typical Thanksgiving holiday type of visit. Johanna is a resident at a nursing home in Hot Springs – she has Alzheimer’s. The facility where she is residing is providing great care. My brother is very thankful for the care that Johanna is receiving and for her caregivers.

My visit today caused me to reflect on all of the people and things in our lives that we should be grateful for. My visit also caused me to think about all of the caregivers out there - whether professional caregivers, family members or volunteers, who are quietly working in the trenches every day to make the life of an Alzheimer’s patient just a little better. For all of these caregivers, I am very thankful. If you know a caregiver, visit them today. If you have the time, sit with their loved one for a little while to give the caregiver a brief respite. And tell the caregiver that you appreciate what they are doing. They are doing their part to make the world a better place.

Sunday, November 15, 2009

Time Out Workshop - Pictures

Here they are at last - pictures of the 2009 Time Out Workshop. As you will see by looking at the pictures, fun was had by one and all. It would take more than a little rain to dampen the spirits of participants.
To see the Time Out Workshop pictures (maybe one of YOU), click on the Facebook Button on the right side of this page. If you have pictures from this day, e-mail them to us and we'll post them.
Remember, the next Time Out Workshop will be called, Alzheimer's 360 - and will be Co-Sponsored by Alzheimer’s Association, Arkansas Health Care Association and The Elder Law Practice of Douglas R. Jones and Cynthia Orlicek Jones.

The guest speaker will be Teepa Snow - you don't want to miss this!!! Save the dates of Jonesboro, Monday, March 8th and Little Rock, Tuesday, March 9th. Watch for more details coming soon.

Doug & Cindy

Friday, November 13, 2009

Dying Decisions – It’s a Good Thing

This may seem to be a strange blog post title, but we all know that death is part of every life. And making a decision in advance as to how you want to die and what treatments you want to receive is usually a good thing. As Elder Law Attorneys, we often are called to assist people and their families toward the end of their life. We have found that families that have had the “dying discussion” with their loved one experience much less stress (caused as a result of wondering whether we’re doing the right thing) than families who have not done so.

Having the talk with your family is crucial. There is no substitute from hearing it directly from Mom or Dad or your Spouse what they want when the time comes. However, talking is not enough. You need to have signed proper legal documents that reflect your directions. In this blog post, we are going to discuss two health care documents necessary to carry out your last wishes - Private Living Will and Do Not Resuscitate (DNR) Order.

A Private Living Will is a legal document in which you can state what medical treatments or interventions you want to receive in an attempt to prolong your life. You can be specific, stating whether you want a particular treatment, or you can leave the decision up to your doctor or person that you have appointed to make health care decisions for you.

I would caution you to not be too specific or you could be “hung by the tongue”. There is an infamous case where a man stated that he did not want hydration (liquid) when he was in the process of dying. When he was later dying with cancer and was in a lot of pain, the medical team determined that they could not give him morphine to dull the pain because of his wish not to receive “hydration”.

The standard language of a Private Living Will in Arkansas states that the “attending physician” may “withhold or withdraw” treatments that only prolong the process of dying. However, most attending physicians that I have met do not want to have to make this decision. It is much better practice to also have a clause in your Private Living Will which appoints a family member as your health care surrogate. In this case, the doctor will state that the person is terminal or irreversible - then the family member can decide what actions to take, based on your written instructions and your prior discussions with them.

By comparison, a Do Not Resuscitate (DNR) Order is a written order by a patient’s attending physician that prevents CPR in the event of cardiac or respiratory arrest. Arkansas provides for recognition of DNR orders by emergency personnel such as EMS workers and hospital emergency room staff. A person can request that their doctor issue a DNR order or they can make this request in their Private Living Will.

This is not an easy issue and is not a discussion that a family wants to have. However, I will promise you that (after the fact) this is a discussion that families are very glad that they had with their loved one while they had the opportunity to do so.

Friday, October 23, 2009

Health Care Power of Attorney

Many of you have personal experience with a loved one in a hospital during their final days or months. If this person has not prepared a Health Care Power of Attorney, who will make health care decisions for them if they are not able to make their own decisions? That is a good question… Many times doctors and hospitals are placed in an impossible situation by the people they are caring for and their families. The hospital and doctors are required to provide necessary care to those who are in their charge. However, if the persons they are treating cannot speak for themselves and do not have adequate health care documents, then no one can make legal health care decisions for them. This situation becomes much worse in cases when there is disagreement among family members.

A Health Care Power of Attorney should be a document that covers only your health care decisions. I see health care provisions “tagged onto” a property power of attorney, but feel that this is a bad idea for the following reasons: (1) There is a separate body of law governing health care powers of attorney under Arkansas law, the "Durable Power of Attorney for Health Care Act" (A.C.A. § 20-13-104) Durable property powers of attorney are governed by A.C.A. § 28-68-201. Therefore, the provisions should not be morphed together in one document; (2) The documents are prepared for totally different uses – one for the medical community and one for the financial community. For privacy and convenience reasons, they should be separate; (3) It is very common to state that, in the event of an incapacity, one individual or entity shall make financial decisions for you and a separate individual or entity shall make health care decisions for you – again, this should be done in separate documents.

It is important to decide which family member or friend that you wish to appoint as your health care attorney-in-fact and have a discussion with him or her to make sure that they are able and willing to carry out the decisions that you would like to have made on your behalf if you are not able to make them yourself. This is not an easy discussion to have, but it is important to make sure that this person is comfortable with the decisions that they are being asked to make on your behalf and will be willing to do so when the time comes.
It is also very important to name a back-up. Many times, people only name their spouse or one child. If you were in a car wreck and that one person was with you, your appointee would not be able to act. For this reason, you should not only appoint a back-up, but you should also have “the discussion” with an adult child or friend who could fill-in if your first choice is deceased or unable or unwilling to act.

Sometimes people want to name all of their children as co-health care attorneys in fact. Although this can legally be done, it’s probably not a good idea. If the agreement of all children are required to make a decision and one doesn’t agree or is out of town, there will be a stale-mate. Additionally, if time critical health care decisions need to be made, you don’t want a committee meeting. It’s important that, if available, all children discuss this issue, but in the end, the decision should be made by one family member or friend.

As you can see from this brief discussion, appointing a health care decision maker is critically important. Do yourself, your family and the medical community a favor by setting an appointment with your estate planning attorney to do a proper health care power of attorney.