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Notes from Wendy A. Craig, P.A.

June 2005



Recent speaking engagements:

  • Presented at NBI seminar "North Carolina Elder Care Planning: How to Protect Assets and Provide for Services"for attorneys and other professionals involved in elder law
  • Presented at May 2005 CarePartners meeting for social workers on advance directives and Medicaid planning
  • Presented at Reuter Center at UNCA to Center for Creative retirement regarding advance directives
  • Presenting at Trinity Baptist Church on June 16, 2005 regarding advance directives, long-term care and Medicaid planning
Recent conferences attended:
  • "'Til Death Do Us Part . . . Marital Deduction Planning," presented by the North Carolina Bar Association on March 3, 2005 in Greensboro, NC
  • "The Marital Deduction: Funding the Trust and Distributing the Property," presented by the North Carolina Bar Association on March 4, 2005 in Greensboro, NC
  • End-of-Life planning presented by the American Bar Association on June 8, 2005
Upcoming conferences:
  • Annual meeting of the Estate Planning section of the North Carolina Bar Association, July 22-24, 2005, Kiawah, SC
  • National Academy of Elder Law Attorneys 2005 Advanced Elder Law Institute - a joint meeting with the National Association of Professional Geriatric Care Managers, September 28 - October 2, 2005, New Orleans, LA.
Did you know that . . .

Our office recently hosted the first educational meeting of the North Carolina Chapter of the National Academy of Elder Law Attorneys. Wendy is currently the co-President of the NC Chapter of NAELA with Greg Wallace in Raleigh. More than 20 elder law attorneys from across the state attended this event in Black Mountain on the weekend of April 23, 2005.

Geriatric Care Managers

The website for the National Association of Professional Geriatric Care Managers, Inc, defines a "geriatric care manager" as a health and human services professional, such as a gerontologist, nurse, social worker, or psychologist with a specialized focus on issues related to aging and elder care.  Geriatric care managers ("GCMs") work privately with older adults and their families to create a plan of care that meets the needs of the older adult.  They will meet with you to help you understand your loved one's needs and to learn what resources and options are available to meet those needs.
Our office frequently works with GCMs as an essential part of the care team for our senior clients. One of the questions we are asked most frequently is how to put together a team and a care plan that will allow our senior clients to remain independent in their own homes. Below is our "top ten" list prepared by "Spike" Gram, GCM-extrordinaire and resident in Asheville, for assisting seniors to age in place. Spike is the owner/manager of Senior Care Consulting, LLC, and can be reached at 828-337-1776.



Ten Tips for Keeping Your Parent Independent
  1. Get a thorough geriatric assessment: this should cover both physical and mental health and should include a review of all medications your parent takes.
  2. Set up a system to monitor how your parent is taking medications; there are many pill dispensers on the market to help remind your parent to take his or her meds.
  3. Arrange to have bills paid in a timely manner: this can be done by auto-debit or through the services of a daily money manager.*
  4. Check your parent's home for safety; a good safety audit can help prevent a broken hip.*
  5. Make sure that your parent has social contact; depression, loneliness, and isolation can be real problems for older adults.
  6. Monitor your parent's food and fluid intake; beware of "the dwindles" and dehydration.
  7. Try to control the clutter; clutter can be stressful for everyone.*
  8. Arrange to have daily or several times daily check-ins with your parent, by phone or in person.
  9. If your parent has to give up driving, be creative in finding ways to be sure she or he is able to get out and be active both physically and mentally.
  10. Don't try to do it all by yourself: consider consulting with a Geriatric Care Manager (GCM) who is a professional in the field of aging and aging services.
* = services a GCM can provide, among others



QUESTION & ANSWER CORNER

My father may be in the early stages of dementia.  Is it still possible to proceed with Medicaid planning and advance directives?

     The term "advance directive" includes the general durable power of attorney, the health care power of attorney and the living will - documents that appoint a decision-maker for your father. Through the general durable power of attorney, your father may appoint someone to manage his assets and financial affairs in the event that he is unable or unwilling to do so. The health care power of attorney permits your father to name the person who should make his health care decisions (including the decision to place him in a long-term care facility) in the event his physician determines that he is no longer capable of understanding treatment options or to give consent to the same. The living will allows your father to tell his attending physician about his end-of-life wishes in very narrow circumstances. The living will permits your father to instruct his physician to withdraw or discontinue extraordinary means and artificial nutrition and hydration in the event he is "terminal and incurable" or in a "persistent vegetative state."

     A diagnosis of dementia does not necessarily mean that your father cannot execute advance directives or engage in Medicaid planning. In fact, most people in the early stages of dementia retain the legal capacity to execute a general durable power of attorney, health care power of attorney and living will. "Legal capacity" means more than the simple ability to sign his name to the document. Legal capacity requires that your father knows "what he is about" and have some general understanding of the effect of the document. An attorney who works frequently with seniors with diminished capacity can determine whether your father can execute advance directives.

     If properly drafted, the general durable power of attorney will permit the attorney-in-fact (the decision-maker named in the document) to engage in Medicaid planning on your father's behalf. Therefore, your father should consult an elder law attorney to draft a power of attorney that specifically permits Medicaid planning as soon as possible. Please note that even if your father has previously executed a power of attorney, this document likely does not include the necessary grants of authority to permit Medicaid planning and should be reviewed by an elder law attorney while your father retains the capacity to execute a new power of attorney if necessary.

     Early planning results in more successful efforts to protect assets for spouses and other family members and establish Medicaid eligibility. Early medical intervention often extends this planning period. Frequently, if the patient diagnosed with dementia sees a physician who focuses her practice on dementia diagnoses and treatment, the early stages of the disease can be extended, allowing the patient to remain at home for as long as possible. In addition, a specific diagnosis (such as Alzheimer's disease, Parkinson's disease or vascular dementia) will also give your father and his family some idea of the progression the disease is expected to take and the time periods for such progression. Therefore, if your father has received only a general diagnosis of dementia, he should request a referral to a specialist to receive a thorough evaluation and a specific diagnosis that may prolong his years of living independently or with family assistance.



We are moving!! We have outgrown the office space we share with GreyBeard Realty. We are currently renovating the building across the street, located at 207 East State Street in Black Mountain, and hope to move into the new space next month. Come see us!

Call Wendy A. Craig at 828-669-0799.

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Wendy A. Craig

Wendy A. Craig, P.A.
Concentrating in Elder Law for Western North Carolina

207 East State Street, Black Mountain, NC 28711
828-669-0799 (Voice) • 828-669-0055 (Fax)

E-Mail Address: Email Me


© 2006 - Wendy A. Craig, P.A.
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