Workshops Help Families Grappling With Alzheimer's Care

Workshops Help Families Grappling With Alzheimer's Home Care

by Ina Jaffe

There are more than 5 million people with Alzheimer's in the U.S., and most are cared for at home. Now, one company has begun offering training to family caregivers to help them deal with the special challenges of caring for an Alzheimer's patient.

The company, Home Instead Senior Care, is the nation's largest provider of nonmedical home care for seniors. The workshops are free and available to anyone, whether they're clients of the company or not.

A recent session in Los Angeles drew about half a dozen people on a weekday afternoon. The need that brought them there was as serious as it was undefined. Tina Stephenson put it this way: "I need help, bottom line."

She's been with her partner, Gino, for 34 years. They live in a one-room apartment, and she says that certain ordinary things, like standing in front of the sink, just freak him out. "I mean, it's so weird. He just all of a sudden resists me and pulls the other way. So I'm looking for some help with that," Stephenson says.

Leading the workshop is John Moser, the owner of the Home Instead franchise in Los Angeles. He got into the home care business after years working as an elder abuse attorney.

"I dealt with a lot of nursing homes and skilled nursing facilities," he says. "I always thought, is this really the only option for seniors?"

That led him to Home Instead. The company's employees help older adults with things like meals, grooming and transportation. "Family members would be so surprised that our caregivers were able to get mom or dad to do certain things" that family members couldn't, says Moser. "They would call the Home Instead offices and wanted to know more about this training."

The training was developed by Home Instead, but it's based on ideas accepted by many Alzheimer's experts — for example, making use of long-term memories and recognizing what triggers anxiety. The company has spent about $3 million over the past three years on developing and presenting workshops for family caregivers. Home Instead says it wants to be a community resource for families grappling with Alzheimer's. It's also a way to get more clients.

When it comes to caring for Alzheimer's patients, Moser tells the group that knowledge is power. "I always tell caregivers: Know 100 things about the person you're providing care to," says Moser. Those things are then recorded in a workbook called "Capturing Life's Journey."
More From NPR
TimeSlips is a program based on the idea that storytelling can be therapeutic for people with dementia.
Shots - Health Blog
Alzheimer's Patients Turn To Stories Instead Of Memories
Alexis McKenzie, executive director of the Methodist Home of the District of Columbia Forest Side, an Alzheimer's assisted-living facility, puts her hand on the arm of resident Catherine Peake.
Shots - Health News
Treatment For Alzheimer's Should Start Years Before Disease Sets In
Patricia Witt at home
Aging At Home: Helping Seniors Stay Put
'Villages' Help Neighbors Age At Home

"Even though short-term memory goes, a lot of people with dementia retain those long-term memories," he says.

And those long-term memories — and lifelong activities — can be rekindled and used to distract a person with Alzheimer's from behaviors that could cause them physical or emotional harm. Or the information can be used to give them a better quality of life.

Read more HERE

------------------------------------------

The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in wills and trusts, estate planning, guardianship, probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for family law issues such as divorce, child custody and visitation, support, and military family law.

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

Durable Power of Attorney in RI

Will your Durable Power of Attorney Work for You?

We often hear that “avoiding probate” is a good thing and in most cases the statement is true. The probate that is “avoided” is usually post-death probate. Many people use revocable and irrevocable trusts or joint-asset and “transfer on death” planning in such situations. But it is surprising how many people fail to have a Durable Power of Attorney prepared. It is even more surprising to see how many of the documents that are drafted cause confusion or simply don’t work in the manner intended by the “grantor” of the power. Here is a list of “do-s” and “don’ts”:

1. Do make your Power of Attorney “durable” so it will survive your incapacity.
2. Do nominate a sensible person as your “attorney-in-fact” and as a successor.
3. Do consider whether the power should be contingent on future events (“springing”) or immediate.
4. Do discuss protecting your assets after your incapacity from an attorney-in-fact who will not fulfill your ultimate estate goals.
5. Do read the power carefully before you sign it. If it does not make sense to you it probably won’t make sense to banks, financial institutions and others when it is used in the future.

1. Don’t nominate a person who has serious health issues or is older than you.
2. Don’t hold the document for more than five years without re-reading it and having an attorney review it. Things change!
3. Don’t confuse everyone by leaving joint attorneys-in-fact with unclear statements as to their respective powers or their separate powers.
4. Don’t place powers regarding medical decisions in your document if you have already designated another person to exercise those same powers in your “medical durable power of attorney”.
5. Don’t put the signing of this document off to the future. Dollar for dollar, it is the least costly way to “avoid probate” since it can avoid the necessity of a guardianship during your lifetime.”

------------------------------------------
The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in Wills and Trusts, Estate Planning, Guardianship, Probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for Family Law issues such as Divorce, Child Custody and Visitation, Support, and Military Family Law. 

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

Durable Power of Attorney Validity

A REMINDER ABOUT THE VALIDITY OF YOUR DURABLE POWER OF ATTORNEY

When you sign a “Durable Power of Attorney” document, you name an “Attorney in Fact”, to act on your behalf in all financial matters. This power endures even if you become incapacitated, disabled or incompetent. However, many people do not realize that once you die, your Durable Power of Attorney is no longer valid. In other words, it dies when you die.

Often, the Attorney in Fact will attempt to access accounts post-death only to be told that he does not have the legal right to do so. Just recently a gentleman came into our office to discuss this very issue. He was a joint owner of his mother’s only bank account, but she was the sole owner of a mutual funds account worth approximately $125,000. On a Friday, this gentleman thought that he should – as his mother’s Attorney in Fact – transfer the mutual funds into the joint account so that he could pay her nursing home bills. But because he had other things that he needed to take care of that day, he put off the transfer intending to do it at the beginning of the following week.

Unfortunately, his mother died that weekend and her son was no longer able to access her mutual funds account. As a result, it became necessary to open a probate estate so that the son could be named Executor and then have the necessary power to access the account. While opening a probate estate is not difficult or complicated, it takes months to clear assets within an estate and there are court costs, inventory taxes and attorneys fees. In short, avoiding probate is a useful strategy to consider in many cases. Here, timely action under the durable power of attorney would have made life much easier for the family.

Whether you are granting a Durable Power of Attorney to a family member, trusted friend, a professional, or whether you are acting as the Attorney in Fact for a grantor of the powers, be mindful of the limitation of this power and act accordingly in managing assets and accounts.
------------------------------------------
The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in Wills and Trusts, Estate Planning, Guardianship, Probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for Family Law issues such as Divorce, Child Custody and Visitation, Support, and Military Family Law. 

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

Choices for End-of Life Caregiving

PlanForCare.org
November 5, 2010

There are many decisions to be made when imminent death is approaching for a loved one. Questions regarding what type of care, medical assistance and even physical location for their last days confront us.

If care at home has been given, should loved ones be moved to a facility or remain at home? If in a care facility should they be moved home for their last days? Will 24-hour care become necessary and more medical assistance be required?

If you are asking these questions, a Hospice service might be a good solution. Hospice can be provided to a person who has a life-limiting illness wherever that person lives. A nursing facility or long-term care facility can receive visits from hospice personnel in addition to the other care and services provided by the facility.

Hospice care is a special way of caring for a patient who is in the last stages of life. Hospice provides a team of professionals who aid the patient and family caregivers. This could include nurses, social workers, physicians, clergy and aides who all work together to plan and coordinate care, 24 hours a day or as needed.

The Hospice Foundation of America outlines the following services of hospice:

• Hospice is a special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments.
• Hospice care neither prolongs life nor hastens death. Hospice staff and volunteers offer a specialized knowledge of medical care, including pain management.
• The goal of hospice care is to improve the quality of a patient's last days by offering comfort and dignity.
• Hospice care is provided by a team-oriented group of specially trained professionals, volunteers and family members.
• Hospice addresses all symptoms of a disease, with a special emphasis on controlling a patient's pain and discomfort.
• Hospice deals with the emotional, social and spiritual impact of the disease on the patient and the patient's family and friends.
• Hospice offers a variety of bereavement and counseling services to families before and after a patient's death.

To be eligible for hospice a physician must certify the patient to be terminally ill with a life expectancy of six months or less and treatment for a cure is no longer provided.
The focus for the patient has changed to supportive care and quality of remaining life.

Hospice is paid for by private insurance, Medicare or Medicaid Hospice Benefit or personal funds.

Here are the conditions that apply for Medicare Hospice Benefits:

• You are eligible for Medicare Part A (Hospital Insurance)
• Your doctor and the hospice medical director certify that you’re terminally ill and have 6 months or less to live if your illness runs its normal course.
• You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness.
• You get care from a Medicare-approved hospice program
• You understand that Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness. Medicare.gov

Special benefit periods apply to Medicare hospice care and some services do not apply.
Be sure to understand the rules and requirements of Medicare payment before you commit.

Hospice is available to anyone, regardless of age or illness. If Medicare or private insurance is not available, hospice services may be available for low income individuals through grants or charitable donations. Many hospices are non-profit and will provide services to anyone in need.

“Many families or their loved ones' doctors often wait too long to order hospice. Hospice is a very valuable service and should be ordered at an earlier stage of illness. Many do not consider hospice for Alzheimer's, degenerative old age or other debilitating illnesses where a person is going downhill fast. They should.

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

When someone is in crisis or appears to be going downhill fast but there really is no hope for recovery, family often call 911 and start a process which can result in great stress and great emotional discomfort. The loved one who is dying ends up in a hospital and may die there or be transferred to a nursing home where death eventually occurs.

When there is no longer hope for prolonging life, especially when this decision is made months in advance, hospice is usually a better alternative to other medical intervention”. National Care Planning Council

The days leading up to the moment of death of a loved one can be rich with meaning and expressions of love. Family and caregivers should allow others to help with the care and daily responsibilities. They need to free themselves from the details of caregiving and instead need to use hospice to allow more time to reminisce, give thanks for a life shared and say goodbye.

http://www.planforcare.org
------------------------------------------
The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in Wills and Trusts, Estate Planning, Guardianship, Probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for Family Law issues such as Divorce, Child Custody and Visitation, Support, and Military Family Law. 

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

RI Elder Care and Probate Laws

New Rhode Island “laws-in-waiting” regarding Probate and Elders

We in Rhode Island have been living in a strange world when it comes to State (RI) estate taxes. If one died or dies after December 1, 2009 with less than $850,000 as a taxable estate, one would owe no estate taxes. It looks like an exemption on the first $850,000, doesn’t it? But if one dies after December 1, 2009 and has $850,001 as a taxable estate, one is currently taxed on the entire $850,001.

Only in Rhode Island do we see legal consequences like this one!

The legislature in its infinite wisdom is now trying to fix this problem by passing a bill retroactive to December 1, 2009 which will establish a $25,200 estate tax credit effectively eliminating the existing tax. (Senate Bill 2195, House Bill 7611 and House Bill 7612) Another Senate Bill (2115) would increase the estate tax exemption to $1,000,000 effective 1/1/2011 and further increases it to $2,000,000 effective 1/1/2012. The tax would then be eliminated beginning January 1, 2013. There are other offerings before our legislature.

We will keep you posted.

With thanks to CATIC (title insurance company) for helping us with these interesting “news-flashes”. I suggest that we all call our legislator(s) and urge them to clarify these issues and to make RI more business-friendly and taxpayer-friendly by eliminating the estate tax.

------------------------------------------
The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in Wills and Trusts, Estate Planning, Guardianship, Probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for Family Law issues such as Divorce, Child Custody and Visitation, Support, and Military Family Law. 

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

RI Estate Tax Revision

I repeat: “Where is the Estate Tax Revision?”

In December I wondered in this newsletter whether our national legislators would pass legislation regarding Federal estate taxes. They did not. Where does this leave us? For the moment we estate planners and elder-lawyers are in limbo. If a client has already died in 2010 or if they die soon, there is no current estate tax. There is talk of remedial legislation that will be retroactive to January 1st. Wait till the litigators “get ahold of” that one!

For your information, there is some precedent that Congress can pass retroactive legislation in matters such as this (that affect the federal pocketbook) but we’ll wait and see. There is also talk that the current administration would like to give a “year off” from paying federal estate (and gift) taxes but it is hard to see how that is wise given the current national financial crisis. It would help very wealthy families and hurt less wealthy families who will pay capital gains taxes on inherited assets over $1.3 million dollars.

After 2010 the estate tax exemption will be one million dollars again and the estate tax rate will increase to 55%. That will affect many more families. Standard language found in many estate plans could leave spouses with nothing. It is important to you check with an elder law or estate planning attorney to make sure your estate plan does what you want it to do. Call us with any estate planning questions.

Jeremy Howe. Kristy Garside. Hilary Carlson. 841-5700

------------------------------------------
The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in Wills and Trusts, Estate Planning, Guardianship, Probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for Family Law issues such as Divorce, Child Custody and Visitation, Support, and Military Family Law. 

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

A helpful tool for Estate Planning and “Advance Directives”

We often find that clients do not follow through with all aspects of their estate and post-death plan because they are reluctant to address their mortality. On the other hand, if clients do prepare a comprehensive plan, they often express a feeling of relief and satisfaction. The key word is “comprehensive.” What should a person consider when organizing their plan? Here is a partial list:

• Disposition of assets
• Payment of debts
• Funeral arrangements and special requests regarding the type of ceremony
• Anatomical gifts for science
• Anatomical gifts for transplants
• Living will provisions
• Disposition of personal property including gifts of specific items to family members and friends
• Charitable donations
• Tax consequences of gifts and bequests
• A family history or personal memoir

It can be a daunting task to organize all of the above matters. We suggest that you review all of these matters with an experienced estate planner and elder lawyer. We also suggest that you consider the use of The Beneficiary Book which is available in book form or in computer disc form. This book is a supplement to a personal or family estate plan. We buy the books and CDs in bulk and deliver them at our cost to clients. Our clients then add their own data and keep it up to date in the future.

Let us know if you would like to look at The Beneficiary Book. We think you will feel better if you leave the gift of a clear and well-organized plan for your family.


------------------------------------------
The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in Wills and Trusts, Estate Planning, Guardianship, Probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for Family Law issues such as Divorce, Child Custody and Visitation, Support, and Military Family Law. 

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

"Homecare" doesn't have to mean nurses.

I recently met with my women's networking group called SeniorRULE. We are Resources Unlimited and Liaisons for Elders. One of the members owns a homecare agency, and she has been in business for about 6.5 years now. Kathy Devlin, founder of "All About Home Care" originally started by providing companion care, which did not include CNA or skilled nursing. She could provide companions to do the cooking and cleaning, grocery shopping, driving, and to simply be there for someone who did not have anyone else. She recently went through the administrative requirements so she could also provide CNAs (Certified Nursing Assistant) in the home, but she continues to staff companions.

Kathy felt it was important to remind us that various services can be provided by a companion, and other services are required to be performed by a CNA. Companions can be much less expensive for the patient, and perhaps one should be considered if you or your loved one needs more attention than you are able to provide. It is typical when people begin using a homecare agency to hear, "I should have done this ages ago!"

If you or your loved one is in need of extra help, and you are not sure where to turn, call us at the Law Offices of Jeremy Howe and we can discuss what services may be available in our area and try to make sure your affairs are in order to make your life and those of your loved ones easier.


------------------------------------------
The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in Wills and Trusts, Estate Planning, Guardianship, Probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for Family Law issues such as Divorce, Child Custody and Visitation, Support, and Military Family Law. 

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

What Robert Shapiro Does Not “Get”

Do you remember Robert Shapiro?

He was O. J. Simpson’s lawyer. Whether you like him or his style you have to admit that he is an impressive and imposing trial lawyer. Frankly, during the past few years, I was quite surprised to see him shilling for “LegalZoom” on TV commercials and on the internet. I asked myself: “Why would a world-famous trial lawyer lower himself to try and convince the public that they can avoid legal costs and draft their own trusts, wills and other important documents?”

Recently, I found out from ElderLawAnswers that he was not only the face of LegalZoom, he was the founder. I will leave it to you to make the call as to why he formed the company. There are other companies who try and sell pre-packaged divorces and other legal documents.

On behalf of consumers, I object to the existence of these companies.

My objection is not a personal financial objection. My law firm will get our share of legal business the “old fashioned way”. I object to the notion that lawyers do not have any role in the estate planning process. We regularly untangle legal work that was drafted by attorneys who should know better. We regularly advise clients who want a trust that they do not need one or convince clients that their goals can be better met with documents or a plan they never considered.

There are many options for clients and LegalZoom never engages clients in an educated discussion of those options. I submit that it is deceptive to declare that by filling out a “cookie-cutter” form that people can draft a legally acceptable and correct set of documents to meet their specific needs. Estate planning is not that simple a task. Class action lawsuits have been filed against LegalZoom for engaging in deceptive practices and for practicing law without a license. There are other lawsuits nationally against Shapiro and LegalZoom.


Modern estate planning involves constant attention to federal and state tax law (income and estate); Medicaid law and procedures; Veteran’s benefits; social security law; elder abuse (physical, emotional and economic) and manipulation; advance directive options; resources for elders losing capacity; resources and programs for remaining at home; care-giver contracts; family dispute resolution and mediation options; funeral and burial arrangements; and Probate Court decedent’s estate, guardianship and conservatorship law and practice.

Estate planning is an ongoing process which requires regular reviews whenever life circumstances change. Shapiro demeans himself and his profession by selling pre-packaged documents and forms.

Caveat Emptor.

------------------------------------------
The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in Wills and Trusts, Estate Planning, Guardianship, Probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for Family Law issues such as Divorce, Child Custody and Visitation, Support, and Military Family Law. 

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

Will your bank accept your durable power of attorney?

Rhode Island Durable Power of Attorney

A client recently had a problem at Bank of America, as power of attorney for his mother. Their policy was to only allow a durable power of attorney if the account holder presented the original form to the bank themselves! This was a problem because client's mom was unable to leave her home. Be aware of what your bank's rules are in order to avoid a problem.

If you have questions about a durable power of attorney, or other elder law issues, call our attorneys at 401-841-5700. We make housecalls!


------------------------------------------
The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in Wills and Trusts, Estate Planning, Guardianship, Probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for Family Law issues such as Divorce, Child Custody and Visitation, Support, and Military Family Law. 

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

Owning Real Estate as Joint Tenants Can Be Risky or Costly

We have clients who ask us to transfer real estate to a child or children during their life-time in order to avoid probate and for other family reasons. This can cause undesirable tax results (capital gains) when the property is sold by the child or children in the future. Further, a joint tenant can sever the joint tenancy without notifying the other joint tenants which converts the nature of the tenancy to a “tenancy-in-common.”

The most famous decision illustrating this result is a 1980 California decision where a wife conveyed her joint interest to herself as a tenant in common before her death. Upon her death, her husband expected to own the property outright but owned it with his wife’s devisees under her will.

While Rhode Island uses a different form of joint holding by a husband and wife called a “Tenancy By the Entirety”, if another person is added as a joint owner, unexpected results can occur.

The moral... Counsel First!

------------------------------------------
The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in Wills and Trusts, Estate Planning, Guardianship, Probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for Family Law issues such as Divorce, Child Custody and Visitation, Support, and Military Family Law. 

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.