Category Archives: Residential Options
There are treatments available now that most families coping with Alzheimer’s or other dementia never hear about that can significantly improve their quality of life.
Called non-pharmacologic therapies (NPTs), these treatments do not come in a pill. Instead, NPTs such as personal counseling and occupational therapy-based strategies are proven to improve the quality of life for people with dementia and their families. NPTs support families and teach them the skills they need to protect their own health and cope with the intense demands of caregiving and help people with dementia stay independent and safe for as long as possible. Some of the NPTs currently used are proven programs that are actually more effective than any known drugs for Alzheimer’s disease.
One example of an NPT, developed at NYU, includes individual and family counseling to reduce conflict and improve communication among family members. Those caring for a spouse with dementia who received the NYU Caregiver Intervention were more satisfied with social support and less depressed, less bothered by difficult behaviors, had better physical health and were able to keep their ill spouses at home longer than those receiving usual care.
Another model developed at Thomas Jefferson University in Philadelphia, employs occupational therapists to assess the patient with dementia and identify preserved capabilities as well as the caregiver’s needs. Families are then provided with strategies to manage day to day care, such as communication techniques, safe-proofing the home, establishing daily routines and engaging the individual with dementia in meaningful activities. Families who participated have reported feeling more confident and less upset, and found that their ill family member functions better and exhibits fewer challenging behaviors.
Another NPT that is now being used is a stimulator device surgically implanted into the brain of a patient in the early stages of Alzheimer’s disease. The implanted device is seen as a possible means of boosting memory and reversing cognitive decline, and has already been used in thousands of people with Parkinson’s. The surgery involves drilling holes into the skull to implant wires into the fornix on either side of the brain. The wires are attached to a pacemaker-like device, which stimulates the brain with tiny electrical impulses generated 130 times a second. The patients don’t feel the current.
Lastly, another effective non-drug Alzheimer’s treatment used to jog memory is music. In nursing homes that use music, the personalized playlists are often meaningful songs chosen by loved ones. According to Alzheimer’s experts, music helps patients become more alert, more cooperative, more attentive, and more engaged. In many cases, even if they can’t recognize loved ones and they’ve stopped speaking, when the patients hear music, they “come alive”.
Geri Hall, a clinical nurse specialist at the Banner Alzheimer’s Institute, explains how music activates a part of the brain that stays active despite the dementia. “There is something about music that gets through to Alzheimer’s patients right up until the very end of the disease,” she said, adding that “familiar music from the past can help people with dementia feel at home. It calms them, increases socialization, and even decreases the need for mood controlling medications.” Read our blog post about Alzheimer’s and Music.
Alzheimer’s slowly robs its victims of a lifetime of memories and the ability to perform simple daily tasks. Instead of focusing on drug treatments, many of which have failed in clinical trials, it may be a good idea to try non-drug treatment options. These programs have been proven effective in randomized controlled trials. And, unlike drug therapy, there are no adverse side effects. There is also an economic argument to be made for better caregiver support. Nearly 11 million family and other unpaid caregivers provided an estimated 12.5 billion hours of care to people with dementia. This care is valued at nearly $144 billion. The country can’t afford the consequences of these caregivers becoming too burned out or sick to carry on. See our recent blog post about the rising cost of dementia.
Moving a person with dementia to a nursing home, while sometimes unavoidable, is expensive. The NPTs described have helped to delay nursing home placement for more than a year. Unfortunately, you cannot delay the inevitable forever, but what you can do is plan ahead for you and your loved ones. Do you or a loved one need nursing home care in the near future or are you looking to plan ahead? Call 703-691-1888 to make an appointment for a no-cost consultation at The Fairfax Elder Law Firm of Evan H. Farr, P.C. We can meet with you, access your situation and determine strategies for your long-term care plan.
Nancy and Nick have three children — Emmitt, Nicole, and Alexa. Very warm and loving parents, Nancy and Nick make education a top priority, and hope to instill their deep-rooted culture and values in their children. Neither Nancy nor Nick want to think about not being there to raise their children. If Nancy and Nick choose not to make a decision and take no action, who will care for their children should the unthinkable happen to them?
Various scenarios, none of them ideal, could happen should Nancy and Nick not choose a guardian for their children. Their relatives could end up arguing in court over who gets the children — or their relatives could agree but not on the people that Nancy and Nick would have chosen. Even worse, a court could end up choosing their guardian for them. That’s why it’s important for Nancy and Nick and for your family to nominate a guardian while it’s still up to you. Here are some actions to take to help you make your best choice:
- Make a list of all the people you know who you would trust to take care of your children, including family members, extended family, close friends, people you know from your place of worship, or even child care providers with whom you and your children have a special relationship.
- Consider values and philosophies. Ask yourself which people on your list most closely share your values and philosophies with respect to your religious/spiritual beliefs, moral values, child-rearing philosophy, educational values, and social values.
- Consider whether each couple or person on your list is a good fit. Would they truly love your children, be good role models, have patience parenting your children, show affection, and are they mature enough to take on the guardian role?
- Think about how raising your children would fit into their lifestyle.
- If they’re older, do they have the necessary health and stamina? Would they really want to be parents of a young child at their stage in life?
- Do they have other children? How would your children get along with theirs?
- How close do they live to other important people in your children’s lives?
- If a married couple divorced or one spouse died, would you be comfortable with either of them acting as the sole guardian, or would want an alternate married couple to become guardian instead.
- Trust your instincts. If one couple or person meets all of your criteria, but doesn’t feel right, don’t choose them. By the same token, if someone feels much more right than any of the others on your list, there’s probably a good reason for it and you probably want to trust your gut instinct. Make your primary choice, then some backup choices. Ideally, both you and your spouse agree on your choices.
- Use a Child Protection Plan to select a temporary custodian as well as your Last Will and Testament to nominate your permanent Guardian. Temporary custodians may be appointed if both parents become temporarily unable to care for their children – for example, as the result of a car accident. Depending on your choice for permanent guardians (for example, if your permanent guardians work and live in another state or another country and will have to take leave and make travel arrangements to come and care for your children), you may want to designate different people to act as temporary custodians. Temporary custodians are designated via a Child Protection Plan rather than via your Last Will and Testament.
- Consider a guardianship panel. Because it’s difficult to predict what your children’s needs will be as they grow older, consider appointing a “guardianship panel” to decide who would be the best guardian when and if it becomes necessary. Choose trusted relatives and friends to make up the panel. The panel can consult with your children and assess their needs and desires to make the most appropriate choice based on the current situation.
Once you’ve narrowed down your choices, talk to everyone involved. Be sure to confer with the people you’d like to choose to ensure they’re willing to be chosen and would feel comfortable acting as guardians. If your children are old enough, you may even want to talk with them to get their input. Create a Letter of Intent to convey information about your children, your parenting values and your hopes and dreams for your children. Set up an appointment with a Certified Elder Law Attorney, such as Evan H. Farr, to prepare the legal documents that are required to put your wishes into action.
If you’ve chosen friends over relatives or a more distant relative over a closer one, be sure to explain your decision in writing. That way – in the unlikely event your choice is challenged by people who feel they should have been chosen – a court should readily uphold your decision, knowing you’ve made your choice for good, solid reasons.
Set up a trust that will hold the assets you pass to your children, and instruct the trustee to provide necessary financial assistance to the guardians. Create specific instructions about special things you’d like the trust funds used for (for example, a particular summer camp, piano lessons etc.).
Having children means always planning ahead and thinking about the future, even as you try to enjoy the present and watch your children grow and thrive. Nominating a guardian (and, if necessary, a temporary custodian) for your children gives you the peace of mind that your children will be protected if something happens to you. Call 703-691-1888 and make an appointment for a no-cost consultation at The Fairfax Elder Law Firm of Evan H. Farr, P.C.
I have chronicled the ups and downs of the reverse mortgage industry for the past five years. In 2010, I exposed two major problems with the reverse mortgage industry — the “competency problem” and the “expense problem.”
- I praised reverse mortgages in 2007 as a viable way for seniors to remain at home as long as possible in my article, Reverse Mortgage Home Equity Loans.
- I viewed reverse mortgages then as an excellent choice for various reasons, explained in detail in my early-2010 article, Using a Reverse Mortgage to Pay for Home Care.
- By mid-2010, I wrote about what I perceived to be discrimination in the lending industry. I completely explain why that was such a nefarious issue to my clients and the elderly at-large in the article, Huge Problems with Reverse Mortgage Industry.
- Merely a few months later I found myself writing about the “expense problem” in, Reverse Mortgage Rules Changing Again, noting Congress’ plan to increase HUD’s Mortgage Insurance Premium.
- In February, 2011, I reported on the fact that one of the reverse mortgage industry’s largest lenders, Bank of America, had dropped out of the reverse mortgage business in No More Reverse Mortgages, Announces Bank of America.
- Last week I explained how the Farr Law Firm has taken steps to help clients get around the “competency problem,” in The Reverse Mortgage Saga Part 5: “How the Farr Law Firm is Helping Clients Stay at Home.”
- This week I provide an update that may signal an end to the “expense problem.”
All of these problems amounted to the beginning of the end for this national industry, because by February, 2011, Bank of America announced it was exiting the industry. MetLife followed Bank of America’s footsteps as of April 30th, 2012.
Officially, Bank of America exited the reverse mortgage industry due to strategic business reasons.
Discussed in No More Reverse Mortgages, Announces Bank of America, the Bank cited “competing demand and priorities, [requiring resources to be allocated elsewhere.]” However, as the article also explained:
“The Bank of America decision [came] in the wake of bad press related to its conventional mortgage business, and peaked recently when a temporary restraining order was issued January 20 of [2011] against ReconTrust, a subsidiary of Bank of America. ‘ReconTrust is trustee on thousands of loans that are in some stage of foreclosure and approximately 8,920 of such loans have already been directly affected by this injunction,’ reported the Las Vegas Sun. The order was issued based on a woman’s suit against Bank of America for “fraudulently trying to foreclose on her home,” as reported by The Street.”
When MetLife announced its’ plans to exit the industry on April 26, 2012, a press release was issued stating the following:
“MetLife’s entire retail banking business, including mortgages, represented under two percent of [its’] 2011 operating earnings. Given MetLife’s strategic focus as a global insurance and employee benefits leader, [it] decided in 2011 that a bank holding company structure was no longer appropriate.” (Emphasis added)
However, just because MetLife’s retail banking business represented less than two percent of operating earnings in 2011 does not necessarily mean it was a miniscule part of its overall business, or business investments. Was the MetLife decision truly a strategic one, or were there organizational problems beneath the surface of the press release??
After looking into the issue – that is, past the MetLife press release – it seems as if there are no such organizational distractions as may have been the case with Bank of America. According to sources quoted by BusinessWeek, the banking sector of MetLife – including its reverse mortgage services – simply were not profitable enough to continue operations. And the burden of increased regulatory standards may have also played a role, further tipping the scales to exit the industry, suggested The Wall Street Journal. The bottom line is best summed up by Reverse Mortgage Daily, stating that the consensus is that unlike the Bank of America situation (where there were problems, perhaps, behind the scenes, “[The MetLife decision is] just another stop in a bigger exit strategy on the part of MetLife, which has been shedding business lines since last year and recently saw its CEO step down.”
Without Bank of America and MetLife, the national industry may be gone, but reverse mortgages are not, as they are still available through independent brokers. The question thus becomes, whether reverse mortgages, as they currently are now offered, are worthwhile options for seniors who want to remain in their homes for as long as possible? Furthermore, what will these institutions do to help senior citizens that the larger institutions did not? I would say waiving the exorbitant fees is a good start.
The “Expense Problem” and one Lender’s Answer
All one needs to do is take a glance at the graph below to see how the “expense problem” affected many American’s decision-making processes when deciding whether to take a reverse mortgage, starting right around the beginning of the recession in 2009. It is drastic, to say the least. Although my article, Huge Problems with the Reverse Mortgage Industry mainly focused on the “Competency” problem, another lawyer aptly commented on the blog:
“[W]hat really convinced me [a reverse mortgage] was not right for my brother-in-law’s parents . . . were the very high fees charged on the mortgage.”
True to the back-and-forth nature of this entire saga, at least one lender is using a tactic to salvage the reverse mortgage home equity loan: no upfront fees! The fees associated with a reverse mortgages have been a long-time sticking point for many people. I received an email late last month from Ernie Castro, Director of Reverse Mortgage Finance for Mortgage Solutions, LTD. In that email, Mr. Castro acknowledged the expense issue:
“Huge upfront fees . . . without a doubt . . . have been the #1 objection to the Reverse Mortgage during my career when discussing the product with financial professionals, elder law attorneys, and CPA’s. Mortgage Solutions has negotiated with one of our lenders a fixed rate Reverse Mortgage with no upfront fees to the borrower…no origination fee, no upfront mortgage insurance fee, no service fee.”
The Reverse Mortgage Lenders Association shows just 73,000 reverse mortgages taken out in 2011, down from a high of 114,000 in 2009. 2012 numbers are not released in full because the fiscal year ends in October, but clearly they are on track to register the worst year since reverse mortgages became very popular in 2007, and the largest 1-year percentage-based decline in history.
What happened? Speaking as an elder law attorney, if I were to chart my enthusiasm towards reverse mortgages for seniors as a way to remain at home longer, it would mirror this chart:
With those fees no longer a deterrent, will the industry come back to life? Perhaps, but only if people are able to jump the “competency” hurdles. If more elder law attorneys provide POA clients with Affidavits of Competency to get signed contemporaneously with the POA signing, then maybe, just maybe, we will see this graph reverse its’ current trend.
A Final Thought (for now)
As everyone knows in these days of financial volatility, market conditions can change quickly and without notice, so for anyone who has previously considered a reverse mortgage but balked at the unattractive fees previously associated with them, now would be a good time to speak with an elder law attorney about how to take advantage of a reverse mortgage if remaining at home for as long as possible is important to you or a loved one.
For even more elder law updates and news stories, please be sure to like our Facebook page and join the discussion! Who knows, we may even feature your comments and opinions in a future blog post!
Image courtesy of FreeDigitalPhotos.net
Credit: (Deirdre O'Neill) / CC BY-SA 2.0
“Presume not that I am the thing I was,” wrote William Shakespeare in the play, 2 Henry IV, reminding us that nothing stays the same.
On the personal side, we all change over time; our families and our other assets grow and shrink.
On the business side, entities both small and large come and go; Internet and technology companies appear out of nowhere and just as often disappear into cyber-obscurity; and the economy has a mind of its’ own. In the wake of the global financial crisis that began in 2007 and the collapse of so many financial giants, it is no surprise that the reverse mortgage industry has recently undergone a major shakedown.
For the past five years, I have chronicled the reverse mortgage industry – starting when its popularity was peaking back in 2007. I exposed two major problems in 2010, leading me to conclude that I could no longer, in good-faith, remain a supporter of the reverse mortgage. Those two problems I shall refer to as the “competency problem” and the “expense problem.”
This week and next week I will add two more articles to my continuing series on reverse mortgages. This week I will explain how the Farr Law Firm has taken steps to help clients get around the “competency problem,” and next week I will provide an update that may signal an end to the “expense problem.”
Here’s a summary of, and links to, my previous articles in this series:
- I praised reverse mortgages in 2007 as a viable way for seniors to remain at home as long as possible in my article, Reverse Mortgage Home Equity Loans.
- I viewed reverse mortgages as an excellent choice for various reasons, explained in detail in my early-2010 article, Using a Reverse Mortgage to Pay for Home Care.
- By mid-2010, I wrote about what I perceived to be discrimination in the lending industry I completely explain why that was such a nefarious issue to my clients and the elderly at-large in the article, Huge Problems with Reverse Mortgage Industry.
- Merely a few months later I found myself writing about the “expense problem” in, Reverse Mortgage Rules Changing Again , noting Congress’ plan to increase HUD’s Mortgage Insurance Premium.
- In February, 2011, I reported on the fact that one of the reverse mortgage industry’s largest lenders, Bank of America, had dropped out of the reverse mortgage business in No More Reverse Mortgages, Announces Bank of America.
The “Competency Problem” Persists: How The Farr Law Firm is “Combating” This Issue
"Combating" the "Competency Problem"
After interviewing dozens of reverse mortgage lenders, it became readily apparent that it is practically an industry guideline to refuse to honor the Power of Attorney (POA) presented for use in connection with obtaining a reverse mortgage: it is systemic. I first discovered this travesty when two of my own clients were sent on scavenger hunts for documents certifying the applicant’s competency when the POA was signed, and a second document certifying the applicant is now not competent, both to be completed by the applicant’s doctor.
I described why these steps were creating an “insurmountable roadblock” for some clients in detail in my May 5th, 2010 article, Huge Problem with Reverse Mortgage Industry, because I believed then – and still do today – that these practices are not only unfair, but illegal and discriminatory. However, because of this unfair practice, the Farr Law Firm has made adjustments to its’ Incapacity Planning services in order to help our clients navigate these obstacles.
How is the Farr Law Firm Helping?
When our clients come in to sign their Incapacity Planning documents (including their POA), we provide them with an Affidavit of Competency to give to their doctor to certify competency as soon as possible after the document signing, thus satisfying the first major “competency” hurdle. Of course, it is the responsibility of the client to actually go to the doctor and get the affidavit signed, but having the affidavit ready to hand to the doctor to sign helps the client get it done.
For clients with borderline competency who might wind up needing to use a reverse mortgage, we provide them with an Affidavit of Competency for their doctor to complete prior to the document signing.
Why Reform is Still Needed
Most people want to remain at home, as long as possible, before entering a nursing home for long-term care. A reverse mortgage is a great tool to accomplish this desire, because in most cases significant in-home health care will become necessary at some point. In-home caregiving is not cheap, and thus adequate funds are needed to ensure one can be hired. Although our firm has taken steps to get around the “competency” hurdle, most attorneys have not, and even though our current efforts will be helpful for clients signing our documents today, they are no help for clients who come to us or other attorneys with an old POA and no Competency Affidavit. So once again, I implore you to visit HUD’s Housing Discrimination Complaint Website and file a “lending discrimination complaint” if you believe you have experienced discrimination. If enough people cry foul, perhaps HUD will outlaw arbitrary, harmful “scavenger hunts.”
Stay Tuned for Next Week
Next week I will provide an update that may signal an end to the “expense problem.”
Image Credits:
“Combating” the “Competency Problem” – Free images from FreeDigitalPhotos.net
As the Baby Boomer generation ages, more and more families are struggling to live with a loved-one suffering from Dementia or Alzheimer’s disease. W
hile memory loss can be a frightening experience for an aging parent or grandparent, its’ impact on the family can be equally frightening, particularly when there are young children in the home.
There are a host of reasons why people invite an aging parent or grandparent to move in with them and their family. It might simply “feel” like the right thing to do; the home could be old and in need of serious repair, and perhaps they have fallen or have been injured as a result of the conditions of the premises.
It might be easy to dismiss occasional forgetfulness as normal – the elder may even laugh at, or make fun of their own inability to recall something. However, when living with someone suffering from a progressive form of dementia, it does not take long to realize the differences between it, and mere forgetfulness.
The transition can be even more difficult when children are part of an active household. When an aging relative has lived alone for many years, this can be especially pronounced.
Unfortunately, it can get to the point that it is not possible to care for one’s own children as well as an aging parent or grandparent at the same time. The needs of one are often diametrically opposed to the other.
Individuals placed in an environment catering to the specific needs of those with cognitive impairments such as dementia, quite often are truly better off. Age-appropriate activities and companionship with people one’s own age is an important aspect not to be overlooked. While it can be a painful reality to accept, quite often others are far better equipped to provide the care a patient with Alzheimer’s or other forms of dementia.
As our population ages, and people live far beyond the life expectancy of even 20 years ago, more and more families will be forced to acknowledge their limitations. Choosing to place a family member in a nursing home is not an admission of failure, but an acceptance of the fact that prolonged life expectancy carries with it a need for more complex care than the vast majority of us can ever hope to provide.
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Siblings often have trouble agreeing on anything, so why should it be any different when it comes to Mom and Dad’s elder care? Unfortunately those of us in elder law see quite often how families have a very difficult time when it comes to determining what is best for aging parents.
In some cases, one sibling may be expected to take on an unreasonable portion of the elder care with other siblings not recognizing (or possibly not caring) that it is a hardship. Perhaps it’s because of geographical closeness, or financial stability, or even perceived favoritism of a particular sibling. Other times, siblings simply can’t agree on the best course of medical intervention or the choice of an assisted living facility.
A certified elder law attorney like Evan Farr can actually help to avoid or work through some of these issues.
The best approach is to start early. Most siblings can likely agree that having your parents make their wishes known in advance is a good thing. (And sticking to them, no matter what, when they become necessary.) The attorney can help them draw up some very important documents before they are even needed. Such as:
- Medical Power of Attorney – This names the person responsible for making medical decisions when the parent is unable to do it for himself or herself.
- Financial Power of Attorney – This is used to determine who will have control of the parents’ finances in order to keep the household going, pay medical bills, etc. during an illness or crisis.
- Living Will – A living will helps to outline the parents’ wishes when it comes to medical interventions and end-of-life care. Having this in place takes some of the burden off of the adult children who would otherwise be making these choices.
If possible, it’s best to have all of the siblings aware of and in agreement about these documents, as it can cut down on the amount of frustration later. Of course, children must also realize and respect that it is entirely up to the parents who they want to nominate as their primary Agents, and whether they may act independently or if they must act in cooperation with one or more siblings.
When things do become more intense and these documents come into play, it is still likely that siblings will have disagreements about what is best. The one who has the largest responsibility for day-to-day elder care may become resentful, while another may also harbor resentments that someone else was chosen to take care of the parents’ finances. Throw in the emotions that surface when facing your parents’ mortality, and there is potential for a major explosion and grief.
In order to diffuse the situation, an elder law attorney can direct you to other forms of outside help. For example, some families choose to hire a “geriatric care manager.” This person is able to manage many aspects of the parent’s care, and because he or she isn’t a family member, much of the associated drama is mitigated. When a situation has become too out of hand, the siblings may need to agree to use a mediator. This impartial listener can help to determine the best course of action for getting the parents the care they need while meeting the needs and wishes of the siblings as appropriately as possible.
In order to salvage an uncomfortable family situation, it may be advisable for members to seek family counseling. This is most likely to work when all of the members are invested in a positive outcome. The staff at the Farr Law Firm can help direct you to many resources for counselors and mediators here in the Northern Virginia area.
If you’re a parent that would like to start laying the proper groundwork for your children now, contact the Farr Law Firm to discuss drawing up the proper documents to make future life transitions as smooth as possible for your family.
Budgeting is part of any effective Life Care Plan and becomes even more important when seniors experience a big life change, such as moving into an assisted living facility, losing a spouse or having a drastic change in health. It begins with an assessment of your resources and your needs. The purpose of Life Care Planning is to improve the quality of life for the person for whom we are planning. Budgeting helps us understand what tools and resources we have to work in accomplishing that goal.
As you prepare your budget, there are several basic concepts you should consider. First, you should determine your needs, broken down on a monthly basis if possible. Consider everything from daily living expenses (rent, food, utilities) to recurring monthly fees (car payments, Netflix subscriptions) and other miscellaneous expenses (charitable donations, gifts, recreational activities). Don’t forget to include extraordinary emergency expenses that could catch you off guard (replacing a roof, unexpected healthcare expenses, etc) as well.
Then think: Is your monthly income sufficient to meet your needs and, if not, how will you supplement or enhance your income to meet your needs? Be realistic. Where possible, consider limiting certain risks by purchasing insurance. If you need professional help, speak with a Certified Financial Planner or someone else who has the skills to help you establish a budget.
Armed with this, we can help you move forward in drafting a Life Care Plan (and the appropriate Medicaid planning) that will give you the best life possible, without depleting your life savings or going into debt.
To Refresh:
Create a budget by:
1. Naming categories that describe your expenses.
2. Estimate expenditures for each category. Use last year’s expenses as a guide.
3. Find areas where you can cut back.
4. Implement your budget, and stick to it.
5. Review and modify your budget at regular intervals.
Helpful Budgeting Links:
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