RSS Feed Print
Things Moving Along
BillBRNC
Posted: Wednesday, May 18, 2016 11:25 AM
Joined: 12/2/2015
Posts: 1018


On Monday, we drove to Asheville to see our Estate attorney, and we signed Wills, POAs, Trusts, and who knows what else. We have moved our condo and investment accounts into the Trust, so that is done. We changed homeowner insurance to name the Trust as owner. I still have to put my wife on my bank account. Everything that needs to be recorded at the courthouse has been recorded by the attorney. My local doc has gladly accepted the handoff from the medical center, and he and my wife spoke with the local neurologist last night after a hospital meeting. I official have the service dog, but not completed with training and delivered until hear the end of June. Interestingly, the local neurologist isn't a fan of Namenda until further along in progression, but he is a fan of upping Exelon and the SSRI. He and my family doctor believe that the SSRI helps with mood and behavior issues that result from Alz and LBD, as opposed to existing on their own separate from the Alz and LBD. The dummy at the medical center kept saying that I had stand alone longstanding depression. How he could know that after seeing me for 5 seconds eludes me, but he is a newly minted master degree in counseling to go with his medical degree where he was a radiation oncologist. I'm shed of him now, so that's good. I haven't noticed any improvement from the lower dose of Exelon, but the neuro guy think that most folks don't notice anything other than the side effects until they are solidly on the middle dose, but I won't start that for a few weeks yet. Things are moving along, so that is nice, other than for having Alz and LBD. Not much nice with that I think.
llee08032
Posted: Thursday, May 19, 2016 7:04 AM
Joined: 5/20/2014
Posts: 4408


Congratulations on the service dog Bill! I am glad to hear you have included the local neurologist along with your PCP. You certainly have accomplished a lot over the last several months!
alz+
Posted: Thursday, May 19, 2016 9:53 AM
Joined: 9/12/2013
Posts: 3608


much easier when you know what you're dealing with. You got a lot done, now relief.

the dog is preparing - exciting news!


Iris L.
Posted: Thursday, May 19, 2016 1:21 PM
Joined: 12/15/2011
Posts: 18519


Now that the legalities have been accomplished, and you are on medication, continue with the rest of Best Practices, and go live your life, Bill!  


I truly believe that we are Dementia Pioneers, because we are the first generation who are actively involved in our own treatments.  


I hope that you have what I have had, better functioning and prolongation of the early stages.


Did you see my post to you about dealing with the agitation and anger?  If not, I will repost it into it's own thread.


Iris L.


Gig Harbor
Posted: Thursday, May 19, 2016 4:38 PM
Joined: 3/10/2016
Posts: 1161


We have not consulted with an attorney yet but I am curious why you are using a trust. If it is just a husband and wife and you live in a community property state is a trust needed? Thanks in advance if any info you can pass on.

 


BillBRNC
Posted: Thursday, May 19, 2016 7:18 PM
Joined: 12/2/2015
Posts: 1018


I don't know if NC is actually a community property state, but what it has is about the same thing. I'm using a trust because the attorney told me to. I think the reason is to avoid having to go through probate court when one of us goes to the other side. It also continues on down the line to our grandchildren. Really, I don't think it is needed, but who knows. It does leave certain tax options open if Congress at some future date were to significantly lower the estate tax exemption. Bottom line, we did it because the attorney told us to. While I used to be an attorney, I don't know anything about estate law, plus I don't know much about anything anymore. Good luck.
Gig Harbor
Posted: Thursday, May 19, 2016 8:54 PM
Joined: 3/10/2016
Posts: 1161


Thank you. I will definitely look into it.
Iris L.
Posted: Thursday, May 19, 2016 9:05 PM
Joined: 12/15/2011
Posts: 18519


From what I understand, people use trusts to get property out of the patient's name.  Then, when Medicaid is needed, the patient can qualify as having no assets because the assets are in a trust. 

 

Iris L.


Mimi S.
Posted: Thursday, May 19, 2016 9:06 PM
Joined: 11/29/2011
Posts: 7027


Wow Bill,

I am impressed with how all are working together.

 

You and your wife make a great team.
The_Sun_Still_Rises
Posted: Saturday, May 21, 2016 11:42 AM
Joined: 7/24/2015
Posts: 3020


Epic Phew for you Bill!  I am so glad things are getting done for you.  I am so, so happ on the Service Dog...I hope you will let me know how it goes when you get it.  <3

-------------------------------------------------------------

Trusts can be used for all kinds of things. 

The most basic use of a trust is for protecting a chunk of your assets from estate taxes when you die.  I think (an this may just be for CA) but you can insulate $365,000 (each spouse) from estate tax via a trust.  Estate tax can be as high as 48%...so it well worth it insulate you money if you have it.

The other huge reason for trusts is have a say in HOW whateve you are trusting over is handled.  For example...I could trust my house my daughter an include a provision that she is unable sell it until my mom passes away.  This would protect my mom. 

A side perk of a trust...is that whateve you put in the trust is no longer yours.  So, if you have $100,000 an you put in a trust...you no longer have it.  You do no immediately qualify Medicaid, however, since Medicaid has a 5 year (60 month) look back...an it IS considered a "transfer" of assets. 

So...in example of couple who have $100,000 that they had hoped leave their children after death.  Now one of couple get's dx'd...an although things still good, they realize that changes are coming...an want be prepared.  They realize that they will likely spend that $100,000 on cares an it will quickly be exhausted an there will be nothing for their children.

They could:

A) divide an give the money their children right now (there will still be nothing for them when the couple die)...and, the couple now have no control over how their children spend the money.  An in 5 years (60 months) will qualify for Medicaid.

Now, maybe they have young adult children who may not have the maturity an foresight yet, spend unwisely...lose an lose it.  The couple might see this as a problem with option A.

B) spend the money (on things other than assets)...an in 5 years (60 months) qualify for Medicaid.  However, this means there is still nothing for their children.

or...

C) put the money in a trust...to be paid their children in whateve way the couple deems appropriate...like, for college, for a new car...at a certain point in their children's lives...like when they graduate college...or, after their death.  An in 5 years (60 months) qualify for Medicaid.

There is, of course, always the option of...as well.

D) keep the money...as disease progresses, spend it on person's care...when money used up, then qualify for Medicaid.  Children get nothing.

In the end...whether you give it away now...or put in trust...it is still a transfer that must be reported an will prevent you from qualifying Medicaid right away.  You have report this for 5 years from date you do it...which is why you do it as early on as you can...since you don't know how disease will progress for you...an by the time you do, an by the time you know you need the help Medicaid can offer you (many services for which you can no cash pay)...it will be too late get rid of that money. 

We are in this process right now for my mother.  She choose spend her money.  This is, sadly, the quickest, best option if your person NEEDS qualify Medicare....OR a Waiver.

Waivered Services (which every state has, under various names)...like the Elderly Waiver...offer a range of in-home supports help your loved one stay in the home.  In our state, they have something called Alternative Care which will allow my mother get on the Elderly Waiver without needing qualify for Medicaid.  The asset limit for Medicaid is $3,000, but the asset limit for our Alternative Care is $20,000...which is great, be cause it will allow my mother keep more of her hard earned assets....AND, allow us get her services care for her...do for her what I have been doing...which will be huge weight off my shoulders as my disease progresses. 

For those choosing the spending down option...it will still need be reported for 5 years them...so you need keep recipts an accurate records what you spent it on.  IT HAS BE SPENT ON THAT PERSON...otherwise is considered a gift or a "giving away" of the money, which is no allowed.  If you can accomplish that, then once money is gone...your loved one should qualify for Medicaid, or the Waivered Services...or Both. 

For us, we had choose the spend down method because we did no have 5 years wait (I will no be able care my mom the next 5 years).  But, if time was no the issue us...we would have chosen the trust option.

Please understand that this is just a very basic overview on trusts, that there are all kinds of trusts that can do all kinds of diff things...that no thing in this should be construed as legal advice, an that you should seek legal consult in learning more about what kinds of trust options would apply your specific situations. 

<3


The_Sun_Still_Rises
Posted: Saturday, May 21, 2016 11:56 AM
Joined: 7/24/2015
Posts: 3020


PS Bill, I re-read you line bout the neurologist no real fan Namenda until later...

Sounds me like he think you have depression an no dementia...or, he is oblivious how Namenda works.  Some times these matters, you have push for what you know be true...an ask what you want. 

With Namenda, Aricept...an the ilk...there is absolutely no benefit derived from waiting start it.  Sounds like he waiting while, just be sure you have it...waiting maybe until he sees it???

On side effect of the Alz Asso, with the good they do...is that they perpetuated the image of elderly far gone dementia patients...an so that is what many doctors (an general public) think of when they hear the dx.  They look at you...an you (I assume) appear no thing like that image...an so they likely begin wonder...what up that. 

Also, unfortunately, many doctors who find out you on an anti-psych med write you off.  I hate that they do that peop.  Not all doctors of course, but some...enough drive me nuts.  You don't hear bout it much these forums...but in chronic illness circles, it is the largest common denominator what causes peop go years an years without diagnosis an treatment.  So bothered am I by this fact, that if I had eve gone on become an attorney...I would have liked do my part in changing the law regarding this an start holding doctors who do this personally liable for those lost years peop's lives.  Seems, if you symptoms do no scream what they are...doctors think you either have depression or anxiey an that that causes eve thing you experiencing!  A friend mine eve told me her doctor said, point blank, that her depression caused her torn muscles from a fall (from her weakness).  'Oh yeah,' the doctor say, 'depression cause all kinds things.' 

Any ways, I could go on for eve this subject...I glad you know bett.  If you want Namenda, I would ask gain...say, "I know you like wait...but I would rather have it now, unless you have a solid medical reason why no give it me." 

Hope that helps.  Up an on...

<3


BillBRNC
Posted: Saturday, May 21, 2016 12:28 PM
Joined: 12/2/2015
Posts: 1018


Sun, I can't say why the local neuro prefers to hold off on starting Namenda, but it isn't because he questions my diagnosis. He knows I won't be coming to him. He was just giving my wife and her  partner his two cents on Namenda. Like many doctors even the neuros, they get hung up on the fact that the label says it is only for use in moderate and severe cases. They think I'm late early or very early moderate, and that is why he thinks we should hold off. The label also indicates that Namenda only is effective for a realiatvely short time, thus the docs fear that the benefit would be lost from prescribing it too early. Now, I think most folks who take the medications know that all of them can benefit for many many years, so there really is no reason to wait on starting it. When it comes to progressive dementia, you either save it now or lose it forever is my way of looking at it, so I think I should start Namenda as soon as I get stable on higher dose Exelon. When I researched Namenda on the web and medical articles, literally all of them say not to give it until the moderate phase and that it works for only a year or so. Now, we all know that Namenda has been joined with an Exelon-like drug to be give early in the process, so that tells me that somebody knows Namenda is good for early stage. Plus all the folks here say almost the same thing. I plan to revisit this Namenda issue with my wife and her partner after I get stable with Exelon. No need to argue about it right now, but I do plan to press for it.
jfkoc
Posted: Saturday, May 21, 2016 2:07 PM
Joined: 12/4/2011
Posts: 21250


Based only on what you have said, or what I think you said, your Dr sounds prudent. It makes sense to add meds and increases one at a time to be able to see what works and what doesn't.
Unforgiven
Posted: Saturday, May 21, 2016 3:54 PM
Joined: 1/28/2013
Posts: 2659


Iris, only irrevocable trusts are judgement proof.  A revocable trust my take certain assets out of your name, but they still are considered to be your assets, although someone else may control them in case of your incapacity.  In either case, there is language written into the trust about how and for whom the assets must be used.  Really, trusts are only useful for avoiding the extra expense of probate, which can get very expensive and frustrating if your heirs are left property in a will or, god forbid, die intestate.

My spouse and I have a family trust that designates who will be the beneficiary of any remaining assets, but it won't protect us from having to spend down to qualify for Medicaid.  Unfortunately, it won't protect us against ourselves during that stage of bad judgement that comes between the onset of dementua and full incapacity.  Knowing what I know now, I actually wanted that, but our lawyer advised against it.


Iris L.
Posted: Saturday, May 21, 2016 4:53 PM
Joined: 12/15/2011
Posts: 18519


Thank you for the information on trusts, Unforgiven.  I understand about using a trust to avoid probate.  But I have seen many posts on the Caregiver and Spouse/Partner boards about putting the PWDs assets into a trust.  I thought that was to protect the assets from Medicaid spend-down requirements or reimbursement requirements.   

Iris L.

Unforgiven
Posted: Saturday, May 21, 2016 5:35 PM
Joined: 1/28/2013
Posts: 2659


I'm not a lawyer, but I've had my experiences with trusts and wills.  I think that it might be possible to preserve assets  in an irrevocable trust, but the downside is the loss of control over the money if any unforseen emergency arises.  The usual advice for preserving family assets if to give away property as a one time gift and hope that (1) your remaining assets will support you until the lookback and (2) your heirs will do the right thing if the time comes.

In fact, an irrevocable trust may be written in such away that the income from it will disqualify you from getting Medicaid because it is too high, even while being insufficient for private pay in a SNF.  

If you have heirs, set up a trust.  A will isn't enough, no matter how fair the split is.  My mother-in-law had a will dividing her assets equally among five children, and it ended up being a nightmare.  If you have no one to leave it to, a will is enough.

There is much bitterness about protecting assets, but sometimes those assets are a house that has been in the family for generations, or a family farm or a business that is a family endeavor.  We might rather be thinking about why a catastrophic illness bankrupts the average American family.   I consider dementia to be a catastrophic illness rather than a normal result of aging.

Oh, and Bill?  You don't sound anywhere near moderate at this point.


BillBRNC
Posted: Saturday, May 21, 2016 6:43 PM
Joined: 12/2/2015
Posts: 1018


Unforgiven, I hope you are right about my staging. I have variable symptoms, which seems to be one of the Lewy Body things, but who knows. I know I'm still relatively independent and can take care of myself, just with difficulty and feeling weird. Oh, I think the trust you were referring to is a Spendthrift Trust. The beneficiary has no control, but the assets in the trust don't count for Medicaid issues. My Sister in Law has one, and she can get Medicaid and some type of disability payments, but not SSD. I'm not sure what she gets, maybe it is called Supplemental SSD. I don't know. If the beneficiary has any control over the money, then you probably don't get to exclude it. Like I said, I'm not an estate or trust attorney. In fact, I'm not even a licensed attorney anymore. I gave it up, as I didn't want to take the continuing legal education courses or pay all the fees and malpractice. So I can't and don't give legal advice to anyone. Folks here need to see Elder Care Attorneys. We have one now, and she seems to know her stuff, and we know her personally, so I know she at least will try not to screw us over. Good luck to all.
Iris L.
Posted: Saturday, May 21, 2016 9:08 PM
Joined: 12/15/2011
Posts: 18519


Moving away from the subject of wills and trusts...I see us as Dementia Pioneers.  We are the first generation of people who are actively involved in our own care with Best Practices.  I don't pay too much attention to stages.  I can dress myself and I don't get lost.  


I am more concerned with how I can prolong where I am today and how I can maintain my independence.  I am looking at myself from the inside, not from the outside.



Iris L.


Michael Ellenbogen
Posted: Sunday, May 22, 2016 9:27 AM
Joined: 11/30/2011
Posts: 4463


Iris it may be very easy to say that when you are in the begin stage but as you get worse you do want to have some idea. Not that it’s easy to figure that out because so many things overlap. It is good to know so you know what to expect. It part of being proactive.

 


Iris L.
Posted: Sunday, May 22, 2016 9:48 AM
Joined: 12/15/2011
Posts: 18519


I am being proactive.  I am being proactive in FIGHTING for my life!  And it's working.  


I'm not sitting around, waiting for the Grim Reaper to take me, nor planning my own demise.


Nor am I calling someone who spent her entire career healing sick children a jailer!

 

I'm LIVING my life every day.  This is what I have learned from researching people who are facing terminal illnesses.


Iris L.