One of the splendid pleasures of growing older is becoming a grandparent.  No matter how much people have tried to explain it to you, no matter how much you think you understand, no matter how much you have laughed at other grandparents for totally losing themselves in the experience and becoming “silly,” you still are not really prepared.  No one can prepare you for what happens to your heart when you gaze on your baby’s baby.  It produces a tsunami of emotions and you are changed, to some extent, forever.

In my own life, I observe two sets of parents raising a total of seven grand-children. The reason I want to write about that today is because I have noticed that way that parents often assure themselves that their child has actually heard what they said.  I have seen parents require the child to stop everything he is doing, and come to them.  Then the parents – rather lovingly, it seems to me – put their hands on either side of their child’s face – and say “Did you hear what I said?  Were you listening?”  Then they repeat whatever they said, knowing they have the child’s full attention.

I even remember going through something of that sort when I was child.  Even more so, I remember my dad getting right in my face when I was a beginning driver and planning to drive somewhere.  He would get so close to my face and go over a short list of things that I should keep foremost in my mind while driving, especially if other teens were going to be with me.  “Did you hear what I said,” he would ask me.  “Sure,” I replied, all the time hoping that he would be quiet and just let me go.  I was thinking of the adventure ahead and not about what he was telling me.

Later, as adults, many of us who received the counsel, love and wisdom of our parents are facing a reverse situation.  We find ourselves concerned about our aging parents and what their needs will be as their health and mental abilities fail them. In some cases the children must take the role as parent in securing the safety and well being of an elderly family member.

In today’s world, many adult children live miles away from their parents.  A client who lives miles away from her mother calls her mother every evening.  The child knows her mother’s health is frail and that she lives alone.  Each night, their conversation goes something like this:  “How are you doing today Mom?”  Mom replies “Everything’s fine.”  The child persists, “Are you taking your medicine?”  “Yes, everything’s fine,” Mom replies. “Mom, do you need anything?”  “No, everything’s just fine,” mom says.

My client does not get much more conversation from her mother. She hangs up wondering “Is everything really fine?”  Maybe her mom just continues to insist that she can take care of herself.  Or her mom could actually think everything’s fine and be forgetting to take her medicine, or pay her bills, or eat.

When we have conversations like the above with our parents, are we really listening?  It may be important to put our face very close to theirs, and really listen.

Sometimes just assuming that “everything’s fine” could be putting your loved one at risk.  Everything may not be fine.  It’s important to become a partner with them in their care.  Of course, the best time to start such a partnership is well in advance of a crisis.

A good way to begin is to sit with your parents and ask questions like, what are your concerns for the future. Do you want to remain in your home? Are you worried about losing your independence? Listen to their answers. You might relate your concerns as well, or your desire and willingness to be of assistance.

To become a collaborater in planning for care and helping your loved one, you need to know what legal and financial arrangements are in place. By asking, “What if you had a stroke, Mom?  I would need to know where your medical and insurance documents are and what you would want me to do on your behalf.”

There are many resources available to help families in caring for their aging loved ones.  In Maryland, you should look at the web site of the Department of Aging – www.aging.maryland.gov/senior.html.  There you will find many resources to assist you as a caregiver, and to assist your aging loved one.  Also, you should look at the Prince George’s County Department of Aging web site – www.princegeorgecountymd.gov/Government/Age.  The Prince George’s County Phone number of the Department of Aging is 301-265-8450.  As you become more educated on these issues, you will know when it is time to bring in professional services to help or when the need to find new living arrangements is necessary.

Beginning now to talk, listen and plan together can make the journey more pleasant for everyone involved.  Thank you for reading.  Stay well.  See you next week.

Last week this column was about Medicaid.  Today, we move on to some ways to avoid having to even think about Medicaid.

What are the ways to pay for long term care?  According to the MIA, (Maryland Insurance Administration), you could choose to invest your money or purchase an annuity and use the returns for paying for long term care.  You could also choose to sell certain assets – for example, your home or other real estate.  You could apply for Maryland’s Medical Assistance program, definitely not a “do it yourself” project.  Or, finally, you could purchase a long term care insurance policy, or a long term care partnership policy.

It is the last two sentences of the above list that require explanation and consideration today. Long term care insurance contracts and long-term care insurance riders to life insurance and annuity contracts provide coverage for certain long term care expenses that are not usually covered by traditional health insurance, HMO contracts, Medicare or Medicare supplemental polices.

Coverage is generally provided when you are unable to do a certain numbers of ADLs (activities of daily living), such as bathing, eating, or transferring.  Coverage is also available for those who may become cognitively impaired.  The exact terms and conditions of coverage depend on your individual policy.  But long term care insurance generally covers services such as nursing home stays for custodial, intermediate and skilled nursing care.  These policies often also cover home health care and adult day care.

The insurance can be purchased as a separate stand alone policy or as a rider to a life insurance or annuity contract.

The older you get, the more costly this type of insurance becomes, and medical underwriting is very strict.  Never the less, it is a wonderful option to investigate.  Before you purchase any long term care coverage, you should find out the answers to these questions:  What type of care is covered?  Is there a waiting period before I can start using the benefits?  What happens if I am late paying the premium?  Is there a maximum number of days the policy covers?  Does the policy have a cash amount limit?  Does the policy take inflation into account?  What are the rules about pre-existing conditions?  What must happen in order for me to receive benefits under the policy or contract, i.e. doctor’s certification or other requirements?  Has the insurer received approval to sell long-term care insurance in my state?  Can I afford the premiums?

If you are considering the purchase of long term care insurance, it is important to understand the Maryland Long Term Care Insurance Partnership Program.  This program is a partnership between Maryland and private insurance companies who issue long term care insurance policies.  A policy sold under the program, by law, must meet the same standards as any policy not sold under the program.  However, a partnership policy must meet certain additional specific federal and state requirements and be officially certified as a partnership policy by the Commissioner of the Maryland Insurance Administration.  Partnership policies, among other things, permit individuals to protect additional assets from spend-down requirements under Maryland’s Medicaid program if assistance under this program is ever needed, and you qualify.

The asset eligibility provisions of Maryland Medicaid are applied to LTC partnership policies by disregarding an additional amount of assets equaling the amount of insurance benefits you have received from your Partnership Policy.  For example, if you had received $200,000 of insurance benefits from your Partnership Policy at the time of application for Medicaid, you generally, under today’s rules, would be able to retain $200,000 of assets above and beyond the amount of assets normally permitted for Medicaid eligibility.  This is not a small thing.  The amount of assets normally permitted for Medicaid eligibility today are a total of $2500 for the Medicaid applicant.

All remaining Medicaid rules for your application would remain consistent with the current state laws and rules for these applications.

Additionally, there may be tax benefits for purchasing long term care insurance.  The insurance benefits you receive from the policy will generally be subject to beneficial income tax treatment.  For example, Maryland law provides for a one time tax credit of up to $500 after you purchase a long term care insurance policy.  In addition, federal law provides tax advantages if you purchase a qualified plan.  The agent selling you the policy will know about these tax breaks.

Existing long term care policies that you own may not be turned into partnership policies if you purchased them before January 1, 2009, or before the date your particular insurer was certified to sell a partnership policy in Maryland.

The Maryland Insurance Administration has a listing of companies approved for partnership policies.  Each has gone through a stringent state review process.  You may obtain a copy of that list by calling 800-492-6116 or on the web site, www.mdinsurance.state.md.us.

Thank you for reading.  Stay well.  See you next week.

“Mrs. Byrd,” the gentleman said as I was walking down the hallway at the Bowie Senior center.  “I need to ask you a question. Do you have a minute?”

Of course, I said I did.  “I was wondering if you could give me a couple of hints or a start in the right direction.  I’m afraid my wife will be needing nursing home care soon, and I want to start spending down our assets, so that we can receive help. Where should I start?  Should I just wipe them all out – give them all away?”

I was on my way to a meeting and that question, which I’ve been asked many times, requires way more time than we had that moment in order to come up with a satisfactory answer.  I told him that current laws allow him to keep funds intended for his support for the rest of his life, and suggested he come by the office for a clarity and confidence consultation so he could actually take the most constructive planning actions.  Oh, and that before that consultation, he definitely should NOT be giving anything of his or his wife’s away.

It’s fascinating.  If you are married, the law allows you to convert a little more than $100,000 from a “countable” asset to an “uncountable” asset for the community spouse (the spouse not in the nursing home.)  You can do this just by saying you want to.  Here’s the complication:  You have to say you want to at exactly the right time.  If you say so one day too soon or one day too late, you lose, and you cannot legally shelter the money for the community spouse.

Many people make the mistake of acting on bad advice from well-meaning family members or friends and neighbors, who almost never have the exact same circumstances as my gentleman friend might.  Sometimes, their aunt, mother, or whomever they use for an example, even lives in a different state.

Remember, although Medicaid is a federal program, many of the rules and regulations are enacted and enforced by the state you live in, and the states differ with regard to their requirements.  Sometimes even counties in the state differ with regard to Medicaid requirements.

Even if the Affordable Care Bill, often called “Obama Care” does not stand up in court, I am sure that at least one emphasis will remain:  That is the intent to use state and federal funds to assist folks so they can stay in their homes whenever they might need long term care. Marylandis working on several programs to further this ambition, and each one is exciting and filled with promise.

On the other hand, most likely nursing homes do not need to be quaking in their boots regarding their demise.  There will always be folks who cannot be cared for at home under any circumstances, and who need the type of custodial care offered by these facilities.  That brings us back to Medicaid.

Medicaid began as a poverty program, and over the years has morphed into a middle-class assistance program as well.  The cost of long term care has gotten so high that virtually only the very wealthy can “self-insure” for it.  Long-term care insurance is a wonderful solution, especially since they’ve developed hybrid programs that turn into life insurance or annuities if you never use them for long term care.  Also, the state partnership program that allows people to shelter as many funds as their long term care insurance provides, is a marvelous step in the right direction.

Never the less, there remain many people who cannot afford long term care insurance, or who cannot pass the stiff medical underwriting required.

So, back at square one, we’re looking again at Medicaid qualification and possible legal asset protection.  At a minimum, if you sit down with an attorney or a financial planner for estate planning advice, be certain that you ask them to point out what in their suggested plan will allow you help in paying for long term care.  If they have nothing to offer, it is my suggestion that you run – fast.  In today’s world, a complete plan must include the answer to the question “Should I need it, how am I going to pay for long term care?”

A common error is the idea that health insurance, Medicare or Tricare for life will pay for long term care.  Not true.

The truth is, for my friend at the senior center and all who wonder, it is possible to get benefits without spending down.  It is also sometimes possible to get benefits when you do spend down.  But, it’s for sure you can get neither if you don’t know the correct rules. You can take advantage of the shelters allowed by law, but you must do it in the right time and in the right way.  Be sure to look for the right advisors.

Thank you for reading.  Stay well.  See you next week.

Even the most devoted mother sometimes wishes the baby would sleep just one more hour. Even the fanatic dog lover, who leaves the dog his entire estate, sometimes wishes a walk wasn’t necessary on a rainy night. And how about a care giver? Yes, a care giver. The tiredness goes all the way to the bone. Family caregivers are often under-appreciated, easy marks for physical and emotional problems, and they frequently pass away before the person for whom they are providing the care passes.  But, day after day, they do it. And they keep on and on and on.

Former first lady Roslyn Carter famously said, “There are only four kinds of people in the world: those who have been caregivers, those who are currently caregivers, those who will be caregivers, and those who will need caregivers.”

An interesting article on the Benjamin Rose Web site (www.benrose.org) suggests a fifth kind of person for Mrs. Carter’s list: Those who are caregivers but don’t realize they are. “This is because they don’t see what they are doing—helping mom balance the checkbook, phoning dad every morning to make sure he takes his cholesterol-lowering, diabetes and arthritis medications, running errands for a disabled neighbor—as care giving. They see it as an extension of their role as spouse or daughter or friend,” writes Sylvia Pla-Raith, director of In-Home Services at Benjamin Rose.

By the time many of them realize they are caregivers, the article continues, they are suffering from symptoms of caregiver fatigue or, worse, caregiver burnout. Symptoms of both conditions are listed in the article: feelings of guilt and inadequacy because they can’t do enough for the person needing care; resentment, anger, impatience and/or irritability at family members and/or the care recipient; social isolation due to caregiving responsibilities that take both time and money, and physical and mental exhaustion.

Mrs. Pla-Raith says that you can expect to take on the role of caregiver when elderly loved ones enter their late seventies and eighties, and perhaps earlier if they have chronic health conditions. The article—titled “When You Look in the Mirror, Do You See a Caregiver?”—suggests some proactive steps that you can take now to make the transition to caregiver easier for you and the person you will be caring for.

First of all, talk to your aging loved ones about their finances, long-term care insurance, where important documents are stored, and their need for a durable power of attorney for health care and for finances, and a living will. If they won’t talk about these things, see previous Senior Moments columns for suggestions regarding starting the dialogue.

Then talk to them and their health care provider, about their health status, both present and future. If they have a medical condition, such as osteoarthritis or Alzheimer’s disease, that will worsen over time, now is the time to learn as much as possible about it and find out about support groups near you.

Talk to your loved ones about the kind of housing they want as they become less able to care for themselves. If they decide they want to remain in their home as they age, investigate equipment, devices and home modifications that might enable them to do so.

Talk to your loved ones about the things that frighten them so that, when planning their care and your help to them, you can help to lessen the chances of the disabling anxiety that emotionally cripples so many of the elderly.

Talk with family members, the elderly person’s physician, friends and representatives from local community service agencies about the activities, organizations and services available in your community. A good place to start is your county’s Department of Aging.

A wonderful care giver support group meets monthly at the Bowie Senior Center.  You can choose the evening or daytime group.  I have heard nothing but wonderful things about this experience.  Call the Bowie Senior Center for more information, dates and times.

And, finally, make plans to take care of your own physical and emotional needs by lining up substitute caregivers, adult day centers and respite care facilities, before you need them.

Helpful care giving information is available from the American Association of Homes and Services for the Aging (www.aahsa.org), Benjamin Rose (www.benrose.org), Children of Aging Parents (www.CAPS4caregivers.org), National Alliance for Caregiving (www.caregiving.org) and National Family Caregivers Association (www.nfcacares.org). And you’ll find a wealth of useful information at www.thoushalthonor.org. Wonderful books available at any bookstore include Elder Care: A Six-Step Guide to Balancing Work and Family by John P. Marosy and Taking Care of Aging Family Members by Wendy Lustbader and Nancy Hooyman.

Thank you for reading. Stay well. See you next week.

My face hurts.  I have been smiling non-stop for two hours.  In addition to smiling, I’ve been laughing, applauding, singing and admiring the joie de vivre exhibited by Maryland’s retirement community of energetic seniors.

Before I tell you where I was, you should know that an awesome highlight of the event was the vocal solo “Summertime” by Sylma Gottlieb, age 89.  Sylma is the grand dame of the music of Bowie, having taught voice to Bowie students for years, and having served on the BRAVA Board from its inception.  She was accompanied on the harp by Mary Fitzgerald, a former White House harpist.  Believe me, it was thrilling.

Okay, okay.  I was at the Bowie Center for the Performing Arts for the Maryland Senior Idol Vocal Competition, an annual event modeled loosely after the “American Idol” TV show.  This was the 6^th year for the competition and eight counties participated.  Each county is invited to conduct their own competition, and is allowed to send two winners to the state competition.

Prince George’s County – and Bowie – won the right to host the state competition for the first time largely through the efforts of Darilyn Marinelli, Bowie resident and senior services coordinator for the Maryland-National Capital Park and Planning Commission, and those who worked with her on this project, whose names I do not know.  Others responded to the opportunity, and climbed on the band wagon with a lot of support, including the Prince George’s County Senior Providers Network.

Gloria G. Lawlah, energetic and vibrant Secretary of the Maryland Department of Aging, addressed the standing-room only crowd, along with 4^th District  County Council Member Ingrid M. Turner, and Elizabeth M. Hewlett, Chairman of the Prince George’s County Planning Board.  They stirred up the crowd, already anxious for the show to begin.

Ms. Marinelli introduced the Mistress of Ceremonies, Christel Stevens, and she in turn introduced the day’s first performer, Mr. Chuck Fisher of Baltimore County who sang the Conway Twitty hit, “Its Only Make Believe.”   Right away you could anticipate that the song selections would be perfect for the crowd, mostly seniors with many arriving on buses from area facilities.   Mr. Fisher’s performance was extraordinary and at its finish, we learned that the judge’s comments would be positive; no Simon Cowell among them.  The three judges were themselves a group of musical history buffs with their own musical resumes, and notable for their own talent.  They were unfailingly comedic, keeping the audience highly entertained.

Mary Ann Evangelista of Howard County bested fourteen contestants to win the event with her beautiful rendition of “You Raise Me Up.”  That song was just stunning, and delivered with attractive elegance.  The judges referred to Ms. Evangelista’s “full, round tones” and the clarity and beauty of her voice.  Barbara Washington, of Prince George’s County, won second place with her feisty and dazzling delivery of the Etta James hit, “Tell Mama.”

Jack Koch, from Washington County, sang and danced the Sinatra Hit “Fly Me to the Moon.”  He brought the house down with his Chairman of the Board moves, a little scat here and there, and his Sinatra timing.

Sterling Dorn, a Prince George’s County resident and the 2011 Maryland state Senior Idol Winner sang, “I know the Lord will Make a Way” while the votes were being counted.  Dorn, obviously a favorite with the crowd, was a masterful performer, and said he has truly enjoyed his winner’s year, which included singing for various events across the state.

After the winners were announced, the crowd stood and sang “God Bless America” along with all the contestants on stage.  The contestants went to the lobby and graciously visited with event attendees.

I brought my own senior, my 80-year old uncle who has spent a lifetime in the entertainment business in New York City.  He said the show was “first class.” He commented that he admired the professional way in which the production was handled and how it ran so smoothly without a single moment being lost.  He was also extremely complimentary of our beautiful Center for the Performing Arts.  I took a minute to explain all the blood, sweat, tears and years that it took to push the facility to completion, another example of how splendid it is to live in Bowie with its activist citizenry!

Three cheers for Bowie, Prince George’s County Department of Aging, the State of Maryland, Park and Planning, other supporters and all the wonderful performers.   Everyone should pat themselves on the back.  Make yourself a note to go next year.

Thanks for reading.  Stay well.  See you next week.

Florian T. Latek didn’t trust notaries.

Mr. Latek owned a small family farm in Indiana, but he lived (and owned real property) in Illinois. In 2009, with the help of a non-lawyer friend, he wrote a letter to the lawyer for a local charity he favored. The letter began “This is my will” and it proceeded to direct distribution of his entire estate to that charity and other recipients. Then he prepared four identical copies of the document, and signed each one.

Apparently Mr. Latek realized he should have the documents notarized, but he wrote that he did not trust notaries; instead, he included his Army serial number with the note that he hoped it would “be good for any legal matters.” Then he had some — but not all — of the copies witnessed by friends, and he secreted one copy (one that had no witnesses’ signatures) behind (not in) a small safe at the Indiana farm. Less than two months later, Mr. Latek died.

Probate proceedings were begun first in Illinois. The Illinois courts initially determined that Mr. Latek had no will; later, when the friend who had helped prepare the document got in touch with the charity named in the letters, the unwitnessed version was found at the farmhouse. When the charity’s lawyer attempted to introduce that will in the Illinois courts, it was initially rejected because it did not meet the Illinois requirements for a will to be valid. Later a copy with witnesses’ signatures was located, but the lawyer could not produce the witnesses to testify about the signing of the letter in the time given by the Illinois court to prove the validity of the will. The result: the Illinois property would pass according to the law of intestate succession, to Mr. Latek’s cousins (he had no children).

Meanwhile, the charity’s lawyer filed one of the letters with the Indiana courts for admission as Mr. Latek’s last will. If admitted, it would control the distribution of the family farm. The personal representative appointed in Illinois objected, arguing that Illinois had already decided that the will was invalid and the Indiana courts were bound by that finding.

The Indiana probate judge disagreed. The will was admitted to probate in Indiana, and the lawyer for the charity was appointed to administer Mr. Latek’s Indiana estate.

The personal representative appointed in Illinois appealed in Indiana. He argued that the U.S. Constitution requires each state to give “full faith and credit” to the rulings of sister states; once the Illinois courts had rejected Mr. Latek’s letter as a will, according to this argument, the Indiana courts were required to adopt the same ruling. The Indiana Court of Appeals, however, disagreed with that argument, and upheld the Indiana probate court’s admission of Mr. Latek’s letter as his last will. Matter of Latek, January 4, 2012.

What does Mr. Latek’s estate tell the rest of us? A number of things jump out:

• It just makes sense to get help with setting up one’s estate plan. Assuming that it will all work out, that one’s Army serial number ought to prove one’s wishes, or that notaries and attorneys are unreliable are not good ideas when dealing with the legal effect of documents.  Would the lawyer have charged him? Of course. But his wishes might have actually been carried out.
• Mr. Latek looks like a classic example of the kind of person who ought to be considering a living trust. Rather than relying on two different probate courts to come to the same conclusion, he could have transferred both his Illinois real estate and his Indiana real estate — along with all his personal property — to a trust that would have been governed by the law of one state or the other. Would that have cost him something to set up? Yes. It would also have permitted his estate to be managed and distributed in a coherent and effective way, at (ultimately) lower cost than two separate probate proceedings in Illinois and Indiana. That would especially have proven to be true when the cost of one appellate case is factored in. If you own real property in two different states, you should particularly pay attention to the outcome for Mr. Latek’s estate.
• State laws vary with regard to the formalities of wills. Some states require notarization OR two witnesses. Some states permit unwitnessed wills to be effective, provided that they are signed and in the signer’s handwriting. But here’s a piece of news for do-it-yourself fans: ALL U.S. states would treat a will as effective if it has both two witnesses and a notary. Yes, some states require the signer, the witnesses and the notary to all have been together at the signing — so it just makes sense to do it that way at a minimum.

Senior Moments is grateful to Fleming and Curti, Phoenix, Arizona,for today’s guest column

As a father my heart goes out to Martin’s family. As a lawyer my head is astounded that the weight of the evidence for and against George Zimmerman seems to ebb and flow every day. As a citizen it’s frightening that a political organization put out a $10,000.00 bounty on Zimmerman and a celebrity (incorrectly) tweeted out Zimmerman’s address which led to the terrorizing of an innocent couple.

Even with the daily contradictions of evidence, which is still not all in yet, the media and court of public opinion has convicted Zimmerman of murder. The devil is always in the details but, in this case, the Devil is only slowly dribbling out of the details which has kept the public outcry on a high boil.

We first learned that Zimmerman got himself into big trouble by following Martin. We don’t know if he continued to do so after told to stop by the 911 dispatcher. Later, we learned from Zimmerman that he said he stopped and then Martin followed and attacked him. We don’t know the truth as there are no witnesses that have yet come forward. There was a witness, only identified as “John” by the Florida Sentinel, who said that Martin was on top of Zimmerman during a struggle. Unfortunately this isn’t evidence of who followed who or who was acting in self-defense. Zimmerman is still the only “Live” witness of those events.

What made the killing worse, if a death can be worse, was that it was first reported that Zimmerman said Martin was suspicious because he was black, a racist comment. Later it was reported that the news media had edited the tape and that Zimmerman said he was black only when asked by the 911 dispatcher to describe him. The distinction is huge in determining if a hate crime was committed. Along those lines, the public isn’t served well by the media describing Zimmerman as a “white-hispanic” and not as a “hispanic” A person of one race is no more likely to be a racist and to have committed murder or to have acted in self-defense than a member of any other race. Playing with Zimmerman’s ethnic designation is inflammatory. I had that same thought when news reports came out attacking Joe Oliver, Zimmerman’s self-described black friend. From a lawyer’s perspective, in evaluating a potential “hate crime”, motive and intent is everything and Zimmerman’s character witnesses are who they are.

The rush to judgment on contradictory  evidence continued when the media released a police lock-up video to show that there was no evidence of a struggle like bruises or gashes on Zimmerman’s head. By Monday ABC had enhanced the video to show injuries and evidence of a struggle. The video doesn’t tell us who followed who, or who started the fight, but it does tend to corroborate a struggle.

At first the voice overheard calling for help on the 911 tape was indicated to be Zimmermans as Trayvon’s father, allegedly, initially told police it wasn’t his son’s voice. Later, Trayvon’s father changed his mind. I have heard multiple reports from different voice experts indicating the likelihood it was Zimmerman at less than 50% and that it was more likely Martin.

George Zimmerman was first reported as being paranoid for having made forty six 911 calls. Later it was pointed out that he was a Neighborhood Watch Captain and that might not be unusual. At first the media used a 7 year old booking picture of Zimmerman  and than later of one of him in a suit as he appears today. At first the media used older photos of Martin as a young, innocent looking 14 year old and than later released Facebook pictures of him at age 17 sporting a gold-toothed and looking hard.   When it came out that Martin had been suspended from school for drug possession there was an outcry that Martin’s character was being assasinated. From a lawyer’s perspective evidence of prior crimes is not generally evidence that someone acted a certain way in the latest situation. However, it’s clear that the media could manipulate public opinion by alternately characterizing Zimmerman and Martin in different lights.

There are so many questions about what really happened in part because the evidence appears to change daily. The irony of the rush to judgment is that it is going to be difficult to get an unbiased jury if charges are ever brought against Zimmerman because everyone in America will have preconceived beliefs and probably heard some evidence but not all. The Devil’s work well-done. Of course that’s thinking like a lawyer. As a father my heart simply goes out to Martin’s family.

A favorite client has given me a very helpful outline titled “Alzheimer’s Disease: From

Start to Finish.” It explains the stages of Alzheimer’s in a very clear, easy to understand way. The information is taken from The Seven Levels of Alzheimer’s Disease (AD) by S. Zeman, from a seminar presentation on AD’s latest assessment and management strategies, at the American Healthcare Institute.

During the past several years I’ve had occasion to observe each of the different levels in family, friends and clients. But I didn’t understand that I was observing a clear-cut stage, or level, of AD. I thought Senior Moments readers would like to know more about these descriptions too.

In the beginning, people with AD do not complain of any memory loss at all, and

clinical evaluation does not reveal any loss. How long a person could remain in this stage is not known precisely, but we do understand that, at least for some length of time, a person can have AD without any symptoms at all.

The second level is known as Mild Cognitive Impairment. Senior Moments has written entire columns on this stage. It is mainly forgetfulness. People complain about memory deficits usually related to forgetting where they placed an object, names of people they know well, etc. Clinical evaluation is usually normal. People with AD in this stage can still function in both social and work situations. Lest any readers should think they are in this category, notice that the forgetting of names relates to people one has known well. Not just to forgetting the name of a new acquaintance.

Early confusion is the name of the third stage. This is usually seen as lower performance at work, difficulties in finding a word or a name, difficulty retaining new information, getting lost in unfamiliar locations, losing/misplacing things, poor concentration. Denial is paramount and anxiety is usually seen. From my experience, this is probably the stage when families begin seeking help. It’s clear to them that their loved one is not functioning as well as he or she once did, but when they bring up the subject, denial and anxiety kick in on the loved one’s part, and the family members find themselves unable to prevent bad situations and outcomes.

Late confusion, the fourth stage, brings moderate cognitive changes. These changes are recognized by poor recent and current memory and the inability to travel without getting lost or to handle finances. People most likely can no longer perform complex tasks. They may still recognize familiar persons and be oriented to time but they tend to withdraw from situations and adamantly deny any problems with memory or behavior.

During the next stage, a diagnosis can usually be made and the stage is named “early dementia.” Moderately severe cognitive changes occur. People at thisstage have an age equivalent of 12 to 9 years old. A person usually can no longer live alone and needs assistance with activities of daily living (ADLs). Current and recent memory is mostly absent, but the person usually knows his or her own name, the spouse’s name and the names of their children. The person can still recall major facts about himself or others. At this stage, the person will need help making any decisions.

In “middle dementia,” the sixth stage, severe cognitive changes are seen. There is an age equivalence of 9 years to 18 months. Forgetting spouse or children’s names is common. People can recall some aspects of their previous life but this can be hit or miss. They are unaware of their environment, disoriented to time, but will respond to and recall

their own name. Incontinence is not uncommon. Sleep may be disturbed; days and nights get mixed up in sleeping patterns. Personality and emotional changes and problematic behavior occur: delusions, paranoia, obsessive/compulsive behaviors, heightened anxiety, violence, inability to follow simple directions. There is a tendency to crave sweets.

In “late dementia” there will be very severe cognitive changes. The age equivalence is 18 months to birth. People become unable to communicate, walk, or

feed themselves. They become totally dependent for all needs. Swallowing is impaired and choking or aspiration is common. They become bed-bound, unable to move on their own. Death is inevitable, usually within about 10 months.

Well, all that’s pretty depressing, isn’t it? I apologize, dear readers, and hope you can think of something cheery right away. AD is a devastating, horrible disease. And right now, there is not a lot of good news on the “cure” front. The genetic research is exciting but I fear we will not see anything positive from that for quite some time. There are medicines intended to delay the onset of more severe stages, and I hope they do.

Thanks for reading. Stay well. See you next week.

Over the last four years we’ve fought the program in the courts. This week Maryland’s Court of Appeals agreed to take the case after it being dismissed by the Circuit Court and that dismissal affirmed by the Court of Special Appeals.

The problems with the speed cameras are well-documented by now. I was involved in a case where the contractor’s representative testified that it was impossible to measure speed using photographs as evidence – despite the fact that the people who get citations are supposed to be able to know they are speeding from looking at the photographs!

Hopefully the Court of Appeals is going to reverse the lower courts and give Maryland citizens back their due process rights.

John and Yoko found a coping mechanism for dealing with one type of unhealthy stress.  How’s your stress level? Are you mellow? The Maryland Chapter of the National Association for the Mentally Ill has an interesting pamphlet titled “33 Ways to Reduce Stress.”

Stress, says NAMI, can be related to happy or unhappy events. It can be triggered by trivial matters as well as major life crises. Stress also builds up gradually when you have more things to do than time in which to do them. Many illnesses are stress related.

However, not all stress is bad. A life without it would be stagnant and boring. Stress challenges us to do our best and to work out problems. It’s constant, unrelieved stress that is nearly always negative, and there are practical ways to avoid, reduce or relieve that kind of stress.

The first stress reducer is touch. Hold hands with a good friend or relative, stroke a pet, hug a loved one. Physical contact is the best stress reliever of all. Find enjoyable ways to exercise. Breathe deeply, stretch your muscles, jump rope, ride a bike, or jog.

Get it off your chest. Bottling up your feelings increases stress. Feel free to complain, express disappointment and let people know if they have hurt your feelings. However, please be sure you do not angrily say things you’ll regret, and ruin the relationship forever.  Give the whole picture some sober thought and pick a constructive way to “get it off your chest.”

Talk to a loving friend or relative. A sympathetic listener is always helpful. They become “band-aid friends.” A band-aid friend helps prevent you from bleeding to death. Find one.

Schedule more fun into your life. Don’t give up seeing friends and doing the things you enjoy because you have too much to do. Work goes faster and produces less stress when fun is part of your life.

Prepare yourself to wait. Long lines in the post office, grocery store or dentist’s office can even be almost pleasant with a good book in hand. Look for the humor in things, even those that cause stress. Every disaster has a funny side to it if you look long enough.

Relax your standards. Doing everything perfectly is not only unnecessary, it’s boring. Ignore some of the dirt.

Get help with the jobs you hate. Whether it’s paying bills, defrosting the refrigerator or cleaning the oven—beg, barter or pay for help. It’s worth it.

Change your perspective. Instead of worrying about what will happen “if,” try asking yourself “So what?” So what if a birthday gift is a few days late? Also, you can think “What is the worst thing that could happen?” Even if our worst fears should be realized, they often turn out to be less horrible than imagined.

Count your blessings. No disaster is so bad that it couldn’t be worse, and it often helps to remember that. My dad always said that if we were allowed to choose trouble by going into a room full of everyone else’s troubles, we would end up picking out our own. There are always people with worse troubles than our own.

Get rid of clothes, furniture and other items you never use and stop activities you don’t enjoy. Anything you can do to simplify your life helps reduce stress.

Pamper yourself. Get plenty of rest and sleep. Learn to use relaxation techniques, and consider finding a new hobby.

To avoid stress in the first place, try getting up earlier in the morning. Giving yourself an extra 15 minutes helps you to avoid morning mishaps. Prepare for morning the night before by picking out your clothes, making lunch, etc. Do not wear ill-fitting clothes. Shoes that pinch or a waistband that binds can be stressful all day. Don’t rely only on your memory, but practice making notes for yourself on things to do and remember. Practice preventive maintenance by keeping automobiles, heaters, air conditioners, washers, dryers and such things clean and serviced. Make duplicates of all keys. Exchange house and car keys with a trusted neighbor, or hide them where only you can get to them. Learn to say “no” more often, and walk everywhere you can. Exercise has a definite soothing effect.

Remember, you are the one who can do the most to reduce your stress level. Be patient. Take one step at a time. Remember there are unlimited options. Coping skills are learned, so they can be changed. Increase your available coping skills. You need to take responsibility for your own health. Good luck!

Thank you for reading. Stay well. See you next week.