Financial Uncertainty in Retirement. . . We Can Help with That!

Life spans are increasing, and many of us are living well into our 80’s and 90’s. At the same time, however, the price of long-term care is increasing, and as we learned last week, you CANNOT count on long-term care insurance to pay for it.

Still, many Americans do not recognize that planning in advance and saving for their golden years should be an urgent priority in their lives, according to Kristen Bonner, GoBankingRates researcher. “The trending attitude today is to enjoy life to the fullest,” she said. “However, even though retirement seems far away to many people, and they think that there is still plenty of time to begin saving, Americans must make their future selves a priority and take all necessary steps to set themselves up for a comfortable financial future.”

Here are some of the challenges we face financially as we get older, and why it is imperative to meet with a qualified financial planner, and plan ahead:

Not enough savings: Because people are living so long, they often outlive their savings and investments. What this means is that along the way to becoming older at age 85 or age 90 or age 95, a number of expenditures have eaten into savings and investments.

Retirement accounts didn’t produce anticipated results: If a senior or a senior couple is relying on investments and savings to augment income such as Social Security or pensions, and for various reasons those retirement accounts did not produce the anticipated results, many seniors find themselves in a bind in later years.

Too much debt: For whatever reason, banks have been particularly liberal about issuing credit cards to older individuals who may not have the capacity to service that debt. The debt may have been necessary because of a major repair to the home, or due to unforeseen high medical bills. Paying back money borrowed on credit cards or through home equity loans eats into income.

Income flow not keeping pace with inflation: This is particularly true for seniors on Social Security or fixed pensions who have to pay for the high cost of medical care. The cost of medical care has been increasing significantly faster than the yearly increases in Social Security. Also, in some areas the cost of maintaining a household due to higher utility bills, higher taxes and higher maintenance costs has risen faster than the cost of living increases in Social Security income.

Failing health: Deteriorating health for a senior – especially a senior of advanced age – will typically trigger the need for intervention and the need for making some serious and costly decisions about living arrangements, costs, government support and family support.

Financial exploitation: Because of the many exposés on television, many of us are aware of phone scams and Internet scams. There are also other scams out there that take advantage of seniors and rob them of their savings.

Need Financial Advice? We Are Now Offering Elder-Focused Financial Services

As you can see, it is important to plan in advance to live comfortably, and to deal effectively with challenges (such as those above) as they arise. For years my law firm and I have been providing you and our other clients with caring and compassionate legal services designed to ensure that your wishes will be carried out when you die, or that your assets are protected from the catastrophic expenses of long-term care. Over the years, as we have all grown older (sigh!), 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 am now offering specialized elder-focused financial services in addition to our traditional elder-focused legal services. I feel it is very important to share these cutting-edge financial strategies with you – strategies that provide long-term care protection but do NOT involve the purchase of traditional long-term care insurance — as well as guide you through the implementation of financial solutions to problems that may threaten your future financial security.

I am extremely proud of the number of families we’ve been able to help in almost 30 years of practicing in the Northern Virginia area, and we have been extremely fortunate over the past 2 years to be able to expand our practice with an office in Fredericksburg, Virginia, and meeting locations in Washington, DC and Rockville, MD.

For many of our clients, the legal plan and documents you have in place were state of the art when prepared, but many laws have changed and have been added over the years. Plus, with almost 9,000 baby boomers turning 65 each day, our current health care and long-term care systems may one day become overwhelmed, making it difficult for all of us to get the care we need at affordable rates if we don’t take steps now.

Congress recognized this when they passed the Pension Protection Act, which since 2010 has allowed those who plan properly to pay for the costs of long-term care using tax-free dollars. The problem is that, while the Pension Protection Act provides some great tools to allow us to plan better, very few attorneys or advisors know anything at all about the law.

As always, we at the Farr Law Firm stay on top of the strategies you need to put in place to keep yourself and your family protected.  In the coming year and beyond, I will be bringing this important message to members of our community through our ongoing monthly seminars. In the meantime, I want to reach out to our newsletter readers to schedule a free Senior Estate Planning & Asset Protection Review to see if there are legal and/or financial steps you need to take to protect yourself and your loved ones.  Normally these free follow-up consultations are only available to members of our Lifetime Protection Program, but for a limited time we are offering this free review to introduce you to our new elder-focused financial services.

My schedule is about to become very full as I take this important financial information to the general public; however, if you’d like to have your own personalized Senior Estate Planning & Asset Protection Review at no charge, please call my office as soon as possible, preferably this week or next week, at 703-691-1888, so we can get you on the schedule.

Retirement is a Complex Issue

When it comes to financial planning, everyone has different needs, situations, and goals. Should you ever want expert guidance with your financial planning process, remember that qualified assistance is available right here at The Farr Law Firm. Our team looks forward to helping you – no matter where you’re at in your financial journey!

In addition, if you have not done long-term care planning, estate planning or incapacity planning (or had your planning documents reviewed in the past several years), please call us to make an appointment for a no-cost initial consultation:

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

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Giving Tuesday is a global day of giving where you can support your favorite charity. Today we ask you to donate to support Reiki Outreach Services for Elders, Inc. (ROSE), a 501(c)(3) charity that I founded whose mission is to bring the gentle yet powerful healing properties of Reiki to elders in elder-centric communities.

This #GivingTuesday, join us as we come together and harness the power of Reiki. The lives you touch will be changed forever.

Your donations can help us:

  • Support and nurture Reiki practitioners who have a passion for helping to heal seniors;
  • Continue our efforts as a bridge between volunteer Reiki practitioners and seniors in senior-serving communities;
  • Conduct more outreach to more senior-serving communities;
  • Continue our mission of building a community where all elders have access to Reiki and its healing powers.

These are just a few of the many things your contribution can assist with today.

Donate now to support ROSE.

Join us for the Farr Law Firm Holiday Open House, which will also help ROSE. Come Celebrate the Holidays at the Farr Law Firm Open House on December 10, 2016 from 2 to 5pm.  Hors d’oeuvres and holiday refreshments will be served. All are invited – bring yourself, your family, and your friends! There will be a silent auction with holiday gift baskets and other wonderful items for you to bid on, with all auction proceeds going to ROSE. We hope to see you on December 10! Learn more and RSVP here.

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Giving Tuesday is Here!

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The Death of Long-Term Care Insurance?

Maureen’s husband is retiring within the next few years, and her family is now planning in advance for long-term care, in case the need should arise in the future. Recently, in doing some research on long-term care insurance, Maureen read that John Hancock is leaving the long-term care market early next year. She couldn’t believe it and was wondering if she was reading the news correctly, since she had heard that John Hancock was one of the largest long-term care insurance carriers. Maureen, and others in her situation, must now consider other options to plan and pay for long-term care (which is a good thing, because there are many other and better options!)

Maureen, in our example, read correctly: John Hancock Life Insurance Company announced earlier this month that it is leaving the long-term care insurance market, just as dozens of other insurance carriers have done before it, and that it will discontinue the sale of individual long-term-care insurance policies starting next year. The company, among the top three in market share for traditional long-term-care insurance, will no longer issue new policies after February 2017, according to a memo sent to distribution partners and producers.

Hancock’s Federal Long-term Care Insurance Goes Up 225%

Not all Hancock long-term care insurance policies will be ceasing. Some group policies are continuing, but premiums are going up by astronomical amounts. According to the Federal Long-Term Care Insurance Program (FLTCIP) Website, a new contract was recently awarded to John Hancock that will result in astronomically larger out-of-pocket costs for Federal Long-Term Care Insurance Program enrollees. The new, seven-year contract retains John Hancock, which last received the contract in 2009. Since the last contract, insurance rates increased annually for enrollees who opted not to pay higher costs up front, at a 4% to 5% annual inflationary increase. In 2009, FLTCIP enrollees saw their premiums jump by as much as 25%. This year, premiums are increasing by a whopping 225%!  This is a previously unheard of increase for the FLTCIP program. Read more about this on our blog.

On another note, another major company (the nation’s largest seller of long-term care insurance policies), Genworth Financial, has agreed to be acquired by a privately-held Chinese investment firm. It announced it will reserve $400 million to $450 million against future long-term care claims, but at this time it is unclear whether the new company will continue to issue any new long-term care insurance policies.

These examples point to the huge trouble being faced by the long-term care insurance industry, and bring into question whether traditional long-term care insurance will continue to exist in the years ahead.

Why is this happening?

Below are some reasons, according to Forbes, why scores of carriers have abandoned the market in recent years, and those that have remained have sharply raised premiums on existing policies and tightened underwriting standards and raised prices on new ones.

• Long-term care insurance companies are struggling with larger-than-expected claims.
• Continued low interest rates have slashed investment earnings.
• Sales have plummeted. Sales of individual stand-alone policies plunged from a peak of about 750,000 in 2002 to only about 130,000 in 2014.

Long-Term Care Costs Are Rising. What to do!

Boomers need to be aware that the national cost of nursing home care is projected to rise from an average of $87,600 per year in 2016 to over $123,000 per year in 10 years and $174,000 per year in 20 years. And these are national averages; costs are much higher in the DC Metro Area! What other ways should people consider to pay these high costs if long-term care insurance is no longer a viable option?

Below are different ways to address your Long Term Care needs:

1) Veteran’s Aid and Attendance Benefits: The VA can help qualifying veterans with long-term care costs. In fact, there is over $20 billion dollars available for long-term care pension money just waiting for veterans to apply for their Aid and Attendance benefits. You must be an honorably discharged veteran who needs assistance in your home, or are living in or considering moving into an Assisted Living Facility or Continuing Care Retirement Community to receive benefits and both you and your spouse could qualify. Read more here.

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

3) Living Trust Plus: If you are still healthy and not yet on the “long-term care continuum,” then instead of Life Care Planning and Medicaid Asset Protection Planning you should consider our Living Trust Plus™ Asset Protection Trust, which is a simpler and less expensive method of asset protection for clients who will most likely not need any long-term care for at least five years. For most Americans, the Living Trust Plus™ is the preferable form of asset protection trust because, for purposes of Medicaid eligibility, this type of trust is the only type of self-settled asset protection trust that allows a settlor to retain an interest in the trust while also protecting the assets from being counted by state Medicaid agencies.

4) Better Financial Planning: The above-described legal strategies are not right for everyone. Fortunately, there are specialized financial planning strategies that are actually better than traditional long-term care insurance, including specialized hybrid products and specialized products that take advantage of the Pension Protection Act. I will discuss this more in next Tuesday’s newsletter.

If you have done your research and decide long-term care insurance is still right for you and your family or if you already have a long-term care insurance policy in place, you should incorporate it as part of your long-term care plan, not as the only form of planning for long-term care.  Keep in mind that there are dozens of long-term care asset protection strategies other than long-term care insurance. If you have not done long-term care planning, estate planning or incapacity planning (or had your planning documents reviewed in the past several years), please call us to make an appointment for a no-cost consultation:

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

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An Alternative Way to Alleviate Chronic Pain

Q. My mother, Grace, suffers from chronic back pain and arthritis. Sometimes, she is so stiff that she cannot move without wincing in pain, and has to stay in bed all day. She has tried everything, including visiting doctors and specialists and taking prescription painkillers. She has even considered complementary and alternative treatments, such as acupuncture and chiropractic help. She recently heard from a friend about Reiki, and was intrigued. I read in your bio that you are a Reiki Master. Can you tell us more about Reiki as an alternative for healing, and about your non-profit, ROSE?

A. Chronic pain, or pain lasting more than three to six months, affects 100 million adult Americans, according to a report from the Institute of Medicine. This equates to more than 40% of the adult population and, according to USA Today, it costs the nation upwards of $635 billion a year — more than cancer, heart disease and diabetes combined.
Chronic pain is not just acute pain that doesn’t go away. The National Institute of Health describes it as pain signals that “keep firing in the nervous system for weeks, months, even years.” There may have been an initial mishap, such as a sprained back or a serious infection, or there may be an ongoing cause of pain, such as arthritis, or cancer. Some people suffer chronic pain in the absence of any past injury or evidence of body damage, and many chronic pain conditions affect older adults.

For generations, the default method for treating unrelenting pain has been prescription and over-the-counter painkillers. However, sustained use of painkillers can lead to its own problems, including stomach ulcers, liver failure, and addiction (which affects 1.9 million Americans). Luckily, pain management is one area in which drug-free treatments are showing promising results. A recent survey found that 75% of integrative-medicine centers across the country were successful at relieving chronic pain with therapies that don’t come in the form of a pill.

Alternative Therapies to Reduce Chronic Pain

Alternative therapies and treatments, including acupuncture, nutritional supplements, massage, chiropractic therapies, certain herbal therapies, and Reiki, have the potential to alleviate chronic pain in many people.

As a Reiki Master and as the founder of ROSE (Reiki Outreach Services for Elders), I have seen for myself the wonderful healing power of Reiki. Reiki is one of many types of energy-based healing practices. It is based on the fact that a universal energy flows all around us, and can be channeled and focused by Reiki practitioners into Reiki recipients, where the energy acts as a catalyst to help jumpstart the recipient’s own internal healing mechanisms.
Reiki is a simple, natural, and safe method of energy healing and self-improvement that everyone can use. It has been effective in helping virtually every known illness and malady and always creates a beneficial effect. It also works in conjunction with all other medical or therapeutic techniques to help relieve negative side effects and promote faster recovery.

When used with the elderly, Reiki can have a two-fold benefit. Most infirm elderly suffer from multiple chronic ailments at once rather than just one, including: respiratory ailments such as emphysema, pneumonia or asthma; Alzheimer’s and other types of dementia; heart disease; kidney disease; osteoporosis and osteoarthritis; and of course cancer. Receiving Reiki not only provides calm and relaxation to the elderly, but can also provide emotional nourishment that elderly often need – all through the simple act of healing touch.

Alternative therapies such as Reiki bring the body and mind to a better place. It may not take your back pain away tomorrow, but it can give you excellent coping strategies and increased awareness of what modifies the pain. Remember, as you are finding ways to help with your body, the greatest way to gain peace of mind comes with planning for your future and for your loved ones.

What is ROSE?

ROSE (Reiki Outreach Services for Elders) is a 501(c)(3) non-profit organization dedicated to helping elders with the healing power of Reiki. ROSE serves as a bridge between volunteer Reiki practitioners and elders in senior-serving communities. Personally, reiki improved my life in extraordinary ways, curing me of several major illnesses that traditional Western medicine said were incurable.  Please read my Personal Statement on the ROSE website for more details.  Please also consider attending the Farr Law Firm Holiday Open House in Support of ROSE on December 10. Please click here to RSVP.

Reiki does not benefit everyone in the way it benefited me, but I believe that everyone – including Elders — should have the chance to experience the gentle healing powers of Reiki. In addition, I believe everyone should be prepared for the future and for the catastrophic costs of long-term care. If you or a loved one is nearing the need for long-term care or already receiving long-term care or if you have not done Long-Term Care Planning, Estate Planning or Incapacity Planning (or had your planning documents reviewed in the past several years), 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

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A Must-Have Document for Family Caregivers

Kayla’s father, Bob, is in the early stages of dementia. She has hired paid caregivers who have come and gone because Bob has tendencies towards anger and violent outbursts. Kayla has decided that the time has come to quit her job to care for her father. Although she didn’t want to at first, she will be accepting payment from him because she truly needs the money.

Previously, when Bob had a caregiver through an agency, the agency had a written contract. However, as an individual caring for her father, Kayla wasn’t sure whether she needed to have a legal agreement. It turns out, for many reasons that I will describe below, that she certainly does.

If you regularly provide paid care to a parent or other family member, it’s essential to have a properly-written caregiver agreement setting out the exact terms of your arrangement.  This agreement (also known by other names, such as a personal care contract or a family care contract), must set out your duties as caregiver and the exact terms of your compensation.

What the Caregiver Agreement Should Include

A caregiver agreement is also not something that you should do on your own, or you risk running afoul of Medicaid and IRS rules. Rather, this type of agreement should only be done as part of a comprehensive Asset Protection Plan prepared and supervised by an experienced Elder Law Attorney such as myself.

Some of the provisions a caregiver agreement should include are:

Caregiver’s duties: The contract should spell out the caregiver’s duties, which can be anything from driving to doctor’s appointments and attending doctor’s meetings to grocery shopping to help with paying bills.

Length of contract: The length of the term of the contract is usually for the elder’s lifetime, so it is important to cover all possibilities, even if they are not currently needed. However, in some states (including Virginia) the contract cannot continue when the elder enters a nursing home if an application for Medicaid is anticipated.

Payment: Payment to the caregiver must be hourly in somestates  (such as Virginia).  Other states allow a lump-sum payment. For Medicaid purposes, it is very important that the pay not be excessive. Excessive pay could be viewed as a gift for Medicaid eligibility purposes. The pay should be similar to what other caregivers in the area are making, or less. The amount you get paid, the hours you work, and the type of care you provide should be approved in advance by a professional skilled in assessing the care needs of older adults, such as a Geriatric Care Manager / Aging Life Specialist.

Other sources of payment: If the elder does not have enough money to pay his or her caregiver, there may be other sources of payment. A long-term care insurance policy may cover family caregivers, for example. The Veterans Aid and Attendance benefit also will allow payment to a family caregiver. Also, there may be state or federal government programs that compensate family caregivers. Check with your local Agency on Aging to get more information.

Reasons to Have a Caregiver Agreement

Having a caregiver agreement has many benefits. It rewards the family member doing the work. It can also help alleviate tension between family members by making sure the work is fairly compensated. The following are additional reasons to have a properly-drafted caregiver agreement:

It is important for Medicaid eligibility: The money a parent pays to a family caregiver, absent a properly-drafted caregiver agreement, will be deemed a gift by Medicaid, causing a period of ineligibility during which the parent will not qualify for Medicaid. How? At the time of a parent’s Medicaid application, Medicaid will total all the “off-contract” payments made to a family caregiver, along with all other gifts, in the past 60 months and divide that total by the relevant “penalty divisor.” The quotient is the penalty period, which equals the number of months Medicaid will not pay for nursing-home care. In Northern Virginia the penalty divisor is $8,367, and in the rest of Virginia it’s $5,933.  In DC, it’s $10,333, and in Maryland it’s $7,940.  As an example of how this works, let’s say a parent pays a family caregiver $60,000 over the course of three years and then applies for Medicaid. Without a proper caregiver contract in place, Medicaid would deem those payments as gifts, causing a penalty period of over 7 months in Northern Virginia ($60,000 divided by $8,367), over 10 months anywhere else in Virginia ($60,000 divided by $5,933), 7.5 months in Maryland, and 5.8 months in DC.

It sets boundaries: A detailed caregiver agreement makes clear the extent of the services being provided by a family caregiver and the amount of money the caregiver is getting paid. A caregiver contract sets the understanding about the requirements and limits of the relationship.

It explains tax ramifications: A well-drafted caregiver agreement makes clear the tax ramifications of the agreement, such as the fact that the child must be treated as an employee and the parent must be treated as a household employer and must withhold income taxes and payroll taxes.

It helps avoid misunderstandings with other family members about the care being provided and the money changing hands. If the agreement doesn’t solve a particular disagreement with family members, you may be able to add something to the document, or change its terms, to address the problem.

It offers security and peace of mind: A caregiver agreement can offer family caregivers security that they will not suffer undue financial consequences. At the same time, the agreement can also offer the care recipient peace of mind that she or he has a caring advocate to manage care needs.

Paying a Family Caregiver is One Medicaid Asset Protection Strategy

Even though most family caregivers want to help, and feel a sense of duty to care for a loved one without pay, the fact is that it is a job – and a very difficult job with heavy time commitments and heavy physical and emotional responsibilities. If there is money with which to pay, family caregivers deserve to be paid (and to have their Social Security funded as household employees), but the payment arrangements must be done through a properly-drafted caregiver agreement that only an experienced Elder Law firm, such as ours, can prepare.  When done properly, a Family Caregiver Agreement can be a very good Medicaid Asset Protection Strategy – one of over two dozen different Medicaid Asset Protection Strategies available.

Caregiver Contracts at the Farr Law Firm

At the Farr Law Firm, we prepare caregiver contracts frequently as part of our Level 4 Planning / Life Care Planning/Medicaid Planning, and the contract is always supported by an independent evaluation that we obtain from a professional Geriatric Care Manager/Aging Life Specialist. But just because family care is being provided does not mean that a Caregiver Agreement is always the best strategy to use. For example, sometimes it’s better for a child to provide the care for free and have the parent make a gift to the child in lieu of paying the child. Which combination of asset protection strategies is best for each family depends on numerous factors, which is why a Caregiver Agreement should only be done as part of a comprehensive Asset Protection Plan.

November is National Family Caregivers Month. If you are a caregiver and your loved one has not done Medicaid Planning, please call us as soon as possible for a no-cost initial consultation:

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

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Your Right to Refuse Medical Treatment and to Die. The Advance Health Care Directive

By Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold, NJ Living Will and Health Care Directive Attorney

Life vs. Death is a topic we often discuss in hypothetical terms because it’s disturbing. New Jersey Law permits life-sustaining treatment to be withheld or withdrawn in certain, limited circumstances. New Jersey is generally regarded as a “Right to Control over Life” state.

The Act defines the term “life-sustaining treatment” quite broadly:

“Life-sustaining treatment” means the use of any medical device or procedure, artificially provided fluids and nutrition, drugs, surgery or therapy that uses mechanical or other artificial means to sustain, restore or supplant a vital bodily function, and thereby increase the expected life span of a patient.

Experimental Treatment

You have the right to refuse life-sustaining treatment when the treatment is experimental in nature and not a proven form of treatment or when the treatment is unlikely to prove effective and merely prolongs the dying process.

Permanently Unconscious

You have the right to die. A living will can and should permit someone to “pull-the-plug” on them when they are a “vegetable.” We know the term “vegetable” is a cliché. Legally being a vegetable means a “vegetative state”. A “vegetative state” is officially called “permanently unconscious.” Your attending physician and a second physician must unanimously conclude that you are in a state of permanent unconsciousness, thus vegetative.

Terminally Ill

Life-sustaining treatment can be withheld or withdrawn when we are in a terminal condition, as determined by his attending physician and confirmed by a second physician. The Act defines “terminal condition” as follows:

“Terminal condition” means the terminal stage of an irreversibly fatal illness, disease or condition. A determination of a specific life expectancy is not required as a precondition for a diagnosis of a “terminal condition,” but a prognosis of a life expectancy of six months or less, with or without the provision of life-sustaining treatment, based upon reasonable medical certainty, shall be deemed to constitute a terminal condition.

But remember just because you’re diagnosed as terminal doesn’t mean you’re left to die. You can actually control the dying process.

Cost-Benefit Analysis

Finally, life-sustaining treatment can be withheld or withdrawn when the risks and burdens of the treatment or ongoing life are likely to outweigh the benefits of the treatment. The State isn’t interested in forcing people to undergo painful procedures that have little benefit or chance of helping the person live a meaningful life.

To discuss your NJ Living Will and Health Care Directive matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at  Please ask us about our video conferencing consultations if you are unable to come to our office.

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Brain Training to Keep Seniors on the Road Longer

Q. When I was growing up, my father used to always be the one to drive our family everywhere. We would never fly, because it was “too expensive,” and I think it was also because dad loved driving. To this day, he and my mother drive their RV across the country, and if you need to find them, they are probably somewhere on the road.

My father’s hearing, peripheral vision, and motor skills aren’t what they used to be, and he’s been in some accidents in the past few years (luckily, nothing serious). I don’t think he should be driving as much anymore, but my mother is reluctant to take the car keys.  She gets nervous on highways and has become accustomed to him driving everywhere.

Is there any way to keep him in the driver’s seat just a little longer, or to help her become more confident.  I know if they were stuck in their house, my father would get depressed and feel a loss of independence, and I would hate to see what happen. Also, can you tell me what indications there are that someone should no longer be on the road?

Thanks for your help!

A. As we age, the prospect of giving up our car keys can be upsetting, and often challenging for everyone involved. This is because, for many of us, the ability to drive represents independence, freedom, social connection, and vitality.

As you probably know, driving requires people to see and hear clearly; pay close attention to other cars, traffic signs and signals, and pedestrians; and react quickly to events. Drivers must be able to accurately judge distances and speeds and monitor movement on both sides as well in front of them. It’s common for people to have declines in visual, cognitive, and physical abilities as they get older. The following factors warrant monitoring and possible driving cessation:

Health Conditions: Physical and mental impairments that accompany aging, such as Parkinson’s disease or Alzheimer’s or other types of dementia, can compromise driving agility and judgment.

Vision Impairment: From accurately reading the speedometer to detecting pedestrians on the side of the road, good driving requires good eyesight. Deterioration in vision is an inevitable effect of aging. Older eyes are more susceptible to cataracts, glaucoma, and other problems that impair vision.

Hearing Impairment: Few people age without some deterioration in their hearing. Hearing loss can happen gradually, without the person realizing it, and undermine the ability to hear horns, screeching tires, sirens, and other sounds that would normally put someone on high alert.

Prescription Drug Use and Drug Interactions: Many drugs can compromise driving ability by causing drowsiness, blurred vision, confusion, tremors, or other side effects.

Problems with reflexes and range of motion: Sometimes older drivers who have problems with reflexes or range of motion are not able to react quickly enough to brake suddenly or quickly look back.  Sometimes older drivers also confuse the gas and brake pedals, finding themselves getting flustered while driving, or quick to anger.

Memory Loss: Memory loss can impact driving if the driver misses exits that used to be second nature or gets lost frequently.

Alcohol Abuse: Drinking and driving is always a dangerous combination. As people age, alcohol remains in the system longer and tolerance declines. Also, elderly folks are likely to be on medication, which can exacerbate the effects of alcohol. If you drink, don’t drive. If you suspect that your family member is drinking and driving, don’t wait to take action.

The Brain Training and Driving Study: Keeping Seniors on the Road Longer

A recent study showed that seniors who stopped driving were nearly twice as likely to suffer from depression and almost five times as likely to go into a long-term care facility as those who still drove. However, there has been some promising research suggesting that brain exercises could help keep older adults in the driver’s seat longer.

A decade ago, Penn State University researchers tested a sampling of 65+year-olds. The Brain Training and Driving Study involved a group of about 2,400 healthy adults ages 65 and older who were currently driving. A portion received cognitive training in either reasoning, memory, or speed of processing. The rest received no training.

They revisited these test subjects 10 years later, and found that the older adults who participated in so-called “brain training” ― exercises designed to improve cognitive ability ― were more likely to continue driving through their 80s than those who did not.

Lesley A. Ross, Penn State assistant professor of human development and family studies, said in a press release that the study measured the effects of three cognitive training programs ― reasoning, memory, and divided attention ― on driving cessation in older adults. Those who completed the reasoning and speed of processing training were 55% and 49% less likely to stop driving within 10 years, respectively. Those in the memory training group experienced “no significant effects,” the study said.

All of the 2,000 participants were drivers at the start of the program and were in good health. The participants were evaluated seven times over the course of 10 years. Participants were asked, among other things, to memorize their shopping lists and to look at images on a PC screen and try to remember them a few seconds later. A part of the sample did not participate in these exercises. Some of the other participants in the speed of processing group received “booster” training sessions. Their group was 70% less likely to stop driving within 10 years.

The study concludes by saying the reasoning and speed of processing training “should be recommended to older adults at risk for mobility decline due to cognitive difficulties.” Ross and colleagues plan to continue to study the effect of cognitive training, including the introduction of Xbox Kinect, a gaming platform, into future research.

Sharpening Your Brain to Maintain Safe Driving Skills

Looking for ways to sharpen your brain to enhance your driving skills? According to AARP, the following quick tips should be kept in mind as you select activities to do so:

1. Variety: Mastering a new skill gets easier with time and practice, so introduce some variety into the types of activities you choose. By changing exercises on a regular basis, your mind will have to work harder to accomplish the task.

2. Challenge: Never let any exercise become too routine — including those for your brain. Challenge yourself with activities that have increasing levels of difficulty.

3. Novelty: Try new things. Parts of the brain (such as the prefrontal cortex) are “exercised” most when you learn to master new cognitive challenges.

For tips and strategies on how to remain a safe driver, consider taking the AARP Smart Driver course — the nation’s first and largest refresher course designed specifically for older drivers. The AARP Smart Driver course is available in a classroom and online, in both English and Spanish. In some states, you may even be eligible for a multiyear insurance discount on completion of the course. For more information, go to or call 877-846-3299.

Plan in Advance

Planning in advance for cessation of driving or for ways to enhance your driving skills and stay on the road longer can help keep you and others safer on the road. If you have not done Long-Term Care Planning, Estate Planning, or 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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Critter Corner: Driver Cessation and the Advance Driving Directive

Dear Angel,

My mother has had Parkinson’s for 5 years and is a little shaky, but her doctor says she can still drive for the time being. Unfortunately, when the time comes for her to give up the car keys, I see it being a very difficult process. Are there any legal documents to help us when the time comes?


Hera Carr-Keyes

Dear Hera,

It is often difficult to talk to an elderly family member about giving up his or her car keys. For your mother, it sounds as though the fear that she may have to stop driving for good in the future may be a lot to bear. Many seniors feel this way. Why? Families often live at a great distance and friends are scattered and may have their own physical challenges to deal with. A driver’s license signifies more than the ability to drive a car; it is a symbol of freedom and self-sufficiency. Still, safety must come first.

When the time comes to consider cessation of driving for your mother, loved ones and medical professionals need to monitor her and keep the following three aspects in mind: life and health (older drivers are more likely to be seriously injured or killed in a car accident), the safety of others (including family passengers, pedestrians and other drivers), and the potential financial liability of a serious accident that damages property and/or destroys lives.

Yes, your family can plan in advance for when your mother should no longer drive. As part of her incapacity planning documents, she can indicate who she would trust to help her if she can no longer drive safely. Our firm can help draw up an Advance Driving Directive to name the person that she wants to initiate the discussion with her about continued driving (or not) when the time is right.

An Advance Driving Directive, which may be included in an Advance Medical Directive does not appoint someone to make the “stop driving decision” for the driver. Rather, it’s about naming whom you would like to have broach this touchy subject with you when the time comes to have the discussion.

Hope this is helpful,


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Intergenerational Living with a Purpose

Mary Steele, 82, spends her days giving rides to children who may have missed the school bus, or teens who need a ride to the mall. She plays trucks with a 5-year-old boy whose mother is at work, and talks to neighbors about their jobs and families. Each month, she enjoys a gathering where 50 or so residents, ages 2 to 82, mingle and catch up. Steele and others share soup, fresh bread, and hugs. Steele is one of 53 older women, along with 10 men, living at Treehouse, an intergenerational community in Easthampton, Massachusetts, designed to support children who are in state foster care, as well as their foster and adoptive parents.

Another resident, Rosa-Lee Young, 70, decided to move to Treehouse even though she had no ties to western Massachusetts. Young enjoys being part of a family with five children, babysitting, attending birthday parties and sharing holidays. “This community provides the opportunity for me to be involved and make friends,” said Young, 70, who has lived there since 2006.

At Treehouse, the “elders” range in age from 58 to 88. They come from around the country to this affordable housing community (rent is only $830/month) in western Massachusetts, with the desire to make a difference in the lives of traumatized children — and their parents. Treehouse is also home to 40 children and 17 parents. The 11-acre development intersperses a dozen townhouses for the families with 48 senior cottages; there’s also a community center with a library, kitchen, and common room.

Steele and Young concur that helping families at the Treehouse gives them a sense of belonging and satisfaction. And it’s not just the children that receive help from the elders. It goes both ways. In an intergenerational living situation, older residents get a network of care. “It may look like the kids are getting all the time, energy and resources. But if the elders need help, the kids step up,” says Judy Cockerton, a former foster parent who opened Treehouse in 2006, based on Hope Meadows, the first community of this kind, located in Rantoul, Illinois.

Advantages of Intergenerational Living

Intergenerational living has become a growing trend across the United States, and there are some benefits to both seniors and children, as follows:

Benefits to Seniors

Less depression and loneliness: Active, involved older adults with close intergenerational connections consistently report much less depression, better physical health, and higher degrees of life satisfaction. They tend to be happier with their present life and more hopeful for the future.

Learning from each other: Children can teach elders lots of things – such as how to use new technology! A loving, supportive older adult can give children someone to talk with – someone who’s “been there” but now, with the benefit of hindsight, can help put issues into perspective.

Feeling younger: Children can help older people, particularly those facing health challenges or other losses feel younger, and see the world anew again, through a child’s eyes.

Making a difference: Seniors in intergenerational living have an opportunity to leave a powerful legacy and to make a difference in the lives of a child.

Benefits to Children

• Developmental Benefits: Through interaction with the seniors at Treehouse, children develop roots, a history, and a sense of continuity and perspective. In addition, children develop higher self-esteem, better emotional and social skills (including an ability to withstand peer pressure), and can even have better grades in school.

• Mentoring: Older adult mentors can make a significant difference in a child’s life. The involvement of a reliable, caring adult helps children develop life skills, and builds self-esteem and confidence. One study showed that when a child is mentored by an adult, they are: 46% less likely to begin using illegal drugs; 27% less likely to begin using alcohol; 52% less likely to skip school.

• Attention and engagement: Children can get time and attention from an older adult that tired, busy parents often can’t always give them.

• Someone safe to talk with and confide in: Seniors have a lot of power and ability to influence a troubled or confused child in a positive way.

• Learning: Knowledge, skills, and attitudes children pick up from seniors tend to stick with them through life more than those picked up from other sources.

• Empathy: By getting to know seniors, children look beyond ageist stereotypes, become more comfortable with aging, and have more empathy for others.

When Assistance is Needed

Most people want to stay in their home or in an intergenerational living setting for as long as possible. If 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.

Fairfax Medicaid Asset Protection Attorney: 703-691-1888
Fredericksburg Medicaid Asset Protection Attorney: 540-479-1435
Rockville Medicaid Asset Protection Attorney: 301-519-8041
DC Medicaid Asset Protection Attorney: 202-587-2797

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