According to a report released in late September, 2009 the number of Alzheimer’s disease cases are increasing at a staggering rate. Dr. Daisy Acosta is the head of the group Alzheimer’s Disease International that released the report. He stated: “We are facing an emergency.” Unless a cure is found, the group predicts that dementia cases will double every twenty years. By 2050 it will affect 115.4 million people. Currently one in eight persons over the age of 65 and one out of every two persons over the age of 85 are affected.
Alzheimer’s disease is a form of dementia. It is a progressive degenerative brain disease. It begins gradually and can be detected when a person starts forgetting recent events or familiar tasks. Eventually the person experiences confusion, personality changes and impaired judgment. At the advanced stages, the affected person can no longer communicate effectively, finish thoughts or follow directions. Moreover, the person can develop paranoia wherein they believe others are out to harm them. Often the person will try to escape the protective environment and begin to wander.
Obviously persons with Alzheimer’s disease have special needs, as do the families that are caring for them. There are high costs of care, especially at the advanced stages. Thoughtful consideration of family care giving needs to be reviewed as the physical demands can also be high, especially regarding a spouse. For example it is not uncommon for the affected person to become combative and sheer physical strength is needed to restrain them – often a spouse is unable to meet those demands. In addition, complex issues of estate planning, powers of attorney, guardianship and long-term health care needs all become very important. Ultimately, nursing home care is an important consideration.
Medicaid planning is important for Alzheimer’s patients. Given the long-term nature of the disease (persons with the disease can live ten years or more), the cost of care – especially nursing home care – can be very high. For those single persons in the early stages it is possible to obtain Medicaid to pay for the nursing home while preserving a high percent of the assets in the estate as long as planning begins early. There are special rules for spouses that make it even more beneficial to plan ahead.
Once a person is diagnosed with Alzheimer’s disease it is important to act quickly to get legal representation. This is because there is a danger that the person with Alzheimer’s may not have capacity to sign legal documents if there is a long delay after the diagnosis. All too often people procrastinate and wait until the symptoms are very pronounced. At that point the legal capacity to sign documents could be gone. Then the options usually involve a court of law to determine competency and who would be the appropriate person or persons to make decisions on behalf of the patient. There may be a bond required and other hurdles that make the process much more complicated, time consuming and expensive.
Some of the issues that should be addressed with a competent elder law attorney are:
1. How does one qualify for Medicaid, Medicare, Veterans’ Benefits or other public assistance?
2. Who will make the decisions in the case of incapacity and, if necessary, who will assume legal guardianship?
3. What types of estate planning are needed, including durable powers of attorney, wills, trusts, and other legal tools?
4. What is the best plan for long-term-care? Should the person be kept at home or should assisted living or a nursing home be considered?
There are many issues to consider when seeking help for a person with Alzheimer’s disease. Many elder law attorneys have geriatric case managers, nurses, social workers or other specialists on call. Thus, in addition to legal counsel they can provide helpers in the areas of medical assessment and care, senior housing, financial management and other areas.
With the increasing number of cases of Alzheimer’s disease come new challenges in the area of geriatrics, including medicine and law. Heritage Elder Law is here to help meet those needs.