Continuity of Care: Helping Elders Live Their Best Lives

It was difficult to convince my Mom to have someone give her a hand after my Dad died.  I remember making an appoint with a care provider, only to arrive at my Mother’s home and find Mom had already flatly stated, “I’m just not in need of this kind of help.”

It took more than a year and a serious illness before she felt ready – and her quality of life would have been much improved had she been able to recast the help as maintaining her in a least restrictive environment rather than viewing it as a loss of freedom.

One of the most difficult things to do is finding the path to early, proactive help for an elder.   Add to this the challenge of locating a facility that’s just right and you’ve got a tough situation.

This piece in the New York Times on the shifts in elders’ lives tells the tale:  even after downsizing to assisted living, multiple moves can be necessary.

Continuity of care – medical, social, cultural – must be well-planned, with a safety net in place to make sure success occurs.

Photo courtesy
of Brian J. Matis


What is ‘Undue Influence?’

When an elderly woman has a relative or someone else living with her who keeps others away, controls where she goes, and what she does, that individual may be said to be exerting ‘undue influence.’

What this means in practical terms is that the person may be trying to take advantage, for personal or financial gain.

We’re seeing this type of thing happen more frequently with the bad economy.  It can occur with caregivers who see an opportunity.  Or with an adult child down on their luck who doesn’t think twice about helping himself to Mom’s pocketbook.

If you see this kind of situation, it merits some investigation.  Contact your local police if you believe an elder is at risk.

New York Times: Post-retirement Jobs

What happens when older people work?  Good things, says a report from Boston University’s Sloan Center on Aging and Work.

According to the Department of Labor, we’re in the middle of a workforce shift that will see workers over 55 increase by more than 35%.   That means increased fulfullment for elders who like the idea of a retirement job – or who don’t see themselves as retired but moving on to new work.

Richard Johnson, a senior fellow at the Urban Institute, says that 25% of workers over 50 will change not just jobs – they’ll change occupations.  And Johnson states, “Workers who change jobs at older ages say they are more likely to enjoy the new job than the old job.”  How much more likely?  Workers over 65 report a 90% job enjoyment rating – much higher than that of younger workers.

NYT’s New Old Age blog has the entire piece on older workers in the workforce – and the benefits go way beyond a paycheck.

Wall Street Journal: Aging Ills Reversed

Age-related degeneration in mice has been partially reversed by scientists, and it could lead to new treatment for similar issues in aging humans.

Researchers manipulated a gene and reversed brain disease, as reported in the journal Nature.  It remains to be seen whether or not the approach used will be similarly beneficial to people.

Read the WSJ piece here.

Elder Law Attorney Craig Reaves on Medicaid and the Primary Residence

Medicaid provides care for elders with a catch.  Their primary residence is exempt, but states impose specific rules and dollar amounts as they wish.

This is why I frequently tell clients it’s smart to gain clarity from their estate planning or elder law attorney.  In this type of situation, an ounce of prevention is truly preferable to a pound of cure.

State laws differ, so check to see what applies where your parent or grandparent lives, but Craig Reaves has several interesting things to say about managing a primary residence when an elder is on Medicaid.  Planning ahead may help avoid a lien on the home after an elder passes, but keep in mind there are many restrictions and rules.

Read the entire New York Times blog post by elder law attorney Craig Reaves.

South Korea’s ‘War on Dementia’

South Korea is marshalling an army.

No, not to fight North Korea’s latest incursion.  This is the country’s ‘War on Dementia’ and they’re enlisting the help of school children to build a younger generation that is aware of what it’s like to be elderly and battle Alzheimer’s.

Strapped into suits that restrict their range of motion and vision, the children move through a series of exercises that help them learn compassion and provide a practical understanding of the limitations some elders face.

South Korea has one of the most rapidly aging populations of any nation.  The government is encouraging early diagnosis of dementia and working to combat the shame and fear that are often attached to aging in general and Alzheimer’s in particular.

Read the full New York Times article here.

More on this in The New Old Age blog in the NYT.

Your Executor: Abe Lincoln, Martha Stewart, and Ed McMahon Rolled Into One

Who will take care of your affairs after your death?  Your executor.

If you have children, likely you’ll choose one of them to manage things. If not, you might select a beloved niece or nephew as your executor.   Or perhaps there is a member of your ‘family of choice’ who will serve.

Here are three characteristics to think about when considering someone to be  an executor:

1.  Integrity

Here’s where the Abe Lincoln comes in.  Make sure you select someone who has a strong reputation, who is honest and who knows enough to use experts.  It’s more important that they manage your assets prudently, than that they know every last detail about stocks and bonds.  The executor can use the funds in your estate to get the help of people who have detailed knowledge.  Select someone with good judgement who is steady and is honest.

2.  Organization

Managing an estate of any size calls for organization.  Bill paying, investing, selling real estate and assets, locating appraisers, and sending out legal notification are just a few of the things an executor is called on to do.  Then there are deadlines for filing and the completion of federal and state taxes.  If your eldest child was late to his wedding, has never filed taxes on time, and arrived at your 50th wedding anniversary celebration mid-way through the party, don’t choose him as your executor.   If this is a task none of your children or relatives is likely to do well, select a professional fiduciary or guardian to wind things up and spare them the heartburn.  Think of Martha Stewart’s ability to multi-task and keep things moving.  Those are important attributes for an executor.

3.  Personable

Being friendly will get your executor far.  This is a task that requires someone who is a good communicator, an individual who likes people.  Otherwise the executor is likely to make one of the worst errors in the book – not communicating with the heirs.  Make sure your executor comprehends how necessary periodic communication is – via phone, in writing and using email.  Each mode supports the central message to heirs that work is moving forward, they haven’t been forgotten, and their inheritance is being managed with accuracy, care and appropriate speed.  Your executor will function as an Ed McMahon/Circus Ringmaster type of person – they’ll direct others, contact experts who know, make decisions, and invite some people closer while keeping others at arm’s length.  They’ll be called upon to keep information confidential.  Make sure they are capable of working gracefully under pressure.

Be sure to talk with the person you select as executor – and always provide a second and third choice to your attorney so that your estate documents name successor executors.

Finally, make sure the person you’d like to have serve as your executor knows of your request and would like to take on the work.  Discuss the details and make sure they are in agreement.  It’s not a walk in the park – it’s more like deciding to take on a side job that may last for months, or in some cases even longer than a year if the estate is particularly complex.  Talk with your attorney about the compensation you want your executor to have and make it part of the discussion with the candidate you’ve selected.

Making an informed choice will lead you to an executor who will manage your estate in such a way that your beneficiaries feel your guiding hand shine through the entire process.