Alzheimer's caregivers, guardians, and conservators

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circular
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Re: Alzheimer's caregivers, guardians, and conservators

Post by circular »

Stavia wrote:Finances are tricky. I am in a different country so this may not apply. When my mum got into her mid 80s, we went to the bank and she made me a full signatory on her account. We just took our passports and drivers licences as identification. I had then had legal powers to transfer monies, use a cash card etc. At the moment of her death this lapsed and the account was frozen but I was executor of her will so it was just a bit of paperwork at the bank to get the remaining couple thousand dollars released to help with her funeral expenses.
(This was separate to the powers of attorney for property and for health which I got before the dementia was too apparent)
Does this option not exist in the US?
Hi Stavia, Not sure how full signatory works in your country, but in the US an account holder can add someone else's name to the account as a joint owner. Then both have full rights and ownership and upon the death of one the account passes to the joint owner outside probate. This is good if it doesn't foul up estate plans, eg where the original account owner's estate is to be divided among additional heirs in the Will besides the new name being added. The account owner and family need to trust that will happen despite the titling not conforming to the decedent's wishes. I think better to use a durable POA and keep the titling clean in such situations, but no doubt some families are problem free in these ways and all will go according to plan regardless of account titles.
ApoE 3/4 > Thanks in advance for any responses made to my posts.
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Re: Alzheimer's caregivers, guardians, and conservators

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Circular and Nords, regarding the MCI/ dementia causes, another possibility is high calcium levels in the blood. My Mom appeared to fall quickly into very severe dementia three plus years ago and they (her drs) wanted to immediately put her in a nursing home; they assumed it was AD for sure. Turned out it was her hyperparathyroid gland over producing calcium, which causes the symptoms of severe confusion and memory problems. My aunt and I had to really fight to get the doctors to address this with the appropriate drug, Sensipar. Once she began the Sensipar, her memory returned (btw similar symptoms are happening again this summer. Again, we have gotten her endocrinologist to prescribe the Sensipar, but it is taking longer for her memory and thinking to return this time... still hoping...seeing a bit of progress). So important to check calcium levels/all labs of our parents who are showing dementia signs.
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circular
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Re: Alzheimer's caregivers, guardians, and conservators

Post by circular »

Nords wrote: MCI is hard to nail down.
After the dx I kept reading that with MCI the person can still function normally, maybe with a reminder system in place. My mother was evidencing symptoms that interfered with her normal functioning, including the issues with managing financial matters. I sent a list of about eight varied examples to the neurologist for a 'reality check'. She pointed out that the neuropsych test which contributes to the dx, is only a moment in time and there will be fluctuations, ie, [my words] things might not always be what they appear by this dx, independent of ruling out other causes for the cognitive dysfunction. She added that based on my observations she 'strongly suggested' we should begin discussing AL or home care. I got the first phase of home care in place before coming home, where I can now focus more on the business/financial work to do. I personally conclude my mother has early dementia, not MCI, of whatever cause, and most likely Alzheimer's, but open to that being wrong and apnea treatment helping if not solving.
ApoE 3/4 > Thanks in advance for any responses made to my posts.
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Re: Alzheimer's caregivers, guardians, and conservators

Post by Nords »

"What a conservator does all day"

My first conservator task for the probate court was inventorying Dad's assets. That produces reports on his balance sheet and his cashflow projection. The polite term is "forensic accounting", and the reality is hours of going through tons of files. It's tedious but it can also cause occasional tears, so I could only handle an hour or two at a time. The Colorado probate court has all of the forms on their website. I downloaded the forms and followed the instructions, filling in the blanks as I went through the files.

Dad was a comprehensive filer even before he developed dementia. He had saved reports, letters, and correspondence going back to the 1950s. (He'd also saved files on his parents, and even some on his grandmother.) First I had to hunt & seek among all the old newspapers, magazines, and junk mail that he'd been saving as his cognition declined. Then I sorted the mass into a four-drawer file cabinet and started paring it down. Luckily he'd also printed out and filed a list of account passwords-- including the password to his computer that he hadn't used in six months.

I had to sort through months of e-mail looking for bills and other financial answers... and I'd occasionally stumble across private exchanges. I had to be the guy e-mailing Dad's recent contacts to let them know about him moving to an Alzheimer's facility. If someone answered back then I could ask them about Dad's finances, particularly:
- where he might have opened accounts or
- have refunds waiting for him.

I also did national website searches for any bank accounts, insurance settlements, or other refunds being held by individual states. I never found anything-- whew.

The probate court understands if you have to keep adding new assets to the inventory (because it can take years to find everything). They're less sympathetic if you take things off the inventory. During the months before our appointments, my brother and I sold all of Dad's furniture and closed out his apartment lease. I also sold Dad's 12-year-old SUV to my brother for $1 so that he could switch the registration to his name. (We discussed everything with Dad and he agreed to it, although legally he was no longer considered mentally competent to agree.) All of that was finished before our probate court appointments and before I compiled the official inventory, so Dad had no vehicles or furniture among his assets. It's probably technically illegal but we acted in a fiduciary manner the whole time and it all would have stood up to court scrutiny. We didn't see any reason to keep losing money while waiting on the lawyers and the court.

On the other hand my initial inventory included four whole-life insurance policies from the 1960s. As I tried to find out more about that inch-thick stack of 45 years of correspondence in Dad's files, the insurance company kept insisting those policies were no longer in force. I eventually stumbled across another insurance policy that Dad had misfiled, and it turned out that the four WL policies had been converted to the other policy in a 1035 exchange. That took a little explaining to the probate court but I had enough letters from the insurance companies to back it up.

Each year I file a conservator's report to update the balance sheet, the cash flow, and the projected income/expenses. If necessary I include a new spending plan for the court's approval. The first time I did the reports it took me about 20 hours of research and another five hours of writing. Each annual report now takes 2-3 hours to prepare (and to check my math). The court's financial staff (professional conservators) examine the reports and ask questions before forwarding it to the judge. The judge usually rubber-stamps the report (based on their staff endorsement) and signs the new conservator appointment letter.

I'd love to be able to do this on a website with Google spreadsheets or other automated analysis tools but... no. The Colorado probate court has some Word forms & templates on their website, and they change them every six months or so. The probate court wants the reports by record postal mail and the staff reviews them by hand-- probably punching calculator buttons to check the math. The most annoying aspect of the reports is that the cash-flow projections have to be filled out in a monthly column and an annual column. I guess that makes it easier for the court accountant to quickly see what's reasonable (and to check my math), but it just forced me to build a bigger spreadsheet to do the math for me. The upside is that conservators & guardians can fill the forms out by hand and can even include copies of actual checkbook registers.

One year my report was received at the court but not scanned into their computer network, and we only found out about the clerk's mistake when we were ordered (by postal mail) to appear for a delinquency hearing. Luckily we were able to sort it out over the phone because I'd saved the USPS receipts to prove that my report had been delivered. Now every year I file my reports and then check back weekly until they're on the network and being reviewed by the staff.

Initially I worried about the details of the checkbook register. When my brother took Dad out to Sunday lunch, did I need to keep a receipt? Did I need to document clothing purchases or new puzzles? These questions were complicated by the fact that my brother, to put it politely, is not a paperwork guy. He tends to put bills in his jacket pockets for "later", and sometimes it takes him a couple months to forward them to me.

I finally decided that paperwork & receipts were his problem. I send him $1000 whenever he asks for it (usually twice a year), include it in the register as "entertainment & personal supplies", and the court agrees that's reasonable. In the context of $90K/year medical expenses, the court probably doesn't worry about $2000/year for clothing, Sunday restaurant lunches, and jigsaw puzzles.

My conservator's routine has settled down into 1-2 hours per week. At the beginning of the month I move Dad's pension & Social Security deposits (plus his brokerage dividends & capital gains distributions) into a credit-union checking account. I update my spreadsheet of his income & expenses and also update the income/expense "checkbook register" on my rough draft of the annual conservator report. I pay his pharmacy bill and the care facility's bills from the credit union's online billpay service. I make sure his account has enough money for the next few months of bills and then I renew any CDs coming due in his ladder.

As the month goes along I may get a medical bill from a doctor's appointment or a hospital test, and I call the biller with the info they'll need to re-file with Dad's Medicare supplemental insurance policy. (Those phone calls are the worst, with long hold queues and occasional call-center clerks lecturing me on HIPAA privacy law.) In January I pay the annual premium on his Medicare supplemental insurance policy. Occasionally Dad's care facility has additional fees, or annual fee increase notices, or they forward Dad's other medical bills that were addressed to them instead of to me.

In March I fill out Dad's tax returns. At first he was receiving his long-term care insurance payout so he paid regular income taxes and I had to set up his estimated quarterly tax payments. Now that the insurance has run out and he has over $90K/year in deductible medical expenses, I only have to file the returns and he no longer pays state or federal taxes. Today the returns take me about 3-4 hours and I file them electronically.

By the time the year ends my conservator's report is 90% finished. Dad's final distributions from his investments usually happen in mid-December and I add those to the spreadsheet. I just have to add up the columns (using the spreadsheet) and complete the summary lines. That takes 2-3 hours unless I find a mistake. Meanwhile my brother fills out his guardian's annual report by hand.

When my spouse and I go on travel, I carry a folder with a copy of Dad's account logins/passwords and a copy of my conservator's appointment. If an emergency comes up (or if Dad passes away) then I'm able to move money around as needed over websites or even wire transfers.

In another post I'll describe how I approach Dad's asset allocation and his estate planning.
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."
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Starfish77
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Re: Alzheimer's caregivers, guardians, and conservators

Post by Starfish77 »

Nords,
This is very helpful information. It is a motivator for those of us who are very senior ourselves, to get our affairs in order. If we then become incapacated our families won't have such a hard time carrying on our financial affairs.
Starfish
circular
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Re: Alzheimer's caregivers, guardians, and conservators

Post by circular »

Starfish on the first page of this thread Nords said:
It doesn't matter how much money (or insurance) you have: if you neglect your affairs and make it harder on your caregivers, then you'll be hurting them far more than dementia hurts you. You'll be unaware (or dead) but the caregiver pain will linger for years.
I'm finding out how true this is. I'm overwhelmed with paperwork and trying to catch up on my own as well. I feel like I have a mountain to move and am only just beginning. Not to seem unwilling to help in a time of need, but I feel very burdened for now while my parent with early 'issues' seems to be enjoying her days. And the preparation Nords is talking about doesn't get to pre-planning a memorial service, obituary, preferences for handling remains and other such things that are hard to address on the fly after someone passes away, which in these cases comes at the end of a long period of other obligations. 'Five Wishes' in the US is a user-friendly approach to documenting some end of life wishes. I think it's approved as a legal document in all 50 states, but one should double check before relying on it.
ApoE 3/4 > Thanks in advance for any responses made to my posts.
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Re: Alzheimer's caregivers, guardians, and conservators

Post by Julie G »

{{{Circular}}} My life changed irrevocably when (overnight) I became the caretaker for my Uncle. I remember the mountain of paperwork, etc. Just breathe and make time to take care of yourself. XO
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Re: Alzheimer's caregivers, guardians, and conservators

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Thanks Julienne, ya, I'm adjusting to the new normal. I also feel pressure to get things organized quickly in case she has another sudden health issue. I can't have things be mid-way reorganized and deal with another hospital stay at the same time; well I can but better to be ahead of the curve. I've been getting a bit more time to do my own thing lately, but it's not long before the pressure builds because I'm not making more headway on these new affairs. Anyway, I'll get there. Going to go do some relaxing before bed. I'm finding it helps to go to bed super early and get up really early. Time for me to learn to take advantage of quiet, wakeful mornings after a good night's rest.
ApoE 3/4 > Thanks in advance for any responses made to my posts.
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SusanJ
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Re: Alzheimer's caregivers, guardians, and conservators

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{{{Circ}}}, sending some extra energy your way.
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Re: Alzheimer's caregivers, guardians, and conservators

Post by Starfish77 »

{{{{Circular}}}}
we appreciate all the good information, like "Five Wishes" that you share with us. Sending you admiration for all that you have accomplished for your loved one, and wishes for strength to carry on.
Starfish
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