- How to Legally and Financially Prepare for Those With Alzheimer’s and Related Dementia
- Long-Time Care Planning and Options for Those With Alzheimer’s
- Financial Assistance for Alzheimer’s Care
- Legal Planning for Alzheimer’s and Dementia Patients
Alzheimer’s and other forms of dementia are lifelong diagnoses. Although therapy can slow the degeneration of memory, it is important to begin legal planning regarding the care of an individual diagnosed with Alzheimer’s or other forms of dementia as early as possible. Keeping an eye out for early signs of these diseases, and responding to them promptly can make a substantial difference in the quality of life of the individual, the success of treatment to slow the progression of the disease, the financial impact on caregivers and family, and even the emotional impact on the individual and their loved ones.
Early identification of dementia symptoms could give both the diagnosed individual and their family valuable time to prepare. Therefore, it is important to be aware of what the symptoms are, especially if you or someone in your family is elderly or otherwise at risk of developing dementia.
Early signs and symptoms of Alzheimer’s Disease include the following:
- Generalized memory loss;
- Confusion and disorientation;
- Misplacement of objects;
- Lack of initiative;
- Social isolation;
- Mood and personality changes;
- Anxiety and aggression;
- Struggling to find words;
- Difficulty following conversations;
- Repeating themselves;
- Impaired problem-solving skills;
- Poor decision-making;
- Getting lost;
- Vision problems.
Alzheimer’s is a degenerative brain disorder marked by progressive memory loss and personality changes, caused by plaques that accumulate between neurons and ultimately disrupt brain function and damage brain cells. Meanwhile, dementia refers to a wide range of memory loss symptoms caused by a variety of underlying disorders, the most common of which is Alzheimer’s. Alzheimer’s is the underlying cause of approximately 60-70% of dementia cases.
Financial concerns are a substantial component of long-term planning for the care of a person with Alzheimer’s or other forms of dementia. Financial considerations that will commonly need to be addressed include, but are not limited to:
- Preparation of a will;
- Preparation of a power of attorney;
- Methods of medical funding;
- Handling of mortgages and home loans;
- Management of bank accounts;
- Applying for Social Security benefits;
- Attending to debts.
A significant expense that should not be skimped on is living arrangements. Laws, regulations, and individual facility standards can vary widely regarding long-term care facilities, and therefore much of the burden of choosing a safe and appropriate care center will fall on the shoulders of the individual and/or their loved ones.
Additionally, an elderly individual may not be capable of communicating negligence or abuse, and may even be coerced into silence. Seniors with Alzheimer’s or other forms of dementia are particularly at risk of this due to confusion, forgetfulness, and increased vulnerability. Therefore, you must go to whatever lengths possible to make sure that the right choice is made the first time.
Nursing homes are living accommodations provided for elderly people who require care around the clock. Nursing home staff is usually a combination of nurses, supporting staff, and volunteer workers. In the case of nursing homes that are supported by government assistance like Medicare or Medicaid, it is required that at least 5% of caregiving hours are handled by volunteers, per the 1983 Hospice Care Final Rule.
It is important to know how many of a nursing home’s workers are volunteers, and how many are accredited nursing staff, as this may reflect on the quality of care. Additionally, it will be prudent to consider the specific care needs of the individual. There are nursing homes that specifically care for people with greater needs, and this should translate into longer staffing hours, and specialized nursing staff.
It is vital that you consider a nursing home’s funding, staffing, staffing hours, practices, standards, and reviews before choosing one, and you should also insist on a walk-through. While nursing homes can often be an important source of support for a community, nursing home abuse is unfortunately common and is often caused by under-staffing, poor training, and lack of an accountability structure.
Assisted living centers are living accommodations for elderly individuals who don’t need as much day-to-day help, although sometimes the terms “nursing home” and “assisted living center” are used interchangeably. In addition to onsite care and emergency assistance, assisted living centers help residents with day-to-day tasks as needed, such as housekeeping, laundry, and personal hygiene.
However, as previously stated, facilities and their standards can vary greatly, and therefore, it will be important to review whether a facility has things like 24-hour support for residents. It is also very important to look into the reputation of the facility. Personal injury through negligence on the part of caregivers at assisted living facilities is unfortunately not rare.
Memory care facilities are residential options that are meant specifically for individuals who suffer from dementia, Alzheimer’s, or other memory issues. They are also sometimes called Special Care Units (SCUs) or Alzheimer’s Care Units. Like traditional nursing homes, these facilities usually involve close supervision and round-the-clock assistance. In fact, supervision is usually increased in memory care facilities. These facilities also include therapy and activities designed to stimulate memory.
Alzheimer’s and dementia are not curable diagnoses. Therefore, these ailments require lifelong care. Considering this, it is important that once a person is diagnosed, the individual or individuals responsible for their care determine a long-term care and treatment plan, which takes into consideration all costs and financial options. There are many financial assistance options available for senior care, and it is important to not pinch pennies when it comes to the care of a vulnerable individual, as much as that is possible.
Eligibility requirements vary for different financial assistance options, and it will be prudent to carefully examine these requirements as early in the process as possible, as whatever financial assistance options the person qualifies for may provide a basis for the overall care plan.
Medicare is federal health insurance for American senior citizens.
In order to qualify for full benefits of Medicare assistance, an individual must:
- Be at least 65 years of age;
- Be a citizen of the United States OR a legal resident for a minimum of 5 years.
Some disabilities may also qualify an individual for Medicare assistance, even if they are younger than 65.
Medicare.gov offers a breakdown of what medical costs are covered based on your personal Medicare plan.
There are several federally-mandated rights and protections regarding medicare, including:
- A right to privacy;
- A right to humane and dignified treatment;
- A right to transparent medical information and records;
- A right to transparent information about Medicare coverage;
- A right to access necessary medical services;
- A right to receive information about medical services in a language you understand and in a way that is respectful to your culture;
- A right to have a hand in your own medical decisions;
- A right to Medicare-coverage for emergency services;
- A right to detailed information about insurance coverage;
- A right to appeal a claim denial;
- A right to file complaints;
- Protection against discrimination;
- Protection against unethical practices.
Medicaid is a health insurance assistance program that covers individuals with limited income or other circumstances that prevent them from being able to pay medical costs within reasonable expectations.
Eligibility requirements for Medicaid are usually determined on a state level. Generally speaking, however, to qualify for full benefits of Medicaid assistance, an individual must be at least one of the following:
- A low-income individual;
- An adult over the age of 65;
- A person with a disability.
In order to qualify for Medicaid, the individual also must be a qualifying resident of both the U.S. and the state within which they are registering. A Social Security number will be necessary.
There are optional Medicaid benefits that can be covered at the discretion of each individual state. However, there are several benefits that must be covered per federal mandate, including the following:
- Inpatient and outpatient hospital services;
- Physician services;
- Laboratory and x-ray services;
- Home health services.
There are several rights and protections regarding Medicaid, including:
- A right to appeal a claim denial;
- A right to appeal a denial of service;
- A right to appropriate notice;
- A right to due process;
- A right to make your own medical decisions (18 and older);
- A right to privacy;
- A right to file a complaint;
- A right to age-appropriate healthcare for minors.
Veterans benefits include health care assistance.
The U.S. Department of Veteran Affairs describes a person who is eligible for basic veterans benefits as:
“A person who served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable may qualify for VA health care benefits including qualifying Reserve and National Guard members.”
Veterans’ health benefits include the following:
- Inpatient and outpatient care at VA facilities;
- Mental health care;
- Women’s health care;
- Prescriptions from VA providers;
- Appropriate long-term care;
- Community health care in lieu of available VA care.
There are several rights and protections regarding veterans’ health benefits, including:
- A right to privacy;
- A right to humane and dignified treatment;
- A right to have access to healthcare in an environment that feels safe.
The following rights concern those who reside at a care facility:
- A right to access the outdoors;
- A right to respect for your cultural values;
- A right to use your finances as you see fit, or to allow a person of your choice to do so;
- A right to reasonable accommodation for personal preference;
- A right to not be restrained except in the case of limited and extreme circumstances;
- A right to keep personal belongings within reason;
- A right to social interaction;
- A right to exercise;
- A right to religious observance;
- A right to open communication;
- A right to visitor support during the day as reasonable.
Social Security disability insurance (SSDI) is a type of insurance that covers people who cannot work due to long-term medical issues. Those who qualify for SSDI are also eligible to apply for Medicare benefits.
In order to qualify for Social Security disability insurance, a person must meet the following criteria:
- Must have been employed in a position that was covered by Social Security;
- Must have a qualifying condition for Social Security disability.
Your disability benefits will depend on how long you worked in a position covered by Social Security. The Social Security Administration provides an in-depth overview on how to earn work credits.
Social Security Income (SSI) benefits are available to Americans over the age of 65. The amount of Social Security benefits to which one is entitled depends on factors such as the individual’s income and the age at which they apply for Social Security benefits.
Most Americans over the age of 65 are eligible for SSI benefits, with a few exceptions, as in the case of the following scenarios:
- The individual chooses to retire in another country (depending on the country);
- The individual has not accrued 40 work credits (approximately 10 years of work);
- The individual did not pay Social Security taxes.
Life insurance is optional, private insurance coverage that pays out to a designated beneficiary in the event of your death. Many companies provide a limited amount of life insurance free of charge to their employees. The payout on life insurance depends on the individual policy.
Many states offer financial assistance for the care of people with Alzheimer’s or other forms of dementia. The Alzheimer’s Association offers 24-hour support for people who are looking for financial assistance in their area.
Nonprofit organizations that provide financial assistance for people suffering from Alzheimer’s or other forms of dementia include the following:
There are also many smaller, local charities that provide assistance for people diagnosed with Alzheimer’s or other forms of dementia, as well as charitable organizations that are not specifically targeted at Alzheimer’s patients, such as Meals on Wheels.
As mentioned above, living wills, property allocation, and other legal matters will need to be tended to for those who suffer from Alzheimer’s or other forms of dementia. These issues are often complicated by the individual’s ability (or lack thereof) to make informed decisions.
A person diagnosed with Alzheimer’s or another form of dementia may or may not be able to sign legal documents, depending on how far the illness has progressed. This is another reason that it is so important to make a diagnosis and start taking steps early; in the early stages of the illness, the individual is usually still capable of signing legal paperwork.
The means by which a person is deemed to have the mental capacity to make an informed legal decision or not often depends on the specific type of documentation. The most common means of determining whether or not an individual is of sound mind to sign legal documentation is simply whether or not they understand what the document is saying, and why they are signing it. It is also important to note that it is illegal to coerce or trick an elderly person into signing legal documentation.
Power of attorney is a legal document that gives someone the power to take legal action on behalf of another individual. Granting someone authority over various legal and medical matters under a power of attorney is an action that can significantly simplify the process of enacting long-term care and financial management for an individual with Alzheimer’s or another form of dementia. As previously stated, declining mental capabilities can cause significant legal roadblocks for people with Alzheimer’s. Signing a power of attorney early can help circumvent these issues.
A living will, also known as an advance health care directive is a document that outlines what measures a person would like to be taken in the event that they need life saving treatment. For example, it would state whether the individual would like to be put on life support or not in the event that it is a necessary condition of their survival. A living will must be signed by the person it concerns, and must be witnessed by two other adults who are not employed by the individual’s healthcare provider.
A living trust, also known as an inter vivos or revocable trust, is a document that transfers a person’s assets into a trust. Upon their death, the assets are passed on to the designated beneficiaries. This can be especially useful in the event that a power of attorney has not been signed, as it gives the trustee the power to immediately take over the finances appointed to them without court intervention if the grantor becomes incapacitated.
A last will and testament is a document that outlines how a person’s assets should be divided once they have passed. It will be necessary to choose an executor, who will be responsible for dividing your assets according to your wishes. This individual can be anyone from a family member to a legal professional. In the event that someone dies without a will, state intestacy laws decide how their assets will be divided.
In order to sign a will, the testator must demonstrate “testamentary capacity,” which is their ability to make an informed decision regarding their will. More specific requirements depend on the laws of the state in which the testator resides.
The measure of testamentary capacity is usually based on the following factors:
- The testator understands the extent and nature of their assets;
- The testator recognizes their beneficiaries and what assets they would receive based on the parameters of the document;
- The testator understands within reasonable expectation the proposed distribution plan, and that by signing the document, they are agreeing to it.
It is possible to obtain guardianship of an elderly individual; this is sometimes also called elderly conservatorship. This is a court-appointed relationship that is put into place when a senior citizen is no longer capable of caring for themselves. The guardian could be a family member, a friend, or even the state itself. A guardian is responsible for the senior citizen’s living arrangements, finances, medical care, and even their social and emotional wellbeing.
The following are notable agencies and organizations that provide information and support for people who suffer from Alzheimer’s, loved ones, caregivers, and researchers:
- National Institute on Aging: This is a division of the U.S. National Institutes of Health (NIH). The National Institute of Aging is a leading figure in research relating to aging, especially as it concerns Alzheimer’s.
- Alzheimer’s Association: The Alzheimer’s Association funds research, provides information about Alzheimer’s and the promotion of brain health, supplies support and contact information, and offers financial assistance.
- Alzheimer’s Foundation of America: The Alzheimer’s Foundation of America provides support, information, and financial assistance regarding Alzheimer’s. The nonprofit also funds Alzheimer’s-related research.
- Eldercare Locator: Eldercare Locator is a service provided by the Administration on Aging that locates helpful, local support services for senior citizens.
- Alzheimers.gov: Alzheimers.gov is a federal resource for information about Alzheimer’s ranging from research initiatives to support services.