Wow, Thanks everyone I did a solid day yesterday and am well into a solid day today. Not getting much exercise but will make up for it. Too many time-sensitive things to accomplish.
Nords, your last post on being a conservator was a great overview. I wanted to mention for clarity that those who have a durable financial power of attorney don't need to report to the court. However, it's good practice, especially if there are siblings or other heirs involved, to keep a good accounting for the record. I'm using Google Sheets for that which can be shared easily.
To facilitate communicating with various financial outfits I scanned the DPOA and my driver's license into one .pdf doc. I then find the relevant phone numbers and email addresses (when possible) online and establish phone contact and email the attached DPOA. I copy my mother just so they know it's on the up and up.
I've been using the Genius Scan app on my smartphone (there are many other scanning apps). I'm 'scanning' all her docs using the app, then exporting them to a file for her documents in my Dropbox account, which sync to my computer. Scanned docs can also be sent to many other different locations. They are then ready to be used as attachments to emails when needed, or are just there for storage and reference. This is particularly important since I live in a different city. I may need various documents handy while traveling.
ApoE 3/4 > Thanks in advance for any responses made to my posts.
One thing that's becoming a bit dicey is the issue of when someone with MCI/early dementia can't make their own health decisions. With a springing health POA, at least in my case, it requires that two doctors say the patient can't make their own decisions. I'm guessing they will never say this unless a child asks them what they think and explain the POA is available. Meanwhile, MCI/early dementia seems to be a borderland where some decisions are suitably made by the patient but not others. I found this guide helpful but it left me wondering what to do with the springing health POA, spring because some issues may be too complex for the patient to decide, or wait for more compromise?
These in particular are my new mantras:
The more serious the risks or consequences of a decision, the clearer the patient’s decisional capacity needs to be. For decisions about high-risk or burden interventions and/or low potential benefit, and which require signed consent, a patient with dementia needs to demonstrate a fairly high degree of understanding to process information.
The patient should be encouraged to participate in the discussion even if another person will be making the actual decision.
A patient has the right to make the “wrong” decision, given that they have decision-making capacity (Schneider & Bramstedt, 2005). A patient’s “bad” decision from the perspective of the healthcare professionals and/or family caregivers is not necessarily a prime indicator of lack of capacity or incompetence.
ApoE 3/4 > Thanks in advance for any responses made to my posts.
A woman in a meeting yesterday said her mother was in a "Green House" care home in Loveland, CO. She was extremely pleased (effusive) with the accommodations, saying it was much more "family like" and like a "family home." She also said she'd told her children, "see how I'm treating grandma, that's how I want to be treated." It looks like there are facilities across the nation, but not in every state. Thought I'd pass this on, in case it is of use. Here is the site.
When my mom was alive, I did have her in a "group home" facility and thought the care was much more personal than from larger facilities. I'd learned this from her, when she too, care of her mom.
I fortunately took Mum and Dad to a solicitor and obtained enduring power of attorney and got them to do their wills. I think in Australia its a little different. The enduring power of attorney is designed to allow the care giver the ability to deal with finances when the loved one becomes unable or incompetent or lacks capacity.. It is very hard /almost impossible to get documentation signed once the loved one is showing signs of cognitive decline. It then all comes down to courts and deciding if someone has mental capacity. Lengthy costly?
I was very lucky because the solicitor doing the POA wouldnt approve it unless i had a letter from Mums specialist. The specialist was dubious about giving a letter in case there were legal repercussions and challenges from family members.
When i explained there was very little money involved and just my sister and i and she was fully supportive and there would never be legal repercussions he signed the document allowing Mum to sign her will and POA.
I can only re iterate it needs to be done as soon as possible before cognitive decline sets in whilst the person has capacity.
Over here it can take effect at once or when the loved one loses capacity to make decisions.
We should really all look into setting one up, particularly those of us in the older bracket.
Don't wait for your ship to come in, row out to meet it.
For the sixth year in a row, I'm a conservator again.
Let me explain what that means. And while you're reading this, compare it to how much time & expense you'd put into creating a revocable living trust for you and your co-trustees.
The Denver probate court appoints conservators with a court-order letter. (In general, financial companies and insurers are unimpressed by conservator appointment letters. But I digress.) When I was first appointed, the court required a complete asset/liability inventory and the annual spending plan. (I had a couple months to prepare it and the court promptly approved it.) Every year after that, the court also requires conservators to file annual reports of cash flow and net worth. If expenses have changed significantly from the initial financial plan then we're asked to file a new plan.
The conservator's appointment letters expire about a month after these reports are due to the judge. Once the annual report has been filed with the court, and reviewed by a CFP or CPA, and approved by the judge, then a new appointment letter is issued by the clerk... for another 12 months.
If I get "fired" as a conservator (or quit), then a court-appointed certified professional (paid) conservator steps in for my father. Six years ago, Denver's probate court conservators charged $100/hour. That's probably 1-2 hours per month (unless there's an invoice problem) and five hours per year for the annual reports. If there's an insurance or Medicare squabble then it usually takes another 1-10 hours to resolve. Most of those hours involve being on hold in the phone queue.
I don't know about other courts, but the Denver court runs on paper and the U.S. mail system. I can't e-mail or even fax in the report. It has to be sent by postal mail. It's then scanned on to the probate court's network for review. The approval letter is printed (probably from the network), hand-signed, stamped, and sent to me by postal mail.
Funny story (well, it's funny now): in 2014, a couple years after being appointed, I sent in my routine annual conservator report. For whatever reason, the computer network "lost" the document. A few weeks after the deadline, a different letter arrived in the mail: the judge's court order to appear (in person) to explain why I hadn't filed my report. (I live in Hawaii but when I was first appointed conservator I signed a waiver of extradition with the Denver court for just these types of "requests".) I was able to figure out the problem pretty quickly with a clerk, and they located the paper copy in their files when I provided my (priority mail) postal receipt. But I still had to write a response to the judge's court order explaining the whole incident (and send it by postal mail). Luckily I didn't need a lawyer for that, although the court requires almost all of its correspondence to be filed as a motion (by postal mail).
Immediately after I was appointed in 2012, when I prepped the conservator's initial inventory and financial plan, I only had a few months. I'd seen this coming, though, and I'd already started the forensic accounting to make sure that I'd located all of Dad's accounts and other assets. Happily there are lots of websites for discovering abandoned accounts, even including TreasuryDirect for U.S. government bonds. I was able to do the search on my own and I'm confident that I (eventually) found everything.
There was a period of nearly a year between Dad's entry into a care facility and the probate court's conservator appointment. (Our lawyer gave us a very low priority.) I prepped Dad's property inventory as of the date of the appointment, not as of the date he entered the care facility. The probate court carefully did not ask (and I did not volunteer) what happened to Dad's personal furniture and his vehicle. In reality we sold his apartment furniture at a garage sale and Dad sold his 11-year-old car to my brother for $1 and the registration fees. The court probably understands exactly what happened and would only pursue egregious fraud or family complaints.
However it took me over a year to figure out that Dad had converted a bunch of 1960s whole-life insurance policies into a single-premium policy via a 1035 exchange. (The "helpful" insurance agent earned a $7600 commission on a $100K policy.) It was done in 2010 when we already knew that Dad was in early-stage Alzheimer's, but he was still able to carry on a coffee-shop conversation for 30 minutes before you noticed the symptoms. Most of the application for the new insurance policy was in someone else's handwriting and Dad's signature is easily forged. But Dad would have wanted to do it regardless of the expense, and justice is expensive, so I decided not to pursue what seemed to be outrageous compensation for a little too much help with the paperwork.
When I prep my annual report I have to transfer spreadsheet data (a checking account register) to a Word document. The document is pre-formatted by the court (downloaded from their website) and I just have to make sure the numbers end up in the right blocks with the right totals. If the year's expenses deviate too far from the financial plan then I have to submit a new plan with the report. If the reported amount is within a few percent of the annual totals (out of ~ $100K) then I'm probably fine. They understand one-time costs like a special medical test or a big tax bill from selling investments. But if the care facility raises their rates or other recurring expenses go up, then I know I'm going to have to draft a new plan.
Part of the reason for the plan is because the court wants to see how we're dealing with the Medicaid spend-down. If assets started disappearing from the inventory then I'd get a quick query. This court lets Dad continue to gift us sons, perhaps because I showed the court that Dad used to do it before Alzheimer's. This gives me a way to remove assets from his accounts and save them in mine, where someday I'd spend them on his behalf. (I think my brother needs his gifted money-- I haven't asked.) Dad has enough assets to continue private pay until 2025 and he first noted his dementia symptoms since 2008. The Medicaid five-year lookback means that he'd stop gifting in 2018 or 2019.
I've learned these conservator lessons through experience. It's too late to change Dad's financial arrangements, but I don't have to put our daughter in this position.
In my personal situation, my spouse and I are drawing up a revocable living trust. We'll be co-trustees and our daughter will be a contingency trustee. Our major assets will go into the trust (investments, real estate) while our minor assets (old vehicles, personal property, checking accounts) are handled by a pour-over will. Of course my spouse would be able to handle our assets on her own (whether or not I have dementia) because they're all joint accounts. The key, though, is that someday our daughter could step up if we parents have to step aside. She'd be able to do all of the trust's financial management without the benevolent oversight of any courts or appointments or other legal hassles. All she'd need would be the trust document showing that she's a trustee. She'd already have the account logins & passwords.
Of course you have to trust your kids. We trust ours, and she's gaining more financial knowledge every day. We share our big-picture finances every year or so, and we keep a detailed update in our "Emergency" folder. When the time comes, she'll have everything she needs to do her job.
Author of "The Military Guide to Financial Independence and Retirement". Royalties go to military charities.
Co-author (with my daughter): "Raising Your Money-Savvy Family For Next Generation FI."
To contact me, please send a PM.
Nords, thanks for the update. My husband and I have done the same thing: revocable living trust with major assets and a pour-over will for everything else. It does make it easier for the contingency trustee.
Your Dad is lucky that you have put so much time into understanding the rules.
If you become a family/friend caretaker for someone with dementia (or work with someone who is), I'd like to suggest that while you're getting your LO's paperwork together and organized, going through drawers etc., you not throw anything away too early if you are going to apply for long-term care insurance. Our claim was denied and I've spent a gargantuan amount of time working on the appeal. I've needed a number of odd documents to prove my LO's cognitive issues were interfering with essential functioning, especially since the insurance company sent their own nurse to assess and my LO made her think and believe all kinds of things were true about her functioning that weren't. For example she said she was still working and I needed a copy of documentation that she had already retired when she said that. Ditto for volunteer work. Luckily I had most of what I needed. I may have tossed a few medical things that could be helpful, but I'd saved enough to send a 3-4" package of documents in support of our claim. So I suggest getting things organized but not to be too aggressive about tossing in a desire to save the trouble later.
ApoE 3/4 > Thanks in advance for any responses made to my posts.
circular wrote:If you become a family/friend caretaker for someone with dementia (or work with someone who is), I'd like to suggest that while you're getting your LO's paperwork together and organized, going through drawers etc., you not throw anything away too early if you are going to apply for long-term care insurance. Our claim was denied and I've spent a gargantuan amount of time working on the appeal. I've needed a number of odd documents to prove my LO's cognitive issues were interfering with essential functioning, especially since the insurance company sent their own nurse to assess and my LO made her think and believe all kinds of things were true about her functioning that weren't.
Absolutely! Sometimes an elder's paperwork is only a few random puzzle pieces without context, and it may take weeks or months to put it together. Other times it takes us a while to learn what's important (like Medicare or insurance paperwork).
When my father entered a care facility with a doctor's "diagnosis" opinion of Alzheimer's, Dad passed the insurance company's dementia exam with flying colors. (In other words, he failed to show the MMSE's symptoms of dementia.) This is common-- Bob DeMarco's mother (of the Alzheimer's Reading Room website) scored high on the MMSE almost all the way to the end of her life. Other times the loved one seems to function adequately in the activities of daily living, but anyone who spends an hour with them would realize they can no longer safely live independently.
In our case we hired a neuropsychologist to give Dad a long interview on questions like "Here's the telephone. How would you dial 911?", "How would you drive to your home from here?", and "Tell me how you pay your bills". It took several hours (and $3760) but the neuropsych's diagnosis of Alzheimer's is considered almost as credible as an autopsy. It was finally sufficient for both the long-term care insurance corporation as well as the probate court petition for a conservator appointment.
Author of "The Military Guide to Financial Independence and Retirement". Royalties go to military charities.
Co-author (with my daughter): "Raising Your Money-Savvy Family For Next Generation FI."
To contact me, please send a PM.
Thanks Nords! That is very encouraging that we might get a favorable outcome on appeal. I posted elsewhere how my LO keeps passing the MMSE. Thankfully we got a second, followup neuropsych in time for the appeal paperwork and it says Alzheimer's. I told the neuropsych doc when he interviewed me that the MMSE is the bane of my existence, and he laughed as if to say, 'ya, what a piece of junk that is', although I don't mean to be quoted as saying an expert said those words. It was just my takeaway.
By the way, I've been reading Bob DeMarco's articles as they're emailed to me ever since you mentioned that site. They great easy bites to fit into busy days.
ApoE 3/4 > Thanks in advance for any responses made to my posts.
Oh Nords, I can so relate to your experience. My uncle, for whom I'm the primary caretaker, was recently reassessed by his LTC company to see if he still qualified for benefits. (I find it humorous that the mainstream medicine opinion that cognitive decline is irreversible is completely disregarded by mainstream insurance who clearly believes it is .) During the assessment, my uncle correctly answered multiple cognitive assessment questions. He typically struggles to get up from a chair, but practically popped up and offered to do one armed pushups for the attractive young nurse to show her how healthy he was; his topic of conversation for the day. It clearly was a particularly good day for him. Thank goodness that he flubbed up when asked the season and year. It was the "Winter of 1983" for him and he was ultimately approved. How frustrating when our LO's paid dearly for this insurance and have to work so hard to make and keep a claim. Grrrr.
I did a solid day yesterday and am well into a solid day today. Not getting much exercise but will make up for it. Too many time-sensitive things to accomplish.
.) During the assessment, my uncle correctly answered multiple cognitive assessment questions. He typically struggles to get up from a chair, but practically popped up and offered to do one armed pushups for the attractive young nurse to show her how healthy he was; his topic of conversation for the day. It clearly was a particularly good day for him. Thank goodness that he flubbed up when asked the season and year. It was the "Winter of 1983" for him and he was ultimately approved. How frustrating when our LO's paid dearly for this insurance and have to work so hard to make and keep a claim. Grrrr.