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  • Employee Benefits and Early-Onset Alzheimer’s

    Getting a diagnosis of Alzheimer’s for those under age 65 can be difficult. Early-onset Alzheimer’s, which can even strike people in their 30s and 40s, affects less than 5% of all Alzheimer’s patients. Because doctors don’t usually suspect Alzheimer’s at such young ages, the symptoms are often attributed to other causes, such as depression, stress, and even (in women) menopause.

    But it’s important that employees get the diagnosis as early as possible, in order to maximize benefits that are available to them. If you are fired before anyone knows what is going on, you won’t be able to take advantage of the benefits for which you qualify.

    As soon as you have a diagnosis, tell your employer and ask for an accommodation before it becomes a problem. The Americans with Disabilities Act (ADA) does not list specific medical conditions that are covered, but an employee with dementia will typically qualify. Work with your employer to determine steps that will allow you to work as long as possible, such as teaming up with another employee, having written instructions, setting short-term deadlines, ride-sharing and flex-time.

    Next, contact your Human Resources to determine the benefits that are available to you and work out a timetable to make sure you take full advantage of them. These include:

    Short-term and long-term disability insurance. These will replace part of your income when you can no longer work.

    Paid leave. You may be eligible for 12 weeks of paid leave under the Family and Medical Leave Act (FMLA). Some employers are exempt from providing the leave, so be sure to ask about it.

    COBRA. When your health insurance discontinues, you will be offered the opportunity to buy continuing coverage. To continue coverage until Medicare begins (see below), you will need to provide the insurance company proof of disability. COBRA can be expensive, so you will want to compare costs and coverage to other plans in the marketplace.

    Social Security Disability. Early-onset Alzheimer’s is on the list of conditions that expedite access to Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) eligibility. Social Security disability benefits begin five months after an employee develops a disability, with payment starting in the sixth month. Begin the application process when you go on short-term disability.

    Medicare. Coverage will start about two years after you have been on disability. When Medicare begins, Medigap coverage can be purchased to help pay for deductibles and co-pays that Medicare does not cover. There are also Medicare Advantage Plans that provide Medicare coverage along with prescription coverage.

     

    Call Marsala Law Firm to learn more about legal and financial planning at (310) 237-3872.

  • Early-Onset Alzheimer’s Hits Hard

    An estimated 5.3 million Americans have Alzheimer’s disease—an irreversible, degenerative disorder of the brain that affects problem-solving abilities, behavior and speech. It is typically associated with old age, and many of us have older family members who have been affected. As baby boomers age, the number of Alzheimer’s victims is expected to increase.

    But approximately 200,000 of those diagnosed with Alzheimer’s are under age 65. Known as early-onset Alzheimer’s, the disease can even strike people in their 30s or 40s—at a time when they are beginning to build their careers, their savings and their families, and are least likely to have the financial and emotional abilities to cope.

    A diagnosis of early-onset Alzheimer’s can be devastating. The person with Alzheimer’s will become unable to work. The spouse often has to work less or even stop working to become the caregiver. Savings can be wiped out quickly. With an average life expectancy of just 8-10 years after diagnosis, dreams of a long life together fade as the Alzheimer’s patient slips away.

    Early-onset Alzheimer’s is difficult to diagnose, primarily because it is not expected at such a young age. And because it progresses gradually, it is often confused with other conditions. It’s easy to blame stress, depression and menopause (in women) for early symptoms, which can include fatigue, disorientation, not being able to find the right words, inability to focus and engage, and forgetfulness. Practically everyone has forgotten where we put something or why we came into a room, and we don’t give these lapses much thought. Medications, a brain tumor, even a urinary tract infection, can cause similar symptoms.

    Often, co-workers may be the first ones to spot that something is truly wrong. Reports and tasks that were routine may become extremely difficult, take much longer and/or have errors. At the same time, it’s important not to assume that these changes in performance mean that someone has Alzheimer’s.

    That’s why it’s important to get the proper testing. Early-onset Alzheimer’s often has a genetic component, with several members of the same family having it. Cognitive testing is also recommended. Ultimately, it may take a brain scan to confirm the diagnosis.

    While there are no cures yet, there are medications that can slow the progression of Alzheimer’s, but they need to be taken early to be most effective. That’s another incentive to have the testing done as soon as you suspect something may be wrong.

    Click here for Early Signs of Alzheimer’s Disease.

    Marsala Law Firm works closely with the local Alzheimer’s organizations, and can not only give you direction on where to get help, but also on ensuring your legal and financial plans are in place.  Call now at (310) 237-3872.

  • Home Improvements to Consider for Aging in Place

    Americans are getting older, and most want to stay in their homes and communities as they age. As a result, many homeowners are taking steps to modify their homes so they will be able to safely and comfortably remain in their homes for as long as possible. This is called “aging in place.”

    With the average annual cost of assisted living at $43,200 and nursing home care at $80,300 you will likely save money over the long run by investing in aging-in-place home improvements. Also, if you have long-term care insurance, it may help cover some of the costs.

    Here are some of the most popular home improvements to consider if aging in place is important for you or a parent. You’ll notice that many are designed to help prevent the risk of falls, which dramatically increases with age.

     

    In the bathroom:

    • Install a shower with a zero threshold entry (no curb) to minimize tripping and to make accessible for a wheelchair.
    • Add a shower chair (for those not in a wheelchair) and a hand-held showerhead.
    • A comfort-height toilet (17-19 inches off the ground) will make getting on and off easier. (You can also buy a toilet seat extender, which sits on top of the existing toilet seat.)
    • Install grab bars near the toilet and in the shower.

     

    In the kitchen:

    • Create counters at multiple heights to have the option to sit or stand when preparing meals.
    • Install an under-the-counter microwave instead of one overhead.
    • Add pull-out shelves in cabinets.

     

    Throughout the home:

    • Install nonslip floors, such as textured stone or linoleum.
    • Increase lighting.
    • Install remote controls for lights and window coverings.
    • Lower electrical switches and raise outlets.
    • Change doorknobs to lever-style handles and cabinet knobs to handles.
    • Move the master bedroom to the first floor and install a bathroom if necessary.
    • Add a ramp to the entrance and widen hallways/doorways to accommodate a wheelchair.

    Many of these options, and more, are thoughtfully being included in new construction for those who want to purchase aging-in-place-ready homes. Custom homes being built for some of our disabled veterans are filled with innovative ideas. You can also consult a design or home improvement specialist who has experience with aging-in-place features.

     

    Call Marsala Law Firm for your FREE life planning consultation.

  • Feeling Squeezed in the Middle of a Generational Sandwich?

    How to Take Care of Yourself as You Take Care of Others

    Raising your kids, working, trying to take care of yourself, and now caring for an aging parent? That makes you part of the Sandwich Generation. You are not alone—almost half of America’s 40- and 50-year olds are in the same boat.

    Most of us have adjusted to balancing children, work and finding some time for ourselves. But when we add caring for an aging parent, it often becomes too much. And usually it’s the “me” part that is sacrificed…until you hit burn out.

    Here are some ways to leverage your time and resources so you can also take care of yourself.

    Enlist Your Kids

    Even the smallest child can spend charming one-on-one time with a grandparent. If your parent lives with or near you, they can spend time together in person. If your parent is not near you, they can Skype on the computer, use FaceTime or play multi-player online games. Your children, no matter what their ages, will benefit from spending time with Grandma or Grandpa, they will see how you value and care for aging family members—and you will get some extra time to return phone calls, make dinner, or even catch a quick nap!

    Ask About Options at Work

    Check with your employer’s human resources department about resources that might be available to you. Depending on how long you expect to be caring for your parent, there may be a multitude of options available to you, including elder care research and referral services, flex time, even working from home options. The Family and Medical Leave Act (FMLA) calls for eligible employees to receive 12 weeks of unpaid job-protected leave. (Private employers with less than 50 employees are exempt.)

    Seek Assistance

    There are legal and community resources that can help you make the best care and financial decisions for your parent. A local Elder Care attorney such as the Marsala Law Firm can prepare the necessary legal documents and help you maximize your parent’s income, long-term care insurance and retirement savings, and qualify for VA or Medi-Cal benefits, if applicable. He/she will also be familiar with various living communities in the area and in-home care agencies. You can also hire someone to review and verify/dispute insurance claims and medical billing.

    Find Your “Me” Time

    Stress is your biggest enemy and you have to find ways to reduce it. Joining a caregiver group, in person or online, will let you share your questions and frustrations, and learn how other caregivers are coping. Don’t be afraid to ask favors of friends and other relatives, such as picking up your kids while you go to the doctor with your parent. You could also learn to order in dinner every now and then without feeling guilty. Learn what you need to maintain your stamina, energy and positive outlook. That may include regular exercise (a yoga class, walk or run), a weekly outing with friends, or time to read or simply watch TV.

  • What Happens When There are No Children to Provide Care to a Parent?

    As we age, it is likely that many of us will need help for at least some period of time with life’s daily activities. (These include bathing, dressing, eating and using the bathroom.) And while we may not want to think much about being in that position some day, it would be a good idea to start thinking now about who will take care of us in our old age.

    According to a 2011 study by the U.S. Department of Health and Human Services, about half of all informal caregiving is provided by adult children, with spouses providing another 20%. In addition to helping with daily activities, these informal caregivers navigate health care options and insurance benefits, manage medications, provide transportation to doctor appointments, and manage finances. Even when people go into nursing homes or assisted living facilities, their children or spouse still provide a lot of hands-on care.

    But what if you don’t have a spouse or child who will be able to take care of you? Your children may live too far away, have health issues of their own, or have family and/or work obligations. Maybe your child or spouse predeceases you. Maybe you didn’t have children. According to a study by Urban.org, nearly one-fifth of women born after 1970 will not have any children.

    You may find you need to rely on a sibling, niece or nephew, distant relative, friends or paid helpers. Assisted living facilities are an option for many people. Nursing homes are often regarded as the place of last resort, but people without caregivers are more likely to enter them.

    Most of these options can be expensive, depending on the type of care you will need and how long you will need it. For example, the national average cost for a home health aide is $45,760 per year; for assisted living, it’s $43,200 per year; and for a semi-private room in a nursing home, it’s $80,300 per year. (Genworth has researched these costs in each state.) So, in addition to determining who will provide your care, you also need to consider how you will pay for it.

    Medicare does not pay for assisted living and only pays for a limited number of days in a nursing home. Aid & Attendance benefits from the Veterans Administration will help pay these costs for wartime veterans and their spouses who qualify. MediCal will pay for nursing home care, but you have to spend down your assets in order to qualify. Long-term care insurance is an option, but if you wait too long it may not be affordable and you may not qualify. If you have substantial savings and/or have equity in your home, those resources can be used to pay for your care.

    The point is this: It is never too late to start thinking about who will care for you in your old age, in what setting you want to receive that care, and how you will pay for it. Don’t assume your first choice is willing to provide hands-on care for you. Have that conversation with your candidates to make sure they are on board with your wishes. If not, you’ll need to come up with Plan B or Plan C. Without a plan, you could end up having no say in your end-of-life care.

    During our life planning sessions, we can assist you with making the best plan so you aren’t left alone when you need help.  Call us today for a free consultation.

  • What Happens if a Family Member Becomes Incapacitated?

    The Unpopular Topic of Discussion Every Family Needs to Have

    Just bringing up the possibility of someone in your family becoming mentally or physically incapacitated is often difficult. We tend to think of only the very elderly needing long-term, hands-on care, but a recent report by the Alzheimer’s Association found that one in nine Americans age 65 or older currently have Alzheimer’s. With the baby boom generation aging and people living longer, that number may nearly triple by 2050. Dementia isn’t the only reason for long-term care, of course, but almost everyone knows someone already affected by it.

     

    Waiting too late to plan can throw a family into confusion about what the Mom or Dad would want, what options are available, and what resources can help pay for care. Rushed decisions are often the most costly. Having the courage to discuss the possibility of incapacity now can go a long way toward being prepared should that time come. By the way, because anyone can become incapacitated at any time due to illness or accident, the entire family would benefit from planning for every family member.

     

    Planning/Discussion Considerations

    Care Options: Depending on the type and expected duration of care needed, options range from in-home care to adult daycare to assisted living facilities to nursing homes. Assistance with activities of daily living (ADL), which include eating, bathing and dressing, are generally not covered by health insurance. Professional care can be expensive; the national average for basic assisted living services is now about $42,000 per year. Care for those with dementia can last longer and cost more. Family caregivers, who provide the bulk of in-home care, are often unpaid, and the emotional and financial tolls can be considerable. Your discussions need to realistically consider family finances and circumstances.

     

    Finances: Where will the money come from to pay these expenses? What resources will be available? Health insurance does not cover assisted living/nursing home facilities or help with ADLs. Medicare covers some in-home health care and a limited number of days of skilled nursing home care, but not long-term care. Medicaid, which does cover long-term care, was designed for the indigent; to qualify, the person’s assets must be spent down to almost nothing. VA benefits for Aid & Attendance may be available for veterans and their spouses. If there are significant assets, you can self-insure and pay the costs as you go. Home equity and retirement savings can also be a source of funds. If you want to protect these assets for your family, long-term health insurance may be an option. (Premiums are much lower when you are younger.)

     

    Documents: Everyone over the age of 18 needs basic legal documents. These include an advance health directive or healthcare power of attorney (legally appointing another person to make healthcare decisions for you if you cannot make them yourself); a durable financial power of attorney (legally appointing another person to make financial decisions for you if you cannot make them yourself); and a trust and/or will.

     

    Having the Discussion: Your parents may be harboring secret fears about what will happen to them if they need long-term care. Talking about this honestly, listening to their fears and desires, and putting a plan in place before it is needed can help reassure them (and you). If you want to talk to your children, reassure them that you are just being realistic. Starting with a story about someone you know or an article you read can be a good way to break the ice.

     

    How to Get Help: An attorney who specializes in Elder Law has already helped many families in these same situations, and will be able to make recommendations that will save you considerable time, money, and stress. He/she can also work with other advisors (financial/investment, insurance, CPA, etc.) to help put together the best plan for your family’s circumstances.

     

    Contact us today or a life planning session.

  • Emergency contact information in your phone

    If you were involved in a serious accident and was unable to answer questions, how would emergency personnel know your essential medical information such as allergies or health care directives?

    One of the first places emergency personnel will look at is your smart phone.

    It takes only a couple of minutes to add the right information to your phone so emergency personal know who to contact.

    Add an ICE Contact – “In Case of Emergency”

    Add an emergency contact in your phone named “ICE” which stands for “In Case of Emergency.”

    image001The Name field should only say “ICE”.  Don’t add the name of your emergency contact in the Name field. You can add the name of your emergency contact in the Company field.

    In the Notes section, you can add other essential information such as your medical condition, allergies, medication, blood type, and anything else you believe emergency personnel should know while treating you. You can add any information someone needs to know in order to give you the appropriate care in case of an emergency.

     

     

     

     

     

     

     

    However, if you lock your smart phone, emergency personnel will not have access to your contacts.  There are 2 solutions to this problem:

    1. Download an app that allows access to information while your phone is locked; or
    2. Change your locked screen wallpaper to a picture with your ICE information.

    Heath App on iPhone

    image003If you own an iPhone, the Health App has a Medical ID feature that allows access to critical information while your iPhone is locked.

    When you open the Health App, it will bring you to the Dashboard.  Click on the Medical ID link on the bottom right hand side.

     

    Then you can add the relevant information in the Medical ID screen, including your emergency contacts, medical conditions, allergies, medications, and other notes.

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    Make sure the Show When Locked is enabled so emergency personnel can access the information.

    To reach the Medical ID information from a locked phone, the emergency personnel would click on “Emergency” from the locked screen, then on “Medical ID.”

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    Smart tip:

    If you are having trouble adding a particular contact as an emergency contact in the Health App:

    1.       Double check that the emergency contact is added as a contact first before designating as an emergency contact.

    2.       If the contact is grayed out and is not available to be selected from the Health App, try editing the contact to unlink any social media accounts. 

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  • My parents aren’t as healthy as I thought

    The holiday season is the time that families gather together, often from long distances. If you haven’t seen your parents in a while, you may notice they are aging more than you remembered. Here are some things to watch for the next time you visit.

    Physical Appearance: Is your parent clean and presentable? Not keeping up with daily routines could be a result of physical, mental, or emotional decline. Do you notice any weight loss? Cooking may have become difficult. Also, some medications can affect taste and cause a lack of appetite. Pay attention to how your parent walks. Is balance or gait a problem? Unsteadiness can increase the risk of falling, which can result in serious injury.

    Home Environment: If your parent has always maintained the yard, home repairs, a clean house and paid bills on time, a neglected yard or repairs, a cluttered or dirty house, or stack of unpaid bills could be clues that things are not quite right. Is your parent able to handle their medications? Should they be driving?

    Memory Loss: Everyone loses their keys or forgets things occasionally. But having trouble with common words, getting lost in a familiar neighborhood, or not being able to follow directions could be indications of something serious. By the way, it’s not always dementia—a urinary tract infection that can be cured with antibiotics, other medical issue, or even a medication can often present with memory loss or confusion.

    Emotional Well-Being: Watch for signs of depression, including withdrawal from social activities, changes in sleep patterns, or loss of interest in hobbies.

    What can you do?

    1. If you see things that concern you, talk to your parent. Have an honest conversation about what you are noticing and see if they are aware of any changes.
    2. Encourage regular medical check-ups and possibly a medical assessment. You may want to go with your parent and discuss results and suggestions with the doctor.
    3. Address any safety issues and prioritize a to-do list. Simple things like adding non-slip pads under rugs or installing handicap bars in a bathroom can prevent falls. Medic alert systems are also valuable.
    4. Identify all available resources. (Also see #6 below.) Maybe you need to hire a housekeeper, someone to run errands, or a home health aide.
    5. If you have siblings, involve them if possible.
    6. Make a list of medications, doctors, and medical issues.
    7. Make sure your parent has all appropriate legal documents, including financial and healthcare powers of attorney and estate planning documents. An Elder Law attorney can be a valuable resource as she has walked this road before with other families, and can help with securing benefits from the VA and Medi-Cal, if applicable.
    8. Long-term care insurance can help preserve your parents’ finances and yours. But don’t wait too long; your parent could become uninsurable.

    Above all, you want your parent to have as much independence and participation as possible. Be reassuring in what can be a scary time for many people. Remind them that you care about them and want them to be happy, healthy and safe—now and as far into the future as possible.

    Our firm is committed to helping families navigate the scary, sometimes confusing maze of long term care.  Please contact us if you would like to discuss your particular situation.

  • Age-appropriate legal documents (Part 2)

    In part one, we met Jim and Sandy, now age 65, and reviewed their need for age-appropriate health care and decision-making documents.  We left off with the question, “How can Jim and Sandy take steps to prevent losing everything in the event their health fails?”

    The costs of long-term care can be staggering.  Home health aides can cost, on average, $45,760 per year, based on care provided 44 hours per week.  Nursing home care on average is nearly double that – $80,300 per year for a semi-private room.

    What are our chances of needing long-term care?  According to the Department of Health and Human Services, someone turning 65 today has a 70% chance of needing some type of long-term care services in their remaining years.  This means Jim and Sandy should be considering how they will pay for that care in the event one or both of them are part of that 70%.

    Jim and Sandy’s choices include:

    1. paying out of their own pocket for care,
    2. purchasing long-term care insurance,
    3. qualifying for government assistance programs, or
    4. any combination of the first 3.

    By planning early, before there’s a health care crisis, Jim and Sandy can take advantage of all three options, yet protect their home and any other cash or assets they wish.  This type of asset protection is done using a specially designed irrevocable trust.  Only a portion of Jim and Sandy’s assets would be transferred to the irrevocable trust, with the remainder either remaining in Jim and Sandy’s name, or held in a revocable trust with special provisions for the surviving spouse.

    By transferring assets to an irrevocable trust, those assets would not be counted in the future (in most cases, after 5 years) if Jim or Sandy needed to qualify for government assistance to help pay for their long-term care.  If Jim or Sandy is a wartime Veteran, there are additional cash assistance programs available through the Veterans Administration that should be explored as another means to help pay for their care.

    To round out the asset protection package, Jim and Sandy would also complete financial powers of attorney and health care advance directives along with living wills.  They would also explore purchasing an appropriate long-term care policy in the event one of them needed care sooner than expected.

    By planning early, Jim and Sandy have tools in place to protect their home and other assets should one or both of them need care in the future – and there is a 70% chance they will.  Jim and Sandy have also lessened the emotional and financial stress placed on a family when a health care crisis does happen.  They’ve taken care of the heavy lifting with regard to their assets, so their family can just focus on what really matters – making sure they have the best care possible.

    If you are interested in exploring how to protect your assets from the rising costs of care, please contact us to learn more.

  • Age-appropriate legal documents (Part 1)

    Twenty years ago, Jim and Sandy, age 45 at the time, went on their first vacation without their kids since they were married.   They had no planning documents in place, and had to scramble quickly to get a simple will and a power of attorney to make sure their kids would be taken care of should something happen to them.  They owned a home with a mortgage, and had very little in savings.

    The will named a guardian for their minor children, and named a trustee to hold their children’s money in trust until they reached age 21. The durable power of attorney only addressed basic financial issues, naming an agent to act in their place (paying bills, writing checks for the kids’ various activities) in the event they were unable to.  Jim and Sandy did not prepare a Living Will, or any type of document that named another person to make healthcare decisions for them if needed.  Their main focus was their children, and making sure the mortgage and other bills were paid if something happened to them while they were away.

    Jim and Sandy arrived home from their trip perfectly healthy, and the documents they signed sat in a safe deposit box for the next 20 years. Now age 65, Jim and Sandy are nearing retirement and have accumulated a nice “nest age” and just paid off their home.  However, they recently had a friend suffer a near-fatal heart attack and it was a sharp reminder to them of how precious life is.  The topic of their will from 20 years ago came up, and they both agreed it was time for an update.

    Jim and Sandy now need documents that address their current age and status – near retirement with substantial savings. Their durable power of attorney that worked for their purposes 20 years ago needs a major makeover.  Jim and Sandy now need to consider who will step in and make financials decisions on all of their matters if they are unable to because of incapacity.  Incapacity can result from a disease, like dementia, or it could come from a more sudden health event, like a heart attack or stroke.  As Jim and Sandy grow older, the possibility of a debilitating health event increases.  They have more assets than they did 20 years ago, including a number of online accounts that would need to be managed.  A “general” form is usually not enough to cover the complex issues that arise as we get older, and as we acquire more possessions.

    This increasing possibility of a health crisis also sheds light on the need to have their medical wishes properly documented through a health care directive. What type of life-sustaining measures should be undertaken for them?  Who will make health care decisions if they are unable to?  The natural choice is to choose the other spouse as agent, but what if the other spouse is unable or unwilling to act?   If Jim and Sandy haven’t designated their agent through proper legal documents, then a court may be left to decide for them – an expensive and sometimes lengthy process that can be very stressful on the family.

    Another issue that is important to discuss is what type of care should be provided if Jim or Sandy need it? Does Jim wish to stay home and receive care there?  If so, who should provide that care?  Do both of them want to transition to independent living at some point when keeping up a home and yard becomes too much?  If the conversation isn’t held while Jim and Sandy are healthy, then other family members and friends are left to guess what Jim and Sandy would have wanted.

    As shown above, age-appropriate legal documents that address health care and financial decision-making are critical. The other critical planning concern is what will happen to all of Jim and Sandy’s possessions if one or both of them get sick and need substantial care on a long-term basis?  Our next blog will address this issue:  How can Jim and Sandy take steps to prevent losing everything in the event their health fails?

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