10. Changes in mood and personality. Of concern: Becoming confused, suspicious, depressed, fearful or anxious; becoming easily upset at home, at work, with friends or in places where they are out of their comfort zone. Normal age-related change: Developing very specific ways of doing things and becoming irritable when a routine is disrupted.
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10 Early Signs and Symptoms of Alzheimer’s Disease
Early diagnosis of dementia provides the best opportunities for treatment, support and planning for the future. The Alzheimer’s Association (www.alz.org) has released the following list of signs and symptoms that can help individuals and family members recognize the beginnings of dementia. If you are concerned about any of these, be sure to see a doctor and, if suggested, begin treatment as soon as possible.1. Memory loss that disrupts daily life. Of concern: Forgetting recently learned information, important dates or events; repeatedly asking for the same information; relying on notes, devices or family members for things they used to handle on their own. Normal age-related change: Sometimes forgetting names or appointments, but remembering them later.2. Challenges in planning or solving problems. Of concern: Changes in the ability to develop and follow a plan or work with numbers, such as having trouble following a familiar recipe or keeping track of monthly bills; difficulty concentrating and taking much longer to do things than before. Normal age-related change: Making an occasional error when balancing a checkbook.3. Difficulty completing familiar tasks at home, work or leisure. Of concern: Finding it hard to complete daily tasks, such as driving to a familiar location, managing a budget at work or remembering the rules of a favorite game. Normal age-related change: Occasionally needing help to use settings on a microwave or to record a television show.4. Confusion with time or place. Of concern: Losing track of dates, seasons and passage of time; trouble understanding something if it is not happening immediately; forgetting where they are or how they got there. Normal age-related change: Getting confused about the day of the week but figuring it out later.5. Trouble understanding visual images and spatial relationships. Of concern: Vision problems that make it difficult to read, judge distance, and determine color and contrast. In terms of perception, they may pass a mirror and think someone else is in the room. They may not recognize their own reflection. Normal age-related change: Vision problems due to cataracts.6. New problems with words in speaking or writing. Of concern: Having trouble following or joining a conversation; stopping in the middle of a conversation with no idea how to continue, or repeating themselves; having problems finding the right word or calling things by the wrong name. Normal age-related change: Sometimes having trouble finding the right word.7. Misplacing things and losing the ability to retrace steps. Of concern: Putting things in unusual places; losing things and not being able to go back over their steps to find them; accusing others of stealing from them. Normal age-related change: Misplacing items (glasses, car keys, remote control) from time to time.8. Decreased or poor judgment. Of concern: Changes in judgment or decision making, especially when dealing with money, such as giving large amounts to telemarketers; paying less attention to personal hygiene. Normal age-related change: Making a bad decision once in a while.9. Withdrawal from work or social activities. Of concern: Not wanting to participate in hobbies, social activities, work projects or sports; having trouble keeping up with a favorite sports team or completing a favorite hobby; avoiding social situations because of changes they are experiencing. Normal age-related change: Sometimes feeling weary of work, family and social obligations.If you notice any of these warning signs, please talk to your doctor. In addition, please contact the Marsala Law Firm (310) 237-3872 so we can prepare a life plan for you that avoid costly court proceedings later and explore your long-term care options. A diagnosis of Alzheimer’s disease doesn’t necessarily mean that it is too late, but planning early is always best. -
What Is Cost Basis and How Do You Prove It?
Knowing the “cost basis” of your property is important for tax purposes, but proving cost basis can be difficult. Cost basis adjusts at death, so it is a good idea to appraise property when a joint owner dies.
Cost basis is the monetary value of an item for tax purposes. When determining whether a capital gains tax is owed on property, the basis is used to determine whether an asset has increased or decreased in value. For example, if you purchase a house for $150,000, that is the cost basis. The cost basis can be increased by improvements to the property. If there are no improvements and you later sell the house for $250,000, you will have to pay taxes on the $100,000 increase in value. (However, if the property is your principal residence, you can exclude up to $250,000 in gain, or up to $500,000 for a couple.)
When a property owner dies, the cost basis of the property is “stepped up.” This means the current value of the property becomes the basis. For example, suppose you inherit a house that was purchased years ago for $50,000 and it is now worth $250,000. You will receive a step up from the original cost basis from $50,000 to $250,000. If you sell the property right away, you will not owe any capital gains taxes.
When a joint owner dies, half of the value of the property is stepped up. For example, suppose a husband and wife buy property for $200,000, and then the husband dies when the property has a fair market value of $300,000. The new cost basis of the property for the wife will be $250,000 ($100,000 for the wife’s original 50 percent interest and $150,000 for the other half passed to her at the husband’s death).
The burden is on the property owner to prove cost basis, and it isn’t always easy to prove, especially if it has been awhile since the property was purchased or improvements were made. Homeowners should keep good records of improvements to a house, which means keeping receipts and purchase orders. If a joint owner of property dies, you should get the property appraised to show the value at the time it is “stepped up” in basis. Be sure to save the documentation so you can use it later.
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What is undue influence?
Saying that there has been “undue influence” is often used as a reason to contest a will or estate plan, but what does it mean?
Undue influence occurs when someone exerts pressure on an individual, causing that individual to act contrary to his or her wishes and to the benefit of the influencer or the influencer’s friends. The pressure can take the form of deception, harassment, threats, or isolation. Often the influencer separates the individual from their loved ones in order to coerce. The elderly and infirm are usually more susceptible to undue influence.
To prove a loved one was subject to undue influence in drafting an estate plan, you have to show that the loved one disposed of his or her property in a way that was unexpected under the circumstances, that he or she is susceptible to undue influence (because of illness, age, frailty, or a special relationship with the influencer), and that the person who exerted the influence had the opportunity to do so. Generally, the burden of proving undue influence is on the person asserting undue influence. However, if the alleged influencer had a fiduciary relationship with your loved one, the burden may be on the influencer to prove that there was no undue influence. People who have a fiduciary relationship can include a child, a spouse, or an agent under a power of attorney.
When drawing up a will or estate plan, it is important to avoid even the appearance of undue influence. For example, if you are planning on leaving everything to your daughter who is also your primary caregiver, your other children may argue that your daughter took advantage of her position to influence you. To avoid the appearance of undue influence, do not involve any family members who are inheriting under your will in drafting your will. Family members should not be present when you discuss the will with your attorney or when you sign it. To be totally safe, family members shouldn’t even drive or accompany you to the attorney’s office. You can also get a formal assessment of your mental capabilities done by a medical professional before you draft estate planning documents.
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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.
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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.
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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.
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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.
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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.
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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.
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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.”
The 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:
- Download an app that allows access to information while your phone is locked; or
- Change your locked screen wallpaper to a picture with your ICE information.
Heath App on iPhone
If 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.
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.”
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.







