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Jill Rosner, R.N., B.S.N. – Guest Contributor – Rosner Healthcare Navigation Most of my articles come from my experiences in my daily life as an Aging Life Care Manager.  All of the topics are meant to educate my readers and bring awareness to issues related to health and aging.  Many of my clients are living with some form of dementia. The take-home message that I want everyone to know is that dementia does not come with a list of manifestations that do or will happen to everyone affected.  There is no cookie cutter Alzheimer’s disease or form of dementia. The most frequently asked question in which I encounter from my client’s family members tends to be: “What is the difference between Alzheimer’s disease and dementia?” The terms have become almost interchangeable over the years. The reason perhaps is because Alzheimer’s disease accounts for the largest percentage of diseases causing the symptoms, which are referred to as dementia.  Dementia itself is not a disease process; instead dementia is a group of symptoms caused by a disease. It is perhaps easiest to think in terms of diseases that cause symptoms that have other consequences to the rest of the body.  For example, diabetes, which causes high blood sugar and the effects of having a high blood sugar.  The symptom of high blood sugar and the consequences that accompany diabetes is a result of an unhealthy pancreas, which is not functioning properly.  The pancreas either does not produce insulin or produces too little or is resistant to insulin, depending on what kind of diabetes is diagnosed.  So, the high blood sugar and other symptoms is not the disease itself but rather the result of an unhealthy pancreas or a disease affecting the pancreas. The same holds true for dementia.  Dementia is not the disease but rather the symptoms caused by an unhealthy brain or neurologic disease affecting the brain. Alzheimer’s disease While Alzheimer’s disease has most often been considered to be the culprit of these symptoms, there are many other forms of diseases affecting the brain causing dementia symptoms. Vascular disease, high blood pressure, stroke or transient ischemic attacks (TIAs) can lead to damage in the blood vessels in the brain, which can lead to a condition called vascular dementia.  A condition, which causes formation of what is called Lewy bodies in the brain, which, causes a disruptive in the brain’s functioning, and is referred to Lewy Body Dementia.  Frontal temporal dementia affects the frontal and temporal lobes of the brain, and results in symptoms of dementia.  These are just the top of the list of causes of the symptoms of dementia.  Various other forms of dementia exist. The most important piece to remember is that all types of brain diseases that cause dementia symptoms may have different manifestations or different symptoms.  This has been an increasingly important issue.  It’s no longer your great-grandmother’s dementia.  Once referred to as senility, the symptoms we think of are those of the very “old” person who has lost their memory and shuffles about – perhaps wandering and eating too many sweets – are the easiest to diagnose. However, the less common symptoms or behaviors are becoming more of a problem in the diagnosis of dementia. I am seeing more and more patients affected by dementia at a younger age and more and more patients affected by symptoms that are not typical and may be less obvious signs.  I have seen patients dismissed and assured that they are just fine because they don’t fit the old, outdated mold.  I recently had a nurse say to me “she is too young to have dementia” when my client clearly had been diagnosed and had severe symptoms of dementia.  Even modern medicine and practice has not caught up to the realities of the epidemic of brain dysfunction that is causing myriad of symptoms. The most disturbing lack of insight comes from the lack of knowledge that memory loss does not have to have the primary symptom of dementia.  Too may people are being misdiagnosed or not diagnosed at all because they are able to answer the typical type of questions such as “What’s your name?  What’s the date?  Who is the president?” and a few others.  Amnesia or memory loss is just one symptom, and for some forms of dementia, memory loss is not the prominent feature! In the case where the frontal lobe of the brain has been more severely affected by frontal-temporal dementia, shrinking of the brain or injury of some sort in the case of vascular dementia, the symptoms may be very different from that of Alzheimer’s disease – where the memory is primarily affected. The frontal lobe affects behaviors such as impulse control, the filter between the thoughts and the spoken word.  For example, some behaviors include: blurting out inappropriate language or taboo thoughts and executive functioning.  The ability to sequence and organize is affected.  Insight and judgment are affected.  This sets the stage for exploitation and poor decision-making.  Paranoia and delusions can be features of dementia. More and more I see clients who don’t have the typical memory loss, and therefore are not being recognized as having a cognitive impairment or dementia.  These unfortunate people are making terrible decisions, are being financially exploited and are often taken advantage of during everyday life.  They are often subject of undue influence where they are easily manipulated into complying with the wishes of another, without understanding the consequences of their actions and acting of their own free will because their judgment is affected. This different or unusual manifestation of dementia often leads to the misdiagnosis and misunderstanding of dementia. The main messages again is this:  Do not assume that all forms of dementia produce the same symptoms or have the same consequences.  Just because one’s memory seems to be fairly good does not mean that the person is not impaired.  Do not make assumptions! It’s a new and ever evolving world of dementia.  If you recognize that something is just “not right” with your loved one, friend or co-worker, I encourage you to tell their doctor, discuss your observations with others who have contact with the affected person, and advocate for intervention.  You could be saving that person from being taken advantage of or being overlooked as having a problem. Far too often the problem is not addressed until way too late in the course of the disease process. For more information contact the Alzheimer’s Association at www.alz.org. Jill Rosner is a registered nurse, certified geriatric care manager and owner of Rosner Healthcare Navigation.  She provides patient advocacy and care management services to clients with health and aging issues.  Contact her at JillRosnerRN@aol.com

By: Jeffrey D. Stauffer – Community Relations Director, jeff@elvilleassociates.com, 443-393-7696 On December 10th, Elville and Associates hosted its first quarterly Client Care Program Continuing Legal Education Event at the John A. Cade Performing Arts Center on the campus of Anne Arundel Community College.  35 Client Care Program (CCP) members and other interested client guests attended the workshop titled, “What to Do Upon the Death of a Friend or Loved One – the Post Mortem Process for Estate and Trust Administration Explained.”  Presenting at the event were Stephen R. Elville, principal at Elville and Associates; Gary Greenwald, principal at the Law Office of Gary Greenwald, P.C.; and Matthew F. Penater, partner at Elville and Associates.  Attendees enjoyed gourmet box lunches, snacks, drinks and the opportunity to get to know one another during the Event. Last fall, after much planning and design, Elville and Associates made the CCP available to its clients.  The mission of the CCP ( “planning that works”) is to provide clients with the comfort and assurance that their estate and elder law plans will work no matter how their goals or situations may change over time, and to ensure planning remains consistent with changes in the laws.  Included in the program are educational workshops for clients, their families and fiduciaries; and funding updates; enrollment in DocuBank, an annual social event, and discounted services; coordination with your planning team professionals (financial advisor, CPA, insurance agent, advocate);  enrollment in Everplans – a state-of-the-art, digital archive for all of your essential information; and additional participant benefits such as fun family events. On May 5 th and 6 th, 2016, the entire estate planning and elder law team of Elville and Associates, along with key support staff members, attended the Client Maintenance Academy in Boston, Massachusetts, to become certified in client maintenance and updating, becoming only the 43rd law firm in the U.S. to attend the Client Maintenance Academy.  Elville and Associates has always been a thought leader in client maintenance and updating through its on-going client legal education programs, family care meetings, and annual Client Education Event.  The firm’s affiliation with the Client Maintenance Academy now puts the firm squarely in the forefront as the leader in estate planning, elder law, and special needs client maintenance and updating in Maryland. Elville and Associates’ next quarterly CCP event, “Trustee Workshop,” will be held on Saturday, April 1st at 10 a.m. at the same location on the campus of Anne Arundel Community College. For more information about the Client Care Program, please contact Asset Alignment Coordinator and Executive Legal Assistant Mary Guay Kramer at 443-741-3635.  Information about the CCP may also be found on our website at www.elvilleassociates-staging.bgbshlgq-liquidwebsites.com.

By:  Olivia R. Holcombe-Volke, J.D., olivia@elvilleassociates.com, 443-393-7696 Scenario One:  Mom and Dad meet with Attorney to prepare their estate plan.  Mom and Dad intend to leave their significant wealth to their only child, Daughter.  Happy with Attorney, they advise Daughter to meet with Attorney for her own estate planning.  Daughter, upon becoming a client of Attorney, discusses her plans for using Mom and Dad’s significant wealth after inheriting it.  A year later, following a family disagreement, Mom and Dad contact Attorney to change their estate plan:  now, they wish to leave 25% to Daughter, and 75% to Daughter’s arch-nemesis and rival in the family business, Cousin. Scenario Two:  Son #2 contacts Attorney.  Dad is experiencing some minor memory loss and confusion.  Son #2 would like Attorney to prepare estate planning documents for Dad.  Attorney determines that Dad has sufficient mental capacity to understand and execute estate planning documents.  Attorney prepares, and Dad executes, the necessary documents.  Several months later, Son #1 contacts Attorney.  Dad’s mental and physical health have gone downhill, and Son #1 wishes to seek a court-ordered guardianship over Dad’s personal and financial affairs. Scenario Three:  Niece is named as attorney-in-fact in elderly Uncle’s power of attorney.  Nephew is named as trustee in Uncle’s revocable living trust.  Niece and Nephew seek Attorney’s assistance in various aspects of handling Uncle’s property.  At a certain point, a major expense arises.  Niece and Nephew disagree as to whether the expense should be covered, and from which source of funds. These three scenarios have one thing in common: the potential for, or actual existence of, a conflict of interest. At the outset, the actions taken by Mom and Dad, Sons #1 and #2, and Niece and Nephew seem so logical.  Why wouldn’t parents who are happy with their estate planning attorney recommend their adult child meet with the same attorney for estate planning?  Why wouldn’t an adult child, faced with an elderly parent’s disability, seek assistance from the elderly parent’s attorney?  Why wouldn’t family members serving in different roles under a family member’s legal documents come to the same attorney for guidance?  These situations are so innocent – how can a conflict of interest possibly arise? For guidance, it helps to know what a “conflict of interest” is, in the context of attorney-client relationships.  The Maryland Attorneys’ Rules of Professional Conduct, codified in the Maryland Rules at Title 19, Chapter 300 (Md. Rule 19-300.1 et seq) – specifically Rule 19-301.7 – states (in pertinent part): …(A)n attorney shall not represent a client if the representation involves a conflict of interest. A conflict of interest exists if: (1)  the representation of one client will be directly adverse to another client; or (2)  there is a significant risk that the representation of one or more clients will be materially limited by the attorney’s responsibilities to another client, a former client or a third person or by a personal interest of the attorney. Of course, in Scenarios One, Two, and Three – as in most real-life situations – the potential for a conflict of interest does not mean that an actual conflict of interest will arise. As attorneys, we are driven to say “yes, we can help you,” and loathe to deny assistance to anyone seeking our guidance – so it is particularly difficult to know what to do for the sake of clients or potential clients, and how best to comply with the Rules of Professional Conduct, when a situation presents itself that might result in a conflict of interest.  Even where an actual conflict of interest may exist, Rule 19-301.7 takes this into account, stating (in pertinent part): (b)  Notwithstanding the existence of a conflict of interest under section (a) of this Rule, an attorney may represent a client if: (1)  the attorney reasonably believes that the attorney will be able to provide competent and diligent representation to each affected client; (2)  the representation is not prohibited by law; (3)  the representation does not involve the assertion of a claim by one client against another client represented by the attorney in the same litigation or other proceeding before a tribunal; and (4)  each affected client gives informed consent, confirmed in writing. Conflicts of interest can arise in even the most innocent of situations.  They are never intended, so the best strategy for avoiding them is for attorneys to advise clients (and potential clients) regarding how (and in what situations) conflicts can be anticipated, and in some instances, to decline the representation. Ultimately, the mere existence of the potential for a conflict of interest does not render the attorney-client relationship impossible, so long as the requirements of informed consent under Rule 19-301.7(b) are met.

Kathrin Shenk – Guest Contributor – Owner and Chief Professional Organizer at FreeYourSpace, LLC. A Zen parable tells of a wanderer who happened upon a river. He wanted to cross it, but there was no bridge. Afraid to wade across the river on foot, he spent hours building his own raft from vines and trees, which ultimately carried him safely to the other side. However, once across the river, he thought to himself: This is a good raft; I might need it again if I must forge another river. So the wanderer carried the raft with him for the rest of his life. Are you carrying your own raft – belongings that once were of service, but quietly morphed into dead weight? Most of us do. Your closets, attic, basement and garage might be overflowing with a lifetime of accumulated possessions – not just your own, but other people’s.  Perhaps you are spending lots of time searching for things. Or you have paid good money to buy items you already own because you couldn’t find them.  Maybe you have lost gift cards, checks and bills in stacks of paper and had to pay late fees. You may have a vision for the basement or spare room which has to remain a dream, because the space has transformed into a storage facility.  Are you longing for an oasis of calm but somehow can’t unwind? That raft you are carrying might be to blame. We have a love affair with stuff. Some experts estimate that the average American home contains 300,000 items. Items that don’t just cost money to acquire, but can make us pay dearly over time in terms of: Space: The U.S. Department of Energy reports that 25 percent of people with two-car garages don’t park any cars in their garages, and 32 percent only have room for one. According to the National Association of Professional Organizers (NAPO) we regularly wear 20 % of the clothes we own, while 80% mostly sit unused. Time: According to a study conducted by a Boston marketing firm, the average American burns 55 minutes a day looking for things they know they own but cannot find. The National Soap & Detergent Association estimates that getting rid of clutter would eliminate 40 % of the housework in the average home. Money: Harris Interactive reports that 23% of adults say they pay bills late (and incur fees) because they lose them. According to an article in Consumer Reports, one in 10 households resorts to renting space at a storage facility. The article goes on to say that “The average national monthly cost of a climate-controlled rental space is expected to reach $1.63 per square foot this year… That means you could spend nearly $2,000 in one year for the most popular 10’ x 10’ unit.” Storing things at home is not free either. Many of us have “outgrown” our first home and are now making payments on a bigger mortgage to house a collection of stuff we feel we can’t do without. Health: In a study done at Princeton University Neuroscience Institute, researchers found that clutter competes for your attention and wears down your ability to focus. A study from UCLA looked at families with homes that were filled with an abundance of toys and household items. The researchers found that the mothers’ stress hormone levels spiked when they were home dealing with their belongings, but dropped when they left. Organizing expert Peter Walsh noticed a link between overconsumption of stuff and overconsumption of food, resulting in weight gain. That’s a hefty price to pay. It may be time to take a good hard look at the contents of your home and storage spaces, and shed some of that dead weight. Here are some practical tips to get you going: Before you start, decide where discards will go and make arrangements: You may decide to take a few bags and boxes to your favorite thrift store, or you may need to contact a hauling service. Evaluate what will serve you going forward: Treasured memorabilia, special family heirlooms, the right furniture, age-appropriate toys, useful appliances, select housewares, your favorite clothes and footwear. Start with an area that’s easy for you: Storage areas likely contain items you don’t need often. You may want to save memorabilia for last. Move from quantity to quality: We use 20% of our possessions, with 80% sitting dormant. Do you like it? Will you miss it? How easy is it to replace? Do you frequently use it or wear it? Watch your visceral response: Does a piece of clothing make you feel like a million bucks? Or does it make you feel guilty for spending all that money and it never fit right? Curate memorabilia: Select one or two objects that serve as the BEST reminder of an event, a relationship, or time in your life. Would you try to save this in a fire? This can be a difficult process. Be realistic and be patient.  You won’t go through a lifetime of possessions in one weekend. In addition, this can be physically taxing work. It may require lifting, squatting, bending or moving up and down stairs. You may encounter dust, mold and perhaps even critters and their leavings. If, over time, you are making less progress than you like, consider this: Are you holding on to items that represent obsolete goals (scholar, gourmet cook, home improvement expert)? It may be time for a reality check. Are you feeling guilty letting certain things go (gifts, mementos, expensive acquisitions)? Give yourself permission to release them. Do you have trouble with the progress of time (loved ones pass on, kids grow up, your own declining health)? Be kind to yourself. Are you physically exhausted or unable to do it? You may need to ask for help. Are you overwhelmed with the sheer volume and/or emotional drain of the task? It may be time to call in a professional. If attempts to get decluttered and organized on your own don’t lead to the desired results, consider hiring qualified help. Professional Organizers help clients declutter, organize and take control of their space efficiently and effectively. The National Association of Professional Organizers (NAPO) provides a convenient practitioner search tool at their web site www.napo.net. As you progress you will enjoy giving select memorabilia and special heirlooms the attention and care they deserve. The right furniture, useful appliances and select housewares will enhance and support your lifestyle. Your favorite clothes and footwear will make you feel great. You will have more space and more time to enjoy life. You may save money. Your overall health might improve. You will be so glad you ditched that heavy raft that you may just jump right over the next river! Kathrin Shenk is the owner of FreeYourSpace, LLC.  She is a member of the National Association of Professional Organizers (NAPO) and is fully insured through NAPOsure, a comprehensive program tailored specifically to the needs of Professional Organizers.  She can be reached at 301-233-3885 or via email at kathrin@freeyourspaceorganizing.com.

Jeffrey D. Stauffer, Executive Director, jeff@elvillecenter.org; 443-393-7696 A young girl is singing in a recording studio to music she composed herself.  A seventh grader who didn’t have his own trumpet last semester is now practicing at home to hit that high G for the first time.  A middle school jazz band is listening to a replay of its winter concert on a new stereo system with HD speakers in its classroom.  And, a third grader is handed a clarinet he’s always wanted to play for the first time and squeaks out the first note to the delight of his teacher. Founded in 2014 by Mr. Stephen R. Elville, Esq., the mission of the Elville Center for the Creative Arts is to improve the quality of life of children of all ages by providing them the opportunity to learn music theory and application, experience cultural events related to the musical and creative arts, and to use music and the promotion of music-related activities to transcend social and economic divisions. Since our last update, the Elville Center has continued to develop new relationships, including the music programs at George T. Cromwell Elementary in Glen Burnie, and Brooklyn Park Elementary in Baltimore.  We recently visited with the Instrumental Music Director of these schools, Ms. Carol Cox, and found her to be very dedicated to her students and working hard to give the gift of music to them despite few resources at her disposal. Ms. Cox mentioned that lack of funding for music at her schools doesn’t allow her to replace supplies once they are depleted, nor fix equipment and instruments when they break.  The Elville Center encouraged her to provide a “wish list” of items that would benefit her classroom and students, which she quickly provided.  Ms. Cox was also the first teacher to invite me to visit one of her classes during a “live session,” and I gladly accepted her offer. A follow-up visit was set in November to deliver much-need items to benefit her schools’ music programs, including: an LG stereo system with CD player and Bluetooth capability; a trombone hard case, alto sax case, bass clarinet case, and trumpet case; boxes of reeds for clarinets and saxophones, oils and rosins; mouthpieces for instruments; and swabs for saxophones and clarinets. The November delivery was just the beginning for Ms. Cox and her students, as the Elville Center visited George T. Cromwell again in December for an early holiday delivery to fulfill more items on her wish list.  During this trip, the Elville Center assisted the music programs with three fully-refurbished violins with cases and new bows; three additional new violin cases for their existing instruments; snare drum stands, cello rock stop straps; and a bell kit with case. “So many of our students don’t have access to an instrument or have the means to rent or buy one.  I’ve seen music brighten the lives of so many students who face difficult challenges in and out of school,” noted Ms. Cox.  “The school’s funds and equipment are lacking to meet the needs of all our students, so the extraordinary donations from the Elville Center for the Creative Arts are helping to bring music to more of our children.  The kids’ excitement when presented with new equipment can’t be compared to anything except to how they might respond to a ton of Christmas gifts!  Thank you to the Elville Center for elevating my students’ musical experience this year with your generous donations!” The Elville Center’s relationship continues to grow with Dr. Max VanDerBeek and the music program at Wiley H. Bates Middle School.  As readers may recall, Bates Middle is home to a Performing and Visual Arts (PVA) Middle School Magnet Program, which is designed to provide students who demonstrate artistic ability, interest and potential a curriculum of rigorous training that emphasizes the creative process through collaborative opportunities.  However, due to financial constraints, many of the school’s students do not have the means to participate in music without some outside support. Over the past several months, the Elville Center has supported Dr. VanDerBeek and the Bates music program with a wide variety of contributions, including three donated, refurbished trumpets; a donated Mapex drum set with cymbals; a donated set of conga drums; a donated, refurbished clarinet; two donated, refurbished flutes with new cases; a new keyboard case; new drum cases; reeds for various instruments and contributions towards repairs for instruments in its current inventory. “We can’t thank the Elville Center enough for its support over the past two years,” said Dr. VanDerBeek.  “We’ve received over 30 instruments from the Elville Center and the difference they’ve made in our music program can’t be put into words.” In January, the Elville Center’s Executive Director, Jeffrey Stauffer, and Dr. VanDerBeek, were interviewed by Jonathan Palevsky, popular radio personality at 91.5 WBJC, to discuss our partnership with Bates Middle School as well as our partnership with the classical music station.  The interview can be heard in its entirety on the Elville Center’s website, www.elvillecenter.org. “On behalf of the students and administration of Bates Middle School, we are extremely grateful to the Elville Center for our relationship,” said Dr. VanDerBeek.  “They’ve given us wonderful, responsive support that has benefited our program so much.” Mr. Elville and the Elville Center were recently featured in the 2017 Maryland Edition of Super Lawyers Magazine in the publication’s “Good Works – Lawyers Giving Back” section.  The article discusses how Mr. Elville created the idea for the Charity, looked back on student Daniel Coleman’s initial involvement in developing the Charity’s first school relationship, and talked about the Charity’s desire to make an impact in the Baltimore City school systems, where the needs are most pressing. “Mr. Elville and the Center have brought a whole new level of music to my life.  Now that we have the instruments to learn, my peers and I are able to not just enjoy other people’s music, but our own,” said Daniel.  “Students have spoken to me about how over the last couple of years, they were not able to play the instruments themselves, but rather on practice on paper.  At school, they used to print out a picture of a piano keyboard and my friends would only be able to ‘play’ on the paper; they never were able to heard the notes.  Now they get to enjoy the sound of the music they make.” A link to the Super Lawyers article can be found on the Elville Center’s website, www.elvillecenter.org. As was mentioned in the Super Lawyers article, the Charity has learned that, while there are needs to be fulfilled all over Maryland, the needs of Baltimore City schools’ are the most dire, and funding is needed for the Elville Center to work to fulfill the needs of these and other schools.  An example is Franklin Square Elementary and Middle School in downtown Baltimore, whose band director, Mr. Marcus Neal, contacted the Elville Center because his music program did not have working music stands, valve oils, trombone slide oils and other supplies for the third and fourth quarters of this year.  And, for every two children that want to play an instrument in his program, there is only one instrument to go around. Fortunately, the Elville Center was able to fulfill Franklin Square’s initial needs, and we are actively working to add to the school’s musical instrument inventory.  However, these needs will reoccur, and for every school that contacts the Elville Center, there are 10 in Baltimore City and beyond we have not yet met that have the same needs.  Funding from donors is an integral part of the Charity’s ability to make a difference in the schools’ music programs. The Elville Center is on the move in 2017, developing new partnerships and fostering existing ones as we continue to “Make a Musical Difference in the Lives of Children.”  And, as a non-profit organization, we depend on the generosity of donors to help make our vision a reality, including donations of used musical instruments and general monetary pledges.  The Elville Center continues to engage in new and exciting initiatives to capture the minds and hearts of our individual and corporate donors and surrounding communities.  These initiatives and donor opportunities include: sponsoring a child (young musician); sponsoring a specific school’s music program; sponsoring/facilitating a fundraising event; making a specifically directed monetary donation; making a gift in memoriam; volunteering/donating time to the Elville Center; and sponsoring the Elville Center through one’s business. The Elville Center is actively seeking donations to further its important work.  If you would like to donate or learn more about the Elville Center for the Creative Arts and its initiatives, please visit www.elvillecenter.org, or contact Jeff Stauffer at jeff@elvillecenter.org, or 443-393-7696.

By:  Jeffrey D. Stauffer – Community Relations Director, jeff@elvilleassociates.com, 443-393-7696 On December 13th, Olivia R. Holcombe-Volke, Esq., became a member of the Women’s Law Center of Maryland Board of Directors. With her selection, Ms. Holcombe-Volke will work with other board members to further the Women’s Law Center’s vision of promoting a legal system that provides justice and fairness for women.  Board members also provide oversight for the organization by setting policy, developing and implementing plans and executing comprehensive fundraising plans to ensure financial stability. “Civic engagement and community action are vital to the strength and success of humanity,” said Ms. Holcombe-Volke.  “It is my honor and privilege to join the Board of the Women’s Law Center of Maryland, an organization committed to perpetuating these very principles on behalf of the citizens of Maryland, and beyond.” The mission of the Women’s Law Center of Maryland is to serve as a leading voice for justice and fairness for women by advocating for the protection and expansion of women’s legal rights through legal assistance to individuals and strategic initiatives to achieve systemic change.  The Women’s Law Center works to protect women’s legal rights in three ways—through representation, education and policy.  It serves over 11,000 individuals a year and engages in advocacy to promote systemic change and equality. As an associate at Elville and Associates, Ms. Holcombe-Volke is an integral member of the firm’s busy estate planning team.  As an associate at Elville and Associates, Ms. Holcombe-Volke is an integral member of the firm’s busy estate planning team, working with clients at all asset levels to craft the perfect estate plan to accomplish their particular financial and non-financial goals. She also regularly addresses the needs of elder law clients, assisting with Medicaid and asset protection planning, special needs planning, and the difficult issues as a result of mental and physical incapacity. Ms. Holcombe-Volke was also recently selected to the 2017 Maryland Rising Stars list by Super Lawyers.  She also currently serves as a volunteer attorney with the Maryland Volunteer Lawyers Service.

By: Jeffrey D. Stauffer, Community Relations Director – jeff@elvilleassociates.com, 443-393-7696 On October 14th, Mr. Stephen R. Elville, principal of Elville and Associates, presented the topic of “Exploring the Nuances of the Advance Directive for Mental Health Treatment” at the National Alliance on Mental Illness Annual Conference at Shepherd Pratt Conference Center in Towson, Maryland. The presentation educated the attendees about the purpose of the advance directive and why it is important, the nuances involved in the document and in health care decision making, offered case studies related to the importance of having the document in place, and offered other considerations in planning for incapacity. By the end of 2016, Mr. Elvillle will have presented at almost 50 workshops, forums, conferences and continuing education events. NAMI Maryland brings people together to tackle our community’s mental health needs and to invest in lasting changes that improve lives. The organization focuses on recovery, resiliency, and the support that is essential to wellness and quality of life. It gives families a place to turn, a place to access a strong network of education, support programs and resources. One out of every four families are affected by mental illness in some way. Elville and Associates engages clients in a multi-step educational process to ensure that estate and elder law planning works from inception, throughout lifetime, and at death. Clients are encouraged to take advantage of the Planning Team Concept for leading edge, customized planning. The education of clients and their families through counseling and superior legal-technical knowledge is the mission of Elville and Associates.

Authored by: Stephen R. Elville, J.D., LL.M. — steve@elvilleassociates.com, 443-393-7696 There is a subtle but unmistakable trend in estate planning and elder law in 2016.  Not surprisingly, this trend is being driven not by the legal community, but by market forces – estate planning and elder law clients.  The trend is this:  clients are increasingly demanding to be cared for – they are seeking and demanding attorney-client relationships where formal client maintenance and updating programs are offered – they are asking attorneys to stop engaging in the long-time practice of limiting the scope of their representation to such an extent that individuals and families are left with plans that are likely not to work over the long term due to many factors, including no commitment on the part of attorneys and law firms to a caring for clients model, and where there is no continuing relationship with the attorney or law firm. This trend, like all value-based concepts, has its origins in foundational principles.  Would a sane person knowingly engage in the estate planning process – enter into a relationship with a law firm, share their most personal information, invest time, effort, and money, and make plans for the future based on the planning, if they knew that the plan was likely not going to work as intended and contemplated during the planning process?  Of course not.  Yet, this is what happens in estate planning and elder law each and every day.  The answer:  client maintenance and updating (client care). To understand client care in estate planning, elder law, and special needs planning is to understand how planning actually works – or more exactly, how it doesn’t work.  In this brief article, we will explore the fundamentals of client care, the mechanics of how it works from plan inception and throughout the following years, and how it ultimately accomplishes its inherent goal of ensuring that planning works as intended, with the added benefit of cost minimization in final administration as a likely natural by-product. Understanding client care is simple – it is treating the estate and elder law planning experience as more than a one-step process, and understanding that planning is not just a set of physical documents, but a lifetime of maintaining and updating those documents on a recurring, predictable basis, with the expectation that through follow-up and on-going counseling in a partnership-type relationship between attorney and client, in coordination with the client’s financial advisor, CPA, and other advisors, all aspects of planning are addressed, including the alignment of assets in harmony with the planning structure.  Traditionally, estate planning has been limited to one step – the design and implementation phase.  It is at this point where most failures in estate planning occur – that’s right, this is where failure happens practically from the very beginning, and as mentioned above, the point where if most clients realized their plans were subject to failure from inception they would likely choose to not plan at all.  This is where plan failure begins because clients are traditionally counseled that the set of documents they obtain is the estate plan.  Nothing could be further from the truth, and proof of this is best summarized in the following statement:  in estate planning, ultimately the only thing that really matters is the answer to this question – how were the assets titled and what were the beneficiary designations at the time of death?  The estate planning documents are ancillary and of secondary importance – they are merely tools by which to control the flow of assets and/or direct them.  Without proper titling, designation, and assignment (asset alignment), documents in and of themselves are potentially useless. Rather than limiting oneself to a one-dimensional process (the design and implementation phase only), estate and elder law planning is a three-step process, inclusive of the following:  (1) design and implementation; (2) maintenance and updating (the client care process); and (3) success in final administration.  Although many analogies are applicable, perhaps the garden analogy best illustrates the truth of the planning process.  To have a successful garden, one must till the soil and carefully prepare the ground for planting, carefully designing the rows or patches, determining what yield is expected and what aesthetic look is desired, and thereafter the seeds are planted.  Then rain comes, and sometimes the wind blows; or at other times the rain does not come and measures must be taken to provide needed water to the plants; but then animals or insects may come and eat the plants or vegetables, frustrating your efforts.  And all during the growing season you must maintain the integrity of the garden by weeding, tending to the plants, placing stakes where necessary, spraying, and otherwise monitoring things on a consistent basis.  After considerable attention in time and effort, assuming the soil is good, the garden yields an abundance of tomatoes, corn, egg plant, yams, beans, squash, broccoli, watermelon, or whatever other plants were cultivated, usually in relation to the amount of planning and care expended in anticipation of a successful harvest.  Estate and elder law planning is the same – in our ever-changing and fast-paced world, one of the only things that is certain is we must recognize and adapt to change – we must implement planning with the understanding that it is not static, but constantly evolving.  Along these lines, the only way to assure the success of your planning, and ultimately the success of your beneficiaries through planning, is to focus on the following:  make sure your voice is heard – engage in planning only with an attorney/law firm that cares enough about you, your family, and the success of your planning to offer a formal client maintenance and updating (client care) program, and that has as its core mission, vision, and philosophy the education of clients and their families, and a commitment to a caring for clients model.

Authored by: Olivia R. Holcombe-Volke, J.D. – olivia@elvilleassociates.com, 443-393-7696 When 529 college savings plans first arrived on the scene (Section 529 of the Internal Revenue Code was adopted in 1996), the primary motivation was addressing the reality of rising college tuition. Through various subsequent iterations, including those of the Economic Growth and Tax Relief Reconciliation Act of 2001 and the Pension Protection Act of 2006, qualified distributions became tax-free, rollovers became allowable, and account owners became able to make some investment changes, expanding the appeal of 529 plans beyond merely paying for the ever increasing costs of college. What is a 529 plan? Legally known as a “qualified tuition plan,” a 529 plan (so called because authorized by Section 529 of the Internal Revenue Code) is a tax-advantaged savings mechanism to pay for future college costs. There are two types:  a pre-paid tuition plan, and a college savings plan. With a pre-paid tuition plan, units or credits toward future tuition and room and board are purchased from participating colleges and universities. With a college savings plan, an account holder establishes an account on behalf of a beneficiary (the current or future college student) in order to pay the beneficiary’s eligible college expenses. The account holder may select among various investment options for the contributions made to the account, with the particular college savings plan then investing the contributions on behalf of the account holder. Withdrawals from these plans can then be used at most, if not all, colleges and universities. The tax implications of contributing to a 529 plan are almost exclusively positive.  Contributions to a 529 plan for the benefit of someone else will move assets out of one’s estate – thereby lowering potential exposure to estate tax.  Any growth in assets invested in a 529 plan will also avoid inclusion in the contributor’s estate.  Gift tax consequences are avoided if annual contributions remain at or below the annual exclusion amount (with no additional gifts in that year to the same beneficiary).  In fact, under special rules applicable to 529 plans, five years’ worth of the annual gift exclusion amount may be contributed (and a special tax election made) without gift tax ramifications; however, the contributor’s death during the five years following the contribution will result in the inclusion of a portion of the contribution in the contributor’s estate.  Finally, while contributions are not deductible for federal tax purposes, Maryland provides a deduction for contributions to the Maryland 529 Plans of up to $2,500 per beneficiary, per year, for contributions made that year, with contributions in excess of $2,500 eligible for deductions for up to the next ten (10) years (or until the full amount of contributions has been deducted). A 529 savings plan account can be established for the benefit of anyone – a friend, relative, or anyone else – and that beneficiary can be changed at any time, without consequence, so that if a beneficiary receives a scholarship, or decides not to attend college, a new beneficiary may be named without penalty.  Additionally, there is no limit to the number of plans that can be set up.  The opportunities presented by contributing to 529 savings plans are immense:  for minimizing estate tax exposure; for providing a legacy that will be put to good use; for the ability to push assets out of one’s estate while still maintaining some level of control over their investment, use, and ultimate disposition.  This combination of benefits is unusual.  If any aspect of this technique is applicable or appealing to you, your estate, and/or your preferred beneficiaries, it is worth discussing with your estate planning attorney today. Addendum:  On April 12, 2016, Governor Hogan signed the Achieving a Better Life Experience (ABLE) Act into law, joining thirty-nine (39) other states in providing a mechanism for many individuals who developed disabilities prior to the age of twenty-six (26) with the ability to open tax-exempt bank accounts to hold funds for use toward certain qualifying disability-related expenses, without the risk of negatively impacting eligibility for means-based government benefits.  Specifically with regard to 529 savings plans, the ABLE law provides for the Maryland 529 Board (formerly the College Savings Plans of Maryland Board) to establish and administer 529 accounts for individuals with disabilities, offering Maryland income tax subtraction modifications similar to those available for contributions to 529 accounts for non-disabled individuals (though more limited), and, most importantly, without the funds in such 529 accounts counting against an individual’s ability to qualify for means-tested benefits. ____________________ 1 Nothing in this article is intended as tax advice.  All readers are advised to speak with a tax professional regarding any federal or state-specific tax applications.

Matthew F. Penater — Of Counsel — The Penater Law Firm, LLC One of the rules in estate planning is to ensure that upon the death of parents, assets are not directed outright to minor children. A bequest directly to a minor child requires a Court-Ordered Guardianship of the Property, at worst, or a Custodianship under the Uniform Transfers to Minors Act (“UTMA”), at best. A Guardianship of the Property can only be obtained through Court action and once obtained, annual accountings must be filed with the Court. Upon a minor’s 18th birthday, all assets subject to the Guardianship are distributed outright to the child, whether it is $100 or $1.0 million. A Custodial arrangement under the UTMA may be utilized under specific circumstances and does not require annual accountings to the Court. In addition, the child would not receive the assets subject to the Custodianship until age 21 instead of age 18. With that said, most estate planners and professional advisors would caution against an estate plan that results in an 21-year old receiving a lump-sum inheritance outright.  Handing over $200,000 in cash to a 21-year old could very well do more harm than good. The entire amount is available for the child to spend and is subject to the claims of any creditors of the child. The tried-and-true solution to the above problem is to leave assets for a younger child in trust, with instructions to the trustee to utilize the trust assets for the child’s benefit, until the child is old enough to manage the assets. Traditional estate planning called for the trust assets to be distributed to the child, outright, once the child attained an age (or in fractional amounts at several different ages) that the parent felt was appropriate: ex. 35 years old. The idea being that at some point, the child should be in charge of his/her inheritance and be able to control how he/she enjoyed it. However, this created another potential problem – exposure to creditors. Once the assets are distributed from the trust to the child, those assets become exposed to creditors of the child (ex. divorced spouse). So how can we give the child control of the assets while still protecting those assets from most creditors of the child? Solution: Beneficiary-Controlled Trusts We can modify the traditional plan of leaving assets to a trust for young children by requiring the assets to remain in a beneficiary-controlled trust instead of being distributed to the child at a certain age, thereby exposing those assets to the creditors of the child. In addition, instead of distributing the assets to the child, he/she becomes trustee of the beneficiary-controlled trust at the age where the trust would have been distributed under traditional estate planning. That way the child is in control of the assets. Under the Maryland Trust Act, a beneficiary can be the sole Trustee of his/her own trust and the assets in the trust are NOT subject to the creditors of the beneficiary. So what have we accomplished under this plan? We have: 1) avoided the need for a Guardianship or Custodianship resulting in a large distribution to a young child; 2) given the child control over the assets as a Trustee when the child is old enough; and 3) protected the assets in the beneficiary-controlled trust from the creditors of the child. If protecting your child’s assets at your death is of importance to you and requires more attention in your plan, contact your estate planning attorney to discuss the best solution for your situation.

Authored by: Lindsay Moss, J.D. — lindsay@elvilleassociates.com, 443-393-7696 For many people caring for a loved one with disabilities, providing care in the home indefinitely is an unrealistic goal. As well-intentioned as most family caregivers are, the fact is that being a caregiver is extraordinarily hard.  Countless caregivers have come to Elville & Associates in crisis, burnt-out from the responsibilities of providing 24/7 care, not knowing where to turn. Acknowledging the extreme demands of being a caregiver and seeking help when at your wit’s end is OK! It is in the best interest of the disabled loved one to not be a burden, and to be cared for in an appropriate environment. This often means accepting the reality that the appropriate environment may be an assisted living or skilled nursing facility. When a family caregiver has made the decision to start looking at placement options, they often don’t know where to start. Selecting the right place for one’s loved one to live can be an emotional roller coaster. And, added to the stress of having to place a loved one in a facility is the overwhelming number of options to decide between; a quick Google search on local facilities will shoot back over 20 million results.  However, there are many steps a caregiver can take to make the selection process more bearable. Understanding the difference between assisted living and skilled nursing is an excellent place to start. Assisted living is often more desirable because of, among many things, the living spaces and the recreational activities offered. Assisted living facilities (ALFs) offer assistance with activities of daily living (ADLs) such as dressing and bathing. They also offer medication management and administration. Larger assisted living facilities can offer extensive ADL assistance, and often have separate memory care units geared towards individuals with moderate to severe dementia. Costs for ALFs can range from about $3,000 per month for smaller, independent facilities (5-12 individuals) to upwards of $10,000 per month for large, chain-type facilities (50-200 individuals). Generally, the bigger the facility, the more amenities available. The cost of assisted living is primarily paid out-of-pocket; however, long-term care insurance policies will pay benefits towards assisted living costs, and Veterans and their spouses may be eligible for Aid & Attendance pension benefits through the Veterans Administration that may be used to help offset the same. Skilled Nursing Facilities (SNFs) are necessary for individuals who require a greater level of care  Rooms are generally semi-private, and recreational activities are available, but limited. Costs for SNFs can range from approximately $8,000 per month for smaller, independent facilities (50 individuals) to upwards of $15,000 per month for larger, chain-type facilities (100-200 individuals). Aside from the increased level of care offered in SNFs, the biggest difference between assisted living and skilled nursing is the source of payment. Once someone enters a SNF, depending on their financial situation, it may be time to start the process of applying and qualifying for Long-Term Care Medical Assistance (more commonly known as Medicaid). Once qualified, Long-Term Care Medical Assistance benefits will cover the costs of skilled nursing care that exceed the resident’s income. After a determination has been made about assisted living versus skilled nursing, the next task is choosing a facility. Research is key, both online and in-person. Both Medicare and U.S. News and World Report publish yearly rankings of skilled nursing facilities throughout the country, both of which are extremely helpful in determining the appropriate placement for a loved one. It is always recommended to visit a facility unannounced, because one can get a better idea of how the ALF or SNF actually operates.There are organizations that can assist with the placement process. Many placement assistance organizations get a referral fee for assisting residents in the selection and placement process. As one of the leaders in Maryland elder law, Elville and Associates helps clients with assisted living facility and skilled nursing facility placement. Our attorneys work with facilities throughout Maryland, and have a vast knowledge bank of experience. If you are contemplating the placement of your loved one outside the home, Elville and Associates is here to help you navigate the complicated and emotional process of selecting the facility that best fits your specific needs and budget, or that of your loved one.

At Elville and Associates’ 2016 Annual Client Event, Elville and Associates’ principal Stephen Elville introduced its next generation Client Care Program (“CCP”).  The following is a brief general description of the CCP.  Stephen R. Elville and discussed the specific details of the CCP at the Client Event and answered questions. Elville and Associates Client Care Program Access to Attorneys and Staff The members of our team will be reasonably available to answer your questions whether by telephone or email whenever and as often as you would like. Client Education Services Our Client Care Program coordinator will notify you and schedule your attendance for on-going educational workshops and client appreciation events – for you, your family members, successor trustees, and planning advisory team.  These workshops will feature topics such as recent changes to the trust and estate, tax, health care, special needs, and other elder planning-related laws, what successor trustees should do if you become disabled and when you die, how to maximize your Social Security benefits, and other topics in contemporary estate planning and elder law.  Each fall you will also be formally invited to our Annual Client Education Event. Document Updates We will review your estate plan whenever you reasonably request, and at least every two years, and we will update your plan as the laws change, when your personal situation or goals change, and as the nature and value of your assets change.  This will ensure that your estate and elder law planning will always be up-to-date. Asset Review, Tracking, and Updating We will provide regular reviews of your asset alignment and funding, and will also provide regular alignment updating to ensure that your estate or elder law plan is fully aligned and funded, and that consequently it will work as intended. Family – Advisor Meeting Within sixty (60) days after your estate or elder law-related plan is completed (or as soon thereafter as you can arrange for your family members to participate), we will provide you the opportunity to have a family – advisor meeting, to include members of Elville and Associates, your family members, and your financial and professional advisors (who will work together collaboratively to implement all aspects of your planning) so we can begin to (1) educate family members appropriately about the essentials of estate planning, (2) explain how your planning works, (3) answer any of their questions, and (4) describe the post-mortem process, including an explanation of how to administer and settle your estate (non-probate or otherwise) upon your death. Coordination and Collaboration with Advisors Our staff will be available to consult with your financial advisors, accountants, insurance professional, and geriatric care managers. Additional Participation Benefits We will provide free notary public services as and when needed and will provide copies of your estate planning documents to your advisors and others upon your request.  You will be enrolled in a health care document retrieval service called DocuBank which provides 24-7 access to your medical records and other documents.  You will also be provided with your own personal Everplan, a state-of-the-art digital archive for all of your essential information.