This is cause for real celebration. It doesn’t matter what you think of the Affordable Care Act. It’s the fact that we can also listen to every word spoken in the Supreme Court that is astonishing. Talk about empowering.

First, make a list of everything you want to discuss with the nurse. That means all your loved one’s medical issues, medications, medical history, along with all the things you think she has trouble with and needs help doing. Ask other people to help you put together this list so that you don’t forget anything.

On the day of the visit, make sure that the primary caregiver is at the home. That may be you, it may be another family member, it may be a home health aide. Whomever can give truthful reporting as to the elder’s abilities and needs should be at this screening. As most of us decline, whether physically or mentally or both, we become very good at downplaying our shortfalls. No one wants to admit that they need help, especially not with the basics of life, like climbing stairs and getting dressed. Elders tend to be embarrassed that they can no longer do these basic things alone and will tell the nurse that they are more able than they in fact are. The caregiver needs to make sure that the screening nurse gets a full picture of the elder’s needs.

Remember that your job is to make sure the nurse has as accurate a picture as you can give her of the elder’s abilities and needs. Only then can she design a plan that will bring in as many services as possible to fit your loved one’s needs.

We are living in the beginning of the age of electronic medical records, so you would think it would be a no-brainer that your Health Care Proxy, HIPAA Statement, and advanced directive would go with you to your new medical institution. But even the best computer systems are run by humans, and we all know that medical institutions are understaffed.

Be on the safe side and bring these documents with you. When you get to the new institution, make sure these are placed in your chart. And then tell every nurse and doctor who comes to see you that they can find these documents in your chart.

Start the rollover process right away! The IRS gives you sixty days, regardless of any blunders by the financial institution. By starting the process immediately, you give yourself some wiggle room to fix any problems and complete the rollover before the sixty days are up.

Ask your doctor to take your advance directive and convert it into doctor’s orders. That way, in an emergency, hospital staff will look in the chart and immediately see your directives, written in a format that they are used to.

If your loved one is confused or forgetful, etc., it is critical that you work with a neuropsychiatrist to nail down as best as you can the exact diagnosis. There are three major benefits to investing the time in finding a diagnosis:

1. You as a caregiver can learn how to modify your behavior to have the most positive interactions with your loved one;
2. You will know what to expect down the line; and
3. The doctor can prescribe the correct medications.

Typically the neuropsych will order an MRI. It takes time to come up with the right diagnosis, but the investment is well worth it.

If you have a serious or terminal illness, complete the Your Way workbook in pencil, and then go over it with your doctor or nurse practitioner. They should be able to help you outline wishes based on what they know may lie in your future as your illness progresses.

Have a hard time getting an appointment with your doctor? Or don’t think he gives you the time you need? There’s an alternative. I work with a wonderful geriatric nurse who can sit down with you, discuss what to expect down the road from your illness and what the medical choices will be at various turns in the road. If you would like to meet with her for a private session, so that she can help you articulate educated, thoughtful end-of-life wishes, please call me.

Trusts come in lots of flavors.  They can accomplish all sorts of fancy tax planning, can include certain family members but not others, can run scholarships or foundations – the things you can do with a trust are endless.  But most clients in my office need what I call the “plain vanilla” trust.  That’s a straight-forward revocable family trust.  Mind you, it’s still twenty pages long and takes hours to put together, but within the world of trusts, this is the simple one.  The one that most of us should have, the one that I have set up for my family.

A revocable family trust serves two main purposes.  The first goal – the one everyone thinks about – is that it will distribute your stuff after you die.  It substitutes for the will.  Within your trust, you do what you typically think of as the will’s job – you say how your want your estate distributed after you die.  Usually people split their assets equally among their children, but that’s not always the case.  We can designate whomever you want and in whatever portions you want under your trust (we can do that under a will, too, but right now we are talking about trusts).

So why would we use a trust instead of a will?  Simple answer: it will save your family lots of headaches. If you don’t direct your assets to a trust, and instead just leave all your assets in your own name, then when you die those assets will be governed by your will.  So far so good.  But after you die, there has to be a legal process of changing title on your assets from your name to the people you’ve named in your will.  That legal process is called the “probate process.”  It requires that your children work with an attorney, go through the court’s system (which can take at least a year, quite often longer), complete lots of paperwork, and spend plenty of money on court fees and attorney’s fees.  If you instead set up a trust now and take the time to transfer your assets to your trust now, then after your death, your children have precious little to do.  The trust will already own the assets.  Now the trustee (probably one of your children) just has to review bank statements, sell the home, and cut checks to all your beneficiaries.  The trustee will have some work to do, but an awful lot less work compared to taking all of your assets through the probate process.

Another reason to have a trust – and this is the reason that no one thinks about except us lawyers who think of all the “what if’s” – is to protect you while you are living.  If you transfer your assets to your trust now, and you go on vacation or are in the hospital or develop dementia, then your successor trustee (usually a child, sometimes a sibling or best friend) can take over managing your assets.  Bills will be paid, that CD will be renewed when the maturity notice comes in the mail, etc.  Your successor trustee steps into your shoes and manages your money, so things continue seamlessly, even though you are unable to manage your own affairs.  What a relief.

I should clarify what it means to “transfer your assets to your trust.” That’s really a fancy way of saying that you are “changing the name” on your accounts.  For example, if you have a money market at the bank in your name, then after you sign the trust, I would tell you to call the bank and have them change the owner of the money market from you individually to the revocable family trust that you just signed.  They will probably have you complete a new signature card.

Since you will be the trustee of your trust, nothing will feel any different on a day to day basis – you are still the one accessing your accounts, reviewing statements, paying bills, etc.  The difference is that you have a Plan.  If you need help managing your assets during your lifetime, you have empowered your successor trustee to step in and take care of you.  And you have lined up your assets so that your family will not have to deal with the hassle and cost of probate after you pass away.  A plan.  Feels good, doesn’t it?

Help your friendly neighborhood caregiver take a break.  Happy Holidays!

Here is what I received from the Alzheimer’s Association: