Tech & LTC: Today’s 1-Time Diagnostic Labs Will Morph Into Real-Time Monitoring

Roles for Tech in Long-Term Care (1):
 
We anticipate that today’s discrete element testing services such as the LabCorp and Quest Diagnostic types, will morph into real-time data gathering models using wearable or implantable devices. Implants like pacemakers have been around for decades. So we’d expect little push-back on those such devices. If we compare that experience with the new implantable glucometers, which can be implanted directly into the senior’s body to track vitals, then perhaps we will get a more welcoming atmosphere for hi-tech monitoring devices. The key to understanding the monitoring is to understand that the information gathered upon which the care team makes decisions is always accurate. Because they are connected, data from these personal devices will be sent to cloud servers by such firms where it will be analyzed and crunched to determine individual patient trends and insights for the patient themselves, and their doctors and family. Ongoing reports will show important discoveries such as a decline in sleeping or exercise, or that insulin levels rise or drop at certain points in the day. Medical intervention can also occur immediately when required. So this type of real-time monitoring will occur not only in hospitals, where we have grown accustomed to IV monitors and such constantly clicking off data observations, but also in the home and about town–for off-site physicians as well as the patient themselves or family members.
 
For those persons suffering from cardiac, diabetes, or hypertension, hi-tech solutions come as biometric sensors, and smart glucometers. These wearable devices track vital signs and send emergency emails or texts in real time to care providers if current reading are outside expected parameters. They can also detect low levels of movement and “abnormal sleeping habits.” Such constant data gathering and monitoring to state individual norms and tracking against those provides necessary information needed by care teams so they can track behavior patterns and check on patients as required.
 
Before we go into the privacy concerns that should be clicking off alarm bells in your minds, we’ll go through several other areas where tech will be constantly monitoring us. “I always feel like somebody’s watching me….”

“Open the Pod Bay Doors, HAL” Today’s 50-Year-Olds Will Live the Space Odyssey

The Squeeze:
 
Recent estimates predict that the population of adults 85 and older in the U.S. will almost triple over the next 40 years. Simultaneously, the working-age population is expected to decline. This means the people requiring support–the elderly–will outnumber the ones able to provide such support, financially and otherwise. AARP calls this the “caregiver cliff.”
 
Meanwhile, costs to provide health care are expected to grow by over 200% for those between the ages of 70 and 90. We already see that governments, payers, and manufacturers, aren’t really producing reductions in healthcare costs. So, seniors need care solutions in order to be prepared for this impending rise in costs.
 
Enter Technology:
 
The new developments in robot and AI technology is expected to employ virtual home assistants and portable diagnostic devices that will be able to help provide better elder care, help control medical costs—and allow more seniors to stay in their homes longer.
 
The question is how receptive seniors will be to this technological intrusion into their lives. Those in their 50s now will probably be more open to relying on technolgoy, while those 20 years older may feel very uncomfortable accepting these changes. Consequently, there will be a growing interest and market for already available and maturing technologies to support physical, emotional, social and mental health.
 
Stay tuned with this space as my new book comes out soon that addresses these realities: The 4Ts of Retirement Income Planning (the name is subject to publisher approval). I’m staying on the cutting edge of planning–make sure you’re there with me!
Meanwhile, if I can help your family in any way, use the robot to schedule an appointment or email or message me!

Aging Parents, Their Pets, and Long-Term Care

There’s no question that pets are family members that bring joy and comfort to us all, but particularly aging family members who have already lost a human companion. Indeed, an increasing number of assisted living facilities are becoming pet friendly–especially those offering independent living apartments. Skilled Nursing Facilities are bringing in pets on certain days for programs allowing residents to hold and play with animals on scheduled visits. There seems to be a special benefit for those with dementia.

But, pets and animals come with their risks also. Care must be taken to keep the situations under control to prevent accidental falls or other injuries. For those elders still in their homes, special consideration needs to be given for the situation especially where balance, diminished vision, and rambunctious pets can intermingle. Families may have to take over care for the pet and then bring it for visits. Pets too age and care needs to be taken that the pets aren’t lost in the fray of changes which occur when moving the elder to an ALF, SNF, or even when staying in the family home. If caregivers are contracted to come into the home, it is essential to include in the job description the caring for the family pets.

Cognitive decline can impair an elder’s ability to routinely care for a pet, despite their best intentions. So, just as we don’t want the pet inflicting unintentional harm on the elder, so too must we ensure the forgetful elder doesn’t wind up inflicting unintentional harm on the pet, such as forgetting regular food, water, and outside access for nature calls.

We plan for all these contingencies in our documents drafted and financial plans formulated to provide funding for the high costs of longevity. Contact us for your situation that requires thoughtful, comprehensive professional planning.

Dementia: Walking in the Shoes of a Caregiver

Dementia has devastating consequences on the patient to be sure. But, it’s toll on the caregiver can be just as great especially when they are giving never ending care. Dementia care is extensive and never ending. Some days it’s very hard. Often both patient and caregiver wonder, “Why, why am I here?” They may try and make light of it as best they can.  Although a caregiver may work outside of the home, they still must manage daily care for the person with dementia. They bathe their relative, help them in the bathroom, cook for the relative and manage the medicine.  But, it’s as if the caretaker’s life is not their own. It is hard. Naturally, the caretaker would like to go do things that other people might do, such as shopping and traveling. But the caregiver can’t do much of that anymore.  Even if the family is fortunate enough to have the financial and emotional support of other family members, they will still have to arrange for outside help several days a week. People who partner with caregivers say that’s the only way to survive it. It takes a toll on your body and your body will send out signals and those signals will lead to behavioral or emotional or physical stress that can affect who you are and what you are doing. Caregivers are at great risk of burnout which include social withdraw and irritability and health problems. To make time for themselves to get adequate sleep. The job of caring for dementia patient is a never ending, lonely task, especially as the disease progresses. Patience. A lot of patience. Dealing with personal care stuff. And — it’s hard.  There are accidents sometimes and the caregiver has no choice but to just suck it up and do it.

Many families struggle with the issues of care for dementia patients. If you are looking for ways to deal with caregiver stress, I’ve posted tips for you on my Facebook page, Atlanta Personal Family Lawyer and WRNichols Law.

10 Early Symptoms of Dementia You Should Know

10 Early Symptoms of Dementia

Dementia is a collection of symptoms that can occur due to any one of a number of possible diseases. Dementia symptoms include cognitive impairment, i.e., interruption of thought processes, difficulties with communication, and ability to recollect. If you or your loved one is experiencing memory problems, it is inappropriate to immediately jump to the conclusion that dementia is the underlying culprit. A dementia diagnosis requires a person needs to have at least two types of impairment that significantly interfere with everyday life to receive a dementia diagnosis. Subtle short term memory changes or trouble with memory can be an early symptom of dementia. The changes are often subtle and tend to involve short-term memory. An older person may be able to remember events that took place years ago but not what they had for breakfast.

Other symptoms of changes in short-term memory include forgetting where they left an item, struggling to remember why they entered a particular room, or forgetting what they were supposed to do on any given day. Difficulty finding the right words Another early symptom of dementia is struggling to communicate thoughts. A person with dementia may have difficulty explaining something or finding the right words to express themselves. Having a conversation with a person who has dementia can be difficult, and it may take longer than usual to conclude.

    Changes in Mood

A change in mood is also common with dementia. If you have dementia, it isn’t always easy to recognize this in yourself, but you may notice this change in someone else. Depression, for instance, is typical of early dementia. Along with mood changes, you might also see a shift in personality. One typical type of personality change seen with dementia is a shift from being shy to outgoing.

This is because the condition often affects judgment.

    Apathy

Apathy, or listlessness, commonly occurs in early dementia. A person with symptoms could lose interest in hobbies or activities. They may not want to go out anymore or do anything fun. They may lose interest in spending time with friends and family, and they may seem emotionally flat.

    Difficulty Completing Normal Tasks

A subtle shift in the ability to complete normal tasks may indicate that someone has early dementia. This usually starts with difficulty doing more complex tasks like balancing a checkbook or playing games that have a lot of rules. Along with the struggle to complete familiar tasks, they may struggle to learn how to do new things or follow new routines.

    Confusion

Someone in the early stages of dementia frequently becomes confused. When memory, thinking, or judgment lapses, occur, confusion may also arise as the person can no longer remember faces, find the right words, or interact with others normally. Confusion occurs for a number of reasons and applies to different situations. For example, the person may misplace their car keys, forget what comes next in the day, or have difficulty remembering someone they’ve met before.

    Difficulty Following Storylines

Difficulty following storylines is a classic indicator of early dementia. Just as finding and using the right words becomes difficult, people with dementia sometimes forget the meanings of words they hear or struggle to follow along with conversations or TV programs.

    A Failing Sense of Direction

Dementia onset commonly brings with it the deterioration of the sense of direction and spatial orientation.

This can mean not recognizing once-familiar landmarks and forgetting regularly used directions. It also becomes more difficult to follow a series of directions and step-by-step instructions.

    Repetitiveness

Repetition is common in dementia because of memory loss and general behavioral changes. The person may repeat daily tasks, such as shaving, or they may collect items obsessively. They also may repeat the same questions in a conversation after they’ve been answered.

    Difficulties adapting to change

For someone in the early stages of dementia, the experience can cause fear. Suddenly, they can’t remember people they know or follow what others are saying. They can’t remember why they went to the store, and they get lost on the way home. Because of this, they might crave routine and be afraid to try new experiences. Difficulty adapting to change is also a typical symptom of early dementia.

If you know someone dealing with these indications and want to know how to plan for the inevitable consequences of dementia, use the scheduling robot to set up an appointment to discuss planning options in confidence.

As found on Youtube

Georgia Assembly Passes DAPT Legislation–Sends to Governor

The Georgia Assembly passes HB 441/AP which would allow the creation of Domestic Asset Protection Trusts (“DAPT”) in state. Georgia has long allowed traditional spendthrift trusts so long as such weren’t self-settled. A DAPT allows a self-settled spendthrift trust. Most states enacting DAPT laws have done so with the intent of encouraging assets to flow into the state’s trust companies. However, at least one opponent of DAPTs has opined that this DAPT law will have the exact opposite effect under Georgia’s legislation. Here’s what HB 441 would and would not do:
1. Allow spouses, parents, lineal descendants of the settlor, employer, any business entity in which the holdings of the settlor represent at least 30% of the total voting power of all interests entitled to vote, or siblings, to serve as an “independent qualified trustee”;
2. Requires at least one beneficiary other than the settlor to whom income and principal may be distributed as a “qualified interest”;
3. A “qualified interest” means that interest of the settlor of the self-settled DAPT to which such settlor is entitled to receive as a distribution of principal or income in the discretion of one or more independent qualified trustee”;
4. Would not protect from creditors of the settlor the following obligations:
a. Alimony or child support;
b. Taxes or other governmental obligations;
c. Tort judgments;
d. Judgments or orders for restitution as a result of a criminal conviction of the beneficiary; or
e. Judgments for necessaries;
f. Financial institutions to the extent that assets of the DAPT were reported to such institution as
belonging to the settlor for the purposes of obtaining or extending credit from such institution.

As we can clearly see, the exceptions may indeed swallow the whole. So, if the legislative intent was to encourage creation of DAPTs in Georgia, the exact opposite may occur: parties desiring to create such trusts may be well-advised to do so in another jurisdiction such as Nevada or Delaware and move their assets to such jurisdictions to actually obtain any such protection from creditors. NOTE: Georgia’s governor has not signed this bill into law as of the date of this writing.

So, what’s a person desiring to engage in lawful estate planning to do? Fear not, WRNicholsLaw has solutions that will accommodate both Georgia law and the desires of those persons. While nothing is fool-proof, our designs are created to comport with longstanding Georgia law and allow you to keep the assets in question invested in Georgia. If you don’t have an estate plan, Book an Appointment by clicking on the widget and schedule a time to speak with us about your planning–you’ll love doing business with WRNicholsLaw!

Romance in the Nursing Home

A perfect storm has developed on the elder care forefront that is comprised of sexual desire, dementia, and nursing home liability. The last sensation to deteriorate as a person reaches the end of life is that of touch. And, the desire for physical contact of whatever sort–whether it be sexual or otherwise, is merely a natural consequence of the human condition.

There has been an uptick in the incidence of sexually transmitted diseases among nursing home residents. Those patients desiring sexual contact can become predatory. The diagnosis of dementia raises the issue of whether that patient has the capacity to consent to sexual activity. Further, dementia can lead to a loss of impulse control.

While many facilities are just ignoring these issues, at least one facility, the Hebrew Home at Riverdale, NY, has published articles about their early adoption of a policy regarding sexual conduct among their residents.

If your family has questions or concerns about paying for the high cost of longevity, contact us via email, facebook, twitter, LinkedIn, or phone.
Continue reading “Romance in the Nursing Home”

Is a Long-Term Care Asset Protection Plan Right for You?


Do you have concerns about:
• Running out of money if you (or your spouse) become ill and require significant care
• Having no control over who provides care for you if you need it
• Choosing the type of care you want and where you want to receive it
• Leaving an inheritance to your loved ones, only to have it taken by their creditors
• Your children misusing the property or money you leave to them
• Providing support to a loved one with a disability both during your lifetime and after your passing
• Making sure your wishes about care and your finances are carried out
If you answered yes to any of the questions above, we can help. A long-term care asset protection plan is not a one-size-fits-all set of documents. Each plan is designed based on your concerns, your desires, and your goals.

Choosing a Health Plan for Your Small Business


If you own a small business you should consider providing a health plan for your family and that of your employees. Health plans help workers and their families take care of medical needs–a fundamental need of all humans. These plans can be one of the most important benefits an employer can provide.

There are many reasons to offer a plan. You and your family can receive coverage under the plan, which can help you save money and improve your health in the long run to be sure. But, by starting a plan, you will also help your employees and their families stay healthy. So, productivity and worker happiness remain higher. A health plan may also help you attract and retain talented people. Moreover, having a group health plan can help you gain significant tax advantages. Employer contributions to the health plan are deductible from the employer’s income. Also, small businesses may be eligible for tax credits under the Affordable Care Act. For more information, visit the IRS’ website at irs.gov or consult your tax professional.  If you start a plan, there are many protections for your health plan coverage including Pre-existing condition exclusions are no longer permitted. Insurance companies can’t charge higher rates or deny coverage because of a pre-existing condition Insurance companies cannot impose lifetime or annual dollar limits on coverage of essential health benefits And there are 2 new ways to hold insurance companies accountable for rate increases and help keep your costs down.

One option for looking for a plan is the Small Business Health Options Program Marketplace, or SHOP. SHOP offers small businesses an easy way to compare and select plans. For more information, go to healthcare.gov or call 1-800-706-7893.

Another option we advise clients with at least 10 employees is to take a look at a plan that offers significantly discounted premiums, $250,000/year/covered person benefits, $0 deductibles, 43% discounts on in-network providers, a concierge service to find the best physicians at the best prices regardless of whether you want to stay in-network, Teladoc to meet with physicians without having to go to the waiting room and expose yourself to other ill patients, and a Critical Illness rider that pays a lump sum cash benefit in the event a covered persons suffers a catastrophe. With 10 or more employees, these plans offer guaranteed acceptance. They pay cash benefits to the claimant as defined in the plan. So, you know what you’re getting instead of spinning the roulette wheel to find out what the company will cover and what it won’t cover. These plans provide thousands in savings that can be used to grow other cash benefits for owners and employees.

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New MEDICAID Rules, Requirements and Changes–Are You Ready?

NBI’s new CLE on Elder Law: New MEDICAID Rules, Requirements and Changes – Are You Ready?, airs 11/28/2017. Check here to learn more.
 
PS: the 1 hour Ethics discussion alone is worth the price of admission. Why? Because I discuss things most lawyers haven’t thought of (at least in a long time) and also how to price your services and niche market your firm’s practice. Join Tom Murphy (30+ yrs experience MA&AZ), Whitney Wilson (10+ yrs Preeminent Elder Law practice in KY) and I discuss Appeals and other aspects of this very technical (and booming) field of law.