Fong Law Group

Wendy Williams Case Shines Spotlight on Guardianships

Takeaways

• Guardianships may be necessary to protect individuals with cognitive impairments, but they can also limit personal freedom and autonomy.

• Wendy Williams’ guardianship case highlights the importance of legal representation and proactive estate planning.

Dementia is on the rise and is affecting millions of families across the United States. As dementia erodes a person’s mental faculties, they lose the ability to manage their life. This can lead to losing money through bad financial decisions or a higher risk of injury from falls or accidents at home or in the community. To help the affected person, family members sometimes have to turn to the court system to ensure the safety and well-being of their loved one.

A court can order a person with compromised mental faculties to be placed in a guardianship or conservatorship arrangement. (Note that the terms used can vary depending on the state.) These arrangements give a mentally able person control over certain aspects of the stricken person’s life. Though the intention of such an arrangement is to protect the afflicted person, it may also end up greatly limiting their freedom and sense of autonomy.

The recent guardianship struggles of Wendy Williams, former radio personality and talk show host for The Wendy Williams Show, and the previous conservatorship lawsuit involving pop star Britney Spears have brought significant attention to the complexities and potential pitfalls of such legal arrangements. Both cases underscore the delicate balance between protecting individuals with cognitive impairments and preserving their personal autonomy.

Wendy Williams’ Dementia and Guardianship

In early 2022, financial institution Wells Fargo froze Williams’ accounts, citing concerns over unusual activity. This action led to Williams being diagnosed with primary progressive aphasia and frontotemporal dementia (FTD) and placed under a court-ordered guardianship. Williams has contested the diagnosis and claims that she is capable of managing her affairs. She has described her experience under guardianship as isolating and akin to imprisonment, expressing frustration over her lack of freedom and limited access to her finances.

Britney Spears’ Conservatorship

Britney Spears’ conservatorship, which began in 2008, placed her personal and financial decisions under the control of her father and legal representatives. Spears publicly described the arrangement as abusive, highlighting forced work schedules, restricted personal freedoms, and financial exploitation. Her testimony in 2021, coupled with the #FreeBritney movement, culminated in the termination of her conservatorship later that year.

Issues and Solutions

Both Williams and Spears experienced legal constraints that severely limited their personal and financial freedoms, despite their public personas and professional successes. These cases highlight several critical issues:

• Oversight and Accountability. Guardianships can be susceptible to misuse and overreach. Regular, independent reviews are essential to ensure that such arrangements serve the person’s best interests.
• Legal Representation. Access to knowledgeable legal counsel is crucial for individuals under guardianship who wish to challenge unjust arrangements and advocate for their rights.
• Public Advocacy. Awareness campaigns, such as the #FreeBritney movement, can shed light on potential abuses within guardianship systems and drive legislative reforms.

FTD and Related Impairments

FTD is a group of brain disorders affecting the frontal and temporal lobes, leading to changes in personality, behavior, and language. Unlike other forms of dementia, FTD often manifests at a younger age, typically between ages 45 and 65. Symptoms vary from person to person but may include impulsive actions, inappropriate social behavior, and language difficulties. People with FTD may have a family history of this type of dementia.

Aphasia affects the frontal lobe of the brain, impairing speech and language abilities, comprehension, reading, and writing. These cognitive impairments can hinder a person’s capacity to manage their personal and financial affairs, sometimes prompting the establishment of a guardianship. As progressive conditions, FTD and aphasia both tend to come with symptoms that get worse over time.

As of this writing, Williams’ guardian, Sabrina Morrissey, and her team are calling for a new medical evaluation to confirm Williams’ diagnosis.

The Importance of Estate Planning

Proactive estate planning is vital for safeguarding one’s autonomy and ensuring that personal wishes are honored in the event of cognitive decline. Key components of your estate plan may include the following:

• Advance Health Care Directive. This legal document outlines preferred medical treatments and designates decision-makers if one becomes incapacitated.
• Durable Power of Attorney (POA). A POA appoints a trusted individual to handle financial, medical, and/or legal matters on one’s behalf.
• Living Will. This legal instrument allows one to specify their desired end-of-life care and medical interventions.

Facing a dementia diagnosis can be distressing. You want to have peace of mind that your wishes regarding your care will be respected. With an attorney’s help, you can set up these legal measures to maintain better control over your affairs and reduce the likelihood of unwarranted guardianship interventions as your cognitive abilities decline.

Learn More About Coping With Dementia

The experiences of Williams and Spears serve as cautionary tales, emphasizing the need for vigilant oversight, robust legal protections, and comprehensive estate planning to protect personal autonomy and prevent potential abuses within guardianship arrangements.

Reach out to your elder law attorney if you have questions about how to care for a loved one with dementia or to plan ahead for the possibility of dementia. These professionals can offer expert help with long-term planning and health care for those diagnosed with dementia.

An attorney can help set up a guardianship if needed but also explore less restrictive options. They can aid in navigating the complexities of Medicaid and other programs that may help cover long-term care. This may include asset protection strategies, such as creating a trust, to prevent losing the patient’s wealth to long-term care costs.

Your elder care lawyer can also assist in identifying and preventing financial abuse of people with dementia, by securing financial accounts or addressing fraud or neglect concerns. If the dementia is severe, they may be able to help secure disability benefits or other assistance the person qualifies for.

Unpaid Family Caregiving Is Worth a Six-Figure Salary

As the population ages, the number of people affected by Alzheimer’s disease and other forms of dementia continues to rise. In turn, families increasingly find themselves providing unpaid care to loved ones with cognitive impairments. This caregiving role, though essential, comes with hidden personal, financial, and societal costs that can be substantial. In fact, a new study reveals that family caregivers of loved ones with dementia, if they were paid for their services, would be making six figures.

The Scope of Unpaid Family Caregiving

Nearly 7 million Americans aged 65 and older are living with Alzheimer’s, a figure projected to reach nearly 14 million by 2060 if trends continue. Many families shoulder the responsibility of care, as residential facilities and formal caregiving options can be financially prohibitive. In 2023, it was estimated that around 11 million Americans were providing unpaid care for family members with dementia, contributing an estimated 18.4 billion hours of care annually. The estimated value of this unpaid care is $346.6 billion.

Unpaid family caregivers often provide a wide range of support for their loved ones with dementia. This may include assistance with daily activities such as bathing, dressing, and eating, as well as managing medications and medical appointments. They also may offer emotional support, companionship, and help with household tasks, ensuring their loved ones maintain a sense of dignity and comfort in their daily lives.

Caring for a loved one with dementia can be particularly stressful. Caregivers often experience emotional strain from witnessing their loved one’s decline, leading to feelings of sadness and helplessness. The physical demands of caregiving can result in exhaustion, while the constant need for vigilance can create anxiety. Balancing caregiving responsibilities with their personal life can further contribute to feelings of isolation and burnout.

The Costs of Dementia Care

Unpaid caregivers often face financial challenges as they balance caregiving responsibilities with their own employment and personal financial stability. Some key financial costs include:

• Lost Income and Job Disruption: Many caregivers reduce their work hours, take leaves of absence, or even quit their jobs to care for loved ones. This reduction in income can be significant, especially for those in their prime earning years. Caregivers also lose out on career advancement opportunities, retirement benefits, and Social Security contributions, which can have long-term implications for their financial well-being.
• Out-of-Pocket Expenses: Caregivers frequently cover out-of-pocket costs associated with their loved one’s care. These expenses include home modifications, transportation, medical supplies, and other caregiving necessities. According to the AARP, caregivers spend an average of $7,200 annually on caregiving expenses, a figure that can climb higher for those supporting someone with dementia due to the progressive and intensive nature of the care required.
• Health Care Costs: Caring for a loved one with dementia can take a toll on the caregiver’s own health and quality of life, leading to increased health care expenses. Studies have shown that caregivers of people with dementia often experience higher rates of depression, anxiety, and chronic conditions, such as heart disease. These health issues can require costly medical treatments and medications.

How Much Would a Family Caregiver Make?

What if family and friend caregivers were paid for the caregiving services they provide to their loved ones with dementia? According to a recent study conducted by Salary.com and Otsuka America Pharmaceutical, Inc., a caregiver would earn a six-figure salary for the daily help they provide. In fact, the approximate salary would be $114,000, on average.

The two companies created a calculator for caregivers to estimate how much they would make if they were paid for their time and effort. Check out the interactive Family Caregiver Calculator.

The Economic Effects on Society

The economic cost of unpaid dementia caregiving extends beyond individual families to society as a whole. The Alzheimer’s Association estimates that the economic value of unpaid caregiving for individuals with dementia is almost $340 billion annually. If caregivers were unable to provide this support, the health care system would face immense pressure to meet these needs, potentially straining public resources.

Getting Support and Planning Ahead

Unpaid caregiving for older adults with Alzheimer’s and other forms of dementia is a deeply meaningful yet challenging responsibility. Thankfully, there are resources for these caregivers.

Family caregivers of individuals with dementia can access a variety of resources designed to provide support, education, and respite. Here are some key resources available to help them navigate this challenging journey:

• Support Groups. Many organizations, including the Alzheimer's Association, offer support groups where caregivers can connect with others facing similar challenges. These groups provide a safe space to share experiences, gain emotional support, and learn coping strategies.
• Educational Programs. Workshops and seminars are often available to educate caregivers about dementia, its progression, and effective caregiving techniques. Understanding the disease can empower caregivers and help them manage their own loved ones’ needs more effectively.
• Respite Care Services. Caregiving can be physically and emotionally exhausting. Respite care services offer temporary relief by providing professional caregivers to take over duties for a short period. This allows family caregivers to rest and recharge, which is essential for their well-being.
• Online Resources. Numerous websites and online forms provide valuable information, tips, and community support. These often offer articles, videos, and tools to help caregivers find the information they need at their convenience.
• Financial Assistance Programs. Some organizations offer financial assistance or guidance on navigating insurance and government benefits. Understanding available resources can help alleviate some of the financial burdens associated with caregiving.
• Home Health Care Services. For families needing additional help, home health care services can provide skilled nursing, therapy, and personal care. These services can be tailored to meet the specific needs of an individual with dementia, allowing caregivers to focus on emotional support.
• Legal and Financial Planning Resources. Caregivers may benefit from consulting with professionals who specialize in elder law and financial planning. These experts can help families navigate issues such as power of attorney, guardianship, and long-term care planning.

By utilizing these resources, family caregivers can find the support they need to manage their responsibilities more effectively, ensuring both their well-being and that of their loved ones. Caregivers need to remember that they are not alone, and that help is available.

The Centers for Medicare & Medicaid Services recently launched a nationwide test program called Guiding an Improved Dementia Experience (GUIDE) Model. This pilot program seeks to support individuals living with dementia and their family caregivers. It allows eligible patients with Original Medicare to consult with a health care provider participating in the model. A 24/7 help line is also available.

For help with planning for long-term care services and other elder-care needs, contact an experienced elder law planning attorney near you. They will guide you through the options available to meet your unique needs and can help you plan for the future.

Claiming the Guardianship of an Elderly Parent

Often an aging parent will lose their ability to think clearly or make informed decisions about their life. This may occur because of dementia, mental illness, stroke, brain injury, or other severe health or disability conditions. Your parent may or may not have prepared for their elder years with a durable financial and medical power of attorney. If not, a guardianship may be necessary to protect their best interests.

When There Is No Durable Power of Attorney

If your parent did not prepare for a loss of capacity and the need for legally recognized help, you will not be allowed to create these documents once they are already mentally impaired. With that moment lost, claiming the guardianship of an elderly parent is a process that requires court approval. This ensures that the protections moving forward represent the best interest of the aging adult.

Medical Requirements for Guardianship

When a parent does not have an estate plan with powers of attorney, they may bristle at the mere mention of requiring a guardian. Your first step is to obtain a doctor’s letter or physician’s certificate attesting to your parent’s physical abilities and mental acuities.

Suppose you meet with resistance to having your parent willingly submit to an evaluation. In that case, you may still apply for guardianship with the court. This may then compel your parent to submit to a court-ordered independent medical examination.

When Is it Time to Step in and File to Be a Legal Guardian?

Over time, you may begin to recognize certain signs that having a guardian may be necessary for your older parent. This might include lapses in bill payments, lack of healthy foods in their home, or your parent’s insistence they can drive after a series of accidents. Driving is imperative to monitor because your parent endangers not just themselves but others. Additional signs it may be time for guardianship include self-isolation, hearing or sight loss, and general forgetfulness, which can lead to injury around stoves, stairs, and other risks.

To file for guardianship, you would apply with the clerk of the superior court; this is a fairly standard procedure. However, by state, there are nuances and differences in law and process.

If possible, have your parent undergo a medical examination before applying; if not, the court can order one later. The court will begin legal guardianship proceedings to determine whether you are fit to be their guardian. This process generally involves assessing any existing conflict of interest, financial responsibility, and even a criminal background check.

Notifying Your Parent and Family of the Proceedings

With the application on file and awaiting court approval, you must notify your parent, the proposed ward, of the application. This notification is a legal requirement and can sometimes create family conflict.

A parent’s frantic contact with other family members upon receiving the guardianship documentation is not uncommon. Notifying these family members or others with a right to know is not only a legal requirement but also best discussed before filing. Having family on board to protect your parent with guardianship is best when you mutually agree.

Your Parent’s Right to Representation

The court will appoint an attorney ad litem to represent your parent. This person will legally advocate on your parent’s behalf, representing their needs. The court may also appoint a guardian ad litem, who may not necessarily be a lawyer, to represent the interests of a parent who may be unable to care for themselves.

Typically, court hearings occur between 15 and 30 days from the respondent (your parent) being provided the filing for guardianship. It may take longer if the court requests a multidisciplinary evaluation. In this instance, the clerk of the court may appoint an interim guardian whose powers include addressing the respondent’s immediate needs.

A Multidisciplinary Evaluation (MDE)

A thorough evaluation may include medical, psychological, daily life skills, education, social work, and vocational rehabilitation needs of your parent, the respondent. With an aging parent, the focus tends to remain on medical, psychological, and daily life skill assessments.

After a full assessment of your parent’s unique situation and your application to become a guardian, the court will decide based on the best interests of your parent. Your parent may pursue a process to appeal the decision. They generally must file this in writing within 10 days of the court’s decision. The appeal will prompt a new hearing before a superior court judge.

Guardianship Laws Vary By State

When applying for guardianship, it is crucial to understand the state laws where you live. Different states use different terms.

Some states require a “guardian” to control your parent’s home environment, health care, and day-to-day needs. In other states, a “conservator” makes financial decisions, such as paying bills and budgeting. Still others will use either of these terms to mean the same thing.

The process can take substantial time and money, particularly if family members disagree. Many states give preference to the ward’s spouse, adult children, and other family members, as they know the aging parent and their needs the best.

The court may also appoint a professional guardian. All guardians appointed by the court are entitled to reasonable compensation, although family members or friends typically will not charge for the service. Compensation for guardians must have court approval.

If the court determines you will serve as your parent’s legal guardian, it will state this in a written court order. You will remain their guardian until:

• your parent dies,
• the court finds your parent has regained capacity,
• you die, or
• the court finds it is in the ward’s best interest to remove you as the guardian or conservator.

Your parent may need your help because of advanced age, a disability, or an illness. However, they may have not appointed a durable power of attorney for health care or finances. Becoming their guardian may be the best option. This will give you the authority to make decisions about medical care, finances, or other needs on their behalf.

Contact your elder law attorney to establish guardianship for your aging parent. They can guide you through applying to become a guardian or conservator. They also can help manage your expectations regarding the best care for your parent.

Can Over-the-Counter Hearing Aids Prevent Dementia?

According to the National Institutes of Health (NIH), hearing loss affects one-third of older adults. As difficulty hearing can lead to communication challenges and social withdrawal, it can also increase the risk of dementia. Dementia includes diseases affecting memory, thinking, and the ability to perform daily activities and affects 55 million people worldwide, per the World Health Organization.

Hearing loss accounts for 8 percent of the world’s dementia cases. The Alzheimer’s Association estimates that global dementia cases will triple by 2050.

Hearing Aids for Brain Health

Hearing aids could reduce the risk of cognitive decline in older adults experiencing hearing loss. A review of several studies also revealed that hearing aid use lowers the risk of dementia by 19 percent across two to 25 years. Using hearing aids for a short time was associated with a 3 percent advancement in cognitive test scores.

Access to hearing aids is essential for seniors at risk of cognitive problems. A study published in The Lancet found that giving audiological counseling and hearing aids to older adults at increased risk for cognitive decline lessened the development of cognitive impairments over a three-year period.

Over-the-Counter Hearing Aids

For older adults experiencing hearing difficulties, over-the-counter (OTC) hearing aids could improve quality of life, preserve social connectedness, and prevent cognitive decline. Following the Food and Drug Administration’s recent approval, devices for adults with mild to moderate hearing loss became available without a prescription in October 2022.

Where to Buy Over-the-Counter Hearing Aids

OTC hearing aids are available in drug stores such as Walgreens and CVS, as well as online pharmacies. Other sellers include Best Buy, Walmart, and Hy-Vee.

Who Could Benefit From Hearing Aids Over the Counter

If you or a loved one are older, experiencing cognitive difficulties, and facing barriers to accessing health care, an OTC hearing aid could help improve your daily life and reduce the risk of developing dementia. Since OTC hearing aids are available without a prescription, those who cannot afford a prescription hearing aid may obtain hearing aids for mild to moderate hearing loss directly from a store.

Those with significant hearing loss will need prescription aids from their otolaryngologist. Yet others who may have difficulty hearing in crowded areas or on the phone but do not have severe hearing impairments could benefit from an OTC hearing aid.

The average cost of a pair of OTC hearing aids is $1,600, about $3,000 less than prescription devices, according to the National Council on Aging’s recent report on the best OTC hearing aids. This makes OTC hearing aids a more affordable option for older adults with mild to moderate hearing loss.

How They Work

Hearing aids have microphones that receive sounds. An amplifier increases the sound’s strength in the wearer’s ear. By receiving and amplifying sounds, hearing aids allow individuals to detect sounds and maintain conversations.

Risks of Not Using a Hearing Aid

The NIH reports that fewer than a third of adults aged 70 and older who could benefit from hearing aids use them. Given the relationship between hearing loss and cognitive decline, forgoing a hearing aid could put you at greater risk of developing dementia

Without a hearing aid, some find engaging in social interactions with friends and family increasingly difficult and may not want to be around people as frequently. Johns Hopkins Medicine has identified social isolation as a factor contributing to cognitive deterioration. An OTC hearing aid could help you stay engaged in conversations with others, fostering a sense of social support and community that protects against cognitive decline.

For those who may have trouble accessing a prescription hearing aid, OTC hearing aids are an alternative that could prevent dementia. If you or a loved one experiences hearing loss, consider whether a hearing aid could help.

Notarizing Documents for Seniors With a Dementia Diagnosis

An Alzheimer’s or dementia diagnosis can be a challenging journey for the person and family alike. When the diagnosis occurs, a ticking clock begins on the timeline for getting proper and sound notarizations done for crucial legal documents.

What Does It Mean to Get a Document Notarized?

According to the National Notary Association, having a document notarized is a process that ensures the document is authentic. The Notary serves as an impartial screener who confirms the identity, willingness, and awareness of the person signing the document.

There are vital issues and implications to be aware of when having documents notarized for individuals with dementia.

Notarizing for a Person With Dementia: A Legal Gray Area

Having documents notarized for seniors with dementia leads to some legal gray areas. There are no laws that prohibit having documents notarized for individuals with cognitive impairments. However, the role of a Notary Public extends beyond the procedural formalities.

Notarizing documents for anyone who is cognitively impaired also comes with a dramatically increased risk for both fraud and elder abuse. This is an issue that Notaries are highly aware of and protect against.

Notaries must assess whether their document signers understand and are aware of the nature of the documents, their contents, and their details. They also must verify the signer’s identity.

Notaries must screen each signer to ensure they are signing the document willingly. The signer cannot be under the pressure or direction of any third party.

The Notary will refuse to notarize a document if they find that any of these conditions fail to meet the standard.

It’s critical for families to act ethically and responsibly in notarizing important documents for their aging loved ones with dementia. If your loved one is facing a dementia diagnosis, establish legal clarity as soon as possible to avoid uncertainties later.

How to Prep When Having Documents Notarized

The following tips will help you prepare:

• Make sure the Notary visits the signer at a time when they are cognitively aware.
• Arrange for the signer to meet privately with the Notary.
• Confirm what type of notarization you need on specific legal documents. If you need anything clarified, check with your attorney or the document recipient.
• Ensure the signer is prepared to present their identification. They also must be able to sign the document, if necessary, as well as the Notary’s record book. Some states also require a fingerprint impression.
• Ensure there are no blank spaces or dates on the documents. To combat fraud, a Notary will refuse to notarize if required entries are blank.

Legal Documents to Have Notarized for Dementia Diagnosis

Certain legal documents, more commonly notarized for seniors, serve the person’s wishes and protect them from undue influence. Those documents include the following:

Power of Attorney (General vs. Durable)

A power of attorney grants authority to a trusted individual to make financial and legal decisions on behalf of someone else. A general power of attorney is effective immediately. In contrast, a durable power of attorney remains in effect even if the signer becomes unable to handle their affairs.

Health Care Power of Attorney

This document designates a representative to make medical decisions when the individual is unable to do so. You may also hear it referred to as a health care proxy. Notarizing it ensures that all parties will respect the signer’s health care preferences.

Living Will

A living will outlines end-of-life medical preferences. Having it notarized provides assurance that medical choices align with the signer’s wishes.

Guardianship/Conservatorship

In cases where dementia has advanced significantly, establishing a legal guardian or conservator for your loved one. In securing notarized documents, you can ensure that the guardian responsibly manages your loved one’s financial and personal affairs.

Will or Trust

Notarizing a will or trust guarantees the proper distribution of assets after your loved one’s passing, minimizing potential disputes.

HIPAA Release Form

A HIPAA release form grants specific individuals access to the signer’s medical information, aiding health care decisions.

Financial Account Designations

You may also want to ensure that all parties will handle your loved one’s financial matters according to their preferences. To do this, you can work with a Notary to notarize designations on your loved one’s financial accounts.

Act Before It’s Too Late

The absence of specific laws surrounding notarial acts and dementia highlights the importance of being proactive. Waiting until the last moment to have something notarized may lead to legal difficulties or disputes.

As soon as you receive confirmation of your loved one’s dementia diagnosis, initiate the process of having key legal documents notarized. It’s essential you do this while your loved one can still articulate their wishes. This way, you can help protect them while reducing potential family conflicts.

What Is Hospice Care at Home?

Hospice care is a type of health care that patients with terminally ill conditions rely on at the end of their lives. This type of care focuses on pain management and emotional, spiritual, and familial support for patients nearing the end of their lives.

There are several options for receiving hospice care, including being cared for at home. The type of intimate care a patient receives while in hospice is more conducive to being received at the patient’s home. This becomes a team effort, and it helps to have a peaceful environment when receiving care.

Who Can Benefit From This Type of Care?

Patients with serious illnesses like cancer, heart disease, dementia, kidney failure, or other fatal conditions benefit from hospice care. This type of care can help the patient live a more comfortable life while decreasing the emotional burden of grief for families by preparing them for the loss of their loved one.

When Is Hospice Recommended?

Hospice care should not only be considered by those who have loved ones nearing the end of their lives. While most of these services are generally reserved for people with six months or less to live, early hospice care can be beneficial for patients and their families as well.

You may wish to consider such services in the following cases:

• The patient has a serious decline in their physical well-being
• After a diagnosis of Alzheimer’s disease or dementia
• You have decided to forgo any treatment to improve your physical treatment or care for your illness

Who Makes Up a Hospice Care Team?

Your hospice team can consist of many different types of people. Various professionals and volunteers may be involved in end-of-life care. Some of those you may see on your care team can include:

• Doctors
• Nurses
• Social workers
• Spiritual advisors
• Trained volunteers

Who Pays for Hospice Home Care?

Like any other health care option, these services can quickly become very expensive. Fortunately, there are several ways to cover the cost, including:

Government Programs

If you qualify for government assistance, there may be insurance plans specifically designed to cover the cost of hospice care.

Seniors enrolled in Medicare Part A may qualify for a Medicare hospice care benefit. This benefit program allocates money to pay for such care at home.

For terminally ill patients on Medicaid, hospice care may be covered depending on the state.  

The Department of Veterans Affairs may also provide coverage for these care benefits for seniors who have served our country.

Private Insurance

Check the terms of your insurance policy to determine if your health insurance covers hospice care. Your policy may cover all or part of your hospice care needs.

Options for Uninsured Patients

Even if you do not have health insurance, you may still have coverage options. There are charitable organizations that work with elderly and disabled individuals who need help paying for hospice care services. Hospice care organizations also often have internal departments that work with patients who qualify for this type of care but are indigent or do not have health insurance.

Is In-Home Hospice Right For You?

Making this choice is an important part of your end-of-life care plan. Be sure to gather as much information as you can before deciding whether this type o care is best for you. For example, you may want to consult Medicare’s hospice compare website or CaringInfo.org’s website for other hospice locator tools.

If you have questions about Medicare or Medicaid, contact your elder law attorney to learn more.

After a Dementia Diagnosis: Preparing for the Future

A diagnosis of dementia, a category of diseases affecting memory and thinking that includes Alzheimer’s disease, can feel overwhelming and upsetting. You might worry that you will lose control over your life and ability to make your own decisions. Fortunately, receiving a diagnosis of dementia or Alzheimer’s does not mean that you cannot execute legal documents or make decisions about plans for your future finances and health care.

People with dementia can execute legal documents to plan for their futures when they have the mental state — or capacity — to do so. Capacity refers to your ability to understand the contents of a legal document, such as a will, and know the consequences of executing it. If you know who your family is, understand your assets, and comprehend your will, you can execute a valid will and plan for the distribution of your estate after your death, provided you understand what you are signing and its effect on your life.

The following can help you in planning where you wish to live, what kind of care you receive, and what happens to your assets if you get severely ill or pass away.

Health Care Power of Attorney

Consider appointing a health care agent to make medical decisions if you become incapacitated. You can name a health care agent using a health care power of attorney, sometimes called a medical power of attorney or a durable power of attorney for health care. Your health care agent can make medical choices if you can no longer do so.

Picking someone you trust, such as a responsible child or spouse, or another family member, can give you peace of mind that they will have your best interests and desires in mind when they make decisions. For instance, dementia patients who prefer receiving in-home care can express this wish to their agent.

In the power of attorney document, you can also state your intentions regarding health care and limit your agent’s capabilities if you wish.

Living Will

For an added layer of protection, you can also draft an advance directive or living will that states your desires regarding medical treatment if you are unable to communicate with your physician. Your living will can express whether you want treatment to prolong your life.

Financial Power of Attorney

Using a financial power of attorney, known as a power of attorney for property, you can select a trusted individual to handle your financial affairs if your disease progresses such that you can no longer make financial decisions. Your financial agent can manage your money and pay bills on your behalf, but they cannot use your money for themselves.

In the power of attorney for property document, you can restrict your agent’s powers. For instance, a person might specify that the agent can manage personal accounts, but not sell the family home.

Long-Term Care Planning

After a dementia diagnosis, consider whether you would like to receive long-term care at home or in a facility, and whether you intend to apply for Medicaid or long-term care insurance. If you want to apply for Medicaid, you might need to prepare your finances to become eligible.

Last Will and Testament

Making a last will and testament, also known as a will, can help ensure your assets go to your family and friends when you pass away. You can determine how much of your money each beneficiary will receive and make bequests to individuals. For example, if you have items of sentimental value, you can leave them to specific people. Without a will, your assets will transfer to your heirs according to the law in your state.

Meet with you attorney to discuss your plans for your future. For additional support and to learn more about Alzheimer’s disease and related disorders, reach out to your local Alzheimer’s Association chapter.

Resources for Caregivers of Older Adults with Dementia

Every year, 16 million people in the United States care for family and friends with dementia, the Centers for Disease Control and Prevention reports. Caregivers of people with dementia provide care for longer durations than those who assist individuals with other conditions. They also have comparably higher risks for anxiety, depression, and reduced quality of life. One-third of caregivers of elders with dementia are older adults themselves.

Although caring for people with dementia can be challenging, a variety of resources can help caregivers assist their loved ones. Apps, devices, activity subscription services, caregiver training, and online resources can aid caregivers with their responsibilities, providing valuable information, structure, and support.

Technology for Caregivers of People With Dementia

Research suggests that technology may benefit people caring for those with dementia, alleviating some of the stress associated with caregiving. Technology should be inexpensive, scalable, and user-friendly to be effective. Among the numerous mobile apps and wearable devices available today are the following:

• Carely — Carely is a free, easy-to-use smartphone app for caregivers. The app facilitates care coordination, connecting families, friends, and healthcare providers. App users can share information about the daily schedule of an older adult with dementia as well as organize appointments and activities on the app’s calendar. Fostering communication between loved ones and caregivers, Carely promotes more companionship for older adults and seeks to lessen families’ stress.
• Care Predict — Individuals with cognitive decline may wear devices that keep loved ones informed about how they are doing. Care Predict provides this kind of technology, recording wearers’ daily patterns, such as how long they spend in bed or in the kitchen and revealing possible health issues family members may otherwise miss. For instance, spending all day in bed could indicate depression or other physical health issues.
  
  CarePredict’s Care Circle App alerts family members of changes and potential concerns. For example, when people living with dementia are at risk for falls, the technology notifies family members, and when falls occur, individuals can use the wearable device to contact family.
  
  The service requires an initial fee for the CarePredict™ @Home device plus a monthly subscription fee.

Activities for Dementia Patients and Loved Ones

Whereas tools such as wearable devices may support the health and safety of individuals with dementia, enrichment activities can also be beneficial. Engaging individuals with dementia promotes higher life satisfaction and better connections with family, friends, and other caregivers.

Caregivers looking to find things to do with their loved ones may subscribe to Connectivities, a monthly subscription box with activities for adults with dementia. Each kit contains eight activities with written and digital instructions, as well as exercise and music therapy videos.

Information for Caregivers

When their loved ones receive a dementia diagnosis, families may feel overwhelmed. Many resources can help those caring for people with dementia learn about the disease and caregiving strategies.

• The Savvy Caregiver is a free, nationally recognized training program for family members of people with dementia. The main program has six weekly two-hour video sessions — available in person or online. Those who have completed the training course reported less depression and distress.

The course covers:

• Understanding dementia diseases
• The elements of cognition
• Confusion in dementia
• Caregiver self-care
• Dementia’s progression
• Methods for helping with daily activities
• Decision making
• Community resources
• Family support

• Individuals caring for people with dementia can make an account on the Family Caregiver Alliance website, which provides a dashboard with resources all in one place and a list of services by state.
   
• The Alzheimer’s Association offers information specific to Alzheimer’s disease, which 50 percent to 80 percent of adults with dementia have.

Keeping Your Emergency Contacts and Medical Information Updated for First Responders

If medical personnel are able to access your medical history during an emergency, it could mean the difference between life and death. But if, for example, you are injured, in shock, suffering from dementia, or are otherwise incapacitated, you may not be able to provide that information yourself.

There are several systems readily available to help make crucial contact and medical history information available to first responders. Consider taking the time to update your details with the following free tools:

• On Your Smartphone: Even when your smartphone is locked, you have options for inputting your emergency contacts as well as other vital information that could help save your life.
   
  • Medical ID for iPhones. If you are an iPhone user, take advantage of the preinstalled Health app to input details about your medical needs so that first responders will have the information they need in an emergency. To do this, open the Health app, choose Review Medical ID, and enter your information.
    
    You can include not only your designated emergency contacts, but also such details as your birthdate, any medical conditions or allergies, your blood type, and your organ donor status. You can then choose to make your Medical ID available on your iPhone’s lock screen for first responders.
    
    In addition, there is an option to share your Medical ID information automatically with a dispatcher, should you ever need to make an emergency call.
     
  • Emergency Information on Androids devices. Depending on your device, you may be able to find “Emergency Information” or “My Info” in your Settings, where you can enter your medical details and emergency contacts. Be sure to add anyone you wish to designate as an emergency contact into your Contacts app as well.
    
    In your Android Settings, you can also add your emergency contact information to your lock screen as a custom message.
     
  • In Case of Emergency (ICE) Contact. This program, which was originally established in 2004, encouraged people to list in their cell phone their “in case of emergency” contacts under the heading “ICE,” allowing paramedics or other medical personnel to know whom to contact in the event of an emergency. Today, there is also a free ICE app for smartphones, which allows you to send an instant message, including your GPS location, directly to your ICE contacts with the tap of a button if you are in an emergency situation. Learn more about ICE.
• The National Next of Kin Registry (NOKR). The NOKR is a free service that allows you to register yourself and your next of kin in the event of such situations as daily emergencies or natural disasters. The information you enter is not available to the public, but it is available to emergency service agencies registered with the NOKR. If you are in an accident, emergency services personnel would be able to search the website to find your next of kin and notify them about your condition. The NOKR stores emergency contact information for those across the U.S. as well as 87 other countries. You can register online, through U.S. mail, or via fax. Learn more about registering for the NOKR.

To get the most out of an emergency contact, you should make sure the person you choose as your emergency contact has agreed to act in this capacity, knows about any allergies or other factors that could affect your treatment, and knows whom to contact on your behalf.

What It Means to Need ‘Nursing Home Level of Care’ for Medicaid Eligibility

When applying for Medicaid’s long-term care coverage, in addition to the strict income and asset limits, you must demonstrate that you need a level care typically provided in a nursing home.  

Whether you are applying for nursing home coverage or through a Medicaid waiver program for coverage at home, you must meet the level-of-care requirement set by the state. Each state has its own criteria for determining if you meet the mandated level of care, and the criteria is not always clear.

The state looks at an applicant’s functional, medical, and cognitive abilities to determine if care in a nursing home is called for. In general, you must be unable to care for yourself or pose a danger to yourself without outside help. The following are the factors usually considered when making a level-of-care determination: 

• You need help with two or more “activities of daily living” (such as bathing, dressing, eating, moving, and going to the bathroom).
• You need frequent medical care, such as assistance with medication, injections, IVs, or other medical treatment. 
• Your cognitive ability is impaired by Alzheimer’s disease or another form of dementia, you have trouble making decisions on your own, or you are unable to process information. 
• You have behavior problems, such as wandering away from home or aggressiveness. 

When assessing a Medicaid applicant, the state will conduct the evaluation. The state may require a doctor’s diagnosis, but it will also likely require the applicant to answer a series of questions about his or her ability to perform activities of daily living as well the applicant’s mental abilities and behavior problems and the applicant’s family’s ability to provide support. 

To apply for Medicaid, contact your local Medicaid office. Your elder law attorney can help you navigate the Medicaid application process, which is not easy.