Alzheimer’s Survival Kit

Revising Wills & Trusts

Whenever a major life event occurs, attorneys recommend that you review your wills and trusts. Your current legal documents may no longer be appropriate. You may want to make changes that reflect your new circumstances. A diagnosis of Alzheimer’s disease is a major life event worthy of this kind of legal review.

Changing Property Titles

The way real estate and other property is titled is important. In some cases, how your property is held means that selling it will require court intervention. Reviewing property titles is also an important part of planning to ensure that you and your family members are protected if you ever need long-term care in a nursing home.

Strategies for Financial or Other Gifts

Consulting a knowledgeable attorney is especially important before you transfer any property or make gifts. The attorney can help you review your financial situation to determine whether a gifting program or other financial strategy is appropriate for your situation. Making gifts can protect your family and help save your estate. But, acting improperly can have severe legal implications, and can even make you ineligible for government benefits.

Long-Term Care Strategies

Now is the time to consider what changes in living arrangements you might need over time. Those arrangements can include independent living, assisted living, an assisted living/nursing home combination for you and your spouse, or nursing home placement. Check provisions of any long-term care insurance you have in effect. (If you don’t already have this kind of coverage, you probably won’t be able to qualify for it once you’ve been diagnosed with Alzheimer’s disease. Still, it may be an option for your spouse.) You’ll want to review this and other possible strategies with your legal advisor.

Medicaid Planning

Medicaid, a federal/state program administered by the states, pays for health care when eligible patients cannot. Many people think they won’t need Medicaid or won’t qualify for it. But Alzheimer’s disease is the third most expensive illness in the United States, after heart disease and cancer. The average lifetime cost per patient is over $200,000. Many people simply can’t manage these costs on their own. Others are afraid to deplete their resources and impoverish their families. Medicaid planning addresses this issue. Proper planning lets you retain as much of your resources for your family as possible while ensuring that you get the benefits you’re entitled to.

Pre-planning and crisis planning for Medicaid are two ways to accomplish these goals. Preplanning involves things you can do over time. If you’re an Alzheimer’s patient in the early stages, you’ll be able to participate in this type of planning. But even in the later states, crisis planning can allow your family to protect you and them from financial disaster. An attorney experienced in this aspect of elder law can help you comply with the law while taking full advantage of options open to you.

Safe Driving

If you have Alzheimer’s disease, you may someday be faced with a recommendation that you restrict your driving privileges. Your doctor may write a prescription that says, “Do not drive.” Or, family members may begin to notice effects the disease has on your memory, judgment, and attention—effects you are unaware of.

Those mental abilities are critical for driving. If you have recently been diagnosed with Alzheimer’s disease, you might not have a problem with driving for a while. At some point, however, you may begin to notice that you lose your way, misjudge the speed of oncoming traffic or fail to notice stop signs or other signals. You may be driving legally—that is you have a valid driver’s license, but you might not be driving responsibly. The last thing you’d want is to cause an accident. And liability for one could cause legal problems and financial burdens for you and your family.

The independence that driving affords isn’t easy to give up. Some people even feel lowered self-esteem when they can no longer drive. We have all grown up in a culture where driving is important to us. And, no one wants to be a burden on others for transportation. So it’s common for Alzheimer’s patients not to admit difficulty behind the wheel.

However, people with Alzheimer’s disease and their families and doctors have a responsibility to balance patients’ convenience and safety along with the safety of other drivers and their passengers. Studies have found that, particularly in later stages of Alzheimer’s disease, you are twice as likely to cause or be involved in motor vehicle accidents as drivers of the same age without the condition.

The American Psychiatric Association (APA) guidelines for restricting driving privileges of patients with Alzheimer’s disease say that all severely impaired Alzheimer’s patients pose unacceptable risks on the road. So do people with moderate impairment who cannot cook or perform simple household tasks. In early stages of the disease, some people can drive safely for as long as two or three years after diagnosis. Others, however, cannot drive even short distances without endangering themselves or others. Discuss this issue openly with your family members and doctor. Trust them to tell you when to turn over your car keys.

Continuing Care

As Alzheimer’s disease progresses, the care you need increases.  In the early stages, you may be able to continue living independently at home or with help from family members or home health aides.  Other possibilities include adult day care or respite care.  With adult day care, you are in a supervised program during the day, then return home at night.  Respire care programs provide substitute caregivers to temporarily relieve family members or others who usually help you with daily activities.

Another possibility is the need for a nursing home.  That’s because Alzheimer’s disease is the leading diagnosis requiring nursing home admission.  You and your family should be aware of the following legal issues concerning the continuing care of an Alzheimer’s patient:

• Guardianship
• Conservatorship
• Legal rights of a nursing home resident

Guardians and Conservators

By the time you need nursing home care if ever, you’ll likely be unable to make decisions about financial matters or health care. If you have not executed a durable power of attorney and a durable power of attorney for health care decisions, you’ll need a court-appointed conservator and guardian. The conservator will manage your financial business, while the guardian will make personal and medical decisions for you.

Legal Rights of a Nursing Home Resident

Each nursing home resident has a right to personal and appropriate care, which is guided by the resident’s care plan. The care plan is a contract created by a “team,” that includes you, the nursing home staff and anyone else you want to involve. The plan should detail your current medical, psychological and social needs and spell out what will be done to maintain or, when possible, improve your health. Because the care plan creates a contract, getting legal assistance with this document is advisable.