Critter Corner: Halloween Tips for When a Loved One has Dementia

Dear Commander Bun Bun,

My mother has dementia and recently moved into our home. Before she was diagnosed, she loved Halloween, especially all the decorations, seeing the grandchildren dressed up in costumes, and eating the chocolate. This year, I am concerned about the stress that the doorbell ringing, the costumes, and the decorations may cause her. Do you have any suggestions so the evening doesn’t turn out to be overwhelming and stressful for her?

Hal O. Wene 

Dear Hal,

Seniors with dementia may face agitation and fear on Halloween, as a result of scary costumes, extra visitors, candy concerns, decorations, and spooky sounds. Below are some suggestions that will hopefully make Halloween less stressful for your mother:

-Discuss plans for the evening with your mother, and describe what will be taking place. Don’t go into a lot of detail. Doing so will prepare her for what to expect, and may bring back some happy memories.

-Show your mother pictures from past Halloweens to help spark her memory.

-Songs like “The Monster Mash” can also bring back memories.

-Avoid using candles and instead use non flame candles or lights.

-Put pumpkins up on tables to avoid tripping.

-Limit decorations. They may cause confusion and agitation.

-If there are decorations on the windows and your mother is picking at them, ask her caregiver to please remove or take them down.

-Avoid floor mats that make sounds and scary decorations that are voice activated.

-Avoid CD’s with creaking doors, ghost screaming, and other scary sounds.

-Try non scary decorations like pumpkins and fall leaves vs. scary ghost, goblins, and witches.

-Limit sugar intake such as candy because sugar increases the desire for more sugar. Instead offer fruit. Or even a caramel apple.

-Keep the candy tucked away until the night of Halloween to limit consumption.

-If your mother is not overwhelmed, encourage her to help you hand out the candy to the children. Remember, supervision at all times is important to avoid elopement or other risky behaviors.

-Create new memories by baking a pumpkin pie, decorating sugar cookies, or painting a pumpkin with grandchildren or other family members.
Halloween can be tweaked and personalized to communicate a meaningful updated ritual for your entire family.

I hop you all have a Happy Halloween!!

Commander Bun Bun

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Critter Corner: I Am A Caregiver Whose Friends Are Deserting Me!


Dear Angel,

My mother needs full-time care, so I quit my job and moved in with her. Before doing so, I had a core group of friends that I went to lunch with, to the movies etc. Now, they are not including me anymore. And, it seems they feel uncomfortable coming to mom’s house. What do you think I should do?


Missy Mai-Frenz

Dear Missy,

While caregiving has many gratifying moments, it’s also intense, tiring, and worrisome. The feeling of being on call 24-hours-a-day can take a toll on anyone, and in many instances, long-standing traditions with friends coming for dinner or going out to the movies often go by the wayside.

So, what can you do to keep those friendships that you need more than ever during this time in your life?

• Ask a family member to handle a few of your eldercare duties, so you can plan lunch with friends.

• Make more of an effort to keep up with friends through phone calls or coffee, even if you can’t spend a lot of time with them.

• Remain capable of holding a conversation that doesn’t include caregiving. To do so, make an effort to follow the news, both national and local, so that you have some subjects that you can discuss other than caregiving and your burnout.

• Try to maintain at least one hobby. For example, if you read books or quilt, continue doing so and discuss it with like-minded friends.

• Make an effort to keep eldercare talk as brief as possible when you are with non-caregivers. Answer polite questions with quick, to-the-point answers, then move to a topic that really interests your friends.

For most of us involved with around-the-clock caregiving, it’s not likely that we can keep up a roaring social life. But, for your own wellbeing, you should do at least minimal upkeep on outside friendships. The day will likely come when our caregiving ends, and we will need our friends more than ever at that time. So, take an interest in what your friends are doing, and try to maintain your friendships as best as you can.

Hope this helps!

Purrs and kisses,

Mandating Overtime Pay for In-Home Caregivers

My mother-in-law, Stella, lives alone in her home in Florida, and her health has been declining for some time. About a year ago, we hired an in-home caregiver for her who comes 4 hours every day from a local agency.  Now her health is deteriorating more rapidly, and we are thinking of hiring a live-in caregiver from the local agency to assist her. When I spoke to the agency about this, the lady I spoke to said something about live-in caregivers soon needing to be paid overtime. If this is true, I am concerned that it is going to cost us a lot more than we anticipated, and that maybe we should consider other alternatives for Stella, such as assisted living. Do you know if there has been any change to the laws when it comes to caregiver overtime pay and, if so, can you explain? Thanks for your help!

Nearly 90% of the nation’s home care aides work for agencies. While industry experts say an overwhelming majority are paid at least the minimum wage, many do not receive time-and-a-half when they work more than 40 hours a week.

For years, labor unions and advocates for low-wage workers have pushed for changes to compensation for these caregivers, including overtime pay. Now, Labor Department officials said such aides will be protected under the Fair Labor Standards Act (FLSA), the nation’s main wage and hour law. How did this happen?

Back in the mid-1970s, the Labor Department created an exemption when it came to overtime for in-home caregivers. Since the early 1990’s, however, Democratic administrations have been trying to eliminate the exemption. Last year, the Obama administration argued that much had changed in the industry since the mid-1970s, and now more professional home care is provided by employees of staffing agencies.

With the intent to change the law to reflect the changing times, in 2014, the Obama administration introduced regulations that were intended to remove the exemption in federal minimum wage and overtime laws. The regulations, which were struck down by a lower court last year, were reintroduced recently and, on August 21, 2015, a three-judge appellate panel ruled that the Labor Department has the authority to eliminate the exemption. This opinion upholding the Home Care Final Rule became effective on October 13, 2015, when the Court of Appeals issued its mandate. The Department will begin enforcement of the Final Rule on November 12, 2015, meaning that very soon all caregiving hours in excess of 40 hours per week must be paid at 1.5 x the basic rate.

How Does This Change Things

Let’s say your mother needs around-the-clock care. Previously, most home health agencies charged a flat fee for live-in care, averaging about $240 per day in Northern Virginia.  This type of flat fee billing is based on the theory that a live-in caregiver provides on average about 10 or 11 hours per day of actual care, but is available at all times, even for emergencies that happen during the night when the care recipient is sleeping.  However, with the new regulations, a live-in caregiver can no longer be billed at flat daily rate, but rather must be billed at an hourly rate, and pay 50% more after 40 hours per week.

Does This Mean That a Live-In Caregiver Must be Paid When He or She is Asleep?

According the Dept. of Labor, it depends, because there are many different types of so-called “live-in” care, ranging from caregivers who work a single 24-hour shift per week all the way up to full-time live-in caregivers who live in the employer’s residence 24 hours a day 7 days a week.

Under the new rules, an employee who is required to be at work for less than 24 hours must be paid hourly even though he or she is permitted to sleep or engage in other personal activities when not busy. All the time is counted as work time that must be paid.  This can result in a significant extra expense due to having to pay overtime pay for all hours beyond 8 hours a day.

If an employee is required to be on duty for 24 hours or more, then the employer and employee may agree to not count as hours worked a bona fide regularly scheduled sleeping period of not more than eight hours, provided that (1) adequate sleeping facilities are furnished by the employer, and (2) the employee’s time spent sleeping is usually uninterrupted.  However, caregivers who work 24-hour shifts but are not live-ins must be paid at least minimum wage and overtime for all hours worked.

Full-time live-in caregivers (i.e., employees who work and sleep on the employer’s premises seven days per week and have no home of their own other than the one provided by the employer under the employment agreement) are exempt from the overtime requirements of the FLSA, as are caregivers who reside on the employer’s premises for “extended periods of time,” meaning employees who work and sleep on the employer’s premises for at least five consecutive days or nights each week.

A live-in caregiver and the employer may make an agreement excluding from hours worked sleep time, meal time, and other periods of freedom from all duties when the worker leaves the premises or stays on the premises for purely personal matters. The live-in caregiver must be paid for all hours worked even if those hours deviate from the agreement.

See and for more details on these new rules.

Given these new requirements, some care recipients may be forced to hire multiple caregivers to avoid paying overtime, resulting in many seniors having less access to the caregiver of their choice due to budgetary concerns.

What are other alternatives?

If the new overtime rules make in-home caregiving too costly, there are other alternatives for your mother, as follows:

Assisted Living:  Assisted living has become an increasingly popular alternative when our aging loved ones need attention and care outside the scope of our capabilities. For those who do not require round-the-clock care, there is a greater degree of autonomy in assisted living than in nursing homes. However, for those relying on Medicaid for long-term care assistance, assisted living is not always an option. Read more about assisted living in this blog post.

Nursing Home:  A nursing home is often the best (and least expensive) place for someone who needs round-the-clock care from skilled nurses and nursing aides. Nursing home staff provides medical care, as well as physical therapy, speech therapy, and occupational therapy. At nursing homes, staff members are encouraged to develop relationships with residents, and make them feel comfortable. Highly rated nursing homes offer residents a good quality of life, privacy, dignity, autonomy, and food enjoyment.

Continuing Care Retirement Communities (CCRC), also known as Life Care Communities, offer older adults a spectrum of services and care facilities, typically starting with independent living arrangements, then advancing to assisted living, and then progressing ultimately to nursing home care. In CRCCs, the shelter and services are offered under a contract that lasts for a period of more than one year, usually for life. The fact that CCRCs offer multiple levels of care within a single community is a very attractive selling point for some seniors, but transitions between the levels of care and other contract provisions, including applying for Medicaid when transitioning to skilled nursing care, have been a major source of tension and lawsuits between residents and providers. Please read our article about CCRCs for more details.

Shared housing: Aging, single boomers are taking a cue from the hit 80’s sitcom, “Golden Girls” and exploring communal living in retirement. Across the U.S., around 500,000 women aged 50 or older live with a non-romantic housemate, says PBS, and an AARP analysis of U.S. Census Bureau data indicates that there are about 130,000 “group homes” in existence today. Watch a recent PBS Newshour video on shared housing.

What happens when nursing home care is needed? Nursing homes cost $10,000-$12,000 a month in the DC Metro area — a catastrophic expense for most families. So, it is always prudent to plan ahead in the event that assisted living or nursing home care is needed in the future.  Life Care Planning and Medicaid Asset Protection  is the process of protecting your assets from having to be spent down in connection with entry into a nursing home, 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. Call us today 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

Veterans DON’T Delay (3-Year Look-Back is Imminent)

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The Department of Veterans Affairs (VA) helps veterans and their families by providing supplemental tax-free income through the VA Special Pension with the Aid and Attendance benefit. The Aid and Attendance benefit helps veterans to offset the high cost of medical care and access care that they otherwise might not have been able to obtain.

While the Aid and Attendance benefit is a needs-based program, there is currently no penalty for applicants who divest themselves of assets immediately before applying for benefits. As it stands, veterans who are unable to perform IADLs (Instrumental Activities of Daily Living), such as bathing, dressing, toileting, etc., without assistance are eligible to receive Aid and Attendance benefits. In addition, the VA presumes eligibility for Aid and Attendance if the veteran is in nursing home care.

Earlier this year, the VA proposed to amend its regulations governing entitlement to Aid and Attendance. The proposed regulations would establish new requirements pertaining to pre-application net worth evaluations and asset transfers to qualify for the benefit.

Proposed changes by the Department of Veterans Affair will severely restrict the benefits available to those who have failed to do the proper planning. They are, as follows:

· Look-back period: A 3-year look-back will be imposed on transfers of assets, including gifts to persons, trusts, or purchases of annuities. Benefits could be denied for up to 10 years due to transfers. All gifts in the look-back period will be presumed to have been made to qualify for benefits. And, there will be no allowance to give away money to your church, for a wedding gift to a grandchild, etc.

· Widow’s penalties will be almost twice as long as veteran’s penalties. For example, if a veteran gave away $50,000, he or she would get a 28-month penalty. That is, he or she wouldn’t qualify for benefits for 28 months. A widow would be penalized for 44 months.

· Clear net worth limit: One good feature of the new rules is that they will establish a clear net worth limit (currently suggested to be $119,220 — Medicaid’s maximum community spouse resource allowance in 2015), but where for Medicaid this amount is an asset limit, for the Aid and Attendance it combines both annual income and assets. This amount would be indexed for inflation by adjusting it at the same time and by the same percentage as cost-of-living increases provided to Social Security beneficiaries.

·  Exempt primary residence: The VA would exempt the claimant’s primary residence and surrounding land (but only up to 2 acres), from being included as an asset. However, if the residence is sold, the proceeds will count toward net worth unless they are used to purchase another residence within the same calendar year.

· Monthly pension sunsetting: The regulations set November 30, 2016 as the sunset date for the $90 monthly pension that has been allowed to veterans or spouses who receive Medicaid paid nursing home care.

· Independent living facilities: The new rules would provide that, generally, payments to facilities such as independent living facilities are not medical expenses, nor are payments for assistance with Instrumental Activities of Daily Living such as cooking, cleaning, and bill paying. However, there would be exceptions for disabled individuals who require health care services or custodial care.

The transfer penalty rule will mean that eligibility for VA needs based pension programs, such as Aid and Attendance, will become similar to that for SSI and Medicaid long term care benefits. The addition of the asset transfer prohibitions and penalties will create a significant new barrier for many veterans and add complexity to the filing and processing of claims. The added complexities suggest that veterans will be even more in need of planning assistance prior to applying for pension.

So, when might all this take place? 

Regulation changes are coming, and some experts believe they could take effect as early as January 1, 2016. At this time, the VA has not established any firm date, but some VA offices are already processing applications as if the rules are in effect. Therefore, veterans should strongly consider working with a Certified Elder Law Attorney, such as myself, sooner rather than later, to investigate their options quickly, wrap up any pending cases, and get them filed with the VA prior to the implementation of these regulatory changes.

Veteran’s Aid and Attendance

Here at the Farr Law Firm, we work with veterans and their spouses to evaluate whether they qualify for the Veterans Aid and Attendance Benefit and/or Medicaid, and we deal with all the paperwork. As an Accredited Attorney with the U.S. Dept. of Veterans Affairs and Certified Elder Law Attorney, I understand both the Veterans Aid and Attendance Benefit and the Medicaid program and the interaction between both benefit programs. Please call us to make an appointment for a no-cost consultation:

Fairfax Veteran’s Attorney: 703-691-1888
Fredericksburg Veteran’s Attorney: 540-479-143
Rockville Veteran’s Attorney: 301-519-8041
DC Veteran’s Attorney: 202-587-2797

P.S. Another benefit of being a veteran is a 15% discount off all services at the Farr Law Firm. We hope to see your family soon!

Critter Corner: New iPhone App Could Transform How We Diagnose Autism

Dear Commander Bun Bun,

I heard somewhere that a new app has been developed by Apple that can be used to diagnose Autism Spectrum Disorder (ASD) using facial expressions. Since you are attuned to what’s going on with technology, have you heard anything about this and how it works?


Di Agnosis


Dear Di,

The app, Autism Beyond, is the result of a several-year-long project led by a team of Duke doctors, researchers, and programmers. It’s one of several new apps that Apple is making available through its ResearchKit platform today.

Autism Beyond plays 20-minute videos while using an iPhone or iPad’s built-in camera to scan viewers’ facial expressions, analyze their reactions, and then indicate if there’s a potential risk of autism. It’s intended for parents to use with their children, who see videos of lights, sounds, and storytellers.

How it works:

• When the viewer smiles, dots line the video version of his or her face.

• After the app collects enough of those visual patterns, it’s able to offer real-time and evidence-based feedback, such as whether a parent should seek out a doctor based on the child’s indicators for autism.

• The app was created to provoke the same instinctual responses that a psychologist uses to gauge in a clinic, as she tries to diagnose autistic children.

Duke researchers hope that parents will start using Autism Beyond to build up a video library of a child’s reactions, which could help doctors prioritize the most at-risk children and bring them into the office for in-person diagnosis. However, if parents don’t want to have their child’s face and features captured on video, they can opt to just record the patterns of dots.

Although autism can be diagnosed in children as young as 18 months, the average age of diagnosis in the United States is more than 4 years old. Delayed diagnoses can stunt a child’s intellectual and social development, due to lack of early intervention therapies.

Learn more about Autism and Beyond and view it in iTunes here.

Note: This app does not provide a definitive diagnosis of ASD. If you suspect your child shows symptoms of ASD, be sure to make an appointment with a developmental pediatrician or neurologist.

Hop this is helpful,

Commander Bun Bun

Debunking the Myths About Autism

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Q. We recently found out that my son, Freddy, has been diagnosed with Autism Spectrum Disorder. After accepting the fact that things will be more challenging for him socially and academically (he is also learning disabled), I told my friends and family about the diagnosis. The first thing my mother mentioned was, “maybe he’s just quirky,” and my sister gave her two-cents stating that a “disproportionate number of mass murderers are on the spectrum,” and that “I better get him therapy right away.” My best friend, Rebecca, who I thought would be compassionate, said “maybe he’ll outgrow it.” Since these are my friends and family, who supposedly care about me and my son, maybe I should take what they’re saying with a grain of salt. Based on your experience with special needs families, what do you think?

A. One in every 68 children today is being diagnosed with autism spectrum disorder (ASD), with kids with ASD in the news, on TV shows, and in your child’s classroom. ASD is so well known these days that many Americans, without a medical or psychology degree, fancy themselves as experts on the subject.

But, don’t despair. Much of what many think of as facts, are really only myths. In answering your question, I will take this opportunity to dispel five of the most common myths, including those you had heard from your family and friend.

Please note: ASD is a spectrum disorder, meaning no two people on the spectrum are exactly the same, and many exhibit different characteristics that make them unique.

Myth #1: People with autism lack empathy

In the past, those with ASD were depicted in clinical literature and in the media as “emotionless,” and “incapable of compassion,” akin to sociopaths. In reality, however, people with ASD are often highly concerned with the feelings of the people around them, sometimes to a paralyzing degree.

Your sister mentioned an often-repeated assertion by media figures, such as MSNBC’s Joe Scarborough, that a disproportionate number of mass murderers are on the spectrum. While it’s true that some are, it is also true that many are not.

When it comes to exhibiting empathy, often those with ASD struggle to make sense of social signals, including subtle shifts in facial expression, body language, and tone of voice. For many children on the spectrum, the use of “social stories” – visual representations of interpersonal interactions – can help accelerate the learning process.

Myth #2: Maybe he’s just quirky

According to Lorna Wing, a pioneer in the field of childhood developmental disorders who advanced understanding of autism worldwide, every trait that is characteristic of autism is also possessed by non-autistic people (i.e., “neurotypical” people), to varying degrees. Autistic people”self-stimulate”; neurotypical people fidget. Autistic people have “special interests” and “obsessions”; neurotypicals have hobbies and passions. Autistic people have “sensory sensitivities”; neurotypicals just can’t stand wearing polyester. That means there’s a huge gray area between autism and non-autism.

However, ASD is a disability, and those who are diagnosed with it meet certain criteria, as established by the DSM-V. For those who meet the criteria, ASD is a profound and pervasive disorder that affects nearly all aspects of life, as anyone with a diagnosis (or a loved one who has one) knows.

Myth #3: Autism is an epidemic

In 1970, the estimated prevalence of autism among schoolchildren in the United States was 1 in 10,000. Now it’s one in 68. Although the numbers have gone up dramatically, ASD is not an epidemic.

In reality, the primary contributor to the dramatic spike in ASD in recent decades is the fact that a broad range of children, teenagers, and adults on the spectrum are now able to get diagnosed. Until the 1980s, there was no “autism spectrum” as a diagnostic category. Autism was defined very narrowly, and mistakenly thought of as rare.

In fact, throughout the 1980s, a parent often had to bring their child to 9 or 10 specialists before finally obtaining an autism diagnosis (which many couldn’t afford to do). And girls with autism were virtually “non-existent” to those in the psychiatric field until the end of the 20th century.

Myth #4: Children can outgrow ASD

According to the Wall Street Journal, “evidence is growing that some children with autism appear to grow out of their symptoms and recover fully.” The article states that clinicians and parents have described patients and loved ones whose autism symptoms seem to disappear completely. However, these individuals haven’t been closely studied, making it hard to determine whether they had autism in the first place or were misdiagnosed. The article points out that possibility of recovery is spurring interest, but more research needs to be done. Please also read our article, “Can Someone Recover from Autism?” for more details.

On this subject, even if children cannot “outgrow ASD,” early intervention and therapy are key to treat the symptoms of the disorder.

Myth # 5: Children with autism are either “intellectually disabled” or “savants.”

When researchers took a look at the long-standing assumption that children with ASD suffer from intellectual disability or are savants, like Dustin Hoffman’s character in the movie “Rain Man,” they found it was far from the truth. Like any human being, each person has skills that they are better at than others, but not all are savants. At the other extreme, some kids on the spectrum are harder to test than others, but that doesn’t mean they are lacking in intelligence.

Hope these truths provide some clarity for you, and help to dispel the myths that you have heard.

Special Needs Planning

Parents of those with special needs, including ASD, are tasked with planning for their children throughout their lifetimes, as many of them will outlive their parents but might not be able to support themselves and live independently. As a parent or guardian, you want to ensure that your child with special needs will remain financially secure even when you are no longer there to provide support. A Special Needs Trust is a vehicle that provides assets from which a disabled person can maintain his or her quality of life, while still remaining eligible for needs-based programs that will cover basic health and living expenses.

If you have a loved one who will likely need care for life, it’s important to provide legal protections for him or her. The Law Firm of Evan H. Farr, P.C. can guide you through this process. Please call us to make an appointment for a no-cost consultation:

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

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What She Doesn’t Know About Social Security Could Cost Her Thousands

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Critter Corner: When it Comes to Social Security, what does “File and Suspend” Mean?

What you should know:

• The primary reason to file and suspend is to allow your spouse to file a spousal benefit based on your earnings record.

• It’s not possible to file for a spousal benefit unless your spouse has already filed for his or her own retirement benefit.

• By filing and suspending, you can make your spouse eligible to take a spousal benefit while allowing your own retirement benefit to increase because of DRCs.

• File and suspend only applies to the retirement benefit of the person who is taking the action. You can’t file and suspend for a spousal benefit or a survivor’s benefit.

• If you’ve begun taking your retirement benefit before FRA, you cannot suspend this benefit until you’ve reached FRA. After that date, you will only suspend—you wouldn’t need to file and suspend, because you’ve already filed.

• If you have begun receiving retirement benefits before your FRA, and you decide at or after your FRA to suspend them, you do not have to repay Social Security any of the benefits you’ve already received.

Financial planners often suggest that couples wait until the older spouse turns 60 to figure out exactly what claiming strategy would be best for them, because then, they will have a better sense of what their Social Security retirement benefits will be. Health and work considerations should also factor into Social Security claiming strategies.

Please keep in mind that according to CNBC, there have been “some concerns that the option might disappear. President Barack Obama’s proposed budget for fiscal 2015 hinted at the possibility, proposing “to eliminate aggressive Social Security claiming strategies, which allow upper-income beneficiaries to manipulate the timing of collection of Social Security benefits in order to maximize delayed retirement credits.”

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