Patinelli & Chang, LLP

How Do We Live Our Lives When A Loved One Has Alzheimer’s?

“The case of restaurateur and lifestyle guru B. Smith, who is battling Alzheimer’s, is drawing scrutiny from her fans and strangers alike, many of whom are dismayed by her husband’s decision to date a woman he calls his "life partner" and keep a room for her in the house he shares with Smith.”

The scenario is worrisome, as no one can be sure that this is something B. Smith would have wanted, if she had been asked before the disease had progressed. However, one good thing has come out of it, according to the article “B. Smith’s Alzheimer’s raises question: How to protect your wishes when incapacitated” from USA Today. There are more discussions about expressing people’s wishes, before they become incapacitated from Alzheimer’s.

More families are experiencing this very same dilemma because of the increasing number of Americans suffering from Alzheimer’s and other forms of dementia. More than 5.7 million in this country are suffering from this disease, which currently has no cure and is most likely to impact seniors, women and African Americans, according to the Alzheimer’s Association.

Without advance planning, it’s impossible to know what someone would want to happen. Discussing this is critical, while a patient is still relatively healthy and able to communicate her wishes to family members and to an estate planning attorney.

People who work in this area say there are two areas that must be addressed. One is drafting legal documents with an experienced estate attorney to determine who should be entrusted with health care and financial decisions. There is also a need for document known as a “statement of values” that will help family members understand goals and wishes and not be left guessing.

These decisions are not easy to consider when a person is still well. However, thinking about them and putting them down on paper, and then having the necessary documents prepared to formalize them and make them enforceable are important.

Here are the documents needed:

Durable power of attorney: This lets a trusted family or friend make financial decisions, in the event of incapacity.

Power of attorney for health care: This document permits a family member or friend to make decisions about health care decisions.

A will. The will is for the disposition of assets after your death. It also names the person who will be in charge, the executor.

A revocable trust. This is one of many documents that can be used to allow you to set conditions and directions about assets, while you are still living but when you have become incapacitated. It can be changed at your direction. Hence, the term revocable. An estate planning attorney will know what type of trust should be used for your situation.

Only four out of 10 Americans have wills, with many hesitating to have them created because they think that only rich people need a will. However, without a will, or the other documents described above, the family is left in a terrible situation, where there will be additional costs, if and when decisions need to be made but no one has been legally empowered to make the decisions.

The revocable trust could bypass many unpleasant situations, like instructing a power of attorney to place your assets in a trust that was set up specifically to pay for your care in a skilled nursing facility of your choice, or to describe with great specificity who was allowed to live in your home, if you became incapacitated.

Another missing step: the family discussion. Getting everyone together to discuss planning for the future, isn’t as fun as going on a family vacation, but it is important. If someone is starting to have the effects of dementia, they may not remember what they told another family member. With everyone in the same room, there will be a better chance that their wishes will be clear.

The moment someone learns that they have dementia, is the time to put all these elements into place, before it is too late.

Reference: USA Today (Jan. 31, 2019) “B. Smith’s Alzheimer’s raises question: How to protect your wishes when incapacitated”

How Can I Make a Trip to the ER Easier for an Alzheimer’s Patient?

“The environment of a hospital emergency room with crowds of people, alarms and noises can be particularly overwhelming and overstimulating for people with Alzheimer's disease.”

Trying to make someone with Alzheimer’s comfortable in an ER is not an easy thing. However, there are some things you can do to make the stimulation-saturated environment a little less overwhelming, says The Advocate in the article “Alzheimer’s Q&A: What should I know before taking someone with Alzheimer’s to the emergency room.”

Start long before you must go to the ER, by creating a list of your medications and have a few copies with you.

Bring the medication list and any assistive devices, including hearing aids, dentures, an extra pair of glasses and any walking aids, like a walker or a cane.

Also, have a list of contact information for all healthcare providers and family members. If you have a power of attorney, bring that as well. If the individual has an advance directive or any other documents, like a do not resuscitate (DNR), bring those just in case. Make sure to have all health insurance information.

Expect a wait, so bring snacks. A portable music player with the person’s favorite soothing music and headphones may provide some comfort. Magazines or books that are used during quiet times at home may be useful. Don’t bring anything of value, like jewelry or a wallet. And don’t bring a crowd. Small children, unless there is no one who can care for them, or other family members, are best left at home.

Unless the individual is having a life-threatening emergency, you will likely have to wait, and you may be waiting a while. Provide simple step-by-step explanations of what is taking place and be honest with them about why they are in the hospital and what is happening.

Focus on keeping them calm and comfortable. Offer a snack and if possible, find a quiet space in the waiting room.

Make sure that the hospital staff is aware you are there with a person who has Alzheimer’s or dementia. They may not have training in caring for dementia patients, so be prepared to advocate for your parent or loved one. Offer suggestions in communicating with the person and ask doctors and medical personnel to limit their questions, which may increase stress and anxiety. Speak with the doctor privately, if possible.

Request that the staff avoid using any physical restraints or medications to control the person’s behavior, unless absolutely necessary. Let the staff know about any fever, medication side effects or changes in mental status. Never leave the person alone in the ER or the evaluation room.

Reference: The Advocate (Jan. 20, 2019) “Alzheimer’s Q&A: What should I know before taking someone with Alzheimer’s to the emergency room”

How to Cope When the Diagnosis Is Dementia

“A key to prolonging independence, participants told her, is to recognize the triggers that aggravate her symptoms and to adjust her routine to head them off.”

A diagnosis of early onset Alzheimer’s is life changing. The story of a busy workaholic sales executive, as detailed in the article “Leading an Active Life with a Diagnosis of Dementia” from The New York Times, has no happy ending. However, it does point to a way forward.

The number of people with Alzheimer’s disease who are 65 and older is expected to soar to 7.1 million in 2025 and 13.8 million in 2050. That’s an increase from today, when 5.5 million suffer from the disease, according to the Alzheimer’s Association. Add to that 200,000 people younger than 65 who are estimated to have the disease, and that is not counting those with dementia from vascular disease, Lewy body, and other kinds of dementia.

There is the possibility, however, that people in the early stages of the disease can still pursue fulfilling lives. They must, however, make plans immediately for future care.

The first step is to create a team of professionals, including an estate planning attorney, the physician, a geriatric care manager and a financial planner. Trusted family members should be in on all planning to coordinate and oversee their work.

The challenging legal question is if a person with a diagnosis of dementia sign legal documents? These necessary documents include financial and health care powers of attorney, as well as a will. The person’s attorney may need to seek a clinical evaluation to determine whether the client still has the decision-making skills to permit them to sign documents.

It is necessary to act quickly, because most types of dementia progress over time. Having the person evaluated, won’t preclude anyone from challenging the documents but it is a strong step in their defense.

An advance health care directive must also be prepared. This typically provides guidance on end-of-life treatment. A person with dementia is capable of living a very long time with their condition. It would be wise to have them involved with the preparation of this document, as well as the decision-making process, while they are still cogent. Instructions can include details, like what they think they would want in terms of care setting or caregivers.

Planning to pay for long-term care is an important part of planning for a long life with dementia. For some people in the early stages, it makes sense to protect assets from long-term care costs. Medicaid, financed by state and federal governments, pays only for people with limited assets while state laws vary. This is an area where you need the help of an elder law attorney. Planning must also be done soon after diagnosis, since there is a five-year look-back and other penalties, if planning is not done on a timely basis.

Many Alzheimer’s Association chapters offer support groups and socialization for patients and caregivers. This is not a journey you want to take on your own and you don’t have to.

Reference: The New York Times (October 5, 2018) “Leading an Active Life with a Diagnosis of Dementia”

Judge Rules that Glen Campbell’s Kids Can Contest his Will

“Last week, a judge in Tennessee ruled that the three children can dispute the validity of the wills that excluded them from inheriting. They petitioned the court to certify that a contest to the will exists, on grounds of his alleged lack of capacity and undue influence.”

When Glen Campbell passed away, he intentionally left three of his children from his second marriage out of his wills. Three of his children have just won a court decision, reports Wealth Management.com in the article “Glen Campbell’s Kids Come After the Rhinestone Cowboy’s Estate.”

The two wills at the heart of the case are from 2001 and 2006. The 2006 will names Campbell’s fourth wife Kimberly, who is the executor of the estate, and five of Campbell’s other children as his beneficiaries. Campbell went public with his Alzheimer’s diagnosis in 2011, but it’s not known how far back his illness began. The legal burden facing his children: prove that he lacked the needed capacity to execute both wills.

If the will is deemed invalid because of lack of capacity or undue influence, the immediately preceding will is resurrected, said one estate planning attorney who is not affiliated with the case. The previous will probably disinherited them also, which is why they must prove the invalidity of both wills.

Kimberly has told a local newspaper that she would not challenge the kid’s right to contest the wills and the judge’s decision noted the lack of opposition. She has also filed a claim seeking reimbursement from the estate for more than $500,000 to cover the cost of his medical care.

It was also reported that one of his daughters, Debbie Campbell-Cloyd, has filed for a complete accounting of all payments made by the estate, as well as payments to and from a previously undisclosed bank account. She alleges that royalties that should have been deposited into an account controlled by Campbell’s estate, were instead deposited into this account, which is now controlled by Kimberly. The singer’s former manager has power of attorney over the account.

Multiple children from multiple marriages make estates complicated, even if you aren’t a legendary country music singer. For blended families, estate planning that includes family meetings can sometimes help prevent misunderstandings and estate battles.

Resource: Wealth Management.com (Aug. 2, 2018) “Glen Campbell’s Kids Come After the Rhinestone Cowboy’s Estate”

Clinic Sued for False Alzheimer's Diagnosis

A now closed clinic in Ohio is being sued by former patients for falsely telling patients they had Alzheimer's disease and treating them for the disease they did not have.

When people get older they naturally begin to get a bit more absent-minded. They sometimes forget little things such as where they left their keys more often than they previously did.

Many people fear the worst. They fear that their forgetfulness is a sign that they are coming down with Alzheimer's disease.

While no one wants to be diagnosed with the disease, it can come as something of a relief to get properly diagnosed so that people know what is wrong with them.

However, what if you were told you had Alzheimer's and really did not? That is what many former patients of an Ohio clinic, that is now closed, allege in lawsuits.

The clinic told them they had the disease and accepted their payments for treatment. It was later revealed that these diagnoses were false and it appears that the clinic's director did not have a license to practice medicine in Ohio.

FOX News reported this story in "Clinic falsely told dozens they had Alzheimer's, suits say."

If these allegations turn out to be true, this is a brazen and disturbing case of elder abuse. One of the people affected even committed suicide.

People are right to worry whether they have a debilitating disease.

If you ever have any concerns that you (or a loved one) are being taken advantage of in a similar way, contact an elder law attorney.

Reference: FOX News (Feb. 8, 2017) "Clinic falsely told dozens they had Alzheimer's, suits say."

Robotic Pets for Alzheimer's Patients in Torrance CA

Therapy animals have been used effectively for all kinds of patients, including those with Alzheimer's disease. However, it is not always practical or safe to use real animals with people suffering from dementia. Some care centers are substituting robotic pets.

Alzheimer's disease and other forms of dementia can give patients a deep sense of loneliness. Patients often cannot remember where they are and who the people are around them. This can lead to feelings of being alone.

One way to combat this is with companionship. However, elder caregivers and elder law advocates all know how difficult it can be to get the necessary companionship on a consistent basis.

Therapy animals have sometimes been used. However, even with specially trained dogs and cats, there is still a safety risk for many patients and the animals themselves.

Of course, real animals have to be cared for and fed as well, which takes up caregiving time.

The New York Times in "Therapy Cats for Dementia Patients, Batteries Included" discusses a new trend to use robotic cats.

Robotics have gotten good enough and cheap enough that some commercially available robotic pets could have benefits for patients with dementia.

The article discusses their use in one nursing home where the residents really enjoy the robots. They give a sense of joy and empowerment, even when the patients realize that the robots are not real animals.

There has been no conclusive research proving any long term benefits of robotic pets for people with Alzheimer's. However, the short term benefits are easy to see for those who work with the patients.

Reference: New York Times (Dec. 15, 2016) "Therapy Cats for Dementia Patients, Batteries Included."