Long-term Care Residents’ Rights Month- “Speak Out Against Elder Abuse”

This month, residents of nursing homes and other long- term care facilities, along with family members, facility staff, and others are honoring the rights of long-term care residents by celebrating Long-Term Care (LTC) Residents’ Rights Month. The theme for LTC Residents’ Rights Month 2013 is, “Speak Out Against Elder Abuse,” with the goal of encouraging residents and others to be educated about and speak out against elder abuse.

Seniors in LTC facilities rely entirely on trusted individuals to help them. Sadly, incidents of abuse, neglect, or exploitation are often not reported to Adult Protective Services or other authorities. One of the most common reasons is the victim’s fear of losing support.

Elder abuse can come in many forms including physical, verbal or sexual abuse, neglect, or financial exploitation. The abuse can occur at the hands of nursing home staff or other residents. Some abuse is obvious, such as hitting a resident. But others are less well-known to the public, such as neglect, false imprisonment, and financial abuse.

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

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• Withdrawn, passive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 linens 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.

At the Fairfax and Fredericksburg Estate Planning Law Firm of Evan H. Farr, P.C., we help our clients preserve dignity and quality of life and thereby drastically reduce the risk of neglect or abuse. If you have a loved one who is nearing the need for long-term care or already receiving long-term care or if you have not done Long-Term Care Planning, Estate Planning or Incapacity Planning (or had your Planning documents reviewed in the past several years), please call us at 703-691-1888 to make an appointment for a no-cost consultation.

Medicaid Asset Protection

When it is Time to Take the Car Keys Away: The Advance Driving Directive

It is often difficult to talk to an elderly family member about giving up his or her car keys — especially if the older person doesn’t agree that continuing to drive will be risky.  Often, families are making the tough choice between safety and independence on their own.

For senior citizens, the fear that they may have to stop driving for good is almost too much to bear. The culture that we live in is built on mobility. Families often live at a great distance and friends are scattered and may have their own physical challenges to deal with. A driver’s license signifies more than the ability to drive a car; it is a symbol of freedom and self-sufficiency. For a senior citizen, the loss of the ability to drive may feel like being trapped, isolated, and alone. Understandably, driving is not a privilege that older Americans typically want to relinquish willingly. Still, safety must come first.

To decide whether driving is safe, loved ones and medical professionals need to monitor seniors and keep the following three aspects in mind: life and health (older drivers are more likely to be seriously injured or killed in a car accident), the safety of others (including family passengers, pedestrians and other drivers), and the potential financial liability of a serious accident that damages property and/or destroys lives.

Factors that warrant monitoring and possible driving cessation or other alternatives include:

• Health Conditions: Physical and mental impairments that accompany aging, such as Parkinson’s disease or Alzheimer’s or other types of dementia, can compromise driving agility and judgment.
• Vision Impairment: From accurately reading the speedometer to detecting pedestrians on the side of the road, good driving requires good eyesight. Deterioration in vision is an inevitable effect of aging. Older eyes are more susceptible to cataracts, glaucoma, and other problems that impair vision.
• Hearing Impairment: Few people age without some deterioration in their hearing. Hearing loss can happen gradually, without the person realizing it, and undermine the ability to hear horns, screeching tires, sirens, and other sounds that would normally put someone on high alert.
• Prescription Drug Use and Drug Interactions: Many drugs can compromise driving ability by causing drowsiness, blurred vision, confusion, tremors, or other side effects.
• Problems with reflexes and range of motion: Sometimes older drivers who have problems with reflexes or range of motion are not able to react quickly enough to brake suddenly or quickly look back.  Sometimes older drivers also confuse the gas and brake pedals, finding themselves getting flustered while driving, or quick to anger.
• Memory Loss: Memory loss can impact driving if the driver misses exits that used to be second nature or gets lost frequently.
• Alcohol Abuse: Drinking and driving is always a dangerous combination. As people age, alcohol remains in the system longer and tolerance declines. Also, elderly folks are likely to be on medication, which can exacerbate the effects of alcohol. If you drink, don’t drive. If you suspect that your family member is drinking and driving, don’t wait to take action.

A study that was recently cited in an Associated Press article found that when doctors warn patients that they may be medically unfit to be on the road, there is a drop in serious crash injuries among those drivers, so if you or a loved one is experiencing any of the factors above, be sure to consult with a doctor. Read our recent blog post about this topic for more details.

What happens when you are the person who should no longer be driving and the time has come for you to hand over your keys? Which loved one would you want to broach this important subject with you? Now, as part of your incapacity planning documents, you can indicate who you would trust to help you if you could no longer drive safely. Our firm can help you draw up an Advance Driving Directive to name the person that you want to initiate the discussion with you about continued driving (or not) when the time is right. Or you can use this one provided by the American Automobile Association.

Unlike an Advance Medical Directive, which transfers decision making about medical decisions to the agent at the appropriate time, an Advance Driving Directive does not appoint someone to make the “stop driving decision” for the driver. Rather, it’s about naming whom you would like to have broach this touchy subject with you.

Planning in advance for cessation of driving or other alternatives can help keep you and others safe on the road, so be sure to incorporate an Advance Driving Directive as part of your planning. If you have not done Long-Term Care Planning, Estate Planning or Incapacity Planning (or had your Planning documents reviewed in the past several years), or if you have a loved one who is nearing the need for long-term care or already receiving long-term care, call the Fairfax and Fredericksburg Estate Planning Law Firm of Evan H. Farr, P.C. at 703-691-1888 to make an appointment for a no-cost consultation.

Coping with the Alzheimer’s Diagnosis

Every 68 seconds there is another person diagnosed with Alzheimer’s disease in the United States.  Since there is no single definitive medical test for identifying Alzheimer’s disease, arriving at the correct diagnosis can take time and patience.  To diagnose Alzheimer’s disease, a doctor will look for symptoms, such as memory problems, difficulty identifying familiar items and faces, getting lost in familiar places, and decline severe enough to interfere with relationships and/or work performance.  Find out more about the Alzheimer’s diagnosis on the Alzheimer’s Association website.

A diagnosis of Alzheimer’s disease is life-changing for both diagnosed individuals and those close to them.  Below are some tips for coping if you have a loved one who is diagnosed with Alzheimer’s:

• Learn as much as you can. Understanding what to expect will help you plan for care and transitions.
• Reach out for support. The more you reach out to others, including family members, professional counselors and support groups, the more you will be able to accept what is happening, know what to expect, have others to talk to, and be able to cope with your loved one’s Alzheimer’s symptoms.
• Don’t take on the caregiving journey alone. Having support in caregiving is key, whether it be from other family, in-home help, respite care, or making the decision to move your loved one to an assisted living or nursing home.

While it’s not easy to think about, if your loved one has recently been diagnosed with Alzheimer’s, it is imperative to make an appointment with a Certified Elder Law Attorney such as Evan H. Farr to determine who to name to make legal, financial, and medical decisions when your loved one is no longer able to do so. In addition, if your loved one hasn’t done so already, it is also of utmost importance to determine how he or she will pay for long-term care without depleting the family’s hard-earned assets.

Medicaid Asset Protection

Ask the Expert: How Can I Update A Will I Established 10 Years Ago?

Q. How can I update the Will that I established when I was in the military approximately 10 years ago?

Asked on AVVO by a resident of Springfield, VA

A. Just as a car needs regular maintenance, your estate planning documents need to be updated or redone, especially if it has been 10 years since you have done so.

Before you do so, please keep in mind that rather than using a Will to distribute your estate at death, you want to consider using a Revocable Living Trust.

A Revocable Living Trust (RLT) generally:

• provides for the creator of the trust (and, if applicable, the creator’s spouse) to have full use of the trust income and principal for life;
• allows for the assets to continue to be held in trust (or be distributed), upon the death of the creator, for the benefit of the named beneficiaries, such as the grantor’s children;
• avoids probate, so the trust assets may be quickly distributed according to the terms of the trust, without the delay, fees, and public exposure of probate;
• is recommended for anyone who owns or may in the future acquire real estate in more than one State, because without an RLT your estate will have to go through probate in both States;
• can provide how the real estate and other trust property is to be distributed at death (as with a Will, you can provide for any number of special situations);
• provides uninterrupted management of your assets by your trustee if you become incapacitated.

Read more about Revocable Living Trusts on our website.

Once you have met with a Certified Elder Law Attorney, such as Evan H. Farr, and created an RLT and other estate planning documents, such as a Financial Power of Attorney and Advance Medical Directive, you need to make sure you update them regularly (at least every 1-3 years, depending on the document). This is the only way to ensure that your estate plan truly reflects who you are, what you care about, and what you have.

So, when are updates needed?  Have there been any changes in your family structure, financial circumstances, or health? The list below pinpoints certain examples of events that could have a significant impact on your estate.

• You get married or divorced
• Your spouse dies or becomes incapacitated
• You become ill or disabled
• You have a new child
• Your child marries or divorces
• Your child becomes ill or disabled
• You have a new grandchild
• One of your beneficiaries shows signs of being financially irresponsible
• One of your beneficiaries develops a drug or alcohol problem
• The value of your assets has significantly increased or decreased
• You retire or change employment
• You acquire property in a different state
• You move to a different state
• There have been changes in the law that may affect the language of your documents.

Even if no changes are necessary, you should annually sign updated Powers of Attorney. Some financial institutions won’t accept a Power of Attorney more than a year old. Similarly, the older an Advance Medical Directive is, the less likely it is that it will be honored by a doctor or hospital.

Don’t let too much time pass between reviews of your plan. The cost of a review is minimal; but the cost to your family if you neglect your plan could be disastrous.  If any of these changes have happened to you or if you haven’t updated your estate plan in the last few years, the time is now. Call the Fairfax and Fredericksburg Elder Law Firm of Evan H. Farr to update your estate plan! Ask about The Farr Law Firm’s Lifetime Protection Program, which ensures that your documents are properly reviewed and updated as needed, so that they will have the proper effect under the law.

Medicaid Asset Protection