Reduced brain function may be indicative of dementia and can result in poor financial decisions. If you are age 50 or older, easy access to your financial assets like stocks and bonds, checking and savings accounts, money market accounts, and other assets can lead to loss of these funds if an unauthorized person gains access to them, or if they are mismanaged. Family members are often unaware their loved one needs help before the unintentionally mismanaged assets, now gone, bring about devastating consequences for both the person living with dementia as well as their family. The Alzheimer’s Association reports that from diagnosis to death, Alzheimer’s disease (AD) care will cost an average of $424,000 per individual, and 70 percent of that cost is out-of-pocket expenses to the family system of the affected loved one.

It is common to have AD symptoms long before an official medical diagnosis. Difficulty managing money is one of the first signs of Alzheimer’s disease. To spot problems early, look for the warning signs of ill-advised financial transactions through oversight. Unopened or unpaid household bills, overspending on credit cards and making just minimum payments on the debt, falling prey to frauds and scams, and not paying attention to more significant investments that constitute the bulk of a person’s wealth are all indicators of mental decline. As a whole, the situation is very concerning as the poor financial outcomes that asset spending brings about are also happening at a time when expenditures to pay for increasing caregiving needs for dementia become extensive.

Projections are that by 2050 , the prevalence of Alzheimer’s will triple in the US. Those individuals suffering from AD who do not have personal or family financial support will most likely become a beneficiary of the US Medicaid program. Total Medicaid spending in the fiscal year 2018 was 593 billion dollars. The federal government paid 62.5 percent, and the states paid 37.5 percent of the budget. Research statistics data from the Centers for Medicare and Medicaid Services ( CMS ) are projecting that, under current law, from 2018 – 2027 national health spending will be nearly 6 trillion dollars with a substantial portion of that going to underfunded seniors living with dementia.

One of the best ways to protect your finances from the unintended consequence of mismanagement due to cognitive impairment is to accept that this problem exists, and there is a need to put systems in place for financial oversight long before mental decline sets it. Meet with an elder law attorney to put the legal documents in place, allowing for the power of attorney, financial control, medical power of attorney, as well as a dementia directive, as early as your 50 ^th
decade. You may also allow a trusted adult family member, friend, or financial advisor to review your monthly spending habits and bill paying.  If there is a noted error in your financial judgment or a lapse in your standard financial operating procedures, they can call it to your attention well before all of your money is gone.

Alzheimer’s Association

According to the Alzheimer’s Association, only 16 percent of seniors regularly receive cognitive assessments in their annual medical exams. Keep yourself from becoming vulnerable by protecting your liquid assets and your net worth with provisions for financial oversight. The safety net you put in place today can protect your finances and even be an indicator that you require testing for cognitive problems. Currently, there is no solution to the problem of Alzheimer’s disease and other forms of dementia, however; there are systems you can put in place to protect yourself financially. It is best to prepare for the possibility that you may develop cognitive problems and have protections in place rather than unwittingly put yourself in financial jeopardy. Please contact us at 973-226-0050 and schedule a free consultation to discuss your legal matters.

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Symptoms such as memory issues should never be dismissed.  There are many resources available through a simple internet search, and professional associations that provide education and guidance through a maze of questions you may have regarding how to approach someone you suspect may be experiencing memory loss, or how to ask for help if that someone is you.  There is even a free online memory test you can take in the privacy of your own home.  But, did you also know that through many years of research, there is a link between diet, exercise, and Alzheimer’s disease?  It is never too late to start making proactive changes to your diet and lifestyle now to help lessen the risk of developing Alzheimer’s.  Even if you have been given an Alzheimer’s diagnosis, a study published in late October by Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, noted that it is possible to improve cognition with modifications to diet, exercise, and sleep.

This study, summarized by the Wall Street Journal, acknowledged that the methods tested would not prevent Alzheimer’s, but through their findings, healthy individuals, as well as those with mild cognitive impairment who followed personalized recommendations over the 18 months of the study, did show improvement in cognition.  The study included 157 participants who varied in age from 25 to 86 and who all had a family history of Alzheimer’s.  A small group in the study had mild cognitive impairment and were asked, after going through certain measurements and many tests, such as blood, genetic and cognitive function, to adhere to a little over 20 recommendations of food selection, daily vitamins, and personalized exercise plans.  Those who followed at least 60% of the recommendations showed significant improvement from their baseline in cognitive testing.  Participants who followed less than sixty percent of the recommendations experienced a cognitive decline similar to the control groups.  Cognitive decline is a precursor to memory problems.

The larger group of participants studied were healthy individuals who had no memory loss though some in this group had less than ideal cognitive testing.  After 18 months of following recommendations, all participants showed improvement in cognitive testing compared to their baselines and the control group, even if all the recommendations were not followed.  Results showed that younger participants did better in general than those who were over 60 years old.  Some of the measurements that went into developing a personalized plan included body fat and muscle mass, since the memory center of the brain, the hippocampus, is known to shrink as belly fat increases.  Because cholesterol, blood sugar levels, and blood pressure are linked to an increased risk of Alzheimer’s, these values were monitored throughout the study.

In reviewing sites such as the Alzheimer’s Foundation of America, a free memory test was found that will test how quickly and accurately you recognize repeated images during a timed test.  On the Alzheimer’s Association website, one can find many recommendations for diet and lifestyle modification to follow, which are also listed in the Wall Street Journal article.  Some examples of diet modification include limiting red meat, adding foods to your diet that are high in omega 3’s, such as a certain type of fish, and foods high in antioxidants, such as strawberries and blueberries.  A mix of aerobic exercise and resistance training/weight lifting was recommended for good brain and heart health.  Hours of sleep and quality of sleep were other factors that can affect mood and memory.  It is generally recommended that a person try to get at least 7.5 hours of sleep each night and reduce caffeine consumption and ‘screen time’ well before bedtime to improve the quality of sleep.  As for general brain health, meditation for stress reduction and learning a new skill, such as a foreign language were recommendations to keep you mentally sharp.  There are many other ways to start now to improve or maintain your brain health with numerous online resources to help.  If you have a family history of Alzheimer’s, don’t let another day go by worrying about what may happen.  Educate yourself and take steps now that could minimize your risk of developing Alzheimer’s disease.  Please contact us at 973-226-0050 and schedule a free consultation to discuss your legal matters.

Sources:  https://www.wsj.com/article/the-link-between-diet-exercise-and-alzheimers

Alzheimer’s Foundation of America at https://www.Alzfdn.org

Alzheimer’s Association at https://www.alz.org

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Assisted living is changing for seniors with new advancements in medicine, technology, and socioeconomics. The rising cost of assisted living means that some families are looking for new alternatives, while those who consider traditional assisted living have new options to consider. Alternatives to assisted living include multigenerational housing and in-home care. As these options become more popular due to the rising costs associated with other, traditional options, the home health care industry will boom in response; the Bureau of Labor Statistics predicts job growth of 70% in the next ten years for personal care aides and home health care professionals. Technology designed to assist in senior care will likewise play a role in alternatives to assisted living, from computer systems tracking medicine intake and remotes for windows, lights, and thermostats to reminiscence therapy and memory care to assist those suffering from dementia. And not only will technology designed for individual users continue to develop, so will platforms for home care agencies and other professionals engaged in the long-term care process.

Meanwhile, the nursing home model of care will continue to decline, while other forms of senior living will take their place. These will include cultural- and lifestyle-based communities, green senior housing like LEED-certified homes and communities, senior-friendly neighborhoods in city centers, and senior co-housing with shared spaces and shared duties. Assisted communities are likely going to emphasize meaningful socialization and recreational activities, while the buildings themselves are likely going to include amenities that remind Boomers of home and improve their independence, such as kitchenettes. Certain design trends may arise for enriched living experience and wellness enhancement, from restaurant-style dining to wellness centers.

These changes are a part of the trend of a widening gap between the increasingly pricey assisted living options, and what people can pay for their long-term care. As life expectancy lengthens and the quality (and therefore price) of assisted living rises, many will find the costs post-retirement to be beyond their means. That is one of many reasons why it is so important to plan in advance! There may be government programs available that can help with the costs of long-term care. Please contact us at 973-226-0050 and schedule a free consultation to discuss your legal matters.

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I have to decide between my two children, who should be my power of attorney when I need help communicating with doctors and handling my financial matters. Can’t I just name them both?

You can, but please don’t. You risk creating conflict or chaos if you name more than one child to serve simultaneously. Instead, pick one child at a time.

Think about which child is better suited to the responsibilities. For health care decision-making, your agent should ideally be calm in stressful situations and be able to advocate courteously but firmly with doctors and nurses for the treatment you want. For financial management, your agent should be organized, careful, and good with numbers.

Your health care agent should live nearby, but if the child who lives locally is terrified of things like needles and blood, the other, sturdier child might be a better choice. On the other hand, who can manage finances from afar, but if that child didn’t cope with a checkbook, the other would be better. So if one child is good in one area and the other child is good in the other, the dilemma is solved. You can name the number-proficient daughter for the financial side and your son for the health care. Or, if just one child is altogether more capable than the other, name that one child for both health care and financial powers.

But you do not want to create a situation where children who share the job start arguing about what health care you would want. Busy physicians have little time or patience to mediate fights like that. Likewise, you do not want your children quarreling about how you would want your money to be spent.

That’s why it’s best to give one child decision-making authority at a time. You can name the other as a backup in case the first child becomes unavailable, but naming both to serve simultaneously is generally not a good idea. Please contact us at 973-226-0050 and schedule a free consultation to discuss your legal matters.

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When caring for an aging family member, a family caregiving meeting can be a great way to coordinate communications and activities. These meetings are beneficial for helping to keep all family members abreast of decisions that need to be made, changes in diagnosis or prognosis, and help to ensure that all family members feel that they have a voice. Family meetings can also help to keep caregiving responsibilities from falling solely on the shoulders of one family member. In addition, family caregiving meetings can foster cooperation among family members and lessen the stress associated with caring for an aging loved one.

Who should attend a family caregiving meeting?

There are a number of people who should be included in a family caregiving meeting. First and foremost, it is important to include the aging loved one in the meeting whenever possible. This helps the aging loved one to feel that they are being heard and that their opinions and thoughts are being considered. If a spouse is living, the spouse should be included, as well as any children and possibly siblings of the aging person. Some families may choose to include other family members, but this really varies from one family to another. Anyone else involved in care for the person should also be there. This could include paid caregivers, family friends, or neighbors. Depending on family dynamics, a facilitator can be helpful in running the meeting.

When should a family have a caregiving meeting?

First, it is important to note that family caregiving meetings are not a one-and-done event. They must occur on a regular basis. The first family meeting can occur before an aging loved one actually needs care. This can give the person who may eventually need care more say in their future care, but oftentimes this does not occur. Most families find that the initial meeting needs to occur when an aging loved when begins to show signs of needing care or when a diagnosis is given that determines care will soon be needed. In addition, meetings should be scheduled regularly to discuss changes in diagnosis, prognosis, or general needs of the loved one or the caregivers.

How can a family hold a successful caregiving meeting?

The key to having a successful caregiving meeting is cooperation. This doesn’t mean that family members will agree on everything, but it is important that all family members are respectfully heard and considered. Families must be willing to compromise and seek the best plan for their aging loved one. Additionally, a smoothly run meeting should have an agenda and families should try to stay focused on the items included on the agenda. When holding a meeting, always put things in writing and be sure that all those involved get a copy of the important information and everyone’s responsibilities.

What challenges do families face in caregiving meetings?

One of the biggest challenges to family caregiving meetings is the family’s history. All families have their own dynamics that can cause problems in a caregiving meeting. There may be members of the family who are at odds with one another, creating an obstacle to having a successful caregiving meeting. The role that each family member plays can be a challenge. Some members may be overbearing and demand control, while others are peacemakers and do not feel free to share their thoughts. Another challenge is that some family members may be in denial of the severity of an aging loved one’s needs which could make it difficult to get a consensus for care.

Family caregiving meetings are beneficial and necessary when an aging loved one can no longer care for themselves. These meetings can help to divide the responsibilities of caregiving and reduce the stress placed on the family members. It is important that families remember that the meetings are for the care of their loved one and cooperate with one another to help the process to run more smoothly and successfully.

If you have any questions about something you have read or would like additional information, please feel free to contact us at 973-226-0050 and schedule a free consultation to discuss your legal matters.

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You would hope your living will is properly prepared and your resuscitation instructions or DNR (do not resuscitate) are in order. While your wishes in a living will may be appropriately documented, that does not guarantee the instructions will be carried out as you stated. The frightening truth is that mistakes about your end-of-life instructions are made while you are at your most vulnerable. Dr. Monica Williams-Murphy , medical director of advance-care planning and end-of-life education for Huntsville Hospital Health System in Alabama has said, “Unfortunately, misunderstandings involving documents meant to guide end-of-life decision-making are surprisingly common.”

The underlying problem is that doctors and nurses have little if any training at all in understanding and interpreting living wills, DNR orders, and Physician Orders for Life-Sustaining Treatment (POLST) forms. Couple the medical professionals’ lack of training with communication breakdowns in high-stress environments like a hospital emergency ward where life and death decisions are often made within minutes, and you have scenarios that can lead to disastrous consequences.

In some instances, mix-ups in end-of-life document interpretation have seen doctors resuscitate patients that do not wish to be. In other cases, medical personnel may not revive a patient when there is the instruction to do so resulting in their death. Still other cases of “near misses” occur where problems were identified and corrected before there was a chance to cause permanent harm.

There are some frightening worst-case scenarios, yet you are still better off with legal end-of-life documents than without them. It is imperative to understand the differences between them and at what point in your life you may change your choices based on your age or overall health. To understand all of the options available it’s important to meet with trusted counsel for document preparation and to review your documented decisions often as you age. In particular, have discussions with your physician and your appointed medical decision-maker about your end-of-life documents and reiterate what your expectations are. These discussions bring about an understanding of your choices before you may have an unforeseen adverse health event, and provide you with the best advocates while you are unable to speak for yourself.

There are several documents that may be appropriate as part of your overall plan. Each of those is discussed below, and we are available to answer any questions you may have about them.

A living will
is a document that allows you to express your wishes about your end-of-life care. For example, you can document whether you want to be given food and hydration to be kept comfortable, or whether you want to be kept alive by artificial means.

A living will is not a binding medical order and thus will allow medical staff to interpret the document based on the situation at hand. Input from your family and your designated living will appointee are also taken into account in your best decision-making strategy while you are incapacitated. A living will become activated when a person is terminally ill and unconscious or in a permanent vegetative state. Terminal illness is defined as an illness from which a person is not expected to recover even though they are receiving treatment. If your illness can be treated this would be regarded as a critical but not terminal illness and would not activate the terms of your living will.

Do not resuscitate orders ( DNRs
) are binding medical orders that are signed by a physician. This order has a specific application to cardiopulmonary resuscitation (CPR) and directs medical professionals to either administer chest compression techniques or not in the event you stop breathing or your heart stops beating. While your living will may express a preference regarding CPR it is not the same thing as a DNR order. A DNR order is specifically for a person who has gone into cardiac arrest and has no application to other medical assistance such as mechanical ventilation, defibrillation, intubation, medical testing, intravenous antibiotic, or other medical treatments. Unfortunately, many DNR orders are wrongly interpreted by medical professionals to mean not to treat at all.

Physician orders for life-sustaining treatment forms ( POLST forms
) are specific sets of medical orders for a seriously ill or frail patient who may not survive a year. This form must be signed by a physician, physician assistant, or nurse practitioner to be legally binding. The form will vary from state to state and of the three instructive documents the POLST is the most detailed about a patient’s prognosis, goals, and values, as well as the potential benefits and risks various treatment options may bring about.

A power of attorney for a health care decision, sometimes referred to as a health care directive, allows you to name an agent to make decisions for you if you are unable to. Unlike a living will which only covers end-of-life decisions, a power of attorney for health care decisions allows the agent to act at any time that you cannot make decisions for yourself.

We can help you determine which documents best suit your current needs, and help you clearly state your wishes in those documents. Please contact us at 973-226-0050 and schedule a free consultation to discuss your legal matters. We look forward to hearing from you and helping you with these important planning steps.

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When you embark on a second marriage, you should be aware of how this will affect you and your new spouses’ Medicaid benefits. Current costs for long-term care facilities can run between $70,000 – $150,000 annually. Studies show that 70% of Americans will need that kind of care, perhaps for three years or longer.

If one spouse in a marriage becomes ill, the assets of both spouses are, by and large, required to be spent on the ill spouse’s care before Medicaid benefits become available. This could be a big problem, especially if the money that the well spouse had saved for her children’s inheritances goes to pay for the ill new spouse’s care instead.

With careful planning, this need not happen. Financial arrangements can be made to protect the estate of the well spouse and to ensure that the spouse who needs care will be responsible to pay his or her own way.

The benefits rules do provide that the spouse who does not need care yet may keep an allowance of a certain sum for that spouse’s benefit. This is known as the “Community Spouse Resource Allowance” (CSRA). But many find that the CSRA is too small to permit the well spouse to maintain her standard of living, pay for her retirement, and still leave enough for her children to inherit.

Any planning or shifting of assets must be done very carefully and only after consulting with experienced professionals like us. The Medicaid rules heavily penalize transfers of assets made without receiving value in return. Gifts, in other words.

Assets can be protected, though, by a number of strategies that are permitted by the Medicaid rules. Some or all of the well spouse’s assets could buy a Medicaid-compliant annuity. This would provide an income stream for the well spouse, without the assets being otherwise deemed available to pay for the ill spouse’s care.

In turn, the assets of the spouse needing care could be transferred to people whom that person especially trusts: a trustee, or an agent for financial affairs, or a family member or beneficiary. That kind of transfer would be subject to penalty, but planned-for, using the strategies permitted under the Medicaid rules. Some relief from penalties can be achieved using existing Medicaid rules.

There are also insurance products available to provide for long-term care coverage, which any newly married couple – or everybody, really – ought to consider. Find advice on the various insurance options here.

The best strategy of all, though, is to consult an experienced elder law attorney as soon as possible. The sooner the consult, the more options are available and the more money can be saved.

When we embark on the adventure of marriage, nobody can tell what the future has in store. But with thoughtful planning, assisted by qualified elder law attorneys like us, you can relax and let the nuptial celebrations begin. If you’d like to discuss ways we can help, please  contact  our office at 973-226-0050.

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A healthy lifestyle can increase your longevity significantly. Your lifespan can be increased by as much as 14 years for a woman and 12.2 years for a man according to the American Heart Association’s journal Circulation study. The United States is one of the wealthiest countries in the world, but according to the World Health Organization, it ranks about 53rd in life expectancy from birth compared to other developed nations, according to 2015 data.

What are these five lifestyle habits? The first is leading a non-smoking life and the second is not subjecting yourself to other people’s second-hand smoke. If you have ever been a smoker, find a way to quit. Try hypnotherapy, patches, gum – whatever it takes – but figure out a way to stop smoking. Breath is life, and without a healthy respiratory system, you are shortening your lifespan. If you do not smoke now or never have, that is great! Stay on that path and do not subject yourself to other people’s smoking.

Exercising for 30 minutes each day is imperative for longevity and coincides with the third thing you can do to extend your lifespan.  Maintain a healthy body mass index (BMI). The best and easiest daily exercise is to walk. If you are currently out of shape and 30 minutes a day seems unachievable, then begin with 10 minutes. Make a plan and increase your time to 20 minutes as you become more physically able to do so. By the time you are ready for 30 minutes of daily exercising, be sure that your pace is moderate to vigorous. Walk every day in the morning at a set time and make it your routine. Walking will help you lose weight, gain muscle, and reduce your body mass index.

The fourth and fifth things to do are eat a healthy diet and consume only moderate amounts of alcohol. Healthier foods are generally found on the outskirts of your supermarket and include fresh fruits and vegetables, dairy and eggs, as well as lean meats. The inside aisles of a supermarket are packed with food products, not real food. Much of this food is so over-processed and chemical-laden that it is not healthy to eat. Consuming moderate levels of alcohol is defined as one drink a day for women and two for men. Adopting a new healthier lifestyle can include days where you choose not to have an alcoholic beverage. If you have fallen into excessive drinking patterns, make changes today. The liver is a restorative organ and can heal itself if excessive damage has not been done.

If these five healthy life choices are something you already do or are willing to implement in your lifestyle and you do add 12 or 14 years to your life expectancy, what if you don’t have the money to survive those additional years? The Social Security Administration says that about one in four Americans 65 or older today will live past age 90 and one out of ten will live past 95. Where will the money come from if you live another decade or longer? Health care costs are skyrocketing and assisted living facilities are expensive. Unless you are already financially independent, 60 is the new 50 and retirement may not come as soon to you. You can make adjustments to your life today that will help you to become more financially fit just as you can make changes to become more physically fit and extend your lifespan.

Saving money aggressively and developing the habit of spending less is possibly the single best way to stretch your retirement assets. Learn to live below your means. Beyond being thrifty, change your trajectory regarding your investment strategy. Talk to a trusted financial advisor to see if you need to shift any investment strategies.

While longevity can only be estimated and everyone will have their own life expectancy experience, increased awareness of healthy lifestyle choices is changing the way seniors are approaching aging. Your longer lifespan will require adequate funding which can be achieved by frugal spending habits, possibly delaying your retirement, and thinking differently about conventional investment strategies in senior years. Getting sound and trusted advice about longevity and your financial aging strategy can bring you peace of mind as well as financial security. If you’d like to discuss ways we can help, please  contact  our office at 973-226-0050.

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