Search This Blog

Saturday, July 31, 2010

What is a Guardianship?

The word "guardianship" often strikes terror into the heart of the person who hears the word. The media prints many horror stories and individuals pass more personal horrors stories to friends. Unfortunately, guardianships have given a bad rap but some of it is earned. Let me tell you how guardianships work in Washington State:

  1. Any concerned person can initiate a petition of guardianship.

  2. The person initiating the guardianship does not have to be the guardian. You may recommend yourself or even someone else but the final decision is that of the Judge.

  3. You may or may not have to pay for the cost of initiating the petition. Talk with an attorney who is familiar with guardianships. If the AIP [Alleged Incapacitated Person] has assets [investments], chances are that the AIP's estate will pay all the costs of establishing the guardianship. If the AIP is low-income, the County may pay for all or part of the fees but at a reduced rate.

  4. Adult Protective Services can initiate a petition of guardianship under very strict guidelines. Typically, the process takes quite a long time. If you have a pressing concern about a loved one or friend and the APS worker agrees that a guardianship is needed, I would recommend initiating the guardianship yourself.

The Process:

  • The first thing that the judge does after reviewing the petition for guardianship is appoint a GAL [Guardian Ad Litem]. This is a specially trained "third party" who talks with the AIP and all who are concerned about the AIP. The GAL reviews the petition with the AIP and asks if the AIP would like to be represented by an attorney. If so, the GAL will return to Court and ask the Judge to appoint an attorney to represent the AIP. The GAL then investigates whether there is financial exploitation, self-neglect, medical and safety issues. Then the GAL puts together a report for the Judge and will state 1) whether or not a guardianship is necessary or if there might be a less restrictive alternative 2) does the AIP need a full or limited guardianship and 3) whether the recommended guardian is appropriate or recommend a different guardian. The GAL has 45-days in which to complete the report and submit it to the Court.

  • The GAL could recommend a full or limited guardianship. A limited guardianship is anything that isn't a full guardianship. The limitations will be laid out in the Order of Guardianship.

  • If the AIP doesn't contest the guardianship, you can expect the process to take a minimum of 90-days from start to finish.

  • If the AIP contests [fights] the guardianship the process can take much longer. The attorney representing the AIP is required by law to represent what the AIP wants. It doesn't matter that the AIP might be unreasonable. The AIP has the right to take the guardianship all the way to a trial, either before a Judge or with a Jury.

After the Guardian is Appointed:

  • Within 90-days of appointment, a guardian [professional or family] needs to file a report. If it is a full guardianship, this will mean an inventory of the IP's [incapacitated person's] possessions and finances and a care plan explaining how the IP will be cared for.

  • After the 90-day report, a yearly report is required within 90-days of the anniversary of the Order of Guardianship. If the IP is on Medicaid or is a DDD [Development of Developmental Disabilities] client, the report time is typically three years.

  • The guardian still needs to notify the Court whenever there are substantial changes to a client's care or the client is moved to a different location. Moving the client out of the county the guardianship was originated in requires a Court Order.

Next: How Does a Guardian Get Paid?

Saturday, July 24, 2010

Mom/Dad Seem to Make Sense... But...

Sometimes Dementia can be very difficult to pin down. It can actually be a "moving target." It can be worse one day a much better the next. If the loved one was highly intelligent before developing dementia, they can finesse it [or cover up] for quite some time. Also, no matter how severe a person's dementia is, that person can pull themselves together and behave perfectly normal for a short period of time. That's why it is sometimes so difficult to convince the doctor or other medical professionals that there is a problem.

Please remember: Anyone who is developing dementia is terrified. One of the unique features of the brain is that while it can immediately tell you of pain elsewhere in your body, it only has a vague awareness that something might be wrong with the brain itself. Most people who have dementia are either totally unaware or only have only a vague awareness that something is wrong.

What does dementia do? In the mild to moderate stages it starts stripping away at social skills. Your loved one may occasionally do or say something totally [seamingly] out of character. What had been personality "quirks" become magnified.

If they were very structured in their routine throughout their life, you might find that they become even more structured. Someone who might have been a detailed person may lose their ability to organize or recognize what are important papers, garbage, etc., so they throw away nothing and will not allow anyone else to throw it away. Sometimes they might spend copious amounts of time going through papers trying to make sense out of them. Even if they ask someone else to tell them what the paper(s) is about, they don't really believe it.

Frequently, the ability to write checks and track money is one of the first signs that the dementia is becoming problematic. Bills may start being paid late or not at all. When you try to discuss a possible solution you are met with agitation and defensiveness.

Over time, your loved one may lose the ability to plan and prepare even simple meals; forget how to use the washer and dryer; lose the ability to clean their home; wear the same clothes for weeks on end; be unable to manage their medication or quit taking their medication altogether.

The worst part is when your loved ones deny they need assistance.

What you can do:
  1. Keep a journal. This can be very helpful to the medical professionals whether your loved one is seeing a doctor or not. It will also help you to identify patterns of behavior.

  2. Encourage your loved ones to get their estate planning papers done if they have not already done so. These include Powers of Attorney (Durable Financial and Healthcare), Healthcare Directive and Will. A Power of Attorney document will allow the designated person to intervene, indirectly if necessary, to ensure important bills and other paperwork continued to be addressed in a timely manner.

  3. Avoid pointing out the problem areas. Nobody likes to be reminded of their shortcomings, especially by their children. Humbly suggest solutions and try to let all but the most concerning problems slide.

  4. Introduce caregivers as "friends" and not "caregivers." This allows your loved one to save face and keep their dignity at a time when their dignity is feeling pretty shredded. This is easier to do when the person designated as power of attorney can set up the caregivers without the loved one's knowledge.

  5. Get the billing addresses changed to the designated power of attorney. This is especially effective if the loved one also has memory problems. What is out of sight is truly out of mind. Do it in slow increments. Have the bank statement addresses changed first and see what happens. If the loved one doesn't miss them, then the designated power of attorney can access the loved one's money to pay the bills. If the loved one does miss the bank statement, then feign an "oops" and change the address back.

  6. Emphasize that you want your loved one(s) to stay as independent as they want for as long as they want. Point out what they are still doing well. Minimize [to your loved one] the problem areas. Ask what they would like you to do to assist and how they would like you to do it.

  7. If you keep running into resistance from your loved one, get a professional consultation from a care manager or someone who specializes in behavior modification.

  8. Remember: You cannot force your loved one out of their home without a court order. If your loved one continues to stay at home and is unsafe, you might need to use some "tough love." That means not rescuing them when they get themselves in a bind and call you for assistance. You will want to plan your "tough love" strategy. Part of this strategy could be calling local law enforcement to do a "wellness check" on your loved one and/or calling Adult Protective Services for their intervention. As a last resort, if nothing seems to work and there are safety issues or extreme self-neglect, you may need to discuss initiating a petition of guardianship for your loved one with an attorney.

Saturday, July 17, 2010

Identifying Signs of Problems

It is easy for friends and family to be unaware that their parent, friend or other loved one is in crisis. Family and friends fall into what I call "conversational patterns" meaning that basically the same things are discussed all the time. An elderly person with dementia knows the socially acceptable answers to these types of questions.

It is impossible to have a clear understanding of what is happening with your elderly friend without spending a substantial amount of time with him/her/them.

Signs of problems:

1. Weight Loss for no apparant medical reason. Even bringing prepared food to the elderly person doesn't seem to help. The food goes bad in the refrigerator. Basically, the elderly person "grazes" or eat bits and pieces.

2. Gets medication mixed up or quits taking medication. The helper finds all kinds of medication in drawers, on the cupboard, etc., but often it isn't what the elderly person should be currently taking.

3. The elderly person starts falling. Now, I often hear family or friends immediately want to put the elderly person in assisted living or a nursing home when they've had a fall or two. If someone is going to fall, he/she will fall there, too. The thing to do is work with the doctor to try to determine the cause. It is not uncommon that an elderly person who falls for no apparant reason has a urinary tract infection (bladder infection) and once it's cleared up the falling stops.

4. Not allow anyone in or allowing everyone into the home. This is a safety issue.

5. Wears the same clothes for weeks on end.

6. Unable to pay their bills on time or at all. This can lead to financial exploitation.

I've been called in to assist an elderly person because a friend or family member, who has been helping out, can no longer assist due to the decline in their own health. The helpers will tell me that the prospective client only needs a limited amount of assistance but when I see the home and talk with the client it is obvious to me that the client is in crisis. Sometimes the prospective client is no longer safe to stay alone at home.

When I run into this situation, I try to find out if there is a Power of Attorney document and contact the person designated so that I can work with the person responsible for the client to make the home a safe place for the client. Sometimes that means hiring caregivers to come in for a few hours a week or daily (depending on the need), accompanying the client to medical appointments and sitting in on the appointments to get a clear view of the medical issues.

If there is no Power of Attorney, the next step is to get Adult Protective Services involved. The 800 number for your State is in the State section of your local phone book. If you still cannot find the number, call your local law enforcement and they will give you the phone number. Adult Protective Services can help get resources in but they work under strict guidelines and cannot remove anyone from the home without a court order.

Sometimes a client needs to move into a facility. Typically, approaching the topic as a temporary situation is more easily accepted by the client than talking about the move as a permanent arrangement.

I realize that this is a simplistic way to resolve a crisis but each crisis is so varied that I will illustrate some in future posts.

Saturday, July 10, 2010

What are they???

With the HIPAA Laws (Privacy Laws), every adult should have a Durable Power of Attorney and a Power of Attorney for Healthcare. If an adult is in an accident or becomes extremely ill and is incapacitated, sometimes even a spouse, adult child or parent is unable to get information from the medical community in order to advocate for the incapacitated person without these documents.

A Durable Power of Attorney gives a designated person the authority to manage a person's finances, for example pay their bills, until the incapacitated person regains capacity [gets better].

A Power of Attorney for Healthcare gives a designated person the authority to advocate for the incapacitated person's medical care.

SOMETIMES they are two separate documents and sometimes they are combined into one document.

These are powerful legal documents. When chosing someone to designate, much consideration needs to be taken to try to ensure that the person designated will make decisions about your medical care and finances that are in your best interests.

There are fill-in-the-blank forms on the Internet but I strongly encourage each reader to invest some money in having an attorney write the documents. If there is a reasonable chance that you or your parent may have to apply for Medicaid [or your State's equivalent], there will need to be special language put into the document to allow the designated person to do Medicaid planning. There is also a need for special HIPAA (Privacy law) language. The fill-in-the-blank forms often do not have these pieces. An attorney would most likely also encourage you to fill out a Healthcare Directive (Living Will) as well to help guide your designated person in making healthcare decisions on your behalf.

Call around to Elder Law Attorneys to find out what they charge. The charges vary. If you are very low income, call your local Area Agency on Aging. They have a program where attorneys donate their time.

If you have these documents but they are over five (5) years old or you have moved to another State, you need to have an attorney review them to make sure that the language is not outdated. Powers of Attorney are somewhat different from State to State. Also, you may realize that the person you designated is no longer the appropriate person or they have died or they have become incapacitated themselves.

Once you have your Powers of Attorney in hand, you need to make sure key people know where to find the originals. PLEASE DO NOT put the originals in a Safe Deposit Box without a key person as a signer on that box. If you are the only person who is signer on your safe deposit box, the designated person or person trying to help will have to get a court order in order to get into the box.

Sunday, July 4, 2010

I Can Pay My Own Bills!

How many of you are dealing with a loved one who is unable to pay bills or even figure out what is a bill and what is trash mail? This is a common problem, especially when the loved one has mild or moderate dementia. One of my more challenging clients is a good example:

Jane [not her real name] was referred to me by her family who lived a very long way away. Jane's daughter, Mary [not real], called explaining that Mom was having difficulty paying her bills but that she had always been very independent and proud. And by the way, Mom had some memory problems. I arranged for a date to visit Jane with Mary who assured me that she would talk with Jane shortly before I arrived to prime her for my visit.

When I arrived Jane let me in but was definitely reserved although polite. It was immediately evident to me that Jane had more than "some" memory problems. Her short term memory was very poor. We chatted a bit and when I brought up the subject of assisting her with paying her bills, I was politely but summarily excused.

This short visit told me several things: 1) Jane had moderate to severe short-term memory lose, 2) I could not approach Jane regarding her bills directly and 3) I was not going to be able to fix this problem quickly.

After thinking about the situation and talking with my other care manager, I decided on the following game plan: 1) I needed to visit Jane daily in order to get into her long-term memory (short-term memory becomes long-term memory with repetition) and 2) I needed to be patient and wait until she allows me to help with something "safe" [not related to bill paying]. In other words, I needed to build some trust with Jane.

It took several weeks of stopping in daily and shooting-the-breeze with Jane before she took that important step of trust and allowed me to purchase something at the store for her. Over time I was able to learn when her bills came and would show up. Our conversation would go something like this:

Me: Hi Jane! How are you doing today? I see that you're working on your bills. Could I write your checks out for you?

Jane: Thanks but no. I can take care of my bills.

[We would chat for a bit]

Me: Are you sure I couldn't help write out your bills? It would only take a moment.

Jane: No thank you. I know you want to help but this is my job and I can handle it.

[We would chat a bit more]

Me: Well, it's time for me to leave.

Jane: Before you go, would you write these checks out for me?

Me: Sure! Let's see, which one shall we do first?

Because of Jane's dementia, it took her a while to process the information [my offer of assistance] and develop a face-saving response. A little patience can really help.

You'll hear more about Jane. She was one of my first clients. She has since lost her resistance "gene" but I still delight in visiting her and seeing what a wonderful quality of life she still has despite severe dementia.

Welcome to this Blog!

I am founder of Bridge Builders, Ltd., a Care Mangement and Guardianship agency. We provide many services in our community but our primary goal is to help our clients preserve their dignity while living as independently as they wish. Sometimes this is as simple as just being a local emergency contact and sometimes we are trying to figure out creative ways of keeping a client safe until they realize they need something different. We work on an as-needed basis and are on-call for our clients 24-hours a day as crises do not happen within the hours of 9 AM to 5 PM. We act as Durable Power of Attorney for those who do not have family or friends that are able to act in this capacity. I and one of my staff are Certified Professional Guardians in the State of Washington, qualifying us as a Certified Professional Guardian Agency. We also provide support services to family and friends who are acting in the capacity of Durable Power of Attorney or Guardian as these jobs can be extremely time consuming and daunting to the "lay" person. We are willing to work with the more challenging behaviors and have a fair amount of success with clients with whom others refuse to work.

My hope for this Blog is to assist those of you who are struggling with issues pertaining to parents and other loved ones in trying to find that balance between safety and independence.