Families must consider the legal, financial aspects of dementia care By Loretta Kaes Dementia can occur at any age and can even affect young people as the result of injury or hypoxia (the reduction of oxygen supply to blood). However, it is mostly a disease of the elderly, affecting approximately 15 percent of those age 65 and 40 percent of those age 80.The most common cause of dementia is Alzheimer's disease. For anyone who has been diagnosed with Alzheimer's disease or another form of dementia, there are immediate legal and financial steps that must be taken.By acting decisively in the early stages of the disease,while the patient retains mental capacity, it eases both the patient's and family's state of mind and prepares for future care in the most responsible and cost-efficient way. Patients and families who postpone making tough decisions and wait until the patient has lost his or her cognitive abilities may find themselves in the courts and having a judge and a courtappointed attorney making decisions for them.When guardianship becomes a public affair rather than a private family matter, it is time consuming, cumbersome and exhausts assets that otherwise should be going for patient care. In New Jersey, for example, a court-appointed guardianship takes two to three months to complete and costs about $7,000 to $8,000.Then, if the family wants to sell or gift the patient's assets, they have to go before a judge to get permission. It is an onerous and expensive process. To avoid these problems, you should meet - as early as possible after dementia is diagnosed - with a certified elder law attorney (CELA).A CELA is an attorney who has sat and passed a special bar examination on elder law.There are approximately 30 CELAs in New Jersey and you can find one listed by town at www.elderlawanswers.com.TheWeb site also provides extensive information about elder law. Jeff Bascelli, aWayne-based CELA who has spoken nationally regarding issues involving estate and elder care planning, says,"The most important thing any family facing a disability should consider is the transfer of the decision making authority to someone other than the affected party, to handle financial matters, or what most people refer to as a durable power of attorney. The other would be a health-care power of attorney with advanced directives for health care." As a dementia patient or family member, you should recognize that as the illness progresses there will come a time when someone has to step in to make the financial and medial decisions, and manage these affairs.This is a highly sensitive issue and some patients are reluctant to face their situation.Bascelli suggests exposing the patient to the many options available for dementia care, in a nonthreatening manner in a public setting.There are talks and seminars on the subject provided free by hospitals, social services, senior centers and assisted living facilities. It may take a little research to find such a forum, but the information is presented in an objective fashion and may help the patient better understand his or her situation and the best way to proceed. Establishing who in the family will be assigned the legal authority to act on behalf of the dementia patient should be the first order of business."A durable power of attorney can be assigned to a single individual and that's probably the best way to do it,"Bascelli recommends. "If you assign it to multiple individuals, there are too many cooks in the kitchen and there may be conflict." Obviously, emotions come into play. For example, it may become financially necessary to sell the house in order to provide care.One sibling may be emotionally attached to the family home, while another sibling may look at it as a purely business decision as to what is appropriate for the parent. Sometimes it is the eldest child, or the child with the most business or medical experience, that is assigned the durable power of attorney. Occasionally, the elder care attorney may have to help the patient look outside the immediate family to assign the power of attorney. Once the decision-making authority is agreed upon, the elder care attorney will want to do a thorough review of the patient's financial assets and liabilities. Gathering and reviewing that financial information as early in the disease as possible may enable individuals with dementia to provide input into the advance planning before loss of cognitive abilities prevents them from doing so. In addition, involving the patient in the advanced planning may relieve some of the burden on caregivers and other family members when important issues arise during the progression of the disease. "In the mid stages of the illness,we require our clients to undergo a mental capacity assessment to make sure that the level of understanding is there, because the patient is creating a contract under which their financial and medical decisions will be made,"Bascelli says. Depending on the scope of the assets, a certified public accountant or a certified financial planner may have to be called in to help determine how patient care will be paid for, or how assets can be invested to generate income to provide for long-term care. "There are so many options. It does not mean the patient will be shipped off to a nursing home,"Bascelli points out."There is inhome care and sometimes a parent moves in with a child. If one sibling takes on this responsibility, there should be some financial recognition.We try to keep the playing field level so there's never any animosity at the end of the day." Loretta Kaes, a registered nurse with certification in gerontology, is vice president of health services at Chelsea Senior Living LLC.Chelsea is based in Fanwood and operates senior living communities in East Brunswick, Manalapan, Tinton Falls and eight other locations. For more information, call (908) 522-0808, or visit www.chelseaseniorliving.com.