Today we’re going to talk about a “life and death” situation that no one talks about: 100% of us are going to die, and at least 50% of us who survive past the age of 65 will spend a substantial period of time in a long term care facility. If you have a loved one who already has a dementia or Alzheimer’s diagnosis, he will almost certainly spend some time – perhaps years – in a care facility. We want to help you know how to protect yourself and your loved ones!

We usually don’t think about it when we’re younger – and some won’t even talk about it when they’re older – but life has a pretty predictable path. There is still 100% correlation between birth and death. And while there are many different causes of death, due to advances in medicine and healthcare there’s a pretty good chance that we’re only going to die in one of two ways:

1. We die suddenly, or relatively quickly.
2. We die progressively over a long period of time and we are maintained by expensive drugs, medical procedures, and nursing homes at an extremely high cost… like almost all who receive an Alzheimer’s diagnosis.

One of the worst things about a lingering death is that our healthcare system was not set up to provide for us when we have a chronic care need. When you get a diagnosis that means you will not get well for the rest of your life, you are pretty much on your own. You must use up all your assets – usually down to about $2,000 – before you can qualify for government help.

I call the typical aging path “the elder care journey.” What I mean by that is most people start their early retirement years as healthy, vigorous seniors, but a high percentage of us will later experience mobility or memory problems. Once we begin to have mobility and memory issues, we become a “declining senior.” In my experience, 90% of those who reach the declining senior stage will need substantial in-home care or nursing home care prior to their death.

Of course, a person can die suddenly anywhere along this timeline, but unless there is a catastrophic event or illness, most seniors will follow this path. The truth is, our legal and financial planning should take the elder care journey into consideration to be able to provide you with the best care and financial security.

Well, as we all know, life does eventually end – but that’s really not the end of the journey for the surviving family. It is my experience that many couples are not really aware of all the issues that arise when the first spouse dies. For example, did you know that the survivor spouse will lose one of the two Social Security checks? In addition, the survivor spouse may lose some or all of any pension. If you don’t think about the fact that your spouse might survive you, you may not take the appropriate steps to ease the blow for the healthy spouse. It is my job as an elder law estate planner to review both your legal and financial resources.

The truth is that at the very beginning of any estate planning, one of the biggest things to keep in mind are long term care costs, so you can provide the best possible benefit for the healthy spouse. As I mentioned, when the first spouse dies, the survivor spouse is going to have to live on only one Social Security check, and may lose any pension (or a 50% portion of the pension) that their spouse had during life.

On top of that, once a spouse becomes ill with Alzheimer’s, Parkinson’s, or other long term illness, it’s easy to become so focused on paying for care that you may overlook the financial needs of the survivor. When you’re focused on caregiving, it’s hard to think about anything else but the immediate problem.

What’s more, there’s a good chance a wife will outlive her spouse, often by seven years or more. Seven years without one of the Social Security checks – and having had all of the money spent on the first spouse’s long term care – can totally devastate the life and health of a loved one. After all, while the grocery bill might be a little smaller, most of the daily costs of living for the healthy spouse are going to stay the same.

Fortunately there are options, and actions you can take to protect yourself and your loved ones. Our job is to help you learn about options for your unique situation. Call my firm today at (913) 338-5713 to learn how to protect yourself and your loved ones.

I hope I’ll hear from you soon!

A client of mine was recently trying to find resources for her husband with young-onset Alzheimer’s – that means he was diagnosed before age 65. In fact, he was diagnosed when he was just 52. His wife worked full time, and her husband was simply bored being home all the time during the day. He sometimes spent the day with his brother, but they spent the day cooped up there as well. She called looking for resources.

Unfortunately, in many parts of the country, there are not many resources for those with young-onset dementia… so caregivers have to get a little creative.

The first thing to do in this situation would be to look for a senior day center. Even though the people there are mostly older, the staff is usually well-trained in dementia care. They’ll know appropriate ways to interact with your loved one to maintain his dignity.

Very often, young-onset and recently diagnosed (less advanced) patients enroll in these centers as volunteers, and can actually assist with much of the programming. The center may need a lot of help moving things around, pushing wheelchairs, and setting up activities. Your loved one can be a huge help – which will make him feel needed, useful, and keep his morale and self-confidence up.

I know a young man (who was actually in his 40’s) who did just that. He was still young, strong and healthy, so the staff put him in charge of an exercise program. With a minimal amount of support he actually ran the exercise program for the other patients in the center! The center used a video of the exercises as he stood in front and lead the group. Everyone was much more engaged and able to participate when they had a live person showing them how. As time went on, and his disease progressed, going to the center was a comfortable and developed routine – and he just segued into the program.

Resources for early-onset patients are starting to be more common in some places, and even if there’s nothing in your area, you might be able to pique some interest based on your loved one’s needs by talking to some local nursing facilities. Give my office a call at (913) 338-5713 if you’d like… we can help recommend some that have day care or memory units that may fit your loved one’s needs.

I could hear the panic in Mary’s voice. Her husband Joe’s health had been steadily declining for years, and Mary has been his primary caregiver. But last week he fell at home, breaking his hip, and now he’s in a subacute facility. The recovery process hasn’t gone well, in part because of Joe’s age and partly because of the toll that Alzheimer’s has taken on his mind. Mary is now facing the prospect of either long term care at a cost of $11,000 per month or, in an effort to keep the cost down, trying to bring him home and provide much of the care herself, supplementing it with a few hours of home aide assistance. “Joe never wanted to talk about long term care and so we never did plan for this,” she tells me. It’s a classic scenario and one that, so often, is more damaging to the wife than the husband. How so?

Mary’s situation is a typical one. At 72, she’s six years younger than Joe. Add the fact that women have a longer life expectancy than men and chances are that the husband will need long term care first. And if the couple hasn’t planned for it, they’ll likely spend most of their savings on his care. Mary and Joe have $400,000 of assets plus their house. Without any guidance Mary could be left with as little as $109,000 and the house before the State will help pay for Joe’s care.

What about their income? Mary will lose much of that towards Joe’s care. He has Social Security of $1,500 and a pension of $2,500 while Mary has only Social Security of $500 because she spent many years tending to the needs of her family. She’ll get to keep approximately $1,500 of Joe’s income when he qualifies for Medicaid, not enough to meet her expenses. Then, when he dies, she’ll take another hit, because Joe chose the maximum pension for his life. There is no survivor option for Mary. Add to that the fact that she will only receive one Social Security check (Joe’s because it is the larger of the two) and her income will drop to $1,500. It, therefore, is so important for Mary to protect as much of their assets as she can to replace the income she loses.

And when Mary does need care it will likely be more expensive and difficult to administer. Why? Because she won’t have a healthy spouse living with her to care for her at home. Chances are she’ll need to hire more care, and she’ll be more likely to need nursing home care earlier. Her children will need to take on a greater role to fill the void.

One more thing. Mary’s concern about keeping costs down is causing her to take on more of the caregiver role herself. That can take a physical and emotional toll and may contribute to a more rapid decline in Mary’s health. Had the couple planned for this possibility well in advance, tapping into available sources of payment such as long term care insurance or government benefits, Mary would be more inclined to pay for additional help.

When you consider all these factors together, it becomes clear that, for many couples, it is the woman who is at greater risk. Mary now realizes it, too. Fortunately, she isn’t too late in reaching out to us. While it would have been better had she called us sooner, we can still help her protect something.

The economic downturn has offered one bright spot for businesses searching for new office space, and we’ve taken advantage of it. Effective August 1, we’ll officially be occupying our new offices at Corporate Woods.

Why the move? We were able to get significantly more space in an excellent location for less than our current lease. With the better lease rates and more flexibility in negotiation, now is a good time for companies to take advantage and save some money. Rental rates are much lower than they were a few years ago so we’re thrilled that we’ve secured a great space to serve our clients in beautiful Corporate Woods. For those of you familiar with this area, Corporate Woods is just west of our current location, so we’ve moved (almost literally) across the street!

One thing that hasn’t changed is our commitment to our clients. We know families have many questions when faced with the difficult task of finding and paying for long-term care for a loved one, and we’re here to help. Give us a call now. We can assist with Medicaid qualification and planning, Estate Planning as well as Wills and Trusts, Powers of Attorney, etc. (See FreeSeniorWorkshops.com for a list of our upcoming seminars on these subjects). Initial consultations are always free. Visit our web site at www.kcelderlaw.com for more information or to request free material. We look forward to being of service.

We hope to see you in our new offices soon!

Great writeup in the Kansas City star on UMKC’s program aimed at training social workers to become more effective in their work with Kansas and Missouri seniors:

http://www.kansascity.com/115/story/954642.html

Caring for a friend or family member can present a variety of challenges…here are some more helpful hints that our Alzheimer’s Resource Center have found to be effective. As always, please feel free to contact us or request our free guide to caring for a loved one with Alzheimer’s Disease in Kansas and Missouri if you have any questions that aren’t answered here.

Is your loved one crying? Depressed? Wanting to be alone? Wanting to stay in bed?

We all have a right to our blue days, and at times, the person with this disease just feels deeply sad. They sense the changes in their lives, and they feel their losses. Put your arms around them and say it’s okay to cry, it’s okay to feel sad. Bit by bit, you may coax them up and about. Try old, familiar stories or old familiar prayers. If they refuse still to get up, come back in a little while and try again, or have a different person try. Music can make an extraordinary difference. Play music they once loved; it will help them to reconnect to life.

In this case, you will be involved in a lot of physical care. Use touch. Stroking and rubbing of hands and feet (unless medically not advised for some other reason) will help keep the person “in touch,” and help with circulation to prevent skin breakdown. Your loved one will also need to be turned from side to back to the other side at regular intervals to prevent skin breakdown, commonly called bedsores.

Is your loved one bedfast (i.e. unable to get out of bed at all, or only with great effort)

Even if the person cannot move on their own, they can be repositioned — such as moved to an upright chair, or a recliner if available. They can therefore be involved in the social activity going on around them and can be a part of it, too. Don’t forget pet therapy or music.

A home health nurse can give instructions on how to do exercises that are appropriate for your loved one.