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Can a person lose speech with early-stage Alzheimer’s Disease?

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January 16, 2012

- Alzheimer's Care, Blog

Because Alzheimer’s affects individuals in different ways, at different rates, with different symptoms and at different times, it is impossible to say that no one with early-stage Alzheimer’s will ever lose the ability to talk. But it is not likely. If loss of speech happens at all, it is typically occurs in mid- to late-stage Alzheimer’s. The brain deteriorates and systematically starts to shut down certain body functions, one of them being speech. At first, a person might struggle with words, and then phrases or concepts. Eventually, entire sentences could be lost. There is also the possibility that someone will talk gibberish: He or she could be talking in full sentences but the words make no sense. Complications of neurological diseases such as Alzheimer’s could include mini-strokes, which could lead to the loss of speech. These mini-strokes, also known as TIAs (for transient ischemic attacks), are not uncommon in people with dementia. Sometimes, strokes come first and a person develops dementia secondarily. Severe strokes can result in the loss of speech. In these cases, time spent with a speech therapist can result in regained speaking abilities. It’s important to consult a doctor if speech is lost soon after a patient’s dementia/Alzheimer’s diagnosis. And, as always with such professionals, if you’re not satisfied with what you hear or how you’re treated, keep looking until you are. Consulting a specialist such as a neurologist is very important, too. Mini-strokes often may be too small to detect with an MRI, experts remind. Doctors who are experienced will be able to determine diagnoses through observation and interviews with family members. Although it is not common to lose speech with early-stage Alzheimer’s, you should always consult your physician whenever a medical condition like this is in question. Remember: Alzheimer’s treats people uniquely. While some characteristics — such as memory loss and insecurity — may be common, some symptoms may never appear in certain individuals. There are, for better or worse, few definites with Alzheimer’s. For more information about Alzheimer’s and how it might affect a loved one, check out the free, Indispensable Alzheimer’s Resource Kit from The Law Offices of Anthony B. Ferraro, LLC.      
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Should I automatically be concerned about wandering when Alzheimer’s is diagnosed?

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January 11, 2012

- Alzheimer's Care, Blog

Wandering isn’t a universal symptom of Alzheimer’s but it definitely can be a concern. Unfortunately, you won’t know if your loved one is a wanderer until he or she wanders for the first time. Each person with dementia travels through this journey at his or her own pace. Upon diagnosis of the disease, immediately register your loved one in the “Safe Return” program with the Alzheimer’s Association. Contact the national organization (http://www.alz.org) or your local Alzheimer’s Association for information about the program and how to enroll. When you register, you will choose the form of jewelry you would like your loved one to wear. The jewelry (a bracelet, pendant or other item) has the Alzheimer’s Association logo on the front and the wearer’s identification number on the back. Most people choose the bracelet because it can be worn with, or like, a watch. Even individuals who did not wear jewelry in the past typically will agree to wear a bracelet. Many caregivers have overcome a loved one’s suspicions or reluctance about wearing this special jewelry by ordering a second piece for themselves. When the caregiver is seen wearing it, the patient often drops resistance. It pays to plan ahead for a variety of situations. Talking with other caregivers at support groups about strategies, devices and interventions that have worked for them is a sound advice. You also should browse electronics stores to what the market has to offer. (The Alzehimer’s Store [http://www.alzstore.com] is a good place to look.) There are also agencies you can hire. They will assess your home and the patient’s living environment and make recommendations about them. Waste no time when you suspect you might have a wanderer. At the first indication, put a baby monitor in the bedroom at night so you can hear if and when your loved one gets up. Also, install safety devices in your home. And by all means, inform your neighbors. Of course, also talk with your physician about treatment for this symptom. When your loved one does wander, call 911 immediately. Many police departments give their officers special education about Alzheimer’s. This can include training officers how best to deal with wandering and other troublesome situations. Another way to prepare is to read an excellent book by Nancy Mace and Peter Rabins, “The 36-hour Day: A Family Guide to Caring for Persons with Alzheimer’s Disease, Related Dementing Illnesses, and Memory Loss in Later Life.” It is both informative and enlightening about the various stages of the disease and what you might encounter.
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Identifying with the person who has Alzheimer’s

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January 9, 2012

- Alzheimer's Care, Blog, Elder Law Articles

It’s said the best way to understand a person’s perspective is to “walk a mile in his shoes.” It’s true that no one can truly empathize with another’s situation without being in it himself or herself. But even when people are in the same situation, we know that each individual will respond to it differently.  The best way to understand how a person diagnosed with Alzheimer’s is feeling might be to read about the experiences of others in similar situations. Numerous people have written books and educational material that reflect on their personal experiences caring for someone with Alzheimer’s or other dementia.  You can “walk” together with others who have “been there.” At times it might be heart-wrenching to hear of their devastating experiences, but they also can prove helpful and educational. Your own emotions might be stirred, but you also might realize how your loved one might be feeling.  You might want to start with either of these books:   * “A Personal Journey Maze of Alzheimer’s,” by Dianna Friel McGowin (Dell/Doubleday Dell Publishing) * “Show Me the Way To Go Home,” by Larry Rose (Elder Books)  They’re available online, at your local bookseller and at your nearest Alzheimer’s Association outlet.
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How long can an Alzheimer’s patient survive?

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January 4, 2012

- Blog

A general review of various expert sources tells us that a person with Alzheimer’s disease can survive from three to 20 years after the first symptoms begin. The average length is about eight years.  Realize that individuals with Alzheimer’s progress at a different rates. Furthermore, not every victim experiences every symptom or ever stage. In addition, some people will plateau at a stage for a long time, while others might speed right through it to the next level. Alzheimer’s itself does not cause death, but it can be a contributing factor. The disease typically progresses to the point where the body’s organs begin to shut down. This, in turn, can cause myriad other problems. For example, some patients become bedridden. This can lead to deadly bedsores or other infections, or an illness such as pneumonia, which a patient might not be able to fight off. An excellent resource for families and caregivers can be purchased online or in bookstores. It is “The 36-hour Day: A Family Guide to Caring for Persons with Alzheimer’s Disease, Related Dementing Illnesses, and Memory Loss in Later Life,” by Nancy L. Mace and Peter V. Rabins. For further information please see the following links Alzheimers: https://abferrarolaw.com/chicago-illinois-alzheimers-caregiving-planning.html Medicaid (Don’t Go Broke in a Nursing Home): https://abferrarolaw.com/paying-for-nursing-home-care-in-chicago-illinois.html
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What is Dementia and How is it Related to Alzheimer’s Disease?

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December 29, 2011

- Alzheimer's Care

It’s important to know the distinctions between dementia and Alzheimer’s disease. The rates of individuals diagnosed with dementia and Alzheimer’s in the general population are both rising. But be clear that the terms are not synonymous. In brief, dementia is a syndrome or group of symptoms that causes loss of intellectual function and usually progresses over time. Alzheimer’s is the leading cause of dementia and the one we hear about the most. In other words, not all people who are diagnosed with dementia have Alzheimer’s disease. To explore it a bit further, consider that according to the American Heritage Dictionary of the English Language, dementia is the “deterioration of intellectual faculties, such as memory, concentration and judgment, resulting form an organic disease or a disorder of the brain. It is sometimes accompanied by emotional disturbance and personality changes.” There are conditions besides Alzheimer’s, such as depression, that also will cause dementia symptoms. Careful diagnosis of any dementia is essential in determining proper treatment and intervention. Some types of dementia are reversible, including: Parkinson’s disease, vascular dementia (stroke), Pick’s disease, AIDS, multiple sclerosis, Huntington’s disease, Wilson’s disease, Lewy body dementia, Creutzfeldt-Jakob disease, frontotemporal dementia and Wernicke-Korsakoff syndrome (alcohol-related dementia) Possible causes of reversible dementia include: depression, drug use, alcohol and other poisons, nutritional deficiencies, brain disorders, certain diseases, a metabolic condition, organ dysfunction, traumatic brain injury, brain tumor, hydrocephalus, syphilis, encephalitis and meningitis. Alzheimer’s disease is an irreversible dementia condition. However, with appropriate interventions, even irreversible dementias can be managed. Family caregivers should seek reliable education and other assistance wherever possible. A good place to start is the doctor’s office, which typically has resources to get families started with this difficult process. For more information on the different types of dementia, visit any of these websites:
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How the Tough New Medicaid Rules for Long Term Care Affect You!!

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December 23, 2011

- Blog, Medicaid and Paying for Nursing Home Care

As we have been anticipating for over a year now, the Department of Healthcare and Family Services (“the Department”) has finally adopted amendments to  “Medical Assistance Programs”, which can be found in 89 Illinois Admin. Code Part 120. These amendments will become effective on January 1, 2012, and will serve to implement the provisions of the Federal Deficit Reduction Act of 2005 (“DRA”) regarding Medicaid assistance for long-term care in Illinois. Before being finalized, the rule changes went through many different revisions. Myself and several other elder law attorneys participated in the review of these rule revisions. The rules that have changed are many and complex.  For example, the new rules change the lookback period for reviewing prior transfers to as far back as January 1, 2007. This means that the rules regarding transfers are being applied retroactively despite outcry from the elder law community and many other industry groups.  The new rules will be applied to persons who file an application for Medicaid long-term care assistance on or after January 1, 2012. Also, regarding asset transfers for which a Medicaid applicant has received less than fair market value, (for example gifts to children or other persons- other that  what the Department considers “incidental”), there will be a period of Medicaid ineligibility for long-term care. This period of ineligibility will not begin,  however,  until the Medicaid Applicant is in the nursing home, spent down to poverty level and a Medicaid application is filed. Then, and only then,  will the ineligibility period begin to run! More specificity about how the new rules are  implemented will hopefully be available once the state issues its Policy Manual about the new rules. As of this date, no revision to the Policy Manual has been published to reflect the new rules. Read more about the devastating impact these rules will have on the senior and disabled community and why “Senior” Estate Planning is more important than ever. A more in depth discussion can be found in the “Elder Law Articles” section of our website. Look for many future blog entries on this topic. This is a “sea change” in the way our taxpayer – clients will become eligible for Medicaid payment for their nursing home care in the days ahead.  
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New Medicaid Law Changes Pose Challenges to Nursing Homes and Residents

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December 22, 2011

- Alzheimer's Care, Blog, Elder Law Articles, Medicaid and Paying for Nursing Home Care

The New Landscape In February of 2006, due to changes brought about by Congress through the federal Deficit Reduction Act of 2005 (DRA), there were massive changes in the federal Medicaid law as it relates to the gifts or asset transfers. Now, on January 1, 2012, Illinois will finally adopt those provisions of the DRA and, thus change Illinois Medicaid law for long-term care forever. You may recall that under the old Medicaid law (expiring on December 31, 2011), a gift or other uncompensated transfer created a period of  ineligibility starting on the date of transfer.
  • For example: Prior to January 1, 2012, a $70,000 gift made by someone in Chicago, Illinois would  create a 10 month penalty from the date the gift was made. (Assume Skilled Nursing Facility (“SNF”) cost of $7,000 a month. $70,000 divided by $7,000 = 10  months). Thus, if the gift were made 12 months prior, the penalties would have already expired.
  • Under the new Illinois DRA law for  Medicaid, for gifts made after January 1, 2012, the same 10 month penalty period will not begin until the following requirements are all met:
1. The person is in the nursing home, 2. Assets are spent down to $2,000 and  3. An application for Medicaid is filed. Only at that time will the penalty period start!  In such a case any gifted funds would then have to be used  for the cost of care to get through the penalty period. But there will be many circumstances in which the gifted funds are no longer available. If, for  example, one of the gifts were made by an Alzheimer’s patient to fund college tuition or given to an individual in the family who simply no longer has the  gifts. What will happen in that case? This is a major pitfall brought about by the new Medicaid  law and one with which nursing homes will have to deal in the days that are coming.  In other words, prior to the  passage of this new Illinois law, various asset transfers would not cause major  problems for nursing homes since the penalties associated with the prior  transfers were self-correcting, in that the penalty would have expired  by the time the applicant was spent down. But now, under the new Illinois law, every transaction will be examined. All small transfers will be accumulated and added together and they will cause penalties which won’t even begin to run until the person is  otherwise spent down, in the nursing home, and the Medicaid application is filed. Nursing Homes Need to Change Procedure In the past, it has been very common to see nursing homes  kindly helping residents with Medicaid applications. There was not a lot of risk associated with this under prior law. That has now all changed. Under the new laws, the same practice may be very risky from a legal and cash flow perspective. That is because it will be now be essential to verify exactly what assets have been spent and transferred without value received in exchange, because the new law will have no safe harbor for prior asset transfers without adequate compensation.
  • So let’s review another example:  Assume Mr. Applicant is a resident of the Gracious Nursing Facility located in Chicago, Illinois and that he has been paying  the Gracious Nursing Facility privately for some months. He will be ready to apply for Medicaid in September, 2012 because at that time he will be spent down.
  • However, in January, 2012, after the new law came into effect, Mr. Applicant made a gift to his granddaughter  for tuition at a local college.
  • Assume that the amount of tuition payment was $70,000. Under the old law, that would have meant that there would be a penalty of 10 months ($70,000 gift divided by $7,000, which is the cost  for a semi private room on a private pay basis at Gracious Nursing Facility=10  month penalty).  Under the old laws, the 10 month penalty calculation would begin on the date of the transfer. Thus, the penalty would have ended by August, 2012.
  • However, under the new laws, the penalty won’t start until September, 2011, when Mr. Applicant is spent down to $2000.  This means he may not be eligible until the same 10 month penalty period ends in June, 2013!
How is Mr Applicant going to pay from September of 2012 to June of 2013, after he has already spent down? Now if the social worker at the nursing home kindly tries to  assist the family by filling out the application and doesn’t understand how the new law will affect Mr. Applicant’s situation, then the application will be  filed with an expectation that Medicaid will be approved. However, you can imagine the disappointment of the nursing home administrator and the family when they later find out (usually some 90 to 120 days after the submission of the application) that the application was properly denied because the new rules are in effect. What will the nursing home do a case like this? What will the family of Mr. Applicant do in such a case? The proper recourse could consist of filing a request for  hardship exception. Illinois, however, has not had a great history of granting hardship exceptions. Furthermore the granting of hardship exceptions is for the  benefit of the resident. The hardship exception is not designed to make sure that the nursing home can maintain its cash flow for properly serving a resident. Thus you can see that these issues will, in the coming days, be very difficult for nursing homes and families dealing with the documentation required for the resident. Many residents will not have the ability to  reconstruct the financial history to the extent required by law (60 months).  In addition, seeking hardship waivers is a  very difficult process and will require proving up certain pleadings. For these reasons this new Illinois law is something that the commentators have called “The Nursing  Home Bankruptcy Act of 2006.”  HARSH BUT TRUE! While I’m not suggesting that the world is ending, I am sure  that this new law will cause enormous hurdles for nursing homes and their residents to overcome. What was at one time a simple Medicaid application should no longer be viewed that way. The services of an elder law attorney who thoroughly understands the new rules and  Medicaid changes as well how to deal with asset issues, property transfers and Medicaid denials will become more important now and in the days ahead.   Anthony B. Ferraro Attorney – CPA
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