Why is an Advance Directive so Important with Dementia?
Advance Directive is Critical for Loved One with Dementia

Why is an Advance Directive so Important with Dementia?

The Roanoke Times advises in the recent article “What to do in absence of advance directive” to talk to an experienced elder care attorney to talk about advance directives and coordinate the necessary legal issues, when dementia may be at issue with a parent or other loved one. Next, ask your physician for a geriatric evaluation consultation for your loved one with a board-certified geriatrician and a referral to a social worker to assist in navigating the medical system. Having an advance directive in place is the first order of business.

It’s wise for anyone older than 55 to have advance directives in place, should they become incapacitated, so a trusted agent can fulfill the patient’s wishes in a dignified manner. Think ahead and plan ahead.

As a family’s planning starts, the issue of competence must be defined. A diagnosis of Alzheimer’s disease doesn’t necessarily indicate incompetence or a lack of capacity. At this point, a patient still has the right to make a decision—despite family members disagreeing with it. A patient’s competency should be evaluated after a number of poor choices or an especially serious choice that puts a patient or others at risk.

An evaluation will determine the patient’s factual understanding of concepts, decision-making and cogent expression of choices, the possible consequences of their choices and reasoning of the decision’s pros and cons. Healthcare professionals make the final determination, and these results are provided to the court.

If a patient passes the evaluation, she is deemed to have the mental capacity to make choices on her own. If she cannot demonstrate competency, an attorney can petition the court for a competency hearing, after which a trustee may be appointed to oversee her affairs.

The time to address these types of issues is before the patient becomes incapacitated. The family should clearly define and explore the topics of living wills, health care proxies, estate planning and powers of attorney now with an experienced elder law attorney.

Taking these proactive actions can be one of the greatest gifts a person can bestow upon herself and her loved ones. It can give a family peace of mind. If you put an advance directive in place, it can provide that gift when it’s needed the most.

Learn more about advance directives.

Reference: Roanoke Times (June 17, 2019) “What to do in absence of advance directive”

Dementia and Guns: A Dangerous Combination

Here’s a worrisome statistic: 45% of all adults age 65 or older, either own a firearm or live with someone who owns a gun. That’s a lot of people and a lot of guns. Firearms are the most common method of suicide for people with dementia, says the article “Guns and Dementia: Dealing With a Loved One’s Firearms” from J.D. Supra.

A person who has a gun and suffers from dementia can put family members or caregivers in grave danger, if the person suffers from confusion and doesn’t recognize the people around them. An investigation conducted by Kaiser Health in 2018 looked at news reports, court documents, hospital records and public death records since 2012. They found more than 100 cases, in which people with dementia used firearms to kill or injure themselves or someone else.

What is the best thing to do? Talk about the guns before they become a dangerous issue, like the moment someone is diagnosed with dementia. This is not that far from the conversation that must take place about driving and dementia, or for that matter, driving and aging.

Frame the issue as one about safety for the person and their loved ones. This is also the time to discuss guns and estate planning. Have a conversation with an elder lawyer that addresses an enforceable agreement about who has access to the guns, where the guns should be stored and what factors will determine when it is time for the guns to be taken out of the home. The gun owner may not remember the agreement, when it is necessary for it to be enforced. However, having the agreement in place will give the family member or other trusted individual clear directions about what steps to take.

What should you do with the guns themselves? You can start by separating the guns from the ammunition. If possible, have the weapons completely removed from the house. Local and state laws about the possession and transfer of firearms vary. Therefore, the family should consult an estate planning attorney, who is experienced in the relevant laws. It may be necessary for a gun trust to be created, and for family members to undergo training and licensing, if the firearms are going to be maintained or transferred to them.

Reference: J.D. Supra (Feb. 12, 2019) “Guns and Dementia: Dealing With a Loved One’s Firearms”

How Do We Live Our Lives When A Loved One Has Alzheimer’s?

The scenario is worrisome, as no one can be sure that this is something B. Smith would have wanted, if she had been asked before the disease had progressed. However, one good thing has come out of it, according to the article “B. Smith’s Alzheimer’s raises question: How to protect your wishes when incapacitated” from USA Today. There are more discussions about expressing people’s wishes, before they become incapacitated from Alzheimer’s.

More families are experiencing this very same dilemma because of the increasing number of Americans suffering from Alzheimer’s and other forms of dementia. More than 5.7 million in this country are suffering from this disease, which currently has no cure and is most likely to impact seniors, women and African Americans, according to the Alzheimer’s Association.

Without advance planning, it’s impossible to know what someone would want to happen. Discussing this is critical, while a patient is still relatively healthy and able to communicate her wishes to family members and to an estate planning attorney.

People who work in this area say there are two areas that must be addressed. One is drafting legal documents with an experienced estate attorney to determine who should be entrusted with health care and financial decisions. There is also a need for document known as a “statement of values” that will help family members understand goals and wishes and not be left guessing.

These decisions are not easy to consider when a person is still well. However, thinking about them and putting them down on paper, and then having the necessary documents prepared to formalize them and make them enforceable are important.

Here are the documents needed:

Durable power of attorney: This lets a trusted family or friend make financial decisions, in the event of incapacity.

Power of attorney for health care: This document permits a family member or friend to make decisions about health care decisions.

A will. The will is for the disposition of assets after your death. It also names the person who will be in charge, the executor.

A revocable trust. This is one of many documents that can be used to allow you to set conditions and directions about assets, while you are still living but when you have become incapacitated. It can be changed at your direction. Hence, the term revocable. An estate planning attorney will know what type of trust should be used for your situation.

Only four out of 10 Americans have wills, with many hesitating to have them created because they think that only rich people need a will. However, without a will, or the other documents described above, the family is left in a terrible situation, where there will be additional costs, if and when decisions need to be made but no one has been legally empowered to make the decisions.

The revocable trust could bypass many unpleasant situations, like instructing a power of attorney to place your assets in a trust that was set up specifically to pay for your care in a skilled nursing facility of your choice, or to describe with great specificity who was allowed to live in your home, if you became incapacitated.

Another missing step: the family discussion. Getting everyone together to discuss planning for the future, isn’t as fun as going on a family vacation, but it is important. If someone is starting to have the effects of dementia, they may not remember what they told another family member. With everyone in the same room, there will be a better chance that their wishes will be clear.

The moment someone learns that they have dementia, is the time to put all these elements into place, before it is too late.

Reference: USA Today (Jan. 31, 2019) “B. Smith’s Alzheimer’s raises question: How to protect your wishes when incapacitated”