Frequently Asked Questions - FAQ
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What is a conservatorship?
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| A conservatorship is a court proceeding in which the judge appoints someone (the "conservator") to act on behalf of a disabled person (the "conservatee.") The conservatorship can be over the "estate" only, meaning that the conservator will make all of the conservatee's financial decisions and manage the conservatee's property. The conservatorship can be over the "person" only, meaning that the conservator will make all decisions about where the conservatee lives. Alternatively, the conservatorship may be over the "person" and "estate" meaning that the conservator controls all aspects of the conservatee's life and financial affairs.
Special powers may be granted to the conservator in specific circumstances. For example, if the conservatee is so disabled that he or she cannot make medical decisions, the conservator will be granted authority to give consent for medical treatment. If a conservatee has dementia, the conservator may be give specific authority to consent to dementia medication or admission of the conservatee to a locked facility to deal with wandering. In California, if a conservatee has psychiatric problems other than dementia and is determined to be gravely disabled, a "Lanterman Petris Short" (known as an "LSP") conservatorship can be initiated by the County for authority to commit the person to a psychiatric hospital and administer psychotropic medication. Because conservatorships require the involvement of the courts, they can be expensive and time consuming. A conservatorship over the estate can be avoided with a simple Durable Power of Attorney for Finances. A conservatorship over the person can be avoided in some cases with a Durable Power of Attorney for Health Care. With those powers of attorney, a trusted agent can do much of what a court appointed conservator could do without going to court, except that an agent under a power of attorney cannot commit someone to a psychiatric facility, authorize the administration of psychotropic medication, or place someone in a locked facility against their will. Back to Top |
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How do I apply for and get SSI?
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| SSI, which stands for "Supplemental Security Income," is administered by Social Security. It is a needs based program for those who are disabled or over the age of 65, have limited assets and have income below the SSI level, which is currently $880 per month in California. (Each state's SSI level is different because some states, like California, provide a state supplement to the federal benefit which is only around $600 per month.)
In order to obtain SSI, the applicant must have no more than $2,000 of "countable" resources. SSI will not count a home, a car, furniture and furnishings, clothing, a burial plot, tools of a trade, or certain other assets. However, cash, stocks, bonds, cash surrender value of life insurance, and other assets that could be turned into case, will be counted. Assuming a person over 65 meets the asset test and has income under the SSI level, he or she need only go to a local Social Security office and apply for benefits. Upon verifying the assets and income, the SSI will be granted. If a person is under 65, he or she must also meet the test of disability, which is defined as the inability to engage in any substantial gainful employment which exists in the national economy in significant numbers. If the person can make change at a self service gas station, or sort nuts and bolts on a conveyor belt, then the person is not "disabled" for SSI purposes. Whether over or under 65, once a person qualifies for SSI, he or she automatically qualifies for Medi-Cal (Medicaide in other states.) This is called "linked" Medi-Cal, because it is linked with the SSI benefits and is administered through the Social Security office. Non-linked community based Medi-Cal, for those who are not receiving SSI benefits, is administered by the county social services office. Back to Top |
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Different Types of Alternative/Complimentary Medicine
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| Alternative medicine can be classified into five major domains of practice: alternative medical systems, mind-body techniques, biologically based therapies, body-based therapies, and energy therapies. Some approaches are understandable within the concepts of modern science. Others are nearly incomprehensible within that paradigm.
Alternative Medical Systems A number of alternative medical systems exist, including traditional Chinese medicine, Ayurveda, and unconventional Western practices of natural healing. Traditional Chinese Medicine: Originating in China thousands of years ago, this system is based on the theory that illness results from the improper flow of the life force (qi) through the body. Qi is restored by balancing the opposing forces of yin and yang, which manifest in the body as heat and cold, external and internal, and deficiency and excess. Various practices are used to preserve and restore health, including herbal remedies, massage, meditation, and acupuncture. Acupuncture is one of the most widely accepted alternative medicine techniques in the Western world. Licensed practitioners do not necessarily have a medical degree, although some medical doctors, often pain specialists, are trained and licensed to perform acupuncture. Acupuncture involves stimulating specific points on the body, usually by inserting very fine needles into the skin and underlying tissues. Sometimes, additional stimulation is added with a very low voltage electrical current or by warming the needle. Stimulating these specific points is believed to unblock the flow of qi along energy pathways (meridians) and thus restore balance between yin and yang. The procedure is not painful but may cause a tingling sensation. (A variation of acupuncture, called acupressure, uses localized massage instead of needles.) Research has shown that acupuncture releases various chemical messengers in the brain (neurotransmitters), including serotonin, that serve as natural painkillers. Besides its potential effectiveness as a pain reliever, acupuncture may help relieve the nausea and vomiting that commonly occur after surgery. However, acupuncture has been ineffective in helping people to stop smoking or lose weight. Side effects of acupuncture are uncommon if the procedure is performed correctly. Infection is one of the greatest risks but is extremely rare. Most practitioners use disposable needles; reusable ones must be sterilized properly. Worsening of symptoms (usually temporary) and fainting are the most common side effects reported by people who have undergone acupuncture. Ayurveda: Ayurveda is the traditional medical system of India, originating more than 4,000 years ago. It is based on the theory that illness results from the imbalance of the body's life force, or prana. The balancing of this life force is determined by the equilibrium of the three bodily qualities, called doshas: vata, pitta, and kapha. Most people have a dominant dosha; the specific balance is unique to each person. Ayurveda uses herbs, massage, yoga, and internal cleansing to restore balance within the body and with nature. Homeopathy: Homeopathy, which was developed in Germany in the late 1700s, is based on the principle that "like cures like" (thus the name homeo [Greek for "like"] and patho [Greek for "disease"]). In other words, a substance that in large doses causes illness is believed to cure the same illness if given in minute doses. The remedies used in homeopathy are derived from naturally occurring substances, such as plant extracts and minerals. These substances are used to stimulate the body's innate capacity to heal. The more dilute the homeopathic medicine, the stronger it is considered to be. Traditional scientists can find no scientific explanation for how the diluted remedies used in homeopathy might cure illness. There are few risks associated with homeopathy. However, side effects, such as allergic and toxic reactions, can occur. Naturopathy: Naturopathy, which draws its practices from many cultures, began as a formal health care system in the United States in the early 1900s. Founded on the notion of the healing power of nature, naturopathy emphasizes prevention and treatment of disease through a healthy lifestyle, treatment of the whole person, and use of the body's natural healing abilities. This system also focuses on finding the cause of the disease rather than merely treating symptoms. Naturopathy uses a combination of therapies, including nutrition, herbal medicine, homeopathy, physical medicine, exercise therapy, counseling, stress management, acupuncture, natural childbirth, and hydrotherapy. Mind-Body Techniques Mind-body techniques are based on the theory that mental and emotional factors can influence physical health. Behavioral, psychologic, social, and spiritual methods are used to preserve health and prevent or cure disease. Because of the abundance of scientific evidence backing the benefits of mind-body techniques, many of the approaches are now considered mainstream. Methods such as relaxation, cognitive-behavioral therapy, meditation, imagery, biofeedback, and hypnosis, for example, are used in the treatment of coronary artery disease, headaches, difficulty sleeping (insomnia), and loss of urinary control (incontinence). These methods are also used as an aid in childbirth, in coping with the disease-related and treatment-related symptoms of cancer, and in preparing patients before surgery. Mind-body techniques are also used in the treatment of high blood pressure, asthma, arthritis, pain, and ringing in the ears (tinnitus), although with less success. There are few known risks associated with the use of mind-body techniques. Meditation: Meditation focuses on stilling the mind and allowing for greater self-awareness. It usually involves sitting or resting quietly, often with the eyes closed. Sometimes, it involves the repetitive sounding of a phrase (a mantra) meant to help the person focus. Most meditation practices were developed within a religious or spiritual context and held as their ultimate goal some type of spiritual growth, personal transformation, or transcendental experience. As a health care intervention, however, meditation may be effective regardless of the person's cultural or religious background. Meditation has been shown to offer numerous health benefits, including relieving stress and pain. Relaxation Techniques: Relaxation techniques are practices specifically designed to relieve tension and strain. The specific technique may be aimed at lowering blood pressure, easing muscle tension, slowing metabolic processes, or altering brain wave activity. Guided Imagery: Guided imagery involves the use of mental images to promote relaxation and wellness or to facilitate healing of a particular ailment, such as cancer or psychologic trauma. The images can involve any of the senses and may be self-directed or guided by a practitioner, sometimes in a group setting. For example, a person with cancer might be told to imagine an army of white blood cells fighting against the cancer cells. Hypnotherapy: In hypnotherapy, a person is put into an advanced state of relaxation in which he is relatively unaware, but not entirely unconscious, of his surroundings. A hypnotized person becomes absorbed in the images presented by the hypnotherapist and tends not to be consciously aware of the experiences he is undergoing. Hypnosis can be used to treat some conditions, such as certain pain syndromes and conversion disorders, in which apparent physical illness is actually due to psychologic stress and conflict. It has been used with some success to help people stop smoking and lose weight. Some people are able to learn to hypnotize themselves. Biofeedback: Biofeedback involves the use of electronic devices to measure and report information about a person's biologic functions, such as heart rate, blood pressure, and muscle tension. The person can then understand why these functions change and can learn how to regulate them. Biofeedback typically is used to treat pain (see Pain: Nondrug Pain Treatments), stress, difficulty sleeping (insomnia), headache, and muscle injuries. Biologically Based Therapies Biologically based therapies involve the use of chemicals, although typically these chemicals are derived from natural sources. Herbal Medicine: Herbal medicine, the oldest known form of health care, uses plants to treat disease and promote health. Either a single herb or a mixture of different herbs can be used. In the case of Chinese herbal medicine, mixtures can also contain minerals and animal parts. Unlike conventional drugs, in which the active substance is extracted from the herb, herbal medicine usually makes use of the herb in its whole form. Herbal medicines are available as extracts (solutions obtained by steeping or soaking a substance, usually in water), tinctures (usually alcohol-based preparations, with the alcohol acting as a natural preservative), infusions (the most common method of internal herbal preparation, usually referred to as a tea), decoctions (similar to an infusion), pills, and powders and even in a moistened cloth applied to the skin. In the United States, the government has very little oversight of herbal products and places few regulations on the industry (see Medicinal Herbs and Nutraceuticals: Safety and Effectiveness). Orthomolecular Medicine: Orthomolecular medicine focuses on the use of proper nutrition to maintain and restore health. It uses combinations of vitamins, minerals, and amino acids normally found in the body to treat specific conditions. Sometimes referred to as megavitamin therapy, orthomolecular therapy emphasizes supplementing the diet with large quantities of vitamins. Some of the more common orthomolecular treatments make use of shark cartilage to treat cancer, chelation therapy (removal of toxic materials from the bloodstream) to treat cardiovascular disease, and glucosamine or chondroitin (substances occurring naturally in the body) to treat osteoarthritis (for which there is good evidence of its effectiveness). Body-Based Therapies Body-based therapies include techniques that treat various conditions through bodily manipulation. Chiropractic: In chiropractic, the relationship between the structure of the spine and the function of the nervous system is seen as key to maintaining or restoring health. The main method for achieving this balance is spinal manipulation. Studies have shown chiropractic to be effective in treating low back pain. In addition, spinal manipulation may be useful in treating a variety of headaches. In general, however, the effect of manipulation on conditions not directly related to the musculoskeletal system has not been established. Serious complications resulting from spinal manipulation are rare but include low back pain from damage to nerve roots at the end of the spine (cauda equina syndrome (see Spinal Cord Disorders: What Is the Cauda Equina Syndrome?Figures) and blockage of blood supply to the brain from damage to arteries supplying the brain (cerebrovascular artery dissection). Other side effects include local discomfort, headache, and fatigue, which usually disappear within 24 hours. Massage Therapy: Massage therapy is the manipulation of body tissues to promote wellness and reduce pain and stress. It involves a variety of techniques, from stroking and kneading (as used in Swedish massage) to applying pressure to specific points (as used in Shiatsu, acupressure, and neuromuscular massage). These techniques are claimed to help the musculoskeletal, nervous, and circulatory systems of the body. Massage has been shown to be helpful in relieving pain, such as that caused by back injuries, muscle soreness, fibromyalgia, and anxiety in people with cancer. Massage has also been effective in treating low-birth-weight infants, preventing injury to the mother's genitals during childbirth, relieving chronic constipation, and controlling asthma. Massage may lower stress and anxiety. Massage therapy should not be used in people who have infectious or contagious skin diseases, open wounds, burns, high fever, tumors, or a low platelet count. Rolfing: Rolfing, also called structural integration, is based on the theory that good health depends on proper body alignment. It is a form of deep tissue massage that is typically performed over a series of sessions. Proper alignment of bone and muscle is achieved by manipulating and stretching fascia (fibrous tissue that surrounds certain body organs, such as muscles). Reflexology: In reflexology, manual pressure is applied to specific areas of the foot that are believed to correspond to different organs or systems of the body. Stimulation of these areas is believed to eliminate the blockage of energy responsible for pain or disease in the corresponding body part. Postural Reeducation: Postural reeducation uses movement and touch to help people relearn healthy posture. The therapies involved seek to release habitual, harmful ways of holding the body by focusing on awareness through movement. Energy Therapies Energy therapies focus on the energy fields thought to exist in and around the body (biofields). They also encompass the use of external energy sources (electromagnetic fields) to influence health and healing. All energy therapies are based on a core belief in the existence of a universal life force or subtle energy that resides in and around the body. Practitioners of energy therapies typically place their hands on or near the body and use their energy to affect the energy field of the person. Bioelectromagnetic-based Therapies: Bioelectromagnetic-based therapies use pulsed fields, magnetic fields, or alternating- or direct-current fields. Magnets, in particular, have become a popular treatment for various musculoskeletal conditions. Magnets have been marketed in clothing, jewelry, and mattresses to relieve pain, although there has been very little scientific investigation of their effectiveness. Reiki: Reiki is a technique of Japanese origin in which the practitioner channels energy through his hands and into the person's body to promote healing. Therapeutic Touch: Often referred to as "laying on of hands" even though actual touch is not needed, this therapy uses the therapist's healing energy to identify and repair imbalances in a person's biofield. Back to Top |
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Can I continue to drive an automobile after being diagnosed with Parkinson's?
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| A diagnosis of Parkinson's Disease alone does not automatically disqualify someone from driving. However, there may come a point when the progression of the disease, combined with the effects of medication, makes it unsafe for a person to continue driving. Driving requires acute muscular reflexes and mental concentration, in addition to good vision and sound judgment. PD can impair any or all of these areas.
Tell tale signs of deteriorating driving skills include traffic tickets for careless infractions, small dents and dings on the car from hitting posts while pulling in and out of parking spaces, tire damage from hitting the curb, getting lost frequently, and family members criticizing the driving. If a person's impairments are patently obvious to a physician, the physician may report the person to DMV. DMV may then require the person to pass a driving test and possibly get a statement from another physician certifying that the person is no longer impaired to the point that they are unsafe to drive. Even if a Parkinsonian has not progressed to the point that he or she is a danger on the road, be aware that the fact that the person as PD may be used (unfairly) against the Parkinsonian if there is an accident and there is a question as to which driver was at fault. My advice to all of my clients is that they maintain insurance limits of $300,000 or more. For those with a diagnosis of PD I would recommend increasing the limits even more and pay attention for those tell tale signs that it is time to stop driving. Back to Top |
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What is long term care planning?
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| Long term care planning is a process of financial planning by an individual, a couple or an entire family, for continuity of care of a person at home, in assisted living and in a skilled nursing facility, as the person's health declines physically and/or mentally. The planning may include long term care insurance for those who can qualify. It may involve placing resources in investments which will generate sufficient cash flow to meet expected needs. It may involve purchasing annuities, specialty insurance policies or other financial products to cover the projected care costs.
For a married couple the planning involves arranging the finances so that the healthy spouse is not impoverished by the needs of the ill spouse. This may involve qualifying the ill spouse for Medi-Cal (California's version of the federal Medicaide program.) The Medi-Cal program might also be appropriate if the disabled person has an adult disabled child or other dependent for whom support is a consideration. There are many Medi-Cal planning options for married couples. There are fewer for single individuals, but there are still planning opportunities nonetheless. Most long term care planning involves more than one single transaction. It may involve a series of steps to arrange financial affairs, possibly obtain public assistance and then avoid a later claim for reimbursement for any public assistance that was obtained. Waiting until a person is already in dire financial straits before addressing the financial issues is not planning. It is simply reacting. The sooner the planning begins the more options that may be available and the more effectively the planning will likely be. Back to Top |
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