Rest in Peace, Sweety

A year ago, Jeannie and I adopted a cat, Sweety, from one of our clients who passed away, and whose family was unable to care for her. This is just one of the many ways in which we sometimes are able to help our clients.

Sadly, our beloved Sweety just died last week of heart failure. We miss her dearly but know that she is in a better place.

Have you lost a pet? Below are some tips from someone who has been through it:

•Be honest about your feelings. Don’t deny your pain, or your feelings of anger and guilt. Only by examining and coming to terms with your feelings can you begin to work through them.
•You have a right to feel pain inside. A member of your family has died, and you may feel alone and bereaved. You have a right to feel anger and guilt, as well.
•Locking away grief doesn’t make it go away. Express it. Cry, scream, talk it out. Do what helps you the most.
•Don’t try to avoid grief by not thinking about your pet. Instead, reminisce about the good times. This will help you understand what your pet’s loss actually means to you.

Some find it helpful to express their feelings and memories in poems, stories, or letters to the pet. Other strategies can include preparing a memorial, such as a photo collage, and talking to others about your loss.

If you have recently lost a loved one, whether a person or pet, please be sure to check out these Resources and Links on our web site intended to help after the death of a loved one.

Do Not Resuscitate Orders Being Placed Without Patient Consent?

All of us can be lulled into believing we’ve got plenty of time, until something unexpected happens. Whether it’s a car accident, a heart attack, a fire, or a stroke, those who procrastinated and didn’t plan in advance often kick themselves for not taking action sooner.

Let’s take, for example, Michelle Singletary, a Washington Post reporter whose mother was in a house fire and was in critical condition. When working with health professionals, Ms. Singletary and her sister experienced a great deal of stress because her mother never prepared any Incapacity Planning documents, indicating her wishes for medical care or life-prolonging procedures.

What if you were in a similar situation, and the decision to pull the plug was made for you? Wouldn’t it be awful if it wasn’t what you intended for yourself or your loved one? Well, that is what is happening in the UK. In fact, tens of thousands of patients are having “do not resuscitate” orders imposed without their families’ consent.

In England, hospitals are failing to tell relatives that they do not intend to attempt potentially lifesaving techniques to save their loved ones, according to the Royal College of Physicians. An audit of 9,000 dying patients found that one in five families were not informed of the plans – equivalent to 40,000 patients a year. In 16% of cases, the study found there was no record of a conversation with the patient about the order, and no planning documents were located.

Advance Directives Are a Must!

Could hospitals take important decisions like this into their own hands in the U.S.? Maybe or maybe not. To protect yourself, however, and guarantee that this won’t happen to you or a loved one, Advance Directives are imperative.

An Advance Medical Directive is the document that give you control over your medical care if you’re unable to speak for yourself. In your Advance Directive, you designate someone to make health care decisions for you if you can’t, and you also give guidance on the types of treatments you would or would not want.

Based on her experience with her mother, Michelle Singletary emphasizes that it is important to meet with an attorney who knows about changes in the law and specific documents that must be signed. She said that “I’m a frugal person but this is not the time to be a penny pincher.” According to Ms. Singletary, “If you care about those who will handle things for you in case you become incapacitated, help them now. Do it if you have dependent children or someone depending on you financially. Do it for the people you will leave behind.”

An Advance Medical Directive (which should include a Long-Term Care Directive and Post-Mortem Directive) is one component of an overall Incapacity Plan.  The other documents that are part of an Incapacity Plan are:

• A properly-drafted Durable General Power of Attorney that contains complete Medicaid asset protection powers, including full gifting and full trust creation and termination powers.
• A HIPAA Authorization.
• A Special Power of Attorney for each piece of Real Estate that you own.
• A Lifestyle Care Plan to ensure you get the best care if you wind up needing long-term care and you are unable to speak for yourself.

For more details on why you should plan for incapacity and details on some of the types of documents you need, please read our blog article, “Are You Prepared For Incapacity?”

When you have Advance Directives, Make Sure Hospitals Can Access Them
At the Farr Law Firm, we enroll our clients in the DocuBank electronic registry to ensure that their advance directives are always available at the hospital. Now, this is especially important, as it was recently discovered that doctors cannot easily get hold of their patients’ advance directives at the hospital, even in an emergency, according to a news report in USA Today/Kaiser Health News.

Ironically, electronic medical records, which are supposed to help find patient information, actually create their own problems, the article explains. One problem is that different medical records are incompatible, meaning that different hospitals can’t share your Advance Medical Directive, and even the same hospital often can’t share your Advance Medical Directive between different departments of the same hospital. So, for example, if your Advance Medical Directive is available in the emergency department and you need to be moved to cardiology, it might not be accessible there.

Another problem is that it could take a while to find your Advance Medical Directive because most electronic health records aren’t set up to store one. “If [medical staff are] not able to access the advance directive quickly and easily, they’re honestly likely not to use it,” says Torrie Fields, senior program manager for palliative care at Blue Shield of California.

In addition, the article affirms that patients frequently (and understandably) forget to bring their advance directives with them.

Lack of availability of your Advance Medical Directive can be an especially big problem in the hospital, where it’s extremely important that your doctors and loved ones have instant access to these documents and therefore to your wishes. These problems are precisely why we register the Advance Medical Directives of our clients with DocuBank. We’ve heard too many horror stories, and we want to ensure that your doctors and loved ones can immediately obtain your Advance Medical Directive so that you can get the best care — the care that you desire.

What Are You Waiting For?

To ensure your wishes are met, it is important to start your planning while your mind is still sharp and your judgment is sound, so you are prepared in advance if a crisis occurs. If you have not done Incapacity Planning, Estate Planning, or Long-Term Care Planning, or if you have a loved one who is nearing the need for long-term care or already receiving long-term care, please contact us for a no-cost initial consultation:

Fairfax Estate Planning and Incapacity Planning: 703-691-1888
Fredericksburg Estate Planning and Incapacity Planning: 540-479-1435
Rockville Estate Planning and Incapacity Planning: 301-519-8041
DC Estate Planning and Incapacity Planning: 202-587-2797

Being Her Brother’s Caregiver

Helen Ries and Paul Knoll

A year ago, Helen Ries’s mother died unexpectedly, and she became the primary caregiver of her brother, Paul Knoll. Knoll has Down syndrome and had lived with his parents most of his life. Ries admits that her first year as a caregiver wasn’t easy, as she attempted to maintain the same standards for her brother as her parents did.

Helen’s parents were there for her brother all day, every day. They washed his clothes, made his meals, and chauffeured him around. They made decisions for him and solved problems for him, without him ever having to ask for help. These were tough demands to follow for Helen, who had a family and a job of her own.

At first, changing her life to be in service to her brother made Helen deeply angry, and she could tell her brother was also feeling resentful, since she was his older sister, rather than his parent. They fought constantly, until one day, she decided to just “let go.” She began encouraging her brother to make his own decisions, rather than enabling him, and he began learning from unexpected and undesirable consequences. For instance, if on occasion, his socks were dirty, his hair was a mess, he couldn’t wake up in the morning, or if he ate popcorn for dinner once in a while, Helen said, “so be it.” When Helen let go and let him manage his life a bit more for himself, he gained a sense of self-confidence and independence, and Helen’s role became a lot more enjoyable, and less stressful.

Similar to Helen, many of us are caregivers for our loved ones. And, as Helen found, there are ways to simplify the role and to reduce stress. Below are some tips from successful caregivers, such as Helen:

• Accept your role: Research shows that caregivers who feel more in control and accepting of their roles are more likely to realize positive benefits from caregiving.
• Practice self-care: Whether it’s exercising daily, meditating, getting enough sleep, or carving out some “me” time every week, successful caregivers know to put their needs first. They know it’s what gives them the strength to care for others.
• Prioritize your own life: Successful caregivers do their best to maintain their careers and their relationships, knowing that caregiving is not forever. They know they can put themselves first and still be an attentive, responsible caregiver.
• Set boundaries: Successful caregivers know their limits and say no to requests that push them.
• Tune out critics: There are always plenty of people willing to tell you what you are doing wrong and what you could do better. Successful caregivers are confident in themselves and tune out the critics. They try not to internalize negative feedback.
• Focus on the big picture: Successful caregivers have bad days and get overwhelmed just like everyone else. They work through those moments by keeping the big picture in mind. Remember that although they may seem challenging, your caregiving experiences allow you to truly connect with someone in a way some people never do, and to be of service to someone you care about in a time of need.

Helen Ries in our example suggests that caregivers should “set up a caregiving circle and use existing tools, such as http://tyze.com/ to do so.” Tyze was originally created for families with a person with a disability, but it’s now being used to facilitate all kinds of caring circles. “Using it (and setting up a caregiver circle) could save caregivers a lot of effort.” Ries also recommends that “It’s important to have good professionals in your life, such as a good lawyer, giving you sound advice – who is willing to go beyond to find solutions.” Read more about Helen’s first year of being a caregiver for her brother and see her suggestions on her blog.

Are You a Caregiver for a Loved One with a Disability?

If you are a family member who cares for someone with a disability, whether a child or an adult, combining personal, caregiving, and everyday needs can be challenging. The Center for Disease Control (CDC) offers a helpful resource, titled, “Caregiving Tips for Families of People with Disabilities.”  These tips provide families with information on how to stay healthy and positive, and can be used to address issues such as being informed, getting support, being an advocate for your loved one, empowering your loved one, and finding balance in your own life.

The following links may also be helpful:

• The Arc advocates for all people with intellectual and developmental disabilities (I/DD) and their families. Whether you’re concerned about the future for your child about to be born with a disability or you have a child with I/DD who is growing into a young adult, your local Arc chapter can help.

• Parent to Parent USA (P2P USA) pairs parents of children with disabilities or complex health conditions with experienced parent mentors who can provide emotional support and help finding information and resources. Contact a P2P program near you.

• There is a network of University Centers on Disabilities around the country that provides training and guidance on all sorts of issues that affect the lives of people with disabilities and their families, including health, education, employment and social services. One of these centers published a helpful guide, “Future Care Planning: A Roadmap for Family Caregivers.”  Page 66 of the guide includes a section of resources for caregivers of adults and children with developmental disabilities.

• Respite care can take place in your own home, where professional caregivers provide an opportunity for parents to have some time to themselves to shop, go to a medical appointment or spend time with other children or a spouse.

• State Councils on Developmental Disabilities advocate for people with developmental disabilities to promote inclusion, acceptance and self-direction.
• The National Down Syndrome Society has more than 375 local affiliates around the country. They provide a variety of services and many have a parent support program. Other services may include new parent support and education, family meetings, sibling and grandparent support, recreational activities, lending libraries, helplines and regional conferences.

• Local chapters of Autism Speaks provide many different services for families with a child with autism. They also have a resource guide for each state that lists employment, transportation and health services, support groups, speech and language therapies, after-school programs and many other services available in your state.

Special Needs Planning

When you are the primary caregiver for a loved one with special needs, it is vitally important to take the right steps to ensure that your loved one will be financially secure and cared for in the event of your death or disability, including:

• Hiring an attorney who is experienced in creating special needs trusts, such as myself;
• Clearly spelling out your wishes for the disbursement of trust funds within the trust document;
• Finding someone you can trust that has your loved one’s best interests at heart to serve as Trustee or Trust Advisor.

Special Needs Trusts

A special needs trust is an essential tool to protect a disabled individual’s financial future. Also known as Supplemental Needs Trusts, this type of trust preserves legal eligibility for federal and state benefits by keeping assets out of the disabled person’s name while still allowing those assets to be used to benefit the person with special needs. Read more here.

When it comes to special needs planning, the Farr Law Firm can guide you through this process. If you have a loved one with special needs, call us to make an appointment for a no-cost initial consultation:

Fairfax Special Needs Planning: 703-691-1888
Fredericksburg Special Needs Planning: 540-479-1435
Rockville Special Needs Planning: 301-519-8041
DC Special Needs Planning: 202-587-2797

Critter Corner: Do Dogs Hold the Key to Successful Aging in Humans?

Dear Baxter,

My labrador retriever, Jessie, lived until she was 17 years old, making her a centenarian in human years. I heard of another lab that lived until 18, or 109 in human years. Have any studies ever been done on how our oldest canine companions can give us clues to how we can age successfully?

Thanks,

Doug E. Lifespann

—-

Dear Doug,

Thanks for your question. I hope to stick around for that long myself!

Yes, there has been research on this fascinating topic. In fact, a leading veterinary gerontologist, Professor David Waters, from Purdue University College of Veterinary Medicine in Indiana is well known for his work on the subject of extending human health span.

He has studied highly successful aging in domestic dogs, particularly in the Rottweiler breed, with the ultimate goal of fully understanding the process of highly successful aging, including cancer resistance, in both domestic dogs and people. Details about his research and some of his findings have been captured in a 13-minute talk by Professor Waters on YouTube, that you can see here.

Another scientist (a veterinary epidemiologist) named Vicki Adams was recently invited to be part of a team to evaluate the results of 10+ years observation of a group of 39 Labrador retrievers. Nearly one-third (28%) of these Labradors achieved an exceptional age, reaching or exceeding 15.6 years. This study, published this week in Acta Veterinaria Scandinavica, produced some exciting results about why some Labradors live to 16 or 17 and others only reached their expected average age of 12 or even below.

A common theme was that the longest lived Labradors had a significantly slower rate of body fat mass accumulation over their first 13 years of life compared to Labradors that lived only to their expected average age of 12 or less, and they also had a significantly slower loss of lean body mass compared to those with the shortest lifespan.

Do dogs hold the key to human longevity? Maybe. According to Adams, researchers are now interested in further evaluating the changes in body fat and lean body mass in canines, and how they apply to humans.  Hopefully, these studies will aid in the development of strategies to improve our chance of healthy aging and living longer.

Hope you take good care of yourself to live a long healthy life!

Baxter

$10,000 – $12,000? That’s for a Year, Right?

Q. I read in one of your recent newsletters that nursing homes in the metro DC area cost $10,000 – $12,000 a month. I think you made a typo, and I wanted to bring it to your attention. Those amounts are for a year, right? If nursing homes cost THAT MUCH per month, then nobody could afford them without going completely broke.

My used car cost $12,000, and I am paying it off. I couldn’t imagine spending that amount each month for my wife to have skilled care in a nursing home. In less than a year, that would deplete all the money we worked so hard for all these years, and saved for retirement. Please tell me I’m right, and the word “month” should have been “year”!

A. Thanks for your inquiry but, unfortunately, you read that right. The cost of a nursing home in the metro DC area is $10,000- $12,000 A MONTH, an amount that is catastrophic for most of us.

Each few years, Genworth conducts surveys of long-term care across the U.S. and summarizes the data in a Cost of Care Study, in an effort to help Americans plan for the potential cost based on their preferred location and setting. The 2016 survey is now out, and provides state-specific cost of care data for all 50 states and comparison to the national median.

Unfortunately, according to the study’s findings, the cost of receiving care continues to rise sharply year over year, especially for services in the home, where most Americans prefer to receive long-term care. Below are some highlights from the survey:

• Home Care Costs Rise Sharply: Nationally, the median monthly costs Home Health Aide Services is $20 per hour.  For 56 hours a week (8 hours a day), that equates to roughly $4,853 per month, a 2.56% increase from last year.
• Assisted Living Facilities Saw a Slight Increase:   Nationally, the median cost of assisted living rose .78% to $3,628 per month. In the DC Metro area, Assisted Living costs an average of $6,700 per month ($80,400) per year.
• Cost for Semi-Private Rooms Increased: Nationally, the median cost of a semi-private nursing home room is up 2.27% to $6,844 per month. In the DC Metro area, the average cost is $10,114 per month.  That’s $121,363 per year on average!
• Cost for Private Nursing Home Rooms Increased: Nationally, the median cost of a private nursing home room is $7,698, up 1.24% from 2015.  In the DC Metro Area, on average, the cost is $11,422 per month, or  $137,058 a year!

For the full report, see Genworth’s Website, and/or download Genworth’s Cost of Care App from iTunes.

People Underestimate the Cost of Long-Term Care

According to a complementary Genworth online caregiving survey, four out of five adults underestimate the costs of home healthcare. In fact, nearly one-third of Americans incorrectly believe that costs for these services run under $417 per month. As you can see from the figures above, people are way off, as the national median rate is nearly ten times more than that.

In addition, people who stand to be affected most by long term care events are also more likely to underestimate the cost of care. This includes women (who are statistically more likely to enter caregiving roles), single adults (who may not have a partner to rely on for caregiving needs), and younger adults (aged 25-45, who are more likely to deal with the reality of a parent needing care).

“The data from our complementary study dramatically demonstrated the huge disparity between what consumers think costs are and what they actually are, which is why it’s so important for families to educate themselves about the costs and plan ahead for how they will pay for those costs before it’s too late,” said Tom McInerney, president and chief executive officer at Genworth.

Understanding and Funding Care Options

As costs continue to rise, consumers should educate themselves on long-term care and options to pay for it, as follows:

• Long-Term Care Insurance: There’s definitely a benefit for some people in purchasing long-term care insurance. However, there are certain issues to consider before you buy, including the rising costs and how long-term care insurance interacts with Medicaid. Keep in mind, also, that there are dozens of long-term care asset protection strategies other than long-term care insurance. For more details, please read our blog post, “Long-Term Care Insurance: Yes or No?.”
• Medicare does not pay a penny for long term care: It is important to understand that Medicare, the public health insurance system for seniors over 65 and disabled adults, does not pay one penny for long-term care. Medicare only pays for medical care delivered by doctors and hospitals and, in certain cases, short-term rehabilitation which might take place in a nursing home.
• The Medicaid program is our country’s largest health and long-term care insurer, covering one in six Americans, including two-thirds of nursing home residents and one in five persons under 65 with chronic disabilities. Keep in mind, however, that Medicaid laws are the most complex and confusing laws in existence, and impossible to understand without highly experienced legal assistance. Without proper planning and legal advice from an experienced Elder Law Attorney, many people spend much more than they should on long-term care, and unnecessarily jeopardize their future care and well-being, as well as the security of their family. Please read the Medicaid Complexity page on our Website for more details.

A Helpful Resource to Have a Conversation with Loved Ones

Through its “Let’s Talk” online platform, Genworth offers a suite of tools and advice to assist families in beginning the planning discussion. This online resource provides tips on how to begin conversations surrounding long term care needs. Let’s Talk also addresses common misconceptions surrounding care and provides a step-by-step discussion guide alongside key issues to cover – cost of care being one of them.

Medicaid Planning in Virginia, DC, and Maryland

Medicaid planning can be started while you are still able to make legal and financial decisions, or can be initiated by an adult child acting as agent under a properly-drafted Power of Attorney, even if you are already in a nursing home or receiving other long-term care.  In fact, the majority of our Lifecare Planning and Medicaid Asset Protection Planning clients come to us when nursing home care is already in place or is imminent.

Generally, the earlier someone plans for long-term care needs, the better.  But it is never too late to begin your planning.

Planning for long-term care will not eliminate your risk or your husband’s risk of needing it, but it enables you to sort options and make smarter decisions ahead of time. As a result, you’ll have the peace of mind that no matter what happens, you will know what to do as a family.

As you have clearly not done any Long-Term Care Planning (and perhaps you’ve also neglected to do Incapacity Planning and Estate Planning), please call us as soon as possible to make an appointment for a no-cost initial consultation:

Fairfax Elder Law: 703-691-1888
Fredericksburg Elder Law: 540-479-1435
Rockville Elder Law: 301-519-8041
DC Elder Law: 202-587-2797