Massachusetts Estate Planning and Elder Law

Geriatric Care Managers - An Important Part of the Team

When caring for an elderly loved one, a team approach is often best.  Each player - the doctors, nurses, home care providers, attorneys, financial planners and caregivers all their their roles. The New York Times has a recent article about Geriatric Care Managers, who are often an integral part of the team when working with elders.

As the article explains:

...many family members don’t know how, or live too far away, to find and manage help for aging parents. That’s where geriatric care managers come in. They serve as guides through the fragmented care landscape, connecting clients with local services, assisted-living facilities and a wide network of paid caregivers, elder law attorneys and financial advisers. They help families find living options, assess the abilities of older people, write care plans and sometimes hire and supervise home help.

Geriatric Care Managers, or GCMs, can help evaluate a situation and make recommendations for the best type of care - whether in home, at a day program or in a facility.  They can then coordinate that care to make sure that nothing slips through the cracks, and that nothing is being duplicated.  GCM's are usually social workers or nurses and are generally very knowledgeable about the resources for elders in their communities.  The clients I've had who have worked with GCM's have appreciated their assistance and expertise - whether they worked with them on a long term basis or just for a few visits. 

You can locate a geriatric care manager in your area by going to the National Association of Professional Geriatric Care Managers website, or by asking your attorney, home care provider, or other allied professional for a referral. 

Free AgeWise Living TeleSeminar - Wednesday Night

AgeWise Living offers free monthly teles-eminars on a variety of topics for caregivers and children of aging parents. 

Barbara Friesner is hosting a seminar on Wednesday March 12, 2008 at 7pm eastern time on Helping Your Loved One Get What They Want and What's In Their Best Interest.
Click here for details and the call-in number. 

You can listen to past seminars by clicking here, including a great one on sibling relationships. 

Even though Barbara is in New York, she does all of her generational coaching by phone, so she can help families throughout the country. 

Economic Stimulus Check Resources for Seniors and Those on Medicaid/MassHealth

Thanks to Patti Dudeck, for her post about Social Security recipients needing to file their 2007 Tax Returns before they will be able to receive their economic stimulus check.

The AARP has a page with answers to questions about the stimulus checks, and who is eligible.  They also have information about how to obtain tax filing help for low income seniors. 

And, note that the funds from the payment will not affect eligibility for needs-based benefits programs, as explained on the AARP page:

Will the stimulus payment affect eligibility for needs-based benefits programs? No. Receiving a payment under the stimulus package does not have any effect on eligibility for or amount of needs-based benefits programs (i.e. Food Stamps). Specifically, the payment does not count as income in the month it is received and does not count as a resource (asset) for 60 days after the month in which it was received.

Keep in mind that it will count as an asset after 60 days after the month in which it was received.  If your public benefits depend on your assets being below a certain limit, always keep an eye on your balance.

What are you leaving behind? Thoughts on decluttering as part of planning.

I posted recently about the health effects of clutter on the person living with the clutter.  However, the effects of your clutter live on even after your death.  This blog, Confessions of a Hoarder, has a post describing the process of trying to declutter an estate after a person's death. 

The author describes how her mother, a member of the American Association of University Woman, was often called to help clean out someone's estate that had been left to the AAUW.  They had to prepare the house for sale, and in doing so they had to clear out decades-worth of things that had been collected by these people who had generously left their estate to the charity. 

The author's mother offered these tips to aging people, as well as their adult children as they decide what to keep and what to recycle, give away or throw away:

1. Do not save months and years of magazines, with a thought towards donating them. 
   
   

   Collections of magazines, such as Life or Look, usually have no value as libraries have copies in their archives. National Geographic and The New Yorker, for instance, are available on CD-ROM. Professional journals are usually available on-line these days. Newspapers, magazines, and other periodicals collect moisture, become mildewy and/or moldy and attract other unhealthy pathogens.

2. If you have collectibles that you want people to inherit from you, think about giving the item sooner along with the story behind it. 
   
3. Identify all keys with tags or labels.  Safe deposit box keys should have the bank name, branch and box listed on them.
   
4. Photographs of unidentified people are usually thrown out if donated to a charity, and are much more valuable to family if they have the identity, date and relationship listed on them. 
   
   It only takes a few generations for the identity of people in photographs to be lost, so if you are looking through unlabeled pictures with an older family member, take some time to ask them who the person is, what they were doing, where they were, and who they were related to. Which is more meaningful, a label that says "Joe", or one that says "Uncle Joe, Joe Sr.'s son, age 19, 1942 in front of his store front in San Francisco."  This type of project is a good one for younger generations to help out with, and can lead to more stories and memories being shared and passed down. 
   
5. Identify flowers, plants, trees and houseplants if you know what they are.  These can be useful for prospective buyers, who may want to know how to continue to care for them.
   
6. Broken, rusted or otherwise unusable tools have no value. Consider having them repaired or throwing them away.
   
7. Identify circuit breakers.
   
8. Clearly mark where the main water shut-off valve it.  Houses that are left vacant can sometimes have pipe-freezes and knowing where to shut off the water coming into the house is vital to stopping the flood.  The plumber can usually find it, but the water should be shut off ASAP in the event of a pipe freeze. 

Many times my clients who are dealing with the estate of a loved one have commented to me about things their mother, father, aunt or uncle saved, and have wondered aloud what made them hold on to so many things.  They often resolve that they will not subject their children to the same onerous task of clearing out their house when the time comes. 

Are there things you are saving because you think they might be of value? Do you need help decluttering and clearing out your house? Are you trying to figure out how to approach your parents about their clutter?  You might try starting with some books on the topic,  and then gently offering to help. Remember that people are often very attached to their clutter (and their sentimental items) so you can't just start throwing things away that don't belong to you, but you can start a conversation and offer to help get things in order. 

New Medical Students Learning to Care for Aging Patients

The Boston Globe has an article today about medical schools focusing on the care of the elderly.   Some of the course work includes a focus on hip fractures, drug costs, and discussing end of life issues with their patients. 

The new emphasis on aging is part of a wave of change sweeping medical schools nationwide as they focus - many for the first time - on preparing all newly minted doctors to treat the growing population of older Americans. Although students have traditionally trained in hospitals filled with older patients, many graduated with little knowledge of how elderly patients' bodies and minds differ from younger ones.

Now, medical schools are increasingly teaching students in settings that include senior centers and nursing homes. They are incorporating lessons on aging in basic coursework. And many are testing students on their skill in treating older patients before they are allowed to graduate.

"This work is crucial to the well-being of older people and the well-being of healthcare in the United States," said Dr. Richard Besdine, director of the Center for Gerontology and Health Care Research, who is leading a curriculum overhaul at Brown. "Every physician in the United States needs to be educated about care of older people unless they're going to do lifetime pediatrics."

It will be interesting to see if the new emphasis on caring for the aged will lead to a resurgence of doctors who make home visits (and not just to the nursing home or assisted living facility.)  As more people choose to age in place, with supports from family, paid care-givers and companions, the need for doctors who make home visits will increase.  Just as you can't have an elder law practice without making home visits to those clients who need them, a doctor  will have a hard time calling herself a geriatrition if she isn't willing to do the same thing for her patients.    

Do you know where your Will is?

I often meet with clients who have Wills that were drawn up 20, or more, years ago.  Usually the clients have copies of the Will and the originals are with the attorney who drafted the Will.  And many times the clients have moved around since the original drafting, and many more times the attorney has moved offices, or even retired.  Did you think to tell your attorney from 20 years ago when you moved last year?  What if he or she was retiring or passed away and the attorney taking over the files needed to notify you? Would they be able to find you? 

If you do not have your original Will, make sure you check with the attorney who does have it to make sure they have your current contact information to be able to notify you in the event that they move their office, or are retiring.  Even better, have your old Will reviewed to make sure that it is still an accurate reflection of your wishes, that the people you appointed as Executor are still around, and that your planning needs have not changed in the last 20 years, which they probably have.  If you had small children when you first drafted the Will, chances are they won't be needing those guardians that you appointed in the Will, and you may even want one of your children to act as Executor now.  And if you are nearing retirement, facing a long term  illness or have a child with special needs or addictions you need to know what types of protections are available to you and your family. 

So find your Will (the original), dust it off, and have it looked at by an attorney.  You'll be glad you did. 

Stories of Harm - Health Care Quality Videos

My friend and former colleague Nicola Truppin of Health Navigator Partners sent me the link to the Health Care for All blog which has a recent post about people who were harmed while getting medical treatment at prominent Boston hospitals, either through misdiagnoses, medical errors or preventable infections.  There are 3 videos - each 3 minutes long - in which each woman describes what happened to her.  Click here to see the videos and read the post. 

The goal behind these videos and the work being done by Health Care for All's  Consumer Health Quality Council is to bring awareness to the problem and advocate for quality improvement and patient safety in health care. 

Family Caregiver Handbook - Free Online Resource

The MIT Workplace Center has recently published a Family Caregiver Handbook, which is available for free viewing on-line.  The handbook deals with such matters as Financial and Legal Issues, Home Health Care & End of Life Care, Caregiver Support, Housing and Transportation, and How to Get Involved.

The book serves as a gateway to the resources available to families and caregivers.  Rather than providing a lot of substantive information, the handbook gives a summary of the issues (such as a summary of MassHealth programs, or the different types of respite care available for caregivers) and then provides the contact information for local and national groups, associations, and government agencies that can provide the necessary services.

This handbook is a great resource  for  seniors, their caregivers and professionals who work with them. 

Setting Goals, Not Resolutions

People like to set resolutions for the New Year - lose weight, spend more time with family, get their estate plan in order, put finances in order.  But resolutions always seem to fade by February. Maybe it's because they are too vague, too big, too unwieldy. Why not set goals instead, with mini-goals along they way to get you there?

If your goal is to get your finances in order, start with tracking your spending.  You don't need anything fancy, a notebook or spreadsheet on your computer will be fine.  Next, keep track of all your bills and income. When you have a month or so of expenses tracked, and all of your bills in one place, contact a financial planner to help you make sense of it all, and put a plan in place for moving forward. This might involve investing your money in a certain way, obtaining appropriate insurance policies, even setting up a college fund for your children. 

If your goal is to "get your affairs in order", again, start small.  First, sit down with your spouse or partner and decide what you want to accomplish.  It might be making sure someone is appointed to care for your children if you are unavailable, or having someone be able to make decisions for you and manage your finances if you are unable.  Perhaps you want to protect your assets, or provide for a child with special needs, or maybe you just want to make things simple for your family if you pass away. 

After you've thought about your "big" goals, think about who the people are that you trust and who you'd want to handle things in the event you are unable.  It might be that you and your spouse choose each other as the primary agent named in your documents, but that you each choose different alternates.  That is fine.  In addition, you can choose different people to manage your finances, make health care decisions and become the guardian of any minor children.  The important thing is that you are choosing people you trust, and who will be able to handle the responsibilities. 

Once you've decided who you'd like to appoint and what your vision for the future looks like, or even if you've just narrowed it down a little, you should contact your attorney to meet and talk about your plans. Your attorney can review your current situation and your goals and let you know what you need to do to achieve them.  Before you know it, you'll be on your way to having your estate plan in place and you can move on to working on your other goals like reducing stress and getting in shape. 

Health (and other) Effects of Clutter

The New York Times had a recent article on the health effects of clutter.  The article points out that if you can't find your shoes, you certainly won't be able to go walking, and if you can't find your medications or other instructions from your doctor that could be harmful to your health as well. 

In addition to possibly harming your health, clutter could make it difficult for your loved ones to help you in a time of crisis.  If you are admitted to the hospital urgently, and a copy of your health care proxy is needed so that someone can communicate with the doctor, you don't want your family to have to search through piles of paper or lots of unmarked boxes.  Additionally, in the event of your passing, your family should be able to easily locate your estate documents such as a will or trust, burial plans, any insurance policies you have and information about your bank accounts and real estate. 

Why not set a goal to get your paperwork in order for the New Year?  A simple fireproof box from an office supply store (make sure you either leave it unlocked or tell your family where to find the key), along with some folders and labels will make quick work of the job.  You can then rest assured that in the event of an emergency, your family can concentrate on what matters - you, and not be endlessly searching through your clutter. 

Information Needed for MassHealth (Medicaid) Application

If you or a loved one find yourselves needing to apply for Medicaid (also called MassHealth) coverage for a nursing home stay, or think you might have to in the future,  you must be prepared for the extensive amount of information required by MassHealth. The following is a list of documentation you will be asked to provide with the MassHealth Application, and you could be asked for more:

1. Copies of birth certificates, driver's license or citizenship papers.  If you were born in a foreign country, these can be difficult to obtain, and obtaining copies of citizenship papers can take time.
2. Copies of all health insurance cards including Medicare.
3. Copies of at least 3 months of bank statements for all bank accounts, including those you share with another person, and accounts which have been closed in the last 3 years.  This means checking, savings, money market, CDs, and passbook accounts.  You will also need to provide an explanation of all withdrawals over $500.00 (and sometimes lower amounts).   You may also be asked for records of where certain deposits came from. 
4. Proof of all income.
5. Copies of the first page of all life-insurance policies, and a letter from the insurance company regarding the cash value of certain policies.
6. Proof of value of stocks, savings bonds, mutual funds.
7. Copies of annuity contracts.
8. Copies of deeds, current tax bills and amounts owed on all real property that you have an interest in - whether it it your principal residence, a vacation home, or a life estate that you hold in certain property. 
9. Copies of the registration for each vehicle, proof of outstanding loans and the current value.
10. Copies of funeral trusts, burial accounts or prepaid funerals.
11. Copies of any trusts of which you are the grantor, trustee or beneficiary, and documents showing financial activity of the trust.
12. Copies of proof of your at-home spouse's living expenses.
13. Documentation and explanation of any transfers you made in the last 36 months of any funds or property.
14. The last two years of tax returns.
15. Clinical information on the applicant, which must be sent in by the facility. 

After the application is filed, there will be a request for more information mailed to you which will often require further explanation of certain things like deposits for withdrawals, proof of certain transactions,  and updated statements for all accounts.  You will have a limited amount of time to get this additional information to MassHealth, and it must be received by MassHealth by the date indicated or it could impact your eligibility.   

It's a good idea to keep your records up to date, and not discard any old passbooks from closed accounts, or bank statements.  Even if you don't need assistance now, you may in the future, and it will save time if you have easy access to your records.  It will also save your family time if they have to take over management of your assets at some point in the future or apply for Medicaid on your behalf.

I provide assistance in preparing and filing MassHealth Applications.  Please call me to set up a consultation if you need assistance with this process, or if you think you or a loved on may need to file a MassHealth Application in the future. 

Important Coversations to Have with Loved Ones

With the holiday seasons coming up, many people will be traveling home to see parents or aunts and uncles. At this time, you may notice that things have changed since you last saw them.  While it can be difficult to talk about changes, and to see them in yourselves and your loved ones, it's important to realistically assess the situation. 

Some things to talk to aging relative about (or to check-in with yourself about)

• are medications up to date, and in clearly labeled bottles?
• where are important documents like powers of attorney, health care proxies, financial information and computer passwords kept? Have they been updated recently?
• have they (0r you) been to the doctor for a complete physical within the last year?
• check to see if stairs and decks are in good condition, doorways are well lit, that there's nothing that could be tripped over.
• do shower rails or raised toilet seats need to be installed?
• is the food in the refrigerator out of date or spoiled?
• are they (or you) able to get out and do things they still enjoy?

You don't have to have a formal sit down to check in on these things. Just keep your eyes and ears open and don't be a afraid to speak up whether you are the adult child noticing things are changing, or you are the parent who is in need of some assistance.

If you find that you or your relatives are in need of legal assistance, call me at 781-749-2284.  If you are in need of other assistance check out the links to the right under "Resources." 

Free Alzheimer's Coaching Services

Part of the difficulty of having a loved one with Alzheimer's is adapting your own actions and expectations to the changing behavior of the person with Alzheimer's.  A coach can help you with that.

Thanks to funding from a Title IIIE Older Americans Act Grant, Alzheimer Coaching Services is able to offer up to three in home coaching visits free of charge.  These visits are available in Braintree, Cohasset, Hingham, Holbrook, Hull, Milton, Norwell, Quincy, Randolph, Weymouth and Scituate.

There are no income or age restrictions for this service, and no referral is required.

Coaching can help you:

• Understand the disease or condition causing the memory loss
• Understand the behaviors cause by the disease/condition.
• Learn how to respond to behaviors in a way that values the person and restores meaning and purpose to life.
• Learn how to maintain and enrich family relationships throughout the disesase.
• Learn about resources to ease care partnering. 

For information and to sign up, contact Beverly Moore at 617-233-1145. 

Planning for the holidays when a loved one has Alzheimer's

The holiday season is coming upon us (or is already upon us if you count the Red Sox being in the World Series a holiday).  If you have a loved one with Alzheimer's or other memory issue, some traditions may need to change in order to make things easier (and safer) on yourself and your loved one. 

If you are caring for a loved one at home, they can often still assist with the cooking and baking, with some adjustments.  Instead of expecting them to remember the recipes or help at the stove, give them a distinct direction such as chopping the carrots, or measuring the nuts, or dropping cookies onto a tray.   People with Alzheimer's often have trouble initiating an action, but can carry it out if prompted.  This allows them to remain involved.

Try to keep the decorations at a minimum.  Flashing lights and lots of clutter can be confusing to people with Alzheimer's.  Also try to keep the gatherings to a small size, and don't have too much background noise like music or TV, which can be disorienting. 

If your loved one is in an assisted living or nursing facility, consider holding a small celebration there instead of bringing your loved one home, if her doctors think a visit home might be too overwhelming.  And rather than having a lot of people show up at once, consider having just a couple of people at a time, and stopping if your loved one seems to be getting too tired or agitated.

And don't forget to take care of yourself. If you are the primary care giver of a relative with memory loss and you usually host Thanksgiving or your family expects you to go all out for New Years but you just don't have the energy - feel free to just say "no."  Ask them to help out before they ask you to play hostess (in addition to your role as nurse, companion, taxi driver, medication dispenser, appointment scheduler, personal care giver, etc.) 

Make sure you are getting enough exercise, enough rest and enough time for yourself and your other priorities.  Take advantage of respite care or day care programs in your area, and think about attending a local care giver support group.

There is a care giver event at Sunrise in Plymouth on Thursday November 1, 2007. The event starts at 5:30 and goes until 8:30.   There will be dinner and entertainment and the feature speaker will talk about  Emotional Freedom Technique, Guided Imagery and there will be reiki demonstrations.  To attend, you should RSVP at 508-584-1561 x272,   

Source: CNN Health Library

When Do you Buckle Your Seat-Belt?

Do you buckle your seat belt when you get in the car?  It's easy, doesn't take much time, and you know you'll be protected in the event of an accident. 

Do you figure that since things are fine now, you'll wait to fasten your seat belt until you feel the car start spinning out of control? Unless you have the reflexes of Superman, you probably won't have enough time. 

Or do you just never buckle your seat belt and figure that your family and other professionals can handle things in the event of an accident, because you are just too busy to do it now. 

What does this have to do with estate planning? Well, other than the fact that you hopefully have your plan in place in the event of an accident, it seems that my clients fall into one of these categories when it comes to planning for the future.

There are those who want to be prepared, and who get their plan done in a few visits.  They don't have to worry about what will happen to them or their loved ones in the event of a crisis.  They have had time to carefully think through their decisions, and make sure everything is just how they want it.  They are calm when they come to see me, and relieved when they leave.   They have their seat belts securely fastened and can enjoy the scenery. 

Then there are those who put off planning until it is almost too late.  They are leaving the country in 3 days and only have time to do a Wills, Powers of Attorney and Health Care Proxies and not the Trust and other planning that they wanted to do.  Or their mental capacity is slipping and the time they have to plan, before someone else needs to handle their affairs, is very limited.  What they have is better than nothing, but it will leave some complications for their loved ones to deal with in the event of their death or incapacity.   The expenses are higher, the risk of running out of time is greater.  They are stressed out when they come to see me, but mostly relieved when they are done. 

Then there are those who make no plan.  These are the saddest cases.  There has been a crisis in the family and instead of being able to concentrate on their parents or other loved ones, the children are visiting the attorney to try to sort out the legal mess.  They are trying to figure out what their parents have so that they can pay for their care, or apply for Medicaid for them.  Maybe they are having to go to Court to get a guardianship over their parents so that they can sell the house or handle the finances.  Maybe there are siblings who don't get along and can't agree over who should do what, and it's back to Court to let the judge decide.  Things that could have been decided when the parents were competent, are now being fought over.   Adult children who have their own lives and families to think about are having to jump through ten hoops to accomplish the same thing that would have been completed with a simple task had their mother or father or aunt or uncle executed a Power of Attorney.

These clients are sad, stressed, worried, angry and scared when the come to see me.  As we work through the issues at office visits, home and hospital visits, trips to Court and telephone calls the burden starts to lift, but the feeling of relief does not come as soon or in the same way as if there had been a plan put in place when there was time.

If you are ready to stop thinking about it and start planning, please call me at 781-749-2284.

Paperless Records can Leave Heirs in the Dark

This article from the Wall Street Journal, Paperless World Can Leave Heirs in the Dark, outlines the dangers of keeping all your records on your computer.  With online bank accounts becoming more common, there might not be paper statements of your accounts, and if you don't leave a record of them, your heirs might never know you had them.  And it's not just your death that would require them to know what you have, if you become incapacitated and funds are necessary to pay for your care - you'll want your loved ones to know where to find those funds.

The article outlines the information you should have in case of an emergency.  It doesn't need to be posted on your refrigerator, but it should be kept in a safe place in your house, and you should let someone you trust know where to find it.  The information includes:

• details about your assets, what they are, how they are held, where to find the account information.  If you have out-of-state real estate or other assets, be sure to include these.
• the names of your advisers - your financial planner, your accountant, your attorney, the guardian you've chosen for your minor children.
• information about any safe deposit boxes you might have.
• where your estate planning documents are located: your Health Care Proxy, Durable Power of Attorney, Will, Trust and deeds.
• insurance policies: long term care, life and health.

A wonderful way to keep track of these things is with the What If... Workbook, created by Gwen Morgan.  The workbook provides a place for you to document:

   

• financial information
• personal contacts
• location of important documents
• whether you want burial vs. cremation
• how to care for pets
• family medical history
• special gifts you'd like to leave for loved ones
• and even space for you to start documenting the type of legacy (other than financial) that you would like to leave behind for your loved ones. 

To help you get started, and to provide the often necessary accountability to complete the workbook, Gwen holds small group sessions or individual meetings.

Click here to receive the Workbook at a special rate, just for readers of this website.  You could get them for you and your family members for the holidays, as a good way to start the discussion about planning and  your wishes for the future. 

   

Quality Rating Tool for Massachusetts Nursing Homes

Choosing a nursing home for yourself or a loved one, either for a short-term stay after a hospital visit, or for a more permanent placement can be overwhelming.  You can talk to your neighbors, get recommendations from doctors and look on-line for facilities in your area. But how do find out about the quality of the facility?

The Massachusetts Department of Public Health provides a Quality Rating Tool for Nursing Homes for the public.  This Quality Rating Tools provides information in 5 areas which is gathered by the DPH during surprise visits to facilities: Administration, Nursing, Residents Rights, Kitchen/Food Services and Environment.  (I have put this link in the sidebar under "Resources" so you can easily find it again.)

You can search for nursing homes here and get information on choosing a nursing home.   The site also provides suggested topics and questions to ask when evaluating a nursing home. 

Tools like these are important because you can't always judge a facility just by the way it looks.  However, if the facility does not look or smell clean, and if the residents seem poorly cared for that is probably an indication that you want to look somewhere else. 

If you need help evaluating a nursing home either because you aren't sure what to look for, or if you live outside of Massachusetts and you are trying to find placement for a relative here, there are geriatric care managers and other professionals who can assist you in the evaluation of the facilities, so you can make the right choice for yourself and your loved one.

Another Reason to Plan Ahead

Sometimes, the first time I meet a client is in the nursing home or hospital following a crisis.  The person's spouse or child or friend has called me to meet with their loved one and draw up the necessary legal documents - a health care proxy, power of attorney, will or trust, maybe a Medicaid Application- while the client is still capable of making decisions and signing documents.   Visits like these are quite common for the elder law attorney, but they are not common for the client.  The client is already in a vulnerable situation, sick or injured, and now there are legal matters to be dealt with because no plan was put into place before. 

I do my best to make my clients feel at ease, shooing the family out of the room so I can speak to my client alone and find out how they feel, what they want, and what they don't want.  Very often the information that the family member gave me over telephone differs from the account of my client, so I want to make sure I get the whole story.  I also assure the client that I am their attorney, not their child's (even if their child is paying my bill) and not "the family's" and I inform the other family members of this as well, so there is no question where my duty and loyalty lie. 

Making decisions about who should serve as your power of attorney, or how to divide your estate should ideally be made after careful thought and not in a moment of crisis.  By making a commitment to yourself that you will meet with an attorney and get your planning done, you are giving yourself this time to carefully think through your choices, and you can rest assured that when a crisis hits, the only people rushing to your bedside are your family and friends - not your lawyer!

Jennifer Sawday of Tredway, Lumsdaine & Doyle, LLP in California, addresses the same issues in her recent post on nursing home visits.

Moving Parent to a Different State - Make Sure to Review Estate Documents

If your parent is moving to a different state, or you are moving your parent here from out of state, one of the first things you should do is have an elder law attorney review their Durable Power of Attorney, Health Care Proxy and Will or Trust to make sure they conform to the requirements of the new state, and take into account the changes that might be down the road.  This is especially important if you moved your parents here because of declining health.

Delaying getting these documents in place can cause significant problems down the road if your parent's health declines to the point where they are no longer capable of signing new documents, or if they need nursing home care and the appropriate plans have not been made. 

The elder law attorney can also serve as a good resource if you need  recommendations for home care for your parents, adult day programs, assisted living facilities or other services. 

Living With Alzheimer's Disease

The New York Times recently had an article about living with Alzheimer's Disease after diagnosis but while the person is still able to carry on conversations, and go about their daily life, although with small but growing differences.   

One important step to take during this time, is to make sure that you have you Health Care Proxy, Living Will, Durable Power of Attorney and Will or Trust set up.  You should also have conversations with your loved ones about your wishes. 

You and your family may also wish to attend a support group for people with early stage Alzheimer's and their care givers.  Some of the support groups are listed here: http://www.alzmass.org/supportgroupleaders.htm  and others can be found here:
http://www.caregiver.com/regionalresources/states/MA/support/plymouth.htm

So, Your Kids Want You to See an Elder Law Attorney?

Many of my clients come to me by way of their children. Their adult children start worrying about their parents “getting their affairs in order” and they call or email me, maybe they even make the appointment.  You may find this helpful, you may find this meddlesome, or somewhere in between.  But they are just looking out for you, as you have always done for them. 

Some important things to keep in mind.

•    There’s more to getting your affairs in order than deciding who gets your stuff when you die. The more important consideration is figuring out who’s going to help you manage things while you are still alive, but need assistance or are unable to act on your own behalf.  Then you can figure out who’s going to get (or not get) your stuff when you die.

•    If we meet, I can review your current situation, answer all of your questions, give you information about what steps I recommend for you, what everything means, what the alternatives are and what the cost will be.  How we proceed is completely up to you. 

•    I can come to your house.  Many of my clients have difficulty getting out, or maybe they are just more comfortable meeting at home, since that is where the big box of papers is. Whatever the reason, if you need a home visit, just let me know.

•    If you hire me, anything you tell me remains confidential (even from your children, even if they made the appointment, even if they are paying my bill.) I will be your attorney, not your children’s.

•    Drawing up your Will, Trust or Durable Power of Attorney can be a relief – you are done with the process, and unless there is a significant change in your circumstances the documents will be good for years to come.  Plus, your kids will stop bugging you about it. 

Old Enough for an Elder Law Attorney?

I often have people ask me, "how old do you have to be to need an elder law attorney?" I usually say that there is no age limit, and if you think you might get old some day, you need an elder law attorney.  I have some clients who are in their 40's, but want to do some long term planning to make sure they will have enough to live on when they retire, and they have questions about long term care insurance and what that pays for.  I have clients in their 50's who are very sick, and at the end of their lives. I have clients in their 60's who are planning for retirement. And I have clients in their 80's and 90's - some of whom are living in a nursing home or assisted living, and others who live at home and are still driving. 

I also have clients who are in their 30's, with young children who have disabilities.  You see, part of elder law is also disability law - helping parents plan for their children's future, and making sure that the resources needed to care for their children, who may never live independently, will be there even after the parents pass away.  Through the drafting of special needs trusts and other instruments, inheritances can provide for the supplemental needs while the medical coverage and payments from government programs are not jeopardized.

So, whether or not you need an elder law attorney is not based on your age, but rather on your circumstances, your children's circumstances and if you plan on getting old some day.

More on Caregiving from a Distance

Has your mom taken her medication today? Did the nurse show up at your dad's on time? Did your aunt fall?  If you live next door or down the street, you can easily find this information. But if you are at the other end of the state or across the country it's more difficult to know without making 37 phone calls a day.

A recent article in the New York Times offers some suggestions of products and services to help keep an eye on your loved ones even though you are far away.

Some of the products are computerized pill dispensers, motion detectors to tell if someone hasn't gotten out of bed, or if the outside door has opened, and even electronic questionnaires which ask the elder how they are feeling  that day and record their blood pressure and weight.  This information can be monitored by the children, and by nurses who can be on alert for changes in behavior or health status.

The article also talks about how geriatric care managers can be a great resource for helping with some of the tasks of taking care aging parents. 

Free Teleseminar on Communicating Across Generations

Age Wise Living, a generational coaching company has two recorded seminars on their website called "You're Not Hearing What I'm Saying" which deal with communicating across the generational divide and communicating through the emotion. 

This coaching can be useful when trying to figure out how to broach difficult subjects with your aging parents - from helping them keep track of their finances and medical records, to suggesting they move into an assisted living facility. 

The company is based in New York but the coaching can be done over the phone, and the teleseminars can be attended from anywhere in the country.

Guardianship - Authority and Responsibility of the Guardian

In general, the guardian has complete control over the financial, medical and personal decisions of the ward. This includes where the ward will live, how the ward's money is spent, and making routine medical decisions for the ward. A ward has no more authority to make these decisions for themselves. 

The guardian also has the responsibility to account for all of the ward's income and expenses. In the beginning of the guardianship, the guardian files an inventory with the Court of all the wards assets, and after that the guardian files an annual accounting with the Court showing how much money came in, where it came from and where it went. At the end of the guardianship, the guardian must file a final accounting with the Court.

Being a guardian is  a big responsibility, and not one to be taken lightly. If there is time to plan before a crisis, you can save so much time and money, and prevent a lot of family conflict, by having some straight forward documents executed that spell out your wishes.  If you think your aging parent needs a guardianship, your lawyer can work with you to accomplish that. What plan do you have in place in the event of your own incapacity?