Read about Glen Campbell advocate for Alzheimer's at the Grammy here.

Alzheimer’s disease is a neurological brain disorder named after a German physician, Alois Alzheimer, who first described it in 1906.

We were impossibly young and so beautiful
When we met and fell in love.

You were the cool guy from the big city
I was the shy small town girl.

I bring you photographs of those days long ago
You look and smile and ask me who those people are.

I take your hand. It is warm and strong in mine.
You don’t remember me but you know that we belong together.

I tell you the stories of those two young people.
You listen intently and study their faces

And look into my face
With wonder in your eyes.

I have come to understand that it doesn't matter
That you no longer remember who we were then.

It only matters that we can sit and hold hands
While I tell you stories of our past.

Like an old photograph, memory can fade away
But love endures.

In the touch of hands, in a smile,
In the wonder I see in your eyes.

People with late-stage Alzheimer's must often be cared for in a nursing home. But a new study shows that many nursing home residents with dementia are needlessly moved to the hospital when infections and other medical problems arise, a move that can be particularly stressful for anyone with Alzheimer's disease.

The new findings, published in The New England Journal of Medicine, showed that nearly one in five residents of nursing homes with advanced dementia were moved to the hospital or another facility during the last 90 days of their lives. In some cases, the patient was moved in the final three days of his or her life, even when such care may not be lifesaving.

"Such patterns of transitions are burdensome, particularly since the overwhelming majority of family members state the main goal of care is comfort," said study co-author Dr. Joan Teno, professor of health policy and practice at the Warren Alpert Medical School of Brown University and a palliative care physician. "Similar outcomes could be achieved by keeping these patients in the nursing home setting."

The authors, among them health economists, note that inefficient financial incentives play a role in the frequent moves. Patients who have been in the hospital for three days, for example, are paid for at a higher rate by government programs than those who remain in the nursing home.

A change in surroundings can be particularly upsetting for anyone with Alzheimer's disease. New settings can make confusion and disorientation worse for anyone with dementia. Such moves also raise the risk for medical errors, since new doctors and other health care staff are often not familiar with the particular needs of the patient.

Different policies and ideas about end-of-life care in different parts of the country can also lead to wide variations in how often someone with late-stage dementia is moved, the study found. The likelihood of a move varied from just one in 50 nursing home residents in Alaska to more than one in three patients in Louisiana. Blacks and Hispanics were also more likely than whites to experience burdensome transitions.

The researchers reviewed data from more than 474,000 seniors with advanced Alzheimer's and related problems who were living in nursing homes during their final months of life. More than 90,000 residents experienced at least one burdensome transition. These included a move during the final three days of life, returning to a different nursing home than the one they lived in before they went to the hospital, or multiple hospitalizations in the last 90 days of life.

In many cases, problems like pneumonia, urinary tract infections or dehydration that prompted the moves could have been easily treated within the nursing home, the researchers found. Other procedures included feeding tube insertions and treatments for bed sores.

Medical crises are difficult and stressful for patients and families, particularly in the final stages of dementia. And some medical care can be lifesaving. But the authors call for better coordination between health care staff and a realignment of payment systems "to make sure that people are getting the right care in the right place at the right time."

Families, too, can get involved with end-of-life care through measures like advance directives and "do not hospitalize" orders for loved ones in nursing homes. That way, nursing home staff can alert family members about impending moves and have a discussion about options with the family.

By ALZinfo.org, The Alzheimer's Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer's Research Foundation at The Rockefeller University.

Pedro Gozalo, Joan M. Teno, Susan L. Mitchell, et al: "End-of-Life Transitions Among Residents With Cognitive Issues." New England Journal of Medicine, Vol. 365, Sept. 11, 2011, pages 1212-1221.

Elderly men and women with mild Alzheimer’s disease and cataracts can benefit from cataract surgery, a new report shows. The surgery led to improvements in thinking, sounder sleep, better mood and other benefits.

"We wanted to learn whether significant vision improvement would result in positive mood and behavior changes, or might instead upset these patients' fragile coping strategies," said Dr. Brigitte Girard, the lead author of the study and a researcher at Tenon Hospital in Paris, France. Surgery produced improvements in many of the patients studied.

The findings are important, since cataracts, which cloud the lens in the eye, are very common in older people. With the advance of lasers and other technologies, cataract surgery has become a relatively simple procedure that can produce dramatic improvements in vision. The results underline the importance of good vision and medical care for anyone with Alzheimer’s disease.

The study is the first to address whether cataract surgery is helpful specifically for people with Alzheimer’s disease. Earlier studies have shown that older people in general show improvements in thinking and mood after cataract surgery to correct vision loss.

For the study, the researchers enrolled 38 men and women with mild Alzheimer’s disease whose average age was 85. All of the study participants had cataracts in at least one eye that severely impaired their vision.

All underwent cataract surgery, involving removal of the faulty lens and replacement with a new, clear lens. After the surgery, all but one of the patients showed dramatic improvements in their vision.

They were also assessed for psychological and cognitive health one month and three months after the surgery. One in four patients showed improvements in thinking and memory skills. Many also showed an easing of symptoms of depression. They did not, however, show improvements in day-to-day functioning.

Most of the participants also slept better after the surgery. They also had fewer nighttime outbursts and behavior problems, a common problem in people with Alzheimer’s.

The researchers speculate that the improved sleep may be due to better processing of melatonin, a hormone involved in sleep. Other studies have shown that cataract surgery can improve melatonin levels.

"In future studies we intend to learn what factors, specifically, led to the positive effects we found, so that we can boost the quality of life for Alzheimer's patients, their families and caregivers," Dr. Girard said. The findings were reported at the American Academy of Ophthalmology's 2011 Annual Meeting in Orlando, Fla.

By www.ALZinfo.org, The Alzheimer's Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer's Research Foundation at The Rockefeller University

Source: The 115th Annual Meeting of the American Academy of Ophthalmology, Oct. 23 to 25, Orange County Convention Center, Orlando, Fla.

An experimental drug showed early promise in fighting Alzheimer’s. The drug, called gantenerumab, lowered levels of a toxic protein that builds up in the brains of those with the disease. Scientists hope that diminishing levels of the toxic protein, called beta-amyloid, will protect against memory loss and other symptoms of Alzheimer’s.

The drug is only available for experimental use, and much more study in larger numbers of people is needed to assess its safety and effectiveness against Alzheimer’s. Many medications show promise in early-stage trials but prove ineffective or too dangerous for clinical use on further testing. But the early results will lead to new studies of the drug as scientists seek ways to stem progression of the brain-ravaging illness.

For the study, researchers at three medical centers in Europe looked at 16 men and women with mild to moderate Alzheimer’s disease. Some received up to seven intravenous injections of the drug every four weeks, at higher or lower doses, while others got a placebo. They also underwent specialized brain scans to assess levels of beta-amyloid in the brain.

Gantenerumab is designed to enter the brain and bind to beta-amyloid, which forms toxic clumps called plaque. Once it binds to the beta-amyloid, it is thought to cause certain cells in the brain to remove the amyloid plaques. The brain scans showed that those getting the drug had lower levels of beta-amyloid in the brain than those receiving the dummy drug.

Other therapies have been tried to reduce levels of beta-amyloid in the brains of those with Alzheimer’s disease. Vaccines, for example, have been developed that reduce beta-amyloid buildup, but some patients receiving the vaccines have developed fatal brain inflammation. In the current study, some patients receiving the higher doses of the drug also developed brain inflammation, though none died.

The current study was small, and it is still unknown whether patients who got the drugs show improvements in memory or other symptoms. But an effective drug against Alzheimer’s is desperately needed. Current Alzheimer’s medications may ease symptoms for a time but do nothing to stop the downward progression of disease.

By stopping the buildup of beta-amloid, a key process in the progression of Alzheimer’s, scientists hope that drugs like gantenerumab may be more effective in actually halting progression of the disease. Such drugs, it is thought, may be most effective in the early stages of the disease, before damage to the brain becomes extensive and irreversible.

It may be possible, one day, to give drugs to people at risk for Alzheimer’s even before symptoms occur, actually preventing the onset of Alzheimer’s. Doctors now think that Alzheimer’s may take many years to develop before symptoms arise.

More studies of this and related drugs are being planned. The findings appeared in the Archives of Neurology, a medical journal from the American Medical Association.

By ALZinfo.org, The Alzheimer's Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer's Research Foundation at The Rockefeller University.

Source: Susanne Ostrowitzki, Dennis Deptula, Lennart Thurfjell, et al: “Mechanism of Amyloid Removal in Paitents With Alzheimer Disease Treated With Gantenerumab.” Online first, Archives of Neurology, Oct. 10, 2011.

I have a close friend who was diagnosed with Early-Onset Alzheimer's disease at the age of 57. Each Saturday morning he begins a 24 hour shift of trying to stay out of trouble while his wife works a 'round the clock shift at her job. Since he is still in the early to moderate stage of the disease she is able to leave him for periods of time without too much worry. Also, finances dictate that she needs to keep her job as a long as possible as they are now down to one income.

For my friend, however, those 24 hours can feel like a month. He doesn't go anywhere, fearing something bad might happen. Instead he performs simple chores around the house, things that won't get him into too much mischief. His jobs include running the sweeper, making the bed, etc.

By 10 a.m. he puts on the news, not really to watch it, but just to go through the motions. He used to love watching college football Saturday afternoons, but sadly, that activity has just become one more thing he has crossed off his "don't bother" list.

By noon feelings of isolation and boredom begin to surround him. He has recently told me that these feelings have intensified during the past winter months. His house feels more closed up with the windows and doors always shut trying to keep it warm. Naturally, he can't help but finally start searching for something to do.

Never intentionally meaning to do anything wrong, it seems that the laws of physics are stacked against him.

For instance, there's a faucet in his garage that has a small leak. It has a magnetic pull calling him, almost demanding that he come to fix it. He fights the urge to the point where he has hung a large sign above it saying: "Don't even think about it!"

When a person has this disease they often live in constant fear of doing something wrong. The average person thinks that staying out of trouble is an easy task, but for my friend it's nearly impossible. I'm not talking about anything drastic (although you never know). It usually comes down to simple projects spiraling out of control.

He believes that, for caregivers, it may be like them having a loyal pet that's so well behaved that they don't worry about them doing anything out of line. Then the day comes when they are left at home alone for an unusually long period of time; upon arriving home it is discovered that possibly this "pet" is not as trustworthy as originally thought! There are reams of toilet paper spread from one end of the house to the other.

According to him, his long Saturdays aren't good for him, but then Sunday through Friday are not that great either.

*[This story is based on many people we have met during our memory support work. It is fiction but grounded in the reality of Alzheimer’s.]

I wish there was someone I could talk to about this. Everyone here is very nice to us, they take good care of Bill, but they don’t really know him; I mean they don’t know the real man inside. What can I do? No one wants to hear the stories about Bill, about how he was a high school football star and a hero in the war. I just wish there was some way I could tell the people here, could show them what a strong, brave man Bill is.

            I still remember the feeling of shock when he asked me to wear his letterman jacket our senior year, how that jacket felt in my hands, how it smelled of leather and wool. It was dark blue wool with white leather sleeves. Bill’s name and number were embroidered on the back, right under the roaring lion. I used to sleep with that jacket every night my senior year in high school. Even though he was the star quarterback, Bill was still shy. He told me later that he was self conscious because his ears stuck out and turned red when he got embarrassed. I didn’t care about football, I was a book worm. It was Bill’s smile that got me, he just kind of lights up when he grins. I used to love it, too, when he would pass me in the hall and give me that grin and then a wink, made my heart beat fast!

            I didn’t know what to feel when Bill joined the Marines right after high school. We were just getting serious and he was going to leave me. I felt angry and sad and proud all at the same time. Everyone was joining up or getting drafted then. Of course in those days, we didn’t question anything; we just did what we were told. Bill was in Italy and then he was sent to Germany. I could not believe it when his mother called me to tell me that Billy had run into a little trouble over there. A little trouble? He almost died saving the company medic, Bob Brooks. Bob was hit bad and Bill picked him up out of a fox hole and ran through the middle of a battle and carried him to safety. Bob went on to become a doctor, and to save a lot of lives himself. Now, Dr. Bob is dead and no one remembers what my Bill did, how he saved that doctor’s life, how he won medals for his bravery. Bill told me later it was all that running, dodging and weaving that he did on the football field that saved them both. He didn’t think it was bravery; Bill just chalked it up to speed and luck.

            And the Lord knows Bill was quick on his feet and in his mind. They used to call him jackrabbit. People said he was so fast, he could throw the football and then catch his own pass! Even though he was quick in everything, Bill had patience for other people. He helped a lot of kids, boys that would have gone bad if it wasn’t for Bill. They come sometimes to visit us here, but they look so sad when they see how Bill is now. Of course, it’s hard for our own kids to visit, too. They don’t know how to handle seeing their dad like this. I know it’s hard for them, but they have to understand that there father is still there, inside. I don’t know what to say to them, to help them understand this. I don’t know what to say to anybody.

            I know that people sometimes think I am mean because I won’t help Bill button his shirt and I won’t let anyone feed him. It’s just that I know Bill, and I know that he feels better about himself when he can do these things on his own. I am trying to be as patient with Bill as he always was with other people. I know that he will never get any better, but I want him to put up a fight. I want us to put up a fight for as long as we can.

Now Bill is beginning to wake up from his nap. He needs to sit up straighter in his wheel chair, and he needs to wipe his chin. Oh, he sees me now. There is that old grin and Lord, feel my heart, he winked at me! My Bill, my hero. 

Being a more or less full-time caregiver doesn’t mean you know how to entertain your caregivee more or less full-time. One of the questions that’s often bandied about on the Alzheimer spouse message board I frequent is: Why do they doze in chairs so much?

Part of the answer is that it’s tiring to live with a semi-functional brain. Navigating the world with only a half or so of a full deck is a surefire battery depleter, so chair-dozing is a pretty normal response. But there’s another theory, and it’s one with which I strongly concur—It’s boring when you can’t do anything. Dozing might often be a simple symptom of not knowing what else to do.

In the litany of losses we see in our stricken spouses, a fading of ambition seems to come early. Nevertheless, it is a classic trick of the Alzheimer mind to sporadically pulse with short bursts of what we figured was gone forever. What happened with Jeff is that about a month or so ago, he latched onto the notion that he would go to law school.

I am not aware that Jeff ever entertained thoughts of law during his functional life, so it’s been a funny thing to come upon us during system failure. But there it was, and he brought it up when we had lunch with his sister one day. What did she think, Jeff wanted to know. Would he make a good lawyer? 

There is hardly anyone with a greater gift for equanimity than Jeff’s sister, and she gently expressed her doubts about whether he would enjoy the shark-like thinking that the study of law (as she understood it) aimed to instill. This put it to rest, but only for that meal. Because for inexplicable reasons, the notion of going to law school had latched onto one of the few neurons in his brain that could retain something. So he kept bringing it up.

“Today,” I would say, as I threaded him into his coat, “we’re going to go to the bank, get lunch, then buy cat food.”

“Then,” said Jeff, with a purposeful look, “law school.” 

More than a few times, I had to stuff my thoughts under the nearest pillow and sit on them, because what was the point? As caregivers, we aim to make life pleasant, not be the reality check-point. How could it help for me to say “Yo...you can’t read, you can’t drive, you can’t follow a movie plot, and you can’t put your pants on straight...how are you going to go to law school?”

No, reality was out, and so was just plain “no.” Just plain “no,” would make me the bad guy. There had to be something other than “no.” There was, as it turns out. There was the LSAT. For all his deficits, Jeff is still capable of understanding (once I pointed it out,) that there is a first hurdle, and it’s the standardized test. So, last week, we made a field trip to Barnes & Noble, and bought the Princeton Review’s strategy guide for the LSAT.

It seems to have been a $24.37 investment that paid off. He could make no sense of the book on his own, as I knew he could not. After a couple days of staring at it, he asked for help. Tests were not a problem he insisted. He had, after all, taken the SAT about two-dozen times over the past fifty years. (Don’t ask me where this idea came from, as we all know that no one wants to take the SAT more than twice, and kissing it goodbye at 17 is always a relief.)

So, we sat down together and cracked the book. I cut to the chase and read the first logic question. A veterinarian wishes to transport animals in four cages, each of which has one upper and one lower berth. There are three male animals. Female animals will occupy the top berths of cages #1 and #2. No cage can contain two males. Therefore, which of the following arrangements (A,B,C,D, or E,) is untenable? Being me, I sketched out my little cage diagram and circled a response. But Jeff selected choice F: Throw the LSAT book on the floor. 

“Do you want to stomp on it now?” I asked. He chuckled. “No, I’m going to celebrate. Because I never have to take the LSAT.” 

Then I helped him find the bathroom, which was located, as always, right across the hall (where it’s been for the past 25 years.) That’s the last I’ve heard of law school. 

It is of the utmost importance to find a qualified attorney to help you plan for the future, particularly when a debilitating illness such as Alzheimer’s enters the picture. But what do you look for, and how do you go about looking?

You can start by checking with either of two associations for elder-law attorneys. The National Elder Law Foundation (NELF) is an American Bar Association-certified organization that certifies the elder-law specialty among practitioners, who are known officially by the designation “CELA” (for “certified elder-law attorney”).

According to NELF, a CELA must be knowledgeable in the following subjects:

• Health and long-term care planning.
• Public benefits (including Medicare, Medicaid and Social Security).
• Surrogate decision-making (including powers of attorney and guardianship).
• Older persons’ legal capacity.
• The conservation, disposition and administration of the older person’s estate (including wills, trust and probate of an estate).

Finding the right elder-law attorney is very important to planning for your future.

You can find a complete directory of CELAs in the United States at the foundation’s website (www.nelf.org), or look for a CELA in your area using their search engine.

The National Academy of Elder Law Attorneys (NAELA) “is a professional association of over 4,300 attorneys who are dedicated to improving the quality of legal services provided to seniors and people with special needs,” according to the organization’s website. It also has a searchable directory of elder-law attorneys throughout the United States, including CELAs, at its website (www.naela.org).

When do you contact an attorney? The sooner, the better. There may be more options available to you and your loved one at the early stages of Alzheimer’s than later on.

Asking the Right Questions
NAELA and NELF recommend meeting with the attorney of your choice armed with lots of questions. Before you agree to meet with an attorney, NAELA suggests that you ask some basic questions:

• How long have you been in practice?
• Does your practice have a particular area of focus?
• How long have you been focused on that particular area?
• What percentage of your practice is devoted to elder law?
• Is there a fee for an initial consultation, and if so, how much is it?
• Are you a member of the National Academy of Elder Law Attorneys and/or are you a CELA?
• What documentation should I bring with me to the initial consultation?

Once you’ve found an elder-law attorney, it’s time for the initial consultation. Here you’ll explain your specifics in some detail to give the attorney the scope of your situation. Before you meet with the attorney, answer as many of the following questions as you can:

• What is the current stage of the illness?
• What needs are currently being met?
• To what extent can the person with Alzheimer’s care for him/herself?
• Is the person with Alzheimer’s capable of handling financial affairs?
• Can the person live at home now, and at what point will assistance with daily activities become necessary?
• Does the person have disabilities?
• Does insurance or entitlement cover the disabilities in question?
• What are the person’s overall financial needs?
• Does this person qualify for federal or state benefits? If so, which ones?
• What are your needs as a caregiver? Are you disabled, or can you foresee becoming disabled?
• In the event of your disability or death, who will provide care for the person with Alzheimer’s?
• Are there other family members who require caregiving, such as a child with disabilities? What are their needs?
• The needs of the person with Alzheimer’s may deplete the available resources. How will other family members react if this happens?
  

  Knowing the right questions to ask can help you find the right elder-law attorney.

• Are you the only caregiver, or are there other family members or friends who are willing to help? How much help can they provide? Do they have the time and the expertise to do so? Can they be trained to handle problems that may arise?
• Is there someone you can trust sufficiently to name them as holder of power of attorney or health care proxy? Will they act in the best interests of the person with Alzheimer’s?
• You may need outside help, particularly if no family members or friends can help. Who can help you in that event? How much will it cost to hire help?
• What are your long-term goals, and what are your long-term goals for the person with Alzheimer’s?
• What are the person’s assets and liabilities? (You will need to carefully compile an inventory all assets, all sources of income, and all liabilities.)

You may need an attorney’s help answering some of these questions. But whether you can answer them yourself or need help, these questions need to be answered soon.

Also, be sure you understand how your attorney’s fee structure works. Ask how the firm bills and how often. Some attorneys ask for a retainer before beginning work, which is money paid in advance to the law firm in order to begin work.

Why a CELA?
Seeking an attorney certified in elder law (a CELA) brings with it certain assurances, according to NELF. A CELA has met rigorous criteria for certification, including:

• Being licensed to practice law in at least one state or the District of Columbia.
• Practicing law for five years prior to applying for CELA certification, and must still be in practice.
• Being in good standing with the bars of every place in which they are licensed.
• Spending at least 16 hours per week practicing elder law during the three years before they applied, and having handled at least 60 elder law matters during that time with specific targets defined by NELF.
• Continuing legal education, with 45 hours logged in the preceding three years.
• Having five references from attorneys familiar with the applicant’s competence and qualifications in elder law.
• Passing a full-day certification examination.

In addition to these criteria for certification, there are expectations for a CELA’s practice that NELF specifies. Among these:

• The capability to recognize issues of concern, including the abuse, neglect or exploitation of older persons; insurance; housing; long-term care; employment; and retirement.
• Familiarity with professional and non-legal resources and services available to meet the needs of older persons, whether public or private.
• Capability to recognize professional conduct and ethical issues that arise as a matter of course during representation.

Hiring an elder-law attorney is worth taking the time to do it right. These guidelines should help you do just that, which is all the more important if you’re dealing with other pressing issues besides legal matters.

Bernard A. Krooks, J.D., CPA, LL.M (in taxation), CELA is past president and founding member of the N.Y. chapter of the National Academy of Elder Law Attorneys and a nationally known and widely quoted expert on elder law. For more information, visit the firm’s website at www.littmankrooks.com.

Finding Your Attorney Without the Internet
If you don’t have a computer or Internet access, here are some recommendations for finding a qualified attorney to help you:

• Get a referral: You may have friends, colleagues, etc., who have used the services of an elder-law attorney and can provide a recommendation to you. Don’t hesitate to ask.
  

  You don't necessarily need a computer to find the right attorney for you.

• Yellow Pages: Your local directory should have listings for the elder law specialty. If not, check the ads, and don’t be afraid to ask the questions listed in this article to find out if the attorney is a good fit for your needs.
• Your state’s bar association: State bars also keep directories of members in good standing. Again, don’t be shy about asking questions of any attorney you contact.

Source: www.ALZinfo.org. Author: Sam Gaines, Edited by: Bernard A. Krooks, J.D., CPA, LLM, Preserving Your Memory: The Magazine of Health and Hope; Spring 2011.

By Bernard A. Krooks,
Certified Elder Law Attorney

During our discussions with clients, we learn about many misconceptions they have and previous errors they have made in their long-term care planning. I would like to share a few of those with you.

Believing Medicaid myths.
Relying on information from family members or friends, many people have a misunderstanding of how the Medicaid program works. Medicaid is a state program funded in part by the federal government. It is the only government program that pays for long-term care. Each state has its own Medicaid rules and regulations; including the District of Columbia, there are 51 Medicaid programs. In some states, Medicaid procedures even vary by county. Thus, it is very important for seniors and their families to consult with an experienced elder-law attorney familiar with the Medicaid program in the state and county in which the Medicaid application is to be filed.

Thinking it’s too late to plan.
It is never too late to plan. In fact, it is possible to begin planning even after the individual has entered a nursing home, although you are always much better off if you plan ahead. Even if someone has already been diagnosed with Alzheimer’s disease, they may be able to sign advance directives if the disease is in an early stage. If the disease has progressed, then planning may still be possible through a guardianship proceeding. With proper planning it is possible to protect a significant portion of the person’s assets.

Giving away assets too early.
These assets belong to the senior or the person with disabilities. Don’t put these individuals at risk by making premature gifts to family members. Premature gifts can also result in tax and Medicaid problems, particularly in light of changes to the Medicaid laws now in effect as the result of the federal Deficit Reduction Act of 2005.

Ignoring exempt transfers.
Some transfers do not result in periods of Medicaid ineligibility. These include certain transfers to children with disabilities, caregiver children, some siblings, certain exempt trusts for persons with disabilities under the age of 65 and certain pooled trusts for persons with disabilities.

Planning for long-term care should not be put off, but it’s never too late to start planning.

Failing to take advantage of spousal protections.
These protections include maximizing the Community Spouse Resource Allowance, exercising the right of “spousal refusal,” purchasing exempt resources or converting countable resources to income.

Applying for Medicaid too early.
Applying for Medicaid within 5 years of making a gift can result in a period of ineligibility that will not start until the senior or person with disabilities is in the nursing home—with no funds available to pay for his or her care. While the rules are complex, there are still ways to protect assets even if a gift has been made within the 5-year look-back period.

Applying for Medicaid too late.
Putting this necessity off can result in spending funds that could have been protected by proper planning. While Medicaid is the payer of last resort, in many cases it must be considered in order to maintain the quality of life of the well spouse and family.

Failing to keep good records.
This has become a critical issue in light of recent Medicaid changes. A Medicaid eligibility worker will thoroughly examine all Medicaid applications. The applicant should retain records to support all items listed on the application, document the applicant’s assets as of the date of admission into the nursing home and verify the disposition of the applicant’s assets for the entire look-back period.

Not considering long-term care insurance.
All those who are healthy and who can afford the premiums should consider long-term care insurance. By purchasing long-term care insurance, you may have more options available to you in the event of a chronic illness. If someone has already been diagnosed with Alzheimer’s disease, it is too late for that person to purchase long-term care insurance. However, this should serve as a wake-up call to other family members that considering long-term care insurance is a vital part of your overall financial and estate plan.

Not getting expert help.
Medicaid asset protection planning is complicated. Most people will require this planning only once during their lives. Because a great deal is at stake, it is wise to consult an experienced, certified elder-law attorney when long-term care is necessary. The attorneys’ fees are an investment, not an expense.

Don’t repeat the mistakes others have made; instead, learn from them. Make sure you do what is necessary to protect your family’s assets.

Bernard A. Krooks, J.D., CPA, LL.M (in taxation), CELA, is immediate past president and founding member of the N.Y. chapter of the National Academy of Elder Law Attorneys and a nationally known, widely quoted expert on elder law. For more information, visit the firm’s website at www.littmankrooks.com.

Source: www.ALZinfo.org. Author: Bernard A. Krooks, Esq., Preserving Your Memory: The Magazine of Health and Hope; Spring 2010.