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Sunday, August 22, 2010

Unsafe and Resistant to Help, Chapter 1

What constitutes being unsafe? In our country we value our independence and our laws reflect it. Short of a court order, which is extremely difficult to get, a person can live as they chose. As people age they sometimes lose the ability to meet even basic needs. Of course, this doesn't happen all at once. It is typically a slow process. As a caring person, when this becomes obvious you want to set in and "fix" the situation. There are seniors who will welcome help, seniors who will tolerate help and [my typical client] seniors to steadfastly deny that they need help. Here is a list of some of the problem areas:

Financial Exploitation: This happens far more often and any of us want to admit. Financial exploitation has many "faces."
  • A family member always in need of money. Maybe the senior has helped them financially all their lives but there comes a point where the senior my develop dementia and can no longer make a conscious choice.

  • "Helpers" or "friends." Too many times a senior in denial looks to a neighbor or "nice" stranger for assistance. At first the "helper" assists for little or no compensation but over time they manipulate or demand more from the senior.

  • Solicitation phone calls. Seniors are fodder for a phone solicitor who is friendly and seems to provide a little companionship for those who are lonely and isolated.

  • Mail solicitations. Seniors get deluged with mail requesting financial assistance for anything from sick animals to disabled veterans to third world countries.

  • Charities: Even religious organizations can be pushy about donations.

Personal Safety: There are many personal safety issues but these are some of the highlights.

  • Hoarding. A senior may lose the ability to determine what is trash and what is important so then will not throw anything away. Over time this can build into a health and/or fire hazard. This problem is becoming so prevalent that there are many books written about it.

  • Falls. As a person ages, the possibility of falling increases dramatically. Even when a person realizes he/she needs to use a walker when outside the home, that same person will park the walker in a corner of the house and hang onto furniture and whatever else that is in reach. If a person is going to fall, he/she will fall no matter the location [home/assisted living/nursing home] so the question the becomes, "Just how long do you want to be on the floor before help arrives?"

  • Allowing anyone who comes to the door into the house. This always strikes a certain amount of terror into my heart. Lonesome seniors who welcome anyone into their home yet refuse appropriate assistance.

  • Driving. This is a real hot button for most seniors. When a senior gives up driving, he/she gives up a huge amount of independence and sometimes does not have the ability to problem-solve well enough to figure out alternatives or understand how the alternatives work.

Inability to follow medical instructions

  • Because of short-term memory problems or the inability to comprehend, the senior is unable to follow through with instructions. This may mean medical tests, medication changes or as simple as remembering the next appointment.

  • Inability to manage medication. I have entered many a home that had medication [old and new] everywhere. Other times a senior had a method of tracking medication but due to illness or dementia that method no longer works and the senior is unwilling to change. I've met other seniors who are so afraid of taking too much medication that they take too little.

  • Doctor "hopping." A senior either doesn't like what he/she hears or cannot comprehend the instructions. The senior denies that he/she has a problem, therefore it must be the doctor and changes doctors frequently.

Inability to manage Activities of Daily Living:

  • Personal hygiene becomes poor. The senior doesn't pass the "sniff" test. He/she insists that he/she bathes regularly but it's tough on the nose to be in the car with them for any length of time. Clothing is dirty but the senior insists their clothes are just FINE. [We occasionally have a client that necessitates the use of an air freshener after transporting the client to an appointment]

  • Unexplained weight loss. The senior is losing weight but there is no medical reason. The senior won't let anyone look in the refrigerator or cupboards insisting that he/she has plenty of food. You take that person out to eat and he/she announces their not hungry but eats most or all that is served. If you can look in the refrigerator, food has spoiled and the boxes and cans in the cupboard are past their pull date.

  • Inability to clean house. The house may be fairly tidy but it become increasingly grimy.

What is the answer? There are often no easy answers. What you need is a big bag of "tricks." In the next post I will list some "tricks" that have worked with some of my more challenging clients.

Sunday, August 1, 2010

How Does A Guardian Get Paid?

Anyone who is appointed by the Court to be guardian for an Incapacitated Person (IP) can be paid as long as the Court approves. The guardian [family guardian or professional guardian] needs to make sure that the ability to be paid is in the Order of Guardianship. If the provision for payment is not in the Order of Guardianship, the guardian can petition the Court for an order specifying payment.

Types of Payment:

Private Pay: An IP who has assets [savings and/or investments] would be expected to pay with the client assets. The Court may approve an hourly fee and/or a monthly fee. Some counties require a budget be submitted to pre-approval. It can be very difficult to guess how much time you as the guardian will put in at the time of appointment. The guardian can expect that the first 3-6 months would require much more time and that the required time would drop off after that. If the guardian gets approval for a budgeted amount and then realizes that much more time is required, the guardian can petition the Court to approve an amended budget.

Medicaid [Welfare]: For IPs who are on Medicaid, the State of Washington allows a base rate flat fee of $175.00 per month payment for a guardian. I have found that most of the time this is adequate, especially if the IP lives in a facility. Sometimes an IP will require more time. The guardian can provide documentation at the reporting period of the addition amount of time and request the Court approve the additional amount. The wording has to be specific to how the law is written. The Department of Social and Health Services (DSHS) will need to be notified within their required period [usually 20-days] and they can send an attorney to contest the additional fees. If the Judge approves the fees, DSHS is obligated to adjust the participation to pay the guardian.

Public Guardianship Program: This program is for those who are not on Medicaid but are indigent or very low income. In Washinton State, the Program pays the professional guardians who are contracted to be a part of the program a monthly flat fee.

Pro Bono: A guardian who agrees to accept a client who does not fit into any of the above categories would need to be willing to provide the service for free. Those who are professional guardians are encouraged to accept some Pro Bono guardianships but it is often difficult to find a professional guardian willing to take a guardianship without getting paid. Being a professional guardian is a business just like any other business and it is necessary to limit the amount of pro bono cases or the business as a whole will suffer. Sometimes a professional guardian will agree to take a client pro bono but is able to find assets later on. The guardian can then return to court to request an order allowing payment.