Introduction     Diagnosis of Mild Cognitive Impairment and Alzheimer's Disease Karen L. Bell, M.D.     Treatment Strategies for Dementia and Mild Cognitive Impairment Mary Sano, Ph.D.     Treatment of Depression, Agitation, and Psychosis in Dementia Davangere P. Devanand, M.D.     Recognition of Vascular Dementia, Dementia with Lewy Bodies, and Frontotemporal Dementia Lawrence S. Honig, M.D., Ph.D.     Neuropsychology of Mild Cognitive Impairment, Alzheimer's Disease, Dementia with Lewy Bodies, and Frontotemporal Dementia Penne Sims, Ph.D.     Neuroimaging in Dementia Scott A. Small, M.D.     Genetics of Neurodegenerative Disease: Alzheimer's Disease, Frontotemporal Dementia Jennifer Williamson-Catania, M.S.     Legal and Ethical Issues for Patients with Dementia Daniel G. Fish, Esq.     Avoiding the Courthouse       Agents and Trustees       Health-Care Proxy and Living Will       Cost of Long-Term Care     Posttest         Accreditation     Reference List     Acknowledgements		Legal and Ethical Issues for Patients with Dementia Daniel G. Fish, Esq. Cost of Long-Term Care   Another issue that I assure you is lurking in your patients' minds is the cost of long-term care. Custodial care can cost 125 to 150 thousand dollars per year. It is not covered by Medicare or supplemental health insurance because it is custodial and not skilled care.   The distinction between skilled and custodial care is not logical. Patients will say, "I can bring in sworn statements from 25 physicians saying I have an illness. I need care at home so I don't leave the water running and flood the building, so I don't wander out inappropriately dressed. Why can I not get my care covered?" These patients do not need sophisticated treatments like CAT scans and MRIs; they need help getting out of bed and getting dressed. Despite the fact that this results from a medical condition, the reimbursement formula might not cover it. If the answer to the question, "Does, for the safety of the patient, he or she require the interventions of doctors or nurses or therapists, physical, speech or occupation?" is no, there is no coverage. The average length of an illness like Alzheimer's is 7 to 12 years, so we are talking about uncovered medical expenses of almost a million dollars.   My clients, the healthy spouses of people with Alzheimer's, are absolutely panicked that a life savings is going to be spent on custodial care. To be in one's late 80s, having given six or seven years of care to a spouse, and then to face having that spouse in a nursing home and living only on Social Security is absolutely frightening.   There is good news in some states, such as New York, where Medicaid, which pays for long-term custodial care, is available to most middle-class people, in particular if they are married. If patients have not sought legal counsel about their eligibility for long-term care at home or in a nursing home, then they are making decisions based on incomplete information. You would never have a patient making a decision on a medical treatment without looking at all of the alternatives; likewise, patients must look at private long-term care insurance and Medicaid. Many people believe they could never be eligible for Medicaid, and they may be completely wrong.     PREVIOUS | POSTTEST