Experts preach the importance of planning
Suzanne Weessies has a keen awareness of the formidable tolls that Alzheimer’s disease exacts on victims and families.
Weessies, a family services coordinator for the Alzheimer’s Association, knows there isn’t a cure for this ultimately fatal brain disease that wreaks physical and emotional havoc on victims and families. But she is adamant in her recommendation for ameliorating financial and legal issues – prepare.
“It’s true pretty much with everything about this disease: If you wait for a crisis before you do something, you will be limited in your options,” said Weessies, who works out of the Greater Pennsylvania Chapter in downtown Pittsburgh. “You won’t have an opportunity to think it through.”
David Posner, J. Lynn DeHaven and Mary Lyn Drewitz likewise embrace preparation. They are partners in the Washington firm of Goldfarb, Posner, Beck, DeHaven and Drewitz, and advocate taking early action on powers of attorney, living wills and other legal matters. Doing so – even before an individual is diagnosed – can prevent or minimize snags while proving to be cost-effective.
Prevention is a philosophy that professionals dealing with Alzheimer’s-related issues accentuate to victim, relative, friend and caretaker alike.
More than 5 million Americans have Alzheimer’s, with another person developing it every 67 seconds. The Alzheimer’s Association projects those numbers to rise dramatically by 2050, to 16 million victims and a new one every 33 seconds.
Alzheimer’s was the official cause of death for 83,494 people in 2010, the sixth-leading cause in the United States.
The financial impact is steep, too. This year, the direct costs for those caring for Alzheimer’s victims will be about $214 billion, with $150 billion coming from Medicare and Medicaid. The association projects those costs in 2050 to be $1.2 trillion in today’s dollars, with the Medicare-Medicaid share increasing about 500 percent.
It is a relentless, merciless disease than breaks more than hearts and spirits of those with Alzheimer’s and the people who love and care for them.
During an interview in their Main Street offices, Posner, DeHaven and Drewitz outlined steps that can be taken in planning.
DeHaven said three early actions are mandatory while “a person is legally competent,” as determined by a judge.
“Everyone needs a will, a regular power of attorney and a medical power of attorney,” he said. “You need these at a minimum.”
Power of attorney, by definition, is the authority to act for another person in legal or financial affairs, and is frequently granted to a close family member, such as a spouse or an adult child.
“When choosing your agent,” Drewitz said, “you have to make certain that the person is on board with my life/death plan. The cardinal rule is to choose someone you trust with your life, stuff and your death.”
Weessies added that: “Power of attorney is probably the most important item. Like other scenarios, if you wait too long to do that, the family that takes action will be in a crisis.”
A living will is “a written statement detailing a person’s desires regarding his or her medical treatment in circumstances in which they are no longer able to express informed consent, especially an advance directive.”
Medical power of attorney is defined as “an instrument that allows a patient to appoint an agent to make health care decisions in the event that the primary individual is incapable of executing such decisions.”
Taking care of these legal matters while clearly competent, Drewitz stressed, is a key to ensuring that a client’s mandates are followed. That may not happen later if a judge determines that he or she is “incapacitated.”
“If you don’t do these things while you are able,” Drewitz said, “you will have to do guardianship, which you don’t want to do. It’s public and far, far more expensive than the pragmatic approach.“
“Having power of attorney – for healthy people, too, of course – is essential,” Weessies said. “If you don’t have it, you may have to go through a guardianship procedure, which is complicated.”
A guardian can be appointed, by definition, when “a person of full age who, as a result of mental disease or physical, mental or psychological handicap is incapable of managing his own affairs.”
Alzheimer’s care can assume many forms. All come at a price, Weessies said.
“There can be a financial burden long before a person is in a care facility,” she said. “Generally speaking, people like to keep a loved one at home as long as they can. A person may be able to stay at home, but needs some kind of caregiving, a personal care attendant or an aide a few times a week. That’s a cost.”
She said an adult child may leave a job or cut back to part time to care for an Alzheimer’s victim and not only lose earnings, but realize “different costs. Your health can decline, your relationships can suffer.”
Adult day care for people with dementia can be costly. Even modifiying a home to make it safer – adding a handrail, a ramp, modifying a bath – can add up.
Then there are nursing facilities, which Weessies said can cost $6,000 to $8,000 a month. Payment options include:
• Out-of-pocket money, from savings and/or individual retirement accounts.
• Long-term care insurance, “only if you prepared,” Weessies said. “The longer you wait (to get it), the more expensive it is.” Plus ... “long-term insurance doesn’t kick in till a person is in a facility maybe 90 days for most insurances.”
• Medicaid. “If it’s a less-expensive facility or you are lower income,” Weessies said, “they will take your entire Social Security, and Medicaid will pay for the rest. If you are higher income, Medicaid will take care of what you can’t pay.”
• In many instances, the family.
• Selling a home. “But that house may not sell for months or years, depending where it is,” Weessies said. “You cannot depend on that money in the short term.”
Even if a home sells quickly, she said, making $120,000 from the sale “will cover only about 18 months of living in a facility.”
Donald Detts Jr. also preaches preparation, centering on a lot of paperwork. He is vice president of investments for Wells Fargo Advisors in Green Tree.
“You want to gather important documents regarding the person’s finances,” Detts, a Washington resident, said in a prepared statement. “At Wells Fargo Advisors, we recommend you work with your financial adviser to prepare or update an Envision profile.
“Know where important documents are located, such as insurance policies, deeds and mortgages, bank and investment account statements.
“You’ll also want to be sure you understand the patient’s Medicare benefits and any supplemental health insurance and/or long-term care insurance coverage available.
“Finally, you will want to create an estate inventory and work with an attorney to draft appropriate estate documents.”
Joseph Marsh is president of Station Capital Inc., an investment/tax preparation firm in Washington. He said an investment client can approach paying for Alzheimer’s care differently than someone with no savings or assets.
He said a “number” of his clients have used Friendship Village, and thus used the Upper St. Clair facility as a benchmark of what may occur.
“The fundamental piece of advice is to encourage a family who suspects that a loved one may ultimately be afflicted with dementia, in any form, immediately explore facilities such as a Friendship Village, that can have the person enter an independent living unit while they are still in reasonably good health,” Marsh said in an email.
“Friendship Village then offers the option to move into their dementia unit once the disease has progressed to the point where the person can no longer remain in an independent living unit.
“It is important to seek moving into a unit sooner rather than later because the choice of facilities can decline rapidly if the individual cannot pass the mental acuity exam of a particular facility. Each facility has their own threshold of acuity that defines who can enter their facility.”
He said “entering a facility like Friendship Village usually requires an upfront lump sum that many times is created by selling the family home. Depending upon the unit, this cost can be $200,000 or more.”
In addition to that, March said, the independent living cost per month averages $3,000. “Once the individual is transferred into the dementia unit, the cost can rise to $5,000 per month.”
“The bottom line,” Marsh wrote, “is dementia is a very expensive way to end one’s life.”
For more information, call the Alzheimer’s Association Greater Pennsylvania Chapter, 412-261-5040.