A family care home cares for two to six unrelated residents in a family like setting.  These homes are often located in residential communities and are staffed by round-the-clock professionals who prepare meals, dispense medication, and provide help with activities of daily living.  (Assisted Living Facilities are licenced for 7 or more and can care for many residents). Because of its very low patient-to-staff ratio, a family care home can provide the utmost in personal, health and medical services to every community member no matter how frail. In addition, each family care facilities have all the comforts of home,  with fully equipped kitchen, dining  living room, where staff and elders prepare and eat meals together. Residents particularly appreciate the fact that each day is unstructured and informal, much like a day when they were in their own homes. The outcome is a, truly rewarding and satisfying day-to-day existence for elders and staff alike. 

If you are looking in Wake County, N.C.,  the Wake County Human Services (Senior and Adult Services) provides a listing of these facilities and reports provided by the Counties Adult Home Care Community Advisory Committee.  The link is:  http://services.wakegov.com/pmcweb/AdultCareListing.aspx?HomeType=AdultCare

Rick Messemer, Community Outreach and Education,      rick.messemer@wgalaw.com

While visiting family and friends this season, here are a few things to look out for!

1. GIVE A HUG

Look for:

• Obvious weight loss. Anything from depression to cancer to difficulty shopping and cooking can be behind a noticeable loss of weight.
• Increased frailty. If you can notice something “different” about a person’s strength and stature just in a hug, it’s noteworthy. Pay close attention to how your loved one walks (shuffles more?) and moves (rises easily from a chair? has trouble with balance?), comparing these benchmarks to the last time you were together.
• Obvious weight gain. Injury, diabetes and dementia (because the person doesn’t remember eating and has meals over and over) might be the cause. So can money troubles that lead to fewer fresh foods, more dried pasta and bread.
• Strange body odor. Sad to say, changes in personal grooming habits because of memory trouble or physical ailments might be noticeable on very close inspection. Look, too, for changes in makeup, hair, or the ability to wear clean clothes

2. RIFFLE THROUGH THE MAIL

Look for:

• Unopened personal mail. Everybody leaves junk mail alone, but few of us can ignore a good old-fashioned, hand-addressed letter.
• Unopened bills. This can be a sign that your loved one is having difficulty managing finances — one of the most common first signs of dementia.
• Letters from banks, creditors, or insurers. They may be routine business. But it’s alarming if they’re referring to overdue payments, overdrawn balances, recent accidents, or other worrisome events.
• Thank-you messages from charities. Older adults are often vulnerable to scammers, and even those who have always been fiscally prudent are vulnerable if they’re having trouble with thinking skills (a common sign of Alzheimer’s disease). Some charities hit up givers over and over, and your loved one may not remember having donating the first time.

3.   TAKE A DRIVE–WITH MOM OR DAD BEHIND THE WHEEL

Look for:

• Nicks or dents as you enter and exit the car. These can be signs of careless driving.
• Whether your loved one fastens his or her seatbelt. Rote basics are usually, but not always, remembered by someone with mild dementia.
• Signs of tension, preoccupation, or being easily distracted. Is your loved one no longer willing to drive at night? Or on highways? Is it hard for him or her to talk to you or listen to the radio and also pay close attention to the road?
• Signs of impaired driving. Tailgating, slow reaction time, going consistently below speed limit, confusing gas and brake pedals are signs to watch for. See 8 more ways to assess someone’s driving.
• Dashboard warning lights. Does the car have sufficient oil, gas, antifreeze, windshield-wiper fluid?

Look for:

• Perishables past their expiration dates. Your loved one might be buying more than he or she needs, as we all do — but you want to be sure there’s a reasonable ability to ditch the old stuff (rather than use it).
• Multiples of the same item. Ten bottles of ketchup or a dozen different vinegars might indicate he or she can’t remember from one shopping trip to the next what’s in the cupboards at home.
• Appliances that are broken and haven’t been repaired. Check the microwave, coffeemaker, toaster, washer, and dryer — any device you know your parent used to use routinely.
• Signs of past fire. Look for charred stove knobs or pot bottoms, potholders with burned edges, a discharged fire extinguisher, smoke detectors that have been disassembled. Accidents happen — but accidental fires are a common home danger for older adults.
• Increased takeout or simpler cooking. If someone who used to cook a lot no longer does or has downshifted to extremely simple recipes, the explanation could be a change in physical or mental ability.

Any single point does not signal a major problem, but several of these, especially if you seen an ongoing history, should cause some level of concern.  The first step might be increased phone or personal contact, having a neighbor “keep an eye out” for your loved one.  If the concern is food, look into Meals on Wheels, or a in-home care agency to supervise medications.

Important and most difficult, is making sure your loved ones legal and financial affairs are in order.  Medical and Financial Powers of Attorney are vital.  Possibly suggest opening a joint checking account sufficient for paying regular bills or to cover final expenses. 

If you have any questions regarding:

• Basic Documents
• Discuss levels of care
• Prepare for Long Term Care
• Or there is a crisis “right now”

Please feel free to contact our office:

Rick Messemer, Director of Community Education

W.G. Alexander & Associates,   Elder Law Attorneys

rick.messemer@wgalaw.com

Assisted Living costs nationally range from $28,800,000 to almost $70,000 per year!

In a recent survey, the median annual cost of a single occupant unit in an assisted living facility was listed as:

• North Carolina:  $33,600.00
• Georgia:  $28,800.00
• South Carolina:  $36,840.00
• Virginia:  $44,460.00
• Alabama:  $34,765.00
• Delaware:  $55,506.00
• Florida:  $31,950.00

The most expensive state was Alaska at $66,000.00.

Planning for costs such as these requires some planning now:

1. Do you have all core documents in order?  Wills, Powers of Attorney, etc.
2. Can you find important documents like Marriage Certificates and Military Discharge papers, needed to apply for assistance.
3. Protect your real property.  There are many programs available with the primary residence excluded from your assets
4. Have you checked all your beneficiary designations?  Will your 401K, insurance or annuity go the right place to protect it?  Keep in mind that these do not pass through your will.

Let us know if we can help with any of these questions.

Email:  Rick Messemer, Community Education Manager          rick.messemer@wgalaw.com

Counseling experts are already witnessing a 66% growth in calls this year from adult children seeking advice on complex medical, legal and financial issues involving aging parents, according to a report being released Wednesday by the ComPsych Corporation, an international provider of 13,000 employee-assistance programs. Add to that high volume the 18% increase during November and December, when families gather after long absences.

“A lot of the calls are financially driven and stress driven,” says Richard Chaifetz, chief executive officer for ComPsych. “People will call and say, ‘I think my father needs to go to a nursing home. Can you help us figure out our options and how to broach it with him?’ “

Chaifetz says it’s best to go home prepared to have a good time but to be aware of changes occurring in older parents. “A lot of people will decide not to say anything to parents when they’re visiting,” says Chaifetz, “but then they’ll go home and start to realize their parents might need help.” At times there might be a crisis, says Chaifetz, when adult children have to find alternative living arrangements for their parents.

During or after your visit, you may think about the following: 

•How do they look? If they were previously fashion divas or dapper Dans and their clothes are dirty or do not match, be sure to ask the next three questions.

•Is the home in good order? If the house and property were always photo-ready for Home and Garden and now are messy or have stacks of old newspapers and magazines scattered around, that could signify other problems.

•Are they eating well? If the refrigerator lacks healthy ingredients, they might not be meeting nutritional needs.

 •How are their cognitive skills? If there are unpaid bills or expired pill bottles, or if they get lost on routine trips, they might be suffering from depression or dementia.

When you are faced with making difficult decisions on behalf of your loved ones, always consider seeking professional help possibly in the form of a Geriatric Care Manager or experienced Elder Law Attorney.  Good advise early on can save the family from financial and emotional stress in the future.

If you have questions regarding general estate planning, the right documents and how to use them (Powers of Attorney, Wills, etc.), protecting assets, tax questions or financially providing for Long Term Care, please let us help.

Rick Messemer, Community Education,   rick.messemer@wgalaw.com

Based on an article by By Janice Lloyd, USA TODAY (off USAToday.com)

For current recipients and future applicants of the VA, Improved Pension, Aid and Attendance benefit, there is great news. 

The 2012 Aid and Attendance Rates will increase per a recommendation made by the Congressional Budget Office.

The recommendation named S.894 Veterans’ Compensation Cost-of-Living Adjustment Act of 2011, was made in May of 2011.  The report and recommendation for the increase in the 2012 Aid and Attendance rates was ordered and reported by the Senate Committee on Veterans’ Affairs on June 29, 2011.

This is great news for veterans and widowed spouses of disabled veterans who depend on this non-service connected disability pension benefit with aid and attendance entitlement.

The aid and attendance rate increase will allow many of these wartime veterans or their widowed surviving spouse receive more care for their well-being and activities of everyday living commonly referred to as ADL.

2012 Aid and Attendance Rates

When Will These 2012 Aid and Attendance Rates Go Into Effect?

All VA benefit rate changes, including the 2012 Aid and Attendance Rates, go into effect on the first day of December of each year.

If you are in need of on-going long term care (in-home caregivers, assisted living or skilled nursing), find out how the Aid and Attendance benefit can help offset the cost of these services.

Monthly seminars on VA and Medicaid eligability.

Contact Rick Messemer at rick.messemer@wgalaw.com or call our office for seminar dates and times.

I recently attended a seminar entitled “Communication Strategies for your loved one with Dementia/Alzheimer’s.  

The strategies were divided into “Verbal” and “Nonverbal” communications.  There were some ideas we’d like to share. 

VERBAL COMMUNICATIONS:

• Use familiar words.  Newer slang and computer terms are very difficult to relate to.  Explain what you are trying to convey.
• Talk slowly
• Limit the number of conversation partners.  Everyone speaking at the same time is very difficult to follow.  One speaker at a time, same topic.
• Don’t have conversation with someone on the other side of the room. 
• Use simple, direct statements
• Be concrete.  Certain topics need special care; medical, financial, family matters should be thought through prior to presenting.
• Avoid arguing.  You may have issue with something that happened right now, they may be thinking of something 50 years ago.
• Provide additional information.  Be prepared to respond to questions, with solid, factual answers.
• Present material matter-of-factly”.  If you are stating your opinion, it is better to begin, “this is my opinion”.

Material was presented by Sandy Christos, M.S., CCC-SLP, Clinical Specialist, Master Clinitian-Dementia.

If you have questions or comments, contact Rick Messemer, rick.messemer@wgalaw.com

We are delighted to have Tovah McDonald as one of our Elder Law and VA Accredited Attorneys.  Tovah would love to speak at your group or organization on the topics of Estate Planning, Wealth Preservation, Guardianship or planning for Long Term Care with the possibility of Veteran’s Aid and Attendance or Medicaid benefits.

Tovah was born inAugusta, Georgia, but as a child of a US Army family has lived in many places. She considersFayetteville,North Carolinaher home. Tovah received her Bachelor of Arts fromNorth CarolinaStateUniversityin 2003 and her Juris Doctorate from North Carolina Central University School of Law. While in law school, Tovah was active with the Guardian Ad Litem program and was the director of the Volunteer Income Tax Assistance program. She also received her Masters in Business Administration by completing the dual degree program.

Prior to starting her legal career at W. G. Alexander & Associates, Tovah worked as a project manager at Cisco inResearchTrianglePark. She obtained her Project Management Professional (PMP) certification and worked on a variety of internal and external projects.  As an Associate Attorney for Alexander Attorneys, she focuses her practice on VA benefits and Medicaid planning. Tovah is licensed to practice law inNorth Carolinaand is a member of the North Carolina Bar Association.    6-2011

The easiest thing you can do for yourself and your loved ones is to start organizing all your important papers.

Here’s just a small list to starting you thinking about where these might be:

• Birth Certificates
• Passports
• Social Security Cards
• Divorce Decrees
• Death Certificates
• Military Discharge Papers (often called DD-214)
• Insurance policies  Make notes if they are term or have cash value
• Deeds to all property
• Loan Papers
• Social Security Award Letters showing monthly amounts and deductions
• Supplemental Health Insurance like AARP, Humana, etc

Also important are your basic documents:

1. Will
2. General Durable Power of Attorney
3. Health Care Power of Attorney
4. Advanced Directive
5. Hipaa Release

If you have any questions or comments,   contact Rick Messemer at rick.messemer@wgalaw.com

Medicaid is tricky & confusing.  Know your options before you apply.  Here’s a short list of the top 8 mistakes people make with Medicaid Qualification.

1. Thinking it’s too late to plan.

It’s almost never too late to take planning steps, even after a senior has moved to a nursing home.

2. Giving away assets too early.

First, it’s your money (or your house, or both).  Make sure you take care of yourself first.  Don’t put your security at risk by putting it in the hands of your children without control.  Precipitous transfers can cause difficult tax and Medicaid problems as well.

3. Ignoring important safe harbors created by Congress.

Certain transfers are allowable  without jeopardizing Medicaid eligibility.  These include:  transfer to disabled children, caretaker children, certain siblings and into trust for anyone who is disabled and under age 65; a transfer to a “pay-back” trust if under age 65; and a transfer to a pooled disability trust at any age.

4. Failing to take advantage of protections for the spouse of a nursing home resident.

These protections include the purchase of an immediate annuity, petitioning for an increased community spouse resource allowance, and in some instances petitioning for an increased income allowance or refusing to cooperate with the nursing home spouse’s Medicaid application.

5. Applying for Medicaid too early.

This can result in a longer ineligibility period in some instances.

6. Applying for Medicaid too late.

This can mean the loss of many months of eligibility.

7. Not getting help.

This is a complicated field that most people deal with only once in their lives.  Often a great deal of money is at stake.  It’s penny wise and pound foolish not to consult with people who focus on guiding clients through the process.

8. Confusion about the difference between lifetime liens on property and estate recovery.

There are a number of exceptions to lifetime liens on property, but for estate recovery there is only a deferral for a surviving spouse and a hardship waiver.

http://www.americanchronicle.com/articles/view/105715

This is a great article addressing ways to prevent fraud directed at seniors.  In this day and age, it is important to protect yourself and your loved ones from scam artists.