Category: Articles

  • Special Needs Planning

    {Play}Over 54 million adults and children in the U.S. have a disability. The concerns of parents of disabled children are the same for most any parent — ensuring that their children are safe, happy and live a meaningful life.

    Some children may be unable to earn a living. Both the federal and state governments understand this and provide benefits so that they receive food, shelter and medical care. Many of these benefits are “means tested,” meaning that the child cannot have much in terms of assets and cannot make much in terms of income. If the child inherits assets from the parents, these benefits will discontinue and the child must expend all of the inheritance before reapplying for benefits.

    To qualify, some parents think that they must disinherit their children so that they can continue to receive benefits or entrust another family member to manage money for the child. The better alternative is the Supplemental Needs Trust. Properly written and administered, this trust allows parents to leave the child their inheritance and allows the child to continue to receive benefits. The trust instructs the trustee to use assets from the trust for the child only over and above what the child receives in benefits.

    The Heartfelt Legacy Foundation will hold a Supplemental Needs Seminar featuring nationally recognized speaker Theresa Varnet, Esq. Visit the foundation’s website for more information.

    HEARTFELT LEGACY FOUNDATION (501(c) 3 nonprofit)
    Stephen B. Yim, Attorney at Law
    2054 S. Beretania St., Honolulu, HI 96826
    808-524-0251 | www.stephenyimestateplanning.com
    www.heartfeltlegacyfoundation.com

    Over 54 million adults and children in the U.S. have a disability. The concerns of parents of disabled children are the same for most any parent — ensuring that their children are safe, happy and live a meaningful life. Some children may be unable to earn a living. Both the federal and state governments understand…

  • Don’t Be ‘Buried Alive’

    {Play}Protecting personal privacy is generally a good thing, but can also have unexpected results. Consider the plight of a 90-year-old lady (“Nancy”) who was the life of her weekly exercise classes. Nancy was very well known for youthful outlook and zest for life.

    So when Nancy missed class one day, her friends tried to contact her. All they were able to learn was that she had been moved to a nursing home. No one would divulge which facility Nancy was in; her friends couldn’t visit. Nancy’s closest relative lives on the mainland, but none of Nancy’s friends knows how to contact that person. After a little detective work, one of Nancy’s closest friends (“Ms. Holmes”) discovered that a local bank was managing Nancy’s finances and that a court proceeding was pending to have a guardian appointed to look after her welfare. The attorney handling the guardianship proceeding and the bank trust officer handling Nancy’s affairs assured Ms. Holmes that Nancy is well and receiving the best of care. However, the lawyer and the trust officer both cited privacy concerns when declining to say anything further. The assurances were small comfort to Ms. Holmes, who still wonders how Nancy feels about her situation and whether she would appreciate visits from her friends.

    According to Ms. Holmes, “Nancy has several friends who want to see her, but we just keep running into roadblocks when we try to find out where she is. No one is even willing to give Nancy a message. We don’t know how she feels about all this and nobody will tell us. To us, it is as if Nancy has been buried alive!”

    Nancy’s friends have run up against federal and state laws that were intended to protect Nancy’s privacy, but which have isolated her and broken the hearts of her friends. The federal law is the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Hawai‘i law provides similar protections for both medical and mental health records and information.

    Under these relevant privacy laws, Nancy could have permitted her caregivers and medical providers to talk with one or more individuals by signing a HIPAA Authorization.

    If Nancy’s story hits home, talk with your trusted advisors who can help you develop your HIPAA Authorization and avoid the feeling of being buried alive if your health falters.

    SCOTT MAKUAKANE, Counselor at Law
    Focusing exclusively on estate planning and trust law.
    www.est8planning.com
    808-587-8227 | maku@est8planning.com

    Protecting personal privacy is generally a good thing, but can also have unexpected results. Consider the plight of a 90-year-old lady (“Nancy”) who was the life of her weekly exercise classes. Nancy was very well known for youthful outlook and zest for life. So when Nancy missed class one day, her friends tried to contact…

  • Financial Planning for Non-parents

    {Play}Those who do not have children tend to have more financial flexibility to pursue their goals throughout life and retirement. This makes sense when you consider that the cost of raising a child from birth to adulthood is currently estimated at $233,610 (before you factor in college). However, childless singles and couples still need to manage their future financial needs.

    Many mistakenly assume the absence of heirs removes the weight of retirement and legacy planning from their shoulders. Don’t fall victim to this myth. Financial planning is just as important for childless adults as it is for anyone else. I encourage my clients who don’t have children to take the following actions:

    ■ Prioritize saving for retirement. Instead of saving for childcare, sports leagues or a college fund, consider doubling-down on retirement savings. You may spend decades in retirement pursuing your hobbies and goals. Calculate what it will take for you to live the lifestyle you want and compare it to your current savings. Create a plan to save the difference. Consider contributing as much as you can to your workplace savings plan, if you have one, and consider building up Roth IRA savings to help create a source of retirement income that is potentially tax-free.

    ■ Investigate long-term care insurance. One of the biggest concerns clients without kids express is who will take care of them later in life. There’s no guarantee that parents can depend on their kids to support them, but for non-parents there is no backup plan — they’ll have to save for long-term care. So, make it a priority to decide how you will manage healthcare costs in retirement. Medical expenses continue to rise, so it’s important to have adequate savings and insurance coverage. Explore your options through Medicare and your current or former employer to see if long-term care insurance would benefit you. Additionally, consider researching caregiving options and long-term care facilities in your area so you are familiar with the choices if you need them further on down the road.

    ■ Put financial decision-makers in place. Who’s going to make financial decisions for you in the case you become incapacitated? It’s important to draw up documents to name a durable power of attorney to look out for your financial interests if you are unable to, including legal and tax concerns. Your agent should be someone you trust, whether that’s a spouse, friend, extended family member or professional. Keep in mind that you don’t have to share your full financial situation and account numbers now. A common approach is to share enough information so your contact person can step in should a situation arise where you need help making financial decisions.

    Plan your legacy. With no direct heirs in line to inherit your estate, you will want to consider what you’d like your legacy to be — including how your assets should be distributed upon your death. You may have other family members, friends or favorite charities you would like to see benefit from your lifetime of hard work. Creating or updating your will is one of the best ways to articulate your wishes. Also consider using trusts, which sometimes allow more flexibility than a will, to help you meet specific legacy goals. Consult with a financial advisor, attorney and tax legal professional to develop a comprehensive legacy strategy that suits your ultimate goals.

    MICHAEL W. K. YEE, CFP
    1585 Kapiolani Blvd., Ste. 1100, Honolulu, HI 96814
    808-952-1222, ext. 1240 | michael.w.yee@ampf.com
    Michael W. K. Yee, CFP®, CFS®, CLTC, CRPC ®, is a Private Wealth Advisor, Certified Financial Planner ™ practitioner with Ameriprise Financial Services Inc. in Honolulu, Hawai‘i. He specializes in fee-based financial planning and asset management strategies and has been in practice for 32 years.

    Investment advisory products and services are made available through Ameriprise Financial Services Inc., a registered investment advisor. Ameriprise Financial Services Inc. Member FINRA and SIPC. 1“Expenditures on Children by Families Report,” U.S. Department of Agriculture ©2019 Ameriprise Financial Inc. All rights reserved.

    Those who do not have children tend to have more financial flexibility to pursue their goals throughout life and retirement. This makes sense when you consider that the cost of raising a child from birth to adulthood is currently estimated at $233,610 (before you factor in college). However, childless singles and couples still need to…

  • SS Benefits Increase in 2020

    {Play}Each year, we announce the Social Security (SS) annual cost-of-living adjustment (COLA). In 2020, nearly 69 million Americans are receiving a 1.6 percent increase in their SS benefits and Supplemental Security Income (SSI) payments.

    Other changes this year reflect the increase in the national average wage index. For example, the maximum amount of earnings subject to SS payroll tax will increase from $132,900 to $137,700. The earnings limit for workers who are younger than full retirement age (age 66 for those born in 1943 through 1954) will increase to $18,240. (We deduct $1 from benefits for each $2 earned over $18,240.) The earnings limit for those turning 66 in 2020 will increase to $48,600. (We deduct $1 from benefits for each $3 earned over $48,600 until the month the worker turns age 66.) More information is available at www.ssa.gov/cola.

    Sign up for a “my Social Security” account today at www.socialsecurity.gov/myaccount. Retirement, survivors and disability beneficiaries who have a “my Social Security” account may view their benefit amounts and will receive future COLA notices securely online via its Message Center, a secure portal where you can conveniently receive sensitive communications that we don’t send through email or text. SS never sends personal information in its notifications.

    For questions, online applications or to make an appointment
    to visit a SSA office, call from 7am–5pm, Mon–Fri:
    800-772-1213  (toll free) | www.socialsecurity.gov

    Each year, we announce the Social Security (SS) annual cost-of-living adjustment (COLA). In 2020, nearly 69 million Americans are receiving a 1.6 percent increase in their SS benefits and Supplemental Security Income (SSI) payments.

  • Gift of Sound – Free Hearing Aid Program

    {Play}The Rotary Club of Honolulu is teaming with Miracle Ear Foundation’s Gift of Sound™ program, which provides free hearing aids to those that qualify. The application fee is $150, which includes a hearing assessment, hearing aid fittings and follow-up adjustments. While supplies last, the Rotary Club of Honolulu will assist those who can not afford the $150 application fee through its Can You Hear Us Now? program.

    Some important facts about hearing loss:

    ■ Hearing loss is the third most common physical condition that affects people of all ages.
    ■ Presbycusis (age-related hearing loss) typically begins as early as 55.
    ■ Individuals with mild to moderate untreated hearing loss are twice as likely to show symptoms of depression and isolation than those with normal hearing or those who wear hearing devices.
    ■ Most of those with hearing loss wait seven to 10 years before getting help. Delaying corrective action may result in irreversible hearing loss.
    ■ Less than 30 percent of our kūpuna use hearing devices due to:

    • Lack of means to purchase
    • Avoidance and denial of hearing issues
    • Unfamiliar with where to go for help
    • Misdiagnosed or untested due to assumptions of other issues

    Currently, most health insurance plans in Hawai‘i offer limited or no coverage for a hearing aid purchase. If offered, the amount of coverage may be low. As a result, many in need choose to delay or forgo the purchase due to the high cost.

    The Can You Hear Us Now? program aims to address that issue. Applicants for assistance must complete the Gift of Sound application form (www.miracle-ear.com/miracle-ear-foundation/eligibility) and must show:

    • Less than $25,750 annual gross income.
    • Evidence establishing the inability to pay the Gift of Sound application fee.

    Eligible applicants must obtain, complete and return the application. For information or to request an application, contact Rick Tabor, Right at Home’s operations manager and chair of the Rotary Club of Honolulu’s Can you Hear Us Now? committee, at rick@eldercareoahu.com

    ROTARY CLUB OF HONOLULU (501(c) 3 nonprofit)
    705 Queen St., Honolulu, HI 96813
    808-922-5526 | administrator@honolulurotary.com
    MIRACLE EAR FOUNDATION – GIFT OF SOUND™
    877-632-6320
    www.miracle-ear.com/miracle-ear-foundation

    The Rotary Club of Honolulu is teaming with Miracle Ear Foundation’s Gift of Sound™ program, which provides free hearing aids to those that qualify. The application fee is $150, which includes a hearing assessment, hearing aid fittings and follow-up adjustments. While supplies last, the Rotary Club of Honolulu will assist those who can not afford…

  • Hospice Support for Body, Heart & Soul

    Navian Hawaii is grounded in a comprehensive care philosophy, providing an interdisciplinary program of care to support patients and their loved ones’ physical, psycho-social, emotional and spiritual well-being. Complementary therapies are a vital part of this care philosophy:

    Pet Therapy has been proven to reduce depression and fatigue, and ease stress and pain.
    Art Therapy uses various forms of visual art to encourage self-expression, reduce stress and improve well-being. It can also be very effective in helping patients’ children understand and cope with death and bereavement.
    Aromatherapy provides a variety of benefits, including easing tension, increasing breathing and circulation and promoting a sense of peace.
    Healing Touch & Reiki are also offered. Healing touch is an energy-based technique that restores patients’ energy system. Reiki is a Japanese hands-on technique that promotes relaxation and healing.

    Additional therapies, such as Hand Casting, Therapeutic Music and Massage Therapy, are available to all patients. We encourage our patients to take advantage of this additional layer of support to help them embrace their end-of-life journeys with comfort and dignity.

    NAVIAN HAWAII (501(c) 3 nonprofit)
    860 Iwilei Road, Honolulu, HI 96817
    808-924-9161 | www.navianhawaii.org

    Navian Hawaii is grounded in a comprehensive care philosophy, providing an interdisciplinary program of care to support patients and their loved ones’ physical, psycho-social, emotional and spiritual well-being. Complementary therapies are a vital part of this care philosophy.

  • Finding the Right Type of Caregiver

    Evaluate the logistics and duration of the care you want and need. If seniors prefer to stay at home for comfort and convenience, the family should consider long-term, in-home caregivers who are part-time, full-time or can reside in-home. Those needing specialized care or end-of-life care often chose full-time caregivers, whose skills, credentials and fees vary.

    There are three primary types of caregiver roles: companions/homemakers; home care aides/assistants; and medical caregivers, such as certified nursing assistants and registered nurses.

    Although companion caregivers are limited when it comes to medical or hands-on assistance, they play a very valuable role, providing support and comfort to seniors when family members are in need of respite.

    Home care aids/assistants can perform the same duties as companion caregivers. In addition, certified home healthcare aides can render hands-on care and help seniors with activities of daily living — bathing, dressing, grooming and ambulation.

    Medical caregivers work in both home and facility settings. They include certified medical assistants (AMAs), certified/registered nursing assistants (CNAs/RNAs) and registered nurses (RNs). An AMA or CNA can fulfill most needs; RNs meet more specialized needs, aiding cancer, advanced dementia and stroke patients.

    OHANA HEARING CARE
    Kona Smith: 808-593-2137
    www.ohanahearingcare.com

    Evaluate the logistics and duration of the care you want and need. If seniors prefer to stay at home for comfort and convenience, the family should consider long-term, in-home caregivers who are part-time, full-time or can reside in-home. Those needing specialized care or end-of-life care often chose full-time caregivers, whose skills, credentials and fees vary.

  • The Right Senior Living Community for You

    {Play}First, you and your loved ones will deal with the emotions of a changing lifestyle. Family and friends may feel guilt and apprehension, even when moving is clearly for the benefit, safety and happiness of a loved one who needs special care.

    Spectrum of Support. Check the senior living community’s reputation by accessing social media postings—better yet, by getting referrals from current residents, family and friends. The best communities focus on both healthcare and hospitality services. Find out if there is a supportive transition plan to Memory Care units available for early-stage dementia patients.

    Body & Mind. The connection between physical and mental well-being is well documented. Make sure the community offers physical activities that can be tailored to keep your loved one vital.

    Nutritional Needs. Providing a variety of nutritious meals and fresh produce options support the brain’s health. Senior meals should be reviewed by a licensed dietitian for balance and nutrition, calories and enjoyment. Upscale communities have regular “menu chat” sessions, when residents meet with the dining services director and executive chef to evaluate menu items.

    Care with Compassion. In addition to quality training and good staff-to-resident ratios, the  management should be committed to delivering service with integrity, dignity and compassion. Great senior living care engages kūpuna, gives them space to be active and offers a complete program of physical and emotional support.

    ILIMA AT LEIHANO SENIOR LIVING
    739 Leihano St., Kapolei, HI 96707
    808-674-8022 | www.kiscoseniorliving.com/hawaii/

    Is it the right fit? Will the community support your wants, needs and desires? When you or a loved one consider senior living, questions and options can become overwhelming.

  • The Pearl State of Dementia

    {Play}These characteristics present many possible challenging situations when it comes to personal care. Here are some tips for having successful interactions with a Pearl.

    ● Appropriately greeting a Pearl. If your person living with dementia’s (PLWD) eyes are closed as you approach, you may consider touching a non-threatening area of the body. Gently placing your hand on their knee or on their hand and telling them your name will help introduce your presence, and reduce combative reflexes. Too many quick movements may cause your PLWD to become stressed and their primitive instinctual reflex to protect oneself may kick in.

    ● Go SLOW. Pearls are ruled by reflexes and can be startled easily. Stabilize unsteady equipment like rocking chairs or recliners. With little to no control over their body weight, a Pearl may experience increased anxiety if they’re rocking back and forth. Verbalize your movements and let  the Pearl know what you plan to do with them next. For example, if you are feeding a Pearl, you may narrate each thought you have: “Let’s scoop up some rice; here it comes to your mouth; open big; bite; yummm; let’s try some veggies now.”

    ● Use the Hand-under-Hand (HuH) technique. This simple hand technique can be used for doing tasks “with” your PLWD rather than “to” your PLWD. We can connect with an individual by using HuH to minimize combative behaviors and provide a sense of independence. Although a Pearl may have range of motion limitations, we can still involve them in their self-care activities.

    ● Non-verbal behaviors are clues! A PLWD in the Pearl state has a very limited word bank when it comes to communicating wants and needs.

    Instead of using words to describe the feeling of pain, a Pearl might scream, attempt to hit, bite or make agonizing facial expressions. Whether we are causing the pain or it stems from an open wound, behaviors are another way of communicating. As a care partner, we can use these behaviors as clues and choose to take a time out to reassess a new approach.

    HAWAII MEMORY FRIENDS LLC
    Caregiver Education & Consultation
    Mapuana Taamu, Certified PAC Trainer
    808-469-5330 | mfriends808@gmail.com
    Learn more about dementia at our upcoming 2020 workshops. Contact Hawaii Memory Friends LLC for details.

    In previous articles that I’ve written for Generations Magazine, I mention the GEMS® states of dementia. There are six GEMS®: Sapphire, Diamond, Emerald, Amber, Ruby and Pearl. The last state, Pearl, signifies that the end of life is nearing. In the Pearl state, bodily functions are shutting down, the person is likely to spend most…

  • Adult Children Become Caregivers

    {Play}As parents age and grown-up children take on more responsibilities in managing their care, unforeseen challenges often arise. The roles of parent and child reverse as adult offspring increasingly manage the often complex affairs of their parents.

    This change can create tension when family members share more time together, such as at get-togethers and holiday celebrations. Here are four tips on how to best handle these situations, mitigate stress and bring everyone closer.

    ◆ Keep lines of communication open: Parents may feel uncomfortable talking about the gradual loss of independence that comes with age and advancing medical conditions. Often, the subject is not addressed directly, or avoided altogether, with the parent dismissing offers of help with a curt “I’ll ask for help when I need it” reply. In this case, it’s important to get a close reading on specific areas where help is needed. A refusal of help is also not final and the topic should be revisited regularly as the situation changes.
    ◆ Be emphatic: Always try to see things from both sides. For parents, loss of mobility and memory issues are not easy to accept after a lifetime of independence. Adult children may attempt, with best interests in mind, to take control of aspects of the parents’ life that they don’t want to relinquish yet. Sometimes it is better to take incremental steps to assist in key areas (driving, shopping, housekeeping chores) and always keep parents apprised on what the plan is going forward. While sometimes a medical emergency may force a decision, it is always good to review options and discuss a plan of action before it occurs.
    ◆ Don’t be afraid to play the humor card: Forgetfulness and other symptoms of advancing age will give rise to many situations where the humor card can be played without disrespect for parents’ feelings — the lighter side of these moments should be recognized and used to ease the mood. Contrary to expectations, parents are often quite prepared to laugh along and see the funny side of their limitations!
    ◆ Bring in a third party to be an objective observer: Sometimes a person who is respected and observed as being honest and true, such as a doctor or nurse, can give their insight and provide direction when decisions need to be made. Suggestions of help from a third party could support the decisions needed to keep parents safe and maintain their quality of life, with just a little bit of help here and there. This will make it easier to increase this kind of help as the parents’ capabilities decrease.

    Perhaps the most important advice for taking care of aging parents is to encourage their full participation in the discussion and decision-making process. By giving everyone a chance to voice
    their opinion, the implementation of care can be fine-tuned so as to respect everyone’s wishes and best interests.

    ATTENTION PLUS CARE HOME HEALTHCARE
    Accredited by The Joint Commission
    1580 Makaloa St., Ste. 1060, Honolulu HI 96814
    808-739-2811 | www.attentionplus.com
    AGING IN HAWAII EDUCATIONAL OUTREACH PROGRAM
    by Attention Plus Care — a program providing resources for seniors and their families, covering different aging topics each month. For class information and upcoming topics, call 808-440-9356.

    As parents age and grown-up children take on more responsibilities in managing their care, unforeseen challenges often arise. The roles of parent and child reverse as adult offspring increasingly manage the often complex affairs of their parents. This change can create tension when family members share more time together, such as at get-togethers and holiday…

  • Inflammation: ‘The Secret Killer’

    Acute inflammation is vital to good health for healing wounds or fighting infection. In contrast, low-grade, ongoing “chronic inflammation” is the underlying driver of many chronic diseases.

    Triggers of chronic inflammation include:
    • Low-grade viral and bacterial infections
    • Pollutants
    • Smoking
    • Belly fat
    • Diet high in processed foods
    • Frequent bouts of stress and anger.

    Free radicals generated by these processes trigger inflammation, which can worsen the stiffening of arteries and promote plaque accumulation. In rheumatoid arthritis, the immune system produces inflammation that wears down the joints.

    Inflammation is also a focus of research in the formation of Alzheimer’s disease. Stress-related hormones — namely cortisol — can further instigate inflammation and exacerbate some of these chronic conditions. Inflammation may also be associated with depression.

    Inflammation can be measured through a blood test called “hsCRP” (high sensitivity C-Reactive Protein). You can manage your inflammatory health through better diet and exercise, as well as pharmacological and nutraceutical treatments. However, not all nutraceuticals and supplements are created equal. When buying any type of supplement, read the label to determine purity (contamination by external elements), bioavailability (greater blood and tissue levels) and cost per dose. Be sure to add all supplements to your list of medications that you provide to your primary care physician and contact them immediately with any adverse reactions. For emergencies, do not hesitate to call 911.

    CARDAX
    2800 Woodlawn Dr., Ste. 129, Honolulu, HI 96822
    800-618-3050 | zanthosyn@cardaxpharma.com
    www.zanthosyn.com/

    As Time Magazine put it in its 2004 cover story, “Inflammation is the body’s first defense against infection, but when it goes awry, it can lead to heart attacks, colon cancer, Alzheimer’s and a host of other diseases.” Understanding and managing inflammation is key to health and longevity.

  • Are Dental Implants an Option for You?

    {Play}The field of dental implants is one of the fastest growing areas in dentistry. In 2019, over 3 million implants were placed in the United States and that number is predicted to grow in 2020.

    Dental implants are very popular due to the high success rate of the procedure (over 90 percent) and the results of these implants are very beneficial.

    In the past, removable full or partial dentures,and/or cemented bridges were the only options available to replace missing teeth. In most dental offices today, single or multiple implant options are available. The function, comfort and longevity of dental implants now make them the superior choice for replacing missing teeth.

    Although the financial investment for dental implants is higher than dentures and bridges, the end result is longer lasting comfort. There are some dental insurance plans that partially cover implant procedures.

    If you have any questions about dental implant procedures or if you wonder if implants are an option for you, consult with your dentist.

    PAUL K. TANAKA, DDS
    4747 Kilauea Ave., Ste. 113, Honolulu, HI 96816
    808-737-6229 | office@paultanakadds.com
    www.paultanakadds.com
    Dr. Tanaka was the first dentist to perform Navigational Dental Implant Surgery in Hawai‘i with the use of X-Guide.

    The field of dental implants is one of the fastest growing areas in dentistry. In 2019, over 3 million implants were placed in the United States and that number is predicted to grow in 2020. Dental implants are very popular due to the high success rate of the procedure (over 90 percent) and the results…