Thursday, August 28, 2014

Support Us As We Walk to End Alzheimer's!

            Alzheimer’s Disease is close to our hearts, as we know it is for many of you, our terrific clients and colleagues. We in our office have the great pleasure of knowing many who suffer from the disease, as well as those of you who so selflessly care for them. In the hope that we can help bring about a cure, our office is participating in the October 12, 2014 Indianapolis Alzheimer’s Association Walk to End Alzheimer’s.

The Alzheimer’s Association has already stated our feeling about this event: “This walk is personal.” Each of us have seen with our own eyes how personal, and sometimes devastating, the effects of Alzheimer’s can be. Family members should never have to witness a loved one forget where they live, or their own name, or the names of their children, or what they loved most in life. We know you agree.


If you’re able, please support our efforts by making a donation to the Alzheimer’s Association on our donation page, which can be found here: Team Page, or let us know if you’d like to walk with us. We look forward to walking on October 12 with an Alzheimer’s-free future in mind. Thanks for your support!

Friday, June 13, 2014

What We Can Learn From One of America's Most Familiar Voices

Most Americans are familiar with the name Casey Kasem. He is a well-known radio personality famous for hosting shows such as American Top 40, American Top 20 and American Top 10 with a career spanning from 1970 until his retirement in 2009. Kasem also played the voice of the loveable character Shaggy on Scooby-Doo for forty years. Unfortunately, Casey Kasem is now famous for something he probably never considered putting on his resumé: the example of what can happen when we age.  
Casey Kasem was diagnosed with a rare form of dementia called Lewy Body Dementia. In the past year alone, his family’s struggles have played out in the media for the entire country to witness. The first instance was back in October when Kasem’s daughters led a protest outside of his LA mansion, demanding their stepmother let them see their ailing father. More recently, daughter, Kerri Kasem, accused her stepmother, Jean, of removing Casey from a nursing home in Santa Monica and fleeing California in order to avoid complying with a court order that gave Kerri control over medical decisions for her father. Casey was found in Washington three days later. Shortly thereafter, the country saw video footage of Jean throwing hamburger meat at her stepdaughter, Kerri, saying “she was throwing it at the dogs”. Jean was back in court in early June asking a judge to resume Casey’s water, nutrition, and medical infusions because Kerri had moved to implement end of life measures after doctors determined that feeding and hydrating Casey had become increasingly painful. Jean was granted the request.
It’s hard to imagine a brutal war between family members, but Casey Kasem’s case is not a rarity.  The struggles over visitation and Kasem’s care have sparked conversations across the country about how this type of fight can be prevented.  From an estate planning perspective, what can we take out of Kasem’s story to better plan for the aging process?
First, it’s important to understand that second marriages require additional questions and planning. Thought must be given to the potential impact a choice may have if your spouse is not the parent of your children. Subsequent spouses and adult children from prior marriages may not only have differing viewpoints on how a situation should be handled, but also struggle as to who should control decision-making from the outset.  A frank analysis of your family dynamic should be done at the outset of the planning process.  Without communication and effective planning, decisions about the type of medical care you should receive or where you should be buried can become complicated if your spouse and children are not in agreement. Inheritance decisions are also trickier. Should the surviving spouse receive the entire estate, or should the children from prior marriages inherit along with the spouse when you die? An estate planning attorney can walk through the different options with you to help make these decisions easier.
It is especially important to discuss who should have control medically and financially should you become unable to care for yourself. Too often we assume our family members know what we would want done instead of taking the time to have a frank discussion with them about our particular wishes.  It is important to realize that your loved ones may all have good intentions, but have different opinions when it comes to the decisions that need to be made. Proper planning can ease this transition and ensure that a plan is made that best reflects your wishes.  To avoid conflict, I suggest these conversations happen openly so that all potential caregivers understand your wishes and have an opportunity to dialogue with you about their fears and concerns. Careful thought should also be given to establishing powers of attorney and health care documents so that specific individuals are designated to make financial and health care decisions on your behalf should you become unable to act for yourself. Living wills and a POST form (if you have been diagnosed with a terminal or chronic illness) allow you to express your specific wishes as to the type and manner of end-of-life care you wish to receive.

Planning and communication while you are alive and healthy is key to ensuring that your family does not end up like the Kasems.  For additional information, or to plan your estate, contact Geyer & Associates at 317-973-4555 or rgeyerlaw.com.  

Sunday, March 9, 2014

Respecting Wishes - Advanced Care Directives Ensure Your End-of-Life Wishes Are Carried Out

Lacrosse, Wisconsin is a picturesque city of just over 50,000, nestled on the banks of the Mississippi about an hour southwest of Minneapolis/St. Paul. Besides its natural beauty and the friendly charm of a small town, Lacrosse has also become a place where people don’t shy away from death. In fact, they talk about it and embrace it as a part of life.

An amazing 96% of the people in Lacrosse have planned for end-of-life issues by putting advanced directives in place. This is a startling statistic given that the nation average is only 30%.  Now other cities across America are looking to Lacrosse, Wisconsin for guidance in developing their own programs for end-of-life planning, also known as advance directives.

It has taken a long time for the issue of end-of-life decisions to make its way into national news, both socially and politically.  Death is not an easy topic and many shy away from discussing it.   As Lynn Keegan and Carole Ann Drick note in their book, The Golden Room: A Practical Guide for Death with Dignity, “[f]or many death is one of the most difficult things to talk or think about. It is a subject that is not part of normal conversation and scary to many. With proper preparation everything will fall into place in the most kind and gentle manner as possible. It requires a shift in attitude so that dying is accepted as a sacred process deserving of compassion, dignity and beautiful surrounding AND available to everyone not just a select few. This is relevant to everyone as we will all die. People need basic ideas of what to expect and how to plan right up to the end. Death is a part of life. How did we ever allow advanced technology to take the place of the old and timeless values of compassionate end-of-life care?”  

The discussion of advance directives has much to do with an individual’s quality of life in his or her final days. Does he or she want to be kept alive on a ventilator or feeding tube when all else has failed? It is fair to burden a family with having to make a difficult decision to let Mom or Dad die?  Is living in a vegetative state or without full usage of one’s faculties something a person might want? And more simply, does the individual want to be cremated or buried?  These are decisions best made in advance.

The discussion of end-of-life issues is becoming more common thanks to a man by the name of Bud Hammes. According to a recent broadcast on NPR, “Some 20 years ago Bud worked at the dialysis center of a LaCrosse hospital.  He discovered only two of the 60 in the center had living wills that specified whether they wanted to be kept alive on machines.  Bud started giving nurses complete training on how to produce an advanced directive with a patient.  It was a long and hard road for Bud. At the start the nurses felt just as uncomfortable as the patients in talking about the inevitability of death and the necessity to plan for it.  Finally, the nurses came to accept it and now these discussions are a daily routine.”

Planning ahead through the use of advance directives also saves money. One quarter of healthcare spending is in the last year of life. That spending goes to hospitals and doctors.  Of the 306 regions in a recent Dartmouth study, Lacrosse spends less on health care than any other place in the country.  This is a direct result of end-of-life planning as fewer people burden themselves with costly medical care which will not provide them with quality of life at the end of their days. 

Many states – including Indiana -- are now turning to LaCrosse in an effort to duplicate its success.  They are reaching out to Bud Hammes to ask him “How do we get people to plan for death?”  A new pilot program in northeast Indiana called Respecting Wishes is modeled after Bud Hammes’ program in LaCrosse.

Respecting Wishes trains of physicians, nurses, and other key medical personnel to discuss advanced care planning with individuals.  A standardized curriculum is being developed to train the members of advanced care planning teams to ensure the delivery of a consistent and reliable advanced care plan, to assist patients with an informed, timely, and specific decision-making process, and to promote timely and appropriate referrals to other needed services.  The goal is to ensure clinical care is consistent with the individual’s wishes, improve the decision-making process by facilitating shared decision-making among patient, physician and the patient’s representative, and to improve patient outcomes.  It is the hope that this program will be adopted in other Indiana counties if the pilot is successful.

If you are interested in ensuring that your end-of-life decisions are documented, Indiana offers the following advanced directives:

Medical Power of Attorney/Appointment of Health Care Representative – allows an individual to appoint a representative to make health care decisions for him or her if he or she becomes unable to make health care decisions for himself or herself.  These decisions include such issues as consent to surgery, access to medical information, release of medical information, choice of a physician, choice of a facility or provider of services, admission to a facility, and withdrawal or withholding of medical care.  A few decisions may also be made after an individual’s death, including decisions about organ donation, whether or not an autopsy should be performed and funeral arrangements.

Living Will – a Living Will allows an individual to state whether or not he or she wants his or her life artificially prolonged by tubes and machines.  In order to be effective, the individual’s attending physician must certify that: 1) he or she is suffering from an incurable injury, disease or illness; 2) his or her death will occur in a short period of time; and 3) the use of life-prolonging procedures would serve only to artificially prolong his or her life.  If those three provisions are met, the individual may elect to have life-prolonging procedures, such as ventilators and artificially supplied nutrition and hydration, withheld or withdrawn so that he or she may die naturally with only medical procedures or medication necessary to keep the individual out of pain and comfortable.

Life-Prolonging Procedures Declaration -  The opposite of a Living Will, a Life-Prolonging Procedures Declaration allows an individual to indicate that if he or she is suffering from an incurable injury, disease or illness determined to be a terminal condition, he or she requests the use of life prolonging procedures which would extend his or her life.

POST (Physician’s Order Scope of Treatment) – Indiana’s newest advanced directive, a POST is completed by the individual or his or her representative with his or her physician if the individual is suffering from a chronic or terminal illness or chronic frailty.  POST allows the individual to be specific about the types of care he or she wishes to receive under the circumstances, including CPR, antibiotics, the level of medical intervention desired (minimal to full), and pain medication.

Funeral Planning Declaration – Indiana also has its own Funeral Planning Declaration form allowing an individual to appoint a representative to carry out his or her wishes for his or her funeral.  The form allows the individual to be specific about the type of funeral and burial he or she may want, including burial, cremation, time and place of service, choice of funeral home, and any other specific directives the individual may wish to include about his or her funeral or burial.  In the absence of a funeral planning declaration, the individual designated to serve as the health care representative is in charge of funeral planning decisions under Indiana law.


For more information about advanced directives or to get assistance with your end-of-life planning, contact Geyer & Associates at 317-973-4555 or www.rgeyerlaw.com.

Sunday, February 16, 2014

Significant Changes Ahead for Indiana Medicaid Law

      Effective June 1, 2014, Indiana is changing the way Hoosiers will obtain Medicaid coverage in the aged, blind or disabled categories. Currently, Indiana is known as a 209(b) state. When an individual applies for disability coverage, he or she is subjected to additional, more restrictive criteria by the state than the Social Security Administration (SSA) requires for its Supplemental Security Income (SSI) and Social Security Disability Income (SSDI) programs. On June 1st, Indiana is converting to an SSI state (otherwise known as a 1634 state) and will follow SSI rules for many of the income and resource eligibility requirements of the Medicaid program. Here are a few highlights of this significant change:

First, beginning June 1, Indiana will automatically enroll individuals that the Social Security Administration determines eligible for SSI into Indiana Medicaid and will accept all SSA determinations of disability. This will eliminate the current burdensome requirement that these aged, blind and disabled applicants complete a separate Medicaid application and go through a second medical review process to be determined eligible for Indiana Medicaid with disability coverage.

Second, under current law, there is no cap on the amount of income an individual may receive and qualify for Medicaid.  Under the new SSI rules, individuals with gross income in excess of $2,163 per month will no longer be eligible for Medicaid unless they establish something known as a Miller Trust.  A Miller Trust is a special legal arrangement for holding some of an individual’s income. A Miller Trust allows the Medicaid recipient to put the amount of his or her income which exceeds $2,163 into the Miller Trust so that his or her income is less than the income standard required for Medicaid eligibility.  Indiana anticipates that 3,900 current nursing home residents will need Miller Trusts as a result of the conversion to an SSI state.  Indiana is not phasing in the Miller Trust requirement, and will be sending letters to all 3,900 nursing home residents about the requirement to establish a Miller Trust when the conversion takes place.
Third, the resource eligibility rules will also be changing as part of Indiana’s conversion to an SSI state.  Individuals will now be entitled to $2,000 in countable resources on the first of each month, and married couples with both spouses receiving Medicaid will be entitled to $3,000 in countable resources on the first of each month, up from $1,500 and $2,250 respectively under current law.  At this time, we do not anticipate significant changes to any other resource eligibility rules.

    The State of Indiana believes that once this transition is complete, recipients should enjoy more comprehensive Medicaid benefits.
     As incoming president of the Indiana Chapter of the National Academy of Elder Law Attorneys (NAELA), my colleagues and I have worked closely with the Family and Social Services Agency (FSSA) to ensure a smooth implementation of these changes. To find more information, you can now visit http://www.in.gov/fssa/4859.htm.  As with any major change, some of the elements may be confusing or difficult to understand.   The attorneys at Geyer & Associates are available to answer any questions and assist Medicaid recipients throughout this process.

Tuesday, February 4, 2014

Communicate Now: Gathering the Necessary Information to Care for Your Aging Parent

            Dealing with the physical and mental challenges of caring for aging parents is a growing issue for millions of American families.  Although it is impossible to prepare in advance for all potential issues, there are steps you can take now to prepare for the future.  By talking to your parents about the following subjects, you will be equipped to make educated, informed decisions on your parents’ behalf, ensuring that they receive the best care under any circumstance.
            Income.  How much income do your parents receive each month and from what sources?  Most Americans age 65 or older receive monthly social security benefits.  Retired individuals may also receive a pension from a previous employer.  If your parent is a veteran, he or she may be receiving a monthly pension from the Veteran’s Administration.  Certain assets – stocks, annuities, certificates of deposits - may also be earning interest or providing payment on a monthly or annual basis.  It is important to know how much monthly income your parents are receiving, how it is paid, and on what date it is received.  Some income may arrive via a monthly check, while other sources may be directly deposited into a bank account.
Assets.  What assets do your parents own?  Do they live in their own home or rent an apartment?  With whom do they bank?  What types of accounts do they possess?  Your parents’ assets may include real estate, bank accounts, stocks and bonds, brokerage accounts, retirement plans, life insurance policies, motor vehicles, safe deposit boxes, and personal property.  Document what your parents own, the value of their assets, and where information can be found with regard to each asset.  Knowing your parents’ income, asset, and expense information will allow you to properly plan for the costs of their future care.
            Expenses.  What are your parents’ monthly expenses?  Do they still have a mortgage on their home?  How much do they owe monthly for utilities, car insurance, food, rent, medication, health expenditures, credit cards, and other liabilities?  Arming yourself with this information in advance will make it easier to step in and begin handling your parents’ financial transactions if the need arises.  Pay special attention to how your parents pay their monthly expenses.  Many individuals have utilities and other payments directly debited from their bank account each month.  Some individuals utilize online banking and bill pay services.  Learning this information while your parents can still communicate is vital as it may be necessary to know your parents’ passwords in order to access bill pay and other financial information.
            Important Advisors.  The names and contact information of each of your parent’s important advisors are critical information which you should possess.  Gather information on your parent’s primary care physician, eye doctor, dentist, any specialists with whom they consult, their lawyer, accountant, and financial advisor.  By knowing these names in advance, you know who to contact in the event of an emergency or if the need arises for additional information.
            Health Insurance.  At some point your parents will almost certainly need medical care.  Whether it is a routine check up or an unexpected hospitalization, health insurance information will be required.  If your parent is over the age of 65, he or she is likely enrolled in Medicare which is federally-sponsored health insurance for individuals 65 and over and certain disabled persons.  Your parents may also have a supplemental health insurance policy.  Who is the carrier?  Are they insured through a former employer?  Do they have a prescription drug benefit such as Medicare Part D?  Do they have long term care insurance?  If so, who is the carrier and what type of benefits does the policy provide?  Familiarize yourself with your parents’ health insurance information and the location of their health insurance cards.  It is also a good idea to copy each card so that you have the information available in the event of an emergency.
Medication.  You should be aware of what medications your parents take and what the dosage amount is for each medication.  As your parents age, they may no longer remember to take their medication regularly.  Knowing what medications your parents should be taking, and in what amount, is a huge help in these circumstances.  You should also know the name and location of the pharmacy where your parents fill their prescriptions.
            Legal Documents.  Have your parents drafted any legal documents addressing what is to occur in the event of their disability or death?  If your parents have done estate planning documents such as a will, trust, power of attorney, and health care directives, you should, at a minimum, know the location of such documents.  Ideally, if you are the named representative to act in the event of a disability or death, you should have a copy of the document giving you such authority.  If your parents have yet to do their estate planning, a consultation should be scheduled with an attorney in the near future.  Failing to properly designate someone to handle transactions upon the death or disability of a parent could result in costly guardianship and other legal proceedings.
            Where are important documents kept?  Knowing the location of your parents’ important documentation – financial records, legal documents, health insurance information, and contacts – is extremely important.  You need to know where to find the information if and when it is needed.  Is all documentation kept at home?  Do your parents have a safe deposit box?  If your parents do have a safe deposit box, at what bank is it located, where is the key kept, and do you have access to the box in the event of an emergency?  Many families possess home safes.  If your parents have a home safe, make sure you know the combination so that you can access their important records.  Don’t forget online banking and bill pay passwords.  Possessing this information will allow for a more seamless transition if you must begin handling your parents financial affairs. 

            By communicating with your parents now about the above topics, you can arm yourself with the tools necessary to advocate on your parents’ behalf should the need arise.  Possessing this information in advance allows you to act efficiently, swiftly, and compassionately while reducing stress in the event of an emergency.  Don’t let another day pass without gathering this information as it may then be too late.