Guns and Dementia: Dealing With A Loved One’s Firearms

Having a loved one with dementia can be scary, but if you add in a firearm, it can also get dangerous.  To prevent harm to both the individual with dementia and others, it is important to plan ahead for how to deal with any weapons. 

Research shows that 45 percent of all adults aged 65 years or older either own a gun or live in a household with someone who does. For someone with dementia, the risk for suicide increases, and firearms are the most common method of suicide among people with dementia. In addition, a person with dementia who has a gun may put family members or caregivers at risk if the person gets confused about their identities or the possibility of intruders. A 2018 Kaiser Health News investigation that looked at news reports, court records, hospital data and public death records since 2012 and found more than 100 cases in which people with dementia used guns to kill or injure themselves or others. 

The best thing to do is talk about the guns before they become an issue. When someone is first diagnosed with dementia, there should be a conversation about gun ownership similar to the conversation many health professionals have about driving and dementia. Framing the issue as a discussion about safety may help make it easier for the person with dementia to acknowledge a potential problem. A conversation about guns can also be part of a larger long-term care planning discussion with an elder law attorney, who can help families write up a gun agreement that sets forth who will determine when it is time to take the guns away and where the guns should go. Even if the gun owner doesn’t remember the agreement when the time comes to put it to use, having a plan in place can be helpful. 

What to do with the guns themselves is a difficult question. One option is to lock the weapon or weapons in a safe and store the ammunition separately. Having the guns remain in the house–even if they are locked away–can be risky. Another option is to remove the weapons from the house altogether. However, in some states, there are strict rules about transferring gun ownership, so it isn’t always easy to simply give the guns away. Families should talk to an attorney and familiarize themselves with state and federal gun laws before giving away guns. 

For more information about dementia and guns, click here and here.
To speak with an experienced Florida elder law attorney, click here or call (850) 613-6923.

Understanding Medicare’s Hospice Benefit

Medicare’s hospice benefit covers any care that is reasonable and necessary for easing the course of a terminal illness. It is one of Medicare’s most comprehensive benefits and can be extremely helpful to both the terminally ill individual and his or her family, but it is little understood and underutilized. Understanding what is offered ahead of time may help Medicare beneficiaries and their families make the difficult decision to choose hospice if the time comes.

The focus of hospice is palliative care, which means helping people who are terminally ill and their families maintain their quality of life. Palliative care addresses physical, intellectual, emotional, social, and spiritual needs while also supporting the terminally ill individual’s independence, access to information, and ability to make choices about health care. 

To qualify for Medicare’s hospice benefit, a beneficiary must be entitled to Medicare Part A, and a doctor must certify that the beneficiary has a life expectancy of six months or less. If the beneficiary lives longer than six months, the doctor can continue to certify the patient for hospice care indefinitely. The beneficiary must also agree to give up any treatment to cure his or her illness and elect to receive only palliative care. This can seem overwhelming, but beneficiaries can also change their minds at any time. It’s possible to revoke the benefit and reelect it later, and to do this as often as needed.

Medicare will cover any care that is reasonable and necessary for easing the course of a terminal illness. Hospice nurses and doctors are on-call 24 hours a day, 7 days a week, to give beneficiaries support and care when needed. Services are usually provided in the home. The Medicare hospice benefit provides for:

  • Physician and nurse practitioner services
  • Nursing care
  • Medical appliances and supplies
  • Drugs for symptom management and pain relief 
  • Short-term inpatient and respite care 
  • Homemaker and home health aide services 
  • Counseling 
  • Social work service 
  • Spiritual care 
  • Volunteer participation 
  • Bereavement services 

Services are considered appropriate if they are aimed at improving the beneficiary’s life and making him or her more comfortable.

Because the beneficiary is electing palliative care over treatment, there are things the hospice benefit will not cover:

  • Treatment to cure the beneficiary’s illness. 
  • Prescription drugs other than for symptom control or pain relief. 
  • Care from a provider that wasn’t set up by the hospice team, although the beneficiary can choose to have his or her regular doctor be the attending medical professional. 
  • Room and board. If the beneficiary is in a nursing home, hospice will not pay for room and board costs. However, if the hospice team determines that the beneficiary needs short-term inpatient care or respite care services, Medicare will cover a stay in a facility. 
  • Care from a hospital, either inpatient or outpatient, or ambulance transportation unless it arranged by the hospice team. The beneficiary can use regular Medicare to pay for any treatment not related to the beneficiary’s terminal illness. 

To download Medicare’s booklet on the hospice benefit, click here.  To speak with an experienced Florida elder law attorney, click here or call (850) 613-6923.

Medicaid Home Care

Traditionally, Medicaid has paid for long-term care in a nursing home, but because most individuals would rather be cared for at home and home care is cheaper, all 50 states now have Medicaid programs that offer at least some home care. This includes Florida. Even family members can get paid for providing care at home. 

Medicaid is a joint federal-state program that provides health insurance coverage individuals who meet medical, asset and income criteria, including care in a nursing home for those who qualify. Medicaid home care services are typically provided through home and community-based “waiver” programs to individuals who need a high level of care, but who would like to remain at home. 

Medicaid’s home care programs are state-run, and each state has different rules about how to qualify. Each state sets its own asset and income limits. For example, in 2019, in New York an applicant must have income that is lower than $845 a month and fewer than $15,150 in assets to qualify. But Minnesota’s income limit is $2,250 and its asset limit is $3,000, while Connecticut’s income limit is also $2,250 but its asset limit is just $1,600. In Florida, an individual can have up to $2,000 of countable assets (many assets are exempt) and up to $2,250 in gross monthly income.

States also vary widely in what services they provide. Some services that Medicaid may pay for include the following: 

  • In-home health care
  • Personal care services, such as help bathing, eating, and moving
  • Home care services, including help with household chores like shopping or laundry
  • Caregiver support
  • Minor modifications to the home to make it accessible
  • Medical equipment

In most states it is possible for family members to get paid for providing care to a Medicaid recipient. The Medicaid applicant must apply for Medicaid and select a program that allows the recipient to choose his or her own caregiver, often called “consumer directed care.” Most states that allow paid family caregivers do not allow legal guardians and spouses to be paid by Medicaid, but a few states do. Some states will pay caregivers only if they do not live in the same house as the Medicaid recipient. Friends and family can also be paid through family care agreements.

If you have questions about Florida Medicaid and home care options, you should speak with an experienced Florida elder law attorney.

Guardianship Basics for Caregivers

No one wants to see a loved one become sick and unable to make decisions for themself. This often happens where a aging parent or relative is diagnosed with dementia or some other condition that prevents that person from being able to take care of themself. If this happens, caregivers can file a petition with the court to appoint a substitute decision maker, called a “guardian.” A guardian is only appointed as a last resort if other, less restrictive, alternatives are not in place or are not working. Less restrictive means include a power of attorney and/or an advanced health care directive.

Guardianship petitions are normally filed in the ward’s county of residence. A “ward” is the person who needs help, and therefore is the subject of the case. The ward is entitled to notice of the case being filed and to be present at court hearings. The proposed ward is entitled to legal representation at the hearing, and the court will appoint an attorney if needed. The court will also appoint an examining committee of three people (two licensed care social workers and one doctor) to evaluate the ward and submit a report to the court. The committee requirement is designed to make sure the neutral independent people, with the ability to evaluate the ward, provide the court with unbiased information.

A court hearing will be held once the evaluations are complete. At the hearing, the court will first determine if the proposed ward is incapacitated. This will require an examination of the examining committee’s reports as well as evidence offered by the petitioner, as well as the ward’s attorney. If the court determines that the proposed ward is indeed incapacitated, the court then decides if the person seeking the role of guardian will be a responsible guardian. A guardian can be any competent adult — the ward’s spouse, another family member, a friend, a neighbor, or a professional guardian (an unrelated person who has received special training). Also, the ward may have previously designated a particular person to serve as their guardian in the event of incapacitation. That decision will be given great weight.

In naming someone to serve as a guardian, courts give first consideration to those who play a significant role in the ward’s life — people who are both aware of and sensitive to the ward’s needs and preferences. If a guardian is appointed, the guardian will need to file annual reports with the court to provide information about the ward’s health and property.

A Florida elder law attorney can help you if you need to request a guardianship over aging parents or another person. We at the Wheeler Firm have years of experience handling guardianship cases. Please contact us for more information at (850) 613-6923.

Do you need an Elder Law attorney?

Many people hear the term “elder law” and think about estate planning, and planning for the end of life, but elder law is far more than that. Yes, an elder law attorney can help you organize your estate plan, and can even probate your estate at your passing. But elder law attorneys can protect you well before the end of your life.

  • Capacity Planning: An experienced elder law attorney will begin by making sure you are prepared in the event you become incapacitated. Durable powers of attorney, health care surrogate designations, preneed guardian forms and living wills are examples of basic planning documents that can make sure decisions can be made if you are very ill. Through these documents, you can protect your assets in the event you can’t protect them yourself, and make sure crucial healthcare decision are made consistently with your wishes.
  • Long-Term Care Planning: In Northwest Florida, nursing home care can easily cost more than $7,000 per month, and the average cost statewide far exceeds that figure. If you have sufficient wealth, or enough long-term care insurance to cover these costs, you do not need to worry about qualifying for Medicaid coverage. For everyone else, Medicaid is the only option. To qualify for Medicaid, you must meet certain income and asset qualifications. An elder law attorney can help you isolate income and position assets in a way that will prevent you from losing your estate while still qualifying for Medicaid benefits.
  • Probate Avoidance: Attorneys can claim over 3% of the value of the estate if you dispose of your estate through a Florida Last Will and Testament. Also, executors are entitled to receive up to 3% of your estate for collecting your assets and disposing of them consistently with a Will. Elder law attorneys can also help you avoid costly and time consuming probate litigation at your passing by positioning your assets to bypass the probate process at your passing.

We help people accomplish all of these goals on a daily basis. If you need a plan to protect you and your family as you age, contact us at (850) 613-6923 for a consultation. We have offices in Okaloosa and Walton County, Florida.