Posted by admin on June 10, 2017 · Leave a Comment
Dear Commander Bun Bun,
I am a long-distance caregiver for my father, who has Parkinson’s and lives 2,000 miles away. My children are in school here, and my husband works for the government in DC, so I don’t foresee us moving to be near dad anything soon. Do you know about any good technology I can use for peace of mind that he is okay, and taking his meds on time etc.? Thanks for your help!
Farah Wei
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Dear Farah,
The way caregivers manage and provide care from any distance (whether on the other side of the house or 2,000 miles away) has been completely transformed by technology. In fact, a recent AARP report estimated that the caregiving market was $42.9 billion in 2016 and will grow to $72 billion by 2020 — and much of that growth will involve technological solutions.
Long-distance caregivers especially need tech solutions to keep tabs on loved ones, and mostly to ensure that they are okay. Below are some handy tools that can help you in your situation:
Communication: A good way to get a read on your loved one’s health is to be able to see him face-to-face. Besides Skype, there is Ohmni, Nest, and several other face-to-face mobile apps. These technologies are very easy to setup and allow you to be in the home with your loved one – virtually.
Protect your loved one’s money: The True Link Card costs $10 a month, and can be set up online to protect your loved one’s money. Algorithms developed by the company track transactions that are then matched to scams targeting the elderly, such as “miracle” products and unwanted subscriptions. Caregivers receive alerts of suspicious charges.
Monitor your loved one’s safety and well-being: Lively personal emergency response provides a wide range of remote monitoring for the safety and well-being of seniors living alone. Lively’s safety watch provides intelligent medication reminders. Activity sensors measure healthy living patterns, while letting family members know when something may be wrong, such as missed meals or decreased physical activity.
For more technologies that support long distance caregiving, Consumer Reports has a good review of such technologies here.
Hop this was helpful,
Commander Bun Bun
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Posted by admin on June 8, 2017 · Leave a Comment
Most people don’t like to think about dying. We’d rather focus our energy on the people and the things we love, happy times, and things that bring us joy. But, as we all know, death is inevitable, and shouldn’t be ignored. Despite what most think,these conversations don’t have to be sad and depressing. They can be positive and thought-provoking. As an example, “death” has recently been the focus of a TED Talks series titled, “New Ways to Think About Death.”
TED is a nonprofit devoted to spreading ideas, usually in the form of short, powerful talks (18 minutes or less) given by thought leaders in their field. TED began in 1984 as a conference where Technology, Entertainment and Design converged, and today covers almost all topics — from science to business to global issues . . . including death — in more than 100 languages.
The following are descriptions and links to TED speakers who offer insights to help us face death more thoughtfully and with greater compassion:
Alison Killing
There’s a better way to die, and architecture can help (Duration: 4:39)
“In this short, provocative talk, architect Alison Killing looks at buildings where death and dying happen — cemeteries, hospitals, homes. The way we die is changing, and the way we build for dying … well, maybe that should too. It’s a surprisingly fascinating look at a hidden aspect of our cities, and our lives.”
Listen here.
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BJ Miller
What really matters at the end of life (Duration: 19:07)
“At the end of our lives, what do we most wish for? For many, it’s simply comfort, respect, love. BJ Miller is a hospice and palliative medicine physician who thinks deeply about how to create a dignified, graceful end of life for his patients. Take the time to savor this moving talk, which asks big questions about how we think on death and honor life.”
Listen here.
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Kelli Swazey (Duration: 13:54)
Life that doesn’t end with death (Duration: 13:54)
“In Tana Toraja, weddings and births aren’t the social gatherings that knit society together. In this part of Indonesia, big, raucous funerals are at the center of social life. Anthropologist Kelli Swazey takes a look at this culture, in which the bodies of dead relatives are cared for years after they have passed away — because relationships with loved ones don’t simply end when breathing does.”
Listen here.
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Candy Chang
Before I die I want to … (Duration: 6:20)
“In her New Orleans neighborhood, artist and TED Fellow Candy Chang turned an abandoned house into a giant chalkboard asking a fill-in-the-blank question: “Before I die I want to ___.” Her neighbors’ answers — surprising, poignant, funny — became an unexpected mirror for the community. (What’s your answer?)”
Listen here.
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Peter Saul
Let’s talk about dying (Duration: 13:19)
“We can’t control if we’ll die, but we can “occupy death,” in the words of Peter Saul, an emergency doctor. He asks us to think about the end of our lives — and to question the modern model of slow, intubated death in hospital. Two big questions can help you start this tough conversation.”
Listen here.
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Matthew O’Reilly
“Am I dying?” The honest answer (Duration: 5:33)
“Matthew O’Reilly is a veteran emergency medical technician on Long Island, New York. In this talk, O’Reilly describes what happens next when a gravely hurt patient asks him: “Am I going to die?””
Listen here.
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Amanda Bennett
We need a heroic narrative for death (Duration: 15:24)
“Amanda Bennett and her husband were passionate and full of life all throughout their lives together — and up until the final days, too. Bennett gives a sweet yet powerful talk on why, for the loved ones of the dying, having hope for a happy ending shouldn’t warrant a diagnosis of “denial.” She calls for a more heroic narrative for death — to match the ones we have in life.”
Listen here.
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Judy MacDonald Johnston
Prepare for a good end of life (Duration: 6:03)
“Thinking about death is frightening, but planning ahead is practical and leaves more room for peace of mind in our final days. In a solemn, thoughtful talk, Judy MacDonald Johnston shares 5 practices for planning for a good end of life.”
Listen here.
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Jae Rhim Lee
My mushroom burial suit (Duration: 7:30)
“Here’s a powerful provocation from artist Jae Rhim Lee. Can we commit our bodies to a cleaner, greener Earth, even after death? Naturally — using a special burial suit seeded with pollution-gobbling mushrooms.”
Listen here.
I hope these talks gave you some new perspectives about death and dying. And, hopefully, you can even use them to spark conversations with your loved ones. For more resources on discussing death and dying with your family, please see our blog posts, Facing the Elephant in the Room, Overcoming the Fear of Death, The End-Of-Life Conversation: What if it NEVER happens?, and Death Cafés Present a Comfortable Way to Talk about Death.
How would you finish this sentence? “The end-of-life care I would want is …”
“I don’t know” or “I don’t want to talk about it,” are how most people fill in the blanks to this statement. But, please give this some thought: What if you became incapacitated and could no longer speak for yourself? Would you want all possible measures taken to save your life? To be in a hospital or at home? Surrounded by family and friends? Once you’ve decided, now imagine arriving at an emergency room unable to speak or tell anyone what you want. In this instance, if you didn’t have the conversation or complete your Advance Medical Directive, you are going to wish that you had!
Did you know that at least half of those 65 and older ending up at the hospital are unable to speak for themselves? Don’t be one of these people; make sure your wishes are known. First, have the conversation. Then, if you have not done Long-Term Care Planning, Estate Planning, and Incapacity Planning (or had your Planning documents reviewed in the past several years), or if you have a loved one who is nearing the need for long-term care or already receiving long-term care, call us 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
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Posted by admin on June 3, 2017 · Leave a Comment
Q. My dad is in his mid-80’s and he still resides in the home where I grew up, without much outside assistance. He is healthy and takes exercise walks daily, to keep himself fit and active. When it comes to cognitive health and memory, he seems to remember most things. However, he is beginning to repeat himself a lot. When I went to his house last week, it was dark because he forgot to pay the electric bill, and forgot where he put it, so they shut off his electricity that morning. After we got his electricity turned back on, I found expired bills in his kitchen drawer. The trash company’s bill was stamped “final notice.” The cable company’s “bill” was actually a check, because he had paid the same bill twice.
I am concerned that my father is unable to handle his finances and, as far as I know, he has never signed a power of attorney. How do I approach this with him and step in, and what steps should I take to transition myself to being in control of his finances? Thanks for your help!
A. Seniors sometimes become incapable of handling their finances and paying their bills on time, or they may become vulnerable to scams or identity theft, requiring the protection and intervention of their children.
A new study published by the Center for Retirement Research at Boston College (CRR) reveals the ages at which aging Americans lose their ability to pay bills, handle debt, maintain good credit, assess an investment’s potential return relative to its risk, and detect fraud. The findings show that most people who don’t suffer from cognitive impairment can continue managing their money in their 70s and 80s.
However, according to the report, “most people with a cognitive impairment will need help managing their money to prevent fraud or abuse and providing this assistance effectively will require overcoming several obstacles.” This seems to be the situation you’re encountering with your father.
Having a Talk with Him
Now is a good time to have a discussion with your father about his finances and what you are witnessing (unpaid bills, utilities being shut off etc.). To start the conversation, you might want to print out this article and give it to him to read, and then launch into your discussion immediately after he has read the article. During your conversation, be sure to explain your desire to help and protect your father, not control him. If he seems agreeable, ask him to provide a list of all his financial resources, including bank and brokerage accounts and safety deposit boxes. Ask to see his tax returns, bank, and brokerage statements and credit reports, and ask that he list any financial and tax advisers. And be sure to have him make an appointment to see us to have a power of attorney drawn up, along with other incapacity planning documents, including an advanced medical directive, long-term care directive, and lifestyle care plan.
If He Resists
While some parents may be relieved that financial responsibilities are taken over by their children, others resist giving up control, particularly when drawing up a Power of Attorney seems to reverse the parent-child role. If this is a situation you face, you should assure your father that he can cancel a Power of Attorney (POA) at any time and that he isnot giving up the right to handle his own affairs, so long as he is legally competent. If you are the designated agent on your father’s POA, he should think of you as an assistant ready to step in if he needs help. As long as he is competent, your father can give you as many, or as few, powers as he wishes, including the authority to pay expenses, invest, file and pay his taxes, operate his business, and transfer property.
Something you can do if your father still refuses help is to offer to help him just with his taxes or see if he needs assistance cleaning out a filing cabinet. Or, if your father is tech savvy, you can organize his online passwords or set him up with a smartphone budgeting app. By helping with these elements, you’ll likely get a lot of ideas of what needs to be done.
Always remember: You are offering your dad assistance, not taking over his life. Offer your help gently and with respect.
Should Your Father Take a ‘Financial Capability’ Test?
If you and your father think it’s a wise idea, it might be well worth having his financial capacity tested, to gauge whether he is capable of managing his finances independently, needs help on some tasks, or is incapable of controlling his finances.
Financial capacity relies on two key abilities: 1. performing financial tasks and 2. making financial judgments, which requires memory, attention, and information processing.
Evaluations are typically done by psychologists or psychiatrists — as part of disease management or Alzheimer’s care, but sometimes people get evaluated for legal reasons. Government systems that pay benefits also have a process for assessing capacity as well. For example, the Social Security Administration and the Department of Veterans Affairs have their own capacity assessment procedures.
How to Manage Your Father’s Finances
If it is determined that your father can no longer manage his finances, here are some recommendations to assist you in your new role:
1. Locate all financial documents. Look for your father’s essential documents in desk drawers, safety deposit boxes, and filing cabinets. You need to find his bank and investment statements including retirement accounts, insurance records, real estate deeds, car titles, as well as medical records, especially if paying for medical expenses is a growing financial concern.
2. Check his cash flow. Take an inventory of exactly what assets your father has and a create a budget showing what income comes in each month and what expenses go out.
3. Streamline spending. Check for ways to simplify his finances and trim spending, wherever possible. Look for credit cards he doesn’t use, a cell phone plan or cable bill that provides way more than he needs, etc.
4. Get help from your siblings. If you have siblings, you can focus on doing the day-to-day finances and someone else could be doing the more strategic or long-range things. If neither you nor your siblings feel competent to take control of your parents’ investments, you can reach out to a Daily Money Manager and/or financial advisor.
5. Make Sure Dad Has a Good Financial Power of Attorney. Discuss with your dad (and siblings) whether you, one or more of them, or some combination, should act as Agent(s) under your dad’s Power of Attorney, and make sure that he has a good power of attorney done by an experienced Elder Law Attorney such as myself, not a junk document done online or something picked up from an office supply store.
A Power of Attorney is a legal document created by one person, known as the principal, to give another person, known as the agent, legal power to act on behalf of the principal. It is the most important legal document that your father, and every other adult, needs to have. The POA document can grant either broad and unlimited powers or limited powers to act in specific circumstances or over specific types of decisions. Typically, a Power of Attorney is effective immediately, but is intended to be used only when necessary at some future date. However, in your father’s case, he will be signing one intending that it be used immediately by you and or one of your siblings
Plan Ahead and Be Prudent
As you know, one of the most important decisions anyone can make is to plan for the future and for your family’s future. The time to plan is always now.
Many of you may not know that through the years, I have begun to encounter more and more clients who need financial services in addition to legal services. Because of this need, in order to more effectively serve all of our clients, I offer specialized elder-focused financial services in addition to our traditional elder-focused legal services. Read more about these services here.
Besides making sure your father has a good incapacity plan and estate plan in place, you need to make sure you (and your spouse if you are married) have a good incapacity plan and estate plan in place. If you do have a plan in place, how long has it been since you updated your planning documents? Don’t let more than 3-5 years pass between updating your plan, as the cost to your family if you neglect your plan could be disastrous. Be sure to ask about The Farr Law Firm’s Lifetime Protection Program, which ensures that your documents are properly reviewed and updated as needed, so that they will have the proper effect under the law.
Ready to plan or update your planning? Please contact us as soon as possible to make an appointment for a no-cost initial consultation:
Fairfax Power of Attorney: 703-691-1888
Fredericksburg Power of Attorney: 540-479-1435
Rockville Power of Attorney: 301-519-8041
DC Power of Attorney: 202-587-2797
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Posted by admin on June 3, 2017 · Leave a Comment
Dear Angel,
My sister named me as agent under her Financial Power of Attorney, and she recently had a massive stroke, so I need to step in and start managing her legal and financial affairs. She’s only 59 years old, so this was VERY unexpected. But at least she was smart enough to do a Power of Attorney a couple of years ago. She still can’t speak much or walk unassisted, and we don’t yet know how much she’ll recover. The doctors are already saying she might need to go into a nursing home after rehab depending on how well she does in rehab. She’s single and has no kids, so she’s saved up quite a bit of money over the years, but I know from reading your newsletters that nursing homes are hugely expensive and could easily bankrupt her given how young she is. I also understand from reading your newsletters that I should be thinking of doing Medicaid Planning, but on the first page of her Power of Attorney, it says I must “act in her best interest.” Of course that’s what I want to do, but I don’t really understand what that means. Does that mean I can’t do Medicaid Planning? Or is Medicaid Planning in her best interest? What exactly should I be doing?
Thanks,
Bess Tintrest
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Dear Bess,
Because you are dealing with your sister’s money and property, your duty is to make decisions that are best for her, and Medicaid Planning, when done with respect for the law and compassion for the person whose assets are being protected, is not only in her best interest, but may be essential to preserving her dignity and quality of life.
To act in your sister’s best interest, these are some guidelines:
- Read the power of attorney and only do what it says: Your authority is strictly limited to what the document and state law allow. In Virginia and in many states, language giving you the broad power to “do anything” that your sister could do is generally meaningless.
- Understand when the power of attorney becomes effective: It may have been effective the moment your sister signed it, or it may be a “springing” or “contingent” power of attorney, only effective when one or more doctors certify that your sister can no longer make her own decisions.
- Look for asset protection powers: Hopefully your sister had her Power of Attorney done by an experienced Elder Law attorney who included asset protection powers, most importantly the ability to make unlimited gifts in connection with obtaining Medicaid eligibility. Without these powers, you may have to go to court to have her declared incompetent to you can become her conservator and ask the Judge to grant you the asset protection powers necessary to protect her assets.
- Consult with a Medicaid Planning attorney as soon as possible: Since the doctors are already saying your sister may need long-term nursing home care, you need to meet with an experienced Medicaid Planning attorney, such as Evan Farr, as soon as possible. He will review the Power of Attorney to see if has the needed asset protection powers and, if not, he can petition the court for you to get the necessary powers to engage in Medicaid Asset Protection Planning.
- As much as possible, involve your sister in decisions: Many things can affect your decisions about your sister’s money and property. For example, you might feel pressure from others.
-Even after it is clear that you must make decisions for your sister, ask her what she wants if she regains the ability to communicate coherently. If she can’t say what she wants, try to figure out what she would have wanted by reviewing her past decisions, actions, and statements.
-Ask people who care about your sister what they think she would have wanted.
– Make the decisions you think your sister would have wanted, unless doing so would harm her.
- Don’t borrow, loan, or give your sister’s money to yourself or others except under the direct guidance of an experienced Elder Law Attorney. Even if the power of attorney or state law clearly allows gifts to you or others, you must be very careful to ensure that any gifts do not increase or complicate your sister’s taxes or change her plans as to how she wants to give away her property when she dies. Any gifts or loans should be in line with what your sister would have wanted.
- Don’t pay yourself for the time you spend acting as your sister’s agent, unless the power of attorney or state law allows it. If you are allowed to pay yourself, you need to show that your fee is reasonable. Carefully document how much time you spend and what you do.
Thank you for your inquiry. I hope this is helpful and I hope to see you soon when you come for you consultation with my owner!
Angel
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Posted by admin on June 2, 2017 · Leave a Comment
The U.S. House of Representatives is set to vote on the so-called CHOICE Act, which would essentially undo all the protections put in place after the last Great Recession and bank bailout. Here are a few questions we all must consider and ask of our Congressional representatives as they prepare to take America’s financial marketplace backward to a less secure place:
Why would a member of Congress vote for legislation that hurts the average American financial consumer in favor of Wall Street Banks that were bailed out during the financial crisis?
Do they like the way payday and car title lenders are killing small businesses by draining income from local communities with their 300% loans?
Are they upset that the Consumer Bureau has used its authority to enforce existing law to return $11.8 billion from financial companies that broke the law back to 29 million consumers?
Are they disappointed that the Consumer Bureau stops loan sharks and debt collectors that rip-off our service members?
Are they against giving consumers access to information so that they can make informed decisions in the financial marketplace?
Do they think it’s bad that student loan borrowers now have a place to go to learn their rights and report abuses by loan servicers?
Are they ignoring polls that show broad bipartisan support for the work of the Consumer Bureau, or are they just counting the contributions from Wall Street and hoping no one will notice?
Call your member of Congress and tell them VOTE NO on the WRONG Choice Act!
202-224-3121
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Posted by admin on June 1, 2017 · Leave a Comment
Maria was cooking in her kitchen when hot oil splashed from a pan onto her hand. Her reaction was a typical one when it comes to pain. She instantly recoiled and ran to the sink to place her hand under cold water from the faucet, attempting to minimize the damage done by the burn.
As you can imagine, Maria’s burn hurt badly and became the main focus of her attention. This makes complete sense, since pain is how your brain tells you that something is wrong. Your nerves sense damage in your body and send a signal to your brain that tells you to feel hurt.
But, when it comes to ongoing pain, especially if it’s something that’s already been treated and is healing, that feeling of “pain” coming from the brain is no longer providing valuable information. It’s just capturing all of our attention. The same is true for hospital patients undergoing painful treatments or procedures — yes, some of these things do hurt, but in these situations, the “hurt” isn’t helpful. Of course there are numerous ways to temporarily mask pain, including plenty of over-the-counter pain relief medications and lots of prescription pain medications, but all of these, when used for a prolonged period of time, can have harmful effects on your stomach and on liver and kidney function, and obviously many prescription painkillers are addictive. Now, there’s a very unique and promising new non-pharmaceutical pain relief therapy — one that uses virtual reality to re-train your brain!
Virtual Reality to Help You Forget About Pain
Pain may be really good at making sure you pay attention to it, but in some cases, technology, such as virtual reality (VR) can be compelling enough to actually take over the thoughts and feelings that would otherwise be dedicated to pain. This may sound like “just a distraction,” but since pain itself is really just a mental signal from your brain, stopping that signal is actually stopping the pain.
An ongoing clinical trial at Cedars-Sinai Medical Center in Los Angeles is investigating whether brief VR experiences reduce pain and anxiety for patients staying at the hospital. In the study, published online yesterday by JMIR Mental Health, researchers examined 100 hospitalized patients who reported pain scores of greater than 3 on the Numeric Pain Rating Scale, which runs from 0 to 10. Fifty patients received virtual reality therapy consisting of wearing VR goggles to watch calming video content such as helicopter rides over scenic portions of Iceland, or imagery of swimming in the ocean with whales. Those patients reported a 24% drop in pain scores after using the virtual reality goggles. Another 50 patients viewed a standard, two-dimensional nature video, depicting relaxing scenes with a calming music audio track, on a close-proximity screen. Although those patients also experienced a reduction in pain, the decrease of 13.2% was less dramatic.
The results from this study and from previous work in this area are promising. It seems that the immersive experience of VR is powerful enough to help treat pain — not just to distract people, but to actually affect the brain in ways that reduce the pain.
How Does VR Work to Reduce Pain?
While it remains unknown exactly how VR works to reduce pain, Spiegel attributes the benefit to what he calls “immersive distraction.” In other words, when the mind is deeply engaged in an immersive experience, it becomes difficult, if not impossible, to perceive other stimuli, including pain. “We believe virtual reality hijacks the senses, but in a good way,” Spiegel said. “It creates an immersive distraction that stops the mind from processing pain, offering a drug-free supplement to traditional pain management.”
Because the VR intervention was only 15 minutes long and included only one visualization, it is possible that pain could rebound after completion of the therapy session, Spiegel said. Longer-term pain reduction might require sustained and repeated exposure to virtual reality content. The research team is now conducting a larger trial as a follow-up to measure the impact of virtual reality on the use of pain medications, length of hospital stay, and post-discharge satisfaction scores.
Some Patients Are Ineligible or Reluctant to Use VR
If you were given the option to use VR instead of feeling pain, would you do so? I certainly would. Unfortunately, some patients at Cedars-Sinai were ineligible to do so, and others were reluctant.
Of all the people at Cedars-Sinai in Los Angeles who were being considered for a VR study, only 6% were both eligible and willing to experience the technology. Why? Exclusion criteria included presence of motion sickness, stroke, seizure, dementia, nausea, and isolation status for infection control, rendering 83% of subjects ineligible for VR. On top of that, 66% of eligible patients refused to participate in the study. This may seem like a very high number, but consider for a moment what it’s like to be a hospitalized patient asked to wear a pair of unfamiliar, toy-like goggles.
Researchers indicated that they have to be very careful about not spreading infection in vulnerable patients, not worsening neurological symptoms, and not precipitating new adverse symptoms in patients already trying to recover from illness. So, the hospital must have special considerations for VR, just as it does for any other new biomedical innovation.
VR Can Trick Your Brain to Forget the Pain
VR for treating pain is being used not just in hospitals. Late last year, Stanford university hosted a VR Pain Conference, the mission of which was to bring together representatives from the research, clinical, regulatory, funding, and business sectors, with a goal of charting a path to move VR forward into the realm of clinical care to treat pain and other disorders.
Just a few nights ago, Lester Holt, the NBC Nightly News anchor, did a report about Dr. Kim Bullock, a neuropsychiatrist at Stanford University who made a remarkable pain-relieving discovery by accident. While studying VR for conditions such as severe anxiety, a welcome side benefit of that treatment was that the patients’ chronic pain disappeared. They showed an example of a man with chronic pain in one arm manipulating objects in virtual reality using his good arm, while the VR environment showed him that he was using his painful arm. Because his brain saw his painful arm doing all of these things without pain, this was apparently enough to trick his brain into believing that he had no more pain in his bad arm, and lo and behold at the end of the experiment his painful arm had no more pain. You can watch the full video here.
Scientists are continuing to explore the specific components of virtual reality that contribute to pain reduction in seniors. For more details, please read our previous blog post on this subject. I will continue to keep you updated on this and other exciting new technologies as I find out about them.
Are you in Chronic Pain?
Unfortunately, many people with chronic pain wind up needing long-term care, sometimes in nursing homes. Nursing homes in the DC Metro area can cost from $120,000/yr to more than $150,000/yr. The Medicaid Asset Protection Law Firm of Evan H. Farr, P.C. handles Life Care Planning and Medicaid Planning, which is the process of protecting you or your loved ones from having to go broke to pay for nursing home care, while also helping ensure that you or 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. If you or a loved one experiences chronic pain, check out virtual reality, but also please contact 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
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