Dad in Nursing Home, have questions about Power of Attorney & Benefits

[Caiyuo]

Warning: incoming a lot of shit

Hoping to get some help on the situation with my dad as I'm to the point where things have grown a lot more nebulous now and I'm getting scared about what comes next.

So, before questions, this is what's going on: In May my dad went to the emergency room for what we found out was having incredible blood loss from something internally. Aside from this, when he was released a few days later after some transfusions, he spent the next 3 months doing nothing to find out what was wrong or to even take care of himself, even refusing basic prescriptions. After the first month I got DCF involved since he seemed to have completely given up but didn't really get anywhere and at the end of those 3 months he was brought back and had a much longer stay at the Hospital. At this point it was the recommendation of his discharge planner that he stay in a nursing home for rehabilitation. That's where he's currently at after being back and forth between the Hospital and 2 separate nursing homes. Originally this was just a matter of getting him taken care of, getting in rehab and eventually resuming his life but the longer this goes on, the less likely that seems. He's also been falling repeatedly because he tries to get up and walk out; every time I've seen him at either place he's only really asked about leaving and has tried to coerce pretty much every visitor to take him home.

I'm not sure of the relevance of this but if it matters, he's been fighting the staff and doctors almost the entire time on everything and denying actually being sick at all because of what seems like a pretty big fear of hospitals and doctors.

As for the details and questions, he's 73, so he has Medicare and has since been approved for special low income part B, Medically Needy prescription coverage and Medicaid. He was also in the Marines for 4 years, but has never done anything with the VA or looked into benefits so I'm not sure what he might be eligible for in that regard. He lives in a mobile home park with his wife who has epilepsy (can't drive) and some form of learning disability who also hasn't been able to work since a work-injury lawsuit years back so they basically live off of his 12k a year from social security. He also has a ton of debt, I think I get calls from debt collector's at my house more or less daily for different stuff, in the amount of who fucking knows which is a concern with power of attorney if I or anyone else becomes liable for this or anything else given he pretty dependably makes horrible life decisions. A concerning one being that he never put his wife on his bank account and has no idea what his ATM pin # is so all of his bills are hinged upon him being willing to sign checks I bring him for bills, where I'm expecting cooperation to wane. I've set up accounts online for him in case that happens, but it also means his wife has no actual cash to do anything with. He has burned most of their bridges so outside help is scarce. The main thing to take away is this is a big fucking mess.

I sat down with a social worker and the business manager at his current nursing home to talk about getting his house in order, but without power of attorney there doesn't seem like anything else can be done other than to wait for him to maybe get better. The business manager mentioned something called financial power of attorney where someone would only be in control of his finances, but does that incur liability on current or future debt?

I know this looks like a mess of blurry, ambiguous shit, but basically, I don't know what to do here anymore. What should I be doing for him at this point? What else might he be eligible for to help them financially? Can his military service be useful here? Is PoA necessary and what are the risks that come with it? Would his wife be a better option even though she's probably not equipped for this?

Thank you for any halp

[solanis]

there are two different documents you should look into.

1. power of attorney: http://www.nyc.gov/html/dhs/download..._%20082010.pdf

as you can see, it's very simple and straightforward. the powers it gives are broad and extensive, and the designation exists specifically for times like this, when the person can't handle their own affairs. this document will give you the ability to handle his finances, get his house in order, access medical documents, etc. this is purely financial/order related. this will allow you to set his financials in order without having to have him sign everything.

2. health care proxy: http://www.health.state.ny.us/forms/doh-1430.pdf

also very simple. this gives you the ability to make medical decisions for him as if you were him yourself.

if his wife isn't appropriate to make financial/medical decisions for him, you should probably step up and do it. it sounds like you're in a tough spot but these two legal documents will help you out a LOT moving forward. I'm not sure what state you're in, but a google search will quickly find the exact forms for your state and the process to get them signed. you should definitely consider getting a PoA and HCP for yourself and your other family members, I have similar things set up because you never know when an emergency will strike. PoA can be particularly useful if you get into an accident or are being held overseas. if you need any advice for setting his finances straight, let me know.

[Tyche]

And a DNR...definitely a DNR

[*Shinzon*]

You're just going to need to talk to a lawyer who specializes with elderly clients and low income clients in your state because rules vary. I'm not sure if getting a power of attorney will make you inherently liable for his debt but you could take care of it with the power. Additionally what you might be able to do is get that attorney to help you with bankruptcy because they're basically living below poverty line with nothing but social security and see what the bankruptcy proceeding would take care of. It sounds like you're going to need to commit them both fully to a nursing home though, so you need to start again, talking with a lawyer about what your options are. Elderly laws vary and you gotta be careful about the decisions you make.

[solanis]

does he not want to be resuscitated? I thought you only got a DNR if you didn't want to be, otherwise it was assumed that you do?

another form I forgot is this: http://www.nysba.org/Content/Navigat...illEnglish.pdf

living will. also very useful and simple, and something everyone should have. I'm 99.9% sure that PoA doesn't make you liable for their debts, just gives you the power to facilitate that debt on the behalf of the individual.

[*Shinzon*]

Yeah a will is a good point, although if hes deemed not mentally competent and doesn't have one at this point you may not be able to get one. Though again, a lawyer in your area would be able to tell you. If there's one on file and he doesn't remember a lawyer in your county/city/state will have to check to see if one exists.

[Tyche]

If he's a fall risk, I really doubt his provider is going to release him and certainly not unsupervised. Your dad really isn't helping himself at all, but you don't need me to tell you that. You should schedule another meeting with the social worker, her job is to answer these kinds of questions and refer you to places that help get these things done. They handle these matters all the time.

[shemei]

And a DNR...definitely a DNR

seriously wtf is up with this? If his dad wants dnr fine, but no one should make that decision for another person...

[miokomioko]

seriously wtf is up with this? If his dad wants dnr fine, but no one should make that decision for another person...

Sometimes it's very necessary to sign a DNR for a parent. Especially when someone's bodily/mental health has deteriorated to the point of not being able to make any sound decisions, let alone a decision at all.

[shemei]

Well it is not your decision to make it is your parent's decision. If they don't let you know before hand to DNR then you shouldn't be the one to decide that. Seriously, do you just want no money spent on their care because that is what it seems like to me. I know I have planned ahead and told my husband/children my wishes in this situation. If a parent or even spouse has never discussed this with you then I would say just let the nursing home or doctor follow standard procedure.

Maybe you should be proactive and have that discussion before your loved ones are in a situation to DNR. I know I have and so have my parents and husband. In fact everyone should probably have and advanced health care directive, as it costs nothing. http://www.caringinfo.org/i4a/pages/...fm?pageid=3289

[Caiyuo]

I wanna take some time tonight to give full responses, but in the interim, thank you for the help, I really appreciate it.

[Weiing]

@Caiyou -

I am a health/medical social worker by profession, internet nerd by trade.

My first question is -- I forget exactly where you live. Every state/country has their own rules and regulations. By knowing where you live, I think we'd be better in answering your questions...

But more generally speaking, you can look into speaking with an attorney or something. Also, if your father is receiving SSI, you can ask to see if you can become the SSI payee. This means you will receive the SSI checks and be in charge of how to handle the money; there is a form you will have to fill out saying WHY your father should not be handling his own money from a medical/competency stand point. Additionally, that way you can maybe at least start working something out with the collections agency, telling them the situation and hopefully setting up a payment plan. You will need to go to the Social Security Admin office in your area to explore those options.

Like suggested before in your post, you may look into being the financial DPOA, or have someone else. Are you the only child? Being a DPOA doesn't mean you're liable or will be blamed for anything, but you will just be the point of contact and person that deals with the finances (and health care decisions if you also become the health DPOA). However, since your father still seems to be alert&oriented, you may want to talk to him to see if he'll sign papers for it. Perhaps frame it in a way that you want to help out at this point, while he's in a SNF and can't manage his money...and that you're really worried for him.

I have seen many patients get very hostile toward staff, but it's understandable. People get tired of going in and out of hospitals and going back to SNF. Has the medical team/SW held a family meeting with your family? To really talk about what's going on? Also, has the SW spoken with you regarding goals of care? Does your father want to keep going to the hospital? Is he actually in denial of being sick or is that his way of coping? Maybe he really does know he's sick and is just afraid? I feel like if a "goals of care" meeting has not been set up at least with a MD and the SW, it may be time to really look into that.

I would hope he had a POLST, since in most states, that's required for SNFs. A POLST obviously doesn't mean DNR; it can be full code, too.

If you have any further questions, you can email me at [email protected]

[Acturus]

^ what this guy said.

[Caiyuo]

Sorry, I couldn't get to this last night long enough and thanks again for the help. To start, we're in Florida. To be truthful the idea of speaking with lawyers, handling his finances and being a health care proxy is intimidating as hell, but having it reinforced here helps to drive home the importance of this. Thanks for the links, the explanation and offer, solanis.

If he's a fall risk, I really doubt his provider is going to release him and certainly not unsupervised. Your dad really isn't helping himself at all, but you don't need me to tell you that. You should schedule another meeting with the social worker, her job is to answer these kinds of questions and refer you to places that help get these things done. They handle these matters all the time.

I tried to be prepared for the meeting since it had been delayed due to his hospital visits, but no specifics were really given other than "try to get PoA" when I asked about the problems we need to address and even that was just something that was forwarded to the business manager. This is mainly why I posted since I came away from the meeting without feeling all that much more equipped to deal with this.

Something I mentioned to friends, though, was that because he was so hard to deal with and now also has a feeding tube, he went from a nursing home that medicare.gov scored 4/5 stars on to a 1/5 star facility, literally the bottom of the barrel within 25 miles because it was the only place that would take him. I don't want to frame it like "oh they aren't helpful I'll do everything on my own" and shoot myself in the foot, just that in this particular regard I'm looking elsewhere for a consensus.

seriously wtf is up with this? If his dad wants dnr fine, but no one should make that decision for another person...

I think I mentioned it before, but in this regard I'm almost positive he would say no while I would say yes just because in the way he speaks and has for awhile now, he's looking to get out and to give up. None of these things have ever come up, it would be genuinely unusual for him to mention something this serious, but I recognize that it's time to talk about them.

[Caiyuo]

@Caiyou -

I am a health/medical social worker by profession, internet nerd by trade.

My first question is -- I forget exactly where you live. Every state/country has their own rules and regulations. By knowing where you live, I think we'd be better in answering your questions...

But more generally speaking, you can look into speaking with an attorney or something. Also, if your father is receiving SSI, you can ask to see if you can become the SSI payee. This means you will receive the SSI checks and be in charge of how to handle the money; there is a form you will have to fill out saying WHY your father should not be handling his own money from a medical/competency stand point. Additionally, that way you can maybe at least start working something out with the collections agency, telling them the situation and hopefully setting up a payment plan. You will need to go to the Social Security Admin office in your area to explore those options.

Like suggested before in your post, you may look into being the financial DPOA, or have someone else. Are you the only child? Being a DPOA doesn't mean you're liable or will be blamed for anything, but you will just be the point of contact and person that deals with the finances (and health care decisions if you also become the health DPOA). However, since your father still seems to be alert&oriented, you may want to talk to him to see if he'll sign papers for it. Perhaps frame it in a way that you want to help out at this point, while he's in a SNF and can't manage his money...and that you're really worried for him.

I have seen many patients get very hostile toward staff, but it's understandable. People get tired of going in and out of hospitals and going back to SNF. Has the medical team/SW held a family meeting with your family? To really talk about what's going on? Also, has the SW spoken with you regarding goals of care? Does your father want to keep going to the hospital? Is he actually in denial of being sick or is that his way of coping? Maybe he really does know he's sick and is just afraid? I feel like if a "goals of care" meeting has not been set up at least with a MD and the SW, it may be time to really look into that.

I would hope he had a POLST, since in most states, that's required for SNFs. A POLST obviously doesn't mean DNR; it can be full code, too.

If you have any further questions, you can email me at [email protected]

Thanks, Weiing, I really appreciate this. In case you didn't see above, we're in Florida. I'm not the only child but he's estranged from his other children so it works out that way more or less. As far as hostility, that's more just him than anything, the stress and pain of all of this on top of that just makes things worse, so talking him down from that or trying to get to a state of understanding is touch and go. That's generally the hard part to explain in these meetings because whether or not he's "there" or not isn't necessarily more helpful in handling any of the important stuff.

As far as discussion of goals, we had a full meeting at his previous nursing home with multiple advisers and his nurse to discuss everything. The current place has just asked what we were hoping for, but I'll see what can be done there. I'm guessing he's just afraid and isn't willing to admit that all of this is necessary, but that's how he is in general so it isn't something I gave a lot of thought about. Nothing I could do previously could change anything when he refused to see doctors, but I'm curious as to whether or not health care proxy or PoA could change that? There never seems to be a agreed consensus on his state of mind so it's hard to make the distinction between a person capable of making decisions for himself and choosing to languish and a person who isn't in his right mind. Especially in the case since I hear "he has a right to choose to be dumb" when our entire history tells me he wants to take the easy way out until things get dire and then wants to be bailed out.

Also not too sure on some of these acronyms lol.

[Weiing]

Sorry ahead of time as I'm on the iPhone.

Acronyms first: POLST = physicians order for life sustaining treatment. It's bright green now, I believe... It used to be pink. It talks about if his heart stopped or he stopped breathing what does he want done. He can be full code (wants everything), limited DNR (eg only wants medications but no intubation or chest compressions), or full DNR. Most states require this in nursing homes.

SNF= skilled nursing facility
SW= social worker :D

Anyway, DPOAs only come into effect in 2 ways:
1) when signing the POA form, the person states that they want the POA to take over decision making as soon as the form is signed and notarized ( in some states )
2) when an event happens, typically when the person becomes incapacitated

If he is alert&oriented and has no POA papers already done, it's still his decision and he still calls the shots. Its important to get a consensus on his mental state now. Has a psych eval been done?

What other questions do you have now?

Let me know

Have to go... Have my patients to see!

[Caiyuo]

Thanks, Weiing. A meeting is set for this week, and he hasn't had a recent psych evaluation, but of the ones he's had the results are usually varied depending on when they talk to him. The only question I can think of right now is regarding his military service, are you familiar with any of that? I wasn't sure if he was eligible for any benefits for either himself or his wife or if the VA was something to consider.

[Weiing]

I'm wondering... When you say his results are varied depending on when you talk with him, is that his baseline? Is he pretty wavering in his lucidity? Does he have any dementia? Any suspected dementia? I'm curious as to his baseline now.

With regards to VA, I'm not so sure about that, sorry. You might want to call a local VA medical office though, to find out what your father might be eligible for. http://www2.va.gov/directory/guide/s...te=FL&dnum=ALL Scroll down to the VA Benefits section and call your local office. They might have a better idea. I have only worked with a handful of veterans who were linked up with VA, and it was different in every case. In half of those cases, it was very difficult for the patient to get into the VA hospital or link up with the VA, but it might be different for your father. VA does provide a lot benefits though, if he can link up with it.

Let me know how your meeting goes.

[Caiyuo]

hey Weiing, finally had that meeting today so just wanted to report back; would you prefer I use your email for this btw? Was using this as the default in case anyone else found it useful but if it's a bother to be checking here I can email, either works for me.

As far as goals go, they said based on the amount of and type of care he needs, it isn't really feasible for him to come home so any plans like that are much further down the road, if they were to ever be practical. His rehab goes especially slow and has been hard for both this and the last nursing home to really gauge his progress just based on how cooperative he is on any given day. They're working on assisted walking since he's fallen so frequently but that's also a ways off.

They said he had a psych evaluation early on and it mentioned confusion, short-term memory loss, dementia, and more ambiguous terms to describe his behavior that I'll try to explain, but as far as I know the evaluation was based on a single instance. During our visitation when he has the strength to speak he's aware and able to converse in a sensible, oriented way, but every evaluation has come to that same general conclusion. When I mentioned a consensus on this I should've said that the disagreement wasn't with them but with us since we haven't seen those symptoms for weeks now, so I'm not sure how to answer regarding his baseline. I'm inclined to presume the evaluations are what the basis should be if not for the fact they're just based on single instances where it's a dice roll on whether or not he's cognizant.

After the meeting I spoke to him about power of attorney and health care proxy and he was agreeable to both, so I'd like to get that started. Should I consult a lawyer and do this through them or is that not necessary? In that regard I'm just worried about payment. I saw you mentioned durable PoA -- would that be more desirable in this scenario than general power of attorney? In either case it's just important that I can act as his agent right away since adding his wife to his bank account asap is a priority.

Also, regarding the situation with his wife, aside from wanting to speak with a disability lawyer, I'd like to see what can be done for food stamps. Would I be doing this in his name or hers at this point? I'm unsure since her name isn't on any of the bills nor is she a senior (she's 43) so I don't know what she qualifies for by herself. Also, in the event that he dies, would she receive any benefit from his social security? Because of the meeting today and the situation being that she's going to be on her own for a long time if not permanently, I just wonder if disability is going to be the only safety net for her in the event she doesn't qualify.

Thanks again for your help, I really appreciate it.

[Acevalefor]

a POLST is also known as an advanced directive. Just in case you start hearing the terms thrown around together. If you can sit down with your father and go over his desires in case of emergencies like Weiing was talking about, it becomes much easier on you to make the decisions knowing that was what he wanted.

My dad didn't have an advanced directive and was in a coma on life support by the time I was allowed to see him. I knew he did not want to be on ALS but since the physicians in the ICU didn't have a POLST from him, he remained on life support for almost a week. It wasn't until the doctors determined he could never breath on his own again that they allowed us to make the decision to terminate life support per his wishes. It was incredibly painful and stressful making the decision to end a life.

I tell you that story as a plea for you to be very honest and open with your father regarding the level of care that he wants when he is no longer able to make the decisions for himself. Ask him lots of questions. It will be hard to talk about some of the things in the advanced directive, but the more you can talk about now, the less taxing it is on you when the time comes to make decisions for him.