Dementia & Estate Planning: What to Remember

Experiencing something personally often has a much different feeling than reading about it, observing it, or talking about it.  Unfortunately, when people are increasingly becoming connected to how a diagnosis of dementia can impact estate and legal planning.  The progression of dementia can range from one patient to another.  However, while a plan for incapacitation may have worked from the outside, the development of the dementia can impede your plan and execution of that plan.  
Estate planning documents, such as a trust and a power of attorney can become increasingly important and should be crafted well in advance of a dementia diagnosis.  Although no one can sure anticipate an diagnosis of dementia. Having these documents in advance is significant for preventing problems. Although there may be no tax issues to worry about with regards to the estate, estate planning goes so much farther than just the taxes or death planning.
A power of attorney, for example, could be used by a caregiver to get the bank to tighten things up with financial affairs when someone faculties decline with dementia.  Since that person might have been the primary financial decision maker responsible for responding to new offers of personal loans, home equity loans and new credit card accounts, a caregiver with an appropriate power of attorney can get this to stop.
Furthermore, lowering limits on credit cards or shutting credit cards down completely, if this person is no longer able to make informed and reasonable decisions on their own, may be important.  But only an individual who has been empowered with the power of attorney is in a position to make these kinds of stipulations and to follow through on them. Schedule a consultation with your own estate planning lawyer to discuss what you can do to protect yourself and your loved ones if you are concerned about a recent diagnosis of dementia or symptoms that might indicate a person could be developing dementia.
The investment portfolio of millennials is changing the face of the estate planning industry.  Estate planners have, for years, been focused on baby boomers who will pass on significant assets to future generations, but the way that millennials are saving and thinking about their own future is altering the industry as a whole.  The estate planning market has for many years handled the distribution of assets among the descendents of deceased wealthy individuals.
If you are concerned about a possible dementia diagnosis or just need your questions answered about your own potential incapacity planning, now is the time to talk to an attorney who has background and experience in this area.
 
 

What is the Connection Between Legal Capacity & Dementia?

In many situations in which an individual with dementia is able to understand the importance and the meaning of any given legal document, he or she most likely has the legal capacity to execute such a document. Legal capacity refers to appreciating and understanding the consequences of your actions.
As long as an individual with dementia has the appropriate legal capacity, he or she is eligible to take part in a legal planning process. An attorney can help to determine what level of legal capacity is necessary in order for an individual to sign a particular document. It is not uncommon for adult children who have elderly loved ones facing dementia to have pertinent questions that can be addressed by an estate planning attorney.
Before an individual with dementia signs a legal document, there are several different steps that you should take in order to ensure that you are evaluating them appropriately with regard to their capacity. These include:

  •       Talking with the person directly to determine whether or not they understand the consequences of their actions.
  •       Get medical advice from a doctor who knows the patient.
  •       Take inventory of any current legal documents already in existence.

An experienced estate planning attorney can help you when it is important to identify some things that you need to do to protect a loved one who is facing a dementia diagnosis.
 

Growing Dilemma: Financial advice for those with dementia

Both government regulators and financial advisors are facing a growing dilemma: what to do for and about people with memory loss.
Sometimes, according to a recent American Association of Retired Persons online article, it is a person at a financial firm who first notices signs of dementia in clients, but that doesn’t mean there are rules and procedures in place for dealing with such a situation.

Memory Loss

Memory Loss

“Regulators and financial firms are starting to tackle the issue of serving clients with diminished mental capacity, something not covered under federal regulations and addressed by only a few states,” according to the story. “Alzheimer’s disease, the most common form of dementia, now affects 5.1 million Americans 65 and older, a number that’s expected to nearly triple by mid-century, according to the Alzheimer’s Association. Already, financial advisers typically serve at least seven clients with Alzheimer’s or other dementia, according to a 2012 study by Cerulli Associates.
“Current regulations require advisers to protect a customer’s privacy and promptly execute orders, even if they’re imprudent. Advisers worry that by following the rules, they could later be sued by, say, the customer’s family, claiming the client didn’t have the capacity to make financial decisions.”
“The most important warning sign is a change in the person’s risk preferences and choices regarding how to invest money,” Daniel Marson, a neuropsychologist and director of the Alzheimer’s Disease Center at the University of Alabama in Birmingham, was quoted as saying. “They are interested in get-rich-quick schemes that they wouldn’t have paid attention to 10 or 15 years earlier.”
“The prospect that someone with a cognitive disorder might quickly deplete a nest egg or fall victim to a scam is why regulators, financial institutions and consumer advocates are trying to get ahead of the problem,” the story continues.
“The silver tsunami is upon us, and it will continue for the next 15 years, according to Lynne Egan, chairwoman of the senior issues and diminished capacity committee for the North American Securities Administrators Association. “We will see a large portion of our population turn 65.
“One-third of those people will have some diminished capacity, mostly related to general aging, but some will be as a result of dementia.”

Growing Dilemma: Financial Advice For Those With Dementia

Senior woman with her caregiver

Senior woman with her caregiver

Both government regulators and financial advisors are facing a growing dilemma: what to do for and about people with memory loss.
Sometimes, according to a recent American Association of Retired Persons online article, it is a person at a financial firm who first notices signs of dementia in clients, but that doesn’t mean there are rules and procedures in place for dealing with such a situation.
“Regulators and financial firms are starting to tackle the issue of serving clients with diminished mental capacity, something not covered under federal regulations and addressed by only a few states,” according to the story . “Alzheimer’s disease, the most common form of dementia, now affects 5.1 million Americans 65 and older, a number that’s expected to nearly triple by mid-century, according to the Alzheimer’s Association. Already, financial advisers typically serve at least seven clients with Alzheimer’s or other dementia, according to a 2012 study by Cerulli Associates.
“Current regulations require advisers to protect a customer’s privacy and promptly execute orders, even if they’re imprudent. Advisers worry that by following the rules, they could later be sued by, say, the customer’s family, claiming the client didn’t have the capacity to make financial decisions.”
“The most important warning sign is a change in the person’s risk preferences and choices regarding how to invest money,” Daniel Marson, a neuropsychologist and director of the Alzheimer’s Disease Center at the University of Alabama in Birmingham, was quoted as saying. “They are interested in get-rich-quick schemes that they wouldn’t have paid attention to 10 or 15 years earlier.”
“The prospect that someone with a cognitive disorder might quickly deplete a nest egg or fall victim to a scam is why regulators, financial institutions and consumer advocates are trying to get ahead of the problem,” the story continues.
“The silver tsunami is upon us, and it will continue for the next 15 years, according to Lynne Egan, chairwoman of the senior issues and diminished capacity committee for the North American Securities Administrators Association. “We will see a large portion of our population turn 65.
“One-third of those people will have some diminished capacity, mostly related to general aging, but some will be as a result of dementia.”

Industrial Designer Found Way To Help Grandmother

A San Francisco-area industrial designer whose grandmother was diagnosed with Alzheimer’s disease did something rather remarkable.
Sha Yao, who attended the Academy of Art University, created Eatwell, which an article on the website mentalfloss described as “a seven-piece tableware set with 20 unique features specifically designed to meet the needs of those with physical, motor, and cognitive impairments.”

Lunch at the Nursing Home

Lunch at the Nursing Home

“Yao exceeded her fundraising goal on Indiegogo last year and her designs won the top prize at the 2014 Stanford Design Challenge,” continues  “The set has bright, primary colors, which Yao chose because of a Boston University study that found that individuals with cognitive impairment consumed 24 percent more food and 84 percent more liquid when they were in brightly-colored containers.
“Other features include bowls and cups with angled bases, allowing contents to naturally fall to one side, making them easier to scoop and drink, as well as ergonomically-designed spoons whose curvature aligns with the contours of the bowls. There are also holes with flaps at the edge of the tray where an apron, bib, or napkin can be tucked to prevent spill damage, plus wide-base drink ware that’s difficult to topple.”
“Raising awareness and addressing the needs of people with impairments will allow them to maintain their dignity, retain as much independence as possible, and reduce the burden on their caretakers,” Sha Yao told Fast Company magazine. “That’s what made designing the Eatwell tableware set so rewarding.”
More information is available at http://www.eatwellset.com/#!features/cf1a.

Early Planning Permits Those With Dementia To State Wishes

Grown Up Son Consoling Senior Parent

Grown Up Son Consoling Senior Parent

It must be grim, but it also must be done.
For people who fear they are experiencing the first signs of dementia or Alzheimer’s disease, making legal plans is essential, because anytime now may be too late, according to the website alz.org.
“It’s important for everyone to plan for the future, but legal plans are especially important for a person with Alzheimer’s disease,” according to an article on the site.  “The sooner planning starts, the more the person with dementia may be able to participate.
“Early planning allows the person with dementia to be involved and express his or her wishes for future care and decisions. This eliminates guesswork for families, and allows for the person with dementia to designate decision makers on his or her behalf. Early planning also allows time to work through the complex legal and financial issues that are involved in long-term care.”
This legal planning, the site adds, should include:

  • Making plans for health care and long-term care
  • Making plans for finances and property
  • Naming another person to make decisions on behalf of the person with dementia
  • Legal capacity

That last aspect is defined in the alz.org article as “the ability to understand and appreciate the consequences of one’s actions and to make rational decisions.”
“In most cases, if a person with dementia is able to understand the meaning and importance of a given legal document, he or she likely has the legal capacity to execute, to carry out by signing it. The requirements of legal capacity can vary from one document to another. A lawyer can help determine what level of legal capacity is required for a person to sign a particular document.”

Caregivers Need Care Themselves

The emotional and sometimes physical stress of caring for a loved one with Alzheimer’s disease or some other form of dementia is intense.

Care in the home

(Photo credit: British Red Cross.)

A recent blog on The New York Times by Jane E. Brody highlights a book by San Jose, Calif., psychologist Judith L. London that focuses on 54 people caught in this plight.
“She based each of the stories on situations confronting caregivers she has encountered, offering suggestions that could help others in similar circumstances,” Brody wrote. “The challenges include convincing patients or other relatives that something is really amiss, that lapses are not only a result of the gradual decline in memory that can accompany aging, as well as keeping people with dementia from slipping unnoticed out of the house and getting lost.”
“Caregiving is an act of love, even for paid caregivers,” London said in an interview. “You put so much of yourself out there all the time, especially with Alzheimer’s patients. The average span of the disease is seven years and it can go on as long as 20 years, and the challenges only increase with time.”
London’s new book is “Support for Alzheimer’s and Dementia Caregivers: The Unsung Heroes,” and it is a sort of follow-up to her first book, “Connecting the Dots: Breakthroughs in Communication as Alzheimer’s Advances.”
“Dr. London worries a lot about the stress on these caregivers, and rightly so,” Brody wrote. “According to the data from Stanford University and the Alzheimer’s Association, more than 15 million people provide unpaid care for family members or friends with Alzheimer’s disease or other forms of dementia. The strain of the task has been shown in many studies to increase the risk of a variety of illnesses, and even death.”
“(C)aregivers are often the casualties, the hidden victims, of Alzheimer’s disease,” London was quoted as saying. “No one sees the sacrifices they make.”

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Denial of dementia can cut both ways, have real consequences

Practically everyone knows of examples where older people refused to acknowledge obvious signs of approaching dementia until it was simply too late.
It doesn’t help the situation at all that the individual’s friends and family members are just as hesitant to ignore a growing problem.
This becomes a double-edged sword.
“Nobody wants to admit they can’t live independently anymore,” Carolyn McClanahan, director of financial planning for Life Planning Partners in Jacksonville, Fla., was quoted as saying in a recent MSN Money article by Liz Weston.
“Denial is common in family members, too, because acknowledging what’s happening can be too painful and frightening,” Weston wrote.
This pattern of denial on the part of the person beginning the spiral into end-of-life forgetfulness and those around them who care can have some very real consequences, the story points out.
These can include:

  • The person with symptoms could be suffering another, resolvable issue, such as a reaction to medication, a vitamin deficiency or an infection.
  • Even if she does have Alzheimer’s, early detection permits treatment with medications that can allow her to remain independent longer.
  • Delay can prevent the person from making her wishes about future treatment known, putting another burden on the family. It can rob her of the opportunity to make important financial and legal plans, including protecting her assets and designating someone to make decisions for her when she no longer can.

“Making a bad financial decision isn’t always a sign of dementia, of course,” the article points out. “Our ability to make good financial choices tends to peak in our late 40s and early 50s, sliding gradually downhill from there, according to research by Federal Reserve economist Sumit Agarwal. So older people in general are more vulnerable to scams and questionable investment pitches than they were in middle age.”
An occasional financial planning lapse may not mean anything, but a pattern may.
“Sometimes the line between normal age-related memory issues and incipient dementia can seem blurry, but the Alzheimer’s Association offers helpful tips for discerning the difference,” the story states.
These include:

  • Forgetting a word now and then is a normal part of aging. What’s not: using made-up names, such as calling a watch a “hand clock,” or having difficulty carrying on a conversation.
  • Getting confused about the day of the week? That can be normal aging, if the person figures it out later. Likewise, misplacing things isn’t a cause of concern if the person eventually can retrace her steps to find what she’s lost. But if she can’t figure out where she mislaid her keys or what day or season it is, there may be a problem.
  • Becoming more set in our ways can be a typical part of aging, and we may get irritated if our routines are disrupted. Big personality or mood changes, however, usually aren’t normal. If someone becomes anxious, easily upset, defensive or suspicious when he didn’t used to be, dementia may be the cause.

Post-traumatic stress, sadly, isn’t exclusive to young soldiers

Although their numbers are sadly and rapidly dwindling, veterans of World War II, the Korean War and even of the War in Vietnam are increasingly coming to realize they suffered and are still suffering from post-traumatic stress syndrome.
“Who knew much about post-traumatic stress syndrome in 1945? The term didn’t enter the official manual of psychiatric diagnoses until 1980; effective treatments didn’t become widely available until the late 1990s.”

Age-standardised disability-adjusted life year...

Age-standardised disability-adjusted life year (DALY) rates from Post-traumatic stress disorder by country (per 100,000 inhabitants). (Photo credit: Wikipedia)

Soldiers were discharged at the end of World War II with the simple expectation that, in spite of what they had seen and done, what they had experienced, they would just resume the lives they had before service to and sacrifice for their country intervened.
The prevailing medical advice … amounted to ‘put it all behind you,’ ” Span wrote.
“The John Wayne approach,” the article quoted Joan Cook, a Yale psychiatry professor and researcher with the National Center for PTSD, as saying. “Older vets believed in that. For many years, they hid their symptoms.”
“Because post-traumatic stress syndrome can trouble veterans’ physical health, their emotional lives and their relationships — here is also a connection to dementia, researchers are finding — the Department of Veterans Affairs and veterans advocacy groups have made it their mission to inform service members returning from Iraq and Afghanistan about their PTSD risk,” according to Span. “But older veterans tend to know less about the syndrome, even as it haunts many of them. Their generation had less experience with psychotherapy, which once carried a stigma. Even now, if they do seek help, they are likely to describe their problems as physical.”
“Because post-traumatic stress syndrome can trouble veterans’ physical health, their emotional lives and their relationships — here is also a connection to dementia, researchers are finding — the Department of Veterans Affairs and veterans advocacy groups have made it their mission to inform service members returning from Iraq and Afghanistan about their PTSD risk,” according to Span. “But older veterans tend to know less about the syndrome, even as it haunts many of them. Their generation had less experience with psychotherapy, which once carried a stigma. Even now, if they do seek help, they are likely to describe their problems as physical.
“Aging itself can exacerbate the syndrome, as the sheer number of Vietnam-era vets streaming into Veterans Affairs centers for treatment in recent years seems to demonstrate. As those men (it is primarily men) experience illness, disability and bereavement, the sense of vulnerability and loss of control that arose in combat can re-emerge. Nursing homes — people in uniform, intercoms, semi-authoritarian routines and schedules — can trigger old fears.”
There is some good news on this sad front.
“Yet even veterans who have suffered quietly for decades can benefit from the contemporary treatments offered by the VA.,” the article stated.
“We can help them out,” said Dr. Steven Thorp, a research psychologist at VA San Diego Healthcare, mentioning such options as relaxation and stress reduction training, cognitive processing therapy and exposure therapy.

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Diagnosis of Dementia Isn’t an End to Making Legal Decisions

Alzheimer’s is insidious.
The definitions of that somewhat old-fashioned term in the Meriam Webster Dictionary include “awaiting a chance to entrap” and “developing so gradually as to be well established before becoming apparent.”
Those all perfectly describe Alzheimer’s disease and dementia, and it is the subtle onset of loss of memory and cognitive abilities that make these such frustrating conditions from a legal standpoint. By the time a man or woman realizes, or is willing to admit, there’s a problem, it may already be too late to take the proper steps.
“It’s important for everyone to plan for the future, but legal plans are especially important for a person with Alzheimer’s disease,” according to the website of the Alzheimer’s and Dementia Caregiver Center. “The sooner planning starts, the more the person with dementia may be able to participate. Making legal plans in advance is important for several reasons. Early planning allows the person with dementia to be involved and express his or her wishes for future care and decisions. This eliminates guesswork for families, and allows for the person with dementia to designate decision makers on his or her behalf. Early planning also allows time to work through the complex legal and financial issues that are involved in long-term care.”
“If you or a loved one has been diagnosed with Alzheimer’s disease, it is necessary to consider legal and financial matters,” a page on the website WebMD states. “People with Alzheimer’s may have the capacity to manage their own legal and financial affairs right now, but as Alzheimer’s advances, they will need to rely on others to act in their best interest. This transition is never easy. However, advance planning allows people with Alzheimer’s and their families to make decisions together for what may come.”
“Most Americans understand the importance of planning ahead for college funds, mortgages and retirement accounts” the American Association of Retired Persons Foundation website advises. “But when it comes to caring for older loved ones, most families don’t even think about it until there’s a problem. That only makes a bad situation worse. Today 30 million families provide care for an adult over the age of 50, a number expected to double in 25 years. As a result, providing care for an aging loved one will be as common in the future as providing childcare is today. If you haven’t begun to talk about creating a caregiving plan for the older ones you love with their needs and wishes in mind, now is the time.”
“There are many legal issues that should be considered when a loved one is stricken with Alzheimer’s disease,” offers the Fisher Center for Alzheimer’s Research Foundation. “Because the issues are sometimes complex and the regulations vary by state, it may be helpful to contact an elder law attorney for advice and counsel. Your local Agency on Aging can also help you understand the overall requirements and resources in your state, as well as help you locate an elder law attorney.
“Elder law attorneys focus on the special legal needs of older persons and persons with disability to protect their autonomy, quality of life and financial security as they age.” ()