Ten Early Warning Signs of Alzheimer’s

What are some early warning signs of Alzheimer’s Disease?

Dementia and Alzheimer’s are often confused as being the same, but they’re not. Dementia describes a set of symptoms that include degraded memory, reasoning, and thinking. Alzheimer’s is a brain disease that causes dementia, but dementia can also be caused by other conditions.

One of the challenges with identifying the symptoms of Alzheimer’s is that memory problems naturally increase with age. It’s important then to distinguish age-related memory changes from memory problems that interfere with daily life.

Here are ten early warning signs and symptoms of Alzheimer’s. If you notice any of them, please see a doctor.

  • Uncharacteristic changes in mood and personality
  • Withdrawal from work or social activities
  • Decreased or poor judgment
  • Misplacing things, unable to retrace steps
  • New problems with words in speaking or writing
  • Trouble understanding visual signs
  • Confusion with time or place
  • Difficulty completing tasks
  • Challenges in solving problems
  • Memory loss that disrupts daily life

21 “Mobile Friendly” Elder Care / Senior Care Directories

If you need help with this elder care matter or with any Elder Care / Senior Care issue, you can find the help you need in one of the following 21Mobile Friendly” Elder Care / Senior Care Directories. These Elder Care / Senior Care – specific Directories are sponsored by the National ElderCare Matters Alliance, an organization of thousands of America’s TOP Elder Care / Senior Care Professsionals who help families plan for and deal with a wide range of Elder Care Matters.

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Financial Power of Attorney

What is a Financial Power of Attorney?

Answer:  A Financial Power of Attorney is not a part of your will.  It is a separate document that authorizes someone you name to act in accordance with your financial intentions.  It becomes effective only when you cannot express your wishes yourself.   With a Financial Power of Attorney, you choose who will act and define their authority and its limits, if any. You should make sure that all your financial professionals (stockbrokers, accountants, financial planners) and banks have a signed copy.

21 “Mobile Friendly” Elder Care / Senior Care Directories

If you need help with this elder care matter or with any Elder Care / Senior Care issue, you can find the help you need in one of the following 21Mobile Friendly” Elder Care / Senior Care Directories. These Elder Care / Senior Care – specific Directories are sponsored by the National ElderCare Matters Alliance, an organization of thousands of America’s TOP Elder Care / Senior Care Professsionals who help families plan for and deal with a wide range of Elder Care Matters.

#eldercarematters

 


Reverse Mortgage

What is a reverse mortgage?

A reverse equity mortgage allows senior citizens who are house rich and cash poor to obtain a loan based on the equity on their home. They retain title to their home as long as the continue to live there and receive nontaxable income which they can flexibly use for their own needs. According to the terms of most mortgages currently available, the loan, interest and other costs such as origination fees do not have to be paid back until the owner vacates the property through a move or death. Almost all reverse mortgages now provide a guarantee of lifetime tenancy. Most reverse mortgages are nonrecourse loans which means the lender can look only to the value of the home for repayment. Payments to a home owner from a reverse mortgage can be in the form of a lump sum of cash, regular monthly advances or a line of credit. New mortgage plans allow a combination of payment methods. The amount of the loan is seldom for the full value of the property; most lenders place minimum and maximum limits on the size of mortgages they are willing to establish. Loan periods can vary. Some mortgages combine a reverse mortgage with an annuity, thereby guaranteeing individuals monthly income for their lifetime regardless of whether they continue to live in their homes or not. The monthly payments are considered annuity advances and thus partially taxable. For purposes of Medicaid eligibility these payments may be counted as income.

21 “Mobile Friendly” Elder Care / Senior Care Directories

If you need help with this issue or with any Elder Care / Senior Care matter, you can find the help you need in one of the following 21Mobile Friendly” Elder Care / Senior Care Directories. These Elder Care / Senior Care – specific Directories are sponsored by the National ElderCare Matters Alliance, an organization of thousands of America’s TOP Elder Care / Senior Care Professsionals who help families plan for and deal with a wide range of Elder Care Matters.

#eldercarematters


Medi-Cal Asset Protection Strategies

What are some Medi-Cal Asset Protection Strategies to consider?

Although with the recent passage of the Deficit Reduction Act, increased restrictions affect the use of some techniques, other asset protection strategies remain viable, especially for married couples where one spouse requires long-term care. Some of these techniques may include setting up an Irrevocable Living Trust, making gifts to family members, and paying for certain Medi-Cal expenses.

Whether you are facing long-term care issues yourself or you have a family member who is, we encourage you to call with your questions or ask us for a free report. Be sure to call sooner rather than later because the timing of the decisions families need to make has a dramatic impact on whether or not someone can actually qualify for this type of support.

Elder Law involves planning for the complex health care, long-term care, and other issues facing elderly and disabled individuals and their families. Studies show that we stand a 40 percent chance of needing long-term care at least once before we die. Therefore, everyone should take into account that at some point residency in a nursing home or an assisted living facility may be needed.

However, the substantial cost of nursing home care for an incapacitated person can wipe away a family’s nest egg and the inheritance planned for surviving family members. The primary alternative to privately paying the nursing home is Medi-Cal.

21 “Mobile Friendly” Elder Care / Senior Care Directories

If you need help with this legal issue or with any Elder Care / Senior Care matter, you can find the help you need in one of the following 21Mobile Friendly” Elder Care / Senior Care Directories. These Elder Care / Senior Care – specific Directories are sponsored by the National ElderCare Matters Alliance, an organization of thousands of America’s TOP Elder Care / Senior Care Professsionals who help families plan for and deal with a wide range of Elder Care Matters.

#eldercarematters


Long Term Care Insurance

What is long term care insurance and is it really necessary?

Long-term care insurance covers the risk that you may at some point in your life be placed into a nursing home by paying for some or all the expenses associated with nursing home care. It also frequently covers assisted living care or care in your home. Long-term care insurance can be a very valuable tool that can help you avoid depleting your estate in order to pay for nursing home care. Nursing homes greatly vary in cost depending on the quality of the home and the geographic area of the country in which the care facility is located. At a minimum, you can expect to pay several thousand dollars a month for decent nursing home care, which can rapidly deplete an individual’s savings.

21 “Mobile Friendly” Elder Care / Senior Care Directories

If you need help with this elder care issue or with any Elder Care / Senior Care matter, you can find the help you need in one of the following 21Mobile Friendly” Elder Care / Senior Care Directories. These Elder Care / Senior Care – specific Directories are sponsored by the National ElderCare Matters Alliance, an organization of thousands of America’s TOP Elder Care / Senior Care Professsionals who help families plan for and deal with a wide range of Elder Care Matters.

#eldercarematters


Divorce and Wills

Does a divorce revoke your Will?

Answer:  If you are facing divorce, or are divorced, you need to take a close look at your estate planning documents to ensure that your wishes are carried out. Wills executed prior to January 1, 1997 are revoked under Connecticut law if the testator of the will is subsequently divorced. C.G.S. § 45a-257e. This severe result under Connecticut law could have drastic consequences to your carefully constructed estate plan. Under these circumstances, your estate would be distributed under intestate law, which may not coincide with your wishes. Another consequence is the additional expense and delay in petitioning the Probate Court to have an administrator appointed. This Court appointed administrator may very well end up being an individual you do not want handling your financial affairs. Although wills executed on and after January 1, 1997 will not be revoked by subsequent divorce, part of your estate could still pass under intestate law if the provisions of your will fail to provide for an alternate beneficiary. C.G.S. 45a-257f. In addition, property that does not pass pursuant to your will may require a change of beneficiary to ensure that your ex-spouse is not an accidental beneficiary to the detriment of your loved ones. A necessary step of the divorce process, although often overlooked, is a systematic review of your estate planning and beneficiary documents. By carefully reviewing your estate planning documents with your attorney, you can ensure the distribution of your assets according to your wishes.

21 “Mobile Friendly” Elder Care / Senior Care Directories

If you need help with this legal issue or with any Elder Care / Senior Care matter, you can find the help you need in one of the following 21Mobile Friendly” Elder Care / Senior Care Directories. These Elder Care / Senior Care – specific Directories are sponsored by the National ElderCare Matters Alliance, an organization of thousands of America’s TOP Elder Care / Senior Care Professsionals who help families plan for and deal with a wide range of Elder Care Matters.

#eldercarematters


Wills and Avoiding Probate

What does a Will do and how do you avoid Probate?

Answer:   A Will allows the person creating it — the Testator (a man who creates a Will) or Testatrix (a woman who creates a Will) to: 1) identify the person, referred to as the “Personal Representative”,(I recommend naming at least two people – the first appointee and then a back-up (Successor) who will pay any last bills, collect any claims, pay debts and file lawsuits if necessary and ensure the instructions in the Will are carried out; 2) provide instructions about how assets are to be distributed – for example, “first to my spouse, and if he/she dies before I do, then in equal shares to my children”; 3) nominate a guardian for any minor or disabled children and 4) create a “Personal Property List” that allows the Testator/Testatrix to list personal or sentimental items to be given by the Personal Representative to the person identified to receive the item (i.e, your black velvet painting of Elvis).

HOWEVER, creating a Will is just the first step to avoiding having your assets supervised for distribution through the Probate Court. Once a Will is created, beneficiary designations must be made for all assets — bank accounts and certificates of deposit (CDs) should have “Pay Upon Death” designations, securities, including stocks, bonds and mutual funds should have a “Transfer Upon Death” designations; U.S. savings bonds have forms for naming beneficiaries. Life-insurance, retirement accounts and IRAs have forms enabling beneficiaries to be named. Real estate should have beneficiary, or lady bird deeds or deeds that name joint owners who will inherit by survivorship created and filed with the Recorder of Deeds office. A beneficiary can be a person, a trust, charity or other entity. The key is to make sure all assets have some type of designation that identifies who is to inherit the asset and that such designation is consistent with one’s Will — inconsistencies between beneficiary designations and instructions in a Will can cause enormous problems, hurt feelings, and end up landing one’s estate in probate to have such inconsistencies sorted out.

Although there are many websites, downloadable forms and resources for creating a Will, it is advisable to see an attorney to ensure that your wishes are reflected in your Will in such a way that they will be carried out, to find out the options you have for distribution of your estate and how to handle sticky or difficult situations — such as leaving assets for the benefit of a disabled child; how to ensure that if a child dies before you, that his/her share will go to who you want to receive it and answer questions you may have and not even know to ask. If you need help with Elder Law or other Elder Care Matters, you can find thousands of Elder Law and Estate Planning Attorneys from across America on ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

You can also find Elder Law Attorneys on ElderLawAttorneys.us and Estate Planning Attorneys on EstatePlanningAttorneys.us – 2 additional websites sponsored exclusively by the national ElderCare Matters Alliance.

21 “Mobile Friendly” Elder Care / Senior Care Directories

If you need help with any Elder Care / Senior Care issue, you can find the help you need in one of the following 21Mobile Friendly” Elder Care / Senior Care Directories. These Elder Care / Senior Care – specific Directories are sponsored by the National ElderCare Matters Alliance, an organization of thousands of America’s TOP Elder Care / Senior Care Professsionals who help families plan for and deal with a wide range of Elder Care Matters.

Debra K. Schuster, M.H.A., J.D.
Debra K. Schuster, P.C.
St. Louis, Missouri
An ElderCare Matters Partner

#eldercarematters


Medicaid Estate Recovery

What is Medicaid Estate Recovery and how can we find an attorney near us who can help us properly plan for Medicaid?

Answer:  Under federal legislation passed in August of 1993, OBRA 93, the federal government mandated that the states begin estate recovery for expenditures of Medicaid dollars. Under Medicaid regulations certain assets are exempt from consideration in determining Medicaid eligibility for nursing home care. Prior to estate recovery, a nursing home patient could retain exempt assets and pass them to his heirs following death. Under the estate recovery law, following the death of the nursing home patient who is receiving Medicaid assistance the state can force the sale of many of the exempt assets, including the principal residence, in order to repay the state for Medicaid dollars expended on the patient. Thus, absent proper planning, Medicaid eligibility may not save family assets from being exhausted on long term care costs. 

21 “Mobile Friendly” Elder Care / Senior Care Directories

If you need help with Medicaid Planning or with any Elder Care / Senior Care issue, you can find the help you need in one of the following 21Mobile Friendly” Elder Care / Senior Care Directories. These Elder Care / Senior Care – specific Directories are sponsored by the National ElderCare Matters Alliance, an organization of thousands of America’s TOP Elder Care / Senior Care Professsionals who help families plan for and deal with a wide range of Elder Care Matters.

Mitchell C. Payne, Esq.
Warner, Payne & Black
Rock Hill, South Carolina
An ElderCare Matters Partner

#eldercarematters


Medicaid Rules

What are some general Medicaid Rules that ALL families should be aware of?

Answer:  The following are some Medicaid Rules that all families in Florida should be aware of.  If you need Medicaid information specific to your state, please consult a qualified Medicaid Attorney in your area.  A list of qualified Medicaid Attorneys can be found on the 21 Elder Care / Senior Care Directories that are provided by the National ElderCare Matters Alliance – a professional alliance of thousands of America’s TOP Elder Care experts.

I am highlighting below the rules that most frequently come into play when processing a new Medicaid application in Florida. Remember that the Medicaid rules comprise 57 pages in total so if you have a question that is not covered in this handout, then please contact me or a Medicaid Attorney in your state.

Bank Accounts

All bank accounts should be held in the name of one individual, although, they may be held as payable on death accounts or in one name with an additional signor. Commingling of funds is prohibited as all of the funds in the account will be attributed to the Medicaid applicant. While it is possible to prove contribution, it is a headache that is best to avoid.

Whole Life Insurance Policies

Are excluded as assets so long as the cash value of the contract or contracts do not exceed $2,500.

Term Life Insurance Policies

Are excluded in total because term insurance does not have any cash value. In practice, both the Medicaid applicant and the Medicaid applicant’s spouse could have unlimited amounts of term insurance and none of the term insurance would be considered an asset of the Medicaid applicant or the Medicaid applicant’s spouse.

Funeral Expense Accounts

All funds for a funeral expense account should be held in a non-interest bearing account. Medicaid rules limit the size of the account to just $2,500.00, so no interest can be earned otherwise you will cause a potential loss of Medicaid benefits.

Joints Trusts between Husband and Wife

There should be no joint trusts at all. If the joint trust includes assets of both the Medicaid applicant and a non-Medicaid applying spouse, then all assets shall be considered to belong to the Medicaid applicant. It is best to eliminate the joint trust by eliminating the Medicaid applicant’s trust and placing all of the assets into the non-Medicaid applicant spouse’s trust subject to applicable asset limits established by current Medicaid requirements. If assets that would be held in the non-Medicaid applicant’s trust exceed the maximum asset limit for the year of application, then those excess assets will need to be converted into an exempt asset or into an annuity, which converts a countable asset into an income stream.

Transfers between Husband and Wife

All transfers between husband and wife are considered valid transfers and they will not create any period of ineligibility for Medicaid benefits. Of course, transfers that exceed the asset limit for the non-Medicaid applying spouse will either have to be converted into exempt assets or into an annuity.

Transfers between Medicaid Applicant and Third Party

All transfers between a Medicaid applicant and a third party, such as a child or some other third party, prior to applying for Medicaid will most likely create a period of ineligibility for Medicaid benefits, unless that transfer occurred further back then the look-back period currently used by Medicaid. In 2014, the look-back period was five (5) years prior to the date of Medicaid application.

Gifting Rules under Federal Estate and Gift Tax

Many people misunderstand that the gifting rules under the Federal Estate and Gift Tax do not apply when talking about gifts under the Medicaid rules. All gifts made during the look-back period for Medicaid applications are prohibited gifts and they are subject to a period of disqualification for Medicaid benefits unless a specific exemption to the transfer applies. The only Federal Estate and Gift Tax rule that applies in the Medicaid situation is that gifts between husband and wife are valid gifts for Medicaid purposes and they will not cause a period of ineligibility for Medicaid benefits unless the gift to the spouse exceeds the spouse’s asset limit that changes from year to year.

Retirement Funds (IRAs, Keogh & Employer or Union Control)

Are considered to be assets available to either a Medicaid applicant or the spouse of a Medicaid applicant. If regular payments are being made to the Medicaid applicant or the spouse of a Medicaid applicant, then it is no longer an asset but an income stream.

Prepaid Funeral Contracts or Irrevocable Burial Trusts

Must be irrevocable to not be considered as an asset.

Burial Expense Funds

A Medicaid applicant and his/her spouse may each set aside up to $2,500 for burial expenses. These must be separately identified as burial expense funds and they should be held in non-interest bearing accounts. These accounts can be in addition to excluded life insurance policies (see above) or irrevocable burial contracts.

Transfers

Any transfer without receiving fair compensation in return is considered a gift. The only exceptions are gifts to a spouse or a gift made to anyone prior to the look-back period.

Look-back Period

The current look-back period is five (5) years.

Purchasing an Annuity

When purchasing an annuity for the Medicaid applicant or the Medicaid applicant’s spouse, the contract may not be for a period longer than that individual’s life expectancy as determined by the actuarial tables used by the Social Security Administration.

Beneficiaries of an Annuity when Purchased for the Medicaid Applicant

The primary beneficiary of an annuity purchased for the Medicaid applicant must name the state of Florida (AHCA) as the primary beneficiary for the total amount of medical assistance paid on behalf of the Medicaid applicant unless the Medicaid applicant has a spouse or a minor or disabled adult child. In that case, the state of Florida shal l be named as the secondary beneficiary after the spouse and/or minor or disabled child. In addition, the annuity must be irrevocable and nonassignable, all payments of both interest and principal must be equal amounts during the term of the annuity, with no balloon or deferred payments, and, finally, the term of years can be no longer then the life expectancy of the individual to receive payments.

Beneficiary of an Annuity when Purchased for the Medicaid Applicant’s Spouse

The primary beneficiary of an annuity purchased for the Medicaid applicant’s spouse (called the Community Spouse under Medicaid terminology) must be the state of Florida (AHCA), except for when the spouse has a minor or a disabled adult child and, in that case, AHCA shall be named as secondary beneficiary after the minor or disabled adult child. This contract must be irrevocable and nonassignable.

Deferred Annuities versus Immediate Annuities

A deferred annuity (any annuity, which includes IRAs and Keogh plans)
that is not making current payments to the Medicaid applicant or the Medicaid applicant’s spouse) is an asset in the hands of the Medicaid applicant or the Medicaid applicant’s spouse. An immediate annuity (any annuity, which includes IRAs and Keogh plans) which is currently making monthly payments is considered an annuity stream and it is not treated as an asset in the hands of the Medicaid applicant or the Medicaid applicant’s spouse.

Transfer of Homestead Property

Is allowable if the individual transfers his home to his spouse or any of the following relatives:

1. A child under 21 years of age; or
2. A blind or permanently disabled adult child (Receipt of SSI or Title II Social Security disability is acceptable proof of disability. Otherwise a disability decision must be obtained in all situations, including adult children over 65. These policies apply to all blind/disabled adult children.);
3, A sibling of the individual who has an equity interest in the home and was residing in the home for at least one year immediately before the individual became institutionalized (the eligibility specialist must accept the sibling’s statement unless there is reason to question);
4. An adult son or daughter of the individual who was residing in the home for at least two years immediately before the date the individual became institutionalized and who provided care to the individual that delayed the individual’s institutionalization (the eligibility specialist must accept the son/daughter’s statement unless there is reason to question).

If the home is transferred to any individual not listed above, the transfer of assets policy is developed. The individual must be given the opportunity to rebut and gather data on the compensation received from the transfer.

After-Acquired Property

Once an individual is qualified for Medicaid it is entirely possible to receive a
lump sum amount of money from an inheritance or the result of a lawsuit (judge or jury award or a settlement (i.e. the Pradaxa cases). When this happens, it is imperative that immediate (within 10 days and also before the next month arrives) action must be taken or Medicaid benefits can be lost and it will still be necessary to take further Medicaid planning action. It is not the purpose of this FYI Tip to go into the solution at this point in time because the timing will vary for receipt of the funds and the solutions will vary depending upon what Medicaid qualifying actions have already been taken and what can and will be available to be taken at that time.

21 “Mobile Friendly” Elder Care / Senior Care Directories

If you need help with this estate planning matter or with any Elder Care / Senior Care issue, you can find the help you need in one of the following 21Mobile Friendly” Elder Care / Senior Care Directories. These Elder Care / Senior Care – specific Directories are sponsored by the National ElderCare Matters Alliance, an organization of thousands of America’s TOP Elder Care / Senior Care Professsionals who help families plan for and deal with a wide range of Elder Care Matters.

Medicaid Attorney
Ivan Michael Tucker, Esq.
Law Office of I. Michael Tucker, PLC
Altamonte Springs, Florida
An ElderCare Matters Partner


The Most Important Estate Planning Document

What is the most important estate planning document?

Answer:  The one estate planning document that everyone 18 and older should have is an Advance Health-Care Directive.  It is not the sexiest tool in the estate planning toolbox, but can head off family strife, heartache, and needless attorney’s fees in ways that no other document can.

The names Karen Ann Quinlan, Nancy Cruzan, and Terri Schiavo may ring a bell for you.  They were three beautiful young women whose legacies are protracted legal battles over how they would be cared for after they lost the ability to speak for themselves.

In Karen’s case, the issue was whether “medical treatment” includes life-sustaining measures (such as use of a ventilator to keep a person breathing), and whether those measures can be declined by a patient or someone acting on the patient’s behalf.  As the law evolved in this area, we learned that the answer is “yes,” under the theory that medical treatment must be consented to before it can lawfully be rendered, and a person has a right to consent—or withhold consent—to receiving life-sustaining medical treatment.  The ventilator was removed, but Karen lived another 10 years.  Although her parents did not believe the ventilator should be continued, neither did they believe that food and water should be withheld.

Nancy’s case took the analysis a step further when her family had to wrestle with the question of whether the array of medical treatment that can be refused includes the administration of food and water by way of a tube.  In that case, the battle was between Nancy’s family, who believed that Nancy would not want to be sustained on a tube, and the State of Missouri, who asserted that only the patient can make that decision.  Unfortunately, Nancy had never given written instructions about her wishes.  Ultimately, Nancy’s family presented sufficient evidence to convince the court that Nancy did not want to be kept alive on a tube, and food and water were withdrawn.  She died 13 days later, but eight years had passed since the car accident that had rendered her incapacitated and the legal battle over her care had begun.

Terri’s case involved the question of who has the authority to make end of life decisions on behalf of an incapacitated person.  The law of Florida, where Terri lived, automatically conferred that authority on her spouse.  When the dust cleared following the legal battle between Terri’s husband and her parents over whether her feeding tube should be removed, Florida law was upheld, and Terri’s husband gave the order that led to Terri’s death 13 days later.

What these cases teach us is that we have a right to say “enough is enough” when it comes to our medical care, including administration of food and water by way of a tube.  We also have the right to name who will speak for us when we cannot speak for ourselves.  The only way to be sure that your wishes will be known and carried out is by having a clear and comprehensive advance health-care directive.

21 “Mobile Friendly” Elder Care / Senior Care Directories

If you need help with this estate planning matter or with any Elder Care / Senior Care issue, you can find the help you need in one of the following 21Mobile Friendly” Elder Care / Senior Care Directories. These Elder Care / Senior Care – specific Directories are sponsored by the National ElderCare Matters Alliance, an organization of thousands of America’s TOP Elder Care / Senior Care Professsionals who help families plan for and deal with a wide range of Elder Care Matters.

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Estate Planning in Hawaii

Estate Planning Attorney in Hawaii

Scott A. Makuakane, Esq., CFP
Est8Planning Counsel LLLC
Honolulu, Hawaii
An ElderCare Matters Partner


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