Taking Mom on vacation this summer? You may rest more easily knowing there are options for getting home if she gets sick or injured on the trip.

If your family member is critically ill, hire an air ambulance. An air ambulance is a chartered plane or other aircraft outfitted with life-support equipment. It is also staffed by a full medical team. It’s the answer if Mom needs treatment immediately at another location or if her health is very fragile.

If your loved one is stable but needs constant medical monitoring, consider hiring a medical escort. Medical escorts are professionals such as flight nurses, respiratory therapists, and paramedics. They are trained to handle health problems in any setting.

How quickly do you need to get home?

• By air. Hiring a flight nurse as an escort on a commercial flight is the quickest option, as long as your loved one is able to sit up for take-off and landing. Flight nurses have additional knowledge of the body’s response to altitude.
• By rail. If flying is out of the question, you may want to have an escort travel with your loved one on an Amtrak sleeper car.
• By ground transportation. Long-distance, nonemergency ambulance transport offers flexibility and simplicity. It can take Mom door to door. Or, if the situation is not urgent, rent an RV to transport your loved one in bed.

To find a medical escort, locate the nearest accredited air ambulance company.

Medicare may cover the cost of medically necessary travel. To learn the rules, download the Medicare Coverage of Ambulance Services booklet. Or contact Medicare (800-633-4227). If your family member has other insurance, contact the insurer. No insurance? Contact Air Care Alliance. These volunteer pilots provide air transport for people who have no insurance and can’t afford a charter flight.

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The following list of signals is a gentle reminder of how truly important it is to keep your will and other estate plans in shape.

Watch for These Signals!

* Changes in your family situation. Your marriage, divorce or remarriage, the birth of a child, or the death of your spouse are obvious reasons to revise your will. Failure to make changes or updates to your will may result in financial hardship for loved ones who depend on you.
* Tax law changes. Last year in 2009, you could have owned up to $3.5 million in assets when you died before federal estate taxes were assessed. Estate taxes are repealed only for the year 2010. Currently, the amount you can own will drop to $1 million in 2011 and thereafter. If your estate plan doesn’t take these changes into account, a revision to your plan may be necessary.
* Changes in your estate’s value. If the value of your assets has changed substantially, you may want to change the size of bequests to your family and favorite causes. The preferred strategy is to use percentages, not dollar amounts, so future changes to your plans may not be necessary.
* Beneficiary changes for assets outside your will. IRAs, retirement benefits and life insurance go directly to named beneficiaries at your death, no matter how your will is written. In addition, assets you own jointly with rights of survivorship automatically pass to the co-owner. To ensure your estate is properly arranged, ask an estate planning attorney to review your asset title and beneficiary arrangements.
* Good Intentions Toward Hospice & Palliative CareCenter. There’s no better way to continue your generous support after your lifetime than through a gift to us in your will. Naturally, you want your philanthropic goals to harmonize with the needs of your family. Fortunately, tax savings permitted by law encourage these mutual objectives.

The official bequest language for Hospice & Palliative CareCenter is: “I, [name], of [city, state, ZIP], give, devise and bequeath to Hospice & Palliative CareCenter [written amount or percentage of the estate or description of property] for its unrestricted use and purpose.”

Contact your estate planning attorney today if you need to update your will. And if you would like to remember Hospice & Palliative CareCenter in your will, we are happy to work with you and your attorney to plan a gift that’s a good fit for you and us. Contact Ellen Coble at 336-331-1312 or ellen.coble@hospicecarecenter.org.

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Do you want to feel more emotionally stable and “up” as you care for your family member?

Studies show that religion and spirituality help family caregivers maintain a sense of well-being. In fact, individuals who draw upon their religious or spiritual beliefs report feeling less burdened and depressed. Those who stay involved with their church or spiritual community also report more optimism and less stress related to caregiving.

But in today’s fast-paced world, it’s easy to get overwhelmed and fall out of touch: out of touch with yourself or out of step with your spiritual practices.

Take a moment for self-reflection. These questions may help you recall simple ways to nurture yourself spiritually.

* How do you describe your beliefs about life? What gives your life meaning? When you’re struggling with your loved one’s needs, recalling those deeper beliefs can help you regain emotional balance.
* What can you do to connect to your spirituality? One way might be spending time in nature. Daily prayer or meditation. Saying grace at meals. Or regularly visiting a place of special significance.
* What activities give to you spiritually? Does singing with others bring you alive? Or would you prefer a weekly reading and discussion group? Perhaps an annual retreat or periodic talks with a member of the clergy?
* Do you feel drawn to a faith community? Give yourself the flexibility to go when you can. You will have more to give your loved one if you take the time to fill your spiritual well.
* How can your faith community help you find meaning in your caregiving? Are there other family caregivers in your congregation? You might meet together to support each other spiritually.

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We all want to maintain our brainpower for as long as possible. If you are caring for a family member who already has memory problems, you may feel especially at risk.

The good news is that, regardless of age, simple changes in lifestyle can help keep a brain strong and resilient. The key ingredient is exercise for the mind and body.

Although adults can’t make new brain cells, we can make new neurons. Neurons are the connections between brain cells. And mental exercise sparks the creation of new neural connections. With more connections, the brain has back-up options, or “cognitive reserve.” And cognitive reserve helps a brain do better for longer.

Is a “brain game” the best exercise to help preserve clear thinking? Not necessarily. Brain games improve a person’s ability to do specific tasks, but they have not been proven to enhance a person’s ability to navigate the complexity of everyday life.

Instead, engage in mental activities that stimulate the brain to think in new ways. Consider these options:

* Volunteering, playing games, and doing crafts
* Attending lectures, theater, or musical events
* Reading, writing, and searching the Internet

What you want to avoid is repetition, and hours in front of the TV. The goal is novelty and challenge!

Physical exercise is also important. Research shows that people who are physically active stay “with it” longer. Aerobic activities such as walking, biking, and swimming increase blood flow, which supports the development of new neural connections. As with mental exercise, the upshot is lower risk for mental decline.

Beware of products that promise to delay or prevent diseases such as Alzheimer’s. Research has not yet discovered any “magic pill” or strategy. Instead, scientists encourage a focus on overall health, keeping blood pressure and blood sugar in check, and getting plenty of physical and mental stimulation.

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Estate Plan Review Averts Potential Heartache

Shortly after her divorce in 2002, Tracy¹ made a will to name a guardian for her 11-year-old son and set up a trust to provide for his future financial needs. “I wanted to make sure my son would be taken care of, my debts would be paid off and my money would go where it was supposed to go,” Tracy explains.

Time to Update
In 2008, Tracy began a new job. In the process, she rolled over a 401(k) into an IRA and filled out life insurance and retirement beneficiary forms at her new place of employment. With her son now nearing adulthood, Tracy felt it was time to look over her existing plans.

Tracy met with estate planning attorney Johni Hays, and, together, they discussed her old will, her current assets and her future goals. While the 45-minute conversation was simple and relaxed, what they discovered will save Tracy’s son from future problems and offers Tracy true peace of mind.

4 Estate Planning Must-Haves for Single Parents
1. Will (to name a guardian) with a trust (to handle the money)
2. Durable power of attorney
3. Health care power of attorney
4. Living will

Issues That Caused Concern

1. Tracy had her younger brother listed as trustee and guardian of her teenage son. She did not, however, have a backup listed if her brother did not survive her.
2. For executors of her will, Tracy listed her brother, who lives out of state, and her father. Because at least one executor must be in state, according to the state law where Tracy lived, Tracy needed a backup for her brother in case her father should predecease her.
3. Tracy had a financial power of attorney in place, but she lacked a power of attorney for health care and a living will to take care of future health care wishes.
4. Of greatest concern, Tracy had filled out her beneficiary forms incorrectly on her life insurance and retirement plan assets—the bulk of her estate. Instead of putting the trustee of her son’s trust as beneficiary, which would distribute payments to him at ages 25, 30 and 35, Tracy had listed her son as beneficiary. As a result, he could receive the full amount when he turned 18, a much younger age than Tracy wished for him to receive a large inheritance.

The Solutions
Hays was able to amend the will with a codicil and draft the other needed documents. To correct Tracy’s beneficiary designations, she requested change of beneficiary forms for her IRAs and her life insurance.

“Tracy’s case is the perfect example of how you need to coordinate your whole estate plan, and that includes more than just a will,” Hays says. Tracy is thrilled she took the time to update her plans.

	To make sure your plans are in order, request our FREE guide to estate planning.

¹Although this article is based on a real-life example, the name has been changed to protect privacy.

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Perhaps you’ve heard of “adult day care.” Although you may be reluctant to consider it for your parent, research shows the benefits are undeniable.

Three basic kinds of adult day programs are offered across the country.

• Adult social programs provide activities, meals, and personal care.
• Dementia-focused programs are like social programs but are geared for individuals with memory loss.
• Adult day health programs provide activities and meals, as well as therapeutic and social work services. They serve individuals with serious medical concerns and/or dementia.

Most programs provide transportation to and from the center. The average cost is $67/day, although you may be eligible for assistance. (If your loved one spends at least 8 hours a day living with you and is financially dependent, you may be eligible for Dependent Care Tax Credits from the IRS.

Day programs create a win:win for you and your parent. Researchers report:

• Reduced stress for family caregivers.
• Increased quality of life for program attendees.
• Fewer dementia-related behavior problems over time.

Concerned that your parent will say “no”? Studies of dementia-focused programs find this is not a common problem. Still, follow these tips for a successful transition:

• Start slowly. Have your loved one attend for a few hours at first, then a full day. Build up to several days a week.
• If your loved one has dementia, new places and faces may cause anxiety or resistance. Stay with them initially to ease their adjustment.
• If your loved one does not have dementia, be sure the program has other non-impaired attendees.
• Discuss your concerns with center staff. They are experienced at helping newcomers fit in.

See our Community Programs page on adult day centers for more details.

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It’s difficult to know what to anticipate when traveling with a frail family member. Here are tips from experienced, disabled travelers to reduce your road-trip stress this summer.

If your travel includes hotel lodging:

• Talk directly with the hotel. Many chains have a centralized reservation system. Get a direct, on-site number instead. Then ask to speak with the head of housekeeping or engineering. With their intimate knowledge of the building, you can ask them to describe the disability features: How wide are the doorways? Does the bathroom have grab bars? And don’t forget to ask about access to the hotel from the street!
• Reserve the room. Confirm that you are guaranteed an “accessible” room. Reconfirm a few days in advance of your arrival. If your room is not available or not accessible, ask to speak with the manager. It is the hotel’s responsibility to find you suitable alternate lodgings.

You might also consider bringing these items. You’ll find them sold online or at medical supply stores.

• A folding ramp. An easy way to eliminate a short flight of stairs.
• Safety items for the bathroom. Consider a lightweight toilet seat extender. For bathing, look for a suction-based grab bar, or folding shower bench and slip-on shower hose. Add nightlights to improve visibility after dark.
• Chair comfort. Bring a lap blanket and special pillows if your family member will be spending a lot of time sitting. Or a small fan to help with cooling. A swivel seat cushion may help a lot with getting in/out of the car.

To help your loved one join in excursions, consider a wheelchair. A wheelchair can preserve your family member’s energy. All transport chairs fold, but some are made for travel and pack easily in a small bag.

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1. Make sure you have an up-to-date will.
Your will is one of the most important documents you own. It provides clear direction for your family after you’re gone, when they’re making major decisions under stressful circumstances. When was the last time your will was updated? If it was years ago, you should arrange a meeting with your estate planning attorney to review your decisions. You might have overlooked a change that can affect your wishes, such as a move to another state, tax law changes, or the loss or addition of a family member.

2. Decide where the money goes.
Take some time to decide how you want to provide for the well-being of each of your family members. Don’t let your worries about fairness and equality discourage you. Simply start with the “big picture” items such as real estate, bank accounts, life insurance policies and retirement plan assets. This will help you prepare to meet with your estate planning attorney.

After you feel comfortable with your gifts for your family, you may begin to consider providing for Hospice & Palliative CareCenter and our mission to provide excellent health care in our communities. Within your estate, there are many assets, such as your IRA or life insurance, that can be used in whole or in part to help you make a big difference. Feel free to contact Ellen Coble at 336-331-1312 or ellen.coble@hospicecarecenter.org to learn about these options. Then, meet with your estate planning attorney to put your ideas into action.

3. Keep your loved ones informed.
Once you’re at peace with your decisions, gather your family and explain your choices. Help them understand your perspective to avoid any heartache later. Following are a few talking points to help you and your family feel more comfortable:

• Thank your family for recognizing what this meeting means to you.
• Emphasize your goals to be fair and your concerns for your loved ones’ futures.
• Detail the responsibilities, items and amounts you’ve chosen to give your family members and why.
• Express your desire to give to charity and your goals for your charitable gifts.

Request our FREE eBrochure on estate planning essentials.

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We’re all aware that diet affects health. But did you know that people with COPD (chronic obstructive pulmonary disease) can help themselves breathe better by making simple changes to their eating habits?

What we eat

The food we eat combines with the oxygen we breathe to create energy and carbon dioxide. Our body needs the energy to function. The carbon dioxide is a waste product we need to dispose of. Too much of it is toxic. But having to exhale a lot can be tiring.

• Limit sugar and sugary foods such as candy, cake, and soft drinks. Carbohydrates (sugars and starch) produce more carbon dioxide than fats or proteins. They make more work for the lungs.
• Fats produce the least carbon dioxide. The best fats are polyunsaturated fats such as vegetable oils and soft margarine (look for those labeled “zero trans fat”).
• Protein is necessary to maintain the respiratory muscles. At least two servings a day is recommended: eggs, dried beans, dairy products, and meats.
• Limit foods that produce gas, such as carbonated beverages, dried beans, cauliflower, and broccoli. They cause the stomach to expand which puts pressure on the diaphragm.
• Limit salt. It can cause the body to retain fluid, making it harder to breathe. See our January 2010 article on reducing salt.

The way we eat

• Consider eating four to six small meals a day and minimizing fluid intake at mealtime. It’s harder to breathe when your stomach is full.
• Eat earlier in the day. If energy is generally low by dinnertime, focus on consuming more of the day’s calories in the morning and afternoon.

As always, check with a doctor or dietitian to determine the diet that is right for your loved one. You can search for a registered dietitian near you at www.eatright.org.

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These additional factors play a key role in adequately protecting you and your heirs.

1. Review ownership and beneficiary designations. You can unwittingly limit your power to distribute certain types of property through your will. In the case of a married couple that owns all property in joint tenancy, the will of the first spouse to die may lose its effectiveness.

2. State your health care wishes through a living will. This simple document outlines your preferences about lifesaving medical treatments in certain circumstances such as if you are terminally ill. Combine this with a durable power of attorney for health care to appoint someone to make your medical decisions if you cannot make them yourself.

3. Keep your financial affairs private. Unlike a will, a revocable living trust is not available under public records, and all assets in the trust are handled with the same privacy. Your personal family business is not exposed.

4. Include a trust in your estate plan. If you have substantial financial assets, consider creating a credit shelter trust in your plans. The potential benefits include estate tax-saving opportunities that can help ensure that your heirs will not have to liquidate those assets to pay estate taxes.1

5. Finally, allow yourself peace of mind. Seeking professional advice and looking at all your options can lead to a tax-wise estate plan that meets the needs of your heirs and your favorite charitable organizations, such as Hospice & Palliative CareCenter, giving you the comfort of knowing that your assets will benefit those you leave behind.

Have questions? We can help. Contact Ellen Coble at 336-331-1312 or ellen.coble@hospicecarecenter.org.

1Currently federal estate taxes are repealed for all deaths that occur in the calendar year 2010. In 2011, estate taxes are scheduled to be reinstated for estates worth more than $1 million at rates up to 55 percent. Congress, however, is likely to address reinstating estate taxes before 2011. What the final legislation will look like and when it might become effective is unknown at this point.

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