According to a recent report put out by the Alzheimer’s Association, 5.3 million people have Alzheimer’s disease. Chances are that you or someone you know has been touched by this illness. In spite of these overwhelming statistics, Alzheimer’s continues to be a disease that sneaks up on individuals and their families, quietly tearing apart lives with uncertainty and confusion. Estate planners and elder law attorneys sometimes see this heartbreaking confusion in our own offices when elderly clients or their families come to us, concerned that a loved one no longer has the capacity to sign or make decisions about legal documents.

A new article in the New York Times discusses the slow and sometimes invisible development of Alzheimer’s disease, and some of the earliest warning signs that your loved one may be suffering. “New research shows that one of the first signs of impending dementia is an inability to understand money and credit, contracts and agreements.” This comes as particularly bad news to families who put off their estate planning year after year, each time telling themselves “We’ll do this next year for certain.”

By the time families come into our office with their suspicions about their aging loved one it may be too late for us to help. “Lawyers have guidelines, published in 2005, that include warning signs of diminished capacity, like memory loss and problems communicating and doing calculations. The guidelines instruct lawyers to look at the legal requirements for capacity in specific situations, like making a gift. But many questions remain.”

Plans created after the suspicion of Alzheimer’s or dementia has set in can be fraught with doubt, and often cause conflict among family members. We have seen the rifts and heartbreak the illness causes in even the strongest of families. We urge you to take care of important legal and estate planning issues early, before questions of competence can cast the shadow of doubt over your wishes.

The legalization of marijuana is on the ballot in California this November, but California isn’t the only part of the country where marijuana is making news. The use of marijuana for medical purposes is being debated around the nation—especially as concerns elderly patients in nursing homes which receive federal funding through Medicare or Medicaid.

This article on the New York Times’ New Old Age Blog reports on this issue, and just how concerned and confused nursing home facility administrators are about what their options are and how to proceed. “Any patient using medical marijuana breaks federal law. Marijuana is listed as a Schedule 1 drug, which means the federal government considers it to have no medicinal value. Despite this, physicians in 14 states and the District of Columbia are allowed to recommend it. . . Many facility administrators wonder how they can comply with federal law and preserve their reimbursements and at the same time permit residents to medicate with marijuana.”

Federal funding isn’t the only conflict attached to the medical marijuana issue. Nursing homes in New Mexico (a state where marijuana was legalized for medicinal purposes in 2007) report that “the lack of dosing direction has caused problems. . . Pills in nursing homes are in what they call vacuum packs: you have to pop a pill out one at a time. They don’t do that with marijuana. It’s an amount of marijuana in a small plastic bag, so there is no way to track if someone took one or two pinches.”

Another issue to consider is the stigma attached to marijuana use, and complaints from other patients or residents.

Medical marijuana is generally prescribed to seniors to help them deal with chronic pain. Oregon’s long-term care ombudsman, Mary Jaeger, asks in the article above “Wouldn’t any one of us, in our own homes, feel that we have the right to live our lives by our own values and choices, to preserve our own dignity and, frankly, to live pain-free?” Will seniors moving to federally supported nursing homes have to find other ways to deal with chronic pain? And more importantly… will they be willing to do so?

We’ve written often on this blog about the concerns that caregiver children have for their elderly parents, but that’s only one side of the story. Many families also have an adult child living far from home, and though the concerns of the long-distance child may be different from the one who lives down the street, they’re no less important. Here are some of the more common concerns we hear about in our office, and some suggestions for addressing them:

I worry that when I talk to my parents on the phone I’m not getting the whole truth about their health or situation. This is one of the most common concerns of long-distance children. The best thing to do is be up front with your parents. Tell them that you want—and need—to know the truth, even if they think it will worry you. If you still don’t think they’re being completely honest, enlist the help of a sibling or nearby friend or neighbor who can be your eyes and ears. You can also ask your parents to sign a waiver with their doctor giving him or her permission to share their medical details with you.

I’m afraid that my mom is losing the ability to manage her money and could end up broke. Seniors are the most common victims of financial fraud, and it’s hard to keep tabs on mom or dad if you live far away. The best way to prevent financial fraud is to talk about money with your parents early and often. It may go against the grain, but discuss your own finances with them if it will help them open up about theirs. Visit as often as you can and watch their mail for letters from promotion companies or shady looking “charities”; and put your parent’s phone number on the National Do Not Call registry (1.888.382.1222 or www.donotcall.gov)

I feel guilty that my sister (who lives in the same town as my parents) is shouldering the bulk of the burden. The sibling who lives closest does often end up being the physical caretaker of elderly parents, but that doesn’t mean those who live far away can’t help. The most common contribution from long-distance children is financial support—and that’s no small thing! Offer to pay for a housekeeper, in-home care assistant, taxi service, etc. And don’t forget to talk to your sister about what she needs. Helping your caregiver sibling is another way of helping your parents.

I love my parents; I want to do more to help than just give them money. A common complaint of seniors is loneliness and fear of being forgotten. One way to help your parent and help calm your own fears is to simply keep in touch. Make a point of calling your parent on a weekly or bi-weekly basis. Send frequent cards or e-mails. Plan a family vacation that your elderly parent can be a part of. You can help your parents with your expertise as well; try to be involved in “the big stuff” such as meetings with estate planners, financial planners, nursing staff, or geriatric care managers. And most importantly, work regular trips to visit your mom or dad into the budget. There’s really no substitute for face-to-face communication.

I think that my siblings close to mom and dad are making the wrong decisions for them, or are pressuring them to make decisions they don’t really want to make. Undue influence is a serious accusation, and if you truly think your siblings may be threatening or manipulating your parent you should seek the help of a professional. Before you take irreversible action you need to have a private conversation with your parent; ask if they are being coerced and try to determine if fear is a factor. If you still think your parent is being manipulated against their will contact an elder law attorney immediately.

I don’t want to miss out on what could be my last moments with my parent. There’s just no way around it, your parents won’t be here forever, and nobody wants to feel that there were things left unsaid. If you truly worry that your parent is facing his or her last days the best advice we can give is to go visit if at all possible, and make your visit matter. Look through old photos, talk about your memories, and say the things that need to be said. If you can’t visit in person make phone calls or send letters. Don’t save your best sentiments for the eulogy—tell your parents how important they are to you today.

Elderly people and their families can spend months—sometimes years—looking for the perfect long-term care living arrangement. Most families try to avoid the nursing home option to the very end, believing that assisted living or small residential care homes provide a better quality of life. But is this fact or fiction?

Paula Span in her article on the NY Times New Old Age Blog suggests that “what variety of facility an older person lives in may matter less than we’ve assumed. And that the characteristics adult children look for when they begin the search aren’t necessarily what makes a difference to the people who move in.”

Span’s suggestion is based on (among other things) a recent study published in The Journal of Applied Gerontology, which found that among 150 Connecticut residents living in various long-term care situations (assisted living, nursing homes, residential care homes), the type of living situation itself made little difference in the resident’s emotional well-being. Rather, happiness and contentment was more a matter of “the characteristics of the specific environment they’re in, combined with their own personal characteristics — how healthy they feel they are, their age and marital status.”

Logically enough, a resident of a long-term care facility of any kind is more likely to report satisfaction and comfort if they had a hand in choosing their living situation, if they were part of the decision making process. In fact, it is the process itself—researching options, visiting facilities, considering current and future social and physical needs and how they will be met—that is the beginning of acclimatization.

Whatever your choice, you’ll want to know that you have options for paying for your long-term care living situation. Medicare.gov has published a chart summarizing and comparing the various options for long-term care financing. Or please feel free to contact our office for more information.

Many adult children of an aging parent get to a point in their parent’s care where they feel they have only two options: move their parent in with them so that they (or their spouse) can provide around-the-clock care, or move their parent into a nursing home. Reaching this point can be a very emotional time for both parent and child; with the parent feeling anger and frustration at the loss of independence, and the child feeling that they have somehow failed their parent.

Improving technology may never be able to remove the need for this decision entirely, but it may be able to postpone it a little. A recent article in the New York Times describes some new technologies that help adult children monitor their aging parent right inside the home, therefore removing the need (or at least delaying the need) for physical around-the-clock supervision.

One of the new technologies mentioned in the article (called GrandCare) “allows families to place movement sensors throughout a house. Information — about when doors were opened, what time a person got into and out of bed, whether there’s been any movement in a room for a certain time period — is sent out via e-mail, text message or voice mail.” It is this kind of in-home monitoring that may allow seniors to remain in their homes longer.

Some seniors have reservations about these new technologies, however, something that they consider to be an invasion of privacy. Nancy Schlossberg is quoted in the article as comparing these new technologies to nanny-cams, “Big Brother is watching you — there’s something about it that’s very offensive.” Some seniors may agree with her, but if it comes down to a choice between technological monitoring or moving to a nursing home they may find that “Big Brother” is the lesser of two evils.

It’s not always easy to know—or to admit—that a loved one is unable to fully care for themselves anymore. The signs develop gradually, and aren’t always easy to pick up on if you see your loved one on a daily or weekly basis. Often it’s the son or daughter who has moved away and comes home for a visit who notices (what is to them) the “sudden decline” in mom or dad’s ability to perform the most basic of tasks.

If you suspect (but aren’t sure) that your loved one may need in-home care, there are a few signs you can look for to help you decide. The “Right at Home” website has an article listing ten signs that home care could benefit your loved one, and Responsive Home Health has a 3 page questionnaire to help you determine whether or not mom or dad is still just fine at home alone. The signs you’ll want to look for include:

* Inability to prepare own meals
* Frequent falls
* Inability to keep up with basic hygiene such as bathing and brushing teeth
* Depression
* Sudden isolation

* And more…

Once you know for certain that your loved one needs in-home care you’ll have to face the sometimes daunting task of finding (and figuring out how to pay for) the right service. A recent article in the Wall Street Journal provides some excellent information on how to find the right kind and level of care for your loved one. For example: does your parent need just a little bit of help with cooking and housekeeping, or is more comprehensive care (such as daily help with bathing, grooming, mobility and medication) necessary? The level of care your loved one needs, as well as what financial resources you have available, will help narrow down your choice of agency or aide.

Always remember, you don’t have to go through any of this alone. There are a number of dedicated professionals who can help you along the way—including our office. Don’t hesitate to contact us with any questions you may have. We’re here to help you.