In yesterday’s Wall Street Journal is a story about a woman who was diagnosed with Alzheimer’s disease at age 56.  “The Curse of a Diagnosis” details the issues the family has been forced to deal with, knowing there currently is no cure for Alzheimer’s.  The article questions whether an early diagnosis of a disease for which there is no cure is a curse or a blessing that allows one to plan ahead for the issues associated with the disease.

According to the Alzheimer’s Association, there is almost 6 million people in the US with Alzheimer’s today and it is projected that an additional 10 million Americans will develop Alzheimer’s over the next thirty years.  It is the sixth leading cause of death, and there is no way to cure it or even slow it down.  Alzheimer’s Association. 2012 Alzheimer’s disease facts and figures. Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association. March 2012; 8:131–168.

The Alzheimer’s Association’s 2012 facts and figures also provides a summary of the estimated cost of Alzheimer’s to our economy:

   ” In 2011, more than 15 million family members and other unpaid caregivers provided an estimated 17.4 billion hours of care to people with AD and other dementias, a contribution valued at more than $210 billion. Medicare payments for services to beneficiaries age ≥65 years with AD and other dementias are three times as great as payments for beneficiaries without these conditions, and Medicaid payments are 19 times as great. In 2012, payments for health care, long-term care, and hospice services for people age ≥65 years with AD and other dementias are expected to be $200 billion (not including the contributions of unpaid caregivers).”

The real lesson to be learned from “The Curse of a Diagnosis” is that we all need to plan for the eventuality of Alzheimer’s, dementia, stroke, debilitating falls, and just plain old aging – for ourselves and our loved ones.

One of the most important steps with such planning is having advance directives in place so that if, or when, the diagnosis of Alzheimer’s, or the stroke, or the fall, occurs that our desires are known and we have empowered those we trust with the ability to take care of our affairs, both medically and financially.

Advance directives consists of various legal documents that designate and appoint our trusted family members, or others, to manage our financial and medical needs for our own benefit, when we are unable to handle those things for ourselves.  They include, at a minimum, a properly drafted durable power of attorney, a health care power of attorney (called a designation of health care surrogate in Florida), and a living will.

Durable Power of Attorney

durable power of attorney allows the person or persons that you designate to manage your financial and business affairs in the event you are unable to manage on your own.  Such a legal document allows the person designated to pay your bills, deal with your insurance companies, manage your investments and other assets, and enter into agreements and contracts on your behalf.

The importance of having a properly drafted power of attorney cannot be over emphasized.  The life expectancy for Americans has doubled over the last century.  We have gotten to the point that we outlive our bodies and our minds, in many cases.  When we are no longer able to engage in the normal activities of daily living, it is often necessary that we have caregivers in our own homes, or move to an assisted living facility, and an increasing number of us to a skilled nursing home.

Only a small percentage of the population has the financial resources to pay for long term care. Often it is necessary that Medicaid, Veteran’s Pension Benefits, or other programs be relied upon to pay for the long term care.  Without a properly drafted durable power of attorney, various legal actions that are necessary to obtain those benefits cannot be undertaken without court intervention.

Designation of Health Care Surrogate – HIPAA Release and Authorization

The designation of health care surrogate (a health care power of attorney) appoints the person or persons you want to make medical decisions for you when you are unable to communicate with your physicians.  For those who have dementia or Alzheimer’s, who have suffered a stroke, or who may be unconcious because of an accident or fall, the importance of a properly drafted designation of health care surrogate cannot be overemphasized.

The designation of health care surrogate should also contain a HIPAA Release and Authorization.  Without the HIPAA release, your health care providers and medical insurance companies cannot legally communicate information about your medical condition to your health care surrogate.  More and more health care providers are refusing to provide such information to those without a proper HIPAA release because of penalties being assessed by the federal government for violations of the HIPAA statutes.

Living Will

The living will is the document that expresses your own desires with respect to the application of extraordinary efforts to prolong your life in the event you are in a vegetative state, end of life condition, or a terminal condition.

These documents should be available for each and everyone of us, regardless of whether we have been diagnosed with Alzheimer’s or any other disease.  We all are subject to strokes, heart attacks, falls, accidents, and other risks of living.  Regardless of your position on whether the early diagnosis of Alzheimer’s is a curse or a blessing, you should have your advance directives in place, no matter your age.

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