Ask the Expert: Forgetfulness: When to Call a Doctor

Q. My mother, Meg, has not been herself lately. Last week, when going to the neighborhood post office, she got completely disoriented and lost. She asks the same questions over and over again and often repeats stories. She even forgot the ingredients for dad’s favorite soup last week, which she has been cooking for 40 years. I am beginning to get concerned about her. I know seniors often experience normal, age-related memory changes. How can I tell if that is what is happening with mom, or if it is time to call a doctor?

A. As we grow older, some change in memory is normal. However, memory loss that disrupts daily life may be a symptom of Alzheimer’s or another dementia. Alzheimer’s is a brain disease that causes a slow decline in memory, thinking and reasoning skills. People with Alzheimer’s experience difficulties communicating, learning, thinking and reasoning – problems severe enough to have an impact on an individual’s work, social activities, and family life.

It’s always a good idea to check with a doctor if a person’s level of function seems to be changing. The Alzheimer’s Association believes that it is critical for people diagnosed with dementia and their families to receive information, care, and support as early as possible. Below are some common symptoms from Alz.org to help you recognize the difference between normal age-related memory changes and possible warning signs of Alzheimer’s disease or some other type of dementia:

• Memory loss:
  • Typical Age-Related Change:  Anyone can forget details from a recent event or conversation and recall them later.
  • Possible Dementia: One of the most common signs of Alzheimer’s is memory loss, especially forgetting recently learned information. Others include forgetting important dates or events; asking for the same information over and over; increasingly needing to rely on memory aids (e.g., reminder notes or electronic devices) or asking for help from family members for things they used to handle on their own.
• Abstract thinking, planning, and problem solving:
  • Typical Age-Related Change: Making occasional errors when balancing a checkbook.
  • Possible Dementia: Some people may experience changes in their ability to develop and follow a plan or work with numbers, and may forget what numbers are for and how they should be used. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before.
• Problems with writing or speaking:
  • Typical Age-Related Change:  Struggling to come up with the right word occasionally
  • Possible Dementia:  People with Alzheimer’s or other types of dementia can have problems remembering even basic words. Their way of speaking may become contorted and hard to follow. They may stop in the middle of a conversation and have no idea how to continue. They may struggle with vocabulary, have problems finding the right word, or call things by the wrong name (e.g., calling a “watch” a “hand-clock”). They also may repeat stories, sometimes word for word and may keep asking the same questions, no matter how many times they’re answered.
• Personality changes:
  • Typical Age-Related Change: Developing specific ways of doing things or becoming irritable when a routine is disrupted.
  • Possible Dementia: People with Alzheimer’s or other types of dementia may have sudden mood swings. They might become emotional – upset or angry – for no particular reason. They might become withdrawn or stop doing things they typically enjoy. They could become uncharacteristically suspicious of family members — or trusting of spammers, solicitors, or telemarketers.
• Disorientation and confusion:
  • Typical Age-Related Change: Misplacing things from time to time and retracing steps to find them.
  • Possible Dementia:  People with dementia may get lost in places they know very well, like their own neighborhoods. They may have trouble completing basic and familiar tasks, such as cooking dinner, bathing, or shaving. They may place objects in inappropriate places, such as putting a toothbrush in the freezer or milk in the cabinet under the sink. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing.
• Lack of hygiene:
  • Typical Age-Related Change: Wearing pajamas and slippers all day, leaving the house in a rush without deodorant, or wearing a shirt with a stain, and not noticing it is there.
  • Possible Dementia:  People who have dressed smartly every day of their lives might start wearing stained clothing or stop bathing
• Poor or Decreased Judgment:
  • Typical Age-Related Change: Making a questionable or debatable decision from time to time.
  • Possible Dementia: Those with dementia may dress inappropriately, wearing several layers on a warm day or shorts in the snow. They may show poor judgment, such as giving away large sums of money to solicitors or telemarketers.

If your loved one is exhibiting any signs of dementia described above, don’t panic. Having these symptoms doesn’t mean that your loved one necessarily has dementia. Other conditions that can cause similar symptoms can include vitamin deficiencies, thyroid problems, depression, drug interactions, and alcohol abuse. Many of these conditions are treatable.

If your loved one does have in fact have Alzheimer’s or another type of dementia, the earlier you catch it and the sooner you plan for it, the more time you’ll have to learn about the condition and prepare for what’s ahead.

Medicaid Planning for Dementia

A diagnosis of Alzheimer’s or any other type of dementia is life-changing for both diagnosed individuals and those close to them.  While it’s not easy to think about, if your loved one has recently been diagnosed, it’s imperative to make an appointment with a Certified Elder Law Attorney, such as myself, 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 financially bankrupting the family.

Medicaid Asset Protection

Persons with Alzheimer’s or another type of dementia and their families face special legal and financial needs. At The Law Firm of Evan H. Farr, P.C., we are dedicated to easing the financial and emotional burden on those suffering from dementia and their loved ones.  If you have a loved one who is suffering from Alzheimer’s or any other type of dementia, we can help you prepare for your future financial and long-term care needs.  We can help protect the family’s hard-earned assets while maintaining your loved one’s comfort, dignity, and quality of life by ensuring eligibility for critical government benefits. Please contact The Law Firm of Evan H. Farr, P.C. in Fairfax at 703-691-1888, in Fredericksburg at 540-479-1435, in Rockville, MD at 301-519-8041, or in Washington, D.C. at 202-587-2797 to schedule your appointment for a no-cost initial consultation.

Common Estate Planning Mistakes Baby Boomers Should Avoid

Baby boomers, or those born between 1946 and 1964, are starting to retire in droves. For these people (and everyone else), it is important to create an estate plan to help protect assets and ensure that wishes are met in the event of death or incapacity. In doing so, it is critical to avoid mistakes that can cost time, money, and aggravation.

When it comes to estate planning, any number of oversights can leave you vulnerable in the event you become incapacitated. Other mistakes can seriously compromise the amount your heirs will inherit when you die. The following are some common estate planning mistakes that baby boomers should avoid:

– Not Planning for Long-Term Care: Most seniors today ignore the greatest financial risk they face — the disastrous expenses of long-term care and how these costs might affect their assets. According to NPR, there isn’t one state where long-term care is affordable for middle-class families. In fact, when paid out of pocket, home care services on average consume 84% of the income of a typical older middle-income family. Nursing home care paid out of pocket would consume a whopping 246% of the income of a typical older middle-income family. And these percentages are based on the national averages which are significantly lower than the rates in the DC Metro area (which can range from $10,000-$14,000 a month). Without proper long-term care planning, the expenses of long-term care are likely to significantly deplete or even wipe your savings and investments before you die.  As I have said hundreds if not thousands of times, “the best estate plan in the world is useless if you fail to plan for long-term care.”

– Failing to regularly update your plan:  Things change in life . . .  such as your health, your family situation, your marital status, your financial situation, and the people you trust to make decisions on your behalf . . . and your estate plan needs to be updated regularly in order to take these things into account. In fact, failing to make regular updates to your estate plan can have disastrous consequences. We recommend reviewing your estate plan annually and making changes as soon as they become necessary. Read our recent article on this topic for more details.

– Avoid Online Do-it-Yourself (DIY) Wills:  Estate planning documents are not something you should do yourself, just as you should not perform surgery on yourself. If you try to prepare legal documents for yourself, there is a great likelihood of making serious legal mistakes or oversights, and you’ll never know because these mistakes and oversights won’t become apparent until you die. And the people left to deal with your mistakes and oversights are the ones you’re probably trying to protect.

– Never Prepare Legal Documents for Someone Else:  Don’t even think about preparing or helping to prepare legal documents for a friend or family member. If you’re not an attorney, preparing or helping to prepare legal documents for another person is a crime called the “unauthorized practice of law” — in Virginia, it’s a Class 1 misdemeanor and can subject you to jail time for up to a year plus a fine of up to $2,500.

– Avoid Using Only a Will, Altogether: It is generally unwise to use a Last Will and Testament to distribute your Estate at death.  Instead, you should almost always use a Living Trust.  When you use a Last Will and Testament instead of a Living Trust, your financial affairs – and the financial affairs of your beneficiaries – become known to the public and will have to go through the nightmare of probate.

– Make sure to have proper Incapacity Planning Documents in Place, including a Financial Power of Attorney and Advance Medical Directive: When you give someone Financial Power of Attorney, you are giving that person the right to handle your financial and legal affairs in the event you become unable to do so. The document typically goes into effect immediately after it is signed, but it intended to be used by your Agent only when needed. Having a Financial Power of Attorney avoids the “nightmare of living probate” — the time consuming, expensive, and publicly embarrassing process whereby someone has to go to court to have you declared mentally or physically incompetent and have a judge appoint someone to serve as your legal guardian and conservator, which process is subject to ongoing court supervision and probate for the remainder of your lifetime. Again, be aware that DIY forms may not be valid, or may lack an adequate scope of powers.  As with anything, if it’s worth doing (which it absolutely is), then it’s worth doing right.

– Don’t Give Your Home to Your Children: Many baby boomers have children in their 30’s and 40’s with young families. It is completely understandable to want to transfer your home to them to ensure that they are provided for later and so that the home remains in the family. Unfortunately, there are many misconceptions that lead parents to make the wrong moves, which may have disastrous consequences in the future, such as debts of children, multiple children, future family discord, taxes, and Medicaid eligibility. Read more about this in our blog post, “Should I Give My Home to My Children?”

Most baby boomers work their entire lives to accumulate what they own.  Everyone needs the peace of mind that comes with making sure that their legal and financial affairs are taken care of if they become incapacitated, that decisions about health care are carried out the way they’d like even if they’re not able to make them, and that their loved ones are taken care of when that time eventually comes. To begin your Estate Planning or to update your existing documents, please call us at 703-691-1888 in Fairfax, 540-479-1435 in Fredericksburg, 301-519-8041 in Rockville, MD, or 202-587-2797 in Washington, DC to make an appointment for an initial no-cost consultation, or sign up for one of our upcoming seminars.

Top 14 Articles of 2014

From non-traditional living options to stricter driving laws in Virginia, we covered a lot of ground in 2014. It was a year that included a new act to help special needs families, enhancements to the Medicaid program, and amazing new technological innovations to help seniors age-in-place. At the Farr Law Firm, we expanded from Fairfax to new locations in Fredericksburg, Virginia, Washington, D.C., and Rockville, MD to offer comprehensive Elder Law and Estate Planning services to help more seniors and their loved ones. To celebrate the new year, we’ve ranked our most popular articles from last year based on open rate. Check out the list to see the year’s highlights and tell us what you’d like to see next year. As always, thank you for reading our newsletter and blog!

1. Casey Kasem’s Daughter Was Granted Conservatorship, But Where is Casey?: Before the sad passing of Casey Kasem, the late radio personality who died from Lewy Body Dementia, his wife and children were at odds over his care and visitation. This article describes the unfortunate details of this ordeal and lessons learned from it.

2. Yellow Dot on Car Can Save Your Life: The Yellow Dot program is designed to help crash victims, especially seniors, communicate with rescuers during the crucial first 60 minutes after a serious crash that can make the difference between life and death for the critically injured. This article provides more details about this potentially life-saving program.

3. John Travolta: Dyslexia or Dementia?: During the 2014 Academy Awards show, John Travolta took the stage and introduced Idina Menzel, but as he read her name from the teleprompter, he said “Adele Dazeem” instead. This article explores whether dyslexia or dementia could be the reason for this major flub, which was seen by more than 43 million people.

4. Non-Traditional Living Options for Seniors: Many Americans assume that when they grow old and frail, they will have go to an assisted-living facility or a nursing home. But this is not always the case. This article focuses on popular non-traditional housing options for seniors, such as co-housing, villages, and more.

5. Don’t Forget These Often-Overlooked Tax Deductions: When filing taxes, you want to make sure you file all the proper forms and take all deductions you’re entitled to. This article provides helpful but often overlooked deductions to keep in mind as you prepare your taxes.

6. Visit Your Parents Often . . . or Else: A national law in China called the “Law of Protection of Rights and Interests of the Aged” requires the offspring of parents older than 60 to visit their parents “frequently” and make sure their financial and spiritual needs are met. This article provides details about this law and whether it could happen in the U.S.

7. Unusual Alternatives for Disposing of Your Body After Death: When most people think of what happens to their bodily remains after death, a traditional funeral and casket burial are what typically come to mind. This article provides details about alternatives, such as green burial, mummification, and more.

8. Top 10 Medicaid Myths: A look at the facts about Medicaid uncovers many common misconceptions about the program that are simply myths. This article looks at and dispels some of myths about exactly who qualifies for Medicaid, what coverage it provides, and how you can plan for long-term care for yourself or a loved one.

9. Intelligent Underwear, Smart Shoes, and Other Amazing Innovations for Seniors:  Technology is contributing to greater independence, expanded personal connections, and healthier lifestyles for seniors. This article explores new possibilities, including the option to plug into healthcare information from home, track symptoms, and access therapy remotely, that make it easier for older adults who are living life more independently.

10. Stricter Law for Mature Drivers Goes into Effect in VA on New Years:  Virginia joined 33 states and the District of Columbia in enacting tougher standards for mature drivers. This article describes that law that went into effect yesterday, January 1, 2015.

11. Before You Choose a Nursing Home . . .: This article explores important things you should do (and look out for) when selecting a nursing homefor a loved one.

12. Better Care Coordination Will Save Tax Payers Billions: Poorly coordinated transitions and hospital readmissions are both excessively costly and risky. This article examines how the Community-based Care Transitions Program (CCTP), part of the Partnership for Patients initiative, is designed to support people coming out of the hospital so they don’t wind up right back in.

13. Are IRAs Considered Countable Assets for Medicaid?: With the possible exception of a primary residence, IRA’s and other retirement assets such as 401(k)’s are often the single largest asset for many seniors. This article explores whether IRAs are countable assets for Medicaid.

14. Tax Day: Seven Unusual Deductions: Did you know you could take a tax deduction for bingo, pet moving, and clarinet lessons? This article discusses some of the wackiest tax deductions you can take.

Thank you for making these our top stories of 2014. We promise many new and exciting things to come in 2015! We also hope you will consider taking the advice that these articles offer. Please consider attending one of our seminars in Fairfax or Fredericksburg (and coming soon to Rockville, MD and Washington, DC). As always, if you or a loved one 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 The Law Firm of Evan H. Farr, P.C. at 703-691-1888 in Fairfax, 540-479-1435 in Fredericksburg, 202-587-2797 in Washington, D.C., or 301-519-8041 in Rockville, MD, to make an appointment for a no-cost consultation.