Helping out with early onset Alzheimer's

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mrgeeze
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Helping out with early onset Alzheimer's

Post by mrgeeze » Thu Oct 18, 2018 10:44 am

Good friend diagnosed at Age 60.
Recently Divorced. X sympathetic but understandably mixed emotions
Daughter working toward disability/Medicaid to provide ongoing income/healthcare
Complicated situation.
Expectation that financial advice and some $$ support will fall on friends soon for stopgap.

One of the many topics
1. Payoff mortgage, 2nd trust, Credit cards with IRA money?
Not sure all of this makes sense.
Simplifies things overall but may not be "best" use of limited nest egg.
Plus makes a tax bill.

The whole thing is heartbreaking.
Long term prognosis not great
Want to do the best for my friend.

Anybody in this boat?
If personal respond through PM

NotWhoYouThink
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Re: Helping out with early onset Alzheimer's

Post by NotWhoYouThink » Thu Oct 18, 2018 11:57 am

I wouldn't incur a tax bill to pay off the mortgage. The house will probably need to be sold before long, unless a family member is willing to move in and become primary caregiver. Even then, paying off the house reduces liquidity which might become a problem.

The family should talk to an elder care attorney. At age 60, the body can hold out for quite some time after the mind goes. And if possible the patient should start thinking about what life saving treatments are wanted and not wanted, or at least appoint a health care POA. And a financial POA if that is not already in place.

jebmke
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Re: Helping out with early onset Alzheimer's

Post by jebmke » Thu Oct 18, 2018 12:02 pm

A colleague of mine in a volunteer organization developed dementia at age 64 (I think it was not Alzheimers but a different form as he progressed rapidly and died approximately a year after it was detected.).

When I was helping his spouse finish their taxes the year it was detected, she mentioned that before it was detected, he had managed to mangle their personal finances and lose a lot of money.
When you discover that you are riding a dead horse, the best strategy is to dismount.

flarf
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Re: Helping out with early onset Alzheimer's

Post by flarf » Thu Oct 18, 2018 1:15 pm

Second the recommendation to see an elder care attorney now. It'll probably cost a few thousand dollars when all is said and done, but this isn't an easy course to navigate. Hopefully you can get access to all of your friend's financial information. Setting up a living will and health care proxy are also critical, as mentioned.

Went through this with my father starting at age 64; we took all non-retirement assets out of his name and moved them into a living trust of which my mother was the trustee. Hard to give specific recommendations for this situation since the amounts are unknown.

Even with my mother there to help, we still hired a live-in caregiver for the last three years of his life. If your friend has limited means and no family, then Medicaid may be in his future.

The two variables which are completely unknown are time and rate of decline. Time left could be a couple years or a couple decades. Ability to live independently could be gone in weeks, months, or years. There's no sugarcoating things here, it sucks.

Skiffy
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Re: Helping out with early onset Alzheimer's

Post by Skiffy » Thu Oct 18, 2018 1:40 pm

See if you can find the 60 Minutes report where Dr. LaPook followed an early onset Alzheimer’s woman for I think 10 or 15 years. It really shows the heartbreaking deterioration both mentally and physically, and the toll it takes on caregivers.

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dm200
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Re: Helping out with early onset Alzheimer's

Post by dm200 » Thu Oct 18, 2018 1:51 pm

No expert - but I believe different folks can "progress" at very differing paces. One issue (get guidance from an attorney as well) is to have durable Powers of attorney all in place before the afflicted person can no longer be competent to do so.

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FGal
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Re: Helping out with early onset Alzheimer's

Post by FGal » Thu Oct 18, 2018 1:52 pm

I would question keeping a house at this time. It might be better to move in the next year or two while they are still competent and get used to a nice apartment/condo in a senior living center that has a memory care facility and reduce the amount of balls in the air (mortgage/maintenance/property taxes). This would also allow the funds from the sale of the house to be invested and hopefully provide more of a backstop to their living expenses down the road. Would likely want to be conservative with investments but even CD rates are rising now, so it may be a good idea. Definitely would need to discuss arrangement of assets with an elder law expert tho.

My father didn't have Alzheimer's but did have a serious, non-curable and progressive/aggressive medical condition that enfeebled him and he finally was convinced to move to a swanky seniors facility, just wish he'd not been so stubborn. He told me he'd wished he'd move years earlier after he got settled in. They had two bedroom apartments with a small kitchen (no stove, but full sized fridge and microwave/sink and cabinets), nice porch/balconies and looked like some of the nicer apartment complexes I've lived in over the years. You could have complete autonomy if you were still physically able, but if you needed help, they would provide. Daily maid service, laundry room if capable (but would provide laundry wash/fold if needed), emergency staff on site, emergency pull cords in every room, no threshold/walk in showers and everything super convenient for the residents. They provided on site exercise, rehab, dining 3X daily (fancy dining area), nurses, day trips and shopping/doctor shuttles. Sure, it was expensive but he was safe, extremely well cared for and could do as much or as little as he wanted there without fear of being left alone and injured for days.

I would also coordinate regular visits from trusted friends/family members to make sure they are not being taken advantage of. Likely would need to set up automatic bills/deposits that he can't access easily, look into a power of attorney for all financial matters and make sure there are barriers involved for any significant changes so they won't be easily manipulated by a dishonest caretaker or worker. Could change their main bank account to contain lower amounts of money for fun spending (and make sure the bank is aware of the restrictions and alert to any odd transactions), but with the main transfers/bill pays set up in a completely separate account they don't have immediate access to. Again, discuss with a professional about all of that, but it is one of the dangers to be concerned with.


I'm so sorry your friend is dealing with all of this. It must be so scary and sad to contemplate the ramifications of this diagnosis, but there are so many promising new treatments and drugs and things that can be explored now and they're discovering new things every day. They may be able to live perfect well for many more years, and I do hope they keep fighting for their health and well being, and it's just lovely that you and their family and other friends are in their corner too - that is a BIG positive on their side.

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dm200
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Re: Helping out with early onset Alzheimer's

Post by dm200 » Thu Oct 18, 2018 2:06 pm

NotWhoYouThink wrote:
Thu Oct 18, 2018 11:57 am
I wouldn't incur a tax bill to pay off the mortgage. The house will probably need to be sold before long, unless a family member is willing to move in and become primary caregiver. Even then, paying off the house reduces liquidity which might become a problem.
The family should talk to an elder care attorney. At age 60, the body can hold out for quite some time after the mind goes. And if possible the patient should start thinking about what life saving treatments are wanted and not wanted, or at least appoint a health care POA. And a financial POA if that is not already in place.
Yes ...

fposte
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Re: Helping out with early onset Alzheimer's

Post by fposte » Thu Oct 18, 2018 2:14 pm

FGal wrote:
Thu Oct 18, 2018 1:52 pm
I would question keeping a house at this time. It might be better to move in the next year or two while they are still competent and get used to a nice apartment/condo in a senior living center that has a memory care facility and reduce the amount of balls in the air (mortgage/maintenance/property taxes).
Agreed. When a friend's dad was diagnosed with Alzheimer's, she was advised that a move is best either right at the beginning, as you say, or when their cognition has gotten so bad that their surroundings don't matter that much. The first way is so much easier on the other people struggling with the situation.

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dm200
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Re: Helping out with early onset Alzheimer's

Post by dm200 » Thu Oct 18, 2018 3:08 pm

fposte wrote:
Thu Oct 18, 2018 2:14 pm
FGal wrote:
Thu Oct 18, 2018 1:52 pm
I would question keeping a house at this time. It might be better to move in the next year or two while they are still competent and get used to a nice apartment/condo in a senior living center that has a memory care facility and reduce the amount of balls in the air (mortgage/maintenance/property taxes).
Agreed. When a friend's dad was diagnosed with Alzheimer's, she was advised that a move is best either right at the beginning, as you say, or when their cognition has gotten so bad that their surroundings don't matter that much. The first way is so much easier on the other people struggling with the situation.
I have know several "caretakers" who have been helped by networking with other caretakers of those with dementia of various kinds.

bsteiner
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Re: Helping out with early onset Alzheimer's

Post by bsteiner » Thu Oct 18, 2018 3:40 pm

He/she should get his/her estate planning done while he/she can.

He/she should pick who he/she wants to handle his/her affairs when he/she will no longer be able to.

TN_Boy
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Re: Helping out with early onset Alzheimer's

Post by TN_Boy » Thu Oct 18, 2018 6:14 pm

FGal wrote:
Thu Oct 18, 2018 1:52 pm
I would question keeping a house at this time. It might be better to move in the next year or two while they are still competent and get used to a nice apartment/condo in a senior living center that has a memory care facility and reduce the amount of balls in the air (mortgage/maintenance/property taxes). This would also allow the funds from the sale of the house to be invested and hopefully provide more of a backstop to their living expenses down the road. Would likely want to be conservative with investments but even CD rates are rising now, so it may be a good idea. Definitely would need to discuss arrangement of assets with an elder law expert tho.

My father didn't have Alzheimer's but did have a serious, non-curable and progressive/aggressive medical condition that enfeebled him and he finally was convinced to move to a swanky seniors facility, just wish he'd not been so stubborn. He told me he'd wished he'd move years earlier after he got settled in. They had two bedroom apartments with a small kitchen (no stove, but full sized fridge and microwave/sink and cabinets), nice porch/balconies and looked like some of the nicer apartment complexes I've lived in over the years. You could have complete autonomy if you were still physically able, but if you needed help, they would provide. Daily maid service, laundry room if capable (but would provide laundry wash/fold if needed), emergency staff on site, emergency pull cords in every room, no threshold/walk in showers and everything super convenient for the residents. They provided on site exercise, rehab, dining 3X daily (fancy dining area), nurses, day trips and shopping/doctor shuttles. Sure, it was expensive but he was safe, extremely well cared for and could do as much or as little as he wanted there without fear of being left alone and injured for days.

I would also coordinate regular visits from trusted friends/family members to make sure they are not being taken advantage of. Likely would need to set up automatic bills/deposits that he can't access easily, look into a power of attorney for all financial matters and make sure there are barriers involved for any significant changes so they won't be easily manipulated by a dishonest caretaker or worker. Could change their main bank account to contain lower amounts of money for fun spending (and make sure the bank is aware of the restrictions and alert to any odd transactions), but with the main transfers/bill pays set up in a completely separate account they don't have immediate access to. Again, discuss with a professional about all of that, but it is one of the dangers to be concerned with.


I'm so sorry your friend is dealing with all of this. It must be so scary and sad to contemplate the ramifications of this diagnosis, but there are so many promising new treatments and drugs and things that can be explored now and they're discovering new things every day. They may be able to live perfect well for many more years, and I do hope they keep fighting for their health and well being, and it's just lovely that you and their family and other friends are in their corner too - that is a BIG positive on their side.
My sympathies as well.

But while I think optimism is good, in terms of setting expectations, I disagree with the part about promising new treatments for Alzheimer's. The track record of treatments for this disease is dismal. Basically, failure after failure. Right now, we have nothing, and I do mean nothing. There has been a little buzz recently about one treatment with one strain of mice. But there have been other ideas that worked in mice and didn't work in people.

And as others have noted, the decline might be fast (hopefully not!) and once significant decline sets in the person often cannot be left alone. At all. They wander, etc. Preparations should be made to handle the case where 24/7 help is required. For example, getting on the waiting list for a place with a good memory care unit.

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dm200
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Re: Helping out with early onset Alzheimer's

Post by dm200 » Thu Oct 18, 2018 6:19 pm

But while I think optimism is good, in terms of setting expectations, I disagree with the part about promising new treatments for Alzheimer's. The track record of treatments for this disease is dismal. Basically, failure after failure. Right now, we have nothing, and I do mean nothing. There has been a little buzz recently about one treatment with one strain of mice. But there have been other ideas that worked in mice and didn't work in people.

And as others have noted, the decline might be fast (hopefully not!) and once significant decline sets in the person often cannot be left alone. At all. They wander, etc. Preparations should be made to handle the case where 24/7 help is required. For example, getting on the waiting list for a place with a good memory care unit.
No medical credentials here, but from what I read (from credible sources) - these "promising" new treatments - have not seemed to work out. It seems that the stuff that goes on in the brain leading to the condition takes decades to develop.

Some (to me credible) things I read indicate that lifestyle changes that improve the health of our arteries can delay the onset of Alzheimer's.

Living Free
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Re: Helping out with early onset Alzheimer's

Post by Living Free » Thu Oct 18, 2018 7:58 pm

I agree with hesitation to pay off mortgage. even if house is paid off there is ongoing expenses (taxes, maintenance issues) so particularly with limited caregiver support moving to a facility if possible, with known fixed expenses might be simpler.

TN_Boy
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Re: Helping out with early onset Alzheimer's

Post by TN_Boy » Thu Oct 18, 2018 8:15 pm

dm200 wrote:
Thu Oct 18, 2018 6:19 pm
But while I think optimism is good, in terms of setting expectations, I disagree with the part about promising new treatments for Alzheimer's. The track record of treatments for this disease is dismal. Basically, failure after failure. Right now, we have nothing, and I do mean nothing. There has been a little buzz recently about one treatment with one strain of mice. But there have been other ideas that worked in mice and didn't work in people.

And as others have noted, the decline might be fast (hopefully not!) and once significant decline sets in the person often cannot be left alone. At all. They wander, etc. Preparations should be made to handle the case where 24/7 help is required. For example, getting on the waiting list for a place with a good memory care unit.
No medical credentials here, but from what I read (from credible sources) - these "promising" new treatments - have not seemed to work out. It seems that the stuff that goes on in the brain leading to the condition takes decades to develop.

Some (to me credible) things I read indicate that lifestyle changes that improve the health of our arteries can delay the onset of Alzheimer's.
Some researchers claim lifestyle changes can delay onset; I believe others are less certain. It can't hurt to ... exercise and eat right. And stay mentally active. But it is obvious (to this non medical person who has had family members with this diagnosis) we don't understand the disease very well and we have no tools right now to substantially alter the course of the disease.

Tanelorn
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Re: Helping out with early onset Alzheimer's

Post by Tanelorn » Thu Oct 18, 2018 8:32 pm

This is a good read about someone here dealing / coping with Alzheimer’s.

viewtopic.php?f=2&t=141387

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