Medical Forum / Diseases and Disorders / Alzheimer's / July 2005
Guardianship?
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June - 24 Jul 2005 19:46 GMT Hi.... Looks like a nice newsgroup here. I'm reasonably lucky in that mother's dementia has progressed slowly (it started in October of '92) and she's become very sweet and easy to get along with for the most part. That's the good news about her dementia. I have a brother who has Durable Power of Attorney over her and thinks that she can decide what's best for herself. For the past several years she has been going to Florida every winter. My brother takes her down there and leaves her and arranges for a neighbor ( this neighbor is 90 years old and not in good physical health) to take her to the store. He was going to use her money to buy her a new car in 2001 so I had to turn her into the state of Florida that she isn't capable of driving and eventually her license was suspended. Anyway he told me that he took her to the doctor (here in Indiana) about a week ago and the doctor told him that she is in the final stages of dementia and might start having physical problems. The doctor pointed out her lack of bathing and increasing confusion were signs of this. He asked the doctor if she could live alone with someone looking in on her and the doctor that would be fine but he neglected to tell the doctor that Mom's nearest relative would be 1100 miles away. . Mom has never wondered off and some days can actually carry on a conversation, use the phone and you wouldn't guess how impaired she is. My brother insists that she go to Florida and he will employ a social service agency to look in on her twice a week. He also said that she would be in Florida a shorter period of time. My question for discussion is should I take him to court for guardianship if he continues to insist that she go. He will not listen to any other family member about this and insists we are all wrong about her ability to make decisions. He is very, very dense. I agreed to give him the POA a few years ago when I was taking care of a special needs grandchild during the day. I still take care of this grandchild but he's much better and no longer has a cpap or trach. He only has a feeding tube now and is learning to eat. He's 4 years old. This may cause a terrible family riff if I take my brother to court and Mom may get along in Florida ok if we're lucky. I can easily talk my mother into staying here in Indiana in an assisted living facility but then my brother talks her out of it. According to my attorney when my mother signed the POA she wanted my brother to make all her decisions. My daughter has had the same problem. She will talk her grandmother into staying here in Indiana but then my brother will talk her out of it. Guardianship would put more stress on me and my husband who has POA for his 101 year old mother. Yikes! We sound like one of those soap operas. Is there another alternative that I haven't thought of? I've called the doctor and asked that she be more direct with my brother about my mother's capabilities. But knowing my brother this probably won't work. Another scenario would be having the doctor sign a statement saying my mother is incompetent when he leaves her in Florida and faxing a copy of the letter to the local social service agencies including the one that is looking in on her. Another legal problem is that she is a resident of Florida. I know there's no easy answer unless by some miracle he comes to his senses. He did eventually agree I was right about the driving thing but it wasn't until he exhausted everything to try to help to get her license back. Perhaps I'm just using you all as a sounding board and I apologize for such a long post. My brother isn't a monster. He takes very good care of Mom on day to day things. That what makes this so hard. He's 65 and not married. Thanks for listening........
Evelyn Ruut - 24 Jul 2005 20:27 GMT > Hi.... Looks like a nice newsgroup here. I'm reasonably lucky in that > mother's dementia has progressed slowly (it started in October of '92) and [quoted text clipped - 49 lines] > of Mom on day to day things. That what makes this so hard. He's 65 and > not married. Thanks for listening........ June, sometimes that is all we CAN do, is to listen. It sounds to me as though your situation is well understood, and any advice we give wouldn't help a lot, since what you really need is for the doctor to ASSURE your brother that she should not ever be alone anymore, in terms even he can understand.
That is what happened to us. The doctor told us that my mother in law was at a point where she could no longer be left alone. It seemed to us, as though she wasn't really all that bad at the time, and in fact we left her in her home for a few more months, during which time she proceeded with several situations to prove to us beyond a shadow of a doubt that she needed full time supervision.
This may be what happens in your mom's case. Your brother seems to be well meaning, but absolutely unaware of her true deficits. He is definitely going to get some kind of a wakeup call, and let's just hope it isn't anything disastrous.
In our case it was a case of her taking too many pills or not enough. (after all her memory didn't work anymore). She left pots on the stove till they burned. She ate food that was there for days thinking she had just cooked it and got sick from it. She paid bills twice or not at all. She got lost going to the corner store. She stopped bathing and eating and lost a lot of weight..... BUT if you talked to her on the phone, you would never know all this was going on!
Only you can know if it is worth creating a horrible family rift over this disagreement about her state of mind. You need to maybe talk to that same doctor who said it was OK for her to go to Florida again, or maybe write him a letter. Doctors don't always know the full scenario when a patient appears to be functioning OK. How can they know the full situation in 15 minutes, especially if your brother is doing all the talking?
If she goes to Florida and something happens and she ends up in a "situation," your brother will finally be forced to face the reality he seems so reluctant to deal with. It could be nothing or it could be a real disaster.
Your brother might be thinking you are worrying too much, but those of us who have been down this road already know that the deficits can be far worse than they appear.
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Best Regards, Evelyn
(to reply to me personally, remove 'sox')
Songbird - 25 Jul 2005 00:40 GMT . My brother insists that she go to Florida and he will employ a
> social service agency to look in on her twice a week. Why? I'm unclear as to her living arrangements the rest of the year. Does she live with him? If so, he may be looking for a respite. Or is it that she has to spend a certain amount of time in the state each year to qualify as a resident and therefore get better tax treatment, perhaps?
If not, which seems more logical since you say there are bathing issues (though even the strongest caregiver sometimes has to give up on that one!), he may still be looking for a break. Or he may be in denial about the actual amount of reduced capacity.
Does Mom want to go to Florida? If it's like "one last trip," could someone go with her and stay just a few weeks to say goodbye to old friends and old haunts?
I'd avoid the guardianship route unless true neglect, abuse or endangerment becomes clear. Caring for someone with this ungodly disease is hard enough -- you all need to work together, as there is more than enough work to go around. And before you take on guardianship, you might want to invite her for a visit so you can see what you are really up against.
Sounds like going to Florida or not, it's time for a family pow wow for what is the next step. I found with my parents it is much easier to plan where they will go when the time comes and keep that as a separate issue from *when* that time will be. That's a separate battle, so to speak.
Songbird
June - 25 Jul 2005 01:31 GMT No. It's total denial on my brother's part. She has a trailer that is about 30 ft from his house that she stays in during the summer months. I'm sure she would enjoy assisted living and does have the means for it. But there again my brother controls her money. He thinks it's too expensive. I think he enjoys her company and perhaps the control and really thinks he's doing her a favor I've tried to explain that if she has to go to a nursing home at some point then her money will spent then. Years ago she got a Florida drivers license to avoid Indiana's excise tax and registered to vote in Florida and it's somewhat of a gray area as to what state she's a resident. As for my brother...he's not the sharpest crayon in the box.....I'm leaning toward letting the chips fall where they may. I know it upsets her if we show disagreement on her care. I'm still holding out hope that the doctor may get through to him. I'll leave a post if there's another installment in the on going saga......
> . My brother insists that she go to Florida and he will employ a >> social service agency to look in on her twice a week. [quoted text clipped - 26 lines] > > Songbird Evelyn Ruut - 25 Jul 2005 02:00 GMT > No. It's total denial on my brother's part. She has a trailer that is > about 30 ft from his house that she stays in during the summer months. [quoted text clipped - 10 lines] > still holding out hope that the doctor may get through to him. I'll leave > a post if there's another installment in the on going saga...... There's a lot to be said for "letting the chips fall where they may" excepting there may be a rather rude awakening when she needs to go into a nursing home and there needs to be a FULL ACCOUNTING of every penny spent on her care up to that point, because Medicare needs a three year lookback period, you know. (I hope your brother knows this).
Unless she is so wealthy that she can pay for nursing home care nearly indefinitely, this can be a big issue.
We don't talk too much about Medicare requirements on this newsgroup because of the fact that there are privacy issues involved, but the truth is that a person who has been diagnosed with Alzheimers (in the USA) is on a time-clock, where their assets can be used for their care (until they are all used up).......... and at which point Medicare kicks in......UNLESS one has not kept proper accounting of the expenditures up till that point, and acceptance by Medicare is questionable.
If the person is not acceptable by Medicare there can be a real problem getting into a nursing home. Relatives who think they can beat the system by transferring assets without proper reason or documentation are in for a rude awakening. That three year "lookback" period is subject to serious scrutiny by "the powers that be".
Getting all ones "ducks in a row" with proper legal arrangements in advance is essential.
Caring for a person who has a debilitating organic brain disease is hard enough, but being a responsible steward of their assets is truly important in the big picture, especially when they reach a stage where they need full time professional care, and are expected to continue needing more. I hope your brother (who isn't the brightest crayon in the box) is aware of all of this.
Is he really ready in case she need to go into a home? Somehow I think he is not up on all the legalities. It is a serious matter and DENIAL is not a river in Egypt.
 Signature Best Regards, Evelyn
(to reply to me personally, remove 'sox')
Songbird - 25 Jul 2005 02:13 GMT >> No. It's total denial on my brother's part. > > [quoted text clipped - 8 lines] > I hope your brother (who isn't the brightest crayon in the box) is aware > of all of this. I also wonder if he maybe doesn't know the difference between assisted living and a nursing home. If he at some point promised he would never put *his* mother in one of *those places,* that may be part of the problem. If he's never been to an AL facility, you may want to see if he would tour one "just to know our options."
And talk to an elder law attorney -- if her legal residency is in question, this could create big problems with Medicaid, which is the program which helps pay for nursing home care. If you live in one state, but are resident in another -- I'm not sure if you could get Medicaid assistance to live where you are. I've never looked into it, but I'm glad my folks have now lived in the same state I do for a year so there would be no question of residency.
Songbird
Evelyn Ruut - 25 Jul 2005 13:21 GMT >>> No. It's total denial on my brother's part. > >> [quoted text clipped - 24 lines] > > Songbird Yes, I forgot to mention that!
At the time we took my mother in law to live with us, one of our worst fears was that she would end up in a nursing home near where she lived instead of near us. Fortunately by taking her to live with us for a long enough time, we established her residency in our area.
 Signature Best Regards, Evelyn
(to reply to me personally, remove 'sox')
June - 26 Jul 2005 00:55 GMT Well it's 97 degrees in Indiana and I think it might snow. My brother actually is starting to waiver about taking my mother to Florida. I called him today and he said he would abide by the doctor's assessment based on all the facts. My mother was very lonely in Florida last year and I keep mentioning that to him. She would call me on phone because she "wanted to hear another human voice" We discussed options about her house down there and I really stressed the importance of her having residency here in Indiana. I gave him some ideas on how to go about it; moving her bank accounts up here and having her Social Security check deposited in a bank in Indiana , having bills sent to her Indiana address, etc. Thanks for pointing that out to me Songbird and Evelyn too. I guess I knew it but it didn't register that it could become a problem with Medicaid. We may go look at some assisted living facilities here in town in next few months. There's a really nice one that's only a few miles from my home and not too far from his. I think I'll sleep a little better tonight. I may have to nag to get him to the bank to get things changed, but what are sisters for? I really appreciate all of you that gave me support and it really helps when somebody knows what I'm going through.
>>>> No. It's total denial on my brother's part. > >>> [quoted text clipped - 31 lines] > instead of near us. Fortunately by taking her to live with us for a long > enough time, we established her residency in our area. Bud - 26 Jul 2005 01:03 GMT > Well it's 97 degrees in Indiana and I think it might snow. Lucky you. ;-) Just to remind - some facilities do not accept Medicaid.
Bud (florid in Florida)
June - 26 Jul 2005 01:36 GMT Well maybe not snow but a minor miracle at least. LOL I'm not sure that we have any nursing homes around here that don't take Medicaid and I don't believe any of the assisted living facilities accept it. We'll be looking for one that she can move from assisted living to an Alzhiemers unit (when the time comes) in the same complex. If anyone has an ideas as to what other questions to ask besides the Medicaid one ...I would appreciate it....Thanks
>> Well it's 97 degrees in Indiana and I think it might snow. > > Lucky you. ;-) Just to remind - some facilities do not accept Medicaid. > > Bud (florid in Florida) Florence A - 26 Jul 2005 21:08 GMT The library has a booklet called New Lifestyles. (The Source for Seniors-) It's free for the taking. Its quite informative. about NH & Daycare, Respite, and Short Term,Assisted Living.(ALF) They have a phone # 800-869-9549 to get a copy if they have one for your State & area . My husband is in an ALF for what was to be a short stay. (still debating this with myself.) He seems happy there. More than with me alone...the companionship counts for much; where as his not making sense just about drove me----
Gwen Love - 27 Jul 2005 01:04 GMT Florence, seems it would be bettter for both of you to leave him in the ALF. Then you can both enjoy your visits. Gwen
> The library has a booklet called New Lifestyles. (The Source for > Seniors-) It's free for the taking. Its quite informative. about NH & [quoted text clipped - 5 lines] > companionship counts for much; where as his not making sense just about > drove me---- Evelyn Ruut - 27 Jul 2005 01:51 GMT > Florence, seems it would be bettter for both of you to leave him in the > ALF. > Then you can both enjoy your visits. > Gwen Hi Florence,
I had the same thought.
Only a little over a year ago I witnessed Ida's seemingly effortless adaptation to the nursing home, with a certain kind of happy surprise. I had feared it would be so much worse.
 Signature Best Regards, Evelyn
(to reply to me personally, remove 'sox')
>> The library has a booklet called New Lifestyles. (The Source for >> Seniors-) It's free for the taking. Its quite informative. about NH & [quoted text clipped - 5 lines] >> companionship counts for much; where as his not making sense just about >> drove me---- Gwen Love - 26 Jul 2005 02:54 GMT We lived in Georgia when my father went to the NH on Medicaid. When we planned to move to Florida, I applied for Medicaid to move him to Florida also and it was approved before either of us moved to Florida. No length of residency was required. Gwen
> >>> No. It's total denial on my brother's part. > > >> [quoted text clipped - 31 lines] > near us. Fortunately by taking her to live with us for a long enough time, > we established her residency in our area. June - 25 Jul 2005 05:10 GMT You all raise valid points. Evelyn you wrote Medicare but I'm sure you meant Medicaid. Like I said in my original letter ..my husband has POA for his 101 year old mother who recently went into a nursing home. She was bowling and sharp as a tack one week and in the nursing home the next and now has serious dementia all within a matter of 3 months but that's another post. In Indiana they can go back up to 5 years if they suspect someone is hiding assets. I warned my brother about having his mother's name on his checking account and he did take it off. He should have closed it but like I said "not the sharpest crayon" ... I am powerless to do anything about her finances or her healthcare. I don't believe he is spending her money on anything but for her. He wanted this responsibility and authority so he has it. It's hard to believe someone could be as dense as he is. Actually I have another brother that was in the same denial but thank God he married a wonderful woman who happens to be a nurse and opened his eyes. He refuses to take any kind of proactive role in her care and lives several miles from here. He has told my brother with POA that he doesn't want Mom in Florida but to no avail. You are right in wondering if he is up to the legalities and I wonder about it myself. Mom does not have a lot of money but could afford assisted living for a few years. Frankly I don't know exactly how much money she has. BTW our governor here in Indiana thinks he has a plan to decrease the number of patients in nursing homes that are on Medicaid by 50%. Beginning to think he's as dense as my brother..... I've mentioned to my brother about prepaying her funeral but I'm sure that won't happen until she goes into a nursing home.
Years ago I read Suze Orman's "9 Steps to Financial Freedom" and promptly went out and got long term care insurance for my husband and myself. In Indiana if your long term care insurance runs out you can go on Medicaid without losing any assets. Just a footnote in lessons learned. I do think my brother equates assisted living with a nursing home. He thinks when she gets really bad that she can go to assisted living. I've warned him that they won't take her if she wonders off. Yes he's in for a rude awakening I'm sure. I'll stand by to help put the pieces together when the time comes. It's what my mother would want... Sorry for all the ramblings.....
>> No. It's total denial on my brother's part. She has a trailer that is >> about 30 ft from his house that she stays in during the summer months. [quoted text clipped - 47 lines] > he is not up on all the legalities. It is a serious matter and DENIAL is > not a river in Egypt. Evelyn Ruut - 25 Jul 2005 13:26 GMT > You all raise valid points. Evelyn you wrote Medicare but I'm sure you > meant Medicaid. Hi June,
Yes, of course I meant Medicaid.... sorry and thank you for making the correction! Had been to a party earlier just before I wrote it, and got my terminology mixed up!
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Best Regards, Evelyn
(to reply to me personally, remove 'sox')
Gwen Love - 26 Jul 2005 02:52 GMT Evelyn, It isn't Medicare that kicks in; you can get Medicaid (or your state's form of Medicaide) if you qualify. Gwen
> > No. It's total denial on my brother's part. She has a trailer that is > > about 30 ft from his house that she stays in during the summer months. [quoted text clipped - 47 lines] > is not up on all the legalities. It is a serious matter and DENIAL is not > a river in Egypt. Dennis P. Harris - 26 Jul 2005 04:13 GMT > We don't talk too much about Medicare requirements on this newsgroup because > of the fact that there are privacy issues involved, but the truth is that a [quoted text clipped - 9 lines] > rude awakening. That three year "lookback" period is subject to serious > scrutiny by "the powers that be". evelyn, you just committed an all-too-common mistake. the program that pays for nursing home care when the patient has no financial resources is medicAID not mediCARE.
and yes, family members who transferred assets within the 3 year lookback period in violation of the medicaid rules can be charged with medicaid fraud and violation of their fiduciary duties, perhaps even embezzlement if the spending was without the patient's consent or the patient was incompetent.
Evelyn Ruut - 26 Jul 2005 12:45 GMT >> We don't talk too much about Medicare requirements on this newsgroup >> because [quoted text clipped - 25 lines] > perhaps even embezzlement if the spending was without the > patient's consent or the patient was incompetent. Yes, I realized too late that I had done that, I apologized and corrected it in another post.
 Signature Best Regards, Evelyn
(to reply to me personally, remove 'sox')
Betty Harris - 28 Jul 2005 02:41 GMT "......and yes, family members who transferred assets within the 3 year
lookback period in violation of the medicaid rules can be charged with medicaid fraud and violation of their fiduciary duties, perhaps even embezzlement if the spending was without the patient's consent or the patient was incompetent."
Of course the easiest way around this is to keep the patient locked up in his/her room until they die from arsenic in their mashed potatoes and/or anti-freeze in their orange juice. Just be sure that their will is changed so that you inherit the house.
Dennis P. Harris - 26 Jul 2005 04:04 GMT > My question for discussion is > should I take him to court for guardianship if he continues to insist that > she go. He will not listen to any other family member about this and > insists we are all wrong about her ability to make decisions. He is very, > very dense. you should ask the court to appoint a guardian. it does not have to be you, or any other family member. the court can appoint someone else, most often a social service agency or a court volunteer, sometimes an attorney.
even if it creates a rift, you mother's safety is the most important thing. if you brother can't do the job, the court needs to appoint someone who can.
you will need to document all these occurences IN WRITING and then contact your state's adult protective services agency. even if she is a resident of florida, indiana law applies if she's there. she might even be considered a resident of indiana if she's there more than 30 days, but you need to talk to adult protective services or an attorney to find out the answer.
good luck!
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