Alzheimer’s disease is America’s sixth leading cause of death.
Deaths from Alzheimer’s increased 68 percent between 2000 and 2010, when deaths from other major diseases decreased.
The number of persons who have Alzheimer’s disease is expected to nearly triple by 2050, from 5 million to 13.8 million, causing some public health experts to call the disease an epidemic.
Are you one of the 15 million people who provided uncompensated care to one of the 5 million Americans who had Alzheimer’s disease in 2012? If so, these statistics probably don’t surprise you, because most Alzheimer’s caregivers seek support and information to resolve their fears and frustrations. The Alzheimer’s Association’s website www.alz.org is the most complete source of information.
When a loved one shows early signs of Alzheimer’s disease, the family should encourage that at least two levels of agents be given legal authority to act on behalf of the person with Alzheimer’s for financial affairs and health issues.
There should not only be a Will, but also, more importantly, a durable financial power of attorney, a Health care power of attorney and an Advance Care Directive, which is also known as a Living Will.
A diagnosis of early-stage Alzheimer’s does not mean that legal documents to establish agency rights and duties cannot be created. A parent who struggles with short-term memory or vocabulary can recognize a need to ask for help, show willingness to delegate authority and express preference for a specific person to serve as the agent. A family that demonstrates unified support at the time that agency documents are signed is less likely to have a courtroom fight in the future about the documents’ validity.
Sometimes, an Alzheimer’s patient waits too long to prepare legal documents. Other times, one family caregiver will want existing agency documents revised to increase his or her authority at the expense of another family member who currently has the authority. In these instances, it becomes more complicated for a lawyer to determine whether a person with an Alzheimer’s diagnosis has the legal capacity to sign documents that delegate agency authority.
It could be important to have a geriatric psychologist evaluate the person with Alzheimer’s immediately before the act of signing to determine if sufficient cognitive competence exists. The psychologist also could determine whether there is any indication of coercion or undue influence about the choice of an agent.
The determination of competency or capacity is ultimately a legal one, which can be supported by medical testimony about cognition. The process of petitioning an Orphan’s Court judge to resolve such a dispute can be as expensive and emotionally charged as a child-custody dispute. Mediation should be considered as an alternative.
After the basic agency relationships have been established, a care plan should be created. Caregiving for Alzheimer’s disease is a marathon, and not a sprint. Consideration is needed to stretch family resources to avoid caregiver burnout related to home care, and to stretch funds if care in a secured personal care home becomes necessary.
Alzheimer’s does not always qualify for care in a skilled nursing home, which is the only facility where Medicaid assistance can be obtained.
Long-term care insurance makes a home care plan or personal care home placement affordable without sacrificing either the economic lifestyle of the well spouse or the intended family legacy. However, once a patient’s medical chart has an Alzheimer’s diagnosis, such insurance cannot be obtained.
Those with a family history of Alzheimer’s should consider insurance as part of their own comprehensive estate plan before it is too late.
Step one should be development of a detailed care plan to consider the various options for care needed presently, or that might be necessary in the future. A budget can project how monthly income, savings and other financial resources, as well as the potential to obtain government assistance, can meet the current and probable future costs. This plan should be available to any involved family member, as well as other advisers, such as an accountant or investment adviser.
Family caregiver agreements build from the care plan and provide a legal way to transfer money from a person with Alzheimer’s to the family.
A total of more than $500 of transfers in any month from an Alzheimer’s patient to family caregivers should be reported to the IRS as a taxable event necessitated by the care plan. Otherwise, money transferred within the family can be considered as a gift and create a period of ineligibility for Medicaid assistance, which is often needed eventually to the pay the $9,000 per month cost of the skilled nursing home, which is not paid by Medicare.
Wartime veterans and surviving spouses can receive special pensions of $1,000 to $2,000 per month to offset the cost of Alzheimer’s care. The application process is comparatively simple and free for those whose total financial resources, other than their home, are less than $80,000. Estate-planning techniques can help those with more assets to qualify sooner, without risking future disqualification for Medicaid to pay for a skilled nursing facility.
Alzheimer’s caregivers know how hopeless it can feel to support a family member with this disease, which has no cure.
Please join us for the Alzheimer’s Walk on Saturday, Sept. 21 at City Island, when we join others to celebrate stories of courage, to honor and remember our loved ones, and to enjoy a picnic and fellowship.
We welcome you to ask your friends and co-workers to make pledges of support for you to take the short walk with us. Or, you can make a tax deductible gift to the Alzheimer’s Association of any amount to encourage our team’s effort. Call Marcia at our office at 697-3223 for more information on how you can join us to be part of the process of hope for an Alzheimer’s solution.
Guest columnist Dave Nesbit is the principal attorney certified in long-term care insurance at Keystone Elder Law P.C. in Upper Allen Township. He can be reached at firstname.lastname@example.org or 697-3223. The Elder Care column appears Fridays in The Sentinel.