WHY YOU NEED TO CHANGE

 

(If you are caring for an Alzheimer’s patient)

CHANGE is not an easy thing you are being asked to do.

CHANGE can be difficult and stressful.

CHANGE and you won’t feel so guilty. Read how this works.

Fuel your resolve to understand something about Alzheimer’s Disease (AD) that will help you see why you need to be the one to change. You’ll discover something about yourself as well. You’ll learn why you feel so frustrated, so despairing, so tired if you are the caregiver. This little book by Jo Huey might be the key to your salvation: “Alzheimer’s Disease: Ten Simple Solutions for Caregivers” is available at bookstores. Huey explains in easy terms why, if you hope to have a rewarding relationship with the Alzheimer’s patient, YOU need to be the one to change. Jo Huey’s website:ww.alzheimersadvocate.com

First, the AD patient has already begun to change ... and the change is permanent and continuing....it doesn’t get any better, only gets worse. It is not the patient’s fault, nor is it your fault. You cannot help Mom remember how to get dressed...how to find her room...when she last ate a meal...where she lives...why she can’t “go home”...why she asks you the same question again and again... or who are you?

This regressive disease erases memory backwards. The most recent is the first to go. And it leaves a few isolated bits and pieces that make it all the more confusing to you. If Dad remembers Alice came over last Sunday, but doesn’t remember you were here too, don’t be surprised. That’s the hit-and-miss part of the erasing. You can erase the word “remember” from your vocabulary. It only upsets him and frustrates you.

Concurrently, memory is impaired, but feelings and emotions are not impaired. What the patient feels when you urge them to remember affects them much more than the thing you want them to recall. Your tone of voice indicates your displeasure with them because they didn’t remember to take their pills, or failed to turn off the oven. Serious subjects to you, but incomprehensible to them. The patient may feel embarrassed that you have found out they are “slipping”. Sometimes they react with truculence or anger because you have accused them of forgetting. They need reassurance, not scolding.

This little book describes and illustrates “Ten Absolutes” to help the caregiver develop a nurturing relationship with an Alzheimer’s patient. Briefly I will mention three:

1. NEVER ARGUE, ALWAYS AGREE

Now, how can you agree when your sister says, "I am back in a hospital," but you know she is at home. She doesn’t remember that she was in the hospital for many weeks as the result of a fall and later complications. Now she is at her daughter’s home with Hospice care. But she insists she is still in the hospital and wants to go home. You try to explain but she gets upset and the two of you end up arguing. How much easier it would be to agree with her that she’s in a different hospital. When she says I want to go home, you can reply, "So Do I," and change the subject.

Arguments over eating are common. She doesn’t like the food, it isn’t salty enough, she’s not hungry, and so on. Just agree with her and distract her by changing the subject, talk about what you have planned for the rest of the day, or the movie you just saw on TV, and as you talk, slip in a bite of food.

2. NEVER ASK THE PATIENT TO “REMEMBER” INSTEAD, REMINISCE

Talk about old events and people they used to know. Use a relaxed conversational tone not inquisitive. Example: Mom says, "Where is June?" Her sister June, your aunt, died last year. You want to say, "But Mom, why can’t you remember? You went to the funeral in Nashville!"

Here, make a Change: You could say, "I haven’t seen her lately but didn’t we always love her cherry pies or was it mincemeat?" Mom might respond to that and if not, you just continue talking of events connected to Aunt June long ago. This may be familiar to her and she will feel happy and content. This also gives you a clue as to what memories remain and the time frame she is in. Then you can bring these in to divert her, and let her remember happy times. It doesn’t even matter if what she remembers isn’t always accurate. It makes her feel good to be talking to you about things you don’t remember.

Suppose your neighbor Diane comes over with a casserole. Mother had lunch about an hour ago. Diane asks her if she has eaten. Mother says, "I didn’t have anything to eat all week." Diane frowns and looks at you. You want to defend yourself and normally would say, "But she just ate a full meal an hour ago." What you might say is, "Oh, this casserole Diane brought looks delicious. Let’s have a bite." And then Mother might eat a little which is fine. Mother’s answer to any question may be untrue or not reliable, so try not to correct her.

3. NEVER SAY, I TOLD YOU ALWAYS REPEAT AND REGROUP

Dad is not dressed for Church but asks if you are going to take him to the Bank.  You say, "I told you yesterday we were going to Church this morning. Why aren’t you ready? Now we’ll be late! And how many times did I tell you the Bank is closed today and we’re going tomorrow?" He may not understand what you said but your tone is loud and clear.

Make a Change: You might have said, "Wouldn’t you know, it’s too late for Church but we can go out for a nice breakfast if you like. The Bank will be open tomorrow and we’re going then."  Dad may ask over and over again, when are we going to the Bank. Finances generally override many other concerns of the elderly especially in the early stages of Alzheimer’s, and even though he forgets other events, going to the Bank is urgent in his mind. It’s the only thing he remembers right now.

Huey explains REGROUP like this: when the questions persist, you need to try distraction and this means YOU should leave the room. Go into another room and shut the door so the patient cannot follow. Bury your face in a pillow and scream if you have to. Then have a good laugh. (They call this “primal scream therapy”.) Or just go out the door and walk around the house. Call someone on the phone and talk about something else, or make a cup of tea. This breaks the repeating behavior of the patient, and breaks your mounting anger. Get out of that negative downward spiral. Later, when you are no longer “losing it”, you need to reassure him, tell him you are going to help him and show him by doing something he loves to do, like singing a familiar tune or playing a simple card game. Take time to learn what are his favorite things. Bribery works and you can use those whenever you need to distract and redirect him

It never hurts to apologize—even when you have no reason to apologize. Never embarrass or shame the patient. It is the look on your face that tells them they have done something wrong or stupid. Never let them know they said something embarrassing . Never lecture, always reassure. Alzheimer’s causes frontal lobe impairment and that’s where impulse control is. You want to keep aggressiveness and combativeness under control. And reassurance helps..

Sometimes it seems the only attention from others is criticism of your hard efforts. They simply don’t understand until they’ve 'walked in your shoes' for a day. Try not to be defensive but do tell them how they can help Mother as well as you. Be very calm and matter of fact. The patient will benefit even if the one who offers help does things a little differently than you do. Just be appreciative of their assistance in any way, shape or form.

It helps to remember:

ACCENTUATE THE POSITIVE

ELIMINATE THE NEGATIVE

And Don’t Mess with Mister In Between.

By Margaret Lynn Duggar

When the Florida Legislature convenes, our elected officials will have to come up with ways to close a $3 billion deficit. While $100 million in savings wouldn’t be a total answer, it could be a significant step. How could they save at least $100 million?

One way would be to ax a financially prudent program that saves the state money. Why would they even consider that? Because when Gov. Charlie Crist asked all agencies to plan for a 10 percent cutback, the Department of Elder Affairs suggested putting the Home Care for the Elderly program on the chopping block.

Legislators beware: Ending this program could stick the state with a Medicaid tab millions of dollars higher.

There are nearly 4.2 million seniors who call Florida home. They are almost 25 percent of our population. Many of these seniors retired to Florida a decade or two ago. For all of these years, they have been buying homes, purchasing cars, paying property and sales taxes. They have paid utility bills and bought groceries, refrigerators and gasoline. They have shopped in our malls – for gifts for grandchildren if not themselves. They have dined in our restaurants. They have donated to our faith communities and served on citizen boards – some have even served in public office. They have invested in our communities as employees and volunteers. They have contributed to every aspect of the life of our community.

Waiting Years for A Ride or Meal

Today, nearly 30,000 of these neighbors are on waiting lists for home care. Being on the waiting list means that the elderly have been assessed as frail enough, according to the state’s criteria, to be eligible for assistance with bathing and dressing, rides to doctors’ offices or to buy groceries, or maybe meals on wheels delivered to their homes by volunteers because they can’t cook for themselves and can no longer drive. But being on a waiting list also means there are no public dollars to pay for those needed services. So people must wait, sometimes for years, to get that ride or meal.

When there is a fall, a stroke or another major event, the state must pay for nursing home care if people qualify for Medicaid, as most of those 30,000 elders on the waiting list do. Suddenly the state must find the dollars to serve them in the most expensive service, nursing home care. In that case, the state’s cost grows to roughly $25,000 annually instead of less than $10,000 a year. That’s on top of the federal share, which is more than $40,000. And that catastrophic event might just have been avoided entirely if the senior had had the right doctor’s care, food and assistance with bathing.

During 2007-2008, nearly 5,000 seniors moved into nursing homes while they were on the waiting list for in-home services. Serving those 5,000 frail seniors at home would have cost the state about $24 million. Instead, the state’s share of serving them in a nursing home was more than $77 million. One argument legislators make for not funding prevention programs is that they can’t afford to wait for the savings in the out years. Well, these savings would have been achieved in the same budget year.

The state could save an estimated $91 million in additional nursing home costs if it were to pay $28,979,025 to provide in home services just for the 6,090 seniors who are most at risk of entering a nursing home.

Cost-Effective, Long-Term Care

In the 1970s, a rural legislator created the program to help families care for their frail, elder relatives at home. The Home Care for the Elderly Program is the most cost-effective long-term-care program in the nation. The elderly family members must be nursing-home eligible and Medicaid eligible. If they qualify, they receive a stipend of $106 a month to offset the costs of caring for the elder at home. Yes, $106 a month. The money can be spent on continence supplies or a railing for a bathtub or someone to stay with the elder while the caregiver goes to the doctor or dentist – whatever they need. Few home-care participants ever go into a nursing home – they remain at home, which they prefer, until they die.

Florida legislators already have some answers to the current budget dilemma: Serve Florida’s frail elders through the nonprofit aging-services network. And save millions of dollars in doing it.

Margaret Lynn Duggar is Executive Director of the Florida Council on Aging, and knows more about community-based aging services in Florida than most. www.fcoa.org.

 State economists presented an overview of Florida’s economy before a meeting of all 40 Senators on Wednesday, January 20, 2010.  The news was not good for Florida Seniors. There are some significant issues you should know about.

 The House Health and Appropriations Committee begins their 2010-2011 budget process with the instruction to prioritize up to 13 programs/services/funding issues as “top priorities” and the total for these 13 programs cannot exceed a cap of $3.9 billion, which is 85% of the committee’s base budget state funds).    Ten or less programs/services/funding issues must then be designated “lowest priorities” and equal 15% of their budget.  The long list of department programs includesDepartments of Elder Affairs, Health, Children and Families, AHCA, Veterans Affairs, and Persons with Disabilities. 

 The Senate Health and Human Services Appropriations Committee is anticipating a significant cut in its spending for the 2010-2011 budget.  Both the Florida Health Care Association and the Florida Association of Home and Services for the Aging are urging support for home health care programs to divert seniors from nursing home care, for the cost savings they provide.  Many clients I represent would prefer to remain in their own home if the cost of appropriate care could be covered, so funding of home based assistance programs is critical.   Even if funded, the program is seriously flawed.  The Diversion Program is a managed care program for people eligible for nursing care. Diversion recipients can receive services at home or assisted living facilities as well as nursing homes. For persons living in assisted living facilities, Diversion providers contract with the assisted living facility to provide the care component at the facility. The typical care contract pays the facility around $1,200 per month. The room and board component is paid by the recipient. Therein lies the major flaw in the program.

 Currently there is no regulation determining how to calculate room and board. Many facilities therefore, subtract the amount of the care component from their private pay rate and allocate that amount to room and board. If the individual’s retirement income is insufficient to pay the room and board amount, the family is called upon to make up the difference. More often than not, the family can’t afford to make up the shortfall and the person must leave the Diversion Program. It is paradoxical that we allow a “silk stocking” Medicaid program to exist.

 The Florida Association of Health Plans (FAHP) proposed to place all Medicaid recipients into managed care.   They believe millions of dollars can be saved by moving all programs and clients under managed care because the fee for services programs are costly, inefficient and difficult to administer, and subject to fraud..  These are the same companies touting and participating in the Diversion Program. Replacing choice of programs with managed care will have devastating effects on Florida’s seniors. 

 It is critically important for all seniors, their families, and their advocates to stay informed about the issues and to stay in touch with elected officials to provide for senior needs in a fair and cost effective way.
 

Nancy Teten of University of South Florida Alzheimer’s Center shared thoughts and ideas on caregiver guilt, anger and resentment at a recent seminar.

    Passing along some of her tips, and other ideas I’ve learned from the Bob DeMarco site atwww.Alzheimersreadingroom.com:

    YOU, the caregiver, are now the patient’s BRAIN.  Right or wrong you become the brain for the patient as long as they live.  That doesn’t mean you do every single thing for the patient.  Let them do what they can, as long as they can.  If you take over completely, remember they cannot relearn to do something you are now doing for them.  They will be much happier if they can continue doing some remembered tasks.  Focusing on what they can do, take over what they can no longer do.  In this way you respect their capabilities and feelings.

    Your own feelings impact the person you are caring for. They can sense when you are angry with them, especially when they hear a false sweetness in your tone.   They interpret the expression in your face and your emotions and they mirror what you have become because that’s how they see you.  Then they become intractable and stubborn---even more difficult to assist.  Try to manage your facial expression and emotions to avoid such behavior. 

    Your face can reveal any unresolved conflicts with this person that could come back to haunt you.  Or, you might remind the patient of a person they like, or maybe don’t like. If you can discern this, take some action to resolve it. 

    Take care of yourself, or you cannot take care of your loved one.  Schedule some relaxing time, let a family member or friend step in and give you a few hours to get away.  Do one thing nice for yourself every day.  You are not the only one capable of dealing with the patient.  When you are not rested and at the top of your abilities, you may become depressed, and complicate the situation.  Guilt and anger follow from the sense that you are not “doing enough” because your mother or father fails to respond to your loving care and get better.  Always remember, you cannot change the progression of this disease. 

    Appreciation and encouragement from family and friends helps far beyond what they realize; but as time goes on, your resentment grows as they may unconsciously abandon you. It is so easy to lose your own life, so make an effort to stay connected.   Get out and do normal things with friends and family.

    Consider another big source of guilt:  your loved one says to you,  “promise me you will never put me in a nursing home.”  I have heard a client’s son or daughter tell me they made such a promise and now they cannot care for the parent.  This guilt must be resolved and reality must be faced when twenty-four hours a day, seven days a week nursing care becomes necessary.  Some can manage such a schedule for a short time, but for long term care it becomes a burden beyond expectation.  Then the caregiver often predeceases the patient.  When the patient has long forgotten even your name, you must look at the level of expectation you have of yourself and modify those expectations. 

    Accept yourself and your limitations.    Maybe you did not make the best decisions sometime during the day....maybe you didn’t get much or any sleep that night ....you find yourself saying “I don’t like what I’ve become”.  Find a support group, or seek professional help.  Recognize that your feelings don’t have to control your actions.

    You can be angry that your loved one is in the grip of this devastating disease.  You can be resentful that you are the one in the family expected to take care of this person.  You can feel guilty because you are angry and resentful, even though you do love the person.  Just remember this is a common experience no matter your age or relationship.  Get help before the experience changes you into someone you wouldn’t like. 

    Anger and resentment can cloud your judgment when it comes to thinking about the expensive path the patient travels.  Do you want to let your loved one’s assets erode, maybe even slip away, without making an effort to protect their life savings?  When the money is gone, the patient becomes dependent on a government system that is in the throes of radical change, probably not for the better. Successful planning for this protection will build your self-esteem and temper guilt, anger and resentment.

In preceding Trustee Test articles, I explained why this is important. Family member trustees are the target for the biggest growth practice in Florida, which is Fiduciary Litigation:  family beneficiaries suing family trustees for failing to meet their duties as trustee.  In representing a family member as trustee our goal is to make the trustee a family hero, not defendant.  If you are serving as trustee, or nominated to serve as trustee, see how you do with the Trustee Test Part Three.  Part One and Part Two were posted earlier.

 

Question 7:  Do you know what happens if a qualified beneficiary does not receive annual accountings?

Answer:    If a qualified beneficiary does not receive an annual accounting, there is no time limit on when that beneficiary can sue for breach of fiduciary duty.

 

Question 8: Do you know how to develop a portfolio that complies with Florida’s Prudent Investor Rule?

Answer:   A majority of states, including Florida, have adopted the “Prudent Investor Rule.” A “prudent investor” diversifies the trust’s assets to obtain an investment strategy that incorporates suitable risk and return based on the projected needs of all beneficiaries and based on the responsibilities described in the trust document. A prudent investor either: 1) has the expertise to invest appropriately under the Prudent Investment Rule or 2) delegates this function to a professional investment agent. A prudent investor has a written strategic plan for investing and meets regularly with his or her attorney and investment advisor to be sure the plan is implemented and changed where necessary. Many investors in the 1990s did very well whether or not they had investment expertise. However, recent market conditions have made determining appropriate fiduciary investments a very difficult decision. We are starting to see progressively more lawsuits being filed against trustees for violation of the Prudent Investor Rule.

 

Question 9: Do you know how to determine the tax cost bases of the trust’s assets?

Answer:   Basis calculation depends on how the assets were acquired. Any assets that the settlor purchased during his or her lifetime retain their original tax cost. However, after the settlor’s death, the tax cost bases changes to the market values of the assets on the settlor’s date of death. The trustee must take the tax cost into consideration in deciding which assets should be sold and the timing of the sale. If the trustee does not know the basis information, unexpected income tax can become due.

 

Question 10:  Do you know which tax returns you will need to file as trustee?

Answer: The trustee is usually required to file an income tax return, even if no tax is due. Typically, the trustee will file a U.S. Income Tax Return for Estates and Trusts (IRS Form 1041). This return is significantly more complicated than an individual’s tax return (IRS Form 1040). Therefore, a certified public accountant or tax lawyer who is totally versed in fiduciary income tax law, should prepare these returns. These are not do-it-yourself returns or returns to take to mass‑market income tax preparers. Additionally, an accountant or tax lawyer familiar with fiduciary tax returns will need to determine if other returns, beside an income tax return, need to be filed with the Internal Revenue Service and/or with a state revenue department.

 

Family member trustees are the target for the biggest growth practice in Florida, which is Fiduciary Litigation:  family beneficiaries suing family trustees for failing to meet their duties as trustee.  In representing a family member as trustee our goal is to make the trustee a family hero, not defendant.  If you are serving as trustee, or nominated to serve as trustee, see how you do with the Trustee Test Part Two.  Part One was previously posted.

 

Question 4:  Do you know who the qualified beneficiaries are?

Answer:   Trust beneficiaries have significant rights. Identifying beneficiaries is often critical and somewhat surprising. The trustee is required to account to all qualified beneficiaries. Qualified beneficiaries are all current beneficiaries, intermediate beneficiaries and first line remainder beneficiaries whether their interests are vested or contingent.

Therefore, the trustee must account to the beneficiaries who are named in or can be ascertained from the trust document, even if the beneficiary is an alternate beneficiary. For example, the trust names Joe as the current beneficiary to receive income for life. At Joe’s death, he has a power of appointment to distribute the trust property to his children and, if his will does not include a power of appointment, the assets will remain in trust for his children. If the assets remain in trust, then after the death of all of Joe’s children, the trust will distribute outright to Trudy. Therefore, the qualified beneficiaries in this case are Joe, Joe’s children and Trudy.

 

Question 5:  Do you understand Florida’s Principal and Income Act? Do you know how to determine if a receipt is principal or income or should be allocated between both? Do you know how to determine if an expense is principal or income or should be allocated between both?

Answer:   Most certified public accountants are not experts at principal and income accounting. Net income calculated based on tax laws is usually not the same as net income calculated based on fiduciary law. The trustee must be familiar with the Principal and Income Act and typically cannot rely on the accountant to prepare the fiduciary accountings or calculate net income.

If there is a life income beneficiary and remainder beneficiaries, each receipt and disbursement must effectively be allocated among these beneficiaries. If a receipt is income, it benefits the income beneficiary and if a receipt is principal, it benefits the remainder beneficiaries. Conversely, if a disbursement is income, it reduces the income beneficiary’s distribution and if a disbursement is principal, it reduces the ultimate amount distributed to the remainder beneficiaries. These allocations are complicated and one of the most important of the trustee’s duties.

 

Question 6: Do you think that a brokerage statement is an annual fiduciary accounting?

Answer:    Brokerage statements are not fiduciary accountings because they do not allocate principal and income. If the accounting is done in the proper format, beneficiaries have six months to complain or the accounting is accepted. If appropriate annual accountings are not prepared and sent to the beneficiaries, the statute of limitation barring the beneficiaries from initiating legal proceedings

 

Need help?  Call Louise Robinson at 727-441-4516  

    Family member trustees are the target for the biggest growth practice in Florida, which is fiduciary litigation:  family beneficiaries suing family trustees for failing to meet their duties as trustee.  In representing a family member as trustee our goal is to make the trustee a family hero, not defendant. If you are serving as trustee, or nominated to serve as trustee, see how you do with the following test:

 

Question 1: Do you understand the terms of the trust agreement and can you explain them to the trust’s beneficiaries?

Answer:  I am amazed at how often trustees want to ignore or avoid the terms of a trust. All beneficiaries of the trust have a right to expect that the terms of the trust will be carried out as directed in the document. The successor trustee does not have the ability to change the trust’s beneficiaries or to amend the terms of the trust, except in very specific circumstances.

 

Question 2: Is there a current beneficiary entitled to income for life? If so, do you know how to calculate the income distributions?

Answer:   One of the most challenging fiduciary jobs is to serve as trustee of a trust naming a life beneficiary with others to receive assets on the death of that beneficiary. Life beneficiaries are usually looking to the trustee to maximize income and to invest trust assets accordingly. The remainder beneficiaries want the trustee to invest for growth over income.

Typically, the trust agreement will state that all net income must be distributed to the life beneficiary on a stated basis. The trustee must know how to calculate net fiduciary income in order to determine how much to distribute. Additionally, Florida law gives certain trustees the power to adjust between principal and income, if the adjustment is fair and reasonable to all beneficiaries. Finally, Florida law also allows certain trustees to convert the trust from paying net income to a unitrust amount, which is a percentage of the trust’s market value on a certain date. Therefore, the trustee must know: 1) how to calculate income, 2) when to consider using the power to adjust and if the trustee has this power, and 3) when to consider converting to a unitrust and if the trustee has this right.

 

Question 3: Is the current beneficiary entitled to discretionary principal distributions? Do you understand the standards which are listed in the trust agreement for making principal distributions? Do you need to consider the impact of all principal distributions on the remainder beneficiaries?

Answer:  The trustee must be careful, consistent and even-handed in making discretionary principal payments to a current beneficiary, unless the settlor is the current beneficiary. While the settlor is still living, the settlor is the sole beneficiary of the trust unless the trust agreement states otherwise. During the settlor’s lifetime, the trustee usually must distribute the trust assets to the settlor as requested by the settlor or based on the terms contained in the trust.

After the trust’s death, the trust agreement may include specific circumstances when the trustee may distribute principal to a current beneficiary, such as for that beneficiary’s health, education, support or maintenance. The current beneficiary may also have a right to withdraw the greater of $5,000 or five percent of the trust’s market value at the end of the year. The trustee must keep in mind that any distributions from principal ultimately reduce the amount that will be distributed to the remainder beneficiaries. Additionally, any distributions from principal reduce the amount invested to produce income.

 

 

The headline story in St. Petersburg Time September 27^th“Lifetime of Premiums Get Him Limited Hospital Time” relates a true story I hear often in my practice.  John was 74 and his wife, Helga, 68 when John’s Medicare and supplemental insurance time was exhausted during his many hospital stays since his stroke in September 2008.  Helga arrived at the hospital one night to learn the doctor’s order that her husband had to leave that night!  With his insurance maxed out they now face the expense of total care at a nursing home.  Their finances are wrecked.  Helga was told to apply for Medicaid.  To qualify they must give up all but $1352 of their monthly $4300 pension, leaving barely enough to make car payment, taxes, groceries and care of their autistic son. Life as they knew it took an abrupt turn for the worse.  Bad things happen to good people every day.   

    Maybe you have executed legal instruments for final disposition of your home and other assets upon death.  You feel that these documents are in place and reflect your wishes.  Perhaps you even have a Living Trust with a Trustee you can depend on to take care of you and carry out your wishes if you were unable to act.

    Maybe you have lived longer than you ever expected and events have intervened:  the death of your spouse;  a catastrophic event such as a stroke, Alzheimer’s, heart disease, ALS, muscular dystrophy, multiple sclerosis, scleroderma, cancer.  Any number of disabling events can change your whole lifestyle and alter all your plans.

    Long term chronic illness or disability does not fit the planning you made fifteen or twenty years ago.  Your spouse is left to cope with your care and the enormous cost involved.  Hospitals, doctors, therapy and medications eat into your income and savings at an alarming rate.  Panic grips you and your family with the realization that a nursing home may be your destination.  How to pay for your care and still have enough for your spouse to live on becomes the primary worry.  If the caregiver falls ill, then both of you need care and your support system comes crashing down.

    You may be a blended family where one or both spouses have children by a previous marriage.  Typically, parties to blended marriages want to provide for their spouse and also for the children of their prior marriage.  Sometimes they want to provide for the children of their spouse’s prior marriage and sometimes not.  When one of the spouses develops long term chronic illness or other disability, it adds another dimension of complexity

    Perhaps your spouse or a child has special needs and requires special care.  Your revised planning must take into account the augmented estate choices, and how those choices fit with the need for Medicaid qualification

    There is a way to deal with these issues effectively. Meeting with a Certified Elder Law attorney will begin the process.  He or shewill assess all aspects of your current situation.  The attorney will ask about medical diagnosis, present living arrangements, each spouse’s level of personal care ability, family assistance, your assets and how they are titled, and review your documents including health care powers, trusts, and wills.  Determining exactly where you stand on these matters is primary to helping you solve your problems.

    As an Elder Law Attorney I learned early on that life with chronic illness, incapacity, or disability is usually far more complicated than planning for death for the individual and the caregiving family.