Posts tagged: elders

Parent-Child Role Reversal

Most everyone would say that they want to be independent and remain in their own homes as long as possible. This sense of autonomy can be kept in place longer than ever before due to medical advances, assistive devices, and in-home care provided by family members and private caretakers. However, what happens when an elder can no longer remain safely in their home and an adult child is trying to get them the help they need?

Esther is 89 years old. She has lived alone since the death of her husband 23 years ago. She gave up driving two years ago, but is regularly visited by her children and grandchildren, who take care of errands or drive her to handle things herself. Lately, she has been rather unsteady on her feet. Additionally, she has been very forgetful and once left the stove on all night. She is also having trouble remembering to take her medications. There were so many her daughter, Susan, sorts them every week into a pill box. Esther still forgets to take them and sometimes actually doubles up on doses. Susan can see its time for more help but Esther is adamant about not having strangers in the house and doesn’t want to end up in “one of those places…”

Many times, elders resent their adult children trying to help them.  In the elderly parents mind, they are still independent and completely able to handle their own affairs.  In the above example, Esther does not appreciate her daughter’s suggestion that they bring in some private home care, or that her mother visit an assisted living facility or rest home. She feels her children are being too pushy, and trying to take control.

But on the other side, Susan feels that Esther isn’t thinking clearly anymore. She is extremely hurt by her mother’s attitude and reaction. After all, Susan is just trying to help. 

The parent/child roles have been reversed, except unlike with young children, the adult child does not have the automatic right to make decisions for the elderly parent. Unless the child seeks to declare the parent incapacitated through a court ordered Guardianship or Conservatorship, or has the parent’s Health Care Proxy and/or Durable Power of Attorney activated, the child has to realize that in the eyes of the law, the parent may make their own decisions. And, unfortunately, people are allowed to make bad decisions.  However, it is important that the adult child watch the situation carefully and not get frustrated and leave the parent to their own devices.  Assisting does not mean taking over against their parent’s will. 

Too many children have simply given up when their “help” is not accepted. If one finds themselves in that situation, they can contact our office for assistance and suggestions for getting through to the parent, discussing the possible need for Guardianship, ensuring that the elder’s estate planning documents are in order, scheduling a medical evaluation, and/or perhaps referral to a geriatric care manager where appropriate.

The elderly years can be as challenging as the terrible twos, terrible terrible teens, and even the terrible twenties.  Elderly parents must be respected by the adult child who is trying to help, even if the parent/child roles have truly been reversed.

Hoarding: How to Help a Loved One Declutter

The issue of hoarding has recently gathered a great deal of attention, particularly due to news reports and popular television shows.  However, hoarding is not a new or a small problem. The problem of hoarding has been documented since the turn of the century and is thought to significantly affect nearly 15 million Americans, many of them elderly. A great article recently appeared in the Boston Hearald dealing with the clinical aspects of Hoarding.  Unfortunately, research has been lacking in this area – until now.

On July 14, 2010, a Bellingham, Massachusetts couple and their dog were found dead in their home.  The ultimate factor in their deaths: hoarding.  Authorities deduced that 75-year-old Richard Lamphere tripped on a pile of trash, fell on top of his wife, 62-year-old Susan Abraham and one of their dogs.  Lamphere died instantly from head injuries; Abraham was severely injured in the fall and died later from her wounds.  Police confirmed that the couple were hoarders.  They had trash and belongings piled everywhere inside their home.  The conditions were uninhabitable and clearly unsafe. For the full story, see this article.

When assessing the severity of a loved one’s hoarding situation, several questions are important to remember:

  • Can the occupant access doors in case of an emergency?
  • Does he have access to the kitchen to prepare and store food?
  • Can he access the bathroom facilities? Can the bathtub/shower be utilized?
  • Can the resident safely reach their bed or have they made other sleeping arrangements?
  • Are the home’s mechanical systems in working order (electrical, plumbing, heating)?
  • Are pets being cared for?
  • What health hazards are present (mold, decaying food, bodily waste, etc.)

If the basic needs of an occupant cannot be met, then it is time to consider intervention.

The difficulty with trying to help a hoarder is that most of them do not seek or want any “help”.  In fact, hoarders typically do not comprehend that they actually have a problem.  Thus, attempts to “clean out” or assist a loved one in “tidying up” his or her home should be done with care and patience.  And, although perhaps difficult, refrain from making judgments.

Tips to aiding someone who hoards include encouraging them and helping them establish new relationships.  Gently remind them that their grandchildren will be able to come and visit if they clean their house.  Perhaps it is time to participate in a local community activity for seniors.  If they are busy with other activities or plans, then getting rid of “stuff” may seem less consequential to them.  Many local companies specialize in professional, home organziation and cleanouts. Additionally, you may look into a hiring a certified home maker a few hours a week to keep up with housework and tackle clutter habits.

As a last resort, do not be afraid to contact the authorities or professional help.  Let someone else be the “bad guy”.  The story of a local hoarder who has made progress over the years can be found here.

Finally, a temporary or limited Guardianship may be necessary, at least until improvements can be made for the individual’s overall safety.   For more information and advice contact your local Elder Services or area Agency/Council on Aging.

More Protection Than a Health Care Proxy Alone?! MOLST- a Pilot Program in Worcester

Some people think that Elder Law and Estate Planning attorneys are only useful further down the road. They think, “I’m healthy. I don’t need to worry about those things now.” Even while you are healthy, there is one document that everyone over the age of 18 should have in place: a Health Care Proxy (HCP). A health care proxy is necessary to ensure that someone, a health care agent, will be available to make medical decisions for you if you are unable to make them on your own because you are incapacitated. Currently, in Worcester County, another form is also worth considering: the Medical Orders for Life-Sustaining Treatment (MOLST) form. This medical order works with the HCP to inform your health care agent and your doctors what you actually want to happen in various circumstances.

In April 2008, the Massachusetts Health Care Quality and Cost Council (MHCQCC) issued its annual report recommending that Massachusetts establish a pilot program to improve communication between patients and clinicians, and other interested parties, regarding end of life treatments. The MHCQCC found that many patients nearing the end of life were unaware of the treatment options available to them, or, if patients had been aware of such treatment options and had discussed them with their doctors previously, nothing was in place to ensure that their preferences were honored. Therefore, the Massachusetts legislature enacted legislation in August 2008 establishing a demonstrative program for the MOLST process in one community in Massachusetts: Worcester. (Yay, Worcester!)

The MOLST form is fairly simple and easy to read; the most difficult part is actually making the decisions and putting them down on paper. The form is only two pages long, and only two sections must be completed in order for the form to be honored. These two sections are Section D (patient information – specifically who is signing the document on behalf of the patient) and Section E (physician information). In   Section D, it is possible for the patient, the patient’s health care proxy, or the patient’s guardian to sign on his or her behalf. If a guardian is signing for the patient, the guardian must ensure that s/he has the legal authority under the guardian appointment to do so. This may require consultation with the patient or guardian’s Elder Law attorney.

If any other section of the form is not filled out, the health care agent is not limited in his or her decisions for life-sustaining treatment for the patient. Sections A, B, C, and F ask the difficult questions regarding resuscitation, intubation and ventilation, hospitalization, respiratory support, dialysis support, and artificial nutrition and hydration. It is critical that you speak with a physician before making these decisions so that you fully understand the meanings of the terms used and the potential consequences. Once these sections are filled out, they must be honored by all health care professions in Massachusetts, where clinically appropriate. The MOLST form is different from a Living Will or another document expressing your “final wishes” because it carries more authority and is more likely to be honored. A Living Will or final wishes document is only used by health care professionals to keep your wishes in mind when making decisions about treatment. While the MOLST form is not currently legally binding, health care professionals are strongly encouraged by the state to honor it.

Finally, Section G simply asks for the contact information of the health care agent. There is also room on the form for other treatment preferences, in which you can more clearly articulate your wishes. There is an expectation that the form will be reviewed throughout the patient’s life so that if his or her preferences change, those preferences will still be honored.

View a sample MOLST form here.

MOLST in Massachusetts from Commonwealth Medicine on Vimeo.

Massachusetts’ Seniors May Consider Filing Tax Returns for Circuit Breaker Credit Refunds

As we all know, tax season has been in full swing for many weeks now, and it is almost over for some. But, did you know that even if you did not have to file a tax return, as a senior, it may be beneficial for you to do so? Did you know there is a tax credit only available to seniors in Massachusetts who pay rent or real estate taxes? There is, and it is called the Circuit Breaker Tax Credit. Even if you don’t owe any taxes at all, you may be eligible for this credit, and it is just like money in your pocket (Certain counties in Massachusetts, including Worcester and Middlesex, have had tax deadlines extended to May 15th, because they have been declared Federal Disaster Areas due to the recent floodings).

Tax returnThe Circuit Breaker Tax Credit is meant to help low to moderate income seniors whose real estate taxes or rent take up at least 10% of their income. Both you, and your spouse, if you are married, must be age 65 or older as of December 31, 2009, and if you are married, you must file a joint return in order to qualify for this credit. No one else can claim you as a dependent, and you must rent or own a home in Massachusetts as your principle residence. This means that if your principle residence is in Florida, you are not eligible for this credit. You are also not eligible if your rent is paid through a federal or state subsidy.

The income limits to qualify for this credit are relatively high, which is a good thing because it means many seniors in Massachusetts can take advantage of it. If you are filing as a single adult, your income must be below $51,000; if you are filing as head of household, your income must be below $64,000; and if you are married filing jointly, your combined income must be below $77,000. Remember, though, that your rent or real estate taxes must be at least 10% of your income in order to qualify. So, if you are married filing jointly and your income is $75,000, your rent or real estate taxes must be more than $7,500. Also, be aware that income here includes social security, retirement, pensions, annuities, and other nontaxable sources.

If you have not yet filed your taxes, and you are interested in filing so that you can take advantage of this credit, there are many organizations that offer free tax assistance. The Circuit Breaker Tax Credit form is easy to fill out, and if it is the only reason you want to file a return, you should not pay a paid professional. In Worcester, there are four VITA (Volunteer Income Tax Assistance) sites, and volunteers at these sites would be happy to prepare a return for you. This is a free service, and contact information for the sites is listed below. You can also visit your local library to pick up the forms you need (Massachusetts Form 1 and Schedule CB), or visit this website to file your return electronically on your own. Finally, if you have not taken advantage of this credit before, you can file Massachusetts Form CA-6 (Application for Abatement/Amended Return) and Schedule CB to obtain the credit for the past three years.

In these hard economic times, we need all the help we can get. If you are over age 65 and more than 10% of your income goes to rent or real estate taxes, take advantage of this credit. The maximum credit amount for 2009 is $960, which is a good chunk of change right in your pocket.

Worcester Community Action Council Inc.
Last day open: April 14th
484 Main Street, Suite 320
Worcester, MA 01608
508 754-1176

Plumley Village
Last day open: April 13th
16 Laurel Street
Worcester, MA 01608
508 770-0508

Main South Community Development Corp
Last day open: April 14th
875 Main Street
Worcester, MA 01610
508 752-6181

Worcester State College
Last day open: April 15th
Sullivan Building, 2nd Floor, Room 220
486 Chandler Street
Worcester, MA 01602
508 929-8635

Safe Driving Bill Approved by Massachusetts House of Representatives

On February 4, 2010, the House of Representatives in Massachusetts amended and approved a bill dealing with safe driving in the Commonwealth. If passed by the Massachusetts Senate, this bill will have a direct impact on the senior citizens of Massachusetts because it will require drivers over the age of 75 to renew their licenses every 5 years instead of every 10 years.

Issues concerning elderly driving have been in the news on and off for many years now, but after a series of accidents involving elder drivers last year, the state legislature is looking to make some changes. The current bill does not just involve seniors though. It also seeks to completely ban text messaging by all drivers, and it provides for higher penalties for drivers under the age of 18 who are caught using cell phones while driving.

eye-chartFor seniors, the requisite 5-year renewal will include passing a vision test that will be administered at the local branch of the registry of motor vehicles. However, the bill would permit the registrar to create regulations allowing seniors to submit a vision screening certificate, signed by an optometrist or ophthalmologist that asserts they meet the minimum vision requirements to hold a driver’s license.

This bill further seeks to allow health care providers to notify the registry of anyone over the age of 16 whose cognitive or functional impairments make it unsafe for them to drive. Decisions regarding whether to revoke a license will depend more on the effects of the cognitive or functional impairment, rather than simply on the diagnosis of such impairment. More detailed regulations will be drafted by the registry with the assistance of various health care professionals, and any reports filed under this section of the proposed law would remain confidential.

Finally, this bill seeks to codify a rule that drivers of any passenger vehicle shall not use mobile telephones, hands-free mobile telephones, or any other mobile electronic devices while driving on duty.This section was drafted in response to the rising number of accidents involving the T in recent years where drivers were text messaging, or using mobile electronic devices in other ways.

Now that the House has published and amended the safe driving bill, it moves on to the Senate Committee on Ways and Means. State Senator Stephen M. Brewer, is one member of the Ways and Means Committee, and he represents parts of Worcester, Hampden, Hampshire, and Franklin. If you are interested in voicing your opinion on this bill, call Mr. Brewer at (617) 722-1540, or email him at Stephen.Brewer@state.ma.us.Click here for the full text of the current bill.

Vickstrom Law • Kristina R. Vickstrom, Esq. • 172 Shrewsbury Street • Worcester, MA 01604 508.757.3800 • View Disclaimer.

Vickstrom Law specializes in Estate Planning, Elder Law, Medicaid (MassHealth) Planning & Applications and Probate and Estate Administration and services Central Massachusetts including Worcester County, and Metrowest Middlesex County Boston area including Worcester, Marlborough, Hudson, Leominster, Fitchburg, Shrewsbury, Westborough, Northborough, Southborough, Stow, Bolton, West Boylston, Holden, Sterling, Spencer, Grafton, Brookfield, West Brookfield, and Sturbridge.