Estate Planning Blog Articles

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How to Protect Your Spouse when Diagnosis Is Dementia

Few illnesses are as terrifying as dementia, for which there is no cure. If estate planning is in place, it may need to be adjusted to address new, more imminent issues. Reviewing the family situation from a legal and financial aspect is critical, and there is no time for delay, explains a recent article from Morningstar, “’I don’t want my wife to lose everything’: I’ve been diagnosed with dementia –I suddenly could not spell or write legibly.”

There are a number of steps to be taken to smooth the path ahead. First is to update your will and create a financial power of attorney. Don’t try to do this without the help of an experienced estate planning attorney.

This may also be the time to reassess your investment portfolio based on your new financial plan and risk tolerance.

An Advanced Healthcare Directive will inform doctors what actions you want them to take when you cannot make those decisions for yourself. You may want to list your wife as your healthcare proxy to carry out these decisions, but be mindful of the pressures put on a marriage when serious healthcare issues occur. Your spouse will need emotional support as well, and you’ll want to have a successor to your spouse for both the healthcare and POA documents.

Share your situation with trusted family and friends to create a team–a community of people who can provide support, part of which will be updating beneficiaries. Now would also be the time to record instructions for access to devices, documents, and even daily habits.

Long-term care insurance will help with expenses and should serve as an example for anyone reading this article. Policies should be purchased early in life when they are relatively affordable to help alleviate the financial burden of nursing home costs.

An estate planning attorney and financial advisor will help you take an accounting for assets, expenses, and projected long-term care costs. You’ll want a team approach to provide as much guidance as possible.

When to put your long-term care policies into payout status is a difficult decision. You’ll need to time this with a Medicaid plan, which your elder law estate planning attorney will be able to help with.

Now may also be the time to create a trust and divest assets to make it through the five-year Medicaid look-back, using your long-term care policy in the next five years.

There are exceptions to the five-year look-back rule for Medicaid eligibility. They include paying off debts, buying medical devices, or making home improvements to improve accessibility. However, eligibility depends upon income and other assets.

Some states, including Florida and New York, have rules exempting homes from assets calculated by Medicaid under certain circumstances. California eliminated an asset limit this year, making a person’s home automatically safe from Medicaid while they are living, but this does not mean it’s exempt from the Medicaid Estate Recovery Program.

Working with a team of professionals, including an estate planning attorney, and having the support of family and trusted friends will be important as time goes by and the disease progresses.

Reference: Morningstar (Feb. 25, 2024) “’I don’t want my wife to lose everything’: I’ve been diagnosed with dementia –I suddenly could not spell or write legibly”

How Can Older Adults Not Get Scammed?

Everyone becomes more vulnerable to scams and financial abuse as we age into our later years, reports a recent article from Kiplinger, “Seven Ways to Protect Older Adults from Financial Abuse.” Older people are swindled out of more than $3 billion every year, and more than 3.5 million people are victims of financial exploitation every year. Protecting financial well-being requires prevention, which also applies to younger adults.

Maintain a heightened awareness level. Talk with family members about the potential risks from thieves, online and in real life. Know that exploitation by family members is just as likely, sometimes more so, than by strangers.

Maintain open communication. Just like meeting with an estate planning attorney regularly to ensure legal affairs are in order, check in with trusted loved ones about their financial status regularly. Talking about money among families can be challenging, depending on the family’s history and dynamics. Nevertheless, an open and ongoing dialogue will help with early detection and prevention of financial abuse.

Arrange for a Durable Power of Attorney. The person selected as a Power of Attorney (POA) should be trustworthy and capable of managing finances in case of incapacity. Talk with your estate planning attorney about whether you need to apply certain limitations for your POA or if it should be a broad document. If you are a “solo ager,” you may want to ask your estate planning attorney to act as your POA.

Make sure your estate planning is in order. Estate planning is an essential area of protection for people of any age, especially older adults. If your will, trust, or estate planning documents have not been updated in more than four years, it’s time to make an appointment with your attorney. There are many legal options for safeguarding assets and ensuring that your wishes are followed.

Monitor accounts regularly. Reviewing monthly statements from investments, banks and other accounts is essential for protecting assets. A few simple steps can avert fraud, including freezing credit, setting stricter controls on social media and setting phones to send unknown callers to voicemail.

Signing up for financial account and credit monitoring helps detect irregularities or unauthorized transactions. Allowing a trusted loved one to monitor accounts may make sense, depending on support needs and comfort level.

Safeguard personal information. If you’re using your birthday or your pet’s name as a password, it’s time for new passwords. The digital world has increased risks, and endless scammers with highly technical skills exist. Consider using two-factor authentication where possible—you can’t get into your account until you confirm with a code sent to your phone, text, or email. It is an added step and effective in protecting accounts.

Stay Up to Date on Scams. Financial scams come and go in waves, like fashion. Some people still receive emails about having been chosen by an overseas family who needs to bring huge wealth to America. Others have been targeted by romantic scammers on dating websites. There are Medicare scams, charity scams, IRS impersonation scams, sweepstakes scams and grandparent scams. In other words, thieves try to access accounts and funds in many ways. Be vigilant!

Reference: Kiplinger (Jan. 8, 2024) “Seven Ways to Protect Older Adults from Financial Abuse”

Florida Guardianship Case Raises Red Flag for Estate Planning

No one likes to think of themselves as being older and vulnerable. However, for one Florida man, a medical crisis and the lack of family nearby led to a terrible series of events. The article’s title, from The Washington Post, sums it up: “The retired pilot went to the hospital. Then his life went into a tailspin.”

The former pilot pulled his Ford Mustang convertible into a gas station and appeared so distressed that someone called 911. He was taken to a nearby hospital, where doctors said he had a stroke. He lived alone, as three out of five Americans in their 80s now do. There didn’t seem to be any family members to call. The hospital went to court and argued that the pilot needed a guardian. The judge agreed.

This is not an unusual situation. More than one million Americans are under guardianship, which has been widely criticized for inviting abuse and theft. As Americans age, there is more focus on this arrangement, but few solutions. This man was like many seniors who relocate far from family, and when they show up alone in emergency rooms, they are at risk of falling into the guardianship system.

The court-appointed guardian sold his home for a very low price to a neighbor who was a realtor. An inspector general’s investigation later found “probable cause” for the exploitation of an elderly person and a scheme to defraud. However, the guardian denied any wrongdoing, and there was no criminal investigation.

As it turned out, the pilot, who never married or had children of his own, did have a family. In the past, he had regularly visited his sister, her spouse and a niece and nephew in the Philadelphia area. The visits stopped when his sister developed dementia and died in 2018. His niece said he became harder to reach but eventually would respond to calls and emails until he entered the hospital and no one heard from him.

After the stroke, he was unable to tell anyone to call his family. It’s not clear how hard the hospital tried to reach any relatives.

Like most senior patients, the pilot was covered by Medicare, which pays the hospital by diagnosis, not by length of stay. Generally, in this part of Florida, Medicare pays $23,000 for an elderly stroke patient, assuming a five-day stay. After that, the hospital begins to lose money. Putting a new patient in the same bed would bring in thousands of dollars a day.

The guardian began liquidating his possessions, selling his cars, gun collection, camera equipment and more at an estate sale. She then sold his home before it even went on the market with a private arrangement with a husband and wife real estate team who lived in her community. She sold it to them for at least $100,000 under market value.

While this was happening, a woman who had become an unpaid citizen watchdog after her own father’s horrible guardianship experience uncovered the case, finding court papers about the sale of the house and seeing the undervalued sale. She filed a complaint with the office regulating guardians, hoping it would draw scrutiny to the situation.

At the same time, the pilot’s niece and nephew were searching for their uncle, including writing a letter to the court. However, months went by without a response. Their letter to the court finally got to someone, and the guardian called the nephew. They were happy to establish contact with their uncle, talking with him on FaceTime calls, but had questions the guardian did not answer.

In July 2022, the inspector general’s office issued a critical report stating the guardian had used a “deficient, deceptive and fraudulent” market analysis submitted by the real estate agent. The home was “undervalued and not publicly advertised.” The inspector general’s office urged law enforcement to look into the handling of this home and two other homes the guardian had sold with the same real estate agents. Sadly, the pilot died two days after the state declined to pursue a criminal investigation.

To protect yourself and your family, speak with an estate planning attorney about the documents you need during life: Power of Attorney, Health Care Proxy, trusts, a will and, equally importantly, creating a plan for contact with family members, no matter the status of your relationships.

Reference: The Washington Post (Nov. 4, 2023) “The retired pilot went to the hospital. Then his life went into a tailspin”

Should I Consume Olive Oil Every Day?

A study presented at NUTRITION 2023, the annual meeting of the American Society of Nutrition, looked at how olive oil intake and dementia-related death could potentially be connected. Prevention’s recent article, “Olive Oil Linked to Lower Risk of Dying From Dementia, Study Shows,” reports that researchers looked at data from more than 90,000 Americans—60,582 women and 31,801 men. The study took place over 30 years in which 4,749 participants died from dementia.

Researchers found that participants who consumed more than ½ a tbsp of olive oil each day had a 28% lower risk of dying from dementia than individuals who never or rarely consumed olive oil. They also saw that switching 5 g (or about 1 tsp) a day of margarine or mayonnaise for olive oil was linked to an 8–14% lower risk of dementia-related death.

The study noted that those who died of dementia were more likely to be APOe4 carriers, a gene that increases the risk of Alzheimer’s disease. However, they said the results were still consistent after adjusting for the genetic risk factors.

These findings suggest that olive oil may have beneficial properties for brain health and may play a part in lowering the risk of dementia-related death.

With its antioxidants and powerful anti-inflammatory compounds, olive oil has many health-protective benefits. Generally, olive oil may help reduce the risk of heart disease, boosting gut health, protecting brain health, and improving health parameters, like A1C levels associated with type 2 diabetes.

Diets like the Mediterranean diet that are rich in unsaturated fats have been found to have cardiovascular health benefits. Plus, studies have found that this diet plays a role in reducing the risk of cognitive decline in individuals at risk of dementia.

“Because olive oil is a source of unsaturated fat and a major component of the Mediterranean diet, incorporating olive oil into a healthy lifestyle may provide additional cardiovascular and brain health benefits,” the article explained.

Compared with rarely or never enjoying olive oil, having more than 1½ tsp of olive oil a day may be linked with a 25% reduced risk of fatal dementia. So, keep a small bottle of extra-virgin olive oil on the table so it’s available for drizzling onto your meals for its various health-protective benefits.

Reference: Prevention (July 29, 2023) “Olive Oil Linked to Lower Risk of Dying From Dementia, Study Shows”

How Do I Make a Care Plan for Mom?

Medicare typically doesn’t pay for basic assistance, and families often don’t try to determine how to provide this care until there is a health crisis, which can lead to unnecessary stress, conflicts and escalating costs.

Nerd Wallet’s recent article, “Create a Care Plan for Older Parents (or Yourself),” says that making a care plan well in advance lets families organize, locate appropriate resources and determine ways to pay for care before a crisis hits.

A care plan is thinking through the logistics of what you’ll need as you age, so that you are prepared when the poop hits the fan with aging. A way to cope is to plan for temporary rather than permanent disability. Ask what kind of help you or your loved one might need after a hip or knee replacement. How well is the home set up for recovery? Who would help with household tasks? Contemplating a two- or three-month disability with an eventual return to health is less daunting but involves much of the same planning as a more lasting decline.

Many seniors would like to stay in their current homes as they age, something called “aging in place.” That typically means relying on family members for care, using paid workers, or both. However, if family members will be tapped, discuss the logistics, including whether and how much they will be paid. If home health aides will be hired, consider who will supervise the process.

Look at any savings that can be tapped and whether the senior may qualify for government help, such as veterans benefits, Medicaid, or state programs. Families may want to consult an elder law attorney for personalized advice.

It is important to look at the current home as “aging friendly.” An occupational therapist can suggest adaptations allowing the older person to remain in the home if they’re disabled. The sooner you get this evaluation, the more time you’ll have to prepare. Even if the home supports aging in place, the neighborhood might not. Consider how the older person will socialize, get groceries, and make it to health appointments if they can no longer drive.

An independent living or senior living facility could provide more amenities. However, these typically don’t provide long-term care. Therefore, see if the senior is okay with moving again later or whether they should begin with an assisted living or continuing care facility that can provide more help.

Once you have a plan, capture the details and share it with family members or others who may be involved. Revisit the document periodically as circumstances change. Aging planning is an ongoing process.

Reference: Nerd Wallet (Aug. 24, 2023) “Create a Care Plan for Older Parents (or Yourself)”

How to Plan Ahead in Case a Loved One Has Dementia

Have the conversation about dementia, says The Tribune-Democrat’s recent article entitled, “Dealing with dementia | Planning ahead: ‘Have the conversation.’” Next, get the legal documents and define the future care. Note that the documents’ provisions are ineffective, until the person cannot make their own decisions.

Having the documents in place can help prevent the person from being placed in guardianship by the court. If they have no advance healthcare directives, the family or caregivers must apply to the court for guardianship if incapacity can be proven. When granted, the court appoints a decision-maker, taking away the individual’s ability to make decisions – either in whole or in part. This court oversight continues throughout the individual’s life.

Advanced directives, like a living will, health care power of attorney and financial power of attorney, allow those facing dementia to make their own decisions while they still have the capacity. Family members and potential caregivers should encourage their loved ones to act and get these important documents in place.

An advanced health care directive can include both a living will, which makes known what end-of-life care the individual wants, and a health care power of attorney, which assigns an agent to carry out the individual’s wishes when making health care decisions. The document states goals and values on which to base the decisions. It doesn’t take away the individual’s rights to make those decisions and can cover a broad range of medical decisions, or it can be narrow and limit the types of decisions.

The documents can be revoked anytime but don’t expire until the individual dies. The agents also don’t become personally responsible for the individuals’ debts. Careful consideration should be used in choosing the agent, which can be a family member or other trusted person. The agent should be capable and have a good relationship with the person.

A financial power of attorney is similar. It names an agent and doesn’t take away the individual’s decision-making ability. It ends with death and can be revised anytime. It can include handling money, checks, deposits, property sales and pursuing legal action. However, changing beneficiaries of insurance or making gifts requires specific instructions.

The agent selected should be a person who understands the individual’s feelings and point-of-view and is trusted to respect the individual’s wishes. They should be adept at handling their finances, as financial management becomes very important regarding where you will stay.

Reference: The Tribune-Democrat (July 29, 2023) “Dealing with dementia | Planning ahead: ‘Have the conversation’”

Will Exercise Help My Memory?

The study, published in the Journal of Epidemiology & Community Health, looked at data from nearly 4,500 people in the UK who had activity monitors attached to their thighs for 24 hours a day over the course of a week. Researchers analyzed how their activity levels impacted their short-term memory, problem-solving skills and ability to process things.

Prevention’s recent article entitled, “These 5 Exercises Boost Brain Health and Improve Memory, Study Finds,” reports that the study found that doing moderate and vigorous exercise and activities—even those that were done in under 10 minutes—were associated with much higher cognition scores than people who spent most of their time sitting, sleeping, or doing gentle activities.

The researchers found that people who did these workouts had better working memory (the small amount of information that can be held in your mind and used in the execution of cognitive tasks) and that the biggest effect was on executive processes, like planning and organization.

However, those who spent more time sleeping, sitting, or only moved a little instead of doing moderate to vigorous exercise had a 1% to 2% drop in cognition.

“Efforts should be made to preserve moderate and vigorous physical activity time, or reinforce it in place of other behaviors,” the researchers wrote in the conclusion.

Working out regularly can also lower your risk of cognitive decline and dementia. Exercise activates skeletal muscles that are thought to release hormones that communicate with your brain to influence the health and function of your neurons, i.e., cells that act as information messengers, Malin says.

“This could, in turn, promote growth and regeneration of brain cells that assist with memory and cognition,” he says.

The CDC recommends that most adults get at least 150 minutes a week of moderate-intensity exercise. You can walk your dog if you have one, as a study found that dog owners walk, on average, 22 minutes more every day than people who don’t own dogs.

However, the latest study suggests that more vigorous activities are best for your brain. Getting your heart rate up is key. That can include doing exercises like jogging, swimming, biking on an incline and dancing.

Reference: Prevention (Jan. 28, 2023) “These 5 Exercises Boost Brain Health and Improve Memory, Study Finds”

What’s the Latest on VA’s Coverage of New Alzheimer’s Drug?

The VA has announced that it will cover Leqembi, a monoclonal antibody therapy made by pharmaceutical companies Eisai and Biogen, for veterans in the disease’s early stages. This makes the VA the first and largest health program in the country to endorse the treatment, reports’ military.com in its recent article entitled, “VA to Cover New Drug for Early Stage Alzheimer’s Disease.”

In January, the FDA granted accelerated approval for Leqembi, also known as lecanemab, when research showed that the medication slowed the physical and mental decline in some patients with early Alzheimer’s by as much as 27%. Although research is ongoing on the treatment’s effectiveness, the drug is among the first to show that it reduces beta amyloid — the toxic protein that contributes to the development of Alzheimer’s — in the brain.

“This treatment option is the latest therapy to target and affect the underlying disease process of Alzheimer’s instead of only treating the symptoms of the disease,” said Dr. Billy Dunn, director of the Office of Neuroscience in the FDA’s Center for Drug Evaluation and Research, during the accelerated approval announcement.

The VA treats about 168,000 veterans with Alzheimer’s, some of whom are in the early stages. Leqembi has an estimated cost of $26,500 a year, and a two-milliliter dose at the VA will cost the department $194.63. A five-milliliter dose will cost $486.57, according to the department’s National Acquisition Center Contract Catalog.

According to VA Press Secretary Terrence Hayes, the drug will be available only at the request of a provider to vets who “most closely align with” patients who meet the selection criteria for clinical trials. This means that the VA patients must meet the same demographic and health history standards as those studied by the manufacturers.

“Each dose of the medication administered for each patient will be tracked and monitored for safety and appropriateness of use, in real-time, by VA’s Center for Medication Safety,” Hayes said in an email to Military.com. “VA will continue to monitor the clinical evidence and safety data for this agent and adjust the criteria for use as appropriate. VA also has capabilities and safeguards in place that are very different from the private sector, such as the ability to conduct real-time medication-use evaluations that will allow for continued safe use of the medication.”

Leqembi is approved for use only in patients with early Alzheimer’s with a “confirmed presence,” via a brain scan, of beta amyloid.

Reference: military.com (March 14, 2023) “VA to Cover New Drug for Early Stage Alzheimer’s Disease”

Use Estate Planning to Prepare for Cognitive Decline

Since 2000, the national median age in the U.S. has increased by 3.4 years, with the largest single year gain of 0.3 years in 2021, when the median age reached 38.8 years. This may seem young compared to the life expectancies of older Americans. However, the median age in 1960 was significantly lower, at 29.5 years, according to the article “Don’t Let Cognitive Decline Derail Well-Laid Financial Plans” from Think Advisor.

An aging population brings many challenges to estate planning attorneys, who are mindful of the challenges of aging, both mental, physical and financial. Experienced estate planning attorneys are in the best position to help clients prepare for these challenges by taking concrete steps to protect themselves.

Individuals with cognitive decline become more vulnerable to potentially negative influences at the same time their network of trusted friends and family members begins to shrink. As people become older, they are often more isolated, making them increasingly susceptible to scams. The current scam-rich environment is yet another reason to use estate planning.

When a person is diagnosed with Alzheimer’s or any other form of dementia, an estate plan must be put into place as soon as possible, as long as the person is still able express their wishes. A diagnosis can lead to profound distress. However, there is no time to delay.

While typically, the person may state they wish their spouse to be entrusted with everything, this has to be properly documented and is only part of the solution. This is especially the case if the couple is close in age. A secondary and even tertiary agent needs to be made part of the plan for incapacity.

The documents needed to protect the individual and the family are a will, financial power of attorney, durable power of attorney and health care documentation. In addition, for families with more sophisticated finances and legacy goals, trusts and other estate and tax planning strategies are needed.

A common challenge occurs when parents cannot entrust their children to be named as their primary or secondary agents. For example, suppose no immediate family members can be trusted to manage their affairs. In that case, it may be necessary to appoint a family friend or the child of a family friend known to be responsible and trustworthy.

The creation of power of attorney documents by an estate planning attorney is critical. This is because if no one is named, the court will need to step in and name a professional guardian. This person won’t know the person or their family dynamics and may not put their ward’s best interests first, even though they are legally bound to do so. There have been many reports of financial and emotional abuse by court-appointed guardians, so this is something to avoid if possible.

Reference: Think Advisor (April 21, 2023) “Don’t Let Cognitive Decline Derail Well-Laid Financial Plans”

Is Low Bone Mineral Density Linked to Dementia?

In a study of community-dwelling older adults, every standard deviation lower BMD at the femoral neck was linked with a 12% higher risk for developing all-cause dementia, says Mohammad Arfan Ikram, MD, PhD, of Erasmus University Medical Center in Rotterdam, The Netherlands, and colleagues.

MedPage Today’s recent article entitled, “Osteoporosis: Another Dementia Predictor?” says that each standard deviation lower for femoral neck BMD was also linked with a 14% higher risk for Alzheimer’s disease during the 11-year follow-up, the group wrote in Neurology.

When the researchers looked at only the first decade of follow-up, older adults falling into the lowest group of BMD in the femoral neck had a twofold higher risk for dementia than those in the highest tertile. In the first 10 years, those in the lowest tertile for trabecular bone score and total body BMD also saw a significantly higher risk for developing all-cause dementia. However, when expanding to the entire follow-up period, only low femoral neck BMD was still significantly connected with dementia onset.

“Low bone density and dementia are two conditions that commonly affect older people simultaneously, especially as bone loss often increases due to physical inactivity and poor nutrition during dementia,” noted Ikram. “However, little is known about bone loss that occurs in the period leading up to dementia. Our study found that bone loss indeed already occurs before dementia and thus is linked to a higher risk of dementia.”

“Previous research has found factors like diet and exercise may impact bones differently as well as the risk of dementia,” Ikram added. “Our research has found a link between bone loss and dementia, but further studies are needed to better understand this connection between bone density and memory loss.”

“It’s possible that bone loss may occur already in the earliest phases of dementia, years before any clinical symptoms manifest themselves,” he explained. “If that were the case, bone loss could be an indicator of risk for dementia and people with bone loss could be targeted for screening and improved care.”

The researchers also noted that prior data suggested a link between low femoral neck BMD with structural brain changes, which may be a major driver of elevated dementia risk. These changes include declined white matter volume, increased white matter hyperintensity volume, the occurrence of silent brain infarction and progression of parenchymal atrophy.

In addition, it’s possible that these individuals experienced some loss of cognition that subsequently lead to poorer dietary nutrition and lifestyle habits.

Reference: MedPage Today (March 22, 2023) “Osteoporosis: Another Dementia Predictor?”