Recognizing the Need for Outside Help in Caregiving

Article: Recognizing the Need for Outside Help in Caregiving

Caregivers often don’t recognize when they are in over their heads, and often get to a breaking point. After a prolonged period of time, caregiving can become too difficult to endure any longer. Short-term, the caregiver can handle it. Long-term, support is needed. Outside help at this point is often necessary.

A typical pattern with an overloaded caregiver may unfold as follows:

· 1 to 18 months--the caregiver is confident, has everything under control and is coping well. Other friends and family are lending support.

· 20 to 36 months--the caregiver may be taking medication to sleep and control mood swings. Outside help dwindles away and except for trips to the store or doctor, the caregiver has severed most social contacts. The caregiver feels alone and helpless.

· 38 to 50 months--Besides needing tranquilizers or antidepressants, the caregiver's physical health is beginning to deteriorate. Lack of focus and sheer fatigue cloud judgment and the caregiver is often unable to make rational decisions or ask for help.

It is often at this stage that family or friends intercede and find other solutions for care. This may include respite care, hiring home health aides or putting the disabled loved one in a facility. Without intervention, the caregiver may become a candidate for long term care as well...

Please read the entire article and previous articles: Either click on the link http://www.planforcare.org or copy and paste the following into your browser: http://www.planforcare.org.

Please note: This article is provided for informational purposes only, and the resources provided when you follow the applicable "link" may or may not be recommended by our office. .

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The Law Offices of Jeremy W. Howe, LTD. are Elder Law Attorneys in Newport, 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

Safe Voyage! Travel For Older Adults

Travel for Older Adults

This is an article from our friends at Senior Helpers that our readers may find helpful. Contact Information: Chad Neighbors (401)825-7200 cneighbors@seniorhelpers.com in Warwick, Rhode Island.

Safe Voyage! Travel for Older Adults

Staying physically active and connecting with other people are two important keys to successful aging, and travel is a great way to do both at once! Discounted travel packages designed for seniors are one of the "perks" of being an older traveler. And with the generations spread across the country, visits keep families connected. But some seniors hesitate to travel because they are afraid of illness or injury, or of getting lost, or encountering hazards along the way.

Even if an older adult's physical condition makes travel more of a challenge, many obstacles and potential problems can easily be overcome with a little advance planning. It is important to:

-review the traveler's health insurance policy before the trip. What are the conditions for receiving medical care out of the service area? Do benefits apply when traveling abroad?

-make sure immunizations are up to date, including the specific immunizations recommended or required for the area being visited.

-bring along enough medication for the trip, packed in carry-on luggage. Especially if traveling abroad, leave medications in their original prescription containers.

Special Assistance for Disabled Travelers

Some seniors are reluctant to travel because they feel insecure negotiating the crowded service desks and corridors of busy airports and other transportation terminals. A person with hearing difficulty often has the hardest time when there is significant background noise. A person with dizziness, limited vision, or mobility problems may fear falling or being jostled by crowds. But people who are basically able to travel and just need a little extra assistance can take advantage of these services available to travelers:

Boarding assistance-
Most airlines and rail lines have wheelchairs available for those unable to walk long distances, and some also offer formal "meet and assist" programs. It is best to confirm these services when booking tickets. At the gate, pre-boarding is usually available for persons who need extra time or feel unsafe in the crowding of general boarding.

Oxygen-
Persons with medical conditions requiring the use of an oxygen tank can travel safely on most kinds of public transport. Airlines have strict requirements about oxygen use. These usually include a letter from a physician explaining the person's oxygen requirement and a statement certifying that the oxygen provided by the airline is acceptable.

Disabled accessibility-
Most aircraft are wheelchair-accessible, though some small commuter planes are not. Trains and ships generally have a limited number of disabled-accessible cabins or compartments. Many resorts offer specially designed rooms and suites for use by persons in wheelchairs. Reservations for special facilities should be confirmed in writing before the trip begins.

Five Health Tips for Airline Passengers

Gone are the days when traveling by plane was a pampering treat! Nowadays, long security lines, delays and cramped seats are the norm. You can minimize discomfort by following a few steps:

-Get plenty of sleep before you leave.
-Drink water and avoid alcohol and caffeinated beverages to avoid becoming dehydrated.
-Change sitting position frequently and walk down the aisle occasionally to avoid stiff joints or (in rare cases) dangerous blood clots.
-If you have a cold, take a decongestant and chew gum on takeoff and landing to avoid ear pain.
-Check with your doctor ahead of time if you have any questions about flying with your medical conditions.


(c)2008 IlluminAge Communication Partners

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The Law Offices of Jeremy W. Howe, LTD. are Elder Law Attorneys in Newport, 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

TAX DEDUCTION FOR FAMILY CAREGIVER SERVICES

TAX DEDUCTION FOR FAMILY CAREGIVER SERVICES

The following Article was written by: Kim Boyer, CELA, BOYER LAW GROUP, www.elderlawnv.com and provided to our office via the Veterans Advocates Group of America monthly e-newsletter called VAGA News.
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Many times family members or friends provide care to a loved one for a fee. These family members or friends are typically unlicensed caregivers. Can the person paying for the care deduct the payments as a medical expense on their income tax return?

Medical expenses, not compensated for by insurance or otherwise, may be allowed as a deduction to the extent that the expenses exceed 7.5% of the taxpayer's adjusted gross income. Medical care can include amounts paid for "qualified long-term care services" as defined herein. The taxpayer must be certified as "chronically ill" by a licensed health care professional. The services must be provided pursuant to a plan of care prescribed by a licensed health care professional.

The U.S. Tax Court recently ruled on the issue of whether payments to unlicensed care providers were deductible. Estate of Lillian Baral v. Commissioner of Internal Revenue (July 5, 2011).

The tax court examined whether payments totaling $49,580 made by Lillian to Ms. Pzevorski and Ms. Jakubowski were deductible. Neither of them were licensed healthcare providers. Thus, the payments were not deductible as medical expenses. However, the court found that payments to them could be deducted if their services qualified as "long-term care services" as defined under the tax code.

After analyzing the tax code, the Court found that the care provided constituted "maintenance or personal care services" for a "chronically ill individual" provided pursuant to a "plan of care prescribed by a licensed health care professional." Thus, Lillian could deduct $43,273 of the payments made to the care providers (the amount paid which exceeded 7.5% of her adjusted gross income).

For Medicaid purposes the payments will be considered gratuitous when provided by a family member, unless there is a written contract. It is advisable that there be a written contract providing for reasonable compensation and specifying the nature of services to be provided.

**This article/newsletter is not intended as a substitute for VA, legal, or other professional advice. Every effort has been made to make the content of this newsletter accurate; however, neither VAGA, nor any of its founders, assume any responsibility for errors in content or damages that may occur as the result of using the information contained within this newsletter or from any associated website or e-mail links.
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The Law Offices of Jeremy W. Howe, LTD. are Elder Law Attorneys in Newport, 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

Myths and Facts About Pain and Older Adults

Article provided by: Senior Helpers (see contact info at end of article)

Answers to "Myths and Facts About Pain and Older Adults"

1. Pain is a normal part of aging.
Myth. Although older adults are more likely to experience pain, it is not a "symptom" of aging, and should not be considered as inevitable.

2. It would be great to eliminate all pain!
Myth. Pain is a signal to the brain that something threatens the well-being of the body. It is the mechanism that warns us of injury or illness. Without it, we could not survive.

3. Sometimes pain is caused by injury to the nerves themselves.
Fact. Sometimes the nerves send "false signals" that something is wrong with a body part or organ. Damage to the nerves, spinal cord, and brain can cause this persistent pain.

4. Pain can be "all in your head." Myth...and Fact. While most pain is the result of physical causes, how we think about pain can make a difference. Stress and anxiety magnify our perception of pain, which leads to more stress and anxiety. But the cycle can be broken through pain control techniques.

5. Medication is the only treatment that can relieve pain. Myth. There are many other options for pain treatment--physical therapy, massage, exercise, regional anesthesia, relaxation training, yoga, and biofeedback, to name a few.

6. Antidepressant medications can be effective in treating pain. Fact. Low doses of antidepressants can be especially effective against nerve pain, possibly because they affect the chemical reaction of nerve cells.

7. Because of the danger of addiction, many pain medications should be avoided. Myth. Certain medications (morphine, codeine, and related drugs) can cause physical dependency, and are prescribed with caution. But researchers now believe that these drugs can have a positive impact on quality of life when used exclusively for the treatment of pain.

8. Older adults are less likely than younger people to ask their healthcare providers for pain relief.
Fact. While older adults are the most likely to experience pain, they are the group that is least likely to ask for help. This can stem from the mistaken belief that they are "just getting old," or "don't want to be a bother." In reality, treating pain can improve the quality of life for older adults, and preserve function and independence.

9. The recommended dosage of pain medication remains the same as we age. Myth. Decreased kidney function may cause substances to be excreted more slowly, which could allow a toxic dose to build up. Side effects of medications are also more common in older adults. And for people taking drugs for multiple conditions, it's important that the pharmacist and healthcare provider have a complete list of all their medications, to avoid harmful interactions.

10. To protect the joints, a person with arthritis pain should not exercise.
Myth. Exercise is actually the most important treatment for controlling pain and preventing disability in people with conditions such as arthritis. Increased strength and flexibility bring a better blood supply to muscles and joints. The person's healthcare provider can "prescribe" an appropriate exercise program.

Untreated pain can cause a significant decline in the well-being and quality of life of older adults, resulting in fatigue and depression, anxiety, withdrawal from social life and reduced ability to perform the activities of daily living. So if you or someone you know is experiencing chronic pain, it is important to work with the healthcare provider to determine the most effective treatment. Pain relief is an essential part of good healthcare!

Contact Information
Chad Neighbors
(401) 825-7200
cneighbors@seniorhelpers.com
Warwick, Rhode Island


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The Law Offices of Jeremy W. Howe, LTD. are Elder Law Attorneys in Newport, 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

Estate Planning Issues to Consider

Estate Planning

In May, 2011, I was asked to speak at the United States Coast Guard’s Senior Executive Leadership Conference on the key issues facing our generation as they relate to elder law and elder care. Many in our generation are taking care of themselves and their children, as well as elderly parents, so I focused on advance care and estate planning.

Just recently I met with the Coast Guard officer who had invited me to the conference. He told me that the “reviews” of my talk were very positive and he asked if I would be willing to come to the next conference since so many of the attendees found the subject matter of personal interest. Of course I was flattered by the invitation, but more importantly, I was reminded how “timely” the subject of estate planning is and how critical it is that people learn now what they should have in place for the future.

Simply put we need to start asking the following:

• What type of medical care do I want towards the end of my life?
• Where do I want to be cared for?
• How can I ensure that my desires will be honored if I am not able to speak or act for myself?
• What financial arrangements should I make now to ensure that I can receive the care I want?
• What resources are available for my care?
• What will happen if I outlive my assets?
• What do I want to happen after my death?

The practice of elder law attempts to assist people in formulating the answers to these questions by articulating goals for care while you are alive and plans for taking care of your estate upon your death. At the very least your planning should include the drafting of Durable Powers of Attorney for Medical Care and Finances and executing a Will or Trust. Our office can help by initiating the discussion that leads to plans that will meet your individual needs.

- Hilary



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The Law Offices of Jeremy W. Howe, LTD. are Elder Law Attorneys in Newport, 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

Bank of America Says Power of Attorney Does Not Grant Access to Online Banking

Newport Rhode Island Durable Power of Attorney

See the link below for this Article entitled,

"Bank of America Says Power of Attorney Does Not Grant Access to Online Banking"

which was provided by ElderLaw Answers.

As an elder law attorney, I would like to know whether Bank of America would allow her to access the account online if there was language in the power of attorney that specifically allowed her that power. The key to most powers of attorney is the language. If it was not specifically listed but the powers given are general, then I would suggest pushing Bank of America's legal advisers to provide the authority for making up their own rules as they go along.

Article: http://www.elderlawanswers.com/resources/article.asp?id=9197


If you or your loved ones do not have a durable power of attorney, medical durable power of attorney and executed living will, call us to make an appointment at 401-841-5700.
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The Law Offices of Jeremy W. Howe, LTD. are Elder Law Attorneys in Newport, 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

Medicaid Planning in Rhode Island

Medicaid Planning Newport Rhode Island

Medicaid covers a variety of programs but when we speak of “Medicaid Planning” we are most often discussing long-term care. About 49% of all long-term care is financed by Medicaid. Medicaid is a federal-state program and states have wide discretion in how they will administer Medicaid in their state. Rhode Island is an “SSI State”. In RI a person receiving SSI is automatically eligible for Medicaid and the income and resource rules of SSI are used to determine Medicaid eligibility. Other individuals who qualify are “medically needy” individuals. They are allowed to “spend down” excess income for medical expenses to qualify for Medicaid. They can also spend down by paying off debts, paying for services, prepay funeral expenses, pay real estate taxes, purchase an automobile, converting an IRA to a Roth IRA, making home improvements, buying household goods or personal effects.

Some programs provide “Home or Community-based Services (HCBS) for those who would require nursing home care but for the program. Assisted living costs are covered under a Medicaid waiver program.

Most Medicaid Planning looks to the resources of the individual (and the spouse ). Not all resources are counted although all resources are disclosed. “Countable Resources” can be converted to “noncountable resources”. Some assets are noncountable resources because they are exempt such as: One automobile, the family home if the applicant “intends to return home”, property used in a trade or business, property used for self-support or employment and personal effects and household goods up to $2,000, an account of $4,000, wedding and engagement rings, life insurance with a face value of $1,500 or less. Certain income producing property is also exempt. “Qualified” assets such as an IRA are not countable assets. The “community spouse” who still resides at home is entitled to a “Minimum Monthly Maintenance Needs Allowance (MMMNA)”. In October, 2011 it was raised to a maximum of $2,841 per month and a minimum of $1,828.75. The MMMNA may be increased at a “Fair Hearing”. The Community Spouse Resource allowance (the CSRA) provides for the pooling and division of the resources of husband and wife and allows the “community spouse” to retain a share of the couple’s countable resources. This is composed of countable resources only. The new minimum CSRA in Rhode Island is $22,728 and the new maximum is $113,640. This is in addition to the $4,000 that the institutional spouse may retain. The minimum and maximum home equity limits used by Medicaid have increased to $525,000 and $786,000, respectively.

The Medicaid “look-back period” for transfers of assets is 60 months if the transfer occurred after February 8, 2006. In cases where it is too late to transfer assets there are transfer strategies used by Medicaid planners. There are risks and costs also when assets are irrevocably transferred so it is wise to consult an expert before transferring any asset. There are exempt transfers from the period of ineligibility such as transfers of the family home in certain circumstances, transfers to the community spouse, transfers to a blind or permanently and totally disabled child. There are transfers for value not subject to penalty such as: the purchase of an annuity; a “self-cancelling Installment Note (SCIN), the sale of a remainder interest in a home, modification of a child’s home for the parent before the need for a nursing home, reimbursement of a pro rata share of expenses, compensation for caregiving services and cost of other living arrangements. Medicaid planners also consider the use of a reverse mortgage or a family reverse mortgage and non-negotiable promissory notes.

The foregoing list is not exhaustive and any person or family who wishes to begin planning with reference to Medicaid should remember: “The sooner the better!”
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The Law Offices of Jeremy W. Howe, LTD. are Elder Law Attorneys in Newport, 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