I’m an independent woman, an elder lawyer, no less.  Yet, when it comes to making decisions about my Mom, I turn first to my brother.  After all, my Mom is his Mom, and I don’t want to totally take charge, although it would be easy to do so. But mostly I like having someone to share the burden with.  Although I help families make decisions about their aging parents, when it comes to mine, I lean on family.

But what happens when you never got over that sibling rivalry?  Or when you honestly just disagree about how your parents should be cared for?

This article offers one solution—elder mediation.  A mediator may well be able to help siblings struggling with how to care for elderly parents and how to pay for that care.  Many elder lawyers are equipped to help work through solutions, but there are mediators in New York who specialize in elder problems.

I’m here to promise you that no one can be forced to disconnect your life support because your living will says so.  It’s unfair to blame the document for that sort of decision.  It was a simply an expression of Elizabeth’s wishes of how she would like her life to end.  Her doctors and the hospital would also have input into that decision.

In New York, a living will is not a legal document, it is an expression of your health care desires if you are unable to express those wishes yourself, if you are in a coma or perhaps in an advanced state of Alzheimer’s.   In New York, you should also sign a health care proxy, that nominates a person who will actually make those decisions for you.  The person you nominate to serve as your proxy can make real time decisions about real situations; not just advance decisions about hypothetical situations.  Those decisions will hopefully be framed by the wishes you expressed in your living will.

No one is “pulling the plug” because of the terms of your living will.  Don’t let fear stop you from signing the most important health care directives:  Your health care proxy, living will and power of attorney.  Even if George Clooney used to play a doctor on TV.

Predicting who may be at a higher risk for the disease is important, as early detection may be an important step to slowing down or stopping the progression of memory loss and cognitive function.

Another marker, according to the press release, is abnormal levels of protein in cerebrospinal fluid.  For more information on this study, click here.

According to Brody, Vitamin B-12 is absorbed less readily as we age, and a deficiency can cause symptoms of memory loss and confusion–the same symptoms as an early Alzheimer’s diagnosis.

A study in the American Journal of Clinical Nutrition found that supplementing people without deficiencies of B-12 did not improve cognitive impairment with normal levels of the vitamin, but did improve cognition among women with a low intake of B vitamins.

Although I’m not a doctor, it seems to me that testing for Vitamin B-12 deficiency in older adults should be a routine procedure.

92% of nursing homes employ one or more people with a criminal conviction.  Nearly half of nursing homes employed people with five or more criminal convictions.  Although most of the convictions took place prior to employment, 16% of the convictions were for offenses after being hired.

Although nursing home facilities are prohibited from hiring or employing persons found guilty of abusing, neglecting or mistreating residents, apparently this prohibition does not extend to workers who had previously been found guilty of crimes against property.

The NY Times reported that although most of the criminal convictions were for activities such as burglary or shoplifting, some  were for personal crimes such as assault.

Residents in nursing homes are a vulnerable section of our population.  These residents are often left alone with aides and supervision is poor.  Nursing homes must do a better job in screening employees.

If you find this as shocking as I do, you should contact an elder lawyer who may be able to help you protect your hard-earned assets.

Seniors (you must be over age 62) can tap the home equity in their homes by obtaining a reverse mortgage in either a lump sum or multiple payments.  The homeowner is not obligated to repay the loan, and the payment is deferred until the homeowner dies, sells the home, or leaves the home by entering a nursing home.

It is available regardless of your current income.  The Housing Department has a website on frequently asked questions about reverse mortgages, found here.

The Problems for Banks

According to the New York Times, both Bank of America and Wells Fargo exited the reverse mortgage business because the loans have become so risky.  With the falling housing market, there is a greater chance there will not be sufficient equity to repay the loans.  Homeowners are still responsible for property taxes (as we know, this is a major percentage of Long Island homeowner budgets) and insurance.  Banks are not allowed to assess borrower’s ability to keep up with these payments.

What Does Met Life Know that These Major Banks Don’t?

Just as Bank of America and Wells Fargo exit the reverse mortgage business, MetLife has come on strong.  They’ve entered the reverses mortgage market as a hedge against declining interest rates.  According to Bloomberg, the loans are guaranteed by “by the Government National Mortgage Association, a U.S.-owned insurer of mortgage- backed securities commonly known as Ginnie Mae. The agency guarantees the loans that are issued by lenders like MetLife and subsequently sold to investors.”

In a recent interview in the New York Times Science Section, cognitive neuroscientist Ellen Bialystock was interviewed about recent studies that have found that being bilingual delays the onset of Alzheimer’s symptoms by an average of five to six years.

Unfortunately, the occasional use of a second language does not qualify for bilingualism.  The second language must be used regularly in your every day life.

The study of 211 diagnosed Alzheimer’s sufferers found that the onset of symptoms in bilingual patients occurred more than 5 years after those monolingual patients, and were diagnosed 5 years later.  Interestingly, the monolingual patients were more educated.

Too Late to Learn a Second Language?

It is probably too late for most of us reading this to learn to speak a second language fluently enough to reap the benefits of this study.  However, it has been well documented that those adults who remain socially, mentally and physically active are better protected against the onset of dementia.

So, you might say that a bit of je ne sais quoi can delay non compos mentis.

Simply put, if you give away money or property during the five years before you apply for Medicaid, that transfer triggers a penalty period during which you are ineligible for Medicaid.

How Does the Penalty Period Work?

The penalty period is calculated by dividing the amount you have gifted or transferred by the average cost of nursing home care in our area, as published yearly.

The 2011 Nassau and Suffolk County average nursing home cost is $11,445.00

So, for example, if you give $91,560 to family members, at $11,445 a month you wouldn’t qualify for Medicaid for eight months.  If you give your home to your children, and retain a life estate, you have also given a gift, the fair market value which is countable towards the transfer penalty.

When Does the Penalty Period Start?

The Penalty period starts the day you apply for Medicaid.  New York State will review the Medicaid application to see if any gifts or transfers for less than fair market value are made for the five years prior to the application.  In other words, the full five years must pass before the gift is protected.  The penalty period does NOT start on the day you transfer the assets.

What Happens After Five Years?

If you need nursing home care, you will be eligible for Medicaid at the end of the five years after the transfer, as long as you have no other unprotected assets.  Contacting an elder lawyer while you are still well enough to transfer assets into an irrevocable trust is essential.

Why does so much money go unclaimed?  The first problem is that someone needs to notify the insurance company that the policy holder has died.  If the beneficiaries don’t know about the policy, this essential first step goes undone.

It is worth getting your affairs in order, putting your life insurance policies in with your other essential estate planning documents and advanced directives.  Let your beneficiaries know where to look for your important papers (I have a folder in my file cabinet labeled “Important Papers”—simple but effective).

New York State does not need your unclaimed funds, your beneficiaries do!