A Primer On Dementia and Alzheimer’s
Many people equate dementia with Alzheimer’s disease but there are a number of causes of dementia. It is important to have an understanding of what dementia is and what can be done about it.
Dementia is a loss of mental function – Everyone has isolated problems with memory but that does not mean they have dementia. People with dementia lose the ability to think, remember, and reason to the point where it interferes with their everyday functioning.
Some dementias are treatable – Everyone who shows signs of dementia should be evaluated by a physician. Certain medical conditions produce dementia symptoms, and when those conditions are treated, the symptoms disappear. Even if a person has an irreversible dementia, some medications may slow the progression of the disease.
Causes of reversible dementia – The following are some of the conditions that can produce dementia symptoms: nutritional deficiencies, some infections, hormonal imbalances, alcohol or drug toxicity, lack of oxygen, depression, and certain types of hydrocephalus. With proper treatment, these symptoms may disappear.
Causes of non-reversible dementia – The most frequent cause of non-reversible dementia is Alzheimer’s disease, but there are other causes. Some of the common ones are vascular dementia (often due to strokes), Parkinson’s disease, Lewy-Body Disease, and Pick’s Disease. Each of these have distinct features, so an accurate diagnosis is important to be sure appropriate treatment is begun. Some medications may slow down the progression of the disease even if they do not reverse it.
Ten Warning Signs – The Alzheimer’s Association has developed the following warning signs for dementia:
1. Memory changes that disrupt daily life
2. Challenges in planning or solving problems
3. Difficulty completing familiar tasks at home, work, leisure
4. Confusion with time and place
5. Trouble understanding visual images and spatial relationships
6. New problems with words in speaking and writing
7. Misplacing things and losing the ability to retrace steps
8. Decreased or poor judgment
9. Withdrawal from work or social activities
10. Changes in mood or personality
What to do
- The first thing to do when a person shows signs of dementia is to help that person obtain a thorough medical evaluation. This will help determine if the individual has dementia, whether it is reversible, and what treatment options the person has.
- The second thing to do is to begin planning ahead. If a person has non-reversible dementia, it is important to help that one complete documents such as a Power of Attorney, Advance Directives, and a Will before he/she loses the capacity to understand and sign these documents. An Elder Law Attorney can not only help with these documents but can also help the person structure his/her financial situation to maximize his/her ability to pay for long term care at a later time.
- The third thing to do is for the caregiver of the person with dementia to develop a support system. While an individual may be able to provide all the needed care in the early stages of dementia, as the disease progresses, caregivers often find their own health declining from trying to provide care without adequate support. This may mean joining a support group, obtaining help at home, using an adult day program, using a facility for respite care, or even placing your loved one in a secure setting. If you are a client of Keystone Elder Law, the Elder Care Coordinator is available to assist you in learning about and evaluating your support options.
The future – Until there are ways to prevent or cure non-reversible dementias, the problems for affected individuals, their caregivers, and society as a whole are only going to get worse. According to a report from the Alzheimer’s Association, in 2010, there were 5.3 million people in the US who have Alzheimer’s disease, and it was the seventh leading cause of death. With successful treatments now available for some chronic medical conditions, Baby Boomers are expected to live longer than their parents, and, with the incidence of Alzheimer’s and other dementias increasing with age, it is expected that the number of people with dementia will rise. With increasing numbers affected and limited resources, the earlier that dementia is recognized and a plan of care is developed, the easier it will be for that individual and his/her caregivers.
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REGISTER HERE for LONG-TERM CARE PLANNINGPower of Attorney
A Power of Attorney can be used to give another person the right to sell a car, home, or other property in the place of the maker of the Power of Attorney. A Power of Attorney might be used to allow another person to sign a contract for the maker of the Power of Attorney (the person who makes a power of attorney is called the “principal”). It can be used to give another person the authority to make health care decisions, do financial transactions, or sign legal documents that the principal cannot do for one reason or another. With few exceptions, Powers of Attorney can give others the right to do any legal acts that the makers of the Powers of Attorney could do them themselves. A General Power of Attorney gives the “power of attorney Agent” or simply “Agent” (the legal name of the person who is authorized to act for the principal) very broad powers to do almost every legal act that the principal can do. When Elder Law Attorneys draft general Powers of Attorney, they still list the types of things the Agent can do but these powers are very broad. People often do general Powers of Attorney to plan ahead for the day when they may not be able to take care of things themselves. By doing the General Power of Attorney, they designate someone who can do these things for them.
Normal Powers of Attorney terminate if and when the principal becomes incompetent. Yet many people do Powers of Attorney for the sole purpose of designating someone else to act for them if they cannot act for themselves. It is precisely when persons can no longer do for themselves that a Power of Attorney is most valuable. To remedy this inconsistency, the law created a Durable Power of Attorney that remains effective even if a person becomes incompetent. The only thing that distinguishes a Durable Power of Attorney from a regular Power of Attorney is special wording that states that the power survives the principal’s incapacity. Even a Durable Power of Attorney, however, may be terminated under certain circumstances if court proceedings are filed. Most Powers of Attorney done today are durable.
Yes. At the time the Power of Attorney is signed, the principal must be capable of understanding the document. Although a Power of Attorney is still valid if and when a person becomes incompetent, the principal must understand what he or she is signing at the moment of execution. That means a person can be suffering from dementia or Alzheimer’s Disease or be otherwise incompetent sometimes but as long as they have a lucid moment and are competent at the moment they sign the Power of Attorney, it is valid even if they do not remember signing it at a later date. At the time it is signed, the principal must know what the Power of Attorney does, whom they are giving the Power of Attorney to, and what property may be affected by the Power of Attorney.
Any competent person eighteen years of age and older can serve as an agent. Certain financial institutions can also serve. There is no course of education that agent must complete or any test that Agent must pass. Because a Power of Attorney is such a potentially powerful document, agents should be chosen for reliability and trustworthiness. In the wrong hands, a Power of Attorney can be a license to steal. It can be a big responsibility to serve as an agent.
For Medicaid
Medicare is health insurance and covers medical services such as physician appointments, therapy, blood tests, x rays, medical procedures and hospitalization. Medicare will sometime pay for rehabilitation in a long-term care facility for a period of 20 to 100 days, but not longer. In long-term care, Medicaid covers the cost of ongoing support services for daily functioning, such as room and board in a nursing home.
Medicaid is a federal program that is overseen by the Center for Medicare and Medicaid Services (CMS). In Pennsylvania, Medicaid is called Medical Assistance and is administered by the Department of Human Services (DHS).
In Pennsylvania, Medicaid funds are not available to pay for assisted living or personal care.
For Medicaid to pay for care in a nursing home, an individual recipient must be determined to need a nursing home level of care by a physician and the local Office of Aging. An individual whose income is not greater than three times the poverty level may keep up to $8,000 of total resources, but may otherwise keep only $2,400. The cash value of life insurance counts as a resource, but one car and a residential home does not count as a resource.
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Empowering Clients with Holistic Planning at
Keystone Elder Law
At Keystone Elder Law, we believe that the physical, social, legal, and financial considerations of our clients all intertwine. We utilize an interdisciplinary approach to evaluate each area, which allows for the creation of a plan that addresses the concerns of the individual as a whole as well as the family. To this end, our model of practice includes a Care Coordinator (usually a nurse or social worker), whose expertise complements our team of attorneys.
When the road of life is smooth, decisions about legal and financial matters are easy to push aside for “a rainy day.” Planning ahead, however, will allow for more options as you view the map of where you’ve been and where you want to go. Don’t let a crisis limit your choices or derail your plans.
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