Education

Legal Tools for Caregivers

If you are caring for a loved one, there are certain legal strategies and tools that you need to utilize to ensure that your loved one gets the best quality of care possible and has the highest quality of life. The tools and strategies come in two forms, the basics that everybody needs and then more advanced planning strategies.

There are certain basics that every caregiver needs to have in place for their loved one. Those basics include things like financial powers of attorney, medical powers of attorney, and personal care plans it is important to work with a certified elder law attorney to ensure that you have these documents in place, because these are the key tools that will allow you to provide and care for your loved one.

The first of the basic tools is a financial power of attorney. The financial power of attorney is a document that allows you to make financial decisions for your loved ones. For example, the financial power of attorney would allow you to pay the bills, work with the bank, move money around to protect against long-term care costs. The financial power of attorney is probably the most important document when it comes to caring for a loved one. It is not a document to be treated lightly or to skip over.

Not all financial powers of attorney are created equal. Many financial powers of attorney put limitations on what you can and cannot do as a POA. In fact, many of the financial powers of attorney actually put handcuffs on the agent, in fact not allowing them to do the things they may need to do when caring for a loved one. For example, many financial powers of attorney do not allow you to create an asset protection trust for a loved one. That is why it is important to work with a certified elder law attorney (CELA) when crafting a financial power of attorney.

The next key tool when caring for a loved one is a medical power of attorney. These may go by different names including patient advocate designation, advanced directive, or living will. What this document does is gives the ability to the person you’ve named to be able to make medical decisions for you, including the ability to remove you from life support. The defaulted in many states is that if you are in a vegetative state you are to remain that way unless there is some clear, written, evidence to the contrary. That is why having a medical power of attorney that includes the ability to be removed from life support is important. Typically, this is the document that doctors and hospitals will ask for.

Now one of the basic documents the many people do not have is a personal care plan. A personal care plan is a document that gives instructions to the financial and medical power of attorney on how best to care for you. The provides guidelines on what type of care do you want to receive, for example do on receive care at home or would you prefer to be in an assisted living. Another example would be what type of food do enjoy or what type of television programming would you want to watch. Now this document is not set things in stone, but it does provide a good guideline for your caregivers, whether those caregivers or family or professional caregivers.

Now that the basic documents are in place, now we need to talk about some advanced planning tools such as personal care contracts and asset protection trusts. But, before those are discussed, it is important to understand some governmental programs that are available to help pay for long-term care costs. There are two very important governmental programs. The first is Medicaid, which in many states can help pay for nursing home costs. However, Medicaid has a $2000 asset limit for single individual as well as a five-year look back period. The second governmental program is the VA benefit which can help pay for home care as well as assisted living. The VA benefit also has an asset test where, typically, if you have more than $30-$60,000 of countable assets you are not going to qualify. So, with these two governmental programs the next tools that will be discussed help us qualify for those governmental programs. They are not always necessary, but they can be helpful in qualification.

An asset protection trust is a great way to protect assets from the devastating cost of long-term care so the governmental benefits such as the VA benefit or Medicaid can help pay the cost of care and then the assets in the trust can be used to pay for additional services. Asset protection trusts will differ depending on the governmental program that they are set up to qualify for. For example, an asset protection trust set up to qualify for the VA benefit will have different rules and regulations around it then and asset protection trust set up specifically to qualify for Medicaid. That said typically a VA asset protection trust will also start the five-year look back. For Medicaid. So, a VA trust also will help you get qualified for Medicaid.

in addition to having an asset protection trust, it also may be important to have a personal care contract if you are providing care for a loved one because by you providing care to your loved one may be entitled to the VA benefit if they were veteran or surviving spouse. One of the qualifications for the VA benefit is long-term care costs. By setting up a personal care contract and having the veteran or surviving spouse pay a family member under the personal care contract, that could constitute long-term care costs for purposes of the VA benefit. In other words, if daughter was providing care for mom was a surviving spouse, mom could pay daughter under a personal care contract and now qualified for the VA benefit, which could pay mom an additional $1153 per month. Another important piece of the personal care contract is it if it’s set up properly the money that mom moves to daughter would not be a divestment under Medicaid’s five-year look back period.

Caring for a loved one can be confusing and frightening. It is important to use the right legal tools to make the process as easy as possible. Those legal tools include things like personal care plans, powers of attorney, asset protection trusts, and personal care contracts. It is important to work with a certified elder law attorney (CELA) to set up these documents and to make sure that you receive as much assistance from the governmental programs such as Medicaid and the VA benefit as possible.

 

Article from Caregiver.com

Read more

Substantial Matters: Life and Science of Parkinson’s – podcasts

The Parkinson’s Foundation has produced a series of podcasts, titled ‘Substantial Matters: Life and Science of Parkinson’s’. The free episodes, hosted by Dan Keller, will discuss a wide range of Parkinson’s topics, including early warning signs, treatments, exercise and nutrition.

For more information, visit parkinson.org/podcast.

Read more

Support Group Facilitator Training

Our Symposium draws attendees from far and wide to learn more about Parkinson’s treatments and resources, and to connect with others who have PD. Many attendees are involved in one or more support groups, so for the last several years, WPA has led a training for support group facilitators on the Thursday before the Symposium.

One of the most important goals of this year’s facilitator training was to hear directly from the facilitators on how things were going in their groups and to identify ways in which WPA can best support their efforts. Stemming from that discussion, here are some important ways in which WPA expects to increase our partnerships with these facilitators and the groups they lead:

  • Creation of a speaker’s bureau in order to simplify the often challenging process of getting PD experts to attend group meetings.
  • Step up our efforts to assist groups to publicize their meetings and reach potential new members.
  • Check in with group facilitators more regularly to hear how things are going, see if they currently need any assistance from WPA, and share their efforts with WPA’s “audience”.
  • Explore ways where we can more often bring together facilitators to exchange ideas and challenges and learn from the best teachers – each other!
  • Develop publications and programming to better serve caregivers, those newly diagnosed with PD and the young onset community.
  • Formalize a grant program to provide small financial support that would have a big impact on the effectiveness of groups and the quality of life of their members.

We are so grateful for the commitment of these support group facilitators to their groups and to WPA!

Read more

Statins may not be used for protection against Parkinson’s disease

Use of statins may speed up the onset of Parkinson’s disease symptoms in people who are susceptible to the disease, according to Penn State College of Medicine researchers.

Some previous research has suggested that statins, used to treat high cholesterol, may protect against Parkinson’s disease. Research findings have been inconsistent, however, with some studies showing a lower risk, some showing no difference and some showing a higher risk of Parkinson’s disease in statin users.

“One of the reasons that may have explained these prior inconsistent results is that higher cholesterol, the main indication to use statins, has been related to lower occurrence of Parkinson’s disease,” said Xuemei Huang, professor of neurology. “This made it hard to know if the statin protective effect was due to the drug or preexisting cholesterol status.”

Another reason for the inconsistent results is that there are two types of statins. Water-soluble statins cannot get into the brain, while fat-soluble statins, called lipophilic, can. Since people with high cholesterol are treated for both kinds, the interpretation of results as it relates to Parkinson’s disease is not easy.

The researchers analyzed data in a commercially-available database of insurance claims for more than 50 million people. They identified nearly 22,000 people with Parkinson’s disease, and narrowed the number to 2,322 patients with newly diagnosed Parkinson’s disease. They paired each Parkinson’s patient with a person in the database who did not have Parkinson’s — called a control group. Researchers then determined which patients had been taking a statin and for how long before Parkinson’s disease symptoms appeared. Researchers reported their results in the journal Movement Disorders.

After analyzing the data, researchers found that prior statin use was associated with higher risk of Parkinson’s disease and was more noticeable during the start of the drug use.

“Statin use was associated with higher, not lower, Parkinson’s disease risk, and the association was more noticeable for lipophilic statins, an observation inconsistent with the current hypothesis that these statins protect nerve cells,” Huang said. “In addition, this association was most robust for use of statins less than two-and-a-half years, suggesting that statins may facilitate the onset of Parkinson’s disease.”

Guodong Liu, assistant professor of public health sciences, said, “Our analysis also showed that a diagnosis of hyperlipidemia, a marker of high cholesterol, was associated with lower Parkinson’s disease prevalence, consistent with prior research. We made sure to account for this factor in our analysis.”

A recent study reported that people who stopped using statins were more likely to be diagnosed with Parkinson’s disease, a finding interpreted as evidence that statins protect against Parkinson’s disease.

“Our new data suggests a different explanation,” Huang said. “Use of statins may lead to new Parkinson’s disease-related symptoms, thus causing patients to stop using statins.”

Huang stressed that more research needs to be completed and that those on statins should continue to take the medication their health care provider recommends.

“We are not saying that statins cause Parkinson’s disease, but rather that our study suggests that statins should not be used based on the idea that they will protect against Parkinson’s,” Huang said. “People have individual levels of risk for heart problems or Parkinson’s disease. If your mom has Parkinson’s disease and your grandmother has Parkinson’s disease, and you don’t have a family history of heart attacks or strokes, then you might want to ask your physician more questions to understand the reasons and risks of taking statins.”

One limitation of this study was that the MarketScan data did not include Medicare patients, Medicaid patients or the uninsured. Also, because it was a private insurance sample, the patients were all under 65 years old, so the findings cannot be generalized to those who are older.

Other researchers on this study are Lan Kong and Douglas Leslie, Department of Public Health Sciences; Nicholas Sterling, Medical Scientist Training Program student; and Mechelle Lewis and Richard Mailman, Departments of Neurology and Pharmacology, all of Penn State College of Medicine; and Honglei Chen, Michigan State University.

The Center for Applied Studies in Health Economics and Penn State College of Medicine funded this research.

Read more