What is the Difference Between a NORC and a NOSS?
Q. My parents are deciding whether to stay in their home or to downsize to an apartment. Currently, they live in a single-family home in an established neighborhood, where most of their neighbors are original owners who have lived in their homes since 1965. The location they live in is so convenient, so most people end up staying there as long as they can. Since this is the case, I read in a recent community newsletter, that the community is becoming what’s known as a Natural Occurring Retirement Community (NORC).
After my brother, sister, and I moved out ten years ago, my parents indicated that the house has become too big and too much of a burden for them to take care of, which is why they are considering the move to an apartment. They have some friends in a nearby apartment complex, and my mom is social, so I am sure she would make new connections with others their age and younger. My mom said her friend describes the apartment community they are considering as a Naturally Occurring Support System (NOSS).
Can you please clarify for me the difference between a NORC and a NOSS, and the advantages of each? Thanks in advance for your help!
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A. Many seniors wish to age safely in their homes and neighborhoods, and others hope to downsize to a smaller place. Among the many initiatives to facilitate aging in place, two prominent community-centered models that have emerged are Naturally Occurring Retirement Communities(NORCs) and Naturally Occurring Support Systems (NOSSs), both of which have “naturally” developed to address the discrepancy between how communities are designed and what older adults need to age in place.
NORCs
The term NORC was coined in 1984 by Michael Hunt, a professor of urban planning at the University of Wisconsin-Madison. It denotes a geographically defined community in which at least 40% of the population is 60 or older and live in their own homes. NORCs can take many forms, ranging from vibrant communities that encourage seniors to stay engaged, to sad places where seniors live in isolation.
AARP has reported in recent years that 25% to 36% of seniors live in NORCs; however, the Administration on Aging puts the figure at 17%. Whichever estimate is accurate, some NORCs thrive while others wither. What typically makes the difference are Supportive Services Programs (SSPs), usually the result of partnerships between local organizations and vetted providers.
The following are some advantages of NORCs:
• As NORCs evolve into NORC-SSPs, they typically offer social services, health care management, education, recreation and volunteer opportunities. Many also have added adult day care, meals, transportation, home care, legal and financial advice, home safety improvements, mental health counseling and disease management.
• NORCs are viewed as a cost-effective aging-in-place model.
• Those with strong attachments to their community can stay in their neighborhood and stick with what they know. Moving elsewhere means leaving all that behind and starting all over at somewhere new and unfamiliar.
• NORCs are good if homeowners are unable to find acceptable housing alternatives. For instance, in Washington, DC, dwelling options (especially apartments) that satisfy the needs of retirees are scarce and expensive.
A disadvantage of a NORC is that houses may not be accessible for a senior’s needs, and may need to be remodeled. To provide adequate comfort, safety, and mobility, various elements of older homes including stairs, railings, hallways, kitchens, bathrooms and more, typically require some modification. Another disadvantage is that most seniors who live in NORCs are empty nesters, leaving them to maintain a home that may be a lot bigger than they need.
NOSSs
A Naturally Occurring Support System (NOSS) is it a relatively new term for a concept that has been around for centuries. Most of us have a NOSS on some level (with family, friends, co-workers, neighbors, etc.). NOSSs are ideal, because it makes good economic sense to share support, rather than pay for everything we need – whether it’s for pet care, tech help, yard care tools, home maintenance advice, and more.
These are some advantages of NOSSs.
• You can buy time and extend resources: When your needs aren’t great, NOSSs can often provide enough support. Sometimes they can even help with growing needs. They also stretch financial resources, because they enable you to stave off moving to assisted living or a skilled care facility until a time when your needs grow beyond the NOSS and supplemented help from a home care company.
• It is good for socialization and to avoid loneliness: Seniors who are part of a NOSS can go to activities together, participate in the book clubs, and watch out for each other. Those who are part of a NOSS foster connections with neighbors and peers and band together to make where they live a better place.
• It can expand and extend quality of life: Seniors can help other seniors in areas where they need help and lend a hand in others where they can provide assistance. For instance, a resident with a significant hearing loss can pair up with a neighbor with very limited vision to stay active and involved. Cognitively intact and impaired residents could bond together and enjoy a wide range of activities and interests. Combining your strengths with the strengths of your peers enables many to age in place longer and delay higher support moves – resulting in big cost savings and extended quality of life.
When a NORC or a NOSS is no Longer an Option
Most people would prefer to age in their home in a NORC or be part of a NOSS for as long as possible, but even with the aging-in-place supports described above, they often can’t. If you or a loved one cannot live independently and are showing signs that they need more assistance, it may be time to consider other alternatives.
Whether the outcome is assisted living, or nursing home care in the future, it is prudent to plan ahead, especially since skilled care facilities costs $10,000 to $14,000 a month in the Metro DC area. Please contact us as soon as possible to make an appointment for a no-cost consultation to discuss Medicaid Asset Protection Planning, or the process of protecting assets from having to be spent down in connection with entry into assisted living or nursing home care, while also helping ensure that you and your loved ones get the best possible care and maintain the highest possible quality of life, whether at home, in an assisted living facility, or in a nursing home.:
Fairfax Elder Law Attorney: 703-691-1888
Fredericksburg Elder Law Attorney: 540-479-1435
Rockville Elder Law Attorney: 301-519-8041
DC Elder Law Attorney: 202-587-2797
Critter Corner: Tips to Ease the Transition
My mother will be downsizing and moving soon. She has lived in the same home for 40 years, and does not do well with change. Do you have any tips for how we can ease her transition?
Lee Vinhomme
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Dear Lee,
Moving out of a place you are familiar with can be a challenge at all stages of age. It’s a big step, but in many cases, it is for the best. Oftentimes, individuals who do it say, “I wish I would have done it sooner.”
Here are some things you can do to ease the transition for your mother:
• Give her time to accept the change and to grieve, if needed: Your mother is likely emotionally vested in the home she is leaving, and it’s expected that there will be sadness and apprehension about the move.
• Talk with her about where she will be living and why she is moving.
• Loss of independence: She may be feeling a perceived loss of control, so give her as much choice as possible as they plan and implement the move.
• Plot the floor plan of her new home on graph paper, and cut out pieces to represent furniture, so she can feel more at ease about where everything will go when she gets to her new place.
• Enlist help from your family: Encourage siblings or other close family members to take a few days off of work. Surround you mother with support and encouragement to ease the emotional stress of moving.
• Sort, organize, and downsize: Go through the house item by item with your support team. You can categorize objects to make the process easier: items to be moved, keepsakes to be left with family, items to be sold or donated, and items to be thrown out. Honor the emotional attachment to personal belongings and allow your mom to reminisce as you help sort out her possessions.
• Plan the Moving Day: A full service mover is the easiest way to go, but also the most expensive. They will load everything, deliver to its destination and put things in place. Families can save money by using a self-service mover, which means their family will load the moving truck, but the cargo will be hauled by a professional mover. Then there’s the do-it-yourself (DIY) option where you can rent a moving truck or trailer. If you do decide to haul everything yourself, consider arranging for your mother to fly to her destination.
I hop these tips with help ease your mom’s transition. Best of luck!
Commander Bun Bun
How to Deal with a Dementia Diagnosis
The father of one of my staff members (let’s call her “Cara”) has had Parkinson’s disease since she graduated from college twenty years ago. Recently, Cara got the call she had been dreading for years – that now, her dad also has dementia. When Cara hears devastating news, she is usually an emotional basket case. This time, it was different
News of the diagnosis hit Cara hard, but she didn’t get emotional about it. She had prepared herself for a long time for it, and she had to keep her calm for her children. She knew dementia was genetic for her father and she knew very well that it’s often par for the course with Parkinson’s (an estimated 50 to 80% of those with Parkinson’s eventually experience dementia as their disease progresses). Emotional, she wasn’t. But, she still felt helpless living 600 miles away, having tons of responsibilities of her own, and simply not knowing how she could help her mother, who was his primary caregiver.
Another thing that concerns Cara is how the news will affect her father, if he does not know already which she believes is the case. Her father saw his mother suffer from dementia, and one of his brothers and his aunt has it also. He has suffered so much with Parkinson’s for all these years, but was still a trivia whiz and had his wits about him. How will he handle it when he finds out about his devastating diagnosis?
What we know about dementia
Unfortunately, there is no course in school telling us what to do and how to be helpful when an aging parent develops dementia, or an easy way for someone with dementia to handle the news of their diagnosis. What we do know, however, is that dementia is a debilitating disease. We don’t have a cure and we don’t know the cause, but we have good ideas about how to stave it off the symptoms for as long as possible. There is no medication that changes the overall course of the disease, though some medications provide temporary improvement in short term memory.
When a loved one finds out he or she has dementia
Reactions to a diagnosis of dementia can vary from relief to a mixture of fear, anger, or denial. Helping people come to terms with their diagnosis, to make decisions and plan ahead, is critical in supporting them to live well with dementia.
Often, things your loved one once did easily will become increasingly difficult, such as maintaining a schedule or managing money. Accepting changes in his abilities and adapting new coping skills will help him restore balance to his life and give him a sense of accomplishment in his abilities as he continues to live with the disease.
Support is out there to help people come to grips with their circumstances, fears, beliefs, and hopes. Remember, when it comes to support, different things are helpful for different people. Knowing the person, their history and interests, and understanding how dementia is affecting their life are crucial if the support offered is to be genuinely helpful. Please visit the Alzheimer’s Association Website for tips, suggestions, and details to help your father cope with his diagnosis. And for more general information on Parkinson’s type dementia, you can click here and here.
How You Can Help
Similar to Cara, what if you live far away from a loved one with dementia and you really want to help? Here are some things you can do to offer help to your family:
Pitch in: Make sure your loved one who is the primary caregiver does not have to carry the caregiver burden all by herself. It’s a heavy load. Give her some encouragement, appreciation, or relieve her yourself when you can.
Take on a task long term: If you cannot get on a plane or drive long distances to visit often enough, then offer your help in other ways. Managing property, bookkeeping, communicating with essential people, doing banking, getting prescription refills and other chores can often be done online or by phone. You can provide significant help even if you live far away.
Avoid criticizing the primary caregiver, no matter what. He or she may not be perfect at the job, but there is nothing more disheartening to a caregiver in the daily grind of the job than to hear fault-finding from a child or a sibling who isn’t doing the work. If you think more help is needed, offer to give it, pay for it, or find it.
Be a good listener. If another family member is on site and doing the hard work of day-to-day caregiving, you can check in on a regular basis and let her vent. It costs you nothing, and requires no more than a patient attitude and the desire to show your love and support by asking how things are going. This can be more helpful than you realize. Watching a parent in decline is sad. Talking about the emotions involved can relieve everyone’s stress.
Visit your loved one: As the disease progresses, your loved one may not know you by name or even know that you’re related, but he or she feels and knows the energy of the people that are closest, and can always feel your love, because love, like everything else in our universe, is energy, and we are all here on our earthly journey to give and experience love in all its forms. (Sorry if this sounds a little too “woo-woo” or “new agey” for some of you, but you’ll have to remember that in addition to being a Certified Elder Law Attorney, I’m also a Reiki Master and founder of a non-profit organization that provides Reiki to Elders, and I know first-hand that the world we live in – and everything that exists — is made of energy.)
Be sure the legal paperwork is in order: Before too much time passes, your loved one may not be competent to sign anything. Take the lead and find out if his legal documents, such as his Financial Power of Attorney, Will, Trust, and advance medical directive, are up to date. If not, be sure to visit an experienced Elder Law Attorney, such as myself, as soon as possible.
Planning for Long-Term Care
If you have a loved one with dementia, it is likely that he or she will eventually need continuous licensed nursing care in skilled care facility. Nursing homes in the DC Metro area cost between $10,000- $14,000 a month, which is a catastrophic amount for most of us. With proper planning, Medicaid will pay for most or all of the nursing home expenses.
In cases where a family member is in the early stages of dementia or Alzheimer’s disease, early planning is especially important. The family member needs to make decisions about financial matters while he or she still has the mental capacity to do so.
Here at the Farr Law Firm, 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
Reverse Mortgages: Yes or No?
Q. I retired last year at the age of 64, and my wife has been a homemaker for quite a while. We are glad that I am retired and we are free to do what we want (we have quite a lengthy bucket list!), but we came to realize that, despite my pension, we just don’t have the sufficient income and assets to live on, and we’d like to hold off on collecting Social Security for as long as we can. On paper, we own our home in Northern Virginia, which has appreciated 600% from when we purchased it, so right now we’re equity rich but extremely limited on monthly income.
I have mixed emotions about reverse mortgages. Part of me knows we could really use the money to enjoy our retirement. Another part would never do that to our children. I would love to leave them with a good inheritance. But, my daughter and son are both doing well for themselves, and we are struggling. Can you tell me more about the pros and cons of reverse mortgages and whether you think they are a worthwhile option to consider?
A. Many seniors struggle financially in retirement, and consider a reverse mortgage as a way to generate extra cash to live comfortably.
With a reverse mortgage, you can borrow against much of the equity in your home. Instead of making monthly payments, the lender can send you monthly payments. The lender keeps a running tab of the interest and fees, and once you sell the property, move out (such as to a nursing home), or die, and the bank is entitled to be paid back the money the bank actually loaned plus accrued interest.
To be eligible for a reverse mortgage, you must meet certain criteria. First, you need to be at least 62 years old. Next, you must not only own your home, but have enough equity in it to support your loan. Furthermore, the home needs to be your primary residence and must conform to certain HUD standards.
Signing up for a reverse mortgage may or may not be the best solution for you, but it is a great option for a lot of people. Here are some of the benefits and disadvantages of reverse mortgages:
Benefits of reverse mortgages
- A reverse mortgage can provide you monthly income to help you cover your retirement expenses and, in the future, your and long-term care expenses.
- You won’t have to move out or give up the title to your home or sell it to get your hands on the money.
- A reverse mortgage can help you delay cashing out your retirement savings. This can be beneficial if your investments are performing well, or if the time isn’t right to liquidate them to free up cash.
- A reverse mortgage might help you delay Social Security and increase your ultimate Social Security benefits. For every year you delay Social Security past your full retirement age, you’ll get an 8% boost in benefits up until age 70. This extra income could be crucial as you navigate life later on as a retiree, and this extra income can seen as helping to offset the interest that is accruing on the reverse mortgage loan.
- Getting an FHA-insured reverse mortgage (called a HECM, which stands for Home Equity Conversion Mortgage) earlier than you really need it can actually help you in the future, because the unused pool of money that is available for you to borrow against grows every year regardless of whether the value of your home grows. This can be a very valuable feature because it essentially gives you access to “free” money the longer you have a HECM loan open. As an example, if your maximum loan value is approximately $394,000 and you don’t use those funds for 5 years, using a typical 3.75% accrual rate you would have available credit of over $474,000 in your credit line after 5 years. If you don’t use those funds for 10 years, you would have over $600,000 available to borrow from. And even if you do borrow from the funds, the remaining funds in the account still continue to grow at the accrual rate.
- FHA HECMs are “non-recourse” loans, meaning the property itself is the only thing at risk even if the outstanding loan amount exceeds the value of the property. There is never any personal liability to the borrowe or the borrower’s children. This protects the borrower and the children from owing on a loan that costs more than the house is worth when sold.
Negative aspects of reverse mortgages
There’s a downside to reverse mortgages, as follows:
- Some people think the fees and closing costs on your loan are too high. However, fees and closing costs have come down greatly in the past several years, and you can work out deals with some reverse mortgage lenders to reduce the fees and closing costs.
- Interest rates on reverse mortgages tend to be higher than rates for traditional home equity loans. Between these fees and interest charges, you might end up with less available cash to work with than you’d expect.
- If you’re struggling to afford your home, a reverse mortgage may not offer much in the way of a solution. Even with a reverse mortgage, you’re still responsible for maintaining your home and paying property taxes on it. If your loan amount doesn’t enable you to cover these costs, you may wind up having to move, regardless.
- If you’re hoping to leave your home to your children, a reverse mortgage might deter you from meeting that goal. Remember, with a reverse mortgage, your loan is paid off when you sell your home or when you die. So if you pass before vacating your home, your property will be sold to pay off your loan balance, which means it won’t be available for your heirs. So there aren’t any surprises, if you do decide a reverse mortgage is right for you, be sure to tell your children about it.
Weighing your options
If you’re having a hard time keeping up with your living costs, a reverse mortgage could give you access to money you don’t need to worry about paying back while you’re alive. And if you aren’t worried about leaving your home to your children, it could be a smart solution to your financial woes. On the other hand, reverse mortgages do have some drawbacks, so be sure to weigh the pros and cons before making your decision.
Something Else to Consider: New Rules for Reverse Mortgages
Reverse mortgages are complicated, and things have sometimes gotten messy for borrowers with surviving spouses or heirs who hoped to inherit the home.
Federal regulators have tried to fix many of the problems in recent years, and last year, the Federal Housing Administration announced another attempt to strengthen the program, by introducing the following rules, which will take full effect on Sept. 19, 2017:
- Borrowers need to seek third-party credit counseling prior to taking out the loan;
- Borrowers must demonstrate that they can manage home upkeep and pay property taxes and insurance;
- Lenders must fully disclose all HECM loan features;
- Include utility payments in the property charge assessment;
- Create a “cash for keys” program to encourage borrowers’ heirs (when there is no equity left in the property) to complete a Deed in Lieu of Foreclosure and gracefully exit the property versus enduring a lengthy foreclosure process;
- Monitoring efforts of appraisers will be ramped up;
- Underwriters will receive special training, allowing them to identify potentially overinflated appraisals; and more.
These new mortgage rules and previous changes help resolve some of the previous pitfalls that were associated with HECM loans, helping them regain popularity. For more details about this and HECM loans in general, and how they interact with Medicaid and the Living Trust Plus™ Asset Protection Trust, please read our previous article on reverse mortgages, Attitudes Are Changing About Reverse Mortgages.
If you or your loved one is facing the possible need for long-term care and/or thinking about getting a reverse mortgage, you should get an opinion from an experienced elder law attorney, such as myself before moving forward. Please call us 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
Critter Corner: Do Reverse Mortgages Affect Medicaid Eligibility?
Dear Ribbit,
My wife and I are considering a reverse mortgage, since we have a lot of equity in our home and very little cash flow. She is in the early stages of dementia. Would the reverse mortgage affect Medicaid eligibility, and what happens if we are considering establishing a Living Trust Plus(TM) income only trust? Thanks for your help.
E. Gagtrom
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Dear Mr. Gagtrom,
If your wife should need nursing home care in the future, as a general rule, a reverse mortgage does not affect Medicaid eligibility. Keeping money in a reverse mortgage line of credit in Virginia, and in most other states, does NOT count as a resource for Medicaid eligibility purposes so long as the house itself is an exempt resource, which it would be for your mother as long as she is living in the home and receiving home-based Medicaid services.
However, transferring money from the reverse mortgage line of credit to a bank account and leaving it there past the end of the month would convert the exempt home equity into a countable resource and that could make her lose her Medicaid eligibility. The important distinction between countable resources and exempt assets is quite complicated.
Reverse Mortgages and your Living Trust Plus(TM)
If you are one of our Living Trust Plus(TM) clients, or considering establishing a Living Trust Plus(TM) income only trust, it will come as very good news to you that you can obtain a reverse mortgage even though your house is titled inside of your Living Trust Plus(TM) income only trust. There are very complex rules for this, and there is only one lender in the country that Mr. Farr is aware of that offers this service, but they have a location in Virginia and he works with them regularly to help many of his clients establish reverse mortgages inside their Living Trust Plus(TM) income only trusts.
Since your wife is facing the possible need for long-term care in the future and you are thinking about getting a reverse mortgage, you should get an opinion from an experienced elder law attorney such as Mr. Farr before proceeding.
Hop this is helpful,
Ribbit
What’s Your Secret, Michael J. Fox?
Photo source: Michael J. Fox Foundation for Parkinson’s Research
Michael J. Fox has had Parkinson’s Disease for 26 years. Yet, he is still smiling. At 55, the father of four is happily married to actress Tracy Pollan, and his mind is still as sharp as a tack. Against all odds, he has continued to act, earning his 18th Emmy nomination last year for his role as lawyer Louis Canning on The Good Wife. His Parkinson’s foundation, meanwhile, has funded more than $700 million for research into Parkinson’s disease. This is all after doctors told Fox more than two and a half decades ago that he only had about ten good working years left.
Parkinson’s disease (PD) is a debilitating disease that affects neurons in the brain. Some of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination. As PD progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally. Primary motor signs of Parkinson’s disease include tremor of the hands, arms, legs, jaw and face; slowness of movement; rigidity or stiffness of the limbs and trunk; and impaired balance and coordination. So how is Michael J. Fox doing so well, after such a long bout of this awful disease?
According to Fox, he “laughs at his own symptoms.” That’s his secret. He also follows these six rules for surviving adversity (in his own words):
- Exercise, especially if you have Parkinson’s disease. “We’ve learned it will prolong your ability to operate positively in the world.”
- Pacing: “It helps me think — the physical motion creates intellectual motion.”
- Acceptance: “It isn’t resignation, and it freed me to actively deal with and endeavor to change my situation. I like to say, ‘My happiness goes in direct proportion to my acceptance, and in inverse proportion to my expectations.’”
- Honesty: Don’t remain silent or ashamed about illness. Once Fox went public with his condition, he says, “it was empowering to have people understand what I was going through — I immediately felt better.”
- Optimism: “I hate when people say, ‘You’re giving them false hope.’ To me, hope is informed optimism.”
- Humor: “I laugh at [my involuntary movements and the scenes they create]. There are times when I love these things.”
Muhammad Ali would Never Quit
What many people don’t realize is that 13 of Michael J. Fox’s 18 Emmy nominations and five of his nine Golden Globe nominations came after his diagnosis. That sounds impressive, but it aligns perfectly to how he’s dealt with the reality of his disease. One of his biggest motivators has been Muhammad Ali, who never gave up!
Muhammad Ali suffered from Parkinson’s for 32 years before his death last June. When Fox told the world about his diagnosis, Ali called him to say, “Michael, now that you’re in it, we’ll win this fight.’”
Another motivator was the feedback generated by Fox’s public embrace of his condition. Doctors reached out to him, and he reached out to doctors. The Parkinson’s community reached out to him, as well, and he felt empowered, knowing there were people who understood what he was going through.
It’s All About Attitude
Linda Maitan was diagnosed with Parkinson’s at the age of 69. According to Linda, the doctor diagnosed it quickly, saying, “It is a degenerative disease, no cure and the medicines don’t work very well!” He sent her to a neurologist for a second opinion which was the same as his.
At first, Linda wondered how this could be happening to her. She was the healthy strong one who took care of everyone else. She never smoked or drank, and she watched her diet and exercised. Unfortunately, there are no answers.
She found the right medications, and moved closer to her daughter. She reached a resignation about her symptoms, which kept changing as time moves on. Although she is uncomfortable with the attention her symptoms cause, she controls her feelings remembering that she cannot change other people … only herself. She tries not to dwell on what others may be thinking.
According to Linda, the trick to living with Parkinson’s is keeping a positive attitude along with keeping one’s mind busy with hobbies. During the past four years, she has picked up oil painting, and has completed about fifty paintings so far. She gives them as gifts to family and friends and the activity helps her to forget her symptoms. She also loves caring for her house, reading, gardening and 1,000 piece jigsaw puzzles.
She keeps moving and doing as much as she can. She feels as if her body is gradually going downhill, but the aging process is taking its toll too. She just lives in the moment … one day at a time.
Linda says, “(t)he longer I live, the more I realize the impact of attitude on life. Attitude to me is more important than facts. It is more important than the past, than education, than money, than circumstances, than failures, than successes, than what other people think or say or do. It is more important than appearance, giftedness, or skill. It will make or break a company … a church … a home. The remarkable thing is we have a choice every day regarding the attitude we will embrace for that day. We cannot change our past … we cannot change the fact that people will act in a certain way. We cannot change the inevitable.
The only thing we can do is play on the one string we have, and that is our attitude. I am convinced that life is 10% what happens to me and 90% how I react to it. And so it is with you … we are in charge of our attitude!”
April is Parkinson’s Awareness Month
Parkinson’s disease is a debilitating disease that affects neurons in the brain. Nearly one million Americans are living with Parkinson’s, and approximately 7 to 10 million people worldwide have the disease. Each year, 60,000 Americans are diagnosed with Parkinson’s disease, and this number does not reflect the thousands of cases that go undetected. As you can see, it is important to have a positive attitude if you have PD, similar to Michael J. Fox, Muhammad Ali, and Linda Maitan in this article. To increase awareness, show support, and raise funds for a cure, millions of people around the world are recognizing April as Parkinson’s Awareness Month.
Do you or a loved one have a degenerative disease, such as Parkinson’s or Alzheimer’s?
At the Farr Law Firm, we are dedicated to easing the financial and emotional burden on those suffering from Parkinson’s Disease and their loved ones. We can help you prepare for your future financial and long-term care needs. We help protect your hard-earned assets while maintaining your comfort, dignity, and quality of life by ensuring your eligibility for critical government benefits. Please call us to make an appointment for a no-cost consultation:
Fairfax Elder Law Attorney: 703-691-1888
Fredericksburg Elder Law Attorney: 540-479-1435
Rockville Elder Law Attorney: 301-519-8041
DC Elder Law Attorney: 202-587-2797
Overcoming the Fear of Death
Q. My mother always said that there are two topics to avoid in conversation, whenever possible: religion and politics. Unlike some of my Facebook friends and others I have known, I took this advice to heart and don’t have many enemies. Now that she is in her 80’s, and I am in my 60’s, and my daughter is nearly 40, I realize that there’s a third topic that might as well be included, because nobody likes talking about iteither, and that’s death.
Everyone knows that we don’t have control over dying, and death is essentially a part of life. What we do have some control over, however, is how we choose to make our exit. But it requires planning. Planning that my mother, my wife, and my daughter would rather put off or avoid altogether.
So, how do I convey to them that it’s time to start talking about the dreaded subject of death, and to start planning, when they are so reluctant to do so? The best way I can think of is by holding a family intervention. This is where I need assistance, mainly talking points. What can I say to convince my family to plan for end-of-life now, while they can still make decisions about this most important topic for themselves?
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A. Although death is an inevitable part of life, many people (including your family, as you described) are reluctant to face the fact that our current physical bodies are not going to last forever and that we should really talk about and plan for our end-of-life choices. As you seem to be aware, thinking about your end-of-life choices today can improve your quality of life in the future and ease the burden on your family.
Many people don’t like to think about or talk about death, but it’s almost impossible to know what a dying person’s wishes truly are unless the issues have been discussed ahead of time and included in incapacity planning documents, including Advance Directives. Talking about death with those close to us is not about giving up on life, but a way to ensure greater quality of life when faced with a life-limiting illness or tragic accident. When your loved ones are clear about your preferences for treatment, they’re free to devote their energy to care and compassion. But how do you discuss your wishes with loved ones who are reluctant to discuss these things?
If Your Loved One is Afraid of Dying
Please have them check out my Spiritual Book List I believe that we are all on a spiritual journey. These are just some of the books that had a profound influence on my spiritual journey, shaping my world view and my understanding of life and death. I began this part of my spiritual journey proximately 25 years ago, after the death of my first son, Jonathan (a preemie who lived for just one day). My journey has continued through the unexpected death of both of my parents at relatively young ages. All of the books on this list (and hundreds more like them) are, in my opinion, conclusive proof that what we call “death” is merely a continuation of our spiritual journey. We are not human beings who have an occasional spiritual experience; we are eternal spiritual beings having a brief human experience. Regardless of your current religious or spiritual views, if you or a loved one have ANY doubt whatsoever about the reality of eternal life, I encourage you to read some or all of these books.
Tips and Talking Points
The only way to be certain that your loved ones understand your wishes is to sit down and have the conversation, or an “intervention” as you described. Here are some tips:
- A good place to start is to choose a time and place where you and your loved ones feel comfortable and at ease, such as after a family dinner, on a walk, or sitting outside in the sun.
- Remember, not everything has to be discussed at once. The conversation can be spread out over different times.
- Be patient with your loved ones. Fear and denial are common. Some people need longer to become comfortable talking about dying, others may have different feelings about what end-of-life plans should involve.
Other ways you could break the ice include the following:
- Remember how someone in the family died—was it a “good” death or a “hard” death? How will yours be different? “I was thinking about what happened to (Uncle Joe), and it made me realize…”
- “Even though I’m okay right now, I’m worried that (I’ll get sick), and I want to be prepared.”
- “I need to think about the future. Will you help me?”
- “I just answered some questions about how I want the end of my life to be. I want you to see my answers. And I’m wondering what your answers would be.”
Source: theconversationproject.org
Discussions with family members can help avoid unpleasant scenes and confrontations if/when you can no longer make healthcare decisions for yourself. While family members may have little legal authority to make decisions for incapacitated patients, they often feel they have moral authority. They may be confused by statements not previously shared with them, and may even try to contest your wishes legally if they feel your choices are not in your “best interest.”
Besides talking to your loved ones, you should share your end-of-life wishes with your physician. He or she can point out any illogical or inconsistent features of your requests, and tell you if there are aspects of your requests that he or she cannot honor because of personal, moral, or professional constraints.
End-of-life Issues in an Advance Medical Directive
The following are issues you should consider and discuss with loved ones and an experienced elder law attorney, such as myself
- Whom do you want to make decisions for you if you are not able to make your own, both on financial matters and health care decisions? The same person may not be right for both.
- What medical treatments and care are acceptable to you? Are there some that you fear?
- Do you wish to be resuscitated if you stop breathing and/or your heart stops?
- Do you want to be hospitalized or stay at home, or somewhere else, if you are seriously or terminally ill?
- How will your care be paid for? Do you have adequate insurance? What might you have overlooked that will be costly at a time when your loved ones are distracted by grieving over your condition or death?
- What actually happens when a person dies? Do you want to know more about what might happen? Will your loved ones be prepared for the decisions they may have to make?
Source: Family Caregiver Alliance
Remember: Don’t feel like you can never change your mind. Your opinions and wishes can change over time and Advance Medical Directives can be revised.
National Healthcare Decisions Day is Next Week!
National Healthcare Decisions Day (NHDD), an initiative of The Conversation Project, is a massive effort to highlight the importance of advance healthcare decision-making. Now in its 10th year, NHDD is expanding from one day to a full week of events from April 16-22.
NHDD exists to inspire, educate, and empower the public and providers about the importance of advance care planning. At the Farr Law Firm, we take ourcommitment one step further by making sure that clients’ healthcare directives are immediately available to family members and to the hospital in an emergency. With a membership in DocuBank that we provide, clients know that a hospital can get their legal directives and other critical medical information around the clock, just by carrying a wallet card. Read more about Docubank here.
Ready for Incapacity Planning?
Talking about end of life issues is an emotional and difficult task for most of us, and it is an important first step to making sure your wishes are clear. Once you have taken the step of speaking with your loved ones about your wishes, it is important to develop incapacity planning documents, including an Advance Medical Directive, to make your wishes legally enforceable. If you and your loved ones have not done Incapacity Planning, Long-Term Care Planning, or Estate Planning (or had your Planning documents reviewed in the past several years), now is a great time to plan and get prepared. Call us to make an appointment for a no-cost initial consultation:
Fairfax Estate Planning Attorney: 703-691-1888
Fredericksburg Estate Planning Attorney: 540-479-1435
Rockville Estate Planning Attorney: 301-519-8041
DC Estate Planning Attorney: 202-587-2797
Critter Corner: How to Choose a Health Care Proxy
Dear Angel,
I have an appointment to do my incapacity planning, and I’m a little indecisive about who I should choose as my health care proxy. What qualities would make someone a good choice for a health care proxy? I’m hoping this will help me make my choice.
Thanks,
Dee Sissions
—–
Dear Dee,
A Health Care Proxy, also known as an Agent under Health Care Power of Attorney, Medical Agent, Medical Representative, or Health Care Surrogate, is someone who will advocate for you if you should become unable to advocate for yourself.
The following are characteristics that are helpful for a health care proxy:
- An understanding of your health condition, symptoms, and possibly your medical history;
- An understanding of how you want to be treated and the treatments you’d like to receive and not receive;
- Attention to detail;
- An understanding of his or her duties, and a commitment to taking those duties seriously;
- Good communication skills.
In addition, your Health Care Proxy should be someone you trust, who you believe understands your values, and will do his or her best to act in your best interest.
If you’re considering naming someone as your Health Care Proxy but aren’t sure if it’s the right person, it might be helpful to have a conversation about the duties and responsibilities of the position, as well as your health care decisions for the future. This may help to determine if the person you’re considering appointing understands your health care wishes, would feel comfortable advocating on behalf of you and your wishes, and would be the right person for the job.
Hope this is helpful,
Angel
New Technology for Better Aging
GPS SmartSole
Many of us want to age-in-place as we get older. Unfortunately, in most cases, safety, health issues, and social isolation can interfere with that plan. This is why a growing number of seniors and their caregivers are turning to technology that helps them to age comfortably in their homes for as long as possible.
New technology, including gadgets and apps, can remind seniors to take their medication and let others know if they didn’t. For caregivers (particularly long-distance ones), aging in place technology offers peace of mind, by offering the ability to discreetly track daily activities of loved ones and in many cases, get notified by text or e-mail if something seems out of the ordinary. Here are 10 examples of new and upcoming products that are designed to make the lives of seniors and caregivers easier:
GPS SmartSole
GPS SmartSole is a smartphone hidden and sealed in an insole, and is particularly useful to keep track of a loved one with dementia or autism, who is prone to wandering. It uses the same GPS and cellular technology as a smartphone, is charged like a phone, and requires activation and a data service plan. Similar to a smart phone, it works cross country within cellular network covered areas.
An advantage to using GPS SmartSole is that it is discreet, non-invasive and your loved one won’t forget to bring it with them or turn it on. And, GPS SmartSole automatically checks in with family members/caregivers every 10 minutes to inform of a loved one’s whereabouts.
Memo Box
Memo Box can help you and your loved one keep tabs on their medication intake. It is a smart pillbox with built-in GPS and Bluetooth technology, connected to a smartphone app. The container has several useful functions: a reminder to take your pills, accidental double-dose prevention, medication tracking, and remote monitoring. As a long-distance caregiver, you can set it up to receive alerts, in case your loved one forgot to take or left his or her pills at home.
Quell
Quell is a wearable medical device that uses powerful intensive nerve stimulation technology to tap into the user’s body’s natural pain relief response, blocking pain signals by inducing the production of endorphins in the brain. The result is a drug-free and long-lasting dampening of pain, better sleep, and a more active life. Quell’s OptiTherapy™ customizes and automatically adjusts therapy dose for optimal pain relief. The device is discretely worn over the calf and connected through Bluetooth technology to the smartphone app which allows you to control therapy and monitor the results. Quell is most beneficial for people with back, nerve, leg and foot pain, and arthritis.
Gyenno spoon
The Gyenno spoon is a gyroscopic self-stabilizing spoon with intelligent control that is designed for people with neurological conditions that result in uncontrollable tremor, such as Parkinson’s disease. This intelligent tableware detects and offsets 85% of the hand shaking. Moreover, it employs the latest motion sensors and intelligent learning technologies, which allow it to adapt to each patient’s individual tremor pattern, making it beneficial for virtually anyone. The device featuresa non-slip ergonomic design, and can be used safely for a long time, enabling users to become more self-reliant.
iHEARHD
iHEARHD is a tiny waterproof device that features high-fidelity digital sound and advanced noise suppression, and is virtually invisible inside of the wearer’s ear. Its modular design allows the patient to customize the fit in less than a minute and the device can be calibrated using the software provided. After that, the gizmo is controlled remotely, and the wearer can easily and discreetly adjust volume based on different sound environments.
RAPAEL Smart Glove
RAPAEL Smart Glove™ is a biofeedback system designed to aid stroke patients in regaining their hand mobility. It includes a glove-shaped sensor device which transmits data via Bluetooth from the patient’s hand to the computer software app. Artificial Intelligence technology creates a set of training virtual reality games simulating daily activities and adjusts the difficulty level according to the participant’s performance. A recent study has proven that, combined with traditional physical therapy, the program may result in significant improvements even after one month of use.
August Home
The August Home Smart Lock, Smart Keypad, and Doorbell Cam, creates the complete Smart Home Access Solution, allowing people to manage their front door from anywhere. The Smart Lock turns a smartphone into a smart key where consumers can lock and unlock their door, create virtual keys for guests, and keep track of who comes and goes with a 24/7 activity log. The Smart Keypad also lets users create unique entry codes for family, friends, and service providers, to unlock an August Smart Lock without a traditional key or smartphone. The Doorbell Cam lets consumers see and speak with visitors at the door, from anywhere, using a smartphone.
Technology, such as the products described above and in several of our prior articles including Critter Corner: New Technology for Seniors Who Are Aging-in-Place; Laser Shoes, Magic Carpets, & More: Technology to Combat Falls; A New White House Report on Technology for Seniors; Amazing Technology to Age-in-Place (But Mom is Reluctant); Appliances That Speak to Each Other, and Other Incredible Aging-in-Place Technology; NASA SmartWatch, Implanted Health Devices, and Other New Technology for Seniors; and New Technology to Age-in-Place. It is changing the way we age, enabling older adults to be healthier, more secure, more connected, and more independent. These devices represent a small part of the industry, which will most certainly continue to improve the quality of life for millions of seniors.
When Aging-in-Place is no Longer the Best Option
Most people want to stay in their home for as long as possible. However, if despite the technology that is available, you or a loved one cannot live independently and are showing signs that living alone is a strain, it may be time to consider other alternatives.
Whether the outcome is in-home care, assisted living, or nursing home care in the future, it is always wise to plan ahead. Life Care Planning and Medicaid Asset Protection is the process of protecting assets from having to be spent down in connection with entry into assisted living or nursing home care, while also helping ensure that you and your loved ones get the best possible care and maintain the highest possible quality of life, whether at home, in an assisted living facility, or in a nursing home. Please contact us as soon as possible to make an appointment for a no-cost consultation:
Fairfax Elder Law Attorney: 703-691-1888
Fredericksburg Elder Law Attorney: 540-479-143
Rockville Elder Law Attorney: 301-519-8041
DC Elder Law Attorney: 202-587-2797
How to Minimize Family Conflict Over Your Estate Planning Wishes
Q. My children are very different, and sadly they don’t get along. My son, John, has been a PhD student for more than 10 years now. He insists that his research is going well and that he will be done soon. At the age of 45, he still lives in our basement with his wife, and their two children, because they can’t afford their own place. His wife works part-time, and my husband and I watch the grandchildren often. We have been wanting to move to our retirement home in Virginia Beach for quite some time, but have hesitated to do so because John and his family needs us.
Meanwhile, my daughter Rae and her husband are both gainfully employed, and don’t ask for a lot of help. Although they are four hours away, they drive to our house and help us whenever we really need it, because John can’t, as he is busy with his dissertation and his family. I often think Rae resents John, and have heard her say that “he is lazy” and “he is mooching off of us.”
My husband and I finally started on our estate planning. Originally, we were thinking of making John the executor because he lives with us. We were also going to give him a bigger share of our assets, because he needs it more. We were going to give Rae more of the sentimental items, because she values them highly, however I know there will be a fight over certain items. I am hoping my children will understand, but I doubt that they will. How can we do our estate planning, while minimizing strain in the family?
A. Many adult children and grandchildren have had experiences with their families being strained by issues similar to yours, including who will be in charge, who gets left what, and why one sibling might get something and the other doesn’t. This is so common, in my experience, that in my office, I have a plaque that reads “Where there’s a will, there’s a family fighting over it.”
Many of the problems of inheritance are themselves inherited. They are both genetic and acquired, but they are not inevitable. Luckily, inheritance disputes can be explained and predicted and are to a large degree preventable. By carefully and thoughtfully planning your estate, you can keep family squabbles down to a minimum.
Top 10 Actions That Can Reduce Conflict
When it comes to minimizing conflict, please keep the following recommendations in mind:
1. Leave to children equally: Treat children equally. Unequal allocation can be seen as a showing of favoritism that will cause resentment and hurt feelings. To avoid fighting, don’t penalize successful children by leaving more to their needy siblings, or conversely, reward successful children because they are favored. An exception for this rule is for children who are truly disabled.
2. Clearly identify gifts and loans: Parents often help adult children who are experiencing financial distress. It is the parent’s decision to structure these amounts as either loans, gifts, or “advancements” (an advancement means that the amount given will be deducted from that child’s share of the overall inheritance before the remainder of the inheritance is divided among the children). Unpaid loans from mom and dad can be a major source of conflict, sparking jealousies about who got more. Parents should resolve uncertainty regarding lifetime financial assistance by clearly addressing them in their estate plan.
3. Hold an open discussion on special assets: There are situations where family input is advisable. For instance, issues such as care for a disabled child, succession of a family business, or continued enjoyment of a vacation home require parents and children to be on the same page.
4. Be detailed about your plans: Taking the approach that “my children will figure all this out” without you providing detailed instructions in your Estate Plan will not lead to a harmonious distribution of your assets. While your children may not be satisfied with the choices you’ve made, they will be less likely to blame their siblings because they’ll know the allocations were what you wanted.
5. Update Your Estate Plan regularly: Make estate planning changes when there has been a change of circumstances, especially after a divorce. Additionally, estate planning should be reviewed after other life changes, such as the death or divorce of a child or the illness, addiction, or incapacitation of any beneficiary.
6. Avoid joint ownership: Joint ownership with a child (i.e., placing a child’s name as a joint owner of a parent’s asset) is an inefficient method of passing assets at death and can produce unintended and unfair results. Joint ownership also exposes the parent to the co-owner’s liabilities and may limit the parent’s ability to change his or her mind in the future.
7. Pre-arrange funeral details: Making funeral arrangements and choosing the form of interment in advance can avoid conflict and the strong emotions that such decisions sometimes elicit. For example, re-married widows and widowers should determine in advance who is to be buried with whom. Pre-planned and detailed written funeral instructions avoid controversy and angst.
8. Include a letter to your children: This letter is not to say who gets what; that should be outlined in your legal documents. This letter is to tell your children you loved them and tried your best to be fair in the Estate Planning process. It can go a long way in reminding them to move past the fact that they didn’t get the clock they wanted from your estate. Remind them in this letter that family goes a lot deeper than possessions and that you hope they will remember that fact.
9. Make logically defensible choices: Determining who is “in charge” is an emotionally loaded issue. It can be perceived as your statement as to who is the most “worthy.” Appointing fiduciaries (such as Trustees and Agents under Powers of Attorney) can also be seen as an act of favoritism and should be thoughtfully considered. Naturally you want the best person for the job to ensure that your wishes are properly carried out. However, parents must still be sensitive to their children’s emotional reactions. Children can rationalize an older sibling being appointed simply on the basis of seniority. They can also accept the naming of in-towners over out-of-towners on the basis of convenience and geographic desirability. It may be best, however, that where children are equally situated, appoint them as co-fiduciaries if they get along very well, or else consider options outside the family.
10. Consider putting someone who isn’t a family member in charge of the assets: Having a third party in charge (such as a law firm or trust company), even if they charge a fee, will eliminate the risk of creating family disharmony. Everyone may end up being mad at the third party, but at least they are not mad at each other. That may be money well spent to preserve family unity.
By using some of the recommendations above when planning your estate, you will be more likely to protect your most important legacy — your family!
Estate Planning is Important for ALL Families
We here at The Law Firm of Evan H. Farr, P.C. have strategies in place to help all types of families plan for themselves and their loved ones. With advance planning, each person, regardless of their family situation, can retain the income and assets it has taken a lifetime to accumulate and the peace of mind that their child(ren)’s needs will be adequately and properly addressed. If you or members of your family have not done your Estate Planning, or not had it reviewed and updated in the last five years, please contact us as soon as possible to make an appointment for a no-cost consultation:
Fairfax Estate Planning: 703-691-1888
Fredericksburg Estate Planning: 540-479-1435
Rockville Estate Planning: 301-519-8041
DC Estate Planning: 202-587-2797