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

January 14, 2014

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

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

By Anthony Ferraro on

January 2, 2014

- Alzheimer's Care, Chicago Elder Law, Eldercare Attorney

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

The 35%Estate Tax is Peanuts! How About the 100% “Medicaid Tax”?|Chicagoland Elder Law Attorney Anthony B. Ferraro

By Anthony Ferraro on

February 18, 2013

- Chicagoland Elder Law, Medicaid spend down planning, senior estate planning

Why has everybody been so concerned about the Estate tax? For years, clients of our office have been very concerned about the Estate tax. I have reassured many clients over the last couple of years that the Estate tax will not impact you unless you have more than $5,000,000 ($10,000,000 if you are married). Now contrast that to the cost of what I call the “Medicaid tax”. The “Medicaid tax” is the government’s requirement that you spend your assets down to $2,000 (as a single person) before you get any Medicaid help for your custodial care or long- term care, either in a Supportive Living Facility (similar to an assisted living facility) or an Intermediate or Skilled Nursing Facility. This terrible governmental requirement to spend down to $2000 is what I refer to as a 100% Medicaid tax. Because, effectively you have to be down to zero assets before you get any assistance with maladies that require custodial care, such as dementia, Alzheimer’s, Parkinson’s, MS, ALS, COPD, muscular dystrophy, etc. Therefore, I politely ask my clients to “wake up and smell the coffee”. Quit obsessing over the effect of the Estate tax. It will not affect most of us. On the other hand, consider the government-mandated Medicaid spend down of your assets to paltry $2,000 – this will affect most of us. Why will this affect most of us? Because, due to the advances of medical science, most of us are living much longer (thankfully). However, while we are living much longer, we also need more care as we age. Couple this with the fact that the average cost of a Supportive Living Facility (SLF) is somewhere around $4,000 a month and the average cost of an Intermediate or Skilled Nursing Facility is $6,000 to $10,000 a month, and you have a “perfect storm” scenario that can lead to a Medicaid spend down of your assets to a measley $2,000. And that $2000 has to last you for the rest of your life. This is, in my view, the equivalent of a 100% “Medicaid tax“. How treacherous is it to be spent down to $2000? Let me give you an example. We recently had a client at our office that needed abscessed teeth to be removed. Our client was 85 years of age and spent down to $2000. She was told that the only available Medicaid dentist in Cook County would take her, but it would require her to wait 6 to 8 hours in the waiting room. My client had moderate to severe dementia and could not last 6 to 8 hours in a waiting room. It would have been nice if she had come to me earlier so I could set aside a rainy day fund for her. A Solution: This would be a legal and ethical re-allocation of her assets so that she could have funds for things like teeth extraction, but still qualify for Medicaid benefits. We had another client that required hearing aids. Hearing aids cost $6,000.How do you buy them when you’re spent down to $2,000? So we inform our clients that they should not be concerned about the Estate tax unless they are very, very wealthy. The more likely severe financial impact that will hit most of our clients comes from the devastating cost of long-term care. Clients have to understand that they must plan while they still can. Unfortunately, this window can sometimes close very quickly due to the onset of a stroke, heart attack, accident, or some other catastrophic disability. At The Law Offices of Anthony B. Ferraro, LLC, we are Attorneys and CPAs. We have been serving clients in matters of Medicaid asset protection, long-term care planning, traditional estate planning, senior estate planning, estate tax planning, and estate and trust administration for a combined 45 years. Today’s environment in which our seniors are asked to fend for themselves and protect themselves and loved ones from Medicaid spend down, taxes, the cost of home care, healthcare, long-term care, creditors, predators, divorcing spouses, and illness, is very complicated to most of our clients. But we deal with this every day. And we are just a phone call away. Consider making the call to our office while you are still are able to plan. Let us provided you with service and guidance that will be essential for your well-being and that of your loved ones. Let us give you options… So you don’t go broke the aging process. Anthony B. Ferraro Attorney-MSTax-CPA The Law Offices of Anthony B. Ferraro, LLC Attorneys & CPAs The Elder Law, Estate & Trust and Asset Protection Law Firm 5600 North River Rd. Rosemont, Illinois 60018 847-292-1220 www.ABFerraroLaw.com

How can we encourage a more collaborative spirit, rather than “them vs. us,” when it comes to my mother’s nursing home staff? ? | Chicago Long-Term Care Planning Attorney Anthony B. Ferraro

By Anthony Ferraro on

August 22, 2012

- Alzheimer's Care, Blog, Elder Law Articles

First of all, for family members: When you first admit a loved one to a nursing home, you should get to know the staff. Let them know that you care about their well being (in addition to your loved one’s) and that you would like an open relationship so you all can discuss issues concerning your mother’s care. Inform them about pertinent information concerning her and her life — what she likes, dislikes, any habits she might have, typical moods, and what seems to work when approach her in different situations. The more her caregivers know, the better they can care for her. Compliment staff members when you learn about them doing something you like. Be involved at the facility as much as possible. Attend social events and family council meetings if you can. One good example of relationships being built very well involves a man who took a picture of his wife and the staff on her unit. He had an 8-by-10-inch shot of it made and wrote the name of each caregiver underneath it. When placed on his wife’s closet door, it served as an aid to helping her recognize the people taking care of her. It also made the staff members feel very included. It made them feel important and let them know that the family really cared about them. This gesture built a lot of good will and enhanced his wife’s care. To the staff: Don’t be intimidated by residents and/or their families. You are the frontline worker, an honorable position. Without you, there would be no care for their loved one. That is a compliment of the highest order. Show interest not only in the resident, but also his or her family. Introduce yourself and tell them a little bit about your background, your interests, how long you have been a caregiver and why you are in that line of work. When family members enter the unit, greet them cheerfully and give them information about their loved one, whether the news is good, bad or indifferent. What many caregivers don’t think to do is call a resident’s family if something good happens during the day. These are blessings that can be few and far between for family members, and they’ll go a long way. Unfortunately, there can be stigmas about nursing homes and their caregivers. For the most part, these workers are intent on doing a good job and truly care about what they do and who is in their charge. Everyone needs to work together to overcome negative stereotypes so residents will have positive experiences in their new home.

My father keeps asking to go home. What do we tell him? ? | Chicago, Illinois Elder Law Attorney Anthony B. Ferraro

By Anthony Ferraro on

August 20, 2012

- Alzheimer's Care, Blog, Elder Law Articles

When your father or any loved one starts to ask about home, someone could drive them past a previous home, even from childhood. Often, he will not recognize the old house because a house and a home are two different things. That’s why it is best to make him feel safe and secure, regardless of wherever he is. To most people, “home” is a place where we feel loved and accepted — and safe. So the best way to answer your question is to think about the word “home” and what it signifies. Depending on where he is with memory loss, your father might be conjuring thoughts of a childhood home with his parents and siblings. Or the home where he was first married, the kids were young or any time before, after or in between He might be living in the same home he’s been in for 20 or 30 years and still ask to go home. Due to the nature of Alzheimer’s, your dad is likely feeling insecure, fearful, even unlovable. Please pay close attention to this next point: It is not your fault. He is dwindling a bit, day-by-day, and he is frightened. Fear can drive many emotions, not the least of which are insecurity, anxiety, anger and low self-esteem. Your father needs to feel safe. If he doesn’t carry good feelings about himself, he probably doesn’t feel he can be loved by anyone. Remember that the most important thing to realize is you need to constantly validate his feelings. Instead of telling him he is home, tell him simply that he is in a safe place and that he is loved very much. You can tell him, for example, “Dad, you’ll be staying with me and Anthony for a while. We’re happy you’re here and we love you.” Reminiscing about his childhood and looking back at his life and life accomplishments also should make him feel good about himself and decrease negative feelings. Because Alzheimer’s patients typically have short-term memory loss, he will nonetheless continue to ask about “home.” Repeat over and over that he is in a safe place and loved very much. Giving hugs throughout the day will truly say much more than words. A hug produces feelings of love, acceptance and security — three big concepts that continually need addressing. For more information regarding how to treat a loved one with Alzheimer’s, click here.

My father has late-stages Alzheimer’s and gets food pocketed in his throat, causing aspiration and food back-up. Does he need to get a feeding tube? | Chicago Elder Law Attorney Anthony B. Ferraro

By Anthony Ferraro on

August 9, 2012

- Alzheimer's Care, Blog, Elder Law Articles

This can be a tricky subject. There is a lot of negative information circulated about feeding tubes, but they also can serve a legitimate, helpful purpose. First off, if your father has an advance directive, review its contents for guidance about his wishes regarding a feeding tube. Be sure to speak at length with his doctor about this issue. Sometimes other interventions are possible, such as speech therapy. Speech pathologists and therapists can introduce special swallowing techniques. However, the patient must be aware enough to understand instructions and carry them out. Discuss the different kinds of feeding tubes with your loved one’s doctor. There are numerous types and each should be explored. Some of them require more invasive procedures than others. Less invasive means less stress for your father. The doctor also should be able to explain the risks of using a feeding tube — and what the risks are if one isn’t used. Don’t hesitate to get a second opinion about feeding tubes. They are frequently an uncomfortable topic. Even if you have used a doctor for many years and trust him or her, it never hurts to get a second opinion. You need to be at peace when you make a decision about a feeding tube.

My mom thinks, after a few sessions, that her doctor-ordered speech therapy is a waste of time. Should we put up with the stress of forcing her to do this if she doesn’t want to? | Chicago Long-Term Care Planning Attorney Anthony B. Ferraro

By Anthony Ferraro on

August 9, 2012

- Alzheimer's Care, Blog, Elder Law Articles

You better go talk to the physician involved before you assert yourself here. Also, discuss this with the speech therapist to find out what type of therapy work your mother is undertaking. The therapist should have her individualized care plan available to discuss. It should include a goal and various steps for meeting it. Speech therapy does a lot more than most people realize. It is not just about talking more clearly. Some of the most important work may have to do with swallowing issues, which can be quite dangerous if not addressed appropriately. As Alzheimer’s disease progresses, for example, swallowing becomes more difficult, sometimes to the point of being life-threatening. Choking is a big concern. Speech therapists can assess such situations and apply therapies as needed. Rather than just having a person form sounds and letters, speech therapists also conduct swallowing tests on people with dementia — sometimes with the use of X-rays. These can help form care plans. It is easy to see why an Alzheimer’s patient might not understand all of this. You probably will want your mother’s doctor to explain the seriousness of the situation to her, and why the speech therapy is needed. Then, if your mother complains in the future, you can rely on the authority of the doctor. You also will both be more knowledgeable and familiar with the reasons for speech therapy. For more information from the Alzheimer’s Resource Kit, click here.

How can you get a loved one with Alzheimer’s disease to eat more? | Chicago Long-Term Care Planning Attorney Anthony B. Ferraro

By Anthony Ferraro on

August 8, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Often, as Alzheimer’s progresses, a person loses his or her appetite. Getting the person to eat can be a constant struggle. This is, in fact, one of the great challenges that Alzheimer’s caregivers face on a regular basis. It might be helpful to serve Alzheimer’s patients food on brightly colored plates and drinks in brightly colored cups or glasses. A study in a recent edition of Clinical Nutrition magazine revealed that when nursing home Alzheimer’s patients were served food on bright red plates, with red cutlery, they ate 24% more than when served on white plates. Similarly, bright red cups led to 84% more liquid being drunk than out of plain glasses. It’s a little-understood fact about Alzheimer’s that as the disease progresses, the ability to process all types of information is often lost. Outwardly it might seem obvious and easy for a person to recognize food on a plate, but it can be a challenge for an Alzheimer’s patient. So if other strategies for encouraging or cajoling more eating and drinking have failed, try serving food on bright red plates and putting beverages in red cups to encourage greater consumption. To learn more, try the Alzheimer’s Resource Kit, click here.

I am going to be president of the new family council at my dad’s nursing home. I plan to have a rep from each department give a description of their duties and responsibilities and then invite questions. What should we do after that? | Chicago, Illinois Elder Law Attorney Anthony B. Ferraro

By Anthony Ferraro on

August 8, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Having a leader from each department is a very good idea. The more the communication, the fewer the problems, in theory at least. When you hear from the department leaders, it will give you a good picture of their responsibilities, and why they do what they do. It’s not always clear to us and can lead to unanswered questions otherwise. Sometimes, there are health department, state, federal or other regulations in place. It’s easier for you and other resident families to deal with when staff members’ routines make more sense. Work on building relationships between staff members and the residents’ families. Invite different staff members to attend your meetings. Remember that nurses and other direct care personnel are very important — not just the department heads. They are usually the ones doing 90% or more of the hands-on caregiving with your loved one. You better believe their input is important. As a group, a family council can develop a method(s) for more effective communication with facility staff if a complaint or concern arises. When something does come up, it then ought to be less threatening for everyone to sit down and resolve it. The council also should consider developing a good way to deliver compliments to staff members, via proper thank-you notes, for example. Plan for picnics or other get-togethers so staff, residents and family members can spend relaxed time together. Treat everyone as family. The council should not simply become a gossip or complaint forum. The meetings also should be structured and effective since nobody wants to waste time — staffers and non-employees alike. For more ideas on what you might do or include, you can call other facilities and ask how they run their family council meetings. Best of all, speak with the actual officers of the family councils at other places, not just staff members or directors.

Since my father just wandered from his nursing home, could it be that he’s placed inappropriately? | Chicago, Illinois Elder Law Attorney Anthony B. Ferraro

By Anthony Ferraro on

August 6, 2012

- Alzheimer's Care, Blog, Elder Law Articles

This depends on a number of factors. If he is considered a high-risk case for wandering and the provider is admittedly not suited to deal with it, then, yes, he may be incorrectly placed. But if this was a first or “one-time” incident and staff members say they can handle it from here on out, try to keep your father where he is. It’s good for him to remain in familiar surroundings. (If you think the facility simply is not living up to its care obligations or has been derelict in its duties, then looking for a different facility would be advised.) Having a person with Alzheimer’s disease move can often be traumatic. What makes this predicament particularly difficult is you can’t typically determine if your father is going to wander until the first time it happens. A facility can be caught off-guard by this but then can recover by ramping up supervision to responsibly take care of him. The facility might, in fact, have a very good resident monitoring system available or in place but did not think to tell you about it because your father wasn’t yet deemed a wandering risk. You can do a little research to help determine the next step. Speak with the facility’s activity director to learn whether your father takes part in activities. If he doesn’t or doesn’t take part much, ask the director to get him more involved in either group of individual activities. This will help keep his body active and his mind stimulated, diverting some of the energy that would be used for wandering. Exercise is a good way to spend excess energy You also can look into engaging private duty or sitting services. Consult facility staff about having someone come in to spend one-on-one time with your father. This would still not guarantee against wandering (due to the nature of the disease) but it would be another proactive measure against it. Have all caregivers track whether your father tries to leave the facility, and if staff members are able to prevent or counteract it. If they can’t prevent it, you might need to explore other options. Also consider: Does your father seem anxious or extremely agitated? His doctor might be able to do something about this with an appropriate intervention. There is also the chance that your father may remain agitated enough to wander no matter where he is. Be sure to keep his doctor up to date on the situation. For more information, go to our Alzheimer’s Resource Kit by clicking here.