Monthly Archives: December 2010

Caregiving and the Holiday Season


For many Americans, the holidays can be a remarkable time of year to gather family and friends together for celebration and cheer. The holidays mean shopping for presents, going to parties, gift wrapping, baking, and decorating, which many people enjoy and look forward to.

To those who work as primary caregivers, whether it is as a job or as the primary caregiver of a family member or friend, the holiday season can add more stress to their already heavy load of responsibilities. It is easy to become overwhelmed, depressed, frustrated or resentful when trying to achieve the ‘perfect holiday.’

Here are a few ways you can minimize your stress as a caregiver during the holiday season:

Set Manageable Expectations


Be realistic about what you are able and unable to do. Caregivers devote an average of 20 hours per week of assistance on top of a full time job. With the amount of time you have left over, decide what is most important to you and focus your energy on those things, instead of trying to spread yourself too thin.

Seek Help

It is important to remember you are not alone. Other caregivers or family members can be a great resource for support. Trying to handle everything on your own is an unnecessary pressure you don’t need to burden yourself with. If someone offers you help, accept it! Provide details on the type of help that you need and be specific as to what they can do.

Don’t Neglect Yourself

Even though you are responsible for another person’s well-being, you cannot dismiss your own feelings and needs. Do things for yourself such as getting exercise, reading a good book, watching a movie, or visiting with a friend. Make sure you get enough sleep; sleep deprivation can drain your energy, distort your thinking, and lead to a maximum level of stress.

Host the Holiday Get-Together

Removing a care receiver from their place of comfort is an unnecessary added stress. Instead, invite family and friends over to the home of the care receiver and make the meal potluck so you are not responsible for all of the cooking. Try to keep the guest list on the smaller side and talk to family and friends before they arrive so they know what to expect. Explain any special circumstances of the care receiver, like if they have trouble eating or become easily confused.

Gift Etiquette

holiday-presentsAsk for gifts that will help you during the rest of the year- frozen prepared foods or the offer to come cook dinner one night, coupons to run errands, gift cards to the beauty or barber shop for your care receiver, subscriptions to Netflix or magazines, or an offer for some relief time for you. Take the hassle out of gift giving by offering the gift of love. Make time to visit with friends and family, or mail-order your gift purchases- and only buy one for each family or household instead of each individual.

Follow these steps to cut down on your holiday stress, and remember to take care of you and your care receiver’s well being.

Estate Planning for Alzheimer’s

Alzheimer’s is a progressive, chronic disease that calls for constant care that is delivered over time and fluctuates day-to-day.  The kind of care needed, known as chronic care, takes the form of daily personal-care assistance, medication distribution, supervision, companionship, helping with chores, etc. Chronic care systems vary from state to state; it includes both community-based and institutional care providers.  There are also state, federal, and private funding sources available.

The need for chronic health care system is ever growing, and the health care professionals can no longer rely on the once abundant Medicare and Medicaid programs to subsidize the chronic care their patients require.  Alzheimer’s is fast becoming the most prevalent and disabling chronic illness in the United States.  As chronic care systems strain to capacity, Alzheimer’s patients and their loved ones should utilize their own resources in the most effective way to ensure the quality of their care.  Here are a few strategies to aid in the planning effort.

Step 1: Advance Directives

– Once an individual with Alzheimer’s disease has lost their memory, ability to reason, and ability to understand consequences, it is too late to designate someone to take care of their decisions.  Choosing a decision-maker in advance of incapacity can be invaluable when trying to maintain the quality of life for a loved one with Alzheimer’s.

– There are five advance directives that must be considered as early as possible: a power of attorney, a health care proxy, a will, a Do Not Resuscitate (DNR) order, and a living will.  The earlier you can get to an estate planning attorney to establish these directives, the better off you and your loved one will be.

Step 2: Estate Inventory

–       An estate inventory is essentially a snapshot of the resources you or your loved one have that can be used to subsidize care giving.  We cannot efficiently plan or manage long-term care without an inventory of the assets at your disposal.

–       There are six long-term care resources: Health Insurance, Income/Assets, Community Resources, Family/Friends, Home Environment, and the Client’s Self-Care Capacity.

Step 3: Care Needs Assessment

–       A care needs assessment for an Alzheimer’s patient examines what the patient requires, how much care can be provided from the family, the configuration of the home, and the patient’s capabilities.

–       These are best performed by family members or close friends.  A care needs assessment will help predict the gradual increase in level of care.

–       Families can also hire independent care managers  or their local elder service agencies to perform the assessment.

Step 4: Defining the Options

–       Once the advance directives are in place, the resources are organized, and the care needs are assessed, the real planning can start.  It is important to consider both short term and long term needs.

–       Safety, resource limitations, and behavior management are all options that must be considered.

Long-term care is a journey, one that must be planned for extensively.  Your plan must be adaptable and based on correct information.  The more knowledge you can gather, the better.  Working to plan for long-term care can be a struggle.  If you are struggling, the help of an estate planning lawyer can make a huge difference.  Don’t hesitate to contact estate planning lawyer Adam Tobin with any questions or to schedule a free consultation.

How Living Situations Affect Estate Plans

Estate Planning based on Living SituationsWhere do you call home? It may be at your home independently, at a facility, or with an adult child. Based on where you live, there are legal issues that must be addressed. These living situation-specific edits are extremely important to consider when creating your estate plan.

1.  If you are living independently at home, the two important legal issues to address are the estate plan itself and a deed transfer.

In regards to your estate, make sure that you first inventory all assets and create a broad life plan. Considering this broad plan, you must decide what sort of estate plan will work for you. Working with an estate planning attorney is the best way to customize your estate plan to fit your needs. Maybe a basic will package (including a will, a living will, and power of attorney) is enough of an estate plan to fit your needs, both financial and physical. On the other hand, you might need a more complex plan that includes several types of trusts. An elder lawyer is a great resource to use when deciding.The second important estate planning step for someone living at home independently is to consider whether a deed transfer with a life estate is something that would fit into your plan. Will you be able to maintain your current lifestyle without access to the equity in your house? If you transfer your house five years before submitting a Medicaid application, you will have preserved an asset. There are risks to a deed transfer, however. Once it is transferred, you cannot get it back without proof of undue influence or fraud. Also, if your adult child (or whomever the house was transferred to) gets divorced or receives a judgment, the house might be subject to some sort of equitable distribution or a lien. These are just a couple of the issues that should be discussed fully with an estate planning attorney.

2.  If you are living with an adult child, the main legal issue to address is the creation of a caregiver agreement. This basically defines the living arrangement between you and your child to avoid any potential conflict in the future. For example, you might want to purchase a life estate in their property or create a landlord/tenant arrangement. You also need to define what portions of funds paid by you will compensate for rent and care. This may seem unimportant if you have a great relationship with your child, but spelling out all the terms of your stay will work to preserve that great relationship. Also, Medicaid recognizes a caregiver agreement when the amount paid is considered reasonable compensation (80% of fair market value.)

3.  When living in a facility, there are several issues to be addressed in an estate plan (and the earlier, the better.) Typically, a parent is placed in a skilled care facility or nursing home due to a recent or sudden accident or sickness and the adult child must figure out how to proceed. It is much more beneficial to work with an elder care attorney beforehand so as to fully outline your preferred plan. The most pressing matter is usually the method of payment. There are four methods of payment available: long term care insurance, Veteran’s benefits, private payment, or Medicaid. Another taxing situation involves preparing for what the social service agency will need in regards to the parent. The real secret, however, is in the “spend down.” Funds must be “spent down” before you can qualify for Medicaid. One of the best ways to do this is to hire a nursing home lawyer, because legal fees are permissible expenses (meaning money can be spent down on payment of legal fees in order to complete a Medicaid application.

So whether you live at home, in a facility, or with an adult child, you must consider situation-specific legal issues. The best way to ensure that you are executing your estate plan in the most efficient way is to work with an elder care attorney. If you have any questions or are ready to begin the estate planning process, contact us now to schedule a free consultation with Massachusetts estate planning attorney Adam J. Tobin.