The losses suffered by someone diagnosed with Alzheimer’s Disease go far beyond the physical and emotional. The disease can cause a great financial strain as well. Recent studies show that the average direct cost of caring for an Alzheimer’s patient from diagnosis to death is $174,000.

One source of financial help many people overlook is the Veteran’s Administration. The agency offers funds and services to disabled veterans who can show a financial need, regardless of whether or not they have a service-related disability.

The VA Aid and Attendance program gives veterans who qualify up to $1,842 per month in assistance. The widow(er) of a veteran may qualify for up to $998 per month.

In order to qualify, a veteran must show both a financial and physical need for benefits. Proof of a physical need can be as simple as a doctor’s letter. The letter must state that the veteran is in need of care or assistance on a regular basis in order to protect them from the hazards or dangers in his or her daily environment. (Any resident in a Skilled Nursing or licensed Assisted Living Facility is presumed to be in need of aid).

A person’s financial need is determined by subtracting his or her income from the VA’s Maximum Annual Pension Rate (MAPR). The MAPR increases if the veteran has dependents. An adjustment is also made for any unreimbursed medical expense, such as fees for adult day care, skilled nursing, assisted living, home health care, doctor, dentist, eyeglasses, prescriptions, physical therapy, and co-pays.

Premiums paid for long-term care insurance, health insurance, Medicare, and Medigap also fall into this category.

In addition to income guidelines, there are also guidelines for the amount of assets a person may have at the time of application. In general, an applicant can have a house and up to about $80,000 in assets, depending on their age, at the date of application. However, there are certain planning techniques which may allow an individual to protect more than $80,000 and still qualify.

Here is a simplified example of how the program can help a veteran with Alzheimer’s disease:

Bill Roberts’ family can no longer care for him at home, so he has moved to an Assisted Living Facility. His income is $1,750, but this does not cover the $4,000 he is paying the Assisted Living Facility each month. Rather than deplete the $45,000 savings his wife may need one day for her care, Bill turns to the VA. After subtracting just the cost of assisted living from his income, Bill will have a monthly deficit of $2,250. He may qualify for the maximum benefit of $1,842 per month from the VA to help with his bills. This and other benefits programs are certainly worth pursuing!

If you are a Colorado resident and would like more information on the VA’s Aid and Attendance program, please request your FREE Guide to the VA’s Aid and Attendance Benefit.

Caring for a loved one with Alzheimer’s Disease can present a variety of challenges…a number of our upcoming entries will focus on providing area caregivers with answers to some of the questions that we hear in our Denver Elder Law office on a regular basis. For more information on Alzheimer’s Disease and Dementia, please request our FREE Guide for Colorado Alzheimer’s Caregivers.

How can I make my home safe for my loved one?

More than likely a person with Alzheimer’s disease is going to walk a lot or pace. Not all individuals with dementia experience this behavior, but many do. Caregivers must allow this behavior by structuring the environment to be as safe as possible. A person with Alzheimer’s Disease is likely to have perception difficulties. Carpet with black trim may look like a “black hole” to be stepped over. A shiny tile floor may appear wet. Good lighting without a lot of glare will reduce misperception, thus reducing anxiety. Removing clutter from around the home is very important. Items like foot stools, baskets on the floor, plants on the floor, papers and magazines lying around can increase confusion. Remove these obstacles wherever possible.

There are many products that can help with increasing security and decreasing the caregiver’s level of anxiety. Bells, alarms, and locks on the doors can aid in keeping track of the person with dementia. Baby monitors are also used for monitoring, especially during the night. If your loved one has trouble with falling out of bed, put the mattress on the floor or put an extra mattress next to their bed to help prevent injury.

Information for purchasing home safety devices can be found at The Alzheimer’s Store. Other safety devices may be found at Radio Shack. Baby monitors can be found at most stores that sell baby products.

Approximately 80% of assisted living facilities are parts of a chain, while 76% are free standing, while 18.9% are part of 85 facilities that combine an assisted living facility with a continuing care, independent living or skilled nursing facilities and 4.6% of facilities offer only independent living. The average length of stay in an assisted living facility is 26.4 months.

It is believed that the explosive growth of the business is due to the aging population and the increased net worth of the elderly. Many elderly persons live alone; women often outlive men, many more couples divorce nowadays, and large numbers of people choose not to marry. The growth in the older population means that more individuals are living to an age where assistance is needed to remain in their own home or to go into institutionalized care. The average occupancy for assisted living residences is near 93%.

In addition, more people are able to afford assisted living facilities because the cost of such facilities is generally less than a nursing home and incomes have risen. Costs vary considerably in Denver, Colorado assisted living facilities, depending on room size and the types of services required. The average cost of assisted living is $2,500 for a studio-type apartment. Medicare does not pay for assisted living directly because it is not considered a reimbursable care setting such as a hospital or skilled nursing facility. However, since the facility is considered the residents home, Medicare in Colorado will pay for some home health services such as nursing services under the direction of a professional registered nurse, physical therapy, occupational or speech therapy, medical social services under the direction of a physician or the part-time or intermittent services of a home health aide. However, if either state law or the assisted living facility contract requires the facility to provide the services, then Medicare typically will not pay for those services.

Medicare in Colorado will also pay for durable medical equipment used by the resident in an assisted living facility if the facility is “used as a home.” Medicare will also pay for physical therapy on an outpatient basis or in the assisted living facility. Hospitals and skilled nursing centers do not qualify under the definition of the beneficiary’s home, but there is no exclusion for assisted living facilities.

Assisted living residents may also receive assisted living facility services if they elect to use this benefit. This is generally less than the cost of combined housing and home health care costs or the cost of a nursing home.

It should be noted that most assisted living centers require an “up-front” fee. Some assisted living facilities bill extra for each ADL they provide while others bundle services together using a tiered pricing formula.

Assisted living facilities are regulated and licensed at the state level. Each state does so according to its own laws– there are no federal regulations on assisted living. For information on Colorado Assisted Living regulations and a listing of Colorado Assisted Living Facilites, please visit the Colorado Senior Answers web site.

1. Approach a Prospective Nursing Facility with a Positive Attitude
   Despite the horror stories that provide fodder for the evening news, most people who work in nursing facilities are professionals who take pride in their work. Of course, some facilities are better than others, and that is why you are evaluating more than one.
2. Do Not Confuse SNF Care with Colorado Assisted Living
   Do not be shocked or upset by the fact that you will see some nursing home residents who are very ill, often mentally as well as physically. You are looking for quality of care. If your family member is more alert and needs a quiet room, be sure to discuss this with the person showing you the facility. The residents in the assisted living facility may look healthier, but that kind of facility may not be able to provide the level of care and supervision by licensed nurses that is provided by a skilled nursing facility.
3. Location, Location, Location
   As with any place you live, location is crucial. A very important factor in receiving quality SNF care is family involvement. Therefore, try to find a facility that is convenient for the family to visit.
4. Conduct Your Own Inspections
   Find the most convenient facilities and check each one three times as follows:
   First Visit: Go in during business hours, tour the facility, meet the Administrator, Director of Nurses (DON), and social worker, read the survey report, and ask questions. If this is a short term admission for physical rehabilitation, talk to the therapy department as well. Find out how each shift is staffed (registered nurses, licensed vocational/practical nurses, certified nursing assistants, uncertified staff) so that you can compare among facilities.  Although there is usually a specific regulatory requirement for nursing hours per day (i.e., 3.5 hours per day of nursing care per patient), different facilities may allocate this differently between nursing shifts and some may exceed the minimum to a greater extent than others.

   Second Visit: Go in during the evening meal and observe interaction between CNAs and residents. Pay particular attention to residents who need encouragement with meals. Are they receiving it?  Are the patients dressed appropriately for the time and season?

   Third Visit: Go in on the weekend. Talk to family members visiting other residents about their experiences with the facility. Look to see if there are activities. Ask to speak to the nurse in charge on the weekend and find out how long he or she has worked there. Get a general feeling for the place during a busy day shift when the higher level administrative staff people are not there. Are the staff members interacting with residents or talking over residents’ heads to each other?

5. Will Your Loved One’s Special Needs be Accommodated?
   If your family member is a fussy eater, ask about how often the dietician visits and how much flexibility is available with the planned menus. If he or she has Alzheimer’s, find out about any special programs as well as what safeguards are in place to prevent wandering. If your loved one speaks English as a second language, ask if there are any staff members who speak your family member’s primary language.

Visit our FREE Colorado Elder Care Resource Center to continue reading the rest of this article…

The losses suffered by someone diagnosed with Alzheimer’s Disease go far beyond the physical and emotional. The disease can cause a great financial strain as well. Recent studies show that the average direct cost of caring for an Alzheimer’s patient from diagnosis to death is $174,000.

One source of financial help many people overlook is the Veteran’s Administration. The agency offers funds and services to disabled veterans who can show a financial need, regardless of whether or not they have a service-related disability.

The VA Aid and Attendance program gives veterans who qualify up to $1,800 per month in assistance. The widow(er) of a veteran may qualify for up to $900 per month.

In order to qualify, a veteran must show both a financial and physical need for benefits. Proof of a physical need can be as simple as a doctor’s letter. The letter must state that the veteran is in need of care or assistance on a regular basis in order to protect them from the hazards or dangers in his or her daily environment. (Any resident in a Skilled Nursing or licensed Assisted Living Facility is presumed to be in need of aid).

A person’s financial need is determined by subtracting his or her income from the VA’s Maximum Annual Pension Rate (MAPR). The MAPR increases if the veteran has dependents. An adjustment is also made for any unreimbursed medical expense, such as fees for adult day care, skilled nursing, assisted living, home health care, doctor, dentist, eyeglasses, prescriptions, physical therapy, and co-pays.

Premiums paid for long-term care insurance, health insurance, Medicare, and Medigap also fall into this category.

In addition to income guidelines, there are also guidelines for the amount of assets a person may have at the time of application. In general, an applicant can have a house and up to about $80,000 in assets, depending on their age, at the date of application. However, there are certain planning techniques which may allow an individual to protect more than $80,000 and still qualify.

Here is a simplified example of how the program can help a veteran with Alzheimer’s disease:

Bill Roberts’ family can no longer care for him at home, so he has moved to an Assisted Living Facility. His income is $1,750, but this does not cover the $4,000 he is paying the Assisted Living Facility each month. Rather than deplete the $45,000 savings his wife may need one day for her care, Bill turns to the VA. After subtracting just the cost of assisted living from his income, Bill will have a monthly deficit of $2,250. He may qualify for the maximum benefit of approximately $1,800 per month from the VA to help with his bills. This and other benefits programs are certainly worth pursuing!

If you are a Colorado resident and would like more information on the VA’s Aid and Attendance program, please request your FREE Guide to the VA’s Aid and Attendance Benefit.

Families–not social service agencies, nursing homes, or government programs–provide the majority of long-term care (LTC) for older persons in the United States. More than 22.4 million informal caregivers provide unpaid help to older persons who live in the community and have various limitations.

These caregivers include spouses, adult children and other relatives and friends. The degree of caregiver involvement has remained fairly constant for more than a decade, bearing witness to the remarkable resilience of the American family in taking care of its own. This is despite increased geographic separation, greater numbers of women in the workforce and other changes in family life. Thus, family caregiving has been a blessing in many respects. It has been a budgetsaver to governments faced with the challenge of covering the health and long-term care expenses of persons who are ill and have chronic disabilities. The economic value of our nation’s family and informal caregivers has been estimated at $257 billion annually.

The enactment of the Older Americans Act Amendments of 2000 established an important new program called the National Family Caregiver Support Program (NFCSP). The program calls for all states, working in partnership with area agencies on aging and local community-service providers, to have five basic services for family caregivers. These services include:

• Information to caregivers about available services;
• Assistance to caregivers in gaining access to services;
• Individual counseling, organization of support groups, and training to assist the caregivers in making decisions and solving problems relating to their caregiving roles;
• Respite care to enable caregivers to be temporarily relieved from their caregiving responsibilities;
• Supplemental services, on a limited basis, to complement the care provided by caregivers.

Currently funded at $155,200,000, this program has served more than 275,000 caregivers nationwide. Efforts regarding NFCSP have resulted in new partnerships, improved access to services, outreach to special populations, and the provision of services to respond to the unique needs of families.

Eligible Populations

• Family caregivers of older adults and
• Grandparents and relative caregivers, age 60 years or older, of children no older than age 18 (including grandparents who are sole caregivers of grandchildren and those individuals who are affected by mental retardation or who have developmental disabilities)

Who to Contact for Help

Older persons and caregivers can call the Eldercare Locator toll-free at 1-800-677-1116 or visit www.eldercare.gov.

Many people believe that Medicare covers nursing home stays. In fact Medicare’s coverage of nursing home care is quite limited.

Medicare covers up to 100 days of “skilled nursing care” per illness, but there are a number of requirements that must be met before the nursing home stay will be covered. The result of these requirements is that Medicare recipients are often discharged from a nursing home before they are ready.

In order for a nursing home stay to be covered by Medicare, you must enter a Medicare-approved “skilled nursing facility” or nursing home within 30 days of a hospital stay that lasted at least three days. The care in the nursing home must be for the same condition as the hospital stay.

In addition, you must need “skilled care.” This means a physician must order the treatment and the treatment must be provided daily by a registered nurse, physical therapist, or licensed practical nurse.

Finally, Medicare only covers “acute” care as opposed to custodial care. This means it covers care only for people who are likely to recover from their conditions, not care for people who need ongoing help with performing everyday activities, such as bathing or dressing.

Note that if you need skilled nursing care to maintain your status (or to slow deterioration), then the care should be provided and is covered by Medicare. In addition, patients often receive an array of treatments that don’t need to be carried out by a skilled nurse but which may, in combination, require skilled supervision. For example, the potential for adverse interactions among multiple treatments may require that a skilled nurse monitor the patient’s care and status. In such cases, Medicare should continue to provide coverage.

Once you are in a facility, Medicare will cover the cost of a semi-private room, meals, skilled nursing and rehabilitative services, and medically necessary supplies. Medicare covers 100 % of the costs for the first 20 days. Beginning on day 21 of the nursing home stay, there is a significant co-payment ($128 a day in 2008). This co-payment may be covered by a supplemental Medicare policy. After 100 days are up, you are responsible for all costs.

If you are in a nursing home and the nursing home believes that Medicare will no longer cover you, it must give you a written notice of non-coverage. The nursing home cannot discharge you until the day after the notice is given. The notice should explain how to file an expedited appeal to a Quality Improvement Organization (QIO). A QIO is a group of doctors and other professionals who monitor the quality of care delivered to Medicare beneficiaries. You should appeal right away. You will not be charged while waiting for the decision, but if the QIO denies coverage, you will be responsible for the cost. If the QIO denies coverage, you can appeal the decision to an Administrative Law Judge (ALJ).

If you have questions that aren’t answered here, feel free to call (303) 4-ADVICE (423-8423) or use our convenient e-mail form. We’d be happy to help.

Over the past couple of years, I’ve watched my midsection grow as my age increased. Where I used to be able to see my belt buckle when I looked down, I now have to stick my neck out. Those slacks with elastic on the sides have become my favorite garments. The buttons on my sport coats no longer match up with the button holes without sucking up.

Even though I was getting concerned about the extra 15 pounds I was carrying around, I couldn’t seem to figure out exactly how to deal with the problem. I started persuading myself into thinking that I was eating less or more healthy, but I would find myself dropping right back into the same old routine and over eat at almost every meal.

I even bought a juicer and started buying mega quantities of vegetables at King Soopers instead of potato chips, Oreos and ice cream. While my juicer served a worthwhile purpose (making me feel better about myself), it started to get old after awhile. I turned back to my old habits.

I could go on and on with all of the same excuses that you’ve heard before, but to spare everybody, I will simply cut to the solution: A system.

I have been studying under a life coach for over 3 ½ years and have been learning the secrets to making my practice more efficient, predictable and easier to run. My coach has emphasized the use of systems so that you don’t have to do anything new more than once. Systems are designed to produce quality as well as economy. In short, with systems, we can do things more efficiently and do them all much more accurately.

Unfortunately, I was missing the point regarding my health and weight management. I couldn’t seem to extrapolute this idea of systems between the two concepts of business and self. Then I ran into an acquaintance about three weeks ago who just started the Nutrisystem™ program and was feeling pretty good about himself. I quizzed him for five or ten minutes because I had been watching the Nutrisystem™ commercials on TV and was getting interested. My friend’s testimonial about the positive effects pushed me over the edge. I went on online, contacted Nutrisystem™ and started digging around. I didn’t buy on the first exploration. Two days later, however, a sales person from Nutrisystem™ called me up and offered a “special discount” and a couple weeks of free food if I would make a decision to buy on the spot. I guess I was ready, so I said “yes.”

I got this huge box of food in the mail last Friday, read all of the enclosed literature and found myself eating my first Nutrisystem™ breakfast on Saturday morning. My daughters laughed at me and predicted that I would fall off the wagon within a few days. I told them that I was committed and I was going for it. My goal is to lose 15 pounds in however much time it will take.

It’s now been five days and I feel pretty darn good. I don’t feel bloated, fat or hungry. The portions I have been eating have been surprisingly small, but I’m satisfied. Two hours after I am done eating, I am required to eat again. And then two hours after that I eat again. In other words, every two to three hours I am eating something that keeps my metabolism up and my hunger at a low ebb.

The key question now is whether I will stick with the program. The bottom line is that I now have a system to follow that gives me comfort and predictability.

As I relate this process to my estate planning practice, I see what Nutrisystem™ does is nothing different than what I do for my clients. I give my clients a system for planning that gives them the comfort of knowing that their desired results for their family will be achieved many years down the road. The Trust, the Powers of Attorney, HIPAAs, Living Wills, our Inner Circle up-dating program…they all work together as a coordinated plan and form the system that creates peace of mind. There’s no guess work or uncertainties. While there is a commitment up front and a continuing commitment to stay up-to-date over time, the system is in place to make sure that everything happens correctly when it’s supposed to.

Many folks come to see me who are unsure of what they really want to do at the initial consultation. When they make the decision to go forward, I believe–now looking at the Nutrisystem™ program–they make that decision because they see and appreciate the system behind what I do. And my guess is that my clients didn’t think they would become clients right away until they saw how the system would solve their problems and make their concerns evaporate. Weight control, estate planning, technology, or exercise; they’re all the same thing. Trust the system.

Intrigued at the prospect that an internet program could so completely replace me, I signed on to LegalZoom.com and paid the money to generate my comprehensive, all-inclusive estate plan for the low, low price of $149.

Well, first of all, it took what seemed like an eternity just to register and supply all of the information requested. I could visualize other registrants, toiling like me, dropping off the site like flies.

Do-it-yourself projects are so intimidating. Even though I have over 30 years experience planning estates for others. I found myself questioning the accuracy of the answers I was giving the computer…as if I were an amateur! I could only imagine what a lay person must be feeling.

I couldn’t stop thinking about how obsessed some people are about saving money. I don’t like paying the electrician or the dentist or the mechanic any more than the next guy, but I know it’s simply a reality of life that you’ve got to pay the piper from time to time when stuff happens in areas of expertise that we’re clueless in. Slaving away in this program seems so…so cheap feeling to me, and I’m one of the all-time, certifiable, world-class tight wads! Just ask my kids and their mother and all of my employees.

But come on…entrusting the disposition of my one-and-only, hard-fought estate to a machine that hasn’t even met me, doesn’t know about the dreams and aspirations I have for my children, my values, what strengths and weaknesses my children possess and how I want the future to look for them when there’s a pot of gold sitting at their feet?

This legal zoom thing looks like it’s going to belch out some mighty pretty documents, but how in the world can they fit me correctly when the creator hasn’t so much as said “Boo” to me?

The further I go with this zoom program, the more uncomfortable I get, but I press onward to completion. I know what I want, and I know that what I’m going to get back in the mail isn’t going to cut it. The program just isn’t sophisticated enough to include all of the variables I need and want. It’s not that I’m so complecated, it’s just that I know what should be part of a professional product that’s worth the money folks spend to get a professional result.

I give seminars on estate planning almost every week all around the city. People flock to them. Why? Can’t they go to the internet and do it all themselves? Can’t they just go out and buy a fill-in-the-blank set of forms and save some dough?

Sure, the internet is one of my competitors, but as long as there are careful, caring and conscientious parents out there that understand that good family inheritance planning is so much more than just a bunch of pretty papers, there will always be a need for truly customized planning that can occur only with personal interaction between client and attorney doing it the old fashioned way…talking.

I invite you to attend one of my upcoming free seminars. You’ll be amazed at how many interesting ideas there are out there that you can use to leave your estate to your family in the proper way and protect yourself all along the way. I’ll teach them to you. You’ll understand. We’ll talk.

Now that you have given your assets away, how in the world are you going to live? You may want to retain what is called a “life estate” in your home so that you retain a lifetime right to live in your home even though you have given away what the law calls a “remainder interest.” There are some pros and cons with this approach, but if having a locked-in right to live in your home is important to you so that you don’t have to rely on the integrity of Mary or any of the other children, the life estate approach may be the way to go. But what about the money you give to Mary that she then later puts into the trust? That becomes a bit more difficult because you would really like to have, at the very minimum, the right to get the interest off of the money during your lifetime. However, the trust that Mary sets up does not provide for a mandatory stream of income to you. Remember, you are not the beneficiary of this trust and we don’t want you to be so you can answer “no” to the Medicaid question of whether or not you are the beneficiary of any trust. You will have to rely on Mary to take care of you during your lifetime and distribute funds out to you that you may need for your survival during the rest of your life. That’s why it is important to have at least one trustworthy child who will take care of you. This is usually not a problem in most families. If you retain a power in the trust to make distributions to the children during your lifetime, you maintain some control over the trust which will influence Mary’s “behavior” when it comes to distributions in the future.

Without going into greater detail, this should give you a pretty good idea of the type of planning that is now recommended for giving assets away while you’re healthy. For this technique to fit you properly, you must be highly motivated to protect your assets from nursing home costs, be willing to give up some control of your assets to accomplish that end, have assets somewhere in the $100,000 to $1,000,000 range for optimum suitability and have at least one child in your family that you would trust to make sure that this plan will work properly over your lifetime. If this sounds like you, you are ready to start planning your estate to protect it for yourself and your family for the years to come.