Monday, February 28, 2011

3 tips to effectively talk to your senior parents about long term care options

Today’s  women are decision makers.  For some couples, the woman is THE decision maker, and there’s nothing wrong with that.  For example, in nearly 8 out of 10 cases where married couples purchase a vehicle, it is the woman who makes the final decision.  And because women outlive men by 5.4 years on average, women frequently make decisions that have long lasting effects upon their children, their spouse, and even their parents.

Today, I want to offer 3 tips to help open the lines of communication between parent and child when it comes to the difficult subject of long term care.

Tip 1: Explain that Elder Law Attorneys are Passionate About Their Clients – Elders!

Elder law attorneys have deliberately chosen a career in a specialized area of law to serve elders.  Moreover, Virginia Rules of Professional Conduct require lawyers to act in the best interests of their clients.  The client of an elder law attorney is the elder.  Not the child. 

Elder law attorneys are equipped to facilitate familial harmony; they place the client’s concerns at the forefront of any discussion, and they orchestrate a plan that can protect a nest egg from the catastrophic expenses of long term care and improve quality of life.  An inheritance is nice – and usually a much larger inheritance is a by-product of the plan devised by an excellent elder law attorney – but the first thing I explain to families I meet with is that the inheritance is not the focus.  The client’s quality and dignity of life is priority #1.

Tip 2: Gather Information with Parents in No-Pressure Environment

Parents love to do things with their kids, and adult children likewise value the time they have with their aging parents.  One easy way to spend time with your parents while gathering information is to attend a free seminar hosted by a local elder law attorney.  Don’t be afraid to research, communicate and explain important statistics to your parents.

Tip 3: Use Easy to Understand Statistics to Convey Your Message: 

Did you know that if you are over age 65:
  • you have a 7.2% chance of having an auto accident every year;
  • a 6.15% chance of needing to file a homeowner’s insurance claim; and
  • a 70% chance of needing long-term care?
Over half of those who need long-term care will require a nursing home.

Here is the statistic you must be concerned with:
  • 13% of drivers are uninsured;
  • 15% of homeowners are uninsured; but
  • 90% of senior citizens are uninsured and unprotected against long term care needs.
This means;
  1. 87% of people insure themselves against an event that has a 7.2% annual probability;

  2. 85% of individuals protect themselves against an event with a 6.15% annual probability; but

  3. Only 10% protect themselves from an event with a 90% probability!

Why is it important to plan for long term care?  Primarily because the expenses of long term care are catastrophic and can wipe out a nest-egg in less than a year.  50% of couples and 70% of singles are impoverished (broke) after one year of entering a nursing home.

Medicaid is a government program meant for those who plan for it.  I encourage you to attend a free seminar on the subject, as it is shocking that so many smart people do not realize that Medicaid – not Medicare – can be used to pay for long term care.

One common misconception is, “We don’t need to plan for our long term care yet, we’re only 65.”  Almost half of all long-term care claimants are under age 65 at the time of disability.  Every day that goes by without a plan, the family is risking possible delay or even forfeiture of government benefits that are meant to pay for catastrophic long term care costs.

Talking to your parents about their long term care options can be understandably difficult, and no other generation has had to simultaneously balance so many familial responsibilities at one time.  But there is a new breed of estate planning and elder law that takes a family-friendly, solution-based approach making it easier to discuss difficult subjects.

Photographer: graur razvan ionut

Thursday, February 17, 2011

Age Related Macular Degeneration: What to Look For

"Approximately 10% of patients 66 to 74 years of age will have findings of macular degeneration. The prevalence increases to 30% in patients 75 to 85 years of age." Source.

"Age-related macular degeneration (AMD) is a disease associated with aging that gradually destroys sharp, central vision," the National Eye Institute explains in its article, "Facts About Age Related Macular Degeneration." 

Since AMD is a common problem for Seniors, it is important for Seniors to understand what to look for. 

First, you should know what "Drusen" means: "[Drusen are] yellow deposits under the retina. They often are found in people over age 60," says the article.

For individuals who have noticed numerous small drusen, or medium sized drusen in smaller amounts, they should realize this may be a signal of "early AMD" even though they aren't experiencing vision loss or other symptoms.

Larger numbers of medium-sized drusen or even one large drusen may be suffering "intermeddiate AMD."  If an individual needs to use more light than usual.

For people with blurred spots in their vision, difficulty reading, or many large drusen, "advanced dry AMD" may be the issue.
Photographer: Salvatore Vuono

Thursday, February 10, 2011

Sign placed over a patient’s bed reads, “I Am Somebody’s Sweetheart”

The month of February and Valentines Day brings a celebration of love and stirs couples to rekindle feelings of romance and devotion. Not so different from young couples are aging seniors, celebrating memories of sweethearts and romance in days gone by.

Sit a while with a senior couple and they will soon be telling you their romance story or listen to a widow or widower as they sing their favorite love song from their youth.

Dementia and Alzheimer’s can rob senior minds of many of these treasured memories, changing their personality and life style. Because of these and other illnesses, many seniors end up in nursing homes or care facilities where only their basic physical needs are cared for by the facility staff. To these seniors, Valentines Day becomes no different from every other day. They often find it difficult to relive memories of the past. In one care facility a sign placed lovingly over a patient’s bed reads, “I Am Somebody’s Sweetheart,” as if to say I once dreamed, lived and loved, please treat me kindly.

When asked how she relates to those she cares for, nurse assistant Karen W. replies that most of the time it's those patients who are causing a disturbance or may be in danger of harming themselves who are the ones that get her attention. Even then she can only take care of the immediate problem. Very seldom has she time to personally get to know well all the elderly people she cares for.

Although this is true with many facilities, the need for more personalized care is, in some cases, being recognized. Assisted living facilities with specialized memory care programs -- some using art, music and dance or physical activities -- are finding great success with increasing the quality of life for those suffering from dementia and Alzheimer’s. Many care facilities across the nation are adding these programs to better serve their residents.

If you cannot find a facility in your area that provides this special attention, home care may be a better option.
Consider this real experience. When Nora would visit her father in the nursing home she would find him sitting, slumped over and disinterested in his surroundings. By the time she and her young children finished their visit, he was alert and talking to them. Feeling he would do better in her home environment, Nora enlisted the services of a Geriatric Care Manager to evaluate her father and determine what would be needed for his care at home so that he could get the social stimulation that he needed.

A Geriatric Care Manager can be a valuable asset to family members when it becomes necessary to look at alternatives for their loved one's long term care. They work with all members of the family in educating about resources and making decisions. Some services provided are.
  • Make an assessment about the type of care need
  • Develop a care plan for care both current and future care
  • Work with physicians in getting medical support
  • Find home care services that work with the families needs
  • Provide assistance with legal and financial issues
Appropriate home care services are also often necessary when a change in environment is called for. Home care services vary, depending on what is needed, and may change as caregiving requirements change in regards to the physical or mental health of the elderly person.
Types of Home Care are:
  • Home health care companies: provide nurses, physical therapists, social workers and aides that assist with basic health care such as changing bandages, taking vital signs and helping with medication as well as a host of other skilled needs.
  • Non-medical home providers: help with bathing, dressing, meals, ambulating, chores, errands, housekeeping and much, much more.
Home care personnel are skilled in working with the spouse and extended family members of their ailing loved one to provide needed services and support in the home. They add consistency in the care and are available in time of crisis or need to add additional services.

With help from her Geriatric Care Manager, Nora brought her father to her home for his care. The care manager worked with her father’s doctor, prescribing a physical therapist and nurse's aid to come to the home. A non-medical home care company was employed to help with daily bathing and dressing.

Another resource available to families, which is not used as often as it should be, is hospice. Hospice care is provided in the home or in a hospice facility, hospital or nursing home. When illness is terminal, hospice service is provided by a team which includes doctors, nurses, grief counselors, aides and social workers as needed. These services can be provided at no out-of-pocket cost by Medicare.

In her internet article Naomi Naierman, President and CEO of the American Hospice Foundation states:
“As a Medicare beneficiary, you are entitled to the Medicare Hospice Benefit without additional premiums. If you are enrolled in a managed care organization (MCO) you have access to this benefit, even if the MCO does not cover hospice services.
The Medicare Hospice Benefit covers the following hospice services in full:
  • Skilled nursing services
  • Volunteer Services
  • Physician visits
  • Skilled therapy
  • Home health aide visits
  • Medical social services
  • Spiritual counseling
  • Nutrition counseling
  • Bereavement support for the family”
There is a growing market for care providers throughout the nation to fill the need of senior care services.  Assisted living, home care and hospice care, geriatric care managers and geriatric clinics are all just part of these services.  The National Care Planning Council supports family caregivers with information and resources of all types of long term care services on its website:

"Somebody’s Sweetheart" may be in need of your loving care someday and help is available to reduce your burden and ease the journey.

Photographer: m_bartosch

Wednesday, February 9, 2011

Elder mediation: is it right for your family?

“My daughter is insisting I move in with her,” complains Martha. “She just wants to control my life and take away my freedom,” she continues. Jenny, Martha’s daughter worries that her mother keeps falling, and fears one day she will break her hip or hit her head.

“I’ll take my sister to court before I will let her get control of mom and my inheritance,” exclaims Jim about Jenny’s desire to move her mother in with her.  It is amazing how quickly formerly cordial relationships between family members will sour when the family has to deal with care of elderly parents or inheritance at their death. Sometimes the consequence of dealing with the final years of elderly parents can break families apart and create long-lasting animosity.

The National Care Planning Council has seen an increase in requests from caregiving children for help in solving disputes with siblings. In one case, the caregiver was being sued by her sister for abusing their parent and stealing the Social Security checks. In another, the caregiving child would not allow siblings to see their mother, claiming they would take advantage of her.

A lot of times it is a “she said,” “he said” situation with neither party really understanding what the elder person needs or wants.

Some families find it hard to communicate with each other when their parent is in need of care. Perhaps when they grew up together they were not accustomed to come together as parents and children to work out problems. And now those children are older and taking care of parents and they don't have this family council strategy to rely on. It may seem unnatural to them. But that is often exactly what is needed, especially in situations where perhaps one child is caring for the parents and the others are left out of the loop.

Children all have a common bond to their parents and as a result a common obligation or responsibility to each other. When disagreements arise, suspicions begin to grow. Suspicions or distrust often lead to anger and the anger often leads to severing the channels of communication between family members. This can occur between parent and child or between siblings or between all of them.

It is often at this point that a neutral third party can come in and repair the damage that has been done and help correct the problems that have come about because of the disagreement.

A practitioner experienced in elder mediation is a perfect choice for solving disagreements due to issues with the elderly.

Mediation is a non-adversarial approach to solving disputes. Mediation is a process of bringing two or more disputing parties together and having them mutually negotiate a solution to their disagreement. The mediator is not a judge and does not render a decision but is there to make sure that communication flows freely between the disputing parties. Elder Mediators are trained in the art of negotiating resolutions between elderly parents and family members.

Mediation can achieve results that the family by itself may not be capable of realizing or have the expertise of achieving. Here are some reasons that make Elder Mediation so valuable.

• A trained expert on communication gives the family a perspective it could not gain by meeting together on its own;
• All family members involved meet and prevent problems from arising by anticipating situations that may cause disputes;
• Allows for the mediator to invite experts such as care managers or other care providers into the meeting to educate the family and give them a new perspective;
• Allows parents to focus on their abilities rather than their limitations;
• Allows children to come up with and consider options not thought of previously;
• Encourages uninvolved family members to become involved;
• Allows parents to express wishes and desires that had previously gone unuttered;
• Allows for a neutral third party to challenge family members and make them take responsibility for their actions;
• Promotes consensus of all involved which in turn creates a much higher rate of compliance with the plan than with any other process; (the success rate for compliance with elder mediation is estimated to be about 80% to 85%)
• Requires a written plan with specific responsibilities which makes compliance feasible.

There are many organizations and companies throughout the country providing expertise in “Elder Mediation” to help seniors and their families. You will also find that mediators often have many coincident professional accreditations such as, Professional or Geriatric Care Manager, Elder Attorney, Clinical Social Worker or Certified Mediator.

In choosing a mediator, consider your needs. Is there a need for a medical assessment to determine the type of care? Are legal concerns with inheritance or family business or power of attorney, the main need? Perhaps, just bringing the family together to communicate on what needs to be done and who will do it is the agenda for now.
In one case, after months of dispute with her parents over their health and safety issues, Connie enlisted the service of a professional care manager mediator.

“Bringing a neutral person with a professional and compassionate attitude into our disputes was the best thing for all involved,” Connie recalled. “My parents shared their concerns and listened with acceptance to mine.
All of a sudden we could communicate and work out a plan that they could live with and I could relax knowing they were safe.”

Seniors Use Mediators to help the family plan for long term care.
In the National Care Planning Council's book, “The 4 Steps of Long Term Care Planning,” the process of creating your own “Care Plan” before you need it is introduced. Quoting from the book:
“If the current or future caregiver wants the other persons attending the meeting to give support with respite care, transportation to doctors, etc., everyone needs to be aware of this and in total agreement to do it. All must also be willing to work with the member of the family, friend or professional who is designated as the Personal Care Coordinator.

If you feel the communication will be strained, consider having a professional mediator present. The mediator will be able to keep things calm and running smoothly
and help work out each person's concerns.”

“The 4 Steps of Long Term Care Planning” book can be found at

Where to Find an Elder Mediator
• In your local phone book, on the internet or with your community senior services.
• References from friends and neighbors
• Contact the local area agency on aging
• Contact your state bar association
• Contact a local university or college and asked to speak to the department that provides mediation training and ask for a referral.
• On the internet look up mediation in your area
• Yellow pages in local phone books

The National Care Planning Council lists Professional Mediators throughout the United States on its website at
List your Elder Mediation service
National Care Planning Council

Photographer: Vlado

Tuesday, February 8, 2011

Reverse mortgage questions after BofA makes big announcement

Since 2007, my opinions on reverse mortgages have been mixed.  Today, I re-examine my previous articles and prior concerns, due to Bank of America’s monumental announcement Friday that it is exiting the reverse mortgage industry.

Initially, I was strongly optimistic about the use of reverse mortgages by senior citizens.  However, over the past year I have been forced to retract much of my praise due to problems (and possibly discrimination) faced by some of my own clients.

In my first article, back in 2007, I explained why I thought (at the time) that many seniors ought to familiarize themselves with the basic advantages of a reverse mortgage.  My second article came almost three years later in early 2010, in which I took the previous article a step further.  Using a Reverse Mortgage to Pay for Home Care expounded upon the possible benefits to seniors who elect to take advantage of a reverse mortgage.  But my enthusiasm was short-lived.

My feelings towards the reverse mortgage industry turned for the worse by the time I wrote my third article, Huge Problem with Reverse Mortgage Industry, in which I stated my concerns with a seemingly industry-wide practice of second-guessing the legitimacy of crucial power of attorney (POA) documents.  I wrote about how two of my clients’ agents, both of whom used a different reverse mortgage lender, were met with a lender’s refusal to honor the POA needed to commence the application process.  They were told to go on what could be referred to as a scavenger hunt – to obtain a letter declaring the mental competency of the applicant when the POA was signed, and a second letter stating the applicant is now not mentally competent.  By the end of the article, I concluded that because of the arbitrary and capricious roadblocks imposed by the reverse mortgage lender in connection with the use of the POA, a child acting as the parent’s agent may be more likely to sell the home and place the parent in a nursing home.  This result is a far cry from the user-friendly tool I anticipated.

In my most recent article, Reverse Mortgage Rules Changing Again, I reported on more problems – this time on new laws which would increase expenses for seniors including an increase in the Mortgage Insurance Premium.  Today, I would like to follow up and comment on these concerns.  I also think it necessary to offer my thoughts on a tell-tale strategic move, announced by Bank of America on Friday, that it will withdrawal from its once-thriving reverse mortgage business.

The Power of Attorney Problem

My first concern – second-guessing POA documents at the expense and delay of law abiding clients – has hopefully been remedied, at least in Virginia, by way of enactment of the Uniform Power of Attorney Act, codified by Virginia Code Section 26-71.01.  The law creates safeguards to keep the POA flexible yet effective, balancing flexibility with prevention of financial abuse.  Below I have outlined some important changes:
Durability: A POA is now considered automatically “durable” unless it expressly states otherwise.  “Durability” is desirable in most cases, because it allows the POA to remain effective even in the event of incapacity.

Photocopies: Photocopies of an out-of-state POA will be treated as an original.  The purpose here is to encourage acceptance of POA documents both in Virginia and elsewhere.  This public policy underscores the importance of incapacity planning as recognized by the Commonwealth of Virginia.

Protection to Accept: If a notarized document is accepted in good faith, then the person who accepted it is protected from liability so long as they possess no actual knowledge relating to a problem with the POA, or the agent’s authority.  But note: the principal’s signature must be genuine for this protection to be operative.  Businesses are protected so long as they use “commercial reasonableness” with regard to employer-employee communications and POA-related instructions.

Accepting/Rejecting a POA: If a third party refuses to accept a POA and the refusal does not fall within the safe harbors provided by the law, then the third party can be ordered to accept.  More significantly, there is potential liability for costs and fees.  If a third party is presented with a POA, he or she has seven business days to take action.  By taking action, I mean the third party must accept it or request a certification, translation, or opinion of counsel.  After the request is satisfied, five additional days are granted to the third party to accept.

What About the Expense Issue?

In my last article, I quoted a Reverse Mortgage Consultant with MetLife Bank, noting that “HUD’s ongoing Mortgage Insurance Premium will be increasing from 0.5% to 1.25% (a 150% increase!), and that the size of new HECM reverse mortgages will shrink anywhere from 1% to 5% depending on the applicant’s age.”
Unfortunately, this issue persists.  According to Money Watch, “[L]ast year’s annual audit . . .  revealed that the [Federal Housing Administration] had fallen below the 2 percent capital reserves required by Congress.” As a result, the FHA proposes to increase the mortgage insurance premium from 1.75% to 2.25%, and will seek approval to raise the annual mortgage insurance premium from its 55% level.  This affects millions of Americans, as the above article notes that the “FHA has become the only lender available for many Americans.  Over the past few years, FHA has gone from insuring around 3 percent of loans to more than 25 percent.”

While the problems associated with POA acceptance may be eradicated if entities abide by the laws and understand its safe harbors, the problems of rising expenses for seniors and the uncertainty of the industry live on.

What is Really Going on with Bank of America?

Doug Jones, Consumer Sales and Institutional Mortgage Services executive for Bank of America Home Loans said the Bank made a “strategic decision to exit the reverse business due to competing demand and priorities that require investments and resources [to] be focused [elsewhere].”  At least for existing Bank of America Reverse Mortgage customers, this decision will not affect their service, as Jones explained, “[Bank of America] fully understand[s] the critical sensitivity of ensuring that our senior customers are provided with the same level of excellent customer service that we have provided in the past.”

Bank of America Home Loans entered the Reverse Mortgage Business five years ago in 2006 and grew quickly after its acquisition of Countrywide Financial and Reverse Mortgage of America, but that growth has now been hampered by bigger problems within the bank.

“What’s really going on here?” The Bank of America decision comes in the wake of bad press related to its conventional mortgage business, and peaked recently when a temporary restraining order was issued January 20 of this year against ReconTrust, a subsidiary of Bank of America.  “ReconTrust is trustee on thousands of loans that are in some stage of foreclosure and approximately 8,920 of such loans have already been directly affected by this injunction,” reported the Las Vegas Sun.   The order was issued based on a woman’s suit against Bank of America for “fraudulently trying to foreclose on her home,” as reported by The Street.  According to a motion filed by the bank, “[The order] has created enormous upheaval and confusion in the foreclosure process across Nevada and immediate review is required.” The order forbids the foreclosures of thousands of Nevada properties until a hearing takes place, scheduled for February 28.  Is the Bank allocating resources away from reverse mortgage operations in order to ensure that its larger, conventional mortgage business does not falter amidst this corporate crisis?

To give credit where credit is due, this past September, Bank of America became the first loan servicer to voluntarily suspend foreclosure sales in the United States while it evaluated its procedures.  As a result, it promised to improve its “staffing, customer impact, and quality controls,” reported Mortgage Professional Magazine.

Not shockingly, the Bank of America ruling is producing conflicting views and will continue to do so until the issue is resolved, as evidenced by some noteworthy public comments.  Some are calling for more responsibility on the part of borrowers, echoing rhetoric that has been commonplace since the start of the recession: “Pay your obligations and you would not have these problems. I am tired of everyone blaming the banks,” one person posted.

Mortgage Electronic Registration Systems (MERS) have been pointed to as potential vehicles to commit  alleged tax and recording fee evasion.  This system for recording was “[c]reated by the real estate finance industry, [and] eliminates the need to prepare and record assignments when trading residential and commercial mortgage loans.” But in response to the consumer-responsibility argument above, one commentator blames seedy practices related to MERS instead:
The big point you are missing is that all of these banks used [Mortgage Electronic Registration Systems] as a method to not pay taxes and recording fees in every county and state in the United States. So even if you are paying your payments on time, you could still have a clouded title to your home because your mortgage and deed of trust were never properly recorded by any of the major banks that used this system.
Chris Dodd (D-CT), Senate Banking Committee Chairman, has been actively searching for answers, as indicated by the November oversight hearing titled, “Problems in Mortgage Servicing from Modification to Foreclosure.”  The purpose of the hearing, according to National Mortgage Professional, was to hear from industry representatives, state representatives, and consumer protection experts on how modifications and unjust foreclosures could have been prevented.

The problems addressed at the hearing: servicers that struggle to meet demand,  cases of lost paperwork, allegations of self-dealing, failure to record transfer and ownership of notes and mortgages, failure to maintain custody of title, and failure to establish or administer mortgage trusts lawfully.

Virginia Updates

Virginia Lawyers Weekly noted on its blog today that  SB 837 remains a possible foreclosure reform bill,  and it would create a civil cause of action against those who knowingly use a false document in support of a foreclosure.  But other bills failed miserably.

A reform with more teeth, SB 798, sought judicial review of foreclosures.  Virginia’s current deed of trust system allows for a trustee to foreclose on a property without supervision of the court.  Don McEachin, D-Richmond was patron, and was unwilling to allow a group created by Gov. Bob McDonnell to control the bill’s future.  Why no trust?  VLW reports that according to at least one consumer lawyer, McDonnell’s group does not represent homeowner or consumer interests, but instead represents banking interests.  McEachin requested an up-or-down vote and the bill is likely going nowhere.

Also going nowhere is SB 838, which relates to the mentioned Mortgage Electronic Registration System flaws.  The bill would have called for stricter recording requirements.

With Bank of America out of the reverse mortgage equation and with the new Uniform Power of Attorney Act in effect in Virginia, only time will tell if the battered mortgage industry as a whole will fully recover in the foreseeable future.  For now, I can only advise individuals to ask as many questions as they can and to potentially consider other alternatives.

Options such as refinancing a mortgage, obtaining a home equity loan, or taking personal loans come to mind as alternatives to a reverse mortgage, but the major drawback to the above three options compared to a reverse mortgage is that they are associated with income and credit score qualifications and must be paid back within a given time period.   I will provide updates as they develop and can only hope reverse mortgages become the efficient, user-friendly tool they once were.

Photographer: Salvatore Vuono

Monday, February 7, 2011

Reverse Mortgage Industry in Trouble?

I’ve written several times over the years on the topic of Reverse Mortgages.  My first article explained the concept and requirements of a Reverse Mortgage and how seniors can use a reverse mortgage. 
My second article, entitled Using a Reverse Mortgage to Pay for Home Care, explained how the Reverse Mortgage can be used as a tool to help seniors stay in their homes and age in place. 

My third article, entitled Huge Problem with Reverse Mortgage Industry, raised a nationwide alarm about how the reverse mortgage industry is “shooting itself in its collective foot”  by routinely second-guessing the legitimacy of every power of attorney document and therefore imposing unnecessary obstacles for, and sometimes turning away, the very people who need a reverse mortgage the most — those frail elders who are unable to care for themselves but wish to remain at home and age in place rather than being forced to sell their homes and move into a long-term care facility. 

In a major move, Bank of America has now announced it is backing out of the industry.  Check both this blog and the Virginia blog later today for an update.  For the time being, you can read this series of articles  below:

Friday, February 4, 2011

Changes occur in way older bodies handle pharmaceuticals

At 83 years old, Martha still lived in her own home, and enjoyed working in her garden and canning peaches. It was becoming harder to motivate herself, to get up in the mornings and achieve the day's tasks. She disclosed to her daughter that she felt anxious and exhausted. Her daughter, who was taking medication for her anxiety, took Martha to her own doctor, not Martha's and got her a prescription for Valium. In doing so, the daughter's doctor, who had never seen Martha and who did not have her medical history, was only aware of a few medications they told him she was taking.

Martha, in fact, was taking 9 different medications as well as herbal supplements.  The addition of Valium to her existing list of prescribed drugs sent her to the emergency room with respiratory distress. If she had gone to her own doctor, he would have found that a dosage adjustment of her current medications would have solved her anxiety.

Medication errors are common in the elderly. Many seniors take on average 6- 8 different prescriptions as well as over the counter drugs. Many times the elderly will not go back to their doctor to have their dosage evaluated and changed if necessary. Family members should be aware, that elderly parents may tend to take the family's advice over going to their own doctor. Even though children want to help increase the health and stamina of their parents, they may in fact be causing damage by misdirecting their loved ones.

Where a younger person can benefit from herbal supplements like Ginkgo Biloba, Saw Palmetto and others, in older people, these herbals may cause adverse reactions with their prescription medications.

In 2003, a panel of experts put together a list of potential medications that would not be appropriate to give to seniors. This is called the “ Beers List ” after one of the research professionals.

Dr. Donna M Fick, R.N. one of the panel members for updating the “Beers List,” states in her article on  
Just as our bodies physically slow down as we age, changes occur in the way that older bodies handle pharmaceuticals, and this has motivated experts to develop a list of drugs that may be harmful to elderly patients. 
"With age, drugs tend to build up in the body, and the distribution and elimination of drugs from the body changes as well," says Dr. Donna M. Fick, R.N., associate professor of nursing at Penn State. "Many drugs, like diazepam (Valium) and other anti-anxiety drugs build up fast." 

An on-line article on, Titled "Drugs and the Elderly," talks about physical symptoms and medications.  
“ Among the first signs that a drug may not be working properly in an older person is a change in mood, energy, attitude, or memory. Too often, these alterations are overlooked, ignored, or chalked off to "old age" or senility. Older people may themselves feel that their blue mood is caused by something external such as the death of a friend or simply by boredom. Nothing could be farther from the truth. Virtually every heart medication, blood pressure drug, sleeping pill, and tranquilizer has been known to trigger depressive symptoms.
When a psychological symptom appears in an older person, examine his or her medication or drug use first. Consider, too, factors like alcohol intake, poor nutrition, and hormone imbalance. And never dismiss the possibility that a real psychological problem has developed and may itself require medication.”
There are many things family members can do to help monitor medications for their elderly parents.
  • Make a list of medicines prescribed and all supplements being taken.
  • Give this list to the doctor and pharmacist and have one on hand for emergencies.
  • Use the same Pharmacy to fill all prescriptions. Pharmacies keep a record of your prescribed drugs and will verify your doctor's instructions. They will also tell you if foods or over the counter supplements will interact with a prescription.
  • Dispense pills in a daily pill organizer box.
  • Have a family member be responsible to call or physically monitor the taking of medication
Family members who live long distances from their elders have available to them new technology in medication monitoring.  
  • Alarms for pill boxes, watch alarms, medical alarm bands and necklaces that ring a reminder.
  • Computerized pill box dispensers that ring a designated number if the pills have not been taken.
  • Home Telehealth -
Technology has developed computer and computer cameras to help the elderly in their homes stay safe and healthy. Home telehealth-set up by medical professionals in the home--enables providers to monitor such things as medications and blood pressure and actually see the patient. Patient questions are answered and advice is given, while the monitoring nurse views through the video phone how his or her patient looks physically.” The 4 Steps of Long Term Care Planning, Pg 92  
  • Home Care Agencies – Home care companies offer a variety of service options in helping families care for and properly dispense medication to their elder parents.
Find a home care agency in your area
Overmedication or taking medication incorrectly may lead to early mental confusion and decline in health in seniors. “If medication problems were ranked as a disease in cause of death it would be the 5th leading cause in the United States”. (from article on LongTermLiving)

Image credit: Photographer: hinnamsaisuy
Photographer: africa 

Thursday, February 3, 2011

Parents of Special Needs Kids: Getting Help From Others Without Forfeiting Federal Benefits

Did you know that in the U.S. alone, about 200,000 people under the age of 65 require long term care?  In the D.C. Metro area, about 40,000 children are considered "Special Needs."

Many families are unsure how to plan financially when they first are faced with news that a child with special needs is on the way.  More on that later -- first we'd like to point out a state-of-the art facility called Jill's House that is creating quite a buzz locally:
Jill’s House will offer an exceptional experience for children with special needs.  There will be activities within the music, art, and computer rooms; in the indoor pool; on the outdoor playground; and within the three unique lodging areas all designed especially for children with special needs. - Jill's House
 For parents and caregivers of Special Needs children who require either short and intermittent care or long term care, everyday tasks can be draining.  If day-to-day efforts seemingly go unnoticed, remember the words of poet Heather Cortez, "To the world you may be one person, but to one person you may be the world." 

What qualifies a child as a "Special Needs" child?  The term is used broadly as illustrated by this information guide: "Pick any two families of children with special needs, and they may seem to have little in common." 

Parents of Special Needs children need to plan for their financial future carefully, although when faced with shocking news regarding a child, it is completely normal to be in an emotional state of disarray.  Meet Jason and Amanda:
Jason and Amanda Purnell met while getting their Ph.D.s in psychology at Ohio State, married in 2007, and were ecstatic when Amanda became pregnant shortly before they moved to St. Louis last July to be near family. Then they learned that their 22-week-old fetus had Down syndrome. They were shocked -- at 29, Amanda was well below the at-risk age to conceive a baby with this condition. "The first 24 hours, I was inconsolable.
 "We know we'll be financially supporting Maya for the rest of our lives," Jason tells CNN.

What should a Special Needs family do to prepare?  At least three measures should be strongly considered, some obvious and others not so obvious: Save as much money as possible, plan for 3 retirements, and consider a special needs trust.

For example, the family mentioned above created a trust but it won't be operational until both spouses are dead.  This can be problematic if friends or family members want to contribute to the child's care during her life.  This can be accomplished through a special-needs trust and can even work without risking the loss of federal disability benefits.

For much more information on Special Needs  trusts, click here.

"Anyone can give up, it's the easiest thing in the world to do. But to hold it together when everyone else would understand if you fell apart, that's true strength." 

Image Credit: Dan

Wednesday, February 2, 2011

How to spot elder abuse, neglect, and exploitation

Many elderly people rely entirely on family or other trusted individuals to help them. Whether it is for physical needs or emotional needs, as people grow older they tend to need more and more help from others. This dependence on caregivers or family members makes an older person more susceptible for abuse.

There are a number of reasons why incidents of abuse, neglect, or exploitation are not reported to Adult Protective Services or other authorities. One of the most common reasons is the victim's fear of losing support. 

Many of the perpetrators are family members and the victim fears that reporting the crime will result in removal of the caregiver, as the perpetrator may face incarceration or may discontinue relations with the victim once accused, charged, or convicted. Many of these victims fear that by reporting abuse they will be left alone and expected to care for themselves or they will be forced to live in a nursing home.

The following is a list of indicators of abuse, neglect or exploitation

It is important to note that the following lists are merely indicators and may not always be violations.

Signs of Abuse: 
•             Unexplained bruises, welts, fractures, abrasions or lacerations
•             Multiple bruises in various stages of healing
•             Multiple/repeat injuries
•             Low self-esteem or loss of self determination
•             Withdrawn, passive
•             Fearful
•             Depressed, hopeless
•             Soiled linen or clothing
•             Social Isolation  

Signs of Neglect/Self-Neglect: 
•             Dehydration
•             Malnourishment
•             Inappropriate or soiled clothing
•             Odorous
•             Over/under medicated
•             Deserted, abandoned or unattended
•             Lack of medical necessities or assistive devices
•             Unclean environment
•             Social Isolation  

Signs of Exploitation: 
•             Missing/"disappearing" property
•             Inadequate living environment
•             Frequent/recent property title changes or will changes
•             Excessive home repair bills
•             Forced to sign over control of finances
•             No/limited money for food, clothes and other amenities 

Prevention can only occur if there is awareness, the statutes are adhered to, and any suspicions of abuse, neglect or exploitation of vulnerable adults are immediately reported to Adult Protective Services and/or law enforcement.

All states have agencies that take complaints of abuse. In some states failure to report abuse of the elderly is a crime. To contact an abuse complaint department, call your local area agency on aging. To find an area agency on aging in your area go to Long Term Care Link

For resources from the National Center for Elder Abuse, click here.  For state fact sheets, click here.

 Image: Photographer: Salvatore Vuono

Tuesday, February 1, 2011

Premarital Issues in Second Marriages

A client who is considering a second (or third or more) marriage often has more complicated estate planning needs than a single client or a client who has been married only once. A premarital agreement can be key to protecting a client's assets, but the attorney must make sure the agreement is integrated with the client's estate plan. At the National Academy of Elder Law Attorneys' 2010 Elder and Special Needs Law Annual Meeting in Orlando, Florida, earlier this year, Virginia estate planning attorney Martin J. Ganderson discussed how to plan for a second marriage and outlined the various estate planning issues that premarital agreements must take into account.

In a second marriage, a client may want his or her children, rather than the spouse, to be the beneficiary on a retirement account. Under ERISA, however, the spouse is entitled to the benefits unless he or she voluntarily waives them. A premarital agreement can address this by stating that the spouse gives up all rights to retirement accounts. Nevertheless, Ganderson stressed the importance of following up with the client after the marriage to make sure the spouse actually signs the forms waiving that right.

If the spouse remains the beneficiary of a retirement account, the premarital agreement needs to address what to do with the account in the event of divorce. The spouse can sign a form that renounces the right to the retirement plan in the event of divorce, but Ganderson cautioned to be careful how that waiver reads. The wavier should allow the owner of the policy the right to change the beneficiary as much as he or she wants without getting approval from the spouse each time.

Premarital agreements are void under only two circumstances: The agreement was not voluntarily executed or the agreement is unconscionable and one party did not have full disclosure of assets. To prevent a void agreement, Ganderson addresses future assets as well as current assets in the premarital agreement. He has the client get a financial statement from a CPA so that his or her finances are out in the open. In addition, before the signing of the premarital agreement, Gunderson has both parties sign a statement waiving any further disclosures.

Avoiding Conflicts Involving the House

One area where it is crucial to make sure the premarital agreement is integrated with the estate plan is with regard to the residence. For example, while many premarital agreements provide that the surviving spouse may remain in the residence, the house may be in a revocable living trust that goes directly to the children. To avoid such conflicts, Ganderson tries to have the estate plan completed before the marriage.

One option for clients who want to allow a surviving spouse to continue to reside in the home is for the wealthy spouse to set up a trust to provide for maintenance on the house. Many clients put restrictions on the surviving spouse's right to stay in the house. For example, a wife may allow a husband to remain in the house as long as he doesn't bring a member of the opposite sex into the home to spend the night. When it comes to the house, Ganderson stressed that it is important to be as specific as possible in the premarital agreement.

POA and QTIP Issues

A general power of attorney also must be integrated with a premarital agreement. The power of attorney can frustrate even the best agreement by allowing the attorney-in-fact to gift away the client's assets. Ganderson recommends making sure that the attorney-in-fact does not have the power to amend the premarital agreement. Ganderson also suggests that if the client's estate plan includes a revocable trust, the trust agreement should provide that the attorney-in-fact does not have authority to amend the trust.

If a client's estate plan includes a Qualified Terminable Interest Property (QTIP) Trust, the client will need to consider whether the principal of the trust can be invaded for the benefit of the spouse. If the principal can be invaded, Ganderson suggests requiring the spouse to provide a financial statement to prove the need for the principal, or risk being cut off from the trust completely.

Other issues that need to be addressed up front with the client when doing estate plans and premarital agreements for second marriages include whom to name as a health care agent and whether there is a duty on one spouse to support another if nursing home care is needed.

The attorney's job is not done once the client ties the knot. Follow-up is often necessary to make sure the client follows through on agreed-upon items. For example, if a premarital agreement addresses how assets are going to be titled, Ganderson explained that it is important to check back with clients after they are married to make sure they actually change the title.

To order the streaming video of this and other sessions from the Orlando meeting, as well as accompanying session materials, visit NAELA's Web site,, and click on the Online Education Library tab under Events.
Image: kongsky /