Critter Corner: How to Convey Love to Someone with Alzheimer’s
Dear Commander Bun Bun,
My mother was diagnosed with Alzheimer’s five years ago. A moment I have been dreading finally arrived. When we went to visit her, she forgot who we were. It hurt a lot to see this happening, and I know it’s just the beginning. What are some ways we can communicate love to my mother, even if she doesn’t recognize us?
Thanks!
Karenna Bowtmom
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Dear Karenna,
Dr. Edward Shaw was a practicing radiation oncologist and a world-renowned brain tumor expert. When his wife was diagnosed with Alzheimer’s and lost her battle, his medical interest shifted from cancer to dementia diagnosis and treatment. He wrote the book, “Keeping Love Alive as Memories Fade: The 5 Love Languages and the Alzheimer’s Journey,” to help people communicate with their loved ones with Alzheimer’s.
The 5 Love Languages provide tools that make it possible to sustain an emotional connection with a memory-impaired person. In Shaw’s case, each member of his family had a special way of communicating their love to his wife. One of his daughters loved spending quality time sitting with her and sharing a cup of coffee. The other would play her guitar and sing words of affirmation. The third snuggled with her mom and rested her head on her mother’s shoulder.
“The 5 Love Languages” describes how individuals, in situations similar to the Shaws, communicate and receive emotional love.
The 5 Love Languages include:
1.) Words of Affirmation: unsolicited words of affection and appreciation
2.) Quality Time: giving someone your full, undivided attention
3.) Gifts: a visible symbol of love such as a purchased, handmade, or found tangible gift
4.) Acts of Service: doing helpful things for another person to lighten their load
5.) Physical Touch: deliberate touch conveying your presence to another
The author and co-authors of the book hope that “The 5 Love Languages” enables other families experiencing Alzheimer’s to enjoy the rewards of staying emotionally connected to loved ones.
Hop this is helpful!
Commander Bun Bun
Do I Have the Alzheimer’s Gene?
Q. My father and several of my aunts and uncles on his side and on my mother’s side have had Alzheimer’s disease, so I know that it is common in my family. I wish there was a way to know if I will get it too, so I could start on my bucket list now and plan ahead. I read recently that you can undergo genetic testing to see if you have the Alzheimer’s gene? Do you recommend it, and if so, how accurate of a predictor is it? Thanks for your help!
A. Genes help control the function of every cell in your body, from the color of your eyes and hair, to whether you are more likely to develop certain diseases, including Alzheimer’s. At this time, researchers have identified a number of genes associated with Alzheimer’s disease. Genetic risk factors are just one of the factors involved in getting it.
The Alzheimer’s Disease Genetics Study, which is being sponsored by the National Institute on Aging, is examining genetic information from families that have at least two family members who have developed Alzheimer’s after age 65. It began in 2001 and will end in 2021. The purpose of the study is to identify and analyze the genes that cause late-onset Alzheimer’s disease. Unfortunately, the results won’t be available for another five years. Until then, there has been some other research that indicates that genetic testing for an Alzheimer’s gene is possible and available.
In general, medical centers offer genetic testing as a clinical service. Patients are generally required to pay for the diagnostic test out of pocket, though some health insurance carriers may cover certain genetic tests. Participants can choose whether or not to be told their test results. Part of the reason why people choose to get tested in a research setting is that this information need not become part of their medical record.
Candidates for genetic testing cite a range of reasons for doing so, including:
• They feel like they need to know. Particularly as they approach the age of disease onset in their family, their anxiety intensifies and they want to know how probable it is that they will get the disease.
• They are motivated to contribute to genetic research, either for their own benefit or that of their younger relatives and coming generations.
• They hope that effective treatment will be developed in time for them, and hope to be eligible to participate in clinical trials.
• Some believe they already have the disease. Fear makes them doubt their mental faculty, and question every instance of forgetting. Interestingly, many of these cases prove not to carry the gene at all.
• People want to plan their finances, for long-term care, retirement, advance directives, and estate planning documents.
• People want to plan their families: will they have children or not, get married or not?
• People want to make changes in their lifestyle include spending more time with family, exercising, eating healthy, etc.
• People want to know what to tell their children and other loved ones.
Should you be tested for the Alzheimer’s Gene?
Getting tested for the Alzheimer’s gene has advantages and disadvantages, as explained by the experts:
Don’t get tested: Even though you can be tested for a gene that would show you to have a predisposition to Alzheimer’s, Dr. Richard Caselli, a top neurologist doesn’t think you should. According to Caselli, “(a)bout 20% to 25% of North Americans carry this particular gene—the percentage varies by geography. That’s a significant number.” Caselli says. However, according to research, the gene variant for Alzheimer’s has been found in healthy members of the community as well as those who develop Alzheimer’s disease. Therefore, current genetic tests that claim to predict risk of Alzheimer’s disease are limited and unlikely to do anything other than create unnecessary anxiety, or a false sense of security.
According to Caselli, “It would be a different story if genetic testing could lead to treatment that would forge a better outcome. But Alzheimer’s testing won’t really improve the subject’s quality of life.” He asks, “What are you going to do? Tell people not to have kids because they’ll get Alzheimer’s when they’re 75 years old?”
Get tested: Dr. Mary Lou Jepson, a former top technologist at Google and Facebook disagrees. Jepson said she has been tested. “Why wouldn’t I want to know?” she asked.
She may have a different perspective based on her own personal experience. Twenty-one years ago Jepson was afflicted with a mystery illness that put her in a wheelchair and covered her in sores. The cause turned out to be an diagnosed brain tumor, which led to life-saving surgery. In her case, early detection definitely led to better quality of life. She would hope the same could happen for those who find out through genetic testing that they are predisposed to Alzheimer’s disease.
Another Way to Detect Alzheimer’s Before Symptoms Appear
Besides genetic testing, a team of researchers at Massachusetts General Hospital (MGH) have found another way to spot Alzheimer’s in the early presymptomatic stages of the disease, using brain scans. The scans revealed that those with the disease had asymmetrical brain structures in the left and right sides of the brain.
According to researchers, “(i)f presymptomatic or early-stage individuals at risk of developing the disease are identified, they can be recruited into studies investigating novel therapies, because preventive treatment can still be successful.”
Whether or not you choose to find out if you have the Alzheimer’s gene, or if your brain is asymmetrical is up to you. Regardless, it is always prudent to plan ahead!
Medicaid Planning for Alzheimer’s and Other Types of Dementia
Alzheimer’s is the biggest health and social care challenge of our generation, and a diagnosis of the disease is life-changing. When it comes to planning for long-term care needs, generally, the earlier someone with dementia plans, the better. But it is never too late to begin the process of Long-term Care Planning, also called Lifecare Planning and Medicaid Asset Protection Planning.
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. Please call us as soon as possible to make an appointment for a no-cost 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
Election 2016 Roundup- Five Major Issues Affecting Seniors
In just a week from today, we’ll be casting our votes for the person who will lead this country for the next four years. If you’re still undecided because you are not entirely thrilled with any of the candidates this year, you can take one last good look at the issues instead of the person when making your decision. In fact, according to the New York Times, 82% of those undecided will vote for the candidate who is most aligned with them on the issues.
Let’s recap the top five issues affecting seniors, and examine once more where Clinton and Trump stand on the issues. This latest information includes stances taken during recent debates and interviews:
Issue #1 – Social Security
Social Security is arguably the most important issue for seniors and boomers. In fact, according to the Pew Research Center, 75% of voters between the ages of 50 and 64 and 78 percent of voters 65 and older list Social Security as a “very important” factor in how they will vote in the 2016 presidential election.
According to the Social Security Administration, 59 percent of seniors retiring in this country rely on social security as their sole source of income. With a majority of seniors using social security in this way, it is important that the program be a top concern for any president.
AARP asked each of the candidates to share their position and plans for Social Security. Below is a summary of the candidates’ views on this very important issue:
Hillary Clinton:
• has pledged to guarantee “dignity in retirement” for future generations;
• has vowed to fight privatizing the social security system;
• opposes the reduction of annual cost-of-living adjustments; and
• opposes efforts by Republicans to raise the retirement age (currently set at 67);
• would like to expand social security to include women who are widows who chose to be stay-at-home-moms instead of joining the workforce and also for those who chose to stay out of the workforce caring for aging or ailing family members.
Donald Trump:
• has said that he believes the key to preserving social security and other programs which benefit seniors and boomers is with an economy is that “robust and growing”;
• has stated that the first step to achieving a more robust economy is to implement a more comprehensive tax-reform plan;
• has suggested repealing the Dodd-Frank and Affordable Care Acts to increase competition and lower costs to consumers;
• feels that a pro-growth agenda is necessary to protect and preserve this valuable program.
Issue #2 – Medicare
Right behind Social Security in importance to seniors and boomers is Medicare. According to information from the Centers for Medicare & Medicaid Services (CMS), the total number of Medicare beneficiaries in the U.S. is at 55.5 million. The challenge each candidate faces with Medicare is finding a solution that will control future costs while avoiding benefit cuts.
According to the Motley Fool, “This is one of the few areas where the candidates agree, even when it comes to most of the ways they plan to fix it. The only major difference is that Donald Trump could face an uphill battle against the rest of the Republicans, who don’t feel as strongly about preserving Medicare as he does. Regardless, the fact that we have two presidential candidates who both feel strongly about the need to preserve Medicare could be a big win for America’s seniors.” Here are more details on their stances:
Hillary Clinton:
• has said that as with Social Security, she will do her best to protect Medicare for seniors and calls affordable healthcare a basic human right;
• is proposing to expand the Medicare program to include retirees starting at age 55;
• also wants to reduce the cost of prescription drugs by negotiating Medicare reimbursements with drug companies and by requiring drug companies to provide higher rebates in the low-income subsidy program.
Donald Trump:
• plans to save Medicare by creating economic growth, eliminating fraud and waste, and allowing Medicare to negotiate prescription drug prices.
• While it’s unclear how much fraud and waste actually exists within Medicare, increased economic growth like Trump’s tax plan is intended to create would result in more tax revenue flowing into Medicare.
• has claimed that negotiating prescription drug prices could save up to $300 billion, although the magnitude of the savings has been disputed.
Issue #3: Healthcare Reform
When it comes to healthcare reform, both candidates emphasize improving the quality of health care and the performance of the health system. Each would like to see more transparency from doctors and hospitals about the prices they charge for their services. However, the candidates would take the nation down distinctly different paths on health care, as follows:
Hillary Clinton:
• In response to reports that insurance premiums would rise an average of 22 percent in 2017 under the Affordable Care Act (ACA), Clinton campaign spokesperson Julie Wood released a statement offering Clinton’s continued support for the healthcare program on October 25, 2016.
• Clinton has been talking about mental health policy throughout her campaign, since hearing directly from American parents, students, veterans, nurses, and police officers about how these challenges keep them up at night. Her goal is that within her time in office, Americans will no longer separate mental health from physical health when it comes to access to care or quality of treatment.
• She proposes dedicating more resources to ensuring that people in poor neighborhoods and rural areas have access to primary care services.
• She proposes additional options such as a cap on prescription drug out-of-pocket costs for consumers.
• She offers a number of new proposals to provide help for families caring for older relatives or family members with Alzheimer’s disease, as well as people with drug or alcohol addiction.
Donald Trump:
• Has stated that he would repeal the Affordable Care Act (what Republicans call “Obamacare”), reduce barriers to the interstate sale of health insurance, institute a full tax deduction for insurance premium payments for individuals, make Health Saving Accounts inheritable, require price transparency, block-grant Medicaid to the states, and allow for more overseas drug providers through lowered regulatory barriers. Trump added that enforcing immigration laws could reduce healthcare costs.
• In an interview on September 15, 2016, Trump said that birth control “should not be done by prescription.”
• Suggested that he supported universal healthcare on September 27, 2015. “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now,” he said.
Issue #4 – Long-Term Care Costs
The availability and affordability of long-term care is another growing concern for the aging boomer population. Someone turning age 65 today has almost a 70% chance of needing some type of long-term care services and supports in their remaining years, according to the U.S. Department of Health and Human Services. According to the National Alliance for Caregiving, 34 million Americans were faced with providing care to an adult age 50 or older because the person was unable to afford to pay for long-term care services from an agency. Here’s where the candidates stand:
Hillary Clinton:
• Supports increasing Social Security benefits for those who take time off from paying jobs to provide caregiving services to family members;
• Is proposing a new tax break for individuals caring for aging parents or grandparents, allowing them to deduct 20 percent of their caregiving expenses up to $6,000 annually.
Donald Trump:
• Has not laid out specific plans for combating the costs associated with long-term care, but has mentioned that the 2016 Republican Party platform makes mention of the importance of affordable homecare.
Issue #5 – Caregiving
About 34 million Americans provided unpaid care to an adult 50 or older in 2014, according to a 2015 report by the National Alliance for Caregiving and AARP. Half of those “informal” caregivers were caring for a parent or parent-in-law. And about one in five said caregiving created a financial strain on them. These are the views of the candidates on caregiving:
Hillary Clinton:
• Believes Americans should receive credit toward their Social Security benefits when they are out of the paid workforce because they are acting as caregivers.
• Announced last year that she would invest in the “caring economy,” as reported by the Associated Press.
• Favors a new tax break for individuals caring for aging parents or grandparents. Under the proposal, a family caregiver would be able to deduct 20% of caregiving expenses, up to a total of $6,000. That would result in a total tax savings of up to $1,200. The proposal would not apply to those taking care of a spouse.
• Favors greatly increasing the amount the federal government spends on its Lifespan Respite Care program, which provides money to states to give family caregivers a temporary break. It spent $2 million in 2015, according to CNN. Obama asked for $5 million for 2016, and Clinton proposes increasing funding to $10 million a year.
Donald Trump:
• Responded to a question about Alzheimer’s at a campaign event by saying the disease is “a total top priority for me… That’s something that we should be working on and we can get an answer.”
• Urged viewers to contribute to the Alzheimer’s Foundation of America telethon in the past for its helpline, educational materials, hands-on care programs and “grants to families for respite care.”
• One passage of the 2016 Republican Party platform refers to “homecare:” It says: “Our aging population must have access to safe and affordable care. Because most seniors desire to age at home, we will make homecare a priority in public policy and will implement programs to protect against elder abuse.” As for taxes, the Republican platform says, “We will be mindful of the burdens on families with children and the impact on an aging population. We will seek simplicity and clarity so that every taxpayer can understand how much of their income is consumed by the federal government.”
To learn more about the presidential candidates’ views on these and other important issues, be sure to visit their campaign websites. And remember, please get out and vote (if you haven’t already) so your voice can be heard!
Have you planned for your future and for your loved ones? Regardless of the election outcome or possible changes in the law, the need to plan in advance remains. If you have not done Incapacity Planning, Estate Planning, or Long-Term Care Planning (or had your 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, please don’t hesitate to call us as soon as possible 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
What Happens When a Power of Attorney and Health Care Directive are Silent About…?
By Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold, NJ Power of Attorney Lawyer
In a recent office conversation with an elderly person and his daughter, he showed me an executed Power of Attorney (POA) naming her as agent and health care agent. The POA did not state how or when the agent could be removed nor did it state a successor Agent in case the original agent could not serve. In this case a sibling suspects the agent is neglecting the principal (his dad) and therefore is placing him at risk when left in the agent’s case and custody.
The POA as written is very good. It approves every authority to the agent imaginable but does not state any grounds for the agent’s removal. Assuming a court can terminate the POA (it can) what grounds exist for a court to do so?
“Forget about going to court” I told the family. If the principal is competent he can revoke the POA at will (meaning any time he wants) pursuant to N.J.S.A. 46:2B-8.10 and the health care proxy under N.J.S.A. 26:2h-23, et seq. If he is no longer competent then both the POA and the health care proxy can be revoked by a court in a guardianship proceeding.
To discuss your NJ Power of Attorney matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com. Please ask us about our video conferencing consultations if you are unable to come to our office.