I, (Rick Law) teach a continuing education class for health care professionals entitled “In the Shadow of Schiavo: Life, Death, and Care Instructions.” Most attendees come to the class assuming they are going to hear some lawyer drone on about boring legal documents. But when life and death are on the line, health care advance directives are part of the human drama.

Very few doctors, nurses, or other health care personnel understand the interplay between the Illinois statutory advanced directives such as the Living Will, Power of Attorney for Health Care, and Do Not Resuscitate Order. When a person lacks effective advance directives, then a physician can trigger the Illinois Health Care Surrogate Act to create a decision-maker.

Unfortunately, many lawyers consider the health care power of attorney as a “throw-in” document in an estate plan. In reality, it’s important to consider the hidden definitions for terms used in the statutory advance directives and the Health Care Surrogate Act.

For example, a principal should be very careful when naming both primary agent and successor agents. Many clients seem to be willing to vest life-and-death authority in persons whom he/she knows are inappropriate. Individuals will put fear of causing offense within the family above their own welfare. We attorneys must point out that even a successor agent may come to hold your life in their hands if your best agent is “unavailable.” Even if an individual is a third or a fourth successor agent, if the higher-priority agents are unavailable, then whichever agent is available will make the final decision. An agent is considered “unavailable” if “the person’s existence is not known; the person has not been able to be contacted by telephone or mail.”

I recommend that attorneys add full contact information of agents into the Power of Attorney. This simple act makes it easier for health care providers to communicate with the highest priority agent during a time of crisis.

When Dementia Hits the Pocketbook

By Rick Law on

May 5, 2011

- Alzheimer's and Dementia, Elder Law, estate planning, Senior Citizens

After a long hiatus, we’re back to posting regularly on our blog! We’ve been very busy over the past year and can’t wait to share what we’ve been doing with our readers; but first, we want to share some important information about an issue that affects many of the clients who come into our office, and something we’d like to help prevent: When dementia hits the pocketbook. We hope you find this information helpful, and please come back next week to read about the exciting things we’ve been doing in our firm and in the community! The first signs of Alzheimer’s or dementia are not always easy to see. Families may go months or more before they realize that a loved one is forgetting a few too many things or confused about more than just the new DVD player. One of the first signs of Alzheimer’s or dementia is also one of the most dangerous—a growing inability to understand and handle financial matters. Elder care lawyers often hear stories that reveal that one of the first signs of dementia is an inability to understand money, personal finances, and contracts. Client families need to take steps to protect the family finances when a loved one grows vulnerable to financial manipulation. There is no legal standard for ‘vulnerability,’ but vulnerable individuals are easy prey for scam artists and just plain poor financial decision-making. One novel idea used by a family to stop the loss of thousands of dollars being spent by a loved one to obtain supposed lottery “winnings” was to limit the affected person’s checking account balance. In addition, family members actively created a lottery game to distract and amuse their loved one. It worked! If family members live far away, some of the first people likely to notice these telltale signs of dementia are the senior’s own advisors—doctor, lawyer, or financial planner. Unfortunately, these advisors often don’t always have the ability to take action. Both doctors and lawyers, for example, are bound by patient or client privilege; even if they want to inform the family of their suspicions, they may not be able to. Recent changes to Illinois State Bar Association Code of Ethics do allow an attorney to take action to protect a client when there is a reasonable belief that the client has become incapacitated and is in danger. The American Medical Association also is not insensible to this issue, and has guidelines for dealing with patients who show signs of incapacity. Unfortunately, doctors are under pressure to spend minimal amounts of time with patients. Many people are able to ‘fake it’ during a short interview by doctors, lawyers, and financial advisors. It is extremely important that the healthy spouse and/or responsible adult child get actively involved in pointing out to professionals any abnormal acts of vulnerability. This may mean doing something that feels very uncomfortable, but is absolutely critical to get the protection needed. No one will ever know what the family is seeing and experiencing at home unless you tell the story to your trusted advisors and friends. It is dangerous to keep your fears a secret. Almost everyone has a loved one who has been or will be affected by the progressive loss of decision-making capacity. What can families do to recognize the signs of dementia and prevent the financial fallout that often results? First of all, it should be a topic of family conversation early and often, long before Mom or Dad is at risk. Talk about the possibility and how it should be handled. Geriatric care managers and elder care lawyers welcome input from the entire family of their clients. Familiarity with the entire family gives more options if signs of dementia do start to appear, and an atmosphere of open communication can go a long way toward preventing suspicion and family fights later on. Attorneys need to know who among the family the client believes are their ‘honest and reliable adult children’ who may be able to safeguard family finances and provide ongoing care and attention to the situation. Care managers will recommend how best to combine family resources with professional services. Experienced elder care attorneys and care managers can help the family to plan for future financial and health care needs. Most families underestimate both the financial impact, emotional burden, and care needs that will be required due to the dementia of a beloved member of the family. Once a family has discussed options for the future and who might be the best person to take control of Mom or Dad’s finances in the event that they are unable, then an elder care attorney can assist them with the development of appropriate legal documents and Power of Attorney for financial decision-making. These documents give a nominated agent the power to make financial decisions for the affected loved one. The time to work on these plans is while the forgetful one still has sufficient capacity to make a Will, Trust, Power of Attorney for Health Care, Power of Attorney for Property, and any other estate protection plans. Lawyers trained in this area of planning work to make sure that the healthy spouse is not excessively impoverished by long term care expenses. The onset of Alzheimer’s or dementia affects the entire family, and should be discussed as an entire family.

Growing Up with Alzheimers

By Rick Law on

April 22, 2010

- Adult Illness, Alzheimer's and Dementia, Inspiring People, Our Friends

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How do you think you would feel if you could not remember a time that your father or mother did not have memory issues? John Remaly was only nine years old when his dad was diagnosed with Young Onset Alzheimers. He and his sister Alyssa have grown up adjusting to the gradual loss of their dad’s memory and ability to care for himself. I spoke to John and his mom, Melinda, and asked them to share with me some of the trials and victories that they have experienced during the last few years. John told me that in his family, they have worked together to provide a united front to withstand Alzheimers’ attack on their family happiness. “Most people, when dealing with something like this, start to fight and blame each other. We have decided to use our gift of humor to find creative ways to work with my dad.” He went on to share with me that his father, Rick Remaly, has always been a guy who loves the quick one-liner jokes and over-the-top comedy. He says that the family enjoys shows like Will and Grace, Everybody Loves Raymond, and Family Guy. John and his sister Alyssa love theater and acting, and they have memorized sketches from the different shows, complete with script, dialogue, jokes, and timing. This helps keep their father engaged and laughing. John quickly added, “Dad can still catch ‘quick humor’ and he is very easily amused. In fact, one evening when he was feeling low, I decided that he and I should have a little fun and put calcium tablets in our mouths. Do you know what happens when you put calcium tablets in your mouth? It doesn’t hurt you, but you foam like a rabid dog! Dad and I could not stop laughing.” Melinda added that life at home is not always humorous and that John has had to take on the role of being an adult and a caregiver for his father. She admires the way John works with his father. Rick seems to take direction better from John than anyone else. “When you’re dealing with Alzheimers, you need to work together as a family and be open to sharing with loved ones and co-workers. You need to be truthful in keeping people informed about the real situation at home.” She went on to say that it’s very important to be able to go out with friends and to have support systems. In fact, one of the key principles in helping the Remalys stay emotionally healthy is recognizing that from time to time, you have to get away from the caregiving at home. The Remaly family is about to embark on a new phase of life. John Remaly has applied to, and been accepted at, Bradley University in Peoria, Illinois. His dad and mom will be losing one of the pillars that support being able to provide for Rick at home. John wrote a college admissions essay in October 2009 which detailed his experiences in growing up with Alzheimers. The entire text is available by clicking on this link: John Remaly’s College Admissions Essay In both October 2008 and October 2009, Melinda Remaly organized a group to participate in the Alzheimers walk in Libertyville, Illinois called “On the Move for Alzheimers.” Each year the family, friends, and John’s friends from school walked together to raise funds for Alzheimers research. All the friends and family members wore t-shirts that said. “Walk for Rick.” On the back of Mr. Remaly’s t-shirt it said, “I am Rick.” We here at Law Elder Law are grateful that the Remaly family has chosen us to be their legal advocates.

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Is Dad At the Shelter?

By Rick Law on

March 4, 2010

- Alzheimer's and Dementia, Caregivers, Senior Citizens

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Recently I was sitting down with some very good friends when a cell phone rang. A look of worry shot across my friend’s brow as he looked at me and apologized, “I’ve got to take this call… my Dad’s missing! He’s gone wandering…” I could not help but listen as he spoke to relatives several hundred miles away. He murmured hopefully, “Maybe they’ll bring Dad to the shelter.” After saying goodbye he looked at me with pain across his face and said, “Nobody knows where he is. He’s got Alzheimer’s, and my mom can’t keep him in the house anymore.” About 30 minutes later he got the call that Dad had been found and everything was okay—this time. As I sat there, I wondered if my friend knew of some of the resources available to help keep track of vulnerable or wandering loved ones—and it occurred to me that our readers may also be unaware of some of these resources. One of the reasons that having a wandering relative afflicted with dementia is so frightening is that they don’t act (or react) in the same way that a typical lost person would. A helpful page at Ask.com explains how wanderers with dementia will not cry out for help or respond to your calls to them, nor will they leave many physical clues to lead you to them. What a wanderer is likely to do is go to an old place of residence or a favorite location. Luckily, there are resources out there to help with wandering relatives—so you don’t have to just wait nervously by the phone. One of these resources is the Medic-Alert Safe-Return program detailed on the Alzheimer’s Association website. This program provides 24-hour nationwide assistance and supplies members with an individual emblem engraved with the program’s emergency response number. If you want to try to stop wandering at its source, the Mayo Clinic has a page detailing some of the reasons why elderly relatives may wander, and includes some suggestions on how you might prevent it. But remember—no matter how much you do, Mom or Dad may still wander. Don’t blame yourself if it happens! The best thing to do is be prepared for the occasions when the wandering does happen. Use the resources provided above, and keep other relatives and caregivers informed.

Why Angels Play Harps!

By Rick Law on

February 17, 2010

- Adult Illness, Alzheimer's and Dementia, Inspiring People

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Most of us have seen angels represented as either winged cherubs or gracefully-robed harp players. Just before last Christmas, I met a real harp-playing angel named Barbara Fackler. I was introduced to Barbara because she had been employed by Passages Hospice to provide music for a resident at Aurora Rehabilitation Center. Frankly, I had never heard of music therapy, so I was eager to understand what Barbara does and how she helps the healing process. Barbara became involved with therapeutic music accidentally. She has loved playing the harp since she was a child—she says there was no other instrument that she wanted to play. Her idea of the perfect harp is a pedal harp, which is a large, heavy, awkward-to-move instrument. She smiled when she told me that her husband, Dan Fackler, always jokes that she married him only because he was the most careful guy that she had “auditioned” as a harp-transporting boyfriend. A number of years ago, Barbara decided she needed to acquire a harp small enough to take when visiting relatives out of town. The first trip the little harp made was to visit her grandfather, whose Alzheimer’s had progressed to the point that he rarely spoke. However, after Barbara played her harp for him, he went from silence to speaking in short sentences. Additionally, he became responsive in his interactions with other family members. It was a stunning discovery. “There is something magical about acoustic sound. Scientific research has repeatedly suggested that acoustic music has a more profound effect than recorded music,” Barbara relates. In addition to her work with hospice patients, Barbara uses her harp as a way to share her gift of music with friends and loved ones who are ill. She takes her harp with her to the hospital sick room. “Having a conversation with someone in the hospital can be very exhausting to the patient. So, I decided to just show up with my harp and play beautiful music. It is great to just go, play, and provide a human connection that does not require any expectations of an interactive response.” Barbara has earned respect for her uncanny ability to connect with many seniors and others who suffer from chronic progressive diseases. One of her clients at Aurora Rehabilitation Center has primary progressive aphasia. “Aphasia” means the inability to create words or speak. This particular client cannot recover and often appears confused and unintelligible. However, following a music session in which Barbara plays the harp for an hour, the client often appears much more capable and articulate for the next few days. One of Barbara’s current endeavors is teaching the harp to senior citizen students. She told me that learning to play a new instrument is one of the best ways to create mental stimulation. She says, “Musicians work between the left and right hemispheres of their brains faster than other people. In addition, it’s great therapy after a stroke. If you teach the dominant side of the body to do something, then the less-dominant side can learn to mimic.” She has seen how learning to play the harp after a stroke allows people to regain more functionality than other types of therapy. Barbara has just completed a new CD entitled Pleasantries & Diversions. You can click on this link: www.hornandharp.com to find out how to purchase that CD. I highly recommend that you consider visiting her website www.harpinstead.com or phoning her at 630-665-6098 to purchase her music and/or engage her services as a harpist.

Marbles Brain Store: The Best Brain for Your Buck

By Rick Law on

July 29, 2009

- Alzheimer's and Dementia, General Interest, Senior Citizens

Marbles store owner Lindsay Gaskins and her team are committed to helping brains age well. And they have a lot of fun doing it! Each of the brain games they sell in their store serves a specific purpose and benefits a specific part of the brain. “The whole concept for the store came out of the idea that there are new developments in science saying that if you exercise your brain you can stave off Alzheimer’s—you can live better and longer.”

Marbles Brain Store: Playing for Keeps!

By Rick Law on

July 22, 2009

- Alzheimer's and Dementia, Senior Citizens

written by Catherine Law, with Rick Law

Most of us think that the only thing we have to worry about as our brains age is memory loss. If you ask your doctor, he’ll tell you that there are different aspects to what we think of as memory: critical thinking, cognitive reserve, auditory processing… it’s enough to make your head spin! Recently I stopped in at a new store called “Marbles” in the Chicago Loop and talked to owner Lindsay Gaskins, who uses brain games to help us make sense of it all. “Nutrition and fitness are the two things that get hammered home all the time,” says Lindsay. “What we really want, from a science standpoint, is mental stimulation. That’s the third cog in the wheel. We think Marbles is a place where you can find that third thing.” The Marbles store grew from the idea that there should be a gym for your brain in the same way there are gyms for your body. The store is divided into five different areas: Memory, Coordination, Visual Perception, Critical Thinking, and Word Skills. The place is exciting and colorful! It’s filled with tables of various games, so you can try out different ones and see what you like best. “[Mental] cross-training is really important,” says Lindsay. “People have heard “memory,” but they don’t realize they need to be working on other skills too. Your whole brain is connected. We try to get people started with something that they like, but then you really need to try something else.” She is convinced that we have to push beyond the comfort zone! Where the biggest difference lies between this brain gym and a physical gym, is that the brain gym is a whole lot more fun! Lindsay went on to explain that since all of these tools can be taken home, they also incorporate the social aspect of mental stimulation—which makes it doubly beneficial when working to boost your brainpower. She said that many of the games are fun and challenging for seniors, but are simple enough that they can be played with the grandkids. In addition, there’s something for everyone: learning games for children, brain-building software, 3-D puzzles, books, even toys to help with coordination. While they have gifts and toys for every type of person, what Lindsay wasn’t expecting was the multiple-generational interest they have seen. She thought this was all going to be about the Boomers. “We weren’t expecting that twenty- to forty-year-olds would enjoy this store.” Want to know what you could do to improve your brain health? Lindsay and the team at Marbles will help you find out. “We have games that work on very specific things people have challenges with; even when they may not be aware of which challenges they have, we can work to assess them. Of course we’re not doctors, but what we have are interesting tools that have been developed by the scientific community and are now available for people to use at home.” Marbles can be found online at www.MarblesTheBrainStore.com, or in the Chicagoland area at their Loop and Old Orchard locations. I highly recommend that you ‘remember’ to visit with them!

CMS Nursing Home Night Stalkers

By Rick Law on

June 25, 2009

- Alzheimer's and Dementia, Caregivers, Long Term Care, Medicaid, Senior Citizens

This blog is not about strangers lurking in an alley. Nonetheless, nursing homes are routinely “invaded” in the wee hours and weekends, because they are subject to unannounced night and weekend visits by trained teams of Medicare inspectors. These snoopy night stalkers show up and “camp out” in the facility for days. These teams have full authority to review and audit over 180 different items covering all major aspects of care in a skilled nursing facility. They inspect the buildings, the medical records, the residents, the cleanliness, the staffing hours per resident, and much, much more. These investigators are there to find deficiencies, note them, and report them to the Center of Medicare and Medicaid Services (CMS). The report is used to provide a rating which is available to the public at the Nursing Home Compare website. The website lists each nursing home and assigns a quality rating between 1 and 5 stars. A 5-star nursing home is heavenly! Unfortunately, a 1-star nursing home is a probably a living hell. CMS has created this rating system to help seniors and their loved ones see behind the scenes and beyond the nice décor to find a safe and nurturing care facility for a frail senior. The most coveted score is a 5-star Medicare quality rating. That score is received by only 10% of all skilled nursing home facilities. There are very few facilities who receive such an award even when they are in the luxury market. It is even more impressive when a facility which accepts Medicaid residents qualifies as a 5-star-rated Medicare facility. Recently Tower Hill Healthcare of South Elgin, Illinois announced in their newsletter that they had received a 5-star award. I was impressed! Tower Hill is a 206-bed Medicaid-certified skilled care facility with a 31-bed Alzheimer’s wing. In my next blog, you will be introduced to a 33-year-old orthodox Jewish synagogue cantor and wedding singer, Jeremy Amster, whose leadership skills have earned the 5-star rating.

The Coming Victory Over Alzheimer’s

By Rick Law on

May 13, 2009

- Alzheimer's and Dementia, Caregivers, Current Events

Last weekend I was blessed to attend the Chicago preview showing of the HBO special documentary entitled “The Alzheimer’s Project.” This is an exciting joint project of the Alzheimer’s Association and HBO which is designed to give us all new insight and hope that we can push back against Alzheimer’s Disease (AD). For those of us in Chicago the documentary was even more personal, in that it included a live interview with Dr. David Bennett of Chicago’s own Rush Alzheimer’s Disease Center. The medical staff and researchers at Rush Hospital are one of the premier teams investigating Alzheimer’s Disease. Dr. Bennett is the director of a large group study entitled “The Religious Order Project.” “The Alzheimer’s Project” focused on some individuals with early-onset Alzheimer’s, which affects people who are younger than 65. We learned several new and startling things. Most people are aware that Alzheimer’s Disease is a brain disease wherein brain function is progressively destroyed by the emergence of plaques and tangles. Surprisingly, there are individuals whose autopsy reveals the presence of the AD plaques and tangles, but the individual did not exhibit memory loss during their lives—some people continue to function in a normal manner. This phenomenon is not yet understood but is currently being referred to as “cognitive reserve.” The presence of this cognitive reserve gives researchers a hopeful avenue of new investigation. In addition, part of the question-and-answer portion of the program focused on current drug therapies. Today there is not a drug which cures or delays the disease. Our current drug therapies are limited to enhancing the remaining brain function during the continuing degenerative progression of the Alzheimer’s Disease. Dr. Bennett told the audience in Chicago that there are numerous medical research and drug trials going on right now which demonstrate new possibilities to not only delay but possibly create a vaccine against Alzheimer’s Disease. There is a high probability that medical science will have these enhanced weapons available to the public within the next five to ten years. This is great news of a brighter view of aging for millions of people who would otherwise face the prospect of AD. If you missed this wonderful program, you can watch each of the documentary films individually online, by streaming them to your computer through HBO’s website. I highly recommend that you click here to see all of the resources that you can download and stream from the HBO program entitled “The Alzheimer’s Project.”

Trapped! The Plight of the Caregiver

By Rick Law on

October 10, 2008

- Alzheimer's and Dementia, Caregivers

Recently, when friend and “founder” Luise May visited our office, Shawn Hunt and I sat down to ask about her experience as a caregiver for her Alzheimer’s–affected husband over the past nine years. Our goal was to further understand the feelings and experiences of the people our firm strives to help–those serving as caregivers for loved ones with long-term care needs. One of Luise’s strongest statements was the feeling that “you are trapped! Financially and socially, you are trapped.” As a caregiver, many choices are simply taken away from you. The only choice left is how you will respond in any given situation. Because of this, it is not unusual for many caregivers to experience burnout. And it’s not only the absence of choices that make you feel trapped, according to Luise, but the lack of control over basic areas of your life. “You can’t control your schedule. You can’t control your loved one’s incontinence or sleeping times. You can’t control what they are going to say or what they are going to do. You lose all freedom.” When we inquired into social activities, Luise told us “I used to try to take Bob with me to concerts, because we both love music. But eventually it got to the point where it was just too much effort and he didn’t enjoy it anymore.” We asked if she could invite friends over to her house, but, she said, “It’s just so difficult. What do you say to them? And what do they say to you? It’s extremely awkward. In addition, there are times when Bob became very angry, and because I’m doing the care-giving, I’m right there for Bob to express his frustration. I didn’t want other people to see that. Remember, you can’t control anything. You lose all your freedom.” As we listened to Luise share her nine years’ experience caring for Bob at home, we could not help but admire once again all the caregivers out there. Her story served as yet another reminder of why we at Law Elder Law do what we do: provide counsel and help to those who lovingly sacrifice their wealth, health, freedom, and careers to provide loving care for a spouse, child, or parent.

Choose Your Agent Carefully: Life, Death & Care Instructions

When Dementia Hits the Pocketbook

Growing Up with Alzheimers

Is Dad At the Shelter?

Why Angels Play Harps!

Marbles Brain Store: The Best Brain for Your Buck

Marbles Brain Store: Playing for Keeps!

CMS Nursing Home Night Stalkers

The Coming Victory Over Alzheimer’s

Trapped! The Plight of the Caregiver

Estate, Asset & Retirement Tax Attorneys

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