No one likes to think about the possibility of their own disability or the disability of a loved one. However, as the statistics below demonstrate, we should all plan for at least a temporary disability. This issue of The ElderCounselorTMexamines the eye-opening statistics surrounding disability and some of the common disability planning options. Disability planning is one area where we can give each and every person and family we work with great comfort in knowing that, if they or a loved one becomes disabled, they will be prepared.

Most Individuals Will Face At Least a Temporary Disability
Study after study confirms that nearly everyone will face at least a temporary disability sometime during their lifetime. More specifically, one in three Americans will face at least a 90-day disability before reaching age 65 and, according to the definitive study in this area, depending upon their ages, up to 44% of Americans will face a disability of up to 4.7 years. On the whole, Americans are up to 3.5 times more likely to become disabled than die in any given year. ​

In raw numbers, over 37 million Americans, or roughly 12% of the total population, are classified as disabled according to the 2010 census. Perhaps surprisingly, more than 50% of those disabled Americans are in their working years, from 18-64. For example, in December 2012, according to the Social Security Administration more than 2.5 million disabled workers in their 20s, 30s, and 40s received SSDI (i.e., disability) benefits.
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Many Persons Will Face a Long Term Disability
Unfortunately, for many Americans the disability will not be short-lived. According to the 2007 National Home and Hospice Care Survey, conducted by the Centers for Disease Control's National Center for Health Statistics, over 1.46 million Americans received long term home health care services at any given time in 2007 (the most recent year this information is available). Three-fourths of these patients received skilled care, the highest level of in-home care, and 51% needed help with at least one "activity of daily living" (such as eating, bathing, getting dressed, or the kind of care needed for a severe cognitive impairment like Alzheimer's disease). The average length of service was more than 300 days, and 69% of in-home patients were 65 years of age or older. Patient age is particularly important as more Americans live past age 65. The U.S. Department of Health and Human Services Administration on Aging tells us that Americans over 65 are increasing at an impressive rate:

The Department of Health and Human Services also estimates that 9 million Americans over age 65 will need long term care this year. That number is expected to increase to 12 million by 2020. The Department also estimates that 70% of all persons age 65 or older will need some type of long term care services during their lifetime.

The Council for Disability Awareness provides startling examples of how disability is likely to impact “typical” Americans.
“A typical female, age 35, 5’4", 125 pounds, non-smoker, who works mostly an office job, with some outdoor physical responsibilities, and who leads a healthy lifestyle has the following risks:

• A 24% chance of becoming disabled for 3 months or longer during her working career; with a 38% chance that the disability would last 5 years or longer, and with the average disability for someone like her lasting 82 months.
• If this same person used tobacco and weighed 160 pounds, the risk would increase to a 41% chance of becoming disabled for 3 months or longer.

“A typical male, age 35, 5’10", 170 pounds, non-smoker, who works an office job, with some outdoor physical responsibilities, and who leads a healthy lifestyle has the following risks:

• A 21% chance of becoming disabled for 3 months or longer during his working career; with a 38% chance that the disability would last 5 years or longer, and with the average disability for someone like him lasting 82 months.
• If this same person used tobacco and weighed 210 pounds, the risk would increase to a 45% chance of becoming disabled for 3 months or longer.

The Alzheimer's Factor
Alzheimer's is growing at an alarming rate. Alzheimer's increased by 46.1% as a cause of death between 2000 and 2006, while causes of death from prostate cancer, breast cancer, heart disease and HIV all declined during that same time period. 

The 2015 Alzheimer's Association annual report titled, “Alzheimer's Disease Facts and Figures” explores different types of dementia, causes and risk factors, and the cost involved in providing health care, among other areas. This report contains some eye-opening statistics:

• An estimated 5.3 million Americans of all ages have Alzheimer's disease. This figure includes 5.1 million people aged 65 and older and 200,000 individuals under age 65 who have younger-onset Alzheimer's. 
• One in nine people age 65 and older (11 percent) has Alzheimer’s disease.
• About one-third of people age 85 and older (32 percent) have Alzheimer’s disease.
• Eighty-one percent of people who have Alzheimer’s disease are age 75 or older. The number of people aged 65 and older with Alzheimer's disease is estimated to reach 7.7 million in 2030 - more than a 50% increase from the 5.1 million aged 65 and older currently affected. 
• Every 67 seconds, someone in the United States develops Alzheimer’s. Thus, approximately 473,000 people age 65 or older developed Alzheimer’s disease in the United States in 2015.
• By 2050, the number of individuals aged 65 and older with Alzheimer's is projected to number between 11 million and 16 million - unless medical breakthroughs identify ways to prevent or more effectively treat the disease. 

​Caregivers are at risk of developing health problems. There were approximately 10.9 million unpaid caregivers (family members and friends) providing care to persons with Alzheimer's or dementia in 2009. According to the Alzheimer's Association, those persons are at high risk of developing health problems, or worsening existing health issues. For example, family and other unpaid caregivers of people with Alzheimer's or another dementia are more likely than non-caregivers to have high levels of stress hormones, reduced immune function, slow wound healing, new hypertension and new coronary heart disease.

Spouses who are caregivers for the other spouse with Alzheimer's or other dementia are at greater risk for emergency room visits due to their health deteriorating as the result of providing care. A study mentioned in the 2010 Alzheimer's Association report found that caregivers of spouses who were hospitalized for dementia were more likely than caregivers of spouses who were hospitalized for other diseases to die in the following year.

Receiving care. According to the National Nursing Home Survey 2004 Study, the most recent of its kind, the national average length of stay for nursing home residents is 835 days, with over 56% of nursing home residents staying at least one year. Significantly, only 19% are discharged in less than three months. Those residents who were married or living with a partner at the time of admission had a significantly shorter average stay than those who were widowed, divorced or never married. Likewise, those who lived with a family member prior to admission also had a shorter average stay than those who lived alone prior to admission.

While a relatively small number (1.56 million) and percentage (4.5%) of the 65+ population lived in nursing homes in 2000, the percentage increased dramatically with age, ranging from 1.1% for persons 65-74 years to 4.7% for persons 75-84 years and 18.2% for persons 85+. According to the U.S. Census Bureau, 68% of nursing home residents were women, and only 16% of all residents were under the age of 65. The median age of residents was 83 years.
See Vol. 4 Issue 5 of the Elder Counselor, The Affordable Care Act:  How It Impacts Our Senior Population, for a discussion of the Affordable Care Act’s Impact on information regarding nursing homes.

Long Term Care Costs Can Be Staggering
Not only will many individuals and families face prolonged long term care, in-home care and nursing home costs continue to rise. According to the Genworth 2015 Cost of Care Survey, Assisted Living, Adult Day Services, and Home Care Costs national averages for long term care costs are as follows:

• Monthly base rate (room and board, two meals per day, housekeeping and personal care assistance) for assisted living care is $43,200 annually, expected to increase .2% annually. 
• Daily rate for a private room in a nursing home is $250, or $91,250 annually, expected to increase 4% annually. 
• Daily rate for a semi-private room in a nursing home is $220, or $80,300 annually, expected to increase 4% annually. 
• Hourly rate for home health aides is $21.50, expected to increase 4% annually. 

These costs vary significantly by region, and thus it is critical to know the costs where the individual will receive care. For example, the median annual cost for a private room in the state of California during 2015 was $104,025, whereas the median cost for a year in a semi private room was nearly $90,000.

Most Americans Underestimate the Risk
Perhaps most importantly, despite overwhelming and compelling statistics; most Americans grossly underestimate the risk of disability to themselves and to their loved ones. According to the Council on Disability Awareness 2010 survey:
 

• 64% of wage earners believe they have a 2% or less chance of being disabled for 3 months or more during their working career; the actual odds for a worker entering the workforce today are closer to 25%.
• Most working Americans estimate that their own chances of experiencing a long term disability are substantially lower than the average worker’s.  

 
Given the high costs of care, this underestimation often leaves Americans ill prepared to pay for the costs of long term care.

Long Term Care Insurance May Cover These Costs
If a parent, their spouse, or family member needs long term care, the cost could easily deplete and/or extinguish the family's hard-earned assets. Alternatively, seniors (or their families) can pay for long term care completely or in part through long term care insurance. 

Most long term care insurance plans let the individual choose the amount of the coverage she wants, as well as how and where she can use her benefits. A comprehensive plan includes benefits for all levels of care, custodial to skilled. Clients can receive care in a variety of settings, including the person's home, assisted living facilities, adult day care centers or hospice facilities. 

Planning in the Event Long Term Care Insurance is Unavailable or Insufficient
Unfortunately, many older Americans will either be medically ineligible for long term care insurance or unable to afford the premiums. In that event, more aggressive planning should be considered as early as possible to make sure life savings are not depleted as a result of having to pay out-of-pocket for care. With the help of an elder law attorney, a plan can be created that will protect much of the assets of an individual or couple that would otherwise be at risk of being depleted. 

All Planning Should Thoroughly Address Disability 
When a person becomes disabled; he or she is often unable to make personal and/or financial decisions. If the disabled person cannot make these decisions, someone must have the legal authority to do so. Otherwise, the family must apply to the court for appointment of a guardian over the person or property, or both. Those who are old enough to remember the public guardianship proceedings for Groucho Marx recognize the need to avoid a guardianship proceeding if at all possible.

At a minimum, seniors need broad powers of attorney that will allow agents to handle all of their property upon disability, as well as the appointment of a decision-maker for health care decisions (the name of the legal document varies by state, but all accomplish the same thing). Alternatively, a fully funded revocable trust can ensure that the senior's person and property will be cared for as desired, pursuant to the highest duty under the law - that of a trustee.

Conclusion
The above discussion outlines the minimum planning everyone, including seniors and their loved ones, should consider in preparation for a possible disability. It is imperative that families work with a team of professional advisors (legal, medical and financial) to ensure that, in light of their unique goals and objectives, their planning addresses all aspects of a potential disability. Our firm is dedicated to helping seniors and their loved ones work through these issues and implement sound legal planning to address them. If we can help in any way, please don’t hesitate to contact our office.

Article written by Liz Farr
​
Tale #1: The Attorney and his Grief-Stricken Widow
“Patrick” was a successful attorney, whose family came from upper crust Chicago and San Francisco society. He and his wife Danielle lived a comfortable and pampered life, and their grown son and his family lived in an equally grand home just two houses down on their exclusive street. A daughter and her family lived in a nearby state.
Patrick had begun the process of creating a trust that would provide for Danielle’s needs. He also wanted to make sure that his children received some of the wealth he had received from his family. But his children feared that Danielle wouldn’t honor those wishes, and that they would end up with nothing.

Unfortunately, Patrick’s health took a dramatic and abrupt turn for the worse, and he found himself in hospice. His cognitive skills were failing, but he wanted to make sure that each of his children received a modest sum from the investments he’d inherited from his parents. So, he summoned another attorney, who helped him draft an updated will and trust documents. With a shaky hand, he signed everything days before he passed away.
Danielle was overcome with grief at his passing and was equally bewildered at the financial decisions she now had to make. She’d always left all of that to Patrick and now suddenly, those fat investment accounts didn’t look so big to her.

With no previous experience handling money, she had no context to judge whether it would be enough. Patrick’s final arrangements included a complex series of bequests and the disclaiming of those bequests.
Filled with grief, Danielle raged at her children, her attorney and the partner working with her accusing accused them all of wanting to see her in the poor house. She adamantly refused to sign anything, disclaim or share her considerable wealth with her children.
At last check, over a decade after his passing, Patrick’s estate was still open and bets in the office were that it wouldn’t likely be settled until Danielle’s death.
Tale #2: The Oil Baroness and the Trust that No One Could Decipher
First we have Julie, daughter of a Texas oil man. Through considerable business acumen, her father created a magnificent oil and gas empire, which spun off royalties in the mid-seven-figures each year. At his passing, Julie and her brother Richard became equal owners in the oil business.
Julie also had a son in his late 20s, who had struggled with mental illness, substance abuse and stints in jail. She had supported him through various attempts at college, vocational training, rehab, self-employment and full-time jobs. Nothing stuck.
At one point, Julie nearly wrote him out of her will, until he and his girlfriend had a son. Now that she was a grandmother, Julie was committed to the welfare of this young child.
However, shortly before the child’s second birthday, Julie’s health took a sudden nosedive. She was in end-stage renal failure, brought on by diabetes. For reasons that were never clear to me, she refused dialysis and she went into hospice care.
Julie summoned the best attorney in her small, rural town to her hospital bed and explained that she wanted to put her oil and gas interests in a trust. She feared that giving her son outright ownership of her business interests would have been a disaster and she wanted to be sure that her grandson was financially taken care of.
Since her son received SSI, her lawyer, who had never written a trust document, recommended a qualified disability trust and a will. At least, that’s what she thought she signed during the last days of her life.
She designated Miriam, her best friend from childhood, as the trustee. Miriam was a struggling professional photographer and had zero experience with financial matters. Oddly, she hired a graphic designer to help her with the accounting of the income and expenses for the trust.
They were both in way over their heads. When Miriam came to our office for assistance in setting up her QuickBooks and to do the tax return, we asked an attorney who specialized in qualified disability trusts to take a look at the trust document and the will.
Besides Julie’s son, several other people were named in the trust document as beneficiaries, but it wasn’t clear exactly what they were to receive. Some people got bequests in the will and were also mentioned in the trust document as being eligible for some kind of financial support.
In addition, it was equally unclear what sort of assistance Julie’s son and his girlfriend were to receive. The instructions in the trust were vague and also conflicted with the instructions Miriam had received at Julie’s deathbed.
Miriam followed her conscience and dispensed odd forms of support to Julie’s son and to some of the people named in the trust. These included car payments and new cars, rent payments, groceries, plane tickets and checks to various people.
Miriam had made multiple trips to Midland, Texas to confer with Julie’s brother Richard, who was now her business partner of sorts in the oil and gas empire. She was also paying herself a generous salary to oversee the trust.
The attorney we consulted called it “a lawsuit waiting to happen.” Even he wasn’t really sure what was supposed to happen with the flood of oil and gas royalty payments that came in every month, but there were way too many problems with it to really call it a qualified disability trust. He recommended going back to court to resolve the issues.
In the meantime, Miriam and her graphic-designer-turned-bookkeeper made a complete muddle of her QuickBooks files. They refused to work with anyone in our office to straighten it out, preferring instead to hire a succession of cut-rate bookkeepers, who each made it worse.
It seemed that each time I looked at her QuickBooks file it was as though someone had taken a giant spoon and scrambled the numbers and accounts. Of course, since we had helped with the initial set up, everything was our fault.
We struggled to get the tax return for the trust done. We kept getting conflicting answers about who had received benefits from the trust and who had received bequests.
It was also hard to figure out how much the son had received and the trust document was no help. Moreover, reconciling the statements from the oil and gas empire with the transactions in QuickBooks was nearly impossible.
Eventually, Miriam fired us and everyone in the office who had dealt with her breathed a sigh of relief. So, what are the lessons for your clients from these two chilling tales?

• Don’t wait until your deathbed to do estate planning, especially if the disposition of their estate is complex
• Consult with attorneys and accountants who have expertise in complex estates
• Get all your family members on board. Take the time to explain your wishes
• Consider hiring an attorney or bank to act as trustee rather than a family friend
• Carefully review trust documents before you agree to work with a new client

Article by A.J. Fudge, JD

​As estate planning attorneys, we strive to provide our clients with excellent service and a comprehensive estate plan that will protect all of their interests. We conduct extensive interviews to get to know our clients, and take the time to truly understand their needs and the nuances of their particular situation. The good estate planning attorney truly leaves no stone unturned; no loose ends.
It’s gratifying to uncover an issue or identify a solution that our client hasn’t thought of yet, and you see the relief expressed on their face that silently says, “I’m so glad you thought of that.” It is these moments when your client truly begins to appreciate the value that you add for them. When you spot something other attorneys have not, it gives your client a lot of confidence that they made the right choice in working with you.

Planning for Animals
One easy and meaningful way for you to do this is by addressing one of the most commonly overlooked aspects of an estate plan, and one that is essential for many clients: continuing care for their animals. Most estate planning attorneys pay little or no attention to their clients’ animals, and this omission can have heartbreaking consequences for clients. If your client has animals, those animals are a part of the family in some way or another. Sensitive planning for the client’s needs requires that the plan provide for those animals and protect and provide for them in their estate plans.
The first step is to spot the issue, which is easy to do by adding an “Animals” section to your intake worksheet. If you use the Intake Worksheet in Wealth Docx®, it’s easy to add a space under the “children” section to add a space for “pets.” As you gather data, it is important to get the animal’s name, age, breed, and a short description. When you see that a client has listed an animal on their worksheet, be ready to include this in your discussion at the initial meeting.
Once you have had a chance to get to know the client and address their immediate concerns, let them know that you would like to include their animal in their estate plan as well. Most clients have a moment of thankful surprise along the lines of “Oh my gosh! I can’t believe I never thought of that. Thank you!” Your clients will be impressed, and it will show them that you really care. (One valuable side effect: when you build that kind of relationship with your clients you can count on great word-of-mouth and lots of referrals!)
Now that you’ve determined your client has an animal that you need to plan for, the next question is how to effectively plan for it? It’s easy! Planning for a client’s animal is actually very similar to planning for a client’s minor child. However, in most cases children grow up to be independent adults who can take care of themselves. That is not the case with animals, which is why planning is so critical.

Animal Care Trust
The central component of many clients’ estate plans is the revocable living trust, and planning for an animal will generally take the form of incorporating additional provisions for an Animal Care Trust. There are instances when it is appropriate to set up a separate, stand-alone Animal Care Trust, but these situations are not nearly as common.
You should never rely on a Will when planning for a client’s animal. First, animals do not have time for probate, their care needs to continue uninterrupted and without delay. Also, a Will does not protect the animal in the event of your client’s incapacity. Finally, because animals are considered property under the law, any conditions on their transfer via a Will are generally unenforceable. There are some State statutes that attempt to address this issue, but a revocable living trust is still the much more preferable option. If your client has an existing trust, it is very easy to amend the trust to add the Animal Care Trust provisions.
The Animal Care Trust provisions will be tailored to suit your client’s specific needs, but they generally name and describe the client’s animal, and the estate, or a certain portion thereof, is set aside to be used to for its care. A caretaker is appointed who is responsible for the day-to-day care of the animal; however, the trust itself legally owns the animal. The trustee oversees the money and the caretaker, and has the ability to remove and replace the caretaker. The money is available to compensate the caretaker, and when the animal passes away, the remaining money is distributed to the final beneficiaries of the trust. In most cases, planning for your client’s animal will be a very simple and straightforward process.

Identify Appropriate Caretakers
Your client must first decide who is going to take care of their animal in the event something happens to them. The caretaker will be responsible for the day-to-day care of the animal. Although the animal will be legally owned by the trust, for practical purposes, the caretaker will be the animal’s new family. It is important to select a caretaker who loves animals, and has experience taking care of them. Your client should name an initial caretaker and potentially two back-up caretakers to serve consecutively. Do not appoint more than one caretaker at a time because you may be unintentionally setting the stage for conflict over the animal. Your client should also select an organization of last resort, such as reputable rescue or no-kill shelter, to take the animal in the unlikely event that none of the individuals selected as caretaker are willing or able to take on the responsibility of caring for the animal.
Have your client confirm that the person selected as caretaker is up for the job. It should never be a surprise to someone that they have been named as an animal’s caretaker. Your client should discuss their plans with these individuals to confirm that this is something they would be willing and able to do. This also gives your client the opportunity to address any concerns the caretaker might have. It is better to address as many concerns as possible during the planning process and ensure that they do not cause problems in the future.

Trust Protectors
Your client should discuss their plans with their successor trustees as well. It is important to make sure these individuals understand your client’s desires and are comfortable administering an Animal Care Trust. While the trustee does not necessarily need to be a huge “animal person,” it is important that they at least like animals and are committed to carrying out your client’s wishes. Trustee abuse is always a concern no matter what type of trust we are talking about, but even more so when planning for an animal. Conflict and expensive lawsuits can cause serious interruptions in the animal’s care.
A trust protector can provide a bit of a safety net, creating a mechanism for dealing with an unresponsive or abusive trustee. Without a trust protector, an expensive, time-consuming, trust-exhausting lawsuit will be their only available tool, which leaves the animal’s future, and possibly even life, in jeopardy.

Instructions
Once the trustees and caretaker are onboard, the client then needs to think about what kind of instructions they want to provide. Trustee instructions address matters such as how and when to apply trust funds, how much to compensate the caretaker, and what type of oversight is needed. Caretaker instructions address the type of care the animal is to receive, and any special information that the caretaker should know. These instructions may be as brief as a few paragraphs, or take the form of a separate Schedule that is incorporated and attached to the trust. The level of complexity and detail depends on your client and their planning objectives.
The amount of money to be set aside in the animal’s trust depends on the type of care your client wants to provide. Remind the client that the money does not have to be used, but will be available to use if the situation calls for it. In a typical situation where you are dealing with a dog or cat, I recommend clients set aside $10,000 per animal. If the animal has extraordinary medical needs or if the client want to provide a uniquely high level of care, then obviously the amount placed in trust should reflect that. Naturally, the more elaborate the care, the more expensive it is. Some clients choose to set aside the entire estate, including their home, so that the animal may continue to live there with the caretaker until the end of the animal’s life. In some cases clients purchase life insurance to provide funds to care for a pet after the client’s death.
These are the primary considerations when planning for an animal, and for the average client, that’s all there is to it. Pet trust provisions usually comprise only a few additional pages to the client’s revocable trust. The strategy is simple and straightforward, but it adds tremendous value to the client’s plan and makes it truly complete.

Special Considerations
It is important to remember throughout the planning process that animals are a responsibility requiring love, time, attention, and money. The animal’s lifespan is also important to consider. Some animals have a very long life expectancy. Some species of birds live to be well over 60, and tortoises can live to be well over 100.
Clients with long-lived animals, you’ll need to plan accordingly. You also need to be aware if your client has an exotic or special needs type animal, mainly because not everyone knows how to care for these types of animals. The client must select caretakers that are familiar with the type of care these unusual animals need.
If the client has horses, comprehensive planning is essential. Bear in mind also that not all horses require the same level of care. Recreational riding horses generally don’t require nearly the same level of care and expense that thoroughbreds or competitive show horses require. It is also not unusual to see horses that are a bit of both, depending on what stage of life they are in. Planning for horses adds layers of complexity.
The horse itself costs a lot of money, and feeding and caring for it does as well. If a client has a competitive show horse, those expenses increase exponentially. The client’s plan must include the money necessary to provide the expected level of care for the horse. Because of their intrinsic value, horses are at a higher risk of being sold for money, including to kill-buyers who send them to slaughter. Once the client understands that their horse may just look like dollar signs to some people, their plan can be drafted to protect against this.
Horses are also dangerous animals if for no other reason than their size, making it essential to choose the right caretakers. It is essential that they be experienced horse-people, who love and understand horses. It may also be appropriate to establish a team of professionals that are available to assist the caretaker with the day-to-day responsibilities of caring for the horse. This team would be overseen by the primary caretaker, and might include a trainer, rider, vet, farrier, chiropractor, etc. The idea is to create a plan that allows the horse’s regular care to continue uninterrupted, whatever care that might be.
Horses are also not generally accepted at most animal rescues. Thus, it is imperative for the client to select an organization of last resort where their horse can safely live for the rest of its life. Again, because of the expense, the client should be prepared to make a financial contribution to the organization selected. Too often old horses that have provided years of service find themselves being transported across the border for slaughter. For the client this would be a heartbreaking end, and it can easily be avoided. If the client has a horse, they really need a plan.

Conclusion
​As estate planning attorneys, our clients rely on us to make sure everything will be provided for once they are gone. It is an honor to be trusted with the responsibility, and a duty that none of us takes lightly. Most clients would shudder at the thought of something happening to their beloved animals, but they need you to spot the issue for them and make sure they are protected.
We certainly would never design an estate plan that fails to provide for a client’s minor children. Nor would we fail to appoint guardians or include instructions for the children’s care. Many animal owners treat their animals like their children. It is up to us to help them understand their options and plan accordingly.
Whether or not you, yourself, are an animal lover, if you pride yourself on being a thorough and comprehensive estate planning attorney, then take this opportunity to help your clients plan for their animals. Show your clients that you truly care about taking care of them and protecting all of their interests, and you will make them proud to call you their attorney. That’s really what it’s all about, and it’s good for business.

By David H. Lenok
​
According to court documents obtained by The Blast, recently deceased star Burt Reynolds intentionally left his 30-year-old son, Quentin, out of his will and named his niece, Nancy Lee Brown Hess, executor of his estate.
Though it may be our first instinct to jump to conclusions about the nature of Reynolds’ relationship with the adopted son he shares with ex-wife Lonnie Anderson, that sort of family drama doesn’t appear to be the case here.
The relevant portion of the will, signed in 2011 and filed in Florida court on Monday, reads:
“I intentionally omit him from this, my Last Will and Testament, as I have provided for him during my lifetime in my Declaration of Trust,”
While Quentin is expressly omitted from Reynold’s will, it appears the Smokey and the Bandit star has provided for him in a trust. In fact, the will doesn’t appear to bequeath any assets at all. Everything looks to be part of the aforementioned trust, of which Hess is the trustee.
The reason that I’m using such wishy-washy language to talk about Reynold’s trust perfectly illustrates one of the main advantages of employing the technique—privacy. Wills have to be probated publicly (which is how news outlets got access to Reynolds’ so quickly), while the terms of a trust—what it holds, who it benefits, etc.—can be kept confidential from all but a select few. In fact, the existence of a trust, as well as Reynolds own words, imply that Quentin’s omission is not a disinheritance at all. He’s already being taken care of.
Trusts also offer estate tax advantages in that, structured correctly, they remove assets from the decedent’s estate. Reynolds’ net worth prior to his death was only estimated at around $5 million. That amount falls well within the currently over $11 million federal estate tax exemption, and Florida doesn’t levy state estate tax, so it’s unlikely that this was the star’s motivation.
Protection from creditors, however, may be a factor. Reynolds’ money troubles over the latter portion of his life were well documented, and it wouldn’t be too surprising to learn that he left behind significant debts. A properly constructed trust could shield his assets to ensure they go to loved ones instead of debt collectors, whereas, during will probate, creditors stand at the head of the line.  
Ultimately, the secrecy of the trust prevents us from knowing exactly how much is in there and who's going to end up with it, so we’re unlikely to get answers to these questions. And that’s the whole point.

You may already know that not getting enough good sleep can cause daytime sleepiness, an inability to make good decisions, car and other accidents, unhealthy food choices, weight gain, depression, high blood pressure, diabetes and a host of other health problems. But could poor sleep increase your risk of Alzheimer’s, too? Three recent studies are pointing us in that direction.
 
In this issue of The ElderCounselor, we will look at the finding of these studies and the latest advancements in the treatment and prevention of Alzheimer’s.
 
Boston University School of Medicine
 
This study, conducted by a team from Boston University School of Medicine, was published in the journal Neurology. They determined that even a small loss of the dreaming phase of sleep, called REM or rapid eye movement sleep, can increase the risk of Alzheimer’s.
 
The Boston team studied 321 people over age 60 who volunteered for a sleep study in the 1990s. Over the next 12 years, 32 developed dementia and of those, 24 were diagnosed with Alzheimer’s. Those who had just a little less REM sleep during the sleep test were more likely to be in the dementia group later. The difference in REM sleep was indeed slight—those who later developed dementia had only 3% less REM sleep than those who did not develop dementia. Most did not even notice the difference in their sleep.
 
It is not clear if the disordered sleep is a cause or an early effect of the dementia process. One of the leaders of the study, Matthew Pace, commented that, “Sleep disturbances are common in dementia but little is known about the various stages of sleep and whether they play a role in dementia risk. Our findings point to REM sleep as a predictor of dementia. The next step will be to determine why lower REM sleep predicts a greater risk of dementia.”
 
Washington University in St. Louis
 
In the second study, published in the journal Brain, a team from Washington University in St. Louis reported that sleep disruption raised levels of amyloid, the protein that clogs the brains of Alzheimer’s patients. They believe that interrupted sleep may allow too much of the compounds, amyloid and tau, to build up and that sleep might help the body clear them away.
 
In this study, the team allowed their group of 17 healthy adults to sleep a normal amount of time but half were prevented from getting deep sleep, called slow-wave sleep. In the mornings, their spinal fluid was analyzed. Those who had their slow-wave sleep disrupted had an increase in their amyloid levels by about 10%. The volunteers also wore sleep monitors to measure their sleep at home. Those who slept poorly for a week at home had measurably higher levels of a second Alzheimer’s associated protein called tau.
 
Amyloid is naturally produced in the brain and researchers know it can cause clogs called plaques. People with more plaques often have memory and thinking problems and dementia but not always, so the amyloid link is not yet entirely clear.
 
Dr. Yo-El S. Ju, who led this study, thinks that interrupted sleep leads to increased brain activity and increased amyloid production. Amyloid is released by brain cells all the time when they fire their synapses, but they don’t release the amyloid when they rest. Dr. Ju thinks the brain may clear out excess levels of amyloid during deep sleep.
 
“When people are in a nice, deep sleep, they get a period of time when, with the normal clearance mechanisms working, the levels of amyloid decrease. If levels are increased over years, they are more likely to cause the clumps, called plaques, which don’t dissolve.”
 
Studies in mice show it takes only an excess of about 10 percent of amyloid to cause amyloid plaques to form. This study showed that just one night of interrupted sleep can increase amyloid levels by 10 percent.
 
Dr. Ju’s team will next study whether treating obstructive sleep apnea, a common cause of sleep disruption, will improve people’s slow-wave sleep and affect amyloid levels.
 
New York University School of Medicine, Rutgers School of Public Health
 
In this study, published in the journal Neurology, researchers at New York University School of Medicine and Rutgers School of Public Health found that sleep apnea can lead to mild cognitive impairment (MCI) nearly 10 years earlier than in those who don’t suffer from breathing problems during sleep. And those with sleep apnea were diagnosed with Alzheimer’s an average of five years earlier than those without sleep issues.
 
Sleep apnea is common in older adults, affecting more than half of all men and a quarter of all women. But many go undiagnosed until they are in a car accident because they are sleepy, they develop high blood pressure or they have a stroke.
 
People with sleep apnea have periods during the night when their throats close up and they briefly stop breathing. Itis caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep and briefly closes the throat until the person partially awakens, gasping for air. Other symptoms are loud snoring, choking and snorting while sleeping. Breathing pauses can last from a few seconds to minutes and can happen as many as 300 to 400 times a night, but the person often doesn’t wake up enough to even be aware it is happening. Instead, they wake up in the morning feeling tired.
 
The team reviewed the medical histories of 2,470 people aged 55 to 90 who had participated in an earlier study designed to look for markers of Alzheimer’s disease. They found that sleep apnea was associated with a much quicker decline in cognitive function. But they also found that people who got treatment declined at the same speed as people who didn’t have apnea at all. Treatments can include machines that help people breathe better as they sleep (called CPAP devices), dental appliances (for mild cases) and weight loss.
 
Sleep apnea leads to drops in oxygen levels, which can affect various organs in the body differently and can damage parts of the brain. Dr. Andrew Varga, an Adjunct Instructor in Medicine at New York University and co-author of the study, noted that certain neurons in the hippocampus, where much of Alzheimer’s is thought to start, are very sensitive to drops in oxygen, and sleep apnea may stress out those neurons. Also, as mentioned earlier, the disrupted sleep may prevent the brain from cleaning out the amyloids that can turn into plaques.
 
Recent Developments in Treating Alzheimer’s
 
Currently, more than 5 million Americans have Alzheimer’s. That number is expected to grow to 28 million by 2050 as our population ages. There is no cure. There are a handful of drugs on the market—Aricept, Namenda and Exelon— that were approved more than a decade ago. They can treat symptoms for a while, but they do not affect the disease itself.
 
There are, however, some new drugs in the works that aim to clear amyloid proteins out of the brains of Alzheimer’s patients in hopes of slowing the disease. But they are not even close to being a cure or even being on the market. The three drugs highlighted at the Alzheimer’s Association International Conference are solanezumab, aducanumab and gantenerumab.
 
Solanezumab, made by Eli Lilly, was first released in 2012 and didn’t seem to help patients. But developers continued to follow those in the trials and discovered that those who got the drug early seemed to be doing better, while those who got the drug later could not seem to catch up. Test scores showed very modest changes but could add to more days living at home for those treated very early. Lilly has started a phase III clinical trial, the last stage before seeking FDA approval. Results are more than a year away.
 
Aducanumab, made by Biogen, appears to be clearing the amyloid from the brains of patients and there is some evidence of improving test scores in patients who got the highest doses. Biogen has also started a phase III clinical trial and will test it in people who have very early Alzheimer’s disease or have mild cognitive impairment.
 
Gantenerumab also failed in tests, but it may be that people were not given enough of it. An analysis did show it was affecting tau protein, but higher doses have caused brain inflammation (which could indicate the drugs are working), headaches, dizziness and, in other drug trials, death.
 
Researchers want to offer hope, both for patients and for investors so they will continue to support the development of new drugs. But they caution that real noticeable progress in patients is still years and many dollars away. The Alzheimer’s Association is also asking Congress to fund more government research.
 
Can We Prevent Alzheimer’s?
 
There is no evidence that anything can prevent Alzheimer’s. But there are some things we can do to help slow memory loss and cognitive impairment. These include improving sleep quality, getting regular exercise, controlling blood pressure, engaging in cognitive training and changing eating habits.
 
Improve Sleep Quality:If you, your sleeping partner or a roommate suspect you have sleep apnea, get tested and follow through with any recommended treatment. Other sleep disrupters include restless leg syndrome, insomnia, jet lag, sleepwalking, night terrors, and stress. If your sleep suffers from any of these, talk to your doctor or a sleep specialist about steps you can take to start getting restful sleep.
 
Get regular exercise:Moderate aerobic exercise, like brisk walking, can have an effect on reducing cognitive impairment later in life. Experts say to aim for 150 minutes a week (30 minutes five times a week). Exercise increases the blood flow to all parts of the body, including the brain, improves physical conditioning and lifts your spirits.
 
Lower your blood pressure:Controlling blood pressure helps prevent heart disease. There is also evidence it can reduce the risk of memory loss and dementia because high blood pressure damages delicate blood vessels in the brain.
 
Engage in cognitive training:According to Dr. Ronald Peterson, an Alzheimer’s expert at the Mayo Clinic, this doesn’t mean crossword puzzles or Sudoku, although those won’t hurt. Instead, he suggests working on memory improvement techniques, called mnemonic techniques. These can include finding a new way to remember a list of grocery items; figuring a tip in your head instead of using a calculator; using new strategies that will help you process and locate information more quickly and efficiently; and working on techniques that will help you remember names and other vital information. 
 
Dr. Peterson cautions that most “brain games” have done little more than show they make people better at playing them. He also encourages people to get out and do things, instead of sitting and watching television for hours.
 
Clean up eating habits:You probably know that sugary foods are not good for you. But did you also know that carbs turn into sugar in your body? And did you know that both can have devastating effects on your brain? Dr. David Permutter is a renowned neurologist. His book, Grain Brain, may provide some insights that just might change your life for the better. 
 
Conclusion
 
Alzheimer’s is a devastating disease. There is no cure. Current medicines, when started early, only help with symptoms for a while and have no real effect on the disease itself. Therefore, we owe it to ourselves, our families, and those we serve to do everything we can to protect our brains from Alzheimer’s for as long as possible and to educate others about how to do so. 
 
If we can be of assistance to you or the seniors you work with, please don’t hesitate to reach out.
 
Additional Sources

1. Poor Sleep Raises Alzheimer’s Risk
2. Here’s How Sleep Loss Can Affect Alzheimer’s
3. Sleep Apnea May Speed Memory Loss, Alzheimer’s Onset: Study
4. New Alzheimer’s Drugs Offer “Exciting Possibilities”
5. What Can Prevent Alzheimer’s? Here’s What the Evidence Shows

 

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Wendi Hashimoto | Community Relations Coordinator
 
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