How Can I Help My Mom Stay at Home - And Manage Her Medications - As Long As Possible?

As an Elder Law attorney, I get asked this question a lot. And I always try to answer it with compassion, concern, and candor. (And, since my own Mom passed away recently, it’s a question that touches me personally, as well.)

I tell people, first of all, that there’s no single right answer; every patient is different, and every situation is different. The bottom line, as far as medication is concerned, is that she needs to take it…on time and in the right dosage!

If she’s capable of taking her medicine, but just needs reminders, there are a number of “medication minders” at drugstores, medical supply stores, and discount stores. For example, weekly minders might work…but someone has to fill them out at the beginning of each week. And it’s important to remember that that there needs to be reminder for your Mom about what time to take her medicine, as well.

There are also medicine-reminders with alarms that go off. Some families rely on a family member to call the patient each time she needs to take her medicine. Modern life being as frantic as it is, though, this may not be the optimal method; and it may place an unfair burden on the person responsible for calling.

If your Mom goes to an adult day care center, make sure the staff knows to remind her. Just be sure you’ve provided them with the original prescription bottle with the original label.

If none of these systems works, you need to hire someone who can go to the house and administer her medicine. And if that becomes too unwieldy, you may have to face the fact that your Mom might be better off in a nursing home or assisted living facility.

At The Law Offices of Alice Reiter Feld & Associates, we get asked questions like this every day. And, over the past 33 years, we’ve helped thousands of South Florida families prepare for the Elder Law Journey…with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset protection plans, and assistance with Medicaid and the VA.

We know every step of the Elder Law Journey. And we’re just a phone call away.

 

How Beneficial is a Dementia Care Unit for Someone with Alzheimer's?

As an Elder Law attorney, I get asked this question a lot. And I tell my clients that it can be very beneficial…if the unit is designed and staffed appropriately.

The goal of such a unit, of course, is to provide specialized care. Personnel should have specialized training for dementia. The unit itself should have smaller spaces, so patients don’t feel overwhelmed. It should be a quieter environment, to prevent over-stimulation. It should be locked securely, as many Alzheimer’s patients move around or pace.

I tell my clients to pay attention to the design of the unit at which they’re looking. Good dementia units are designed to provide more specialized care and less stimulation. In fact, many no longer have intercoms or p.a. systems.

A dementia unit should also have its own Activities Director, who designs specialized programs. Staff are often trained in how to help the seniors participate and enjoy themselves more.

Your state’s Department on Aging might provide you with a list of facilities in your area, or else point you toward the proper agency.

Another thing I tell my clients: Visit at least three facilities! Take a friend who can be objective. Then…

• Meet the staff – and observe their interaction with the patients.
• Is the facility clean? Are the grounds well-tended? (And secure??)
• Ask to see their most recent state survey.
• If the survey indicates deficiencies, what were they?
• Were they addressed? How?

 After speaking with the friend who accompanied you, make a list of pros and cons. AND LISTEN TO YOUR GUT!!

If you have a loved one with dementia, you’ll be asking yourself new questions every day. At the Law Offices of Alice Reiter Feld & Associates, we've been answering these questions every day – for 33 years.

We’re Elder Law attorneys. And we've helped thousands of South Florida families with these questions…along with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset-protection plans, and assistance with Medicaid or the VA.

If you've got questions, we've got answers. And we’re only a phone call away.

Hurricane Sandy, And The Sin of Denial

Whew! Fall has arrived! And we’ve made it through another hurricane season without a storm, right?

Well…not me! I just got back from a week in New York City – and Hurricane Sandy!

No, I am not a hurricane chaser. Just bad timing!

It was strange for a Floridian. Down here, we’ve learned through experience. But, despite the destruction wrought by last year’s Hurricane Irene, the Northeast was totally unprepared. I mean totally unprepared! Forget generators...they didn’t even have flashlights! They didn’t even go to the gas station before the storm hit. They had no idea what they were in for.

Even the least-prepared Floridians have the basics down. But the ignorance and self-deception up North – despite nearly a week of warning - was baffling. And very scary.

Many folks up there acted as if it would just be rainy and windy. And this was a denial of “hurricane” proportions.

As an Elder Law attorney, I see denial every day. Not about hurricanes, but about illness and incapacity, death and dying. I’ve watched clients approach the long-term care journey with the same denial New Yorkers had about the storm.

And I know how easy it is to be in denial. Nobody wants to think about getting sick in their later years. But many of us, eventually, will. Would you rather face that possibility with the security of having planned for it? Or would you rather just bet – everything! – that you won’t need to plan?

Nobody wants to think about dying, either. But we’re all going to do it! Some of us will be prepared for that eventuality, with asset-protection and long-term care plans. Others of us – who haven’t planned properly – may have to choose between their quality of life and their heirs. And those who haven’t planned at all may come to the end of their days having lost every cent.

At The Law Offices of Alice Reiter Feld & Associates, we practice Elder Law. For the past 33 years, we’ve worked with thousands of South Florida families to prepare them for the inevitable changes (and end-result) of the aging process…with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset-protection plans, and assistance with Medicaid or the VA.

Death is inevitable. And illness is likely. You can’t deny it. But you can prepare for it.

We’re just a phone call away.

'Spiritual' Estate Planning Passes on Values of Departed

By Donna Gehrke-White, Sun Sentinel

8:36 a.m. EST, November 11, 2012

 



 

"Spiritual" estate planning — deciding how to pass down money based on values — is becoming a hot topic for baby boomers who want to make sure their values are passed along with their money, South Florida financial planners say.

Bequests to charities are up 19 percent in a year, according to Charity Navigator, a nonprofit that monitors charities. But it goes beyond leaving money to a favorite group, said South Florida attorney Alice Reiter Feld.

"It's leaving money with a purpose," she said.

That extends into deciding how to give — or not — money to family members, said Feld who will talk at a free seminar about spiritual giving next Monday, Nov. 19, at the Adolph & Rose Levis Jewish Community Center, 9801 Donna Klein Blvd. in Boca Raton.

Many South Floridians drawing up an estate plan first have to decide who their kin includes in this age of blended families and second or third marriages, Feld said.

"With all the kinds of families these days, there's no simple answer," Feld said.

Other thorny questions from today's complicated relationships: Should couples in a relationship, for example, make sure their children from a previous marriage get their own bequests — separate from the new spouse?

Yes, Feld recommends.

A surviving step-parent may give the couple's possessions to his or her children. Step-children can then get passed over – unless estate planning leaves them a specific amount, Feld said.

In setting up a will, parents also need to consider: "Have you passed on your financial values to kids?" Feld said she asks clients. "Sometimes, I have to send them home to think about it."

Some retirees who believe in frugality, may decide to leave money in a trust to guarantee that free-spending kids — or their spouses — won't squander it all, she said.

Putting money in a trust for surviving relatives can protect it from any creditors or even an ex-spouse, attorney Feld added.

"It's more control beyond the grave," added Mari Adam, Boca Raton financial planner, who has seen more clients wanting to have a say how their kin spends their inheritance.

A growing number of South Florida parents also are deciding not to give equal amounts to their surviving children, financial planners say.

Rather, some feel morally responsible in caring for less well-off children, said Ben Tobias, a Plantation financial planner.

If one of their children is wealthy, for example, some parents may decide they need to give more of an inheritance to an adult son or daughter who is less well off or who or has a special needs child, Tobias said.

"For whatever reason, they are opposed to doing it equally," Tobias said.

Feld has seen the same trend, although she personally feels that children should be treated equally.

If mothers or fathers are going to leave more money to one child, then they need to communicate that before they pass away, she said.

Tobias agreed. It's a matter of keeping peace in the family, he said.

Parents especially "should sit down with a child who is going to be given less and explain the reasons," Tobias recommended.

"Otherwise real problems may develop," he said. "I've seen deep resentment develop."

dgehrke@tribune.com or Twitter @donnagehrke

Copyright © 2012, South Florida Sun-Sentinel

Originally posted in: Alice Reiter Feld in The News

Alice's Mom and Dad, Part 6: What I'd Do The Same

Anyone who’s lost a parent knows that the aftermath is often filled with uncertainty about whether you handled the situation “correctly” – if there is such a word in that situation. Often, we wonder if we could have handled certain situations differently…or if we’d handle them the same way all over again.

In my last blog, you’ll recall, I talked about what I’d do differently, now that my Mom has passed away (two months ago) and my Dad is on hospice with terminal cancer. Today, after giving it some thought (a lot of thought!), I’d like to talk about what I’d do the exact same way all over again.

One thing I did right was the way I handled the finances and prepared for the long term care needs for my parents. It was a bit of a tricky game – I had to try and time who would die first. I wanted to put money in my mother’s name, and I wanted to move assets appropriately, which I was able to do. As an Elder Law attorney, I know planning opportunities and strategies. And I know about long-term planning and crisis planning.

I did my planning in advance. People have said about my Dad, “I never thought he’d live this long.” But we’re all living longer these days. Today, the life expectancy for a woman of 88 is actually another five years. We can’t assume that we’re going to die at eighty anymore!

So I secured the services of a Geriatric Care Manager who lived near my parents. These days, we’re all overwhelmed. And – talk about overwhelmed – just take a look at the over-worked, under-staffed, under-paid, and over-regulated nurses at your nearest hospital. If you could see their working conditions first-hand, you’d understand the need for a Care manager - and a patient advocate.

I tell my clients that you can’t go into the Medicaid or Medicare systems without an advocate …or you’ll come out very bloody.

You also need a Healthcare Surrogate, who can make decisions for you if you can’t. (And we’re not necessarily talking about being on your death-bed, here; it could be an accident, etc.)

Those of you who know me, know that I’m not very big on clichés. But there’s one I’d like to use here…because nothing says it better.

Those who fail to plan…are planning to fail.

Alice's Mom and Dad, Part 5: What I'd Do Differently

As you know by now, my Mom died on September 3. And my Dad’s now in hospice. So I’m about to experience a double shot to the caregiver’s gut.

It’s been a learning experience, to say the least. I’ve learned what I’d do the same, if I had it to do all over again. And I’ve learned what I’d do differently.

First of all, I had no idea my parents would live so long…my Mom was 90, and my Dad’s 91!

But they had bought only three years’ worth of long-term care. Had I known then what I know now, I would have told them they needed more…a lot more!

For their generation, my parents lived a long time. And for the current generations of younger seniors and Baby Boomers, the lessons are right there in front of their noses. PEOPLE ARE LIVING LONGER THAN EVER. OFTEN, THEY’RE LIVING WITH INCAPACITATING CONDITIONS. SO YOU’D BETTER HAVE ENOUGH LONG-TERM CARE PROTECTION!

I’ve learned that, if you can afford the monthly payments for lifetime protection…get it! Because you can’t put a time limit on illness. And you can’t put a time limit on the aging process.

I’ve learned that I should have gotten my parents policies with inflation riders, because long-term care doesn’t cost the same in 2012 that it did in 2000. And it sure as heck won’t cost the same in 2020 as it does in 2012.

In addition, I’d tell my fellow Boomers that it’s better to be a little early than a little late; once you’ve been diagnosed with an illness, it’s too late to get a long-term care policy! ( I’d also tell boomers to get into my office asap so they don’t burden their children with their long term care isues. )

Another thing I might do differently – and this is very personal – I would stop feeling badly that my brother didn’t spend more time with my parents in their end-days. My brother lives in New York. But he’s retired, and able to travel. However, as I mentioned in my last blog, our father could be a difficult man…and my brother isn’t spending much time with him. Sadly, my father’s now reaping what he sowed.

However, I would share more of the details about what’s going on with my brother; I didn’t really share with him about our mother. I should have, because he should have been aware of what I was going through. And, if I had it to do over again, whenever he started giving me advice about what I should or shouldn't do, I’d tell him that I’d welcome his advice – if he wanted to become more involved in their care.

In my career, I’ve seen too many out-of-town siblings telling the local (caregiving) siblings what they should be doing. It’s easy to give advice from a thousand miles away. But, since the out-of-town siblings don’t really see what’s happening on a day-to-day basis, I believe they should probably listen more than talk. And appreciate what the caregiver provides even if they are not living with the parents on day to day basis.

If I had it to do all over again, I’d magically move my parents closer than a 50-minute round-trip. With an active law practice and a demanding caregiver role, it would have made things much easier for me.

All of this, of course, is hindsight. And hindsight is always 20/20. None of us can predict the future. Who would have guessed, for example, that I couldn't sell my house now even if I wanted to?

 

NEXT BLOG: WHAT I DID RIGHT

Alice's Mom and Dad, Part 4: My Dad's on Hospice

As I mentioned in my last blog, my mother passed away on September 3rd.

Just a week later, believe it or not, my Dad was diagnosed with terminal lung cancer. And he’s now on hospice.

Everyone in my family is amazed that he’s lived this long – until 91 – and that he’s survived my mother. My Dad is 75 pounds overweight. He has a pacemaker. The only exercise he’s really gotten has been his all-too-frequent trips to the refrigerator…where he would open the door and come out with a huge slab of ham or sausage or pork. He smoked when he was younger. And he was an ironworker – which meant he was constantly breathing soot and dust.

My Dad is not in pain, thankfully. And, for a man who lost his wife last month and is now on hospice himself, he’s in fairly good spirits.

I’m going through mixed emotions, trying to sort out my clashing feelings. My Dad can be a hard man. He was a loving man, but a difficult man…impatient, and a yeller. He was a wonderful uncle to his nieces and nephews. And though he could be gruff and loud around the house, my brother and I always knew there was never a doubt that he’d give you the shirt off his back if you needed it.

When he called me to yell at me a week or so ago, I listened for a few minutes…and then hung up on him. Ill or not, I believe he had no right to speak to me like that. I’m not a little girl anymore. I’m an adult, with a lot of responsibility…not only to my family, but also to my clients. Emotionally, physically, psychologically, and emotionally, after the past few months, I’m stretched about as far as a person can be. So, while I’m carrying an overwhelming burden of sadness about my Mom’s passing, and my Dad’s impending passing, I’m also doing what I encourage my clients to do – trying to take care of myself, and trying to look after myself as well as my Dad.

My father’s got a full-time aide. He has a Care Manager. He’s got a driver. When he was in rehab for four months, I was there all the time. I tell my clients in similar situations that we can only do as much as we can do. And we don’t have to apologize to anyone for it.

So once again, it seems, I’m on a sort of “death watch.” While I’m still getting over the death of my mother.

If I didn't know what it felt like, before, to be one of my clients, I sure do now.

Alice's Mom and Dad, Part 3: My Mom Is Gone

Some of you may recall the blogs I wrote on my Mom and Dad a couple of months ago. In the last one, my Mom was in Hospice, and my Dad was in rehab. My parents live locally in Davie.

Well, my mother, Rose Meister, passed away on September 3rd, at the age of 90. And, now, believe it or not, my Dad is on hospice. So I find myself, an elder law attorney - again - in the position of so many of my clients.

My mother's death was hardly a surprise. She had been failing for years, and she had spent four months on hospice. And I had actually been mourning her (impending death) for years, as well. I can remember vividly the time it first hit me.

My son Danny, now in law school, used to love Grandma's chicken cutlets. Once, about seven years ago, he asked her to make some for him. And her response sent chills up my spine.

"I can't," she said to Danny. "I just can't." For this woman, who loved to cook, it wan an admission that she just wasn't up to it anymore. I knew then that she was failing. And that's when I started to mourn her passing - seven years before she actually passed.

It was hard watching my son - who has already lost his father - dealing with the death of his grandmother. And it was tough watching my niece - who has already experienced several losses - going through this one, as well.

These days, I seem to drive past many things that remind me of her. And I seem to always think of questions I wanted to ask her, but can't. In fact, I can't ask those questions to anyone, because she was the last family member of her generation. She comes back to me at the strangest times, in life's little vignettes...for example, at the doctor's office, when I have to fill out a form asking for the names of my parents; or when I look at her Durable Power of Attorney and Living Will and know that I will and can't ever use them again.

To be honest, I'm also feeling, these days, a sense of relief. Relief that the long downward slide, the long-term care journey, for her, is over. Relief that she - who had deep fear of death - never really understood that she was dying. Relief that she died peacefully, in no pain, without being force-fed by medicine or that would only prolong her - and our - pain.

And relief that she simply died of old age - not disease - and with dignity, in the comforting setting of hospice.

Now, more than ever, I can really identify with my clients.

How Will I Know When My Dad Can No Longer Swallow His Medication?

People with Alzheimer's often develop trouble with swallowing as the disease progresses. Simply put, the brain no longer signals the throat to swallow. And what was once a natural instinct suddenly becomes an insurmountable obstacle.

The problem, of course, is that Alzheimer's also generally robs the individual of his ability to communicate that there's a problem. Which, of course, puts the onus on the caregiver. You've got to be aware - somehow - of when this is happening.

When it's time for your Dad to take his medication, you need to watch carefully. But just as important, you need to watch when he eats. Does he keep chewing and chewing, but never swallow? Does he keep the food (or medication) in his cheeks for a long time?

If so, you've got to take some action.

Talk with your Dad's doctor. Is it possible he's taking a medication that he can possibly do without? The doctor probably wouldn't have prescribed medicine if it wasn't necessary... but it's worth a try. If the doctor says he still needs it, can it be prescribed in liquid form? (And would your Dad even be willing to take it in liquid form, since liquid medicines are often bad-tasting?)

If the medicine comes only in pill-form, can the pills be crushed, and then put in pudding or yogurt or drinks? Or would they lose their effectiveness if crushed?

At some point, the doctor may advise that it's no longer worth the struggle to get your Dad to take his medicine.

Are you a caregiver who feels overwhelmed by the 24/7 obligation, and the 24/7 questions? We can help. At The Law Offices of Alice Reiter Feld & Associates, we have one of the largest Alzheimer's/Dementia Resource Centers in South Florida.

Over the past 33 years, we've walked thousands of South Florida families through the Alzheimer's/Dementia Journey. And we've helped protect their rights - both legal and financial - with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset-protection plans, and assistance with Medicaid or the VA.

We can walk your family through the Alzheimer's/Dementia Journey, too. We're just a phone call away.