Category Archives: Alzheimer’s Care

Picking a Strategy – In Order to Protect Against the Costs of Long-Term Care

Installment 8 of 10

In Our Series:

“Long Term Care Costs for the Middle Class: 10 Steps to Asset Protection through Medicaid in Illinois, for Middle Class Seniors and Boomers”

Picking a strategy is not something one can easily do on their own. Selecting strategies in order to minimize the cost of long-term care requires an understanding of both the requirements of sophisticated estate planning and access to governmental benefits.

However in order to provide an overview of how strategies are selected, you must understand that strategies will vary depending on whether or not the senior is in one of the following phases:

  1. Preplanning Mode
  2. Wait-and-See Mode
  3. Crisis Mode

Preplanning can be done when there is no threat of a long-term care stay that is imminent.  Wait-and-see mode exists when there is a diagnosis but the senior will not be leaving home in the near term, and crisis mode is when the senior is in a nursing home or soon to be in a nursing home.

In preplanning, because time is on our side, we can engage in such strategies as looking for long-term care insurance to cover all, or part of, the cost of long-term care. Perhaps a long-term irrevocable trust that will put assets outside of the estate may be useful. Sometimes purchasing certain types of assets that are exempt non-countable is advisable.

In wait-and-see mode, because there is often a diagnosis, good powers of attorney for health and property and the preparation of wills and trusts that bypass the ill senior are essential. Also, changing the beneficiary designations on various assets so that they do not pass automatically on the death of the healthy spouse to the ill spouse is another consideration. It may be even possible, at this point, for the healthy spouse to obtain long-term care insurance.

In a crisis mode, it is essential that the ill senior be made eligible for Medicaid in order to cut the costs of long-term care. The only way a senior can be eligible is to be an asset level of no more than $2000, exempting non-countable assets like prepaid burial arrangements, personal effects, very small life insurance policies, and limited other resources. All other assets must be converted to a non-countable status. This is not always possible, so quite often it is necessary in crisis mode to transfer assets from the senior. You must understand that this will result in a period of ineligibility for the senior. However, with the assistance of competent elder law counsel who specializes in Medicaid asset protection planning, it is possible to transfer assets while at the same time retaining enough assets in a form that will allow the penalty period to be paid down and the transferred assets to be protected.

Selecting a strategy for asset protection planning in long-term care is not an easy matter, but with the proper planning our office does it all the time. It is essential that Medicaid rules be followed strictly. This sounds like a heavy task, and it is, but the alternative of not selecting a strategy to protect assets from long-term care costs results in the impoverishment of seniors at a time in their life when they should not be destitute for such simple quality of life items, like hearing aids, eyeglasses, podiatry care, medications and certain therapies not covered by Medicaid.

Plan ahead, it’s your quality of life that is at stake in your senior years.

Creating a Blueprint – For Asset Protection from Long Term Care

Installment 5 of 10

In Our Series:

“Long Term Care Costs for the Middle Class: 10 Steps to Asset Protection through Medicaid in Illinois, for Middle Class Seniors and Boomers”

 Why create a Blueprint (Medicaid asset protection letter) for your asset protection planning?

Just like in building a home, you don’t hire a contractor to start slapping bricks together until you have decided on the number of rooms, type of rooms, location of the rooms, etc.

Likewise, many are quick to suggest creating a will, trust, powers of attorney, perhaps an irrevocable trust, or an annuity, etc.

This can be very costly and foolish. How can you create a plan consisting of various documents that are supposed to protect you without a design in mind? Mindlessly putting together layers of documents accomplishes nothing except large bills.

Before our clients create any legal documents we suggest to them that they do a blueprint, which is in effect a Medicaid asset protection letter. In that letter we outline the following:

  1. Planning strategies that can be done in preplanning mode, or crisis mode, depending on where you are in the long term care journey.
  2. Planning strategies available for single individuals, or the community spouse when an ill spouse is going into a nursing home.
  3. An outline of the current status of the law as it relates to Medicaid eligibility.
  4. Finally, planning recommendations that are broken down into things that you must do immediately and things that you may be able to defer until later.

Below are some examples of our final recommendations in our Blueprint:

Immediate Action

  • Creation of powers of attorney for healthcare and powers of attorney for property. However, our powers of attorney have many more powers and are more substantial than the average power of attorney that most people have.
  • Creating wills and trusts that have special needs trusts built into them for a surviving spouse or a minor or adult disabled child. This takes advantage of certain relief that Congress intentionally placed into the Medicaid laws.

Deferred Actions

  • The purchase of a Medicaid compliant annuity or a Medicaid compliant promissory note.
  • Our office files a Medicaid application.

Conclusion

As you can see from the above, there are strategies that we rely on that result in the savings of a lot of assets for middle class seniors and boomers who are going into long-term care. However, because these measures are complicated, it makes sense to have a blueprint laid out describing them in detail using your asset and income numbers before actually engaging in these actions.

We want our clients to go into strategies and solutions with eyes wide open. The only way that can be accomplished in most cases is to create blueprint that lays out all of the Medicaid asset protection planning strategies in the form of a letter that the client can study, and ask questions about. We usually resolve all of the questions the client may have at our subsequent “Design Meeting.”

Make sure you look before you leap.

Guardianship – The Last Resort

Installment 3 of 10

In Our Series: “Long Term Care Costs for the Middle Class: 10 Steps to Asset Protection Through Medicaid in Illinois, for Middle Class Seniors and Boomers”

Many people ask, “What is guardianship in the state of Illinois?” Simply put, guardianship is the process of applying to a court to be able to legally assist an individual over the age of 18, if the person has a disability. A disabled person, for purposes of guardianship laws, is someone who cannot make basic life decisions or manage their own property or money.

Due to the participation of the court system and the attorneys’ fees involved, this process is an expensive proposition and should be avoided at all costs, if possible. Guardianship is avoided by using other methods of surrogate decision making for disabled individuals such as powers of attorney, trusts, the Health Care Surrogate Act, and other related surrogate roles. Unfortunately, many people wait too long and do not have the authority to execute powers of attorney, trusts, etc. because they are incapacitated. In such cases, we are grateful that the guardianship court exists.

Guardianship is achieved to the following general steps:

  • Filing of a petition for appointment of a guardian to be determined at a court hearing
  • Issuance of service of summons;
  • Appointment of a guardian and guardian ad litem, an unrelated individual who will be the eyes and ears of the judge in understanding the circumstances;
  • Obtaining the necessary physician’s report establishing that the individual does not have decision-making authority, and;
  • Giving notice to all spouses, children, siblings and agents under power of attorney so that they can concur or object with the guardianship itself.

The benefits of guardianship are that the day-to-day management of financial affairs can be handled by the guardian of the estate, and the day-to-day management of health matters can be accomplished by the guardian of the person. Sometimes the same individual is the guardian of both the estate and the person and sometimes different persons are appointed to these roles because of their different skill sets.

Guardianship can consist of both:

  • Uncontested guardianships: when everybody agrees with the process of the person selected, or
  • Contested guardianships: when the Ward (the person that is the subject matter of the guardianship process) or someone known to the Ward may object to the guardianship, in which case the guardianship process becomes what is called a contested guardianship (which results in expensive litigation)

The guardianship process is a last resort when people have not taken time to do the appropriate estate planning. I recommend that people get powers of attorney for property and powers of attorney for healthcare in place at age 18, in order to avoid guardianship in the event they become incapacitated. Remember, at age 18, you are an emancipated adult and you can make decisions for yourself and nobody else can make decisions for you, unless you authorize them to do so. It is for this reason we recommend powers of attorney whenever we can.

Don’t allow your personal and health matters to fall into guardianship. We are grateful that guardianship exists for tragic situations where proper planning has not taken place. But, now that you know that you can avoid guardianship through proper estate planning, prudence would indicate that you take the steps to do such planning.

Early-Onset Alzheimer’s Assistance | Illinois Estate Planning and Elder Law Attorney

What happens if you or your loved one is diagnosed with early-onset dementia? This typically means that the patient was diagnosed before the age of 65. Unfortunately, there are not very many resources for those who have early-onset dementia, but there are a few things that a caregiver can do:

  1. Look for a senior day center. The staff will be well trained in dementia care and they’ll know the right ways to interact with your loved one;
  2. Have your early-onset diagnosed loved one volunteer in a senior day center like the type I mentioned above. This will ensure that they are in a safe environment while also giving them a sense of confidence; and
  3. Talk to local nursing facilities.  Some facilities have day care or memory units that may fit your loved one’s needs.

Resources like these have become more and more common in recent years. Even if you don’t have a senior day center in your area, don’t worry. There is plenty you can do.

-Anthony B. Ferraro

Choosing the Right Nursing Home | Chicagoland Elder Care Attorney

Choosing a nursing home for a loved one may be one of the most daunting things we have to do in life.  But, when a loved one is in a condition that requires them to be in a nursing home, as a caregiver or agent under power of attorney, it is your job to choose the place that is best for them.  You want them to get the proper medical attention while still feeling like they’re at home.  Your worst case scenario would be for them to feel neglected or to be treated poorly.

There are ways to ensure that this does not happen.

For starters, when beginning the nursing home selection process I recommend that you visit https://abferrarolaw.com/senior-resource-kits/alzheimers-resource-kit/.  There you will find the guide, “How to Choose the Right Nursing Home and Ensure Your Loved One Gets Great Care,” which includes:

1)      A Nursing Home Evaluation Form, which gives you a lot of insight pertaining to issues that people tend to overlook when choosing a nursing home;

2)      3 steps to make the nursing home transition a smooth one; and

3)      1 huge secret on how to connect with nursing home staffers so that your loved one gets the best treatment.

After narrowing down the nursing home selections, the next best thing to do is to contact someone on the nursing home staff, such as the social worker, to voice your concerns and engage in further questioning on your nursing home of choice.  After contacting staff, they may offer to give you a tour of their facility to give you an even more in depth insight on what may soon be your loved one’s new home.

All in all, throughout the whole process, make sure to involve your loved one. Make sure that they know that the journey they are about to embark on is not a scary one, but an exciting one.

-Anthony B. Ferraro

What If My Loved One Is a Flight Risk or Wanders Away? | Chicago Estate & Elder Law Attorney-CPA, Anthony B. Ferraro

Wandering is one of the most dangerous and feared side effects of Alzheimer’s and dementia’s.  Usually, the main reason for someone wandering is they are trying to find some place that is familiar to them.  A problem with wandering is someone with Alzheimer’s or dementia may not realize they are doing dangerous acts, such as walking into traffic.

The good news is that wandering can be prevented.  The website below includes some resources you may find helpful for protecting your loved one from the dangers of wandering.

http://www.alzheimershope.com/symptoms_strategies/wandering.php

Even though it is completely understandable to be scared and agitated when a loved one wanders away, it is very important to refrain from confronting them and badgering them.

When a loved one wanders away a frantic confrontation will only make things worse.

While it is certainly easy to say that one should not show fear or anger when a loved one wanders, putting that into practice is another matter. One of the most important things to keep in mind is not to lecture your loved one about wandering, in order to prevent an outburst.

Alzheimer’s not only affects the memory, but may control that part of the brain which controls our behavior. Don’t  increase the fright of your loved one, or the chance of an outburst, by lecturing them.

When it comes to wandering, simply remember to try to remain calm.

-Anthony B. Ferraro

Should Your Loved One with Alzheimer’s Still be Driving? | Illinois Estate Planning & Eldercare Attorney-CPA Anthony B. Ferraro

One of the dilemmas a caregiver for someone with Alzheimer’s faces is whether or not they should continue to let their loved one drive.  No longer allowing your loved one to drive can lead your loved one to a feeling of defeat and taking away their keys can mean the loss of your loved one’s independence; however,  you must balance that loss with the safety of others on the road.

An issue that many caregivers face surrounding the driving issue is their loved one’s insistence that there is no reason why they can no longer operate a vehicle.  Even if you get the doctor to insist to the patient that they should no longer drive, due to the memory loss, the patient may completely forget what the doctor told them.  So, you will find yourself in a seemingly never ending cycle of your loved one insisting on driving and you telling them no.

In this case, the best thing to do is change the topic of conversation when the driving topic is brought up.  Diverting to a lighter topic of conversation by saying something like, “What do you want for dinner tonight?” may feel odd at first, like you’re ignoring your loved one, but the truth is, switching to a lighter topic of conversation can be a great stress reliever for both you and your loved one, even if it is only for a brief moment.

Changing to a lighter topic should not take away from the overall seriousness of the driving issue, but for the time being, it provides some relief and you both can move forward.

It is important to realize that driving is one of the most challenging issues surrounding Alzheimer’s today.  Helpful answers to this issue can come from the Alzheimer’s resource center at abferrarolaw.com/senior-resource-kits/alzheimers-resource-kit/.

-Anthony B. Ferraro

Alzheimer’s Caregivers’ Advice | Illinois Estate Planning & Eldercare Attorney-CPA Anthony B. Ferraro

Assuming the role of a caregiver for a loved one with Alzheimer’s is very hard. It can be a struggle, both physically and mentally.  As an Alzheimer’s caregiver, you are going to be approaching challenges that are both new and frightening.

Alzheimer’s is a complex disease and it can affect your loved one in many different ways.  Someone with Alzheimer’s may struggle doing simple tasks such as getting dressed or eating.  The typical Alzheimer’s patient will also face confusion and, therefore, you will receive repetitive questions and see odd behavior.

In a situation like this, it is normal to feel trapped.  However, I am here to assure you that there are ways to make you and your loved one’s journey through Alzheimer’s easier.

First off, I suggest that you abferrarolaw.com/senior-resource-kits/alzheimers-resource-kit/.  There you will find many tools on how to cope through the Alzheimer’s journey, including the recording called, “Caring for and Communicating with the Alzheimer’s Patient.”

Other helpful information covered on the above website includes paying for the cost of Alzheimer’s care, discovering hidden VA benefits, and how to approach crucial legal documents.

-Anthony B. Ferraro

Coping with Alzheimer’s | Chicago Estate Planning & Eldercare Attorney-CPA Anthony B. Ferraro

Alzheimer’s has been termed “The Long Goodbye” due to its devastating effects that last for many years.  When our loved ones have Alzheimer’s, it doesn’t only affects them, it affects us.

However, there is still hope: hope in learning how to cope with Alzheimer’s.  As of today, there is no official cure for the disease, but by taking the simple steps many Alzheimer’s caregivers are using to cope, we can regain some peace of mind.

By visiting the website below, you will gain access to the Indispensable Alzheimer’s Resource Kit.  This is a helpful tool that will assist you in providing stress-free care for both you and your loved one, as well as ways to pay for Alzheimer’s care without going broke.

abferrarolaw.com/senior-resource-kits/alzheimers-resource-kit/

I also encourage you to visit www.AlzheimersHope.com, which is an internet community that will give you the opportunity to connect with Alzheimer’s caregivers from around the world.

You are not alone in your journey through Alzheimer’s, and the above websites will assure you that there are many others experiencing the same thing as you.

If you have any other questions about Alzheimer’s or any other legal-related issues, please call my office at (847) 292-1220.

-Anthony B. Ferraro

Attorney-CPA

Would I benefit from a support group for Alzheimer patient family members? | Chicago Elder Law Attorney Anthony B. Ferraro

First off, a support group is not necessarily for everyone. BUT for most Alzheimer’s family it IS a godsend.

There are many types of groups you can join. You need to find one that makes you feel comfortable. They typically have a special theme or focus, such as for spouses, adult children, caregiving aspects, etc. You should find a group that meets at least twice a month to get the best benefit.

You also might consider a group that generally discusses caregiving issues. Most issues with caregiving are similar, no matter what the disease. Some issues confronted might be frustration, guilt, anger, fatigue, finances, physical challenges such as incontinence and so on.

The goal of a support group is to give you a confidential, secure way of expressing your feelings and concerns. This can lessen pressure or anxieties you might be feeling. The caregiving you’re doing is a difficult job, one that nobody really asks for. You don’t volunteer for it but are volunteered for it, so to speak.

Sharing with others who identify with your situation can be affirming, comforting and validating. You also can talk to the group to find solutions to problems you might be having. Odds are that someone else in the group already has experienced a similar problem and can relate to it, and probably supply a practical solution.

The individual with Alzheimer’s also can benefit from being part of a support group. He or she needs to talk about feelings and experiences with the disease. Joining a support group can help lessen frustration and anger. Members of such groups talk openly about having the disease, what to expect and how to plan for it. Therefore, the participant must first be aware of his or her diagnosis to take part.

Support groups for patients themselves is a fairly new concept so you might not find them as readily available as those for family members. So far they have typically been more common in larger metropolitan areas.

Keep in mind that if you live in an area that does not have a support group, there are groups established online. One example is The Alzheimer List, which is sponsored by the Alzheimer’s Research Center in St. Louis and can be found here.