Alzheimer’s and Dementia Part 3

 

4.      Financial Status

Use this week to ask tough questions about your parents financial status. Be sure that their finances are appropriately managed after their diagnosis of Alzheimer’s or Dementia. Find the location of safety deposit boxes, bank accounts, investment or brokerage accounts, outstanding debts or other assets unknown to the family. If you don't have these hard discussions, funds that could be used to cover the costs of long term care could be lost and forgotten when memory loss ultimately occurs.

5. Contacts and information

Ask now, while memories are still sharp. Begin to work with your elder parents to compile a list of important contacts and other information that will be useful to the family if memory loss occurs. Get information on doctors, professional advisors (ie. accountant, attorney, financial advisor) and important passwords for online accounts.

“These conversations are NEVER easy. Having these talks though can ease every member of the family's transition into living with Alzheimer’s or Dementia.” says Steve Cohen. “Plan Ahead, if at all possible, don't leave these things till it is too late and you have to react instead of plan. Your parents will appreciate your care and concern that their wishes be followed and honored ”.

 

For further information contact our elder law attorneys at Cohen & Oalican, LLP.

Alzheimer’s and Dementia Part 2

 

According to the law firm of Cohen and Oalican, elder law attorneys in Boston, MA, there are 5 specific conversations adult children should have with their parents as soon as the opportunity presents itself. They comprise the following:

1. Long-term care preferences

Would your parents prefer nursing home, long term care, or in-home care if there had to be a choice?  If they prefer a long term care or nursing home facility, what amenities and activities are important to them? Asking these questions early can smooth the moving to an assisted living facility or a home-health care program far simpler should the need ever present..

2. Legal Documentation

What good is a living will if no-one knows where to find it?  It is critical that you know what legal documentation your parents have before incapacity occurs. This includes making sure their parents have a power of attorney, health care directive and HIPAA forms so someone can easily step in to make financial or medical decisions on their behalf.  In absence of this documentation, the family can be forced into petitioning a court for control over their parents.  This can be expensive, time consuming, and may not result in what your aging parent wanted with their lives.

3. Medical Preferences and Wishes

Please discover what type of, and how much care your aging parents want as soon as possible after their initial diagnosis of Alzheimer’s or Dementia. Understand their desires about life support and  other end-of life medical treatments. Who do they want to make these decisions for them if and when they can’t?  This will help your parents' security in knowing that their desires in this area will be carried out, despite the family trauma that enfolds itself around Alzheimer’s and Dementia.

to be continued….

Alzheimer's and Dementia

 

While most of the country is involved in Valentines activity this week, those who care for elders with special needs are more than aware that this is also Alzheimer’s and Dementia awareness week (February 14th –21st).  This week is the perfect time to show your love for those you care for by having the “tough love” hard conversations with elderly aging parents about their wishes and plans should the disease ever strike.

“Does Dad want to be in an assisted care facility, or a nursing home?”

“Does Grandma look at life with Alzheimer’s or Dementia to be quality of life?”

“Do you have, and where do you keep legal documentation ensuring someone can act financially on mom or dad’s behalf  if they are no longer able to act on their own behalf?”

These are many questions that experts in all fields urge adult children to ask of their parents during this year’s Alzheimer’s and Dementia Awareness Week (February 14th- 21st).  These answers help family’s build a plan, and know how to execute their parents’ wishes in the tragic event that mental illness strikes.  Don’t leave the decisions to when it becomes a battle between siblings, or until there isn’t enough time to financially prepare.  Have these heartfelt conversations now.

“We see so many families that waited on important conversations, that come to us in crisis mode, instead of planning mode regarding Alzheimer’s or Dementia  - Crisis mode is expensive, and results too often in knee jerk, and expensive decisions.” says Boston elder lawyer, Stephen Cohen. “Legally, if an adult child doesn’t know  their parents’ wishes, or can’t put their hands on instruments like a durable power of attorney, they can be left with a legal, financial and tax quagmire, while simultaneously dealing with the physical and emotional needs of this debilitating disease”, adds elder law partner Eric Oalican.

 

to be continued…

Sharing of Data Leads to Progress on Alzheimer’s Disease–Part 2

The need was for all researchers and experts to come together to work and evolve a standard data set. But how was this possible? It would entail an incredible collaboration as no one company or researcher could manage to do this alone. The project would involve 800 subjects with varying degrees of memory impairment; some normal, some with a little impairment, some with Alzheimer’s and all had to be tested for the biomarkers and then followed up for several years to judge whether the markers heralded the progression of the degenerative disease. It did seem an impossible project and one that was way beyond anybody’s implementation.

But in the car, Dr. Potter had an intuitive flash when he felt that this project due to its seriousness of objective and aim of ending untold suffering may well propel people to work together in a way that had never been attempted before. The concept was to make the National Institutes of Health the go-between or broker between the world of academia and the pharmaceutical industry. Very soon afterward the director of the National Institute on Aging Dr. Richard J. Hodes talked about this to the former scientific director at the National Institute of Mental Health, Dr. Steven M. Paul and the latter agreed to consult the drug companies to find ways of getting funding for the research. Soon it became clear that all these companies were ready to assist as the development of diagnostic methods was a gigantic task that no one could manage on their own. Collaboration was the need of the hour. Congress established the Foundation for the National Institutes of Health to find ways and means to garner private funds for the institutes. Dr. Steven M. Paul was appointed to the board of the foundation.

Ultimately, $ 41 million was given by the National Institute on Aging, $2.4 million was contributed by some other institutes, 2 non-profit associations and 20 organizations together managed $27 million and this became the initial seed money to get the project started and keep it going for the first 6 years. The National Institute of Aging advanced another $24 million last year and on the basis of further federal and private funding the foundation made plans for the project to continue for another 5 years.

In the beginning, the unique parameters of the project had many scientists worried as they wondered whether giving up ownership and sharing valuable data with all and sundry would result in anything positive at all. There could be misinterpretation, misuse and wrong information being disseminated that could do more harm than good. But despite the misgivings, all realized that there was no alternative to this collaborative endeavor. Even the drug companies, who were usually looked upon with suspicion, were roped in and everyone had to overcome this mental block, according to Dr. John Karlawash an Alzheimer’s researcher at the University of Pennsylvania.

Dr. Karlawash stresses the need to combine resources and work together. The need to find these valid biomarkers for Alzheimer’s was urgent and the entire process demanded such huge funding and massive research that it was impossible for any one company or academic institution to even think of embarking on the project. It had to be a collaborative exercise and now all concerned are making use of the data. The huge data set has been downloaded at least 3200 times and the data sets comprising images of brain scans have been downloaded almost a million times.

The positive outcome of the project has delighted Dr. Buckholtz who says that he is quite “pleasantly surprised” by the way it has turned out. No one was sure how this innovative concept of sharing everything in the public domain in a research project would evolve, but they were confident that ultimately there would be some good coming out of the hard work and combined research. That is how it has turned out to be and it has kindled new hope for the conquest of these diseases.

Could someone you love have Alzheimer’s? Do you have a long term plan to deal with the Medicaid issues surrounding this? Call Cohen & Oalican, LLP to draw up a plan.

Sharing of Data Leads to Progress on Alzheimer’s Disease - Part 1

A project was initiated in the year 2003 when the National Institutes of Health, the Food and Drug Administration, the drug and medical-imaging industries, universities and nonprofit groups joined hands in a joint endeavor to find the biomarkers that reveal the progress and evolution of Alzheimer’s disease in the human brain. It was a unique project in the annals of medical research and it is yielding results now, which are evident in a deluge of research papers on the subject.

Early diagnosis of Alzheimer’s is being done with PET scans and spinal fluid analysis and more than 100 drug studies are in progress to find formulations that might slow down or even cure the disease. This remarkable collaborative effort is showing the way for more such projects and a similar one has begun for Parkinson’s disease. The Michael J. Fox Foundation has sponsored a $40 million study to find the biological markers for Parkinson’s disease that will enlist 600 subjects in Europe and the USA.

The project has generated great excitement among the research fraternity as the agreement to share all data and make all findings public was something unheard of in the scientific world. Anybody with a computer anywhere can access all the data and go through the findings of all the research studies on the subject. The objective was not just to raise funds, or do research but share all the facts and figures and everything going on in the project on a global scale. There would be no ownership or patent of the data or the research finding and everything would be in the public domain. Private pharmaceutical companies would of course benefit in the long run from the drug formulations or imaging tests that were being developed during the project.

Dr. John Q. Trojanowski, an Alzheimer’s researcher at the University of Pennsylvania is stunned by the amazing scope of the project. It is a project that is unique and path-breaking in scientific research, according to him. But it is the only way to do it, as unless we kept aside our egos and intellectual property issues, the task of finding the biomarkers for these diseases would be an impossible one, he says. It does not mean that a person having the biomarkers would definitely get the disease, but that is also part of the project. The study aims to find those biomarkers that herald the onset of the degenerative disease.

The Alzheimer ’s disease Neuro-imaging Initiative or ADNI came about during a normal conversation about 10 years ago. Neil S. Buckholtz, chief of the Dementias of Aging Branch at the National Institute on Aging was being driven to the airport in Indianapolis by Dr. William Potter who was himself a neuroscientist at Eli Lilly. Dr. Potter was seriously thinking about the ways to hasten the progress of the drug research on Alzheimer’s. He wanted to come out of the typical drug development syndrome of the 19^th century, where a drug was administered and then everyone waited around for it to work. He felt that there must be some other method, where one could view the brain as Alzheimer’s developed and then formulate drugs to halt that development. There were efforts to locate biomarkers, but there was not much progress as different scientists in many different parts of the world were doing their own studies in their universities and with their own patients. They were obviously coming up with different results due to this.

Could someone you love have Alzheimer’s? Do you have a long term plan to deal with the Medicaid issues surrounding this? Call Cohen & Oalican, LLP to draw up a plan.

New Pathways to Parkinson’s and Alzheimer’s Diseases

Cohen & Oalican, LLP share recent Alzheimer's research.

Although Alzheimer's disease, Parkinson's disease and Huntington's disease have different genetic causes and pathways, all these ailments have one thing in common. All of them cause untimely death of the brain cells and the reason that this happens has been a dilemma to the treatment of these fatal diseases.

A recent study by a group of doctors and others at the Sanford-Burnham Medical Research Institute that was published in the July 30 issue of the medical journal Molecular Cell, throws some light on this brain cell death in patients of these diseases. The sudden and untimely transfer of a gaseous molecule called NO or nitric oxide from one cell protein to another could be the answer. Earlier research had revealed that NO and other molecules were responsible for nerve cell death or survival, but in this case, NO was seen to actually move from one protein to another through new molecular channels, triggering cellular suicide.

This was explained by the senior author of the research study group and the director of the Del E. Web Center for Neuroscience, Aging and Stem Cell Research at Sanford-Burnham, Stuart A. Lipton, M.D., Ph.D. Since this molecular evidence for the untimely cell death in Parkinson’s, Alzheimer's, and Huntington's diseases has been discovered, it would be possible now to utilize this new breakthrough to diagnose, treat and hopefully prevent these illnesses in the near future. As a Harvard-educated neurologist who runs his own clinical practice, Dr. Lipton is familiar with these fatal diseases as he observes his patients.

This research study has revealed that NO molecules relocate from the caspases to the XIAP proteins; the former are proteins that usually trigger cell death while the latter inhibit it. The caspases protein throws the NO molecule away like a “hot potato” to the XIAP protein to avoid the imminent cell death and this process happens through a chemical reaction called transnitrosylation. This action brings about a dual distress for the brain cells, as these cells are programmed to self-destruct when caspases do not have NO on them or XIAP have the molecule attached to them. Either way then it is death for the brain cells, as both these fatal actions happen simultaneously. In the study, it was shown that persons with neurodegenerative diseases had the NO molecule attached to the XIAP protein more frequently than those with normal brains. This reinforced the theory that this change in protein structure brings about cell degeneration.

The research group used a new arrangement of the Nernst equation to understand and analyze whether the caspases or the XIAP protein is more likely to end up with the NO molecule. The Nernst equation is taught in every chemistry class and is a mathematical equation that was found in the 19^th century. This possible prediction of the NO attachment to the brain cell proteins may ultimately help doctors to make earlier diagnosis of these neurodegenerative ailments, thereby kindling hope for treatment and cure. Cerebrospinal fluid and brain tissue from patients suffering from Parkinson's and Alzheimer’s is being studied and analyzed to find out whether the NO-attached proteins could be utilized as biomarkers to understand the progress and evolution of these diseases.

In ongoing research based on these findings, to formulate treatment and therapy to treat these neurodegenerative ailments, Dr. Lipton and his team are using robotic technology in Sanford-Burnham's Conrad Prebys Center for Chemical Genomics. Chemicals are being screened in their thousands to discover drugs that may stop the movement of the NO molecule from one protein to another, which may soon prevent brain cell death.

Do you have a plan if nursing home care is needed for yourself or your spouse? Will your home be protected?

Call Cohen & Oalican, LLP, they will help you to protect your home and all of you savings so you can focus on your loved one.

Alzheimer’s Disease and Dementia Care for Veterans - Part 3

Alzheimer’s Disease and Dementia Care for Veterans -
US Department of Veteran Affairs -
Part 3

Question: My father was a veteran of World War II and my widowed mother is afflicted with Alzheimer’s disease. Is she entitled to any VA facilities or services?

Answer: Certain VA health services are available for spouses of veterans. The websites given below can be looked at for more detailed information on these programs.

1. 1-800-827-1000: You can get information on VA benefits that are not medical.

2. CHAMPVA and CHAMPVA for LIFE (CFL), These sites give information on the health services available for the spouses and other dependents of veterans.

3. TRICARE and TRICARE for Life (TFL): The site provides information on the health services available for retired military personnel, their families and surviving dependents.

4. This site has the complete list of VA Medical Center locations and the contact details.

5. State Veterans Home Program: Owned and managed by the various states of the country, the admission criteria are also decided by the individual states. Care and services provided may sometimes be chargeable. The State Veteran’s Home offers a range of services, including day care, domiciliary, nursing home care and others. Some of these Homes take in the spouses of veterans, but there is no funding given by the particular state or the VA for the spouses or other family members of veterans. Your mother therefore would have to pay for all the services provided at the State Veteran’s Home, while the admission application would have to be made to the state authority concerned.

6. This site has information on the Aid and Attendance Benefit


Call one of our Elder Law attorneys at the offices of Cohen & Oalican, LLP, and let us guide you through the government requirements and available programs.

Alzheimer’s Disease and Dementia Care for Veterans - Part 2 Application Procedures

Alzheimer’s Disease and Dementia Care for Veterans -
US Department of Veteran Affairs

Part 2

Application Procedures

1. The person (veteran) must be enrolled for VA medical services. You can call 1-877-222-VETS (1-877-222-8387) toll-free or apply online by filling in the enrollment application form. You may also contact the enrollment coordinator at your nearest VA Medical Center or the VA Community-Based Outpatient Clinic.
2. At the VA facility, you can have a detailed discussion with the patient-care coordinator to understand and choose the suitable services that are available and appropriate for the medical condition of the veteran. The enrolled veteran’s priority status would matter in the payment for certain services. The services could be provided free of cost or may need some co-payment for some part of the services. The coordinator could help you with the different options available, offer you the specifics that you are looking for and also explain the co-payment terms and conditions. The prescription benefits are also part of the medical care provided by the facility. The veteran must go through a medical checkup by an authorized VA physician to obtain the medication from a VA pharmacy. The medication according to the prescription would be given as per the veteran’s priority group and income. There could be co-payment for this as well depending on the status of the veteran.

State Veterans Home Program:

The various states own and operate the Veteran Homes and establish their terms for admission and care. A variety of extended-care services, including adult day care, domiciliary and nursing home services are provided, though there may be charges for some of them.

The Department of Veteran Affairs pays a portion of the daily expenditure (per diem), which does not exceed 50% of what the state provides, for the veterans who are admitted to a State Veteran’s Home. The admission for application to the Home is made directly to the state concerned and the veteran need not be enrolled with the VA health care system to do this. He should however be eligible to get the VA per diem payments. The State Department of Veterans Affairs should be contacted for all the details on the Veteran’s Home services, including the procedures for admission and residency. The department would also be able to provide guidelines for the specific services provided for Alzheimer’s disease and dementia. The National Association of State Veterans Homes have a list of the State Veteran’s Homes, which is useful for knowing the locations of the different centers.

To discuss your Medicare and Long Term Care planning needs call Cohen & Oalican, LLP elder law attorneys in Boston, Andover and Raynham.

Alzheimer’s Disease and Dementia Care for Veterans : Part 1

Alzheimer’s Disease and Dementia Care for Veterans -
US Department of Veteran Affairs

There are misconceptions about the care provided for veterans afflicted with Alzheimer’s or Dementia. There are some usual queries that people usually ask us about this assistance.

Question: My father has been diagnosed recently with Alzheimer’s disease and he was a veteran of World War II. What kind of care and support does the Department of Veteran Affairs (VA) provide for people with dementia and what is the method of application for such services?

Services offered by VA: Veterans who qualify and are eligible for care, can avail of the range of services offered by the VA, which includes in-house care, community, outpatient care, inpatient and extended-care services.

The entire ambit of VA services includes the following:

• Primary Care/Home-based: This would be focused on support for the homemaker and home-health aide, with respite being an important area. It would also include adult day health care, visit to the outpatient clinic and related services.

• Extended/Inpatient care: Veterans with dementia are entitled to general care in the VA outpatient and inpatient facilities. Along with this, some care infrastructure has been developed for specific dementia services, which includes Dementia Clinics for outpatient treatment and extended care in a Dementia Unit for inpatient services.

There are no special eligibility conditions for veterans with dementia. The normal procedures for eligibility and applications must be followed.

To discuss your Medicaid and long term care planning needs call Cohen & Oalican, LLP elder law attorneys in Boston, Andover and Raynham.