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As you age, keeping your brain healthy is just as important as keeping your physical body in shape.Every brain changes with age. Cognitive changes are common, but there are many things you can do to maintain a healthy brain and prevent cognitive decline.For anyone looking to preserve cognitive health, as well as for those individuals who are experiencing cognitive issues due to an injury or event, keeping your brain active is key. Exercising your brain stimulates connectivity and strengthens your brains ability to protect against some of the natural changes that come with aging. Specialized services such as Cognitive Rehabilitation Therapy can help to preserve and strengthen cognitive skills without using medication or invasive treatments.Evidence shows that functional Cognitive Rehabilitation Therapy is effective in compensating for problems you may be experiencing with memory, attention, or communication. These issues can be frustrating and worrisome. The good news is that thanks to decades of research, there are many proven strategies that you can use to protect your brain and improve your cognitive skills. You will feel sharper, in control, and more confident when you put these strategies to use.Eat a balanced diet. Good nutrition supports brain function and decreases inflammation. Start by making one new choice or healthy substitution each day.Do your best to move your body every day. Exercise improves blood flow and stimulates brain cells to make new connections.Stay connected with others. Socialization helps with communication, improves mood, and lowers the risk of depression.Incorporate specialized services like Cognitive Rehabilitation Therapy, which can help to sharpen skills and compensate for problems with thinking.Taking a balanced and proactive approach to maintaining your brain health by using the above strategies will result in improved recall, better communication skills, increased confidence, more independence and simply living your best life.Editors Note: This article was submitted by Jessica Chappell, MA, CBIT. Jessica is the Executive Director of Main Line Rehabilitation Associates, Inc. If you would like more information on Cognitive Rehabilitation Therapy, call 1-877-480-6714 or email jchappell@mainline-rehab.com. Please see their website at www.mainline-rehab.com and their ad on page 26.

A trip to the hospital can be stressful for people with Alzheimers disease or another dementia and their caregivers. Being prepared for an emergency and planned hospital visits can relieve some of that stress. This article suggests ways to help you prepare and tips for making your visit to the emergency room or hospital easier.Hospital visits and COVID-19Due to COVID-19, hospitals continue to update appointment and visitor policies to comply with state department of health guidelines to protect the health and safety of patients, visitors, and employees. For example, visitors may be required to wear a face mask or cloth face covering. Or they may not be allowed to accompany patients in clinics, hospital departments or the emergency room, with exceptions in certain cases. Before you plan a visit, call or check the hospitals website for information on their policies. Get the latest public health information on the coronavirus at coronavirus.gov.Hospital emergencies: What you can doA trip to the emergency room (ER) can tire and frighten a person with Alzheimers or other dementia. Here are some ways to cope: Ask a friend or family member to go with you or meet you in the ER. He or she can stay with the person while you answer questions. Be ready to explain the symptoms and events leading up to the ER visitpossibly more than once to different staff members. Tell ER staff that the person has dementia. Explain how best to talk with the person. Comfort the person. Stay calm and positive. How you are feeling will get absorbed by others. Be patient. It could be a long wait if the reason for your visit is not life-threatening. Recognize that results from the lab take time. Realize that just because you do not see staff at work does not mean they are not working. Be aware that emergency room staff have limited training in Alzheimers disease and related dementias, so try to help them better understand the person. Encourage hospital staff to see the person as an individual and not just another patient with dementia who is confused and disoriented from the disease. Do not assume the person will be admitted to the hospital. If the person must stay overnight in the hospital, try to have a friend or family member stay with him or her. Do not leave the emergency room without a plan. If you are sent home, make sure you understand all instructions for follow-up care.What to packAn emergency bag with the following items, packed ahead of time, can make a visit to the ER go more smoothly: Health insurance cards Lists of current medical conditions, medicines being taken, and allergies Healthcare providers names and phone numbers Copies of healthcare advance directives (documents that spell out a patients wishes for end-of-life care) Personal information sheet stating the persons preferred name and language; contact information for key family members and friends; need for glasses, dentures, or hearing aids; behaviors of concern; how the person communicates needs and expresses emotions; and living situation Snacks and bottles of water Incontinence briefs, if usually worn, moist wipes, and plastic bags Comforting objects or music player with earphones A change of clothing, toiletries, and personal medications for yourself Pain medicine, such as ibuprofen, acetaminophen, or aspirina trip to the emergency room may take longer than you think, and stress can lead to a headache or other symptoms A pad of paper and pen to write down information and directions given to you by hospital staff A small amount of cash A note on the outside of the emergency bag to remind you to take your cell phone and charger with you By taking these steps in advance, you can reduce the stress and confusion that often accompany a hospital visit, particularly if the visit is an unplanned trip to the emergency room.Before a planned hospital stayWith Alzheimers disease and related dementias, it is wise to accept that hospitalization is a when and not an if event. Due to the nature of the disease, it is very probable that, at some point, the person you are caring for will be hospitalized. Keep in mind that hospitals are not typically well-designed for patients with dementia. Preparation can make all the difference. Here are some tips. Think about and discuss hospitalization before it happens, and as the disease and associated memory loss progress. Hospitalization is a choice. Talk about when hospice may be a better and more appropriate alternative. Build a care team of family, friends, and/or professional caregivers to support the person during the hospital stay. Do not try to do it all alone. Ask the doctor if the procedure can be done during an outpatient visit. If not, ask if tests can be done before admission to the hospital to shorten the hospital stay. Ask questions about anesthesia, catheters, and IVs. General anesthesia can have side effects, so see if local anesthesia is an option. Ask if regular medications can be continued during the hospital stay. Ask for a private room, with a reclining chair or bed, if insurance will cover it. It will be calmer than a shared room. Involve the person with dementia in the planning process as much as possible. Do not talk about the hospital stay in front of the person as if he or she is not there. This can be upsetting and embarrassing. Shortly before leaving home, tell the person with dementia that the two of you are going to spend a short time in the hospital. During the hospital stayWhile the person with dementia is in the hospital: Ask doctors to limit questions to the person, who may not be able to answer accurately. Instead, talk with the doctor in private, outside the persons room. Help hospital staff understand the persons normal functioning and behavior. Ask them to avoid using physical restraints or medications to control behaviors. Have a family member, trusted friend, or hired caregiver to always stay with the person with Alzheimers if possibleeven during medical tests. This may be hard to do, but it will help keep the person calm and less frightened, making the hospital stay easier. Tell the doctor immediately if the person seems suddenly worse or different. Medical problems such as fever, infection, medication side effects, and dehydration can cause delirium, a state of extreme confusion and disorientation. Ask friends and family to make calls or use email or online tools to keep others informed about the persons progress. Help the person fill out menu requests. Open food containers and remove trays. Assist with eating as needed. Remind the person to drink fluids. Offer fluids regularly and have him or her make frequent trips to the bathroom. Assume the person will experience difficulty finding the bathroom and/or using a call button, bed adjustment buttons, or the phone. Communicate with the person in the way he or she will best understand and respond. Recognize that an unfamiliar place, medicines, invasive tests, and surgery will make a person with dementia more confused. He or she will likely need more assistance with personal care. Take deep breaths and schedule breaks for yourself! If anxiety or agitation occurs, try the following: Remove personal clothes from sight; they may remind the person of getting dressed and going home. Post reminders or cues, like a sign labeling the bathroom door, if this comforts the person. Turn off the television, telephone ringer, and intercom. Minimize background noise to prevent overstimulation. Talk in a calm voice and offer reassurance. Repeat answers to questions when needed. Provide a comforting touch or distract the person with offers of snacks and beverages. Consider unexpressed pain (i.e., furrowed brow, clenched teeth, or fists, kicking). Assume the person has pain if the condition or procedure is normally associated with pain. Ask for pain evaluation and treatment every 4 hoursespecially if the person has labored breathing, loud moaning, crying, or grimacing, or if you are unable to console or distract him or her. Listen to soothing music or try comforting rituals, such as reading, praying, singing, or reminiscing. Slow down; try not to rush the person. Avoid talking about subjects or events that may upset the person. Working with hospital staffRemember that not everyone in the hospital knows the same basic facts about memory loss, Alzheimers disease, and related dementias. You may need to help teach hospital staff what approach works best with the person with Alzheimers, what distresses or upsets him or her, and ways to reduce this distress.You can help the staff by providing them with a personal information sheet that includes the persons normal routine, how he or she prefers to be addressed (e.g., Miss Minnie, Dr. James, Jane, Mr. Miller, etc.), personal habits, likes and dislikes, possible behaviors (what might trigger them and how best to respond), and nonverbal signs of pain or discomfort.Help staff understand what the persons baseline is (prior level of functioning) to help differentiate between dementia and acute confusion or delirium.You should: Place a copy of the personal information sheet with the chart in the hospital room and at the nurses station. With the hospital staff, decide who will do what for the person with Alzheimers disease. For example, you may want to be the one who helps with bathing, eating, or using the bathroom. Inform the staff about any hearing difficulties and/or other communication problems, and offer ideas for what works best in those instances. Make sure the person is safe. Tell the staff about any previous issues with wandering, getting lost, falls, suspiciousness and/or delusional behavior. Not assume the staff knows the persons needs. Inform them in a polite, calm manner. Ask questions when you do not understand certain hospital procedures and tests or when you have any concerns. Do not be afraid to be an advocate. Plan early for discharge. Ask the hospital discharge planner about eligibility for home health services, equipment, or other long-term care options. Prepare for an increased level of caregiving. Realize that hospital staff are providing care for many people. Practice the art of patience. For more information on dealing with dementia and hospitalization, see the University of California, San Francisco, Memory and Aging Centers Tips for Hospitalization.You may also be interested in Reading more about advance care planning Learning about common medical problems that occur with Alzheimer's Finding resources for getting help with Alzheimer's caregiving For more information about hospitalization and Alzheimer'sNIA Alzheimers and related Dementias Education and Referral (ADEAR) Center 800-438-4380 adear@nia.nih.gov www.nia.nih.gov/alzheimers The NIA ADEAR Center offers information and free print publications about Alzheimers and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.Alzheimers.gov www.alzheimers.gov Explore the Alzheimers.gov website for information and resources on Alzheimers and related dementias from across the federal government.Eldercare Locator 800-677-1116 eldercarelocator@USAging.org https://eldercare.acl.govThis content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date. Reprinted from https://www.nia.nih.gov/health/alzheimers-caregiving/going-hospital-tips-dementia-caregivers?fbclid=IwAR2i1Hsl_Vk9x442hJ4dSxJ3qOSjGNGu63oMquXB9AKFpr5DNHGZL9K46dQ.  

Many senior citizens may need the services of a nursing home or at-home care at some point in their life. You might assume that government assistance or health insurance will step in and cover the cost if you cannot afford these services. Unfortunately, neither health insurance nor Medicare covers long-term care. Because obtaining long-term care insurance can be very expensive, Medicaid could become your only option.Medicaid coverage isn't a given, however. If you have assets or recently transferred assets, Medicaid may determine you don't qualify for coverage until a certain amount of time has passed. If this happens, you and their family can face significant medical bills. If you cannot pay, nursing homes may take you to court to get reimbursed.What steps can you take to avoid this? First, before applying for Medicaid, get a better understanding of the timelines in your state known as lookback periods that can affect your eligibility. Then you can engage in proper Medicaid or asset protection planning in advance of these timeframes. A good age to begin planning is around age 65, although everyones situation is different.Individual states run Medicaid programs, and every state has different rules regarding Medicaid eligibility. These programs were designed as a payor of last resort in other words, to qualify, you must meet strict requirements. There are two primary types of Medicaid benefits: home care and skilled nursing home care. Lookback PeriodsYou must submit an application to your local Medicaid office to qualify for these benefits. As part of this process, the state will look at any money or property you may have transferred within a certain lookback period. In New York, for example, this period of time will soon be 30 months for home care and 60 months for skilled nursing care. These lookback periods can have serious consequences. If you haven't engaged in appropriate asset protection planning, you may not be able to qualify for home care or nursing home care for many months. The result is that many elderly individuals must then spend down their savings and liquidate their assets to pay privately for their home care before Medicaid starts covering anything. If a person no longer has resources and is subject to a disqualification penalty period, family members may have to step in and bear these costs on their own.So, what can you do? The answer is to start planning as soon as is practical.Options to ExploreSpeaking with an elder law attorney can help you and your loved ones explore options available to avoid you or them being personally responsible for the costs of your care. Medicaid Asset Protection Trust  One common approach is placing assets in a Medicaid Asset Protection Trust. You may be able to use this to shelter various assets such as stock accounts, savings, a home with unprotected equity, and much more. Pooled Income Trust  Another option you may explore is contributing income that exceeds Medicaid allowances to a Pooled Income Trust. This can allow you to qualify for Medicaid while diverting excess income to a trust that pays qualified expenses on your behalf. This will enable you to benefit from the income and not spend it on things Medicaid could have otherwise covered.Spousal Refusal  Your spouse may also have options that can help you qualify for Medicaid. One such option includes exercising a right of spousal refusal a process available in some states by which the income and assets of your spouse can be removed from consideration in your Medicaid eligibility analysis.Finally, an attorney can help you understand if certain transfers are permissible under Medicaid rules without triggering a penalty period.Without proper planning, individuals with assets and income exceeding specific state-set thresholds would have to spend this income and their assets on their care or exempt items before they can receive Medicaid benefits. For assistance in planning, consult with a qualified elder law attorney in your area.

Your Kids Will Thank YouOne of the questions I often ask people who come to our workshops, is What do you want to accomplish when doing your estate plan?  Most people tell me they want to protect stuff from the nursing home, while others want to be smart about taxes. Some people say they just want to make things easy for their family. They dont want to be a burden and they want to keep the family peace. With this goal in mind, I want to share some tips on how we can put together a meaningful plan for your family to reduce their stress when you are affected with health issues. When you pass away, your family will go through the grieving process, but you dont want it to be a stressful time from a financial and or legal standpoint. Rather, you want to set your kids up for success.What Does It Mean By Setting Your Kids Up For Success? Often, when people do an estate plan theyll want to write a Will. When they pass away, the kids tend to take over as executor or trustee. If a parent gets sick before they pass away, the kids may take over as power of attorney or guardian. What Is Guardianship?Lets assume that people dont do any planning, and have no legal documents. Should they become incapacitated, their kids will end up in guardianship. Lets take Fred for example, who hasnt done any planning, and is a widower. If he has a stroke, his kids need to get control of the money and make decisions. However, if Fred has not done any planning, his kids cannot make decisions simply because they are his children. They have to go through a process called guardianship. This means taking Fred into the courthouse to be declared legally incapacitated, by a judge. The judge may request that the guardian reports back regularly, so that the judge can make sure the guardian is the right person to make the decisions. This can be an expensive legal process, which can also be emotionally challenging.Can Guardianship Be Avoided?Its easy to avoid the guardianship process by simply having a Power of Attorney document. This document lists somebody to be your agent, who will be your legal and financial decision maker. In the event that you become incapacitated, somebody else can act on your behalf. They can walk into any bank or financial institution with the Power of Attorney document, and do what needs to be done, while acting in your best interests. Fortunately, we dont need the courthouse to make it happen. While we cannot prevent getting sick as we get older, whether its having dementia or a stroke that affects us, we can give our kids the legal authority to make decisions. Communicate With Your KidsIn addition to having a Power of Attorney, you also need to have a Will or a Trust in place. We encourage our clients to use a trust instead of a Will, to avoid going through the probate process. Regardless of whether your child is the executor of a Will or the trustee of trust, when you pass away, they will have roles and responsibilities. It is important for you to communicate with your children to tell them about what their future roles and responsibilities will be. It is not enough to just create a document and leave it on the shelf. You need to tell your kids where your assets are, where you bank, who the financial advisor is and who the attorney is. Avoid The StressIt often happens after a parent has passed away, that the adult children come to us with a bag of their parents documents and paperwork, trying to make sense of it. The kids are not only grieving after losing a parent, but they now have to sort through mom or dads belongings and paperwork. They are also confused about what their responsibility is as an executor or trustee. I urge you to make it easy for your kids to fulfil their roles, by sharing details of where your assets are. You dont have to share details of the value of your assets while youre still living, but I encourage you to share the necessary details with your kids. This will help them with the administration and avoid a stressful situation.Why You Need An Advanced DirectiveWho would make any health care decisions, if you are affected by a health issue and cannot make decisions? You need to decide who that person will be, and communicate with them. If you are elderly woman with no surviving spouse, one of your children will have to make decisions if you are unable to. You would need a document called an Advanced Directive, stating what must be done if you get sick or become incapacitated. It is wise to appoint two different family members to make financial and healthcare decisions respectively.Consider Having A Life Care PlanI encourage you to consider enlisting our help to create a Life Care Plan, which we offer at Sechler Law Firm. This plan takes into consideration where you will get care, and how you will pay for it. It means your family will not have to worry about whether they have made the right decision about your care. We have a social worker and a healthcare professional on our team, because life care planning is more about healthcare planning than it is traditional legal work. However, we consider it to all be part of doing estate planning. To find out more, call 724-564-6615.  You can also learn more by coming to one of our Three Secrets Estate Planning Workshops. Call to register for an upcoming free workshop!