What Is Elder Law?

Estate planning concerns distributing assets after one dies, including the use of last wills, trusts and preparing the estate to minimize assets passing through probate. Elder law is more focused on protecting the individual during their lifetime.

Elder law provides people with legal rights and protections, as they become older and become vulnerable. The field of elder law covers a range of issues impacting seniors, including long-term care planning options, end-of-life and estate planning and problems including nursing home abuse or neglect. There are a variety of issues for which seniors benefit from legal assistance, says a recent article titled “Elder Law: A Complete Guide” from Forbes.

Medicare Planning and Social Security. An elder law attorney can help seniors understand their options to maximize Social Security benefits. Claiming benefits before full retirement age results in a reduction in monthly benefits, while a delayed claim leads to a larger monthly income. Signing up for Medicare can be daunting, with so many options and decisions to be made. An elder law attorney can help get it right the first time.

Incapacity Planning. While one can become incapacitated at any time in life, the chances of becoming physically or mentally impaired increase as one ages. Having a living will allows you to specify what kind of medical treatments you want to accept or decline. A durable power of attorney allows you to name an agent to control your assets, and a healthcare power of attorney lets another person make medical decisions on your behalf.

Guardianship. If no incapacity planning has been done and action needs to be taken on your behalf, the court will assign a guardian. This could be a family member, or if none is available or the court does not deem the family member to be a good candidate, a professional guardian might be assigned.

It takes time for a person to be declared legally incapacitated and for a guardian to be appointed. The process can be costly and is stressful for all concerned.

Long-Term Care Planning. Someone turning 65 today has as much as a 70% chance of needing some type of long-term care during their lifetime. Long-term care planning addresses making decisions in advance for having care at home or moving into a nursing home for rehabilitation or as a permanent resident. Long-term care planning includes planning for Medicaid and protecting assets.

Elder Abuse Laws. Unfortunately, seniors are vulnerable to abuse, especially when they must rely on others for care. Elder abuse laws exist to protect you from physical, mental, emotional, sexual, or financial abuse. An elder abuse claim can be pursued to recover compensation for medical bills, loss of assets, emotional distress, or physical pain.

An elder law attorney can help create a plan to address issues and protect those who are lucky enough to enjoy a long life.

Reference: Forbes (Jan. 11, 2023) “Elder Law: A Complete Guide”

Can a Dementia Patient Sign Legal Documents?

Once a diagnosis of dementia has been received, families need to immediately begin advance care planning, as explained in a recent article titled “Can Someone With Dementia Sign Legal Documents” from Health News. Depending on their medical condition, some patients with dementia, particularly in early stages, may be capable of making their own decisions regarding legal decisions. However, discussions must begin early, so the person can be involved and understand the planning process.

When family members don’t know the wishes of their loved ones, they are more likely to experience distress and difficulties in making decisions. Families report feelings of guilt, self-doubt and stress while making advance care decisions with no input from their loved ones.

Laws concerning advance care vary from state to state. An elder law attorney can help older adults interpret state laws, plan how their wishes will be carried out and understand financial options.

Advance care planning focuses on both long-term care and planning for funeral arrangements. These documents typically include a durable power of attorney for healthcare, a living will and Do-Not Resuscitate orders, often called a DNR. Depending on state law, there may also be a MOLST document, short for Medical Orders for Life-Sustaining Treatment.

The durable power of attorney for healthcare names another person who can serve as a proxy for the person with dementia, if and when the person is not able to make informed healthcare decisions for themselves.

A living will states a person’s wishes for end-of-life treatment. This documents their views about specific medical procedures including but not limited to dialysis, tube feeding or blood transfusions. If the person should become unconscious, then families may make treatment decisions based on what their loved one wanted.

A Do-Not-Resuscitate order is placed in a patient’s medical chart if the person does not want to receive CPR (cardiopulmonary resuscitation) if their heart stops or breathing ceases. This must be signed by a doctor before it is placed in the chart.

Planning for a funeral is a difficult task. However, it will alleviate stress and possible guilt in the future. People with dementia can tell their loved ones in advance what they want regarding a funeral or memorial service, burial, or cremation. If any arrangements are already in place, such as the purchase of a burial plot, providing details to family members will make it easier to manage.

Advance care planning can be a sensitive topic but seeking legal advice early on is useful so the family can focus on making sure their loved one has the care they want. Involving the person with dementia in the process is respectful. An elder lawyer attorney will be able to guide the family to ensure planning is done properly.

Reference: Health News (Jan. 11, 2023) “Can Someone With Dementia Sign Legal Documents”

What Documents are Included in Advance Care Planning?

Starting discussions earlier helps ensure that a person with dementia stays involved and understands the planning process. In the same fashion, regular reviews of plans over time are beneficial for ensuring that their wishes are carried out.

Health News’ recent article entitled “Can Someone With Dementia Sign Legal Documents?” cautions that, when family members don’t know the preferences of their loved one, they have difficulties and stress in making decisions. Family members may also have feelings of guilt, self-doubt and stress while making advanced care decisions.

Laws in each state may differ. Working with an experienced elder law attorney can help seniors interpret state laws, plan how wishes should be carried out and understand financial options.

Geriatric care managers, trained social workers, or nurses can also offer support to those living with dementia, as well as their families.

While advance care planning, families and their loved ones with dementia should create a plan for long-term care and plan for funeral arrangements in advance.

Advance care planning documents commonly include the following:

A durable power of attorney for healthcare names someone to function as a proxy for the person with dementia, when he or she may be unable to make healthcare decisions for themselves.
A living will includes an individual’s wishes for end-of-life treatment. This can concern specific procedures such as dialysis, tubal feeding, or blood transfusion. If the person becomes permanently unconscious (coma), families can make treatment decisions based on wishes expressed in a living will.
A do-not-resuscitate order (DNR) is put with a patient’s chart when the patient doesn’t want to receive cardiopulmonary resuscitation (CPR) if their heart stops or breathing ceases. A doctor needs to sign these DNR orders before they can be placed in the patient’s charts.

Advance care planning can be a sensitive topic for families and those with dementia.

Getting medical and legal advice early is helpful in planning advance care. Involving the person with dementia in the planning process also helps families ensure that the wishes of the patient are respected.

Reference: Health News (Jan. 11, 2023) “Can Someone With Dementia Sign Legal Documents?”

Do I Really Need Eight Glasses of Water a Day?

Researchers say individual water needs vary from person to person. Therefore, general recommendations for water intake shouldn’t be used. Their recent findings were published in Science, a journal of the American Association for the Advancement of Science.

Money Talks News’ recent article entitled “8 Glasses of Water a Day? Nonsense, Says a New Study” reports that for decades, study co-author Dale Schoeller, a University of Wisconsin-Madison emeritus professor of nutritional sciences, has studied how water intake impacts the body.

In a summary of the study findings, he says, “The science has never supported the old eight glasses thing as an appropriate guideline, if only because it confused total water turnover with water from beverages and a lot of your water comes from the food you eat.”

Schoeller says the new research is the best to date for measuring daily water turnover and the factors that influence it.

“Water turnover” is the amount of water going into and out of the body. As a result, it serves as a measurement of how much water the body actually uses each day.

In the study, the researchers measured water turnover in more than 5,600 people of all ages and from 26 countries.

They found that daily averages of water consumption range from one liter per day to six liters per day. (There are about 33.8 ounces in 1 liter.)

The study measured the time it took water to move through a person’s body by tracking the turnover of what researchers call “labeled water.”

In short, the study participants drank water containing trackable isotopes that allowed researchers to know how much water went into and out of their bodies.

The biggest factors that impacted water turnover in the participants included, activity level, sex, age, pregnancy, socioeconomic status and environmental characteristics (latitude, altitude, air temperature and humidity).

In addition, another primary factor was the Human Development Index of the county a participant lives in. This was developed by the United Nations. It’s a measure of a country that combines life expectancy, schooling and economic factors.

In the end, the study findings suggest that given how much variation there is in people’s water turnover patterns, “pointing to one average doesn’t tell you much,” Schoeller says.

Reference: Money Talks News (Nov. 28, 2022) “8 Glasses of Water a Day? Nonsense, Says a New Study”

What Is ‘Food Insecurity’?

“The pandemic has exacerbated existing trends in food insecurity,” Cindy Leung, ScD, MPH, assistant professor of public health nutrition at the Harvard T.H. Chan School of Public Health, in Boston, said in an email. “People who were already experiencing food insecurity found themselves at more severe levels, and other people were experiencing food insecurity for the first time. Older adults were no exception, on top of a higher risk of COVID-related disease burden and hospitalizations.”

MedPage Today’s recent article entitled “Food Insecurity Among Older Adults Remains a Problem” explains that food insecurity, which is defined as a lack of access to a sufficient amount of nutritious foods, was an issue in the U.S. even before the pandemic started.

Leung and her then-colleagues at the University of Michigan conducted a survey of about 2,000 older adults in 2020 that found that 14% of those ages 50-80 had experienced food insecurity in 2019. This appeared to be connected to worse physical and mental health, the researchers reported.

“Nearly half of adults aged 50-80 who were food insecure rated their physical health as fair or poor (45%), compared to 14% of those who were food secure,” while “almost a quarter of those who were food insecure reported fair or poor mental health (24%) compared to 5% of those who were food secure.”

The researchers also found that about 54% of food-insecure respondents had multiple (two or more) chronic conditions, compared to 41% of food-secure individuals. Food-insecure individuals were more likely than food-secure individuals to report having these conditions than food-secure respondents:

Asthma
Chronic bronchitis or chronic obstructive pulmonary disease
Chronic pain; diabetes
Kidney disease; or
A sleep disorder.

There were no significant differences in cancer, heart disease, high blood pressure, high cholesterol, or non-alcoholic fatty liver disease by food security status, however, they noted.

“Food insecurity is actually a really big problem among older adults,” Nicole Heckman, vice president of benefits access at the AARP Foundation, said in a phone interview at which a press person was present. “Nearly 9.5 million adults ages 50 and older are food insecure.”

Heckman gave several reasons for the problem. “One is obviously a lack of income,” she said. “Those that are at or below the poverty line struggle to afford the food they need, especially when we think about the inflation and just the crazy food prices and how much they have gone up over the last 2 years.”

The federal government addressed the general issue of food insecurity during the pandemic in part by expanding access to food programs like the Supplemental Nutrition Assistance Program (SNAP), as well as expanding the dollar value of available benefits. However, Heckman said, “many older adults aren’t actually aware of the programs and benefits to help them put food on their table. Research shows there are over three million older adults that missed out on more than $200 a month in SNAP benefits” during the pandemic.

Reference: MedPage Today (Jan. 10, 2023) “Food Insecurity Among Older Adults Remains a Problem”

Can Hearing Aids Have a Cognitive Benefit for Seniors?

Use of hearing aids by adults with hearing loss was linked to a significant 19% relative reduction in risk of any cognitive decline, compared with uncorrected hearing loss across long-term studies with follow-up ranging from two to 25 years.

MedPage Today’s recent article entitled “Use It, or Lose It: Hearing Aids Linked to Cognitive Benefit” reports that hearing aid or cochlear implant use was also linked to a 3% improvement in short-term cognitive scores, according to Benjamin Kye Jyn Tan, MBBS, of the National University of Singapore, and colleagues.

“Importantly, this benefit is evident for both normal baseline cognition and baseline mild cognitive impairment,” after “adjusting for possible confounders, including age and gender, education, socioeconomic status, and comorbidities,” the group reported in JAMA Neurology.

Hearing loss has been identified as a top modifiable risk factor for dementia, the researchers noted. “This study adds to the growing evidence base and serves as an impetus for clinicians treating patients with hearing loss to persuade them to adopt hearing restorative devices, to mitigate their risk of cognitive decline, such as dementia.”

While the analysis couldn’t establish causality, the findings support inclusion of hearing evaluation “as part of a standard workup for patients who may be experiencing cognitive decline,” agreed an accompanying editorial by Justin S. Golub, MD, MS, of Columbia University Vagelos College of Physicians and Surgeons in New York City, and coauthors.

However, there’s been a hypothesis that hearing loss and cognitive decline might occur independently as a result of a common mechanism of age-related neurodegenerative processes, Tan’s group acknowledged.

While noting that “hearing loss in dementia is likely to be multifactorial,” the study authors discussed several theories for how hearing aids might exert cognitive benefits. For example, the “sensory deficit hypothesis suggests that lack of sensory input may lead to structural alterations [in the brain], including atrophy,” they wrote. “Allowing hearing restorative devices to provide sensory stimulation before prolonged deprivation may cause cortical changes that could prevent cognitive deterioration.”

Another possible mechanism, they added, is that “hearing aid use may prevent social isolation [well-known to accompany hearing loss] and its resultant development of cognitive impairment, although further studies are required to analyze this association.”

The analysis examined long-term associations between hearing aid use and cognitive decline in a pooled analysis of eight studies with a total of 126,903 participants, as well as short-term outcomes in 11 studies with a total of 568 participants. Most were prospective cohorts or other observational designs; the two randomized clinical trials had only short-term data available.

Reference: MedPage Today (Dec. 5, 2022) “Use It, or Lose It: Hearing Aids Linked to Cognitive Benefit”

Will I Live Longer If I Walk Every Day?

In a study of more than 25,000 older adults who didn’t regularly exercise, engaging in three sets of vigorous activity for up to two minutes each at some point during the day was connected with a 39% lower risk for all-cause mortality versus no activity at all, according to Emmanuel Stamatakis, PhD, of the University of Sydney in Australia, and colleagues.

MedPage Today’s recent article entitled “Can Just Minutes of Daily Activity Prolong Life?” reports that even the minimum of 1½ minute-long sessions of exercise daily reaped mortality benefits compared with not engaging in any activity at all. However, those at the top of the range in this study — getting 11 short bursts of vigorous activity daily (about 16 minutes total) — saw all-cause mortality risk drop by even more.

Engaging in just a few minutes of vigorous intermittent lifestyle physical activity (VILPA) throughout the day was also protective against cardiovascular disease-related mortality, the group reported in Nature Medicine. Engaging in three one-minute bouts per day was linked with a 49% lower cardiovascular mortality risk. Those that engaged in the maximum frequency again saw the greatest benefit. Nonetheless, even engaging in the minimum was still significantly protective against heart-related death.

The researchers also found the same pattern for cancer-related mortality risk.

“We found that as little as 3 to 4 minutes of VILPA per day was associated with substantially reduced mortality risk compared to doing no VILPA,” Stamatakis told MedPage Today, noting how these were “very sizeable effect sizes.”

“We were not surprised that we detected beneficial associations; we knew that vigorous physical activity is very potent, especially when it is intermittent and repeated,” he said. “But the large magnitude of the associations was quite surprising, considering how little daily physical activity we are talking about.”

“Interestingly, is not unlikely that participants in this study did not know that they were doing vigorous physical activity,” Stamatakis remarked.

These short bursts of vigorous-intensity physical activity were considered a part of daily life. They included instances of short bursts of fast walking during a commute or climbing a set of stairs.

Reference: MedPage Today (Dec. 8, 2022) “Can Just Minutes of Daily Activity Prolong Life?”

How to Talk to Parents about Estate Planning

Research from the National Alliance for Caregiving (NAC) and AARP shows that more than 50 million Americans currently serve as unpaid caregivers. This number has increased by nearly 25% since 2015. Statistically, baby boomers and women take on the biggest caregiving burden when it comes to providing care for aging family members. As life expectancy increases, and baby boomers advance well into senior years of their own, the need for caregiving will only continue to rise.

Forbes’ recent article entitled “Holiday Season Tips For Caregivers” says that as the number of seniors in America continues to grow, we find ourselves on the verge of the largest transfer of wealth in history. It is estimated that 45 million Americans will transfer some $68 trillion over the next 25 years.

As a result, having estate planning conversations has become more important than ever.

Discussions about money and mortality can be challenging and emotional. Here are some tips on how to broach this sensitive subject with family and loved ones.

Schedule a time: This can be an overwhelming topic, but don’t ignore it. Scheduling dedicated time to open the dialogue and creating a timeline to complete the basic estate planning documents can make the process more manageable and keep everyone involved accountable.

Share your wealth of knowledge: Share your knowledge about what the documents mean, how and when they come into play, as well as what happens if there’s no estate plan in place. Remind them that this is their chance to ensure that their wishes are carried out.

Ask questions: Provided the person is in a sound state of mind, they’re in a position to be involved in the decision-making. Ask open-ended questions like what steps have already been taken and document as much as possible without judgment.

Share your plan: Sharing your ideas and discussing your own plans can ease tension and help eliminate fears. It shows others that they’re not alone in the planning process.

Leave the conversation open-ended: The key to these planning conversations is empathy because many seniors are experiencing a variety of emotions. Reassure them that you’re available for future conversations and will plan to check back in at the times set forth in the timeline you created together.

You should also ask an experienced estate planning attorney for assistance.

Reference: Forbes (Nov. 29, 2022) “Holiday Season Tips For Caregivers”

What Games are Best for Brain Health?

Researchers at Columbia University in New York City and Duke University in Durham, North Carolina, recently found that older participants — with an average age of 71 — who were trained to complete computerized crossword puzzles showed more of a cognitive improvement compared with those who were trained to use web-based cognitive video games, reports Money Talks News’ recent article entitled, “Crossword Puzzles or Video Games: Which Better Protects Your Brain?”

In a summary of the study’s findings, Dr. D.P. Devanand, professor of psychiatry and neurology at Columbia, remarked:

“This is the first study to document both short-term and longer-term benefits for home-based crossword puzzles training compared to another intervention. The results are important in light of difficulty in showing improvement with interventions in mild cognitive impairment.”

The researchers explain that mild cognitive impairment is a stage between the cognitive decline that is normal with aging and full-blown dementia. Those with mild cognitive impairment may struggle with memory, language, thinking or judgment.

The researchers went on to note that those with mild cognitive impairment are at a significant risk for dementia, including Alzheimer’s disease.

As part of the study, 107 participants with mild cognitive impairment were trained for 12 weeks in either crossword puzzles or cognitive games.

Follow-up “booster sessions” were then held for up to 78 weeks.

While both forms of training were equally effective early in the course of disease, crossword puzzles were better in the later stages. Those who used crossword puzzles showed less brain shrinkage at 78 weeks.

Dr. Devanand says the study results show that further research on developing a home-based digital therapeutic for delaying Alzheimer’s disease “should be a priority for the field.”

Reference: Money Talks News (Nov. 5, 2022) “Crossword Puzzles or Video Games: Which Better Protects Your Brain?”

How to Find New Doctor for Mom if She Moves

Seasons’ recent article entitled “How do I help an older adult switch doctors after a move?” advises that breaking the process into manageable pieces will help you make sure you don’t miss any details.

First, check mom’s insurance because Medicare options are different when moving states. Check with Medicare to determine the process based on your mom’s existing coverage. Then you can find new health care providers.

Caregivers should have at least one dedicated three-ring notebook with dividers specifically for their loved one’s important information. Two is even better: one for financial information and one for medical information. Separate notebooks allow you to take the one with medical information to appointments without having sensitive financial information out and about at appointments.

Place some blank calendar pages in the front of the medical notebook. You’ll be able to organize your mom’s appointments in one place, as well as have a record of past appointments.

If you also use an online calendar like Google Calendar or iCalendar, create a color specifically for your mom’s appointments, so you can easily see the dates and times of her appointments.

Try using the paper option even if you also use an online calendar because this makes certain the information is easily accessible in case you need to share information with another person who helps with the caregiving.

Having all of your loved one’s medical information in one place that’s easily accessible will be invaluable when going to appointments at different doctors’ offices. You’ll have all of the info ready to share with different medical providers.

Once you get a system started to keep your mom’s information in an easily accessible place, it will be a pretty simple process to keep doctor appointments and medical information organized.

Reference: Seasons (Nov. 28, 2022) “How do I help an older adult switch doctors after a move?”

Estate Planning Blog Articles

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

Can a Dementia Patient Sign Legal Documents?

What Documents are Included in Advance Care Planning?