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Caring for someone with a dementia

3 Aug

 

Caring for someone with a dementia

 

There are lots of different kinds of dementia and they have slightly different presentations, but the key points about all dementias is that they are changes to the brain, that affect memory and brain function, that is deteriorating.  There can be changes in personality and the deterioration might not seem to make sense, as someone can still retain one key skill long after they have lost other key skills, it doesn’t always work that the person with dementia loses everything at a nice even pace!  And importantly, eventually it will be terminal.

 

It is useful to get a diagnosis of the kind of dementia that the person has, as it will help the carer to understand some of the changes that will happen.  Diagnosis is also a gateway to access some services, that will support both the person with dementia and/or their carer.  And making sure that the carer is supported is really important, as without the carer their life would be much more impaired and disempowered.  The carer will facilitate the best outcome that can be achieved.  In the UK dementia costs £26bn a year, the biggest part of that figure is made up of the work of unpaid carers, £11bn, and the NHS and social services make use of that unpaid care, which means supporting the carer to ensure that carers can keep going.

 

There is no cure for dementia, there is a lot of worldwide work being done currently looking at different cures, creating new drugs and repurposing existing ones and although there have been some promising initial results, I have been told that a cure is a least 10 years away, if not more.

 

Because there is no cure, the only therapies are those that keep the person in the state that they are in, but do not roll back the clock on the progression of the illness.  These drugs only work for a certain period of time, as they will not stop the underlying progression of the illness, but will maximise the cognitive abilities that they have.

 

The other therapies that are useful are the social interactions, as long as they are meaningful and there is a lot of work being done on these.  Music seems to be quite powerful to many people.  Football dementia cafés are great for football fans and here in Plymouth we are lucky enough to have a dementia café for veterans.  Elsewhere there are dementia farms, which for former farm workers is incredibly powerful that they are once again able to participate in the workings of a real farm.  When the idea was first mentioned there was concern about the risk, but the risk is managed and the participants get a lot of value from it.

 

Carers need support and respite, they need to be able to have a life of some kind away from their caring role, for an hour, a day or a week. Family carers do an amazing job to care for people with dementia and yet they are working alongside a progressing condition that is slowly taking their loved one away.  85% of carers are clinically depressed within a year of diagnosis, it is hard dealing with the condition and its progression.

 

A person with dementia can live a fulfilling life, they can be empowered to do the things that they want to for as long as they are able to.  It takes the carer and the understanding of a whole community to do it well.

 

If you need help caring for a loved one with dementia, let me know, I understand what it is like.

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Plain English

15 Jun

Plain English

 

There has been a campaign in recent years for legal advice to be in plain English and long may it continue.

 

Sometimes the complexities of a legal case or legal argument may be hard for the layperson to understand and in which case it is the role of the solicitor to explain as best they can, but so they do understand.  Some unsophisticated clients just want to know that their case is being handled in a skilled manner and don’t feel the need for a detailed explanation of the situation.

 

Any case law or arguments in legal language should be a discussion between lawyers and should not involve the client, unless they have the requisite understanding, as some sophisticated clients do.

 

Historically the language of law was constructed to ensure that lawyers were seen within society as highly skilled and educated.  The process of becoming a lawyer was intentionally hard to keep the numbers in the industry small, the skill level high and in a really historic way, the province of rich white men!!!  This historic construction of the industry meant that lawyers were well paid and usually well respected in society.  Today we are still reasonably well paid and hopefully reasonably well respected.  We are closely monitored by the Solicitors Regulation Authority and are required to have training every year to ensure that our knowledge is up to date.  It is still hard to become a solicitor and as one there are lots of outcomes we are required to follow to ensure that we at all times act in the best interests of our client.

 

Some lawyers take extra exams to distinguish themselves from other lawyers and better qualified, most lawyers I know take a huge amount of pride in their work and go to great lengths to ensure that the advice that they have been given is of excellent quality, myself included, I’ve passed my Solicitors for the Elderly (SFE) exam and my Society of Trust & Estate Practitioners (STEP) exam.  In my area of law the only other exam I can take is the Associate of Contention Trusts and Probate Specialists (ACTAPS), but as I don’t litigate, it seems fairly pointless.

 

There is a LOT less Latin in the legal language than there used to be, but still some, it must be said, which is a good thing, as I never did Latin at school!!!  The detail of some legal arguments can sometimes still be hard to follow, but that should not put off the solicitor from trying to explain it to their client in a language that their client will understand.  By using plain English we are helping the client to understand that we are on their side, that is what all the regulation of the legal industry is about, the SRA has little or no sympathy for a lawyer or law firm that has not treated the client fairly.

 

So long may it continue, long may we used plain English to demonstrate to the client that we are on their side and hopefully we will be rewarded and respected for the great quality of the work that we do.  I know that’s always what I strive very hard to do.

 

 

Acting as a Financial Attorney

18 May

Considerations when acting as a financial attorney

 

When someone has appointed you to act for them, there are several duties that the attorney should fulfil.  The most important consideration is what is in that donor’s (the person for whom you are acting) “best interests”.

 

Firstly you must collate all the information, so that you can understand the situation.  How can you manage someone’s financial affairs when you don’t know what assets and liabilities they have?  The next thing is to work out how to manage those affairs going forward to get the best result for that person, whilst taking into account what they have done in the past.

 

So in the past they may have ethically invested and as long as this investment strategy is still going to provide a reasonable return, then that should continue.  However if that person gave away a big proportion of their income each month to someone who should be more financially independent, then continuing with this strategy is not appropriate.  The donor’s money is for them first, not anyone else.  The only extension to that is other people to whom they have an obligation to provide for, such as minor children.  That doesn’t mean that the donor cannot give gifts of any kind, but the gifts need to be for birthdays / Christmas / marriage etc, which is otherwise known as “on occasion”!  Importantly gifts need to be appropriate to the size of the estate.  It is considered to be in the best interests of the donor that their friends and family “remember them fondly”, but clearly within reasonable limits.  There can at times be a conflict of interest between the donor and attorney, if they are spouses or parent and child, because the more spent on care, means the less the attorney will inherit!  The money remains the donor’s, so the best interests of the donor, not the ultimate beneficiary is what is of paramount importance.

 

The next thing to ensure is that the donor is as well cared for and comfortable as can reasonably be managed, but clearly some of these decisions involve “caring” decisions, which are beyond the authority of the financial attorney, nevertheless whatever care is decided upon has to be paid for, which the attorney has the authority to deal with.

 

All the time, circumstances change, so for example on admission to a care home, that home might be able to meet that person’s needs, but 3 months later after a major deterioration, they may no longer be able to do so, in which case a new placement must be found.

 

Acting as an attorney can often be a lonely, difficult and thankless task.  If you are an attorney and you need help, please contact me, I will be happy to assist you.

Caring for a dying relative

4 May

A coffin with a flower arrangement in a morgue

Caring for a dying relative

 

This is a very hard subject.  We don’t like to think about ourselves or our loved ones dying, but it is nevertheless an important subject.

 

If our loved one dies instantly, it is a huge shock, especially if we have not been expecting it.  If you have not had a conversation, then the next stage is commonly a state of shock before you can move into a more active mode of sorting out the arrangements.  This state of shock can last varying amounts of time, we are all different and how we deal with grief is different.

 

The death needs to be registered, the funeral arranged and then afterwards the estate can start to be sorted out.

 

If our loved one dies fairly quickly, this may give us an opportunity to say goodbye, to thank them for being in our lives and to let them know that they can go, if that is the right thing to say to them.  Saying thank you and goodbye is something we do for us, for them too of course, but letting them know that it is OK to go is something we do for them and a bit for us.  How we do that and whether we can do that will be different, sometimes we are not ready to let our loved ones go, especially if they are still young and we think that they have not finished their lives.  We can then have a little time to process the situation and try to emotionally deal with it.  And we cling to hope.

 

If our loved one dyes a lingering death, then we have that time to say thank you and goodbye and assure them that it is OK to go (assuming that it is).  We are upset and then process how we feel about it, however we cannot live on the adrenalin that this heightened state of anxiety will give us, so we get slightly used to it.  During this period of waiting, our loved one might rally, so we are given hope, perhaps only a glimmer or maybe a shining light, but we have hope.  And then they deteriorate and our hope dies.  If they have a fluctuating presentation, we can cycle through these emotions of despair and hope and we start living slightly on edge all the time, just waiting and not knowing.  This is very hard to watch as we see our loved one slowly slip away.

 

What happens if our loved one experiences a painful death?  Pain is something most of us fear.  We often wish we could trade places with a loved one in pain, but we can’t.  We can hold their hand, talk to them, feed them, play them music and lots of other things to try to comfort them and us, but we cannot take their pain.  Pain can be managed with drugs, but often it cannot be eliminated, watching a loved one in pain, whether or not they are dying is a horrible experience for both them and us.  I have been involved with many families when they are dealing with a loved one dying and a “peaceful” death is preferable, even though the death is often dreaded.

 

There is a finality with death, our relationship is forever changed, we can still love them, just not in person.  Death may be the time we stop and grieve, but if we are involved in sorting out their affairs, we may keep ourselves busy with that and not grieve and it is only when that is over that we do finally stop and grieve, which can come as a huge shock to anyone not expecting it, particularly since the death was some time before.  Greif takes time, but we can get over it and move on with our lives.

 

If during any of these stages we need help, friends and family may be around, but if we are faced with administration, legal or advocacy issues, I am here to help.  And I understand.

The Big Conversation – Dying Matters!

16 Feb

A coffin with a flower arrangement in a morgue

#TheBigConversation

 

There are a number of different organisations that are involved in this subject of talking about dying.  We live in a death phobic society, we rarely see real dead bodies, just fake ones in movies.  When a neighbour dies, they are not laid out in the dining room for the neighbourhood to come and pay their respects or anything like that anymore!  We avoid using the word “death”, there are lots of other sayings: “fallen off their perch”, “gone to the other side”, “passed on” etc.

 

And yet, this is something that eventually we will all do, yet we don’t talk about it much.  Lots of families find this a very difficult and uncomfortable conversation, but often once that first barrier is broken, of starting the conversation, the whole thing becomes much easier.

 

It is entirely understandable that people want to focus on living and therefore want to talk about living, about the exciting things they want to do with their life, the place they want to go on holiday this year or just what’s for dinner!  But it is still worth having a conversation, perhaps once a year or every other year about what you want to happen as you are dying and after you have died.

 

What sort of end of life treatment do you want?  Who will make those end of life decisions if you can’t?  What do you want to happen if you have a 50% chance of survival?  But what about a 70% survival chance or a 10% chance.  And what does “survival” really mean?  What is it about your life and lifestyle that is important to you?

 

And once you have died, what sort of funeral do you want?  Who do you want to be there?  Do any of these decisions matter or do you want your family to make some or all these decisions?  Is your family going to hold a wake, should there be a theme?  How do you want to be remembered?

 

In legal terms, this also leads into the making of a Will, which I have blogged about before.

 

Your family will be sad that you have died (hopefully) and one of the important ways that they are comforted in their grieving process is to be able to fulfil your wishes.  They can only do that if they know what your wishes are.  And they will only know what your wishes are if you have had a #BigConversation with them!

Wills and succession for business owners

2 Feb

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Wills in relation to business owners

 

If you are a sole trader, partner or director in a business, think about what if something serious happened to you and you died, what would you like to happen in respect of your business?

 

Some of the issues are the same as if something happened, but you are still alive.  Will the business continue?  How will it continue?  Is it to be sold?  Does it need to be sold to particular people or can it be sold on the open market?  How will the value be maximised?

 

The next thing to do is look at your business agreement and see what, if anything it says about those circumstances, as there may already be a clause covering those circumstances.  If there isn’t a clause or if you don’t like what it says, the next thing to do is talk to your partners / directors and discuss changing the agreement, if that is possible.

 

Think about the dynamics of the people who are left behind, do they get on and will they work together to achieve the outcome that you want?  Families often row and after the death of a family member can be a time when small niggles become full blown knock down fights!

 

You can put a clause in your Will in relation to any business assets that you own.  Wills are for individuals and the financial assets that they own at the date of their death.  You will need to consider whether the clause in your Will is going to work in relation to your business agreement.  You should think very carefully about who you appoint as your Executor and can they delegate the running of your business or will they run it themselves.  Are you essential for the business, so without you it will collapse?  Whatever the situation is currently, do you want that situation to be in place if you were to die tomorrow, if not, then you should consider what changes need to take place to ensure that your business is in a robust condition.

 

After you have gone, you need to think about how those who survive you will manage, such as, does your spouse / partner need the income from the business?

 

One very important step to take is to have a conversation with your family about what you want to happen.  They will always be upset, but it can be very helpful in their grieving process to know that they are fulfilling your wishes, but if they don’t know what your wishes are, they cannot fulfil them!

 

How to prepare for the future – part 4

4 Aug

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How to prepare for the future part 4

 

When I gave my talk at the #BigConversation, I discussed creating a Will, Powers of Attorney, having a discussion and then getting your paperwork in order.

 

Filing is usually no-one’s favourite job, but it is necessary.  It doesn’t matter what system for keeping your records in order, just as long as it is clear.

 

In your conversations with your family members, if you want, you can tell them as much as you like.  You can tell them how much money you have and where it all is held along with other information such as who your pension providers are etc.  The choice is entirely yours. If you choose not to tell them, then they will need to know where to find the information and therefore perhaps that is all you tell them.

 

It is useful to keep your paperwork in some kind of logical manner, so that when the person dealing with it (Executor or Attorney) finds it, they will be able to understand the picture of your finances fairly easily.  You may want to also have a file of obsolete paperwork, so that they can know what is no longer current, just in case they knew about it before, but mark it old obsolete paperwork, so that they will realise that!

 

It is not a good idea to leave your telephone banking and/or internet passwords with your paperwork, which is just for you.  If your Attorney or Executor needs to access your account, they can do that in their own right.  Using your access masquerades them as you and that is not how they are acting, you have given them authority in their own right.  That way their actions are traceable and they can be asked to be accountable for their actions.  The other issue is the risk associated with leaving your passwords around, as anyone could come along and access your account if they found it, so your are at risk of theft.

 

If you choose to leave your paperwork in a mess, then it takes hours to find everything, go through it, work out what is current and deal with it.  It might also include lots of wasted letters or it could mean that whoever is looking after you has to instigate an asset search.  Speaking from personal experience, when I have dealt with messy affairs, it takes hours and a lot of space on a very big table, it is frustrating and if the person has appointed a professional, will cost lots of money that it didn’t need to.

 

It may be boring, but get your paperwork in order, it will make life lots easier for you and for anyone helping you!