A Warning for Long-Term Care Patients: Monitor Your B12 Levels

too many meds macroToday’s entry is a little different from my usual blogs, and it’s written especially for my clients who are currently receiving some form of long-term care.

A brand-new study out of Canada, reported in U.S. News & World Report, finds that Vitamin B12 deficiency is surprisingly prevalent among long-term care patients, and it’s a real concern.

Vitamin B12 deficiency is linked with:

  • Amenia
  • Changes in skin pigmentation
  • Depression
  • Difficulty walking
  • Fatigue
  • Gastrointestinal upset
  • Heart palpitations
  • Lightheadedness
  • Nerve problems
  • Respiratory problems
  • Vision loss
  • Weakness

Many of those conditions can exacerbate problems already common among long-term care patients.

Most concerning, though, is the fact that several studies have shown a direct link between vitamin B12 deficiency and memory loss, including dementia. That’s startling when you consider that dementia is emerging as one of the primary factors in the rising need for long-term care in the first place.

While many people assume that the deficiency is caused by a lack of B12 in the diet, it often stems from medications and/or underlying medical conditions that interfere with the body’s ability to absorb the B12 already in your diet.

The good news is that most cases of B12 deficiency can be easily managed. Detection is the key. That’s why we’re sounding the alarm.

If you or someone you love is in long-term care, have a talk with your healthcare provider about vitamin B12 as soon as possible.

You Can’t Paint Long-Term Care Insurance with a Broad Brush

Forbes has an interesting new article that traces the history of long-term care insurance in America. It’s a topic I suspect many college history courses fail to touch upon, and not many more law school classes either.

Essentially, the summary looks like this: For a long time, long-term care insurance wasn’t very good. Then, in the 1990s, it became almost too good to be true, with great benefits at a surprisingly low price. Those untenable policy benefits eventually led to higher premiums, though, along with a reduction in benefits and a dramatic consolidation of the available plans.

Today, we’re somewhere in between. There are fewer long-term care insurance plans available, and those that exist range from modestly helpful to moderately helpful — and never entirely sufficient on their own.Long-term care insurance form and dollars.

There is a tendency among some Americans to take out a long-term care insurance policy and decide that they’ve done everything they need to take care of themselves in old age. That’s far from the truth, and those people may be in for a rude awakening.

On the other hand, though, there is an equally misguided tendency in the industry to write off long-term care insurance altogether.

For some people, long-term care insurance can make sense as one piece in a larger advance planning puzzle. It’s all a question of timing, premium, benefits, and your personal needs and financial standing.

In other words, long-term care insurance remains an option worth considering, but it’s a very fact-specific inquiry.

If you’d like to know whether long-term care insurance might play a role in your own plans for the future, I’d be happy to talk about it. Give me a call today.

A New Year, A New Hope for Dementia

Memory LossStar Wars is all anyone is talking about these days, so I supposed it’s appropriate to be blogging about “a new hope.” (For those who’ve been hiding under an asteroid for the last forty years, A New Hope is the retroactively applied subtitle for the original Star Wars film.)

Over the last year or so, I’ve had the opportunity to tell you about a lot of really encouraging advances in the war on dementia:

…And that’s only scratching the surface.

I’ve frequently commented on how encouraging it is to see so much research springing forth, especially given that dementia was essentially a profound scientific mystery for so many years.

Well it turns out that I’m not the only one to notice the trend. A new report in the Independent says that scientists believe 2016 may be their breakthrough year. They’re confident precisely because 2015 brought them so many advances in their fundamental understanding of this terrible disease.

To be clear, no one is talking about a cure. There may never be one, and if there is, it’s likely a long way off. It’s important that we not conjure up any false hope — the reality is that dementia progress is still in its relative infancy.
But each new morsel of knowledge pertaining to prevention and treatment represents a significant milestone, not only for people already suffering dementia but also for those who might otherwise receive new diagnoses in the decades ahead.

Let’s hope 2016 is every bit as momentous as dementia experts expect it to be (and then some). If these are the Dementia Wars, may 2016 be the year that Science Strikes Back.

This New Year, Resolve to Estate Plan

ThinkstockPhotos-502050910New Year’s resolutions always seem to be the same — eat less, run more, get better sleep, etc. Sadly, breaking those resolutions has become as traditional as making them in the first place!

Forbes reports that only 8% of Americans manage to maintain their resolutions for the full year. Most of us ditch them in just a few weeks! Maybe we’re aiming too high.

Here’s an idea for an easier-to-keep resolution… one that’ll pay real dividends in the future. Plan your estate!

As I’ve written about in the past, the majority of Americans agree that they need an estate plan; they just prefer to procrastinate as long as possible. Procrastination is a very anti-New Year’s state of mind, though, so I think this month represents a golden opportunity to finally cross estate planning off your eternal to-do list!

Here’s an easy-to-follow plan:

  • If you don’t have any kind of an estate plan, call my office today and let’s have a friendly chat. It’s that simple. I can handle all the hard work for you.
  • If you already have an estate plan but haven’t updated it in the last few years, seize the opportunity to do so now. Estate plans are never truly finalized — you need to incorporate all the latest changes in your family, as well as recent evolutions in technology and the law.
  • If you have all the basic documents in place and they’re fairly up to date, set your sights on long-term care planning. That might be the best thing you ever do for your family. Americans are living longer, and more of us than ever will require long-term care. Unfortunately, it’s very expensive. Advance planning empowers you to provide for your future with a manageable and affordable approach in the meantime.

Let’s make 2016 your “I finally did it” year. My office can help with any of these resolutions and plenty of others, so let’s make the most of January while it’s still here. Give me a call today.

Three Youthful Myths About Estate Planning for Millennials

Funny day with the best friendsBlitheness is the prerogative of the young. Arguably, no generation has better exercised its right to youthful nonchalance than the Millennial one, known for its “Peter Pan” reluctance to embrace the burdens of adulthood.

Then again, maybe that isn’t fair. Millennials might think about growing up in different terms than those who came before them, but they are also coming of age in a different world than the one we grew up in.

And who’s to say they aren’t responsible? The New York Times recently reported that more and more young people — even without a family of their own — are beginning to make estate plans. That’s something those of us who practice estate law have been recommending to young Americans for a long time, but the message has often fallen on deaf ears. It’s nice to see that changing.

The Times report notwithstanding, though, there may still be a pervasive sentiment among Millennials that estate planning is a concern for their far-off futures.

Financial e-magazine The Street recently argued on behalf of estate planning for Millennials, and we might match the points they made to three common myths among the young:

1. Young people don’t own anything of value. That is surely a myth. Most Millennials do indeed have estates of their own. While they might not own homes, their possessions can still add up to a lot, not only in terms of financial worth but also sentimental value. That needs to be accounted for.

2. Estate planning is for rich people. This myth is popular among people of all ages, but it is equally untrue for all of them. Everyone has assets. You don’t have to be wealthy to own things that matter. Moreover, even in the absence of high-dollar assets, you still have a body. Healthcare directives, powers of attorney, and other documents are all essential for making sure that someone will make the right decisions for your health and welfare if you’re ever unable to.

3. There’s still time to do it later. That’s an easy assumption to make, especially while you’re young, but the truth is that none of us have that guarantee. Unexpected accidents, illnesses, and deaths have left many families in terrible binds. Young people can alleviate enormous burdens for their loved ones by putting an effective estate plan in place now.

If you’re a young person (or the parent of one), and you’d like to learn more about estate planning for Millennials, I can help. Give me a call.

For Dementia Patients, Increased Awareness Brings New Dignity

Things are changing on the dementia front, and we might say they’re changing for both the better and the worst. On the one hand, the overall rate of dementia is (according to most projections) rising rather rapidly. On the other, though, scientists are finally starting to make some real headway in their understanding of this terrible disease.

With the growing diagnoses and the more frequent dementia-related headlines in the news, we’re seeing more widespread awareness about dementia than ever before.

Statistical models show that if you don’t already know someone affected by dementia, you probably will within the next few decades (or sooner), unless things change. In other words, the disease is really hitting home for many Americans.Group Of Senior Couples Enjoying Meal Together With Home Help

In a sense, that is encouraging news — history shows us that medical advances often follow a rising tide of cultural awareness.

For today’s dementia patients, this newfound awareness also heralds a more immediate benefit — dignity. New nursing homes are popping up with dementia-specific care programs. Seniors have a growing number of alternative care options, too, like “Dementia Villages,” which are designed to provide a neighborhood-like living environment for those with advanced care needs.

Recently, I came across a story about a pub in Mill Creek, Washington that offers a 90-minute dementia “supper club” every week, designed to offer a good meal and a respectful network of support for dementia patients and their caregivers. “Mac ‘n’ cheese with a side of dignity,” they call it.

Dignity is crucial to the dementia patient’s experience, and it ought to be a paramount objective in every service we seek out for them. It’s always a chief goal in my efforts as a Middlesex County elder law attorney, and I’m pleased to see that people in other lines of business are getting on board with that notion as well.

This Holiday, Honor Caregivers with Random Acts of Kindness

Nursing homeThe news is filled with horrifying headlines. As comfort, we remind ourselves that the world knows more kindness than tragedy, even if the former never earns the lion’s share of the coverage.

Though we seldom hear about them, millions of acts of kindness unfold on Earth every single day, big and small. I see some of them in my own clients.

America has a large and ever-growing elderly population, and many of those seniors require long-term care. For some, that involves a mix of professional services and volunteer family care. For others, a loved one’s sacrifice represents the primary or even sole source of daily care.

Indeed, the overwhelming majority of the long-term care provided in this country comes from unpaid family members. There are 40 million of those caregivers in the U.S. alone.

Family caregiving isn’t just an act of kindness. It is a lifestyle of kindness, defined by dedication, sacrifice, and love — day after day. These noble caregivers deserve our respect, appreciation, and shows of gratitude.

Last month marked National Family Caregivers Month, and as part of that, the AARP launched a Random Acts of Kindness Contest. They’re encouraging people to surprise caregivers with unexpected, heartfelt acknowledgements of their service. The winners will share a prize pot of $10,000.

The contest runs throughout the holiday season and on into March, so there’s still time to reflect on the caregivers in your life and devise the perfect surprise. Need inspiration? The Huffington Post offers a few ideas:

  • Send uplifting greeting cards and text messages
  • Offer to take care of time-consuming tasks, like boxing up holiday decorations after Christmas
  • Compile the latest research on whichever condition they’re providing care for (especially if the developments are of the encouraging kind)
  • Pay for their next meal or grocery list
  • Chocolate (because who doesn’t love chocolate?)

Whether those are bold enough to win a contest remains to be seen (AARP insists you don’t have to break new ground or get especially creative to win). Winners or not, though, they are guaranteed to lift the hearts of those who could probably use a pick-me-up now and then.

In my own practice as a Massachusetts elder law attorney, I see the wonderful work and tremendous sacrifice of family caregivers every day. To those people, I am proud to say thank you, bless you, and Happy Holidays.

Even for Dementia Patients, There’s No Place Like Home

The yellow brick roadNBC paved yet another yellow brick road to ruby-red-hot ratings with their latest live musical event this month, The Wiz LIVE!

The Wizard of Oz holds a special place in our cultural consciousness, with the 1939 MGM version standing out as perhaps the most-watched movie in the whole history of cinema. Nearly every American has seen it, and for decades now, scholars have pondered how that original novel and its two most famous adaptations (the 1939 film and Broadway’s The Wiz) have molded our collective notion of home.

Indeed, the banner song in The Wiz is a beautiful ballad entitled “Home,” in which Dorothy wrestles what it really means to “go home.” (By all accounts, actress Shanice Williams knocked it out of the park on NBC.)

Incidentally, I recently ran across a U.S. News & World Report piece that grapples with that very same question for dementia patients. What does “home” mean for someone who might struggle to remember where that is?

“Caregivers are initially caught off guard when people in the middle to late-middle stage of dementia plead, ‘I want to go home!’” the article explains. Often, the home they’re referencing is the one they knew long ago in their childhood, as those earliest memories tend to last the longest.

Of course, childhood homes are often inaccessible for the elderly, so World Report offers these tips for helping dementia patients feel “at home” in a place they don’t recognize:

  • Talk to them about the “home” they remember. Describe it to them. Show pictures if you have them. Recount stories they might have shared with you about the place they grew up in.
  • Have a conversation. Some patients hang on to more communication skills and/or stronger memories than others, but a few simple questions about their past — or about whichever “home” they’re referring to — can help them to feel centered and engaged.
  • Offer to take them home. Simply going on a journey can be encouraging to them. You may or may not actually make it there. For that matter, that “home” may not even exist anymore! But just like the rest of us, for dementia patients, the journey can mean more than the destination.

Truly, there’s no place like home, and that’s a notion that can stick with us long after memories fade.

A Change in Your Sense of Humor Could Mean Dementia

Doctor and patientThe things that make you laugh may have caused plenty of arguments about which movie to see at the theater over the years, but they’ve never been of much clinical interest to doctors… until now.

As The Wall Street Journal reports, a new study conducted by University College London and published in the Journal of Alzheimer’s Disease has found that changes in a person’s sense of humor can signal oncoming dementia by as much as ten years.

The Journal cites stories of people with dignified senses of humor who suddenly became snide, or those who’ve always adored satire but then took an unexpected interest in slapstick. For some, it could be a simple shift in personality, but many of those people go on to develop dementia.

Why is that? Dr. Jason Warren, one of the neurologists responsible for the study, puts it like this: “Humor is like a stress test. The same way you’re on a treadmill to test the cardiovascular system, complex jokes are stressing the brain more than usual.”

Until now, scientists have looked primarily to memory as a marker of cognitive change. But the patient’s sense of humor may hold more diagnostic value because friends and family are more likely to pick up on changes in humor than to notice subtle memory problems.

I rather like the way that the Journal sizes up our brain’s relationship with the comedy we enjoy:

“…Most forms of humor require some form of cognitive sleight-of-hand. ‘Getting’ satire hinges on the ability to shift perspective in a nanosecond. Absurdist jokes play fast and loose with our grasp of logic and social norms; black humor lampoons taboos. All are a rich source of data about the brain.”

Data about the brain is exactly what makes this study so encouraging — we are getting more and more of that data all the time. The ability to recognize new warning signs of dementia as much as a decade in advance could be game changing for people we know and love — maybe even for ourselves. It’s no laughing matter, but I know I’ll appreciate the things that do make me laugh all the more now.

Married with No Estate Plan But Too Busy to Make One?

Signing DocumentsFact: 64% of Americans do not have a will.

Fact: 1/3 of America’s married couples are without life insurance.

Fact: Even among those couples that do have life insurance, 43% still say they would be in financial trouble if one of the spouses passed away.

This month, NerdWallet and USA Today are teaming up with tips for married couples who need to get some sort of plan together but can’t seem to find the time to actually do it. (Sound familiar?) Let’s look at a few of those tips below:

  • Figure out how much life insurance you actually need. In most families, at least one spouse should carry coverage. If your employer offers a policy, that’s a start, but don’t assume it’s all the protection you will need. It almost never is. Research is the hard part, but a professional can help with guidance. The actual application can be done in an afternoon.
  • Make a “financial safety box.” Put all your important documents, records, and other such information in a single location. Then make sure that everyone in your family knows where it is. In the event of an emergency or a sudden death someday, a frantic scramble to find essential information is a hassle that no one wants to deal with, and it can cause big problems. USA Today suggests making a “one-page, quick-start guide” that lists your bank accounts, insurance policies, and other important information. Put that page on top of the stack and update it often.
  • Have a conversation. Do you know what your spouse wants for his or her burial? And where should his or her personal assets go? Assumptions about the answers to these questions are one of the leading problems in estate planning. Don’t assume. Communicate about it instead. (Isn’t that the answer to just about every relationship challenge?)
  • Let Noreen handle it. Okay, they don’t put it quite that way in their article, but that is one of NerdWallet’s essential recommendations — let an experienced professional do the heavy lifting. As a Middlesex County estate planning lawyer, I’ve helped many couples put together wills, trusts, and other essential documents to protect their families for the future. I can do the same for you. I want you to be involved, but I also want to respect your time. I know that life is busy, and that’s why I’m here to shoulder the stress.

If you and your spouse know you need a plan in place but just can’t find the time, I understand. Give me a call and we’ll have a quick chat about how my office can make a difference. Let’s talk.