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Medical Forum / Diseases and Disorders / Alzheimer's / April 2004No Personal Physician visit in 8 mos for AD NH resident???
Dad, sadly is gone now. The staff of his dementia unit were absolutely wonderful to him. I had a problem getting him placed initially because my mother didn't want to pay. When he finally was placed, the RN unit told me the NH had considered getting a court ordered placement to protect him. I filled out all his original paperwork... advance directives... what to give.. what not to give, named his personal care physician, who to contact in case of emergency, name of funeral home etc. then my mother signed the paperwork. Dad was a resident for 9 months. Then my mother moved him to a State run veteran's home. It was a lockdown facility, but it was not a dementia unit. This facility, while providing medical and dental facilities, did not include laundry, etc. which normal nursing homes do. Dad was a resident of this awful institution for 6 months. It made me physically ill to visit him in such a horrible place. Unknown to me.. in May 2003, my mother and my sister made plans to move Dad back to his original NH. I only learned of this when I overheard my mother on the telephone talking to my sister. My sister called again later in the day.. and I asked her if she and my mother were moving Dad. She said yes.. he was going back to his original nursing home. My sister lives 1-3/4 hrs from my mother and I. I asked my sister why my mother didn't tell me she was moving Dad back. We live in the same household... and I would have jumped for joy knowing that Dad was returning to a lovely facility. My sister.. said she didn't know. All I had to do was take a 1/2 off from work. My sister has 4 children who at that time were all under the age of 3. It would have taken me 2 hrs at most to get Dad out of the institution and get him back to the dementia unit at the NH 3 minutes from my house. My sister and my mother moved Dad from the Veteran's home back to his first nursing home. Dad had a brain hemorrhage on Jan 26. He died Jan 29. The nursing home called my sister at 1030pm on Jan 26 to tell her he had been taken to the hospital because of a possible stroke. Then she called my mother and me. My first question is why didn't the NH call my mother and me? We are 3 minutes by car from the nursing home. I asked my sister... she said... oh I guess they thought it was too late. During Dad's first placement, I had received numerous calls from the nursing home after 10 pm. Any time Dad fell, pushed another resident to the ground, etc. we received the phone calls at home. Now that I've been going through all the papers, etc. settling estate matters.. I can find no Medicare or Tricare Explanation of benefits showing that Dad had been visited by a personal attending physician during the last 8 months of his life. In the NH handbook, it says that each resident (or their representative) is to select the personal attending physician. Naturally, the death certificate shows the primary cause of death as the hemorrhage... caused by high blood pressure. In looking at the pharmacy receipts of drugs sent to the NH for Dad... I see none for high blood pressure medications. Dad had been taking blood pressure meds for over 20 years. Second question......at the time of replacing Dad in his first NH in May of 2003, would new paperwork have been filled out... or would the NH simply just grab the old file?? He had been gone from the facility for 6 months. Thanks. > Second question......at the time of replacing Dad in his first NH in May of > 2003, would new paperwork have been filled out... or would the NH simply just > grab the old file?? He had been gone from the facility for 6 months. I think you need to have a long talk with your mother about why she was not ensuring that your father had proper meds and proper care. If you were living in the same house & she wasn't telling you when she moved him, it sounds to me like you two have a communication problem that's beyond this group's ability to solve. >Subject: Re: No Personal Physician visit in 8 mos for AD NH resident??? >I think you need to have a long talk with your mother about why >she was not ensuring that your father had proper meds and proper >care. If you were living in the same house & she wasn't telling >you when she moved him, it sounds to me like you two have a >communication problem that's beyond this group's ability t I have asked her. The answers I get are "I don't know"... "I don't remember"... "I was too stressed out". I have a feeling I've got a real mess on my hands. Two months after Dad was originally placed in the NH, my mother deleted him from 35% of their cash assets and put my sister's name on them. Two months later, she rewrites her will, disinheriting my father and changing the distribution of her estate to 75% for my sister, and 25% to me(it had been equal distribution in her prior will which was drawn in 1979)... yet I am still the executrix... and I have her Durable Medical Power of Attorney. When I did my parents 2002 tax return, she told me the check drawn to the attorney was for guardianship work.. which is tax deductible. It was for her new will and medical POA. Guardianship of my father didn't take place until March 2003. I asked my mother who drew the new will for her. She couldn't remember his name. I asked her how she found him. She claims out of the phone book. His last name is Kelly. My mother is vision impaired. There is no way she could have worked her way almost 1/2 way down the listing. I asked my mother why she disinherited my father. She claims the attorney did it. Most of my mother's fine jewelry is gone from the house. She came to me in Feb with a receipt for a sapphire and diamond bracelet . She asked me what it was. I told her it was her 40th anniversary present. She told me she didn't remember it. A week later, while we were at my sister's house.... we found out that my sister has the bracelet. She has the other jewlery as well.. including my birthstone pin from my grandmother. I explained to my sister that the pin was given to me when I was born as Grandma and I are both August babies.... and I asked her nicely to return it. She refused. My mother does not remember giving her any jewelry. When I complained to my mother about my sister not returning my pin, my mother said I placed too much sentimental value on things! I tried to go with Mom to her last doctor's appointment to speak to him about her memory. She refused to go to the dr. if I went with her. My mother claims there is nothing wrong with her memory. There is nothing wrong with her memory.. yet she doesn't remember giving my sister a box full of fine jewelry. My mother said why would I remember. It's not important to me. Hmm.. then why did she have it locked up in her metal box if it wasn't important to her??? My mother continually complained about the NH costs (around $6500 per month)... yet in October of 2003, she writes three checks to my sister totalling $7,000. Those checks combined with the missing cash from the house exceeded the IRS marital gift allowance for 2003. The jewelry further exceeds the IRS allowance. I had a CPA prepare the 2003 returns. When I picked up the returns, my CPA told me my sister had called and was raising a fuss about my parents returns. My sister also told the CPA that there was nothing of value in my parents house...and that I shouldn't have to file a state estate return. My sister is lying through her teeth... I had previously discussed with the CPA the need for certified appraisals which will pass IRS muster on many one of a kind items... including investment grade diamonds. The CPA told me my sister will be a "problem" for me. I believe what I need to do is get guardianship of my mother. The attorney who handled the guardianship of my father for her agrees that she needs guardianship and that she is no longer competent to assign a Durable Power of Attorney. My mother, obviously, will contest the guardianship. However, getting back to the original question regarding the paperwork for the readmission......is it possible neither my mother nor my sister designated a personal physician for my father?????? Or would the NH merely use the paperwork I initially filled out prior to his first admission? Thanks. > I believe what I need to do is get guardianship of my mother. The attorney who > handled the guardianship of my father for her agrees that she needs > guardianship and that she is no longer competent to assign a Durable Power of > Attorney. > > My mother, obviously, will contest the guardianship. actually, your sister will, and from what you've said, you shouldn't trust her at all. it sounds like you mother is indeed incompetent and your sister is controlling her. you need to move quickly, and you may have to sue your sister for the items that she stole from your mother's estate once you are the guardian. you might want to find yet another attorney if you don't trust this one to do things right. I can only guess at whether or not the NH had new paperwork completed on your dad, but I would assume most places would since he had been gone for six months. Since they communicated with you the first time he was there, would they talk to you now about why there were no doctor's visits made to him in eight months? The NH's my parents and my husband were in required a doctor's visit at least once a month. It sounds as if your sister did fill out new papers and had herself listed as the one responsible so they would contact her. It certainly sounds like she is manipulating your mother and it would be a good idea for you to get guardianship papers for your mother if you can. JMO. Gwen  Signature=========================================================== No one can walk all over you without you lying down on the ground first! =========================================================== | Dad, sadly is gone now. The staff of his dementia unit were absolutely | wonderful to him. I had a problem getting him placed initially because my [quoted text clipped - 56 lines] | | Thanks. Perhaps to avoid family discord, you should call protective services (if you are in the US) to investigate this situation, and chose a third party guardian that is neither you or your sister. LA > It sounds as if your sister did fill out new papers and had herself listed > as the one responsible so they would contact her. It certainly sounds like [quoted text clipped - 7 lines] > =========================================================== > " >Subject: Re: No Personal Physician visit in 8 mos for AD NH resident??? >Perhaps to avoid family discord, you should call protective services (if you >are in the US) to investigate this >situation, and chose a third party guardian that is neither you or your >sister I called our state equivalent 3 months ago. There has been no action. It is entirely up to the probate judge who would serve. He's not particularly fond of 3rd parties as the incidence of subsequent lawsuits by family members increases. I discussed guardianship with the attorney who handled my dad's guardianship.. He was the one who said my mother is incompetent and that she needs a guardian. And to add a little bit more info. my mother has suffered with severe chronic depression for over 10 years. It has been very poorly treated by her general practioner.. and she has not cooperated in her own treatment as well. She fills the scripts.. then only takes the pills for a week or 10 days... when the script is for a month. However..... I'd really like to know about the NH paperwork. Thanks. > However..... I'd really like to know about the NH paperwork. THEN GO AND ASK THEM. Why would you expect caregivers in this group to know the particular procedures at a particular nursing home? >Subject: Re: No Personal Physician visit in 8 mos for AD NH resident??? >THEN GO AND ASK THEM. Why would you expect caregivers in this >group to know the particular procedures at a particular nursing >home? NH SOP are fairly well regulated. I did ask them. I received no answer. > >Subject: Re: No Personal Physician visit in 8 mos for AD NH resident??? > [quoted text clipped - 3 lines] > > NH SOP are fairly well regulated. I did ask them. I received no answer. Then go ask again. Go higher in the organization. Many NHs are not independent, there is a higher owner company -- ask them. If you get no answer, contact the licensing board for the NHs in your state and ask them. Or if you know who was designated as his PC physician, ask him. The group has told you that would be odd for him not to be seen for eight months, but if you really want anwers, you will have to be persistent in asking the people who have them. Of course, the question is also: Why is this important? I don't mean to sound cavalier, but your dad is gone now. By your own account, the staff was wonderful to him. If this is part of your own "making sure we did everything we could" stage of grieving, I can understand that. In that case, though, I would suggest you also seek out a grief support group to help you sort through the issues. Songbird While I understand some of your need to understand what went on with your father's care for emotional closure following his death - I'm not entirely sure what you are hoping to accomplish. I doubt the outcome would have been any different no matter who saw him, or who called who, or what the paperwork showed. He was elderly, he was frail and fragile and demented, and in a nursing home, he had a stroke and he died. Would there have been a lot of motivation to try and prevent the end? By that I mean, would having extended his life been kind, improved the quality of his life, or It seems to me that whats done is done, and you have a MUCH more pressing priority in your mother's developing dementia, and your sister's apparent manipulation and exploitation of your mother's situation, plus what appears to be her financial malfeasance. Your energy and attention would be much more wisely spent on straightening out the situtation with the living rather than the dead. You can't change what happened to your father - but you may be able to head off some disasters for your mother and yourself. You should probably start with a consultation with a lawyer, and a letter to your mother's doctor alerting him or her to what you are seeing. Mary G. > While I understand some of your need to understand what went on with > your father's care for emotional closure following his death - I'm not [quoted text clipped - 20 lines] > > Mary G. This is to add my voice to Mary's and Songbird's. You have more important issues with your mother and sister to deal with at this time than to delve into the past which will avail you nothing. Best Regards, Evelyn |
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