New Change for Special Needs Trusts

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On December 13, 2016, the President signed into law the 21st Century Cures Act. Section 5007 of this Act affects the Special (or Supplemental) Needs Trusts, dealing specifically with the d(4)(A) Special Needs Trusts. A d(4)(A) Special Needs Trust is a trust created for the sole benefit of someone under the age of 65 who is disabled. The d(4)(A) Special Needs Trust is established by the beneficiary’s parent, grandparent, legal guardian, or the court, and it is funded with the beneficiary’s own assets.  This type of trust must include repayment language, which states that any remaining assets at the beneficiary’s death must go to any state Medicaid agency (up to the amount paid by the state for the beneficiary under the Medicaid program).

For d(4)(A) Special Needs Trusts created before December 31, 2016, the trust has to meet the following requirements to be valid:

  • The trust contains the assets of an individual who is under 65 and disabled.
  • The trust is established for the benefit of the individual through the actions of a parent, grandparent, legal guardian, or a court.
  • The State will receive the remaining amount in the trust after the individual dies up to an amount equal to the total Medicaid assistance paid on their behalf.

With the new Act signed into Law, an additional provision has been added to the requirements for d(4)(A) Special Needs Trusts (dated after December 31, 2016). Now, the trust can be established for the benefit of the individual through the actions of the individual, parent, grandparent, legal guardian, or a court. All other requirements still apply. This is good news for those who may utilize this type of trust for their disabled loved ones! Our firm specializes in Trusts and Estates. We would be happy to help you create this trust for yourself or a loved one who is under 65 and disabled.

Monthly Tour Programs for Individuals with Early-Stage Dementia

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On the third Tuesday of each month, the Fort Wayne Museum of Art will host tour programs specially designed for individuals with an early-stage diagnosis of Alzheimer’s disease or another form of early-stage dementia. Museum guides who have been trained to effectively communicate with individuals with early-stage dementia diagnoses will be leading the tours. The program is a partnership between the Fort Wayne Museum of Art and the Alzheimer’s Association Greater Indiana Chapter. It is designed to provide an experience of the visual arts to individuals with an early-stage diagnosis of dementia  in a way that meets their needs.

This new program is modeled after the Museum of Modern Art’s program in New York City, which was developed during its Alzheimer’s project initiative from 2007 to 2014. From that project, the Museum of Modern Art developed training materials to be adapted for museums across the country. These training materials were implemented at the Indianapolis Museum of Art with great success. Therefore, the Alzheimer’s Association Greater Indiana Chapter staff felt that program could also be successful in Fort Wayne.

Tours are free of charge for participants and their caretakers and are held on the third  Tuesday of each month at 2:00 p.m., lasting about an hour. If you are interested in bringing a loved one with dementia to the monthly tours, you must call the Fort Wayne office of the Alzheimer’s Association first at 800-272-3900 to have your loved one pre-screened. Individuals will not be able to participate in the program unless they are first pre-screened for an early-stage diagnosis and you register for the program by calling the Alzheimer’s Association.

2017 Tour Dates: August 15, September 19, October 17, November 21, and December 19.

What is Dementia?

Dementia

An estimated 5.5 million Americans suffer from dementia. Likely, one of your relatives or someone you know has dementia. What is dementia? Dementia is a chronic disturbance in a group of mental processes. It is not a disease but rather an umbrella term that describes a combination of signs and symptoms. Dementia can be due to many different causes. It affects a person’s memory, learning, reasoning, planning, language, attention, perception, and behavior. More than 70% of those suffering from dementia also exhibit behavioral disturbances. Common behavioral disturbances include agitation, apathy, mood swings, and psychotic symptoms.

These are some early warning signs of dementia:

  1. Memory difficulties that affect every day life
  2. Difficulty planning or solving problems
  3. Confusion with place and time
  4. Difficulty with familiar tasks at home
  5. Misplacing things
  6. Difficulty recalling words or following a conversation
  7. Problems with vision or perception
  8. Problems with judgment
  9. Changes in personality
  10. Social and work withdrawal

There are many different types of dementia and some patients have more than one type. Five types of dementia include:

  1. Alzheimer’s disease. 50-70% of all cases. Alzheimer’s is the sixth leading cause of death in the United States. Every 68 seconds, someone in America develops Alzheimer’s. The number of people with Alzheimer’s disease doubles with every five year interval beyond the age of 65. Early symptoms include apathy, depression, and difficulty remembering names and recent events. Later symptoms include impaired judgment, disorientation, confusion, behavior changes, and difficulty speaking, swallowing, and walking.
  2. Vascular dementia. 20% of all cases. A decline in thinking skills caused by conditions that block or reduce the flow of blood to the brain, depriving brain cells of vital oxygen and nutrients. This often results from a stroke or mini strokes.
  3. Lewy body dementia. 15-20% of all cases. Similar to Alzheimer’s, those with Lewy bodies often experience memory loss and thinking problems. However, unlike Alzheimer’s, they tend to have early symptoms such as sleep disturbances, well-formed visual hallucinations, and muscle rigidity or other parkinsonian movement features.
  4. Parkinson’s disease dementia. 5% of all cases. An early symptom of the disease is problem with movement. If dementia develops, the symptoms are similar to those with Lewy bodies.
  5. Frontotemporal dementia. 5% of all cases. Typical symptoms include changes in behavior and personality and difficulty with language. Nerve cells in the front and side regions of the brain are especially affected.

In 60% of those with early Alzheimer’s disease, the condition is not recognized by their family or evaluated by a doctor. By the time family members notice signs of dementia, it has usually developed to a moderate stage. Dementia can be diagnosed by obtaining a thorough medical and psychiatric history.  The doctor will also conduct an examination of the medical, neurological, and mental status of the patient. Neuropsychological testing may be necessary. The Mini Mental State Exam (MMSE) is one of the most common screening tools for dementia in clinical practice.

How can dementia be treated? Lifestyle modifications can help delay or prevent dementia in some people. Some lifestyle changes that can be beneficial include avoiding smoking and excessive alcohol intake, engaging in physical exercise, participating in mental and social activity, and doing cognitive training. Medication can improve mental processes like memory and sometimes slow the progression of Alzheimer’s disease. Other medications can help dementia due to Parkinson’s disease or Lewy body disease. In 2012, more than 15 million family members and unpaid caregivers provided care for patients with dementia. Their contribution was valued at $216 billion.

You can find more helpful blog topics such as How to Communicate When They Have Alzheimer’s, Planning Ahead for Medicaid, and Talking to Your Parents About Assisted Living in the “Elder Law and Medicaid” tab under Topics.

Source: https://www.gmeded.com/gme-info-graphics/what-dementia#

7 Important Questions to Ask Your Aging Parents

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No matter what age we are, it is vital that we have our estate planning documents in place. However, this area becomes especially important as we get older. For your parents who are getting older, you want to make sure they have all the necessary legal documents in place. As such, here are seven important questions you should ask your parents:

  1. Do you have a Will or Trust? Wills and Trusts are legal methods to direct what happens to your possessions and assets when you pass. The best way to make your wishes clear is to have a Will or Trust that clearly states who will be in charge of your estate and who will receive your assets. When your parents’ wishes are in writing, this can help avoid confusion and arguing among family members. It also keeps everyone on the same page as to what Mom and Dad wanted for their family.
  2. Do you have a Power of Attorney? A financial Power of Attorney allows you to appoint someone (called an attorney-in-fact) to act on your behalf for financial matters in case you are not able to. For example, the attorney-in-fact can pay bills and write checks for you. As your parents get older, they may not be able to care for their financial matters anymore. It is important that they have a Power of Attorney in place before they reach that point.
  3. Do you have Advance Directives for Health Care? Advance Directives for Health Care allow you to appoint an attorney-in-fact to act on your behalf for health care matters when you are unable to do so yourself. The attorney-in-fact would be able to make decisions for you regarding medication, end-of-life treatment, and health records. It is essential that your parents have this in place before they are unable to care for themselves.
  4. Where can I find your legal documents if I need them? These legal documents won’t be very helpful to your parents in an emergency if nobody knows where they are located or how to access them. Your parents should keep their documents at home where they are easily accessible at any time. If the documents are in a fire-safe, then make sure you have the combination and know how to get inside.
  5. Are your documents current and up-to-date? Perhaps your parents created these documents many years ago, even decades ago. Make sure that the documents reflect your parents’ current situation and current wishes. There may be new additions to or deaths in the family. Also, the laws and legal requirements can change so it is a good idea to have an estate planning attorney review your parents’ documents so that they are up-to-date legally.
  6. If you are unable to care for yourself at home, where would you prefer to live? Start the discussion early before your parents require assisted-living care. By involving your parents in the process, you can find out what their preferences are regarding assisted-living communities.
  7. Do you have long-term care insurance? The cost for assisted-living and nursing home care can overwhelm your parents’ financial situation. It’s important to make sure they have some type of long-term care insurance in place or are planning for Medicaid. Read over the insurance policy to make sure you understand it and call the insurer if you have any questions about what is and is not covered.

By discussing these seven important questions with your aging parents, you can be better prepared to deal with the future and make sure your parents are prepared as well.

Respectful Caregiving for Elderly Loved Ones

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If your loved one has dementia, he may not be acting like himself anymore. He may become increasingly confused and need more care as his disease progresses. It’s important to remember, though, that your loved one is an adult, not a child, and to treat him as such. Our elderly loved ones deserve respectful treatment that dignifies them as an adult, despite their deterioration. You can show respect and honor for your elder loved ones by honoring their wishes and trying to maintain a similar lifestyle to what they had prior to dementia. This will bring them a measure of comfort and reassurance. Here are some tips to caring for your loved ones with dementia while maintaining their dignity:

  • Do not parent them. When you are helping someone with the basic activities of life (such as using the restroom or getting dressed), you may tend toward a parental tone with them. Parenting your elderly loved one can come across as disrespectful and condescending. It can make them feel like a child. Avoid using childlike words such as potty, diaper, or bib. Instead try to use more respectful terms such as bathroom, underwear, or apron. Be mindful of your tone and word choices. Try to speak to your loved one as an equal as much as possible.
  • Be open-ended. Help your loved one in conversation by focusing on open-ended discussion rather than specific details. For example, rather than asking how many children he has, ask how he felt raising his children or his favorite memories of them growing up. It may be difficult for your loved one to recall specific details.
  • Being right is not most important. Sometimes your loved one may be in a different time or incorrectly recalling certain events. Rather than correcting your loved one, listen to him and encourage more discussion. Those dealing with dementia often struggle with sequencing and logical thought. It can be appropriate to fib to your loved one when telling the truth would cause pain, anxiety, or confusion. For example, if your loved one wants to drive to the store but is no longer a safe driver, you could tell him that the car is in the repair shop or that you will drive because you need to go out anyway. This can be more loving than telling him that he is no longer a safe driver due to his dementia, which may cause pain and confusion.
  • Get out of the house. It can be difficult to go out of the house with your loved one if social situations make him anxious or stressed. Rather than isolating your loved one at home, take the time to plan a successful outing. This can be rewarding and offer a change of pace for the day. Choose a time of day when your loved one is most active and in the best mood. Allow for ample time to get ready and arrive to where you are going. Think about the types of things your loved one enjoys and incorporate that into the outing. Try to be relaxed and calm because this will help your loved one to feel the same.

Above all, it is important to remember that your elderly one is still the same person you have known and loved. The dementia may cause him to act differently and require extra care, but he still deserves to be treated respectfully and as an adult. These tips can help you to accomplish that as you continue to care for your loved ones with dementia.

Source: http://www.aplaceformom.com/senior-care-resources/articles/dementia-dignity

Talking to Your Parents About Assisted Living

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Talking to your parents about moving to an assisted living facility can be daunting and stressful. Many elderly ones resist this conversation and move because they don’t want to leave their home or lose their independence. You may be avoiding this conversation as well because you may fear your parent’s reaction and don’t want to face the reality of their situation. However, it is important that you prepare for this move to assisted living (if that’s what they need) before a crisis. These tips can help you discuss the move to assisted living with your parents in a way that doesn’t result in accusations and anger.

1. Make it a process instead of “the talk”. Before your parent reaches the point of needing an assisted living facility, begin the process of talking to them about it. You can discuss the future with them in a non-threatening way by asking what their wishes are regarding their care. Instead of ganging up on your parent with “the talk,” you can make it an ongoing discussion of opinions and options. If the time comes for your parent to move to an assisted living facility, it will already be an open topic of discussion.

2. Control your tone and watch your words. Speak in a positive and upbuilding manner to diffuse potential frustration and anger. Use words like community or condo rather than facility or rooms. Focus on the opportunities and social activities instead of the doctors and medications. Speak in a tone of voice that is calm, quiet, and pleasant. If your parent feels he is not being heard, he may speak louder or shout. Do not respond loudly or you will end up in a shouting match. Listen and validate your parent’s feelings. Make sure he knows that the final decision is his. This will help your parents feel in control and calmer about the situation.

3. Find out what they want. If both your parents are alive, tactfully speak with them about possible future events, such as one of them dying or needing to sell the house. It can be difficult and sad to discuss these things, but getting your parents’ wishes on the matter will help you if the situation arises to handle it in the best way possible. This will also show to your parents that you value their feelings and want to give them the best care possible.

4. Be understanding. Understand your parents’ feelings on why they are resistant to moving to an assisted living facility. Many people feel that they are going there to die. It is difficult to face your own mortality. It may also be difficult for your parent to face their changing role with you. It can be hard for them to accept that you are now taking care of them instead of them taking care of you. Moving to an assisted living facility can also mean a loss of independence and leaving a home they may love. Keep these concerns in mind and be empathetic to their feelings. Give them the ability to make as many decisions as possible regarding where, how, and when they will receive additional care.

5. Learn about the options. Do your research and find out the different types of senior living communities. If they are healthy enough, you can bring your parents with you to tour different facilities. Figure out the costs for different places in your parents’ area. Although it may be a private topic for your parents, try to discuss with them their financial situation. You will need to help them figure out what they can afford. It would also be a good idea to research different funding options, such as Medicaid or long-term care insurance.

6. Understand their illness. If your loved one has been diagnosed with Alzheimer’s, dementia, or another disease, take the time to research the progression of their illness or speak with their doctors. This can help you understand how the illness will impact your parents’ ability to stay at home. Ask the different senior communities how they will provide for your parents’ needs and what services they offer.

While discussing the move to an assisted living facility can still be daunting and stressful, applying these tips can help the discussion to go as smoothly as possible.

How to Communicate When They Have Alzheimer’s

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When our loved ones are diagnosed with Alzheimer’s, or another form of dementia, we may feel overwhelmed and unprepared to deal with the impending challenges. Watching our loved one deteriorate as the disease progresses can be very painful. As their simple forgetfulness becomes greater and greater, we are faced with the challenge of how to communicate with them successfully. Knowing how to communicate with our loved ones who suffer from dementia can be an important key as their condition worsens.

Communication allows us to create a strong emotional connection. Because our loved ones with dementia are suffering from memory and cognitive impairment, we need to adjust our communication skills to their needs. Here are some communication tips that can help:

  1. Think big instead of small. It is best to ask open-ended questions, rather than detailed ones, because this encourages discussion and conversation without making our loved one feel frustrated that they cannot remember a certain point or detail.
  2. Do not judge or be critical. We never want to be judgmental or critical, but we want to make them feel comfortable and at ease. Instead of correcting our loved one, try to be compassionate and let any misstatements or inaccuracies go.
  3. No distractions. Speak with your loved one in a distraction-free and quiet environment. This will allow your loved one to focus all their mental energy on the conversation.
  4. Be a good listener. Nod your head and smile throughout the conversation. If you don’t understand something, ask an open-ended question to encourage more conversation. When you maintain eye contact and have comfortable body language, your loved one will feel at ease and recognize that you are someone familiar, even if they don’t remember who you are.
  5. Speak calmly. Speak clearly in a calm voice and do not use excitable language. Use people’s names rather than pronouns to help your loved one follow along. Make sure to greet your loved one by name and use it in the conversation.
  6. Be agreeable. Accept the blame when something is wrong instead of arguing with your loved one. Agree with your loved one and allow plenty of time for them to understand what you are saying. Be patient, reassuring, and forgiving. Try to focus on how they are feeling rather than what they are saying. Do not argue with them or confront them. Leave the room if you must to avoid confrontation.
  7. Keep it simple. Use short simple sentences for better comprehension. When giving instructions, use the same wording each time to help them remember. You may need to repeat instructions several times. Speak clearly and naturally on one subject at a time.

There is currently no cure for Alzheimer’s or other types of dementia. Your loved one may have good days and bad days. Always do your best to keep the communication positive and pleasant. Be patient with your loved one and always be loving and respectful. Reflect on the good memories with your loved one and recognize that they cannot control their deterioration. Knowing how to communicate more effectively can help you cope with this difficult situation.

Source: http://www.aplaceformom.com/blog/11-09-15-what-to-say-to-someone-with-alzheimers/