Category Archives: Family Caregivers
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.
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.
As I’m sure you’ve heard (and felt!) this week has already shown record-breaking temperatures across the country, and this heat wave is only expected to move further east through the end of this week. Temperatures are expected to break 100 today and tomorrow with a heat index of up to 110! While high heat is usually just an inconvenient downside to summer, when it crests as high as this we should consider taking some precautions. Caregivers, make sure to pay special attention to your elderly loved ones during this unbearable heat wave.
According to The Weather Channel, heat is the number one weather-related killer in the United States outpacing hurricanes, tornadoes and other natural disasters. Soaring temperatures pose the biggest threat to the elderly, the very young, and the ill, as well as those who cannot afford air conditioning or live in the heart of big cities. Check on your elderly neighbors and invite them into your air conditioned home if they don’t have it. (Who knows, you might even trade some interesting stories over a cold glass of iced tea!) If you are living in a big city, the threat is two fold. High temperatures often continue through the night as concrete and asphalt release the heat they’ve absorbed throughout the day, leaving you in a baking oven even in the dead of night. Less obvious but just as threatening is the increase of pollutants in the air (due to the stagnation caused by lack of air circulation) that can irritate those with sensitive respiratory systems. For seniors already suffering from emphysema or asthma, this can be particularly threatening.
Caregivers and family members, keep on the lookout for symptoms of the two most common heat-related illnesses in the elderly: heat exhaustion and heatstroke. Heat exhaustion is defined as a “mild form of shock marked by heavy sweating, weakness, cold, clammy skin, a weak pulse, fainting and vomiting.” If not quickly caught and treated, the condition can possibly lead to heatstroke–a life threatening illness that can result in brain damage or even death if not treated by emergency medical help immediately.
Seniors and those caring for them should take extra care to prevent any ill-effects from this suffocating heat. Ensure that those most at-risk are in an air-conditioned and cool room if possible. If not, you may want to consider temporarily helping them move to a location that does have air conditioning to keep them more comfortable. Of course, make sure to drink plenty of water as well. Even the strongest of us can fall prey to the heat if we aren’t aware and don’t take the proper precautions.
Source: The Weather Channel
Many of my clients ask me how I feel about reverse mortgages, and even more so this past week because of a favorable story that appeared in last week’s Washington Post entitled “Reverse Mortgages are Not the Next Subprime.” This excellent article was written by the ”Mortgage Professor,” a Professor of Finance Emeritus at the Wharton School of the University of Pennsylvania (incidentally, my Alma Mater), and clears up much of the confusion and myths and fears surrounding the reverse mortgage. I encourage all of you to read it. Another good source of information about reverse mortgages is the Federal Trade Commission Fact Sheet.
As a Certified Elder Law attorney, one of my primary goals is to help preserve the dignity and enhance the lives of my elderly clients. For many of my clients, remaining in their homes as long as possible is one of their highest priorities. I have been a long-time fan of reverse mortgages because they help my clients do exactly that — remain in their homes as long as possible.
Why? Because in order to remain in your home as long as possible, you will most likely at some point need some home care. “Home Care” can be health care and/or supportive care provided formally in your home by health care professionals (typically referred to as home health aides) or by paid or unpaid family members or friends (typically referred to as caregivers). Often, the term “home care” is used to mean non-medical care, or custodial care, which may be provided by persons who are not nurses, doctors, or other licensed medical personnel. The term “home health care” typically refers to care that is provided by a licensed health care professional — most often a Certified Nurse Assistant (CNA). However, the terms are often used interchangeably, and for simplicity in this article I will use the term “home care” to refer to both types of care.
The goal of home care is typically to to allow you to remain at home and age in place, rather than being forced to move to an assisted living facility or nursing home. Home Care providers render services in your own home. These services typically include a combination of health care services and life assistance services.
Health care services may include services such as wound care, administration of medication, physical therapy, speech therapy, and occupational therapy. Life assistance services typically include help with daily tasks such as meal preparation, medication reminders, laundry, light housekeeping, errands, shopping, transportation, companionship, and help with the activities of daily living (ADLs), which typically refers to six activities (bathing, dressing, transferring, using the toilet, eating, and walking).
Although some home care is provided by family members for free, most family caregivers need to be paid, and these payment arrangements should always be made pursuant to a written caregiver contract (prepared by an Elder Law Attorney) between the caregiver and the care recipient. Because home care is quite expensive, having the proceeds from a reverse mortgage is often one of the only ways that elders can afford to pay for appropriate home care. According to The 2009 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs, the 2009 national average hourly rate for home health aides increased by 5.0% from $20 in 2008 to $21 in 2009. The national average hourly rate for homemaker/companions increased by 5.6% from $18 in 2008 to $19 in 2009.
Most of my clients, when they start out needing home care, will typically start with receiving 4 hours of care 3 days a week, which costs about $1,000 per month and is easily affordable for many people. But over time, most of my clients progress to the point of needing upwards of 12 hours per day of home care, costing over $7,000 per month, and very few people can afford to pay for this type of care without eventually tapping into their home equity via a reverse mortgage.
The most common type of reverse mortgage is the Home Equity Conversion Mortgage (HECM), which completely protects your ability to remain in your home. So long as you pay your property taxes and homeowners insurance, and maintain your property, you can remain in your home forever. If the reverse mortgage lender fails, any unmet payment obligation to the borrower will be assumed by FHA.
According to the Mortgage Professor’s article mentioned in my first paragraph, in 2009 about 130,000 HECMs were written, and feedback from borrowers has been mostly positive. In a 2006 survey of borrowers by AARP, 93% said that their reverse mortgage had a mostly positive effect on their lives.
For many of my clients, a reverse mortgage is the best way, and often the only way, for them to be able to afford to remain at home, despite the fact that reverse mortgages are expensive to obtain. However, reverse mortgages are not for everyone, as there are other programs that may be able to help you remain in your home. For instance, many of my clients are eligible for the Veterans Aid and Attendance benefit or for home-based Medicaid, or can be made eligible for these benefits through our process of Asset Protection.
Whether you own your home outright or in a Revocable Living Trust or in my proprietary Living Trust PlusTM Asset Protection Trust, if you think a reverse mortgage might be the solution you need, please contact me for a free consultation so I can evaluate your specific situation and advise you as to whether a reverse mortgage is your best option for allowing you to live comfortably in your home.
There is a popular tune played this time of year called “Grandma Got Run Over by A Reindeer” which relates that Grandma — after drinking too much eggnog — went out into the winter cold to get her medication and was run over by a reindeer. The question is . . . “Who was supposed to be watching Grandma?”
Though this little tune is just for fun, it may very well raise alarms to many caregivers of the elderly. Caregivers know that even at a holiday party they cannot let down their diligent watch over their elderly loved one. As far-fetched as it may sound, with all the people and noise, an elderly family member with dementia or Alzheimer’s may be enjoying the family gathering and then suddenly become confused and walk to the door and leave.
For family caregivers the added stress of the holidays with decorating, shopping, parties and keeping up with all the family traditions is an overwhelming quest. Feelings of isolation, depression and sadness come with this added stress. There are millions of Americans who are caring for elderly frail loved ones and most of these caregivers will go through some of these emotions, especially this time of year.
There are some things you can do as a caregiver to help you and those you care for enjoy the holiday season.
First take care of yourself. Try to eat right, get plenty of sleep and exercise. This will help reduce stress and strengthen your ability to cope with caregiving responsibilities.
Prioritize your holiday traditions. Perhaps instead of cooking a large family dinner, have everyone bring his or her favorite dish. Use paper plates. Forfeit the traditional outside light decorating for a lighted wreath on the front door. Choose one or two parties or concerts to attend instead of trying to do it all.
Arrange for help. Call on other family members to help with the caregiving while you do your shopping or go out for the evening. If family is not available, ask your church group or a neighbor if they would donate a few hours.
Use community services. Many senior centers provide meals for the elderly and supervised activities, onsite, at no charge or a minimal charge. For locating senior services in your state, call your state Area Agency on Aging or check the national locator website at http://www.n4a.org/
Use adult day care services. Some assisted living facilities provide day activities and meals for seniors on a day by day basis. Other organizations called “adult day service providers” specialize exclusively in this sort of care support at a reasonable cost. These support services provide respite for caregivers from their caregiving responsibilities as well as social interaction for their elderly family members. There is a cost for adult day services, but the benefit for all is worth it.
Technology to the rescue. Here is a solution that would have kept “Grandma” from going out in the winter cold and getting run over by a reindeer. Companies that have created monitoring systems, security alarms and other safety equipment are “tweaking” them to adapt to the needs of seniors and their care givers.
Here are a few examples:
- Ankle or wrist bands that monitor location and alert the provider when a person has gone beyond the designated perimeter, such as out the front door of the house.
- Motion detectors. Set throughout the home, motion detectors allow someone outside the home to follow a senior as he or she moves through the house.
- Smart medication dispensers. Live monitoring and dispensing of pills.
- Emergency response alert. At a touch of a button on a desktop monitor, bracelet or necklace, emergency help is summoned.
Whether providing care in your home or helping senior family members in their own homes, your use of monitoring and “tech” help aids can provide extra safety for your loved ones, and peace of mind for you.
You are not alone. Join a caregiving help group. Your local senior center may have one or go on the internet to find one. Hearing about other caregivers’ problems and solutions and being able to share your own and ask questions is a great way to relieve stress and gain a new perspective. Check out websites like the National Family Caregivers Association at http://www.nfcacares.org/
Work with a Senior Care Professional. Recognize that you are doing the very best you know how. You are not a geriatric health care practitioner, geriatric care manager, home care nurse or aide, hospice provider or family mediation counselor, nor do you have the years of training and experience these professionals have, but you can definitely use their experience. In fact, using a senior care specialist will make caregiving easier for you and more beneficial for your elderly family member.
You can find a wide variety of care professionals in your area on the National Care Planning Council website at www.longtermcarelink.net and on our website at http://www.virginiaelderlaw.com/TrustedReferrals.htm.
One more thing to remember. As a family caregiver, the greatest gift you are giving this holiday season is “Love.”
November is National Family Caregiver’s Month. Most family members who help their older loved ones don’t see themselves as caregivers. Yet a caregiver is anyone who helps an older person with household chores, errands, personal care, or finances. Most caregivers also don’t realize that caring for themselves is an important part of providing care for someone else. Among all the hardships of providing care to another, a caregiver faces time restraints and stresses that might be physical and/or psychological in nature. Particularly today, given the current economy, a caregiver may also feel the burden of financial stress. The simple truth is you can’t be a good caregiver if you don’t take care of yourself. The following advice comes from my book, The Virginia Nursing Home Survival Guide, which you can obtain from our firm or from Amazon.com.
What You Can Do
Take charge of your life. Don’t let your loved one’s illness or disability always take center stage. While you might fall into a caregiving role because of an unexpected event, somewhere along the line you need to step back and consciously say “I choose to take on this caregiving role.” It goes a long way toward eliminating the feeling of being a victim.
Set realistic goals. Caregiving creates many conflicting demands on your time; it is vital to set realistic goals. Recognize what you can and cannot do. Define your priorities and stick to them as much as you can. You have the right to set limits and, though it is hard, it is okay to say no.
Seek out help from family and friends. When others offer assistance, accept it and suggest specific things they can do. Some caregivers see asking for help as a sign of weakness, failure or inadequacy, when in fact it is just the opposite. Reaching out for assistance before you are beyond your limits is one characteristic of a strong person. While they might not be comfortable helping with bathing and dressing needs, friends and family can help by running errands, shopping for groceries, preparing meals or just visiting. They can call regularly, taking some pressure off you to be the primary social outlet.
Seek out appropriate geriatric medical professionals. A geriatrician is a medical doctor who is specially trained to prevent and manage the unique health concerns of older adults. Older persons may react to illness and disease differently than younger adults. Geriatricians are able to treat older patients, manage multiple disease symptoms, and develop care plans that address the special health care needs of older adults. Geriatricians are typically primary care physicians who are board-certified in either Family Practice or Internal Medicine and have also acquired the additional training necessary to obtain the Certificate of Added Qualifications in Geriatric Medicine.
National Family Caregiver’s Month
The National Family Caregivers Association (NFCA) provides education and support to those who are caring for a loved one. Founded in 1993, their motto is “Believe in Yourself, Protect Your Health, Reach Out for Help and Speak Up for Your Rights.”
Fairfax County has regular Free Seminars for Family Caregivers. The seminars take place in October and November and are all geared towards educating the Family Caregiver. Some of the titles include: Planning Quality Time for the Person with Dementia (10/22), End of Life Decisions: What Families Need to Know (10/28) and When Do I Step In (11/5). You can click here to register for any of these free seminars.
The Farr Law Firm is dedicated to helping caregivers by providing outstanding legal services that help preserve assets in order to protect the dignity and integrity of their loved ones.
Free Seminars for Family Caregivers:
National Family Caregivers Association: