Book Review from the
American Journal of Alzheimer's Disease

Reviewed by Emily S. Starr, Immediate Past President for the Massachusetts Chapter of National Academy of Elderlaw Attorneys

Alzheimer's Disease: "Fighting for Financial Survival," by Edward D. Beasley and David H. Ferber. Concord, NH: Beasley & Ferber, 2000; 135 pages.

Alzheimer's Disease: "Fighting for Financial Survival" is self-described as a financial and legal guide to economic survival for Alzheimer's patients and their families. Written by attorneys Edward D. Beasley and David H. Ferber, and published in 2000 by their Concord, New Hampshire, law firm of Beasley & Ferber, this book is an easy-to-understand survey for laypersons on the many legal and financial topics about which Alzheimer's patients, their families, and those who work with them should be familiar.

The 135-page book is organized into nine chapters and four appendices. Though the book does not have an index, the table of contents is clear and comprehensive enough to enable the reader to locale easily each topic addressed in the book. One of the early chapters presents a case study that is used throughout the remainder of the book to illustrate the concepts being presented. This case study is very useful in assisting the reader to understand the application of the complicated legal principles that this book examines.

The first substantive chapter focuses on estate planning and describes basic estate planning documents, including wills, trusts, powers of attorney, and advance directives. This chapter demystifies estate-planning tools and assists the reader to understand the significance of these documents. It is important for the reader to understand, however, that, though this chapter seems completely factual, it is laced with the authors' opinions as to how estates of Alzheimer's victims should be planned, and, in fact, there may be no universal agreement as to how this should be done. For instance, the authors recommend that the spouse of an Alzheimer's victim leave his or her estate to the children as opposed to leaving the estate to, or for the benefit of the Alzheimer's spouse. This reviewer cautions that such an approach may deprive the Alzheimer's patient of support while living in the community and of the funds required for supplemental services, even if the Alzheimer's patient is receiving Medicaid-funded institutional care. An alternative that is not suggested would be to leave some assets in a carefully drafted trust for the Alzheimer's spouse.

The remainder of the book focuses on paying for nursing homes with a view toward how persons can preserve their estates by taking advantage of financial subsidies from the Medicaid program. The authors break down this very complicated area into four chapters and, in comprehensible language, carefully guide the reader through the Medicaid maze. The chapters cover the Medicaid eligibility rules, the current strategies for achieving Medicaid eligibility for persons in crisis, the strategies that are available to persons who have time to plan in advance, and conclude with a discussion on sheltering the house with Medicaid planning. The authors explain many of the current techniques used, including half-a-loaf planning, annuities, life care contracts, raising the community spouse resource allowance, and gifts to children. With regard to the latter technique, the authors appropriately caution the readers on the danger of this strategy and emphasize the importance of managing the gifted assets.

To write a book for a national audience on this topic is a very ambitious undertaking. That is because, though the basic architecture of the Medicaid program is federal, the detail is applied by the states in their administration of the program. The rules necessarily vary from stale to state; thus, drafting such a book is a daunting undertaking. For the most part, the authors have risen admirably to the challenge, generally noting the possible differences in application by each state. However, in one respect the authors have failed. In most states. However, in one respect the authors have failed In most states, as long as a person's income will not preclude Medicaid eligibility. However, certain states limit long-term care Medicaid eligibility to individuals whose incomes are less than a certain amount. In these states, known as "income cap states", eligibility planning for Medicaid has additional, significant dimensions. A discussion of this topic and the approaches for addressing it are missing from the book.

Alzheimer's Disease: "Fighting for Financial Survival" is rich with resource referrals. The authors advise the reader on not only how to contact the National Academy or Elder Law Attorneys, but also give the names, addresses, and telephone numbers of the presidents of the state chapters of that organization. Other appendices include the names, addresses, and telephone numbers of the state bar associations, the state chapters of the AARP, and, most important for the audience of this book, all of the Alzheimer's Association chapters throughout the United States.

This book is no substitute for advice and representation by counsel. As attorney's Beasley and Ferber repeat, this extremely complicated area should not be navigated without the assistance of a competent elder law attorney. However, a person who has read this book will be an educated consumer of legal services and will be well prepared to work with an attorney to structure a plan to meet the individual needs of his or her family.