What Is Hypertensive Chronic Kidney Disease and Glomerulonephritis?

Unlike an acute kidney injury (AKI), where the loss of kidney function may be reversible, chronic kidney disease is “progressive.” That means it gets worse over time. The damage to your kidneys causes scars and is permanent. Among the diseases that can cause CKD are diabetes, hypertension, glomerulonephritis and polycystic kidney disease. This post looks at glomerulonephritis.

Very Well Health’s recent article, “Causes and Risk Factors of Chronic Kidney Disease,” explains that glomerulonephritis is a group of diseases that cause inflammation of the glomeruli and nephrons. Glomerulonephritis usually affects both kidneys and can happen alone or as part of another disease.

While it’s often hard to pinpoint what triggered the inflammatory response, the causes can be broadly broken down as follows:

Focal segmental glomerulosclerosis, a group of diseases that cause the selective scarring of glomeruli
Autoimmune disorders, which either damage the kidneys directly (IgA nephropathy or granulomatosis with polyangiitis) or trigger whole-body inflammation that indirectly damages the kidneys (such as with lupus); and
Inherited disorders like polycystic kidney disease, which causes the formation of cysts in the kidneys; Alport syndrome, which damages the blood vessels of the kidneys; or Goodpasture syndrome, which damages kidney membranes.

In some cases, the cause of glomerulonephritis is never found. There are also other, less common causes of CKD in adults and children. They include the following:

Heavy metal poisoning, including lead poisoning;
Hemolytic-uremic syndrome, in which ruptured red blood cells block renal filters (occurs exclusively in children);
Hepatitis B and hepatitis C, both of which are associated with glomerulonephritis and renal vascular inflammation;
Interstitial nephritis, inflammation of the kidney tubules often related to the long-term use of analgesics or antibiotics;
Pyelonephritis, a bacterial infection of the kidneys;
Prolonged urinary tract obstruction, including an enlarged prostate, kidney stones and certain cancers;
Recurrent kidney infections; and
Reflux nephropathy, the backing-up of urine into the bladder.

In addition to known causes, CKD can often be idiopathic, meaning the cause can’t be found.

Reference: Very Well Health (July 25, 2021) “Causes and Risk Factors of Chronic Kidney Disease”

How Do I Care for a Loved One with Arthritis?

Those with arthritis know how stiffness and pain can restrict the ability to move and function properly.

VeryWell Health’s recent article entitled, “Caring for Someone With Arthritis,” says there are some things that you can do (or keep in mind) when caring for someone with arthritis. These may include the following:

Understand their condition. Have a clear understanding of your loved one’s arthritis condition. This can help you see where they may need help. For example, suppose an individual has rheumatoid arthritis that affects their hand and upper extremity movement. In that case, they may need assistance opening bottles and jars or managing fine motor tasks, like handling medication.
Keep lines of communication open. Talking with your loved one about arthritis is a great way to understand how it impacts them. You should also share your feelings about caring for them with someone, since providing care and helping someone consistently may take an emotional toll on you.
Know when to help and when to stand back. Most people with arthritis want to remain as independent as possible. Therefore, be sure your loved one has the opportunity to be as functionally independent as possible and know that they will ask for assistance when needed.
Help manage medication. Sometimes managing arthritis means managing various medicines. If your parent has difficulty keeping drugs and dosages straight—or if they physically have difficulty handling medicine—be ready to assist.
Help with managing assistive devices. Some people with arthritis need assistive devices, like canes or walkers, to get around. Sometimes using these can be hard to use. You may help by learning how their assistive device should be used and how to operate it properly.
Encourage and help with exercise. Exercise has proven to be beneficial for many with arthritis. Movement helps keep joints lubricated and muscles strong, and exercise can help maintain or improve functional mobility.

Know that your family member may have times when your care and assistance are welcomed and when they want to do it alone. Stay flexible in your care and provide help when necessary and when it is welcomed.

Reference: VeryWell Health (May 29, 2022) “Caring for Someone With Arthritis”

What Is Best Method to Set Up Digital Estate Plan?

We now live in a digital world. As a result, many things we hold dear aren’t physical. What happens to our digital assets when we die? That’s where digital estate planning comes in, explains Kiplinger’s recent article, “How to Tackle Digital Estate Planning in Four Easy Steps.”

Let’s look at the article’s four steps:

First, some digital service providers have a tool or service to designate what happens to all of your assets after you pass away. One example is Yahoo’s inactive account manager, which can be used to designate a person to guide what happens to your digital assets.
If there isn’t this type of tool, the owners’ legal documents should dictate what should be done with the asset.
Next, if these two scenarios don’t help, the service provider’s terms of service should say how the executor can access those accounts.
Before making a digital estate plan, you must understand what is included in your digital estate. Your digital estate includes all of your electronic and virtual accounts and assets, such as:

Social media accounts
Email accounts
E-commerce and online store accounts
Photos saved in the cloud
Cryptocurrency keys
Cellphone apps
Domain names, blogs, and domains
Text, graphic and audio files
Other intellectual property
Loyalty program benefits, like credit card perks
Online banking accounts; and
Gaming accounts.

Note that electronic bank accounts are also considered digital assets. However, the money in the bank account isn’t a digital asset. The same is true for cryptocurrency. The crypto account access platform, like Coinbase, is a digital asset. However, the actual cryptocurrency, such as Ethereum or Bitcoin, isn’t a digital asset.

Reference: Kiplinger’s recent article entitled, “How to Tackle Digital Estate Planning in Four Easy Steps”

What Happens to Digital Assets on Death?

You’ve probably thought about who will inherit your home, your great-grandmother’s jewelry collection and your collection of superhero comics. However,what about your digital assets, asks a recent article from Coast Reporter, “Make sure your estate plan considers your digital assets.”

Digital assets may have significant value. Digital assets include cryptocurrency, non-fungible tokens (NFTs), domain names, digital photos, digital rights to literary content, musical compositions, blog content, online video channels where your content is generating revenue, online gaming, digital online betting accounts, PayPal accounts or even prepaid subscriptions to online content or goods and services.

If your estate plan hasn’t adequately accounted for these assets, your heirs may be unable to access them. Do you and your executor even know what digital assets you own?

Having a list of your digital assets is a start. However, this doesn’t mean your executor can access the assets after your death. Photos and videos stored online may be inaccessible, social media accounts may stay online forever and heirs might not receive money or other assets you intended them to have.

The first hurdle is knowing the passwords for your accounts. Some can be accessed by cybersecurity professionals, like breaking into your phone or a laptop. However, others, like cryptocurrency keys, could be lost forever. Unless you’ve given explicit authorization to someone to access your accounts, they could violate data privacy laws, a criminal offense in most states.

Here’s a game plan for your digital assets and estate plan:

Document digital assets. Know what you own and understand that there’s a difference between owning a digital asset and owning a non-transferable license to use the asset.

Back up your digital assets. Ensure that all online documents, data and assets are backed up to the cloud and store them on a local computer or external hard drive, so your family can access them with fewer obstacles.

Leave digital assets to your spouse. This will avoid the assets being taxed and give the surviving spouse time to plan for the tax liabilities upon their death with an experienced estate planning attorney.

Provide authorization in your will. Update your will so your executor can bypass, reset or recover passwords. If your digital assets are significant enough, talk with your estate planning attorney about having a separate will to deal with digital assets and name an executor knowledgeable about digital assets for the second will.

Check-in regularly. Digital assets are still new for most people, so speak with your estate planning attorney to be sure your wills and powers of attorney reflect any changes in the law or your digital assets.

Reference: Coast Reporter (June 21, 2023) “Make sure your estate plan considers your digital assets”

Who Pays Taxes, the Estate or Heirs?

If you needed another reason to prepare an estate plan besides saving your family the time and trouble of guessing your wishes for the distribution of property, avoiding litigation among family members and maintaining control of your estate by the family and not the court, perhaps a legacy of leaving heirs an expensive tax bill could get you to make an appointment with an estate planning attorney.

According to a recent article from Forbes, “Heirs Can Be Personally Liable For Estate’s Taxes,” a recent court case involving the estate of the founder of Gulfstream, the aircraft manufacturer, presents an example of why an estate plan and a knowledgeable executor are so important.

The founder died in 2000 in an estate worth about $200 million, primarily held in a living trust. His widow and surviving children were beneficiaries of the estate and trust. Each of them had, at one time or another, acted as a trustee or executor.

The estate tax return was filed, and an election was made to pay the $4.4 million in taxes over 15 years. The estate was able to do this in installments because the main asset of the estate was a business.

The IRS said the estate was worth more than stated on the estate tax return and took the estate to court, where it won the case. The estate now owed an additional $6.7 million in estate taxes, which it also elected to pay over the course of 15 years.

Here’s where things went south. Long before the court decision, the estate was fully distributed to beneficiaries. The estate and trust no longer owned any assets. Several estate tax payments were missed. The IRS sought to collect—from the heirs. The heirs took the matter to court.

A district court sided with the heirs, saying they were not responsible for the estate’s tax obligations. However, a federal appeals court recently reversed the decision. The appeals court ruled that the tax code imposes personal liability for unpaid estate taxes on successor trustees and beneficiaries of a living trust.

The beneficiaries argued they were liable only if they received property from the trust before its creator passed or if they had control of it on the date of death. The court disagreed and said the law places liability on anyone who received or had an interest in the estate’s property, either on the date the estate owner died or at any time after that. The heirs were found personally liable for the unpaid taxes of the estate.

Trustees and estate executors should be extremely cautious about final asset distributions. Great care must be taken in assessing the potential for the IRS or state tax authorities to claim additional estate or income taxes. Until the statute of limitations passes, executors may want to retain enough assets to pay any potential additional taxes, and beneficiaries who receive final distributions from trusts or estates must be aware that they may find themselves personally liable for additional taxes.

Reference: Forbes (June 21, 2023) “Heirs Can Be Personally Liable For Estate’s Taxes”

What is a Good Exercise Routine for Seniors?

Recent studies at the Center for Exercise Medicine at the University of Alabama verified that seniors can achieve muscle growth and strength. The key is consistent effort and following a fitness scheme consisting of at least 30 minutes three times a week.

Senior Living’s article entitled, “Seventy (70) Is The New Forty (40) – Exercising Your Total Body Is Good News For Baby Boomers,” says to first consult with your doctor and make sure they give you the OK to start your fitness scheme. Then, start with the basics at a slow to moderate pace. Here’s a basic routine:

Warm up. Take a short walk for about 10 minutes to get your blood flowing, and your body loosened up.
Push Ups. Start with 5 to 10 pushups. If you cannot do regular push-ups, you can do these standing up, pushing off a wall. The modified pushups still work your chest muscles and triceps.
Stretch Bands. Hold the bands with your hands and put your elbows next to your sides, feet shoulder width. Pull the bands across your chest. Do eight reps (repetitions) to start. When you get these bands, note that they will come in various resistance strengths. Choose a band with the least resistance, then as you increase your reps to 12, move up to the next band and start over at eight reps, building back up to 12 reps.
Shoulder Exercise using Dumbbells: Dumbbells come in various sizes, starting at 2½ pounds and going up. Start with 2½- or five-pound dumbbells. Stand with your feet shoulder width, push the weights over your head and then bring them back down to the top of your shoulders. Do eight reps, and increase the weight when you build up to 12 reps.
Bicep Curls using Dumb Bells. Stand erect with your feet at shoulder width. Using 10-pound dumbbells, place them in your hands, arms by your side, palms forward. Curl the weights up to the top of your shoulders, then lower them back down to your side, keeping your palms facing out to the front and your elbows tucked into your side. Start with eight reps and work up to 12.
Tricep Extensions. While holding a 2½- or five-pound dumbbell in your right hand, bend forward at the waist slightly while placing your left leg out in front of your bent body, slightly bend your left leg. Rest your left forearm on your knee or upper thigh. Pull the dumbbell up along your right side waist-high, extend the right arm straight back and then bring it back to the side of your waist where you started. Reverse this position and do the same for your left tricep.
Squats. For beginners, use your body weight. Stand up straight, feet shoulder width, as you squat down, push your buttock out, bending slightly forward at the waist. Don’t go past a half-squat position. Start with eight reps and work up to 12 reps.
Lunges. Start with no weights. Stand up straight, extend your left foot, bend both knees simultaneously, and go down as far as possible. Don’t overextend yourself. Remember also that you need to concentrate on your balance. Return to your starting position. Do eight to 12 reps. Repeat this for your right leg. Don’t consider using weights for lunges, until you can do 25 reps per leg.

Reference: Senior Living (March 30, 2021) “Seventy (70) Is The New Forty (40) – Exercising Your Total Body Is Good News For Baby Boomers”

How is the VA Handling Aging Veterans?

The Department of Veterans Affairs and veterans organizations across the country are working to care for a new generation of older veterans who are apt to have greater expectations for longevity and independence than earlier generations, yet also may struggle with more complex medical conditions, reports Military Times’ recent article entitled, “America faces a tidal wave of aging military veterans.”

“We’re kind of compounding multiple variables, in the sense that not only are people living longer, but … many of them survived something that wasn’t survivable,” says Scotte Hartronft, the director of geriatrics and extended care at VA. “A lot of veterans have survived significant injuries over the last couple of conflicts that [they] wouldn’t have survived in previous wars.”

In California, the most populous state and home to the highest number of vets, the State Department of Veterans Affairs, known as CalVet, the state’s veterans department, is working to create a modern facility that centers the needs and dignity of older veterans. Like VA facilities across the country, people charged with caring for veterans must address the same question: How do we best care for those who have served on our behalf as they grow old?

Other states also have issues: between 2021 and 2041, the number of veterans older than 85 is expected to increase by 31%. That’s partially because the overall number of veterans nationwide is actually decreasing. Between 2000 and 2018, the number of veterans in the country declined by a third — the bulk of Americans who have served in the military served decades ago.

Vietnam and Gulf War-era veterans represent a different slice of the population than veterans who fought in World War II and Korea: the number of women veterans over 65 is expected to increase by 237% between 2021 and 2041. Racial diversity is also increasing, and the geographic distribution of veterans is shifting. As a result, veterans’ care must change. Women, for example, have a greater life expectancy than men do. Women veterans will generally need more support to continue to live independently as they age for longer — a fact compounded by the fact that women, who tend to be informal caregivers to friends and family, often have more difficulty than men finding their caregivers when needed.

In addition to higher rates of post-traumatic stress and other conditions affecting mental health, veterans are more likely to be exposed to risk factors, such as traumatic brain injuries or toxic exposure, for Alzheimer’s and other dementias. Vets also have a higher chance of being diagnosed with certain types of cancer, like lung and skin cancer. Roughly 50,000 new cancer cases among veterans are reported annually; that number is expected to rise as veterans age.

Every VA medical center will offer veteran-directed care within the next two years. This popular program provides qualified veterans with a stipend to hire local caregivers to assist them with daily living or even companionship. VA is expanding home-based primary care — which provides health care to veterans at home, many of whom are housebound — to 75 new sites and expanding its Medical Foster Care program. This lets some vets live in a private home with a caregiver rather than in a nursing home. They’re also piloting a program using predictive analytics to help determine which veterans are at the highest risk of nursing home care in the coming years to connect them with preventive services.

Reference: Military Times (June 2, 2023) “America faces a tidal wave of aging military veterans”

What’s the Best Way to Find the Right Assisted Living Facility?

News 19 Alabama’s recent article entitled “How To Choose the Right Assisted Living Facility,” provides some valuable tips for researching assisted living facilities and finding the best option for you:

Get recommendations. Ask friends, family and your doctor about assisted living facilities in the area and if they would recommend them. If someone you know lives in an assisted living facility, ask them how they like it, as their experience can provide insight into what facilities have the best reputation in your local area.

Consider your needs. Residents in assisted living facilities typically need assistance with some basic activities of daily living. This includes bathing, dressing, eating, and getting around. Some assisted living communities specialize in caring for people with specific conditions, such as Alzheimer’s. The level of care assisted living facilities offer can vary greatly, so consider how much assistance you require.

Consider the cost. Remember that Medicare doesn’t cover assisted living costs, which is why most people pay with private funds even though it’s expensive.

Consider location. A facility near friends and families is often the best choice. This lets residents receive lots of visitors. Employees will also see that the resident’s visitors scrutinize their care.

Ask questions. Before calling assisted living facilities, consider these questions:

How many residents live at the facility?
Are pets allowed?
What amenities are available to residents?
Are there personalized care plans for each resident?
How are additional services billed?
Are there doctors, nurses, pharmacists, physical therapists, housekeepers, cooks, and activity directors on staff?
Does the facility run background checks on staff?
What happens if a resident’s health deteriorates and needs additional care or a hospital stay?
What safety features does each residential unit feature?
What is the staff-to-resident ratio during the day and at night?
What are the meals the facility serves?
Are all utilities included in the overall cost of a unit?

Take note when you visit. When you tour a facility, look at the cleanliness, activities, safety features, available common areas, the friendliness of the staff and how healthy and happy the residents appear.

Compare several facilities before you decide. Don’t just choose the first facility you visit. Instead, tour several facilities and compare them.

Carefully examine contracts. Read assisted living contracts from start to finish and look for unexpected fees or deposits. Yous should also pay attention to the rules regarding discharging or evicting a resident, late or missed payments and how the facility handles (or limits) your rights to file a lawsuit should there be an issue.

Reference: News 19 (May 14, 2023) “How To Choose the Right Assisted Living Facility”

What is the Purpose of a Blind Trust?

One type of trust offers a layer of separation between the person who created the trust and how the investments held in the trust are managed. The trust’s beneficiaries are also unable to access information regarding the investments, says the article “What is a Blind Trust?” from U.S. News & World Report.

The roles involved in a blind trust are the settlor—the person who creates the trust, the trustee—the person who manages the trust—and beneficiaries—those who receive the assets in a trust.

Blind trusts, typically created to avoid conflicts of interest, are where the settlor gives an independent trustee complete discretion over the assets in the trust to manage, invest and maintain them as the trustee determines.

This is quite different from most trusts, where the owner of the trust knows about investments and how they are managed. Beneficiaries often have insight into the holdings and the knowledge that they will eventually inherit the assets. In a blind trust, neither the beneficiaries nor the trust’s creator knows how funds are being used or what assets are held.

Blind trusts can be revocable or irrevocable. If the trust is revocable (also known as a living trust), the settlor can dissolve the trust at any time.

If the trust is irrevocable, it remains intact until the beneficiaries inherit the entire assets, although there are some exceptions.

In some instances, irrevocable trusts are used to move assets out of an estate. Settlors lose control over the holdings and may not terminate the trust or change the terms.

Blind trusts can be used in estate planning if the settlor wants to limit the beneficiaries’ knowledge of the trust assets and their ability to interfere with the management of the trust.’

People who win massive lump sums in a lottery might use a blind trust because some states allow lottery winners to preserve their anonymity using this type of trust. They draft and sign a trust deed and appoint a trustee, then fund the trust by donating the winning ticket to the trust prior to claiming the prize. By remaining anonymous, winners have some protection from unscrupulous people who prey on lottery winners.

One drawback to a blind trust is the lack of knowledge about how investments are being handled. The blind trust also poses the issue of less accountability by the trustee, since beneficiaries have no right to inspect whether or not assets are being managed properly.

Do you need a blind trust? Speak with an experienced estate planning attorney to discuss whether or not your estate would benefit from a blind trust. If you want to separate yourself from investment decisions or would rather beneficiaries don’t know about the holdings, it might make sense. However, if you have no concerns about privacy or conflict of interests, other types of trusts may make more sense.

Reference: U.S. News & World Report (June 1, 2023) “What is a Blind Trust?”

How Do I Start Saving for Retirement, if I’ve Been Lazy?

Many people think that time is running out for them to save.

Most Americans (66%) worry that if they don’t increase their retirement savings soon, it will be too late for them to have a comfortable retirement.

This is up from 61% last year, reports Forbes’ recent article, “It’s Not Too Late to Save for Retirement: Five Ways to Step It Up.”

Take advantage of all benefits through your employer. Your employer likely has benefits to help you save for retirement. Many employers offer to match employee contributions to their 401(k) plans. An easy way to increase your savings is to make sure you contribute enough to get the full match.

Failing to contribute enough to get the full match is like throwing away free money. Some employers also offer programs to help employees receive matching funds without reaching the contribution threshold. For example, starting in 2024, a provision in the SECURE 2.0 Act will let employers match contributions to retirement savings for the amount employees pay back in student loans.

Increase savings by 1%. The best way to have more in savings is to save more. A good strategy is to increase your contributions to retirement savings accounts by 1% every year.
Convert savings into a Roth IRA. One way to control taxes on your savings is to convert it into a Roth IRA. Many retirement savings are made in tax-deferred accounts like a 401(k) or IRA. Taxes will be due when you begin withdrawing from those accounts to fund your retirement, so converting those funds into a Roth account and paying taxes now can help lower your taxes and increase your retirement nest egg.
Consider where you’ll retire. Your take-home retirement income will vary based on where you live. If you worry about stretching your savings, living in a low-tax state could help. Eight states have no income taxes (Alaska, Florida, Nevada, South Dakota, Tennessee, Texas, Washington, and Wyoming). They don’t tax wages, salaries, dividends, interest, or any income, including Social Security benefits.
Make catch-up contributions. If you are 50+, the IRS lets you contribute additional money to 401(k) and IRAs above the standard limit. This can help increase your savings in tax-advantaged accounts.

Reference: Forbes (June 5, 2023) “It’s Not Too Late to Save for Retirement: Five Ways to Step It Up”

Estate Planning Blog Articles

Estate & Business Planning Law Firm Serving the Providence & Cranston, RI Areas

What Is Hypertensive Chronic Kidney Disease and Glomerulonephritis?

How Do I Care for a Loved One with Arthritis?