When will skilled care be paid for by Medicare?

By Attorney David Engler

Skilled nursing facility care will be paid by Medicare when your ward or parent needs daily skilled care that cannot be provided in the community or on an outpatient basis. The benefits are the cost or partial cost of rehab in a nursing home facility. Medicare part A will pay for the first 20 days at the full patient cost, and up to 80 more days with a co-pay. The issue that a guardian is often confronted with is whether the patient is benefitting from the care being received. There are horror stories of older patients receiving care that could not possibly benefit them. With the federal government focused on saving money in the entitlement areas like Medicare, be sure that there will be increased scrutiny on the payment for skilled care and whether it is needed.

That is where the guardian has to become the advocate for the patient. You need to observe the changing condition of the patient and ideally the improvement. There will be an ongoing assessment of rehabilitation goals. One of the manners in which this is determined is improvement in gait. The patient does not have to be considered curable for Medicare to pay.

Services can be provided at home through a Medicare certified home health agency. The patient will need to have the doctor write a plan of care. This plan of care should be discussed by the guardian with the doctor and make sure that it is updated every two months.

Attorney David Engler
Phone: 330-729-9777
http://www.DavidEngler.com Attorney Engler’s website
Areas of Practice: Family Law, Elder Law, Domestic Relations, Bankruptcy, Criminal

The Power of Attorney Abused

By Attorney David Engler

Aside from flat-out driving an incompetent victim to their bank and taking their money, the first choice of the thief is the power of attorney.

A Power of attorneys is recognized in every state and there is little to no regulation of its use. In most states the only time it is recorded is when real estate is being transferred. There should be extreme caution given by any professional who drafts a power of attorney. Care should be taken to truly understand not only if the signer is competent, but is the person being coerced even if subtly.

As a lawyer I have seen power of attorneys given to care givers who might have come into the elderly person’s life because they were hired. The constant contact with the person presents an opportunity for the caretaker to overstep their role. This is yet another good reason why family members should choose a person who is a registered guardian. It is a far better course of action to choose a stranger who is trained and bonded than checking the inventory at death to find out all the assets were depleted.

The power of attorney most often survives incompetency if it was drafted within the last 20 years. It is true that there is plenty of case-law indicating that a person cannot use a power of attorney for their own benefit, but self-dealing is usually not detected or discovered too late. By then assets are gone and usually unrecoverable.

As part of planning for the care of your mother or father or other person who seems unable to handle their own finances because of mental or physical reasons, a good start is to ask if there are any power of attorneys out there and better yet send a notice of revocation to all the banks with which the person might be doing business.

Attorney David Engler
Phone: 330-729-9777
http://www.DavidEngler.com Attorney Engler’s website
Areas of Practice: Family Law, Elder Law, Domestic Relations, Bankruptcy, Criminal

Keeping Track of Your On-Site Visits

By Attorney David Engler

One of the most important jobs of a guardian is to keep track of the times you visited your ward at a nursing or group home. Just last night I was visiting my own mother at a rehabilitation facility. Now while she seems to be completely competent at age 82, I can see the difference in treatment because the staff knows I am a lawyer and involved in the guardianship business. Most importantly I am keeping track of what I am seeing and letting them know that I am. My mom has complained about not getting her medications at the right times and about rude treatment by an aide. Her roommate confirmed the complaints.

It is remarkable how some staff that work at nursing homes do not seem to like their jobs and treat all patients like unruly children.

Well, they should be listing the complaints they receive directly from the patients on their charts. They do not! It is information that might show a pattern of neglect and therefore better not to list. But the fear of litigation is a powerful deterrent and if you demand that your complaints on behalf of your ward be documented and that you are recording the same, your client will get better care.

My Mom hit the nurse’s button and was not supposed to use the rest room without assistance. The response took more than 20 minutes. Now she is on a diuretic and it is hard to wait. The aide finally showed up and said, well just do it in your bed. You have to be kidding! She wasn’t! Believe me, these understaffed and under trained statements are coming out every day to our wards who find themselves relying on the care of others. Let the facility know up front that you will document the issue in your own case notes.

Our software (www.eguardianship.com) allows the guardian to keep track of case notes and these notes are searchable. Contemporaneous notes are admissible as business records if litigation is needed in the future. We have to put the pressure on the residential care-givers to keep them honest and accountable.

Vary the times you come to visit so your schedule is not predictable. If they know you show only at 4 P.M. then maybe they will not bathe your ward until that time. Do not be shy about letting the residential care facility know that your job is as an advocate on behalf of your ward. Let them know that you keep electronic records even if they do not.

Attorney David Engler
Phone: 330-729-9777
http://www.DavidEngler.com Attorney Engler’s website
Areas of Practice: Family Law, Elder Law, Domestic Relations, Bankruptcy, Criminal

Why Guardians Matter

By Attorney David Engler

At our affiliated company, eGuardianship.com, our clients who are guardians are people who take care of other people. There is no higher calling. The genesis of this profession can be found in the founding principle of every religion. And as our world moves us faster and faster and with greater and greater distance between us – technology can be part of the fabric that holds us together. It can be the means of communication that allows us to make sure our mother is getting the best care or that a veteran is sure to have a home. Reporting on visits or reporting to a court are all done with binary precision.

I have had this debate over many years with friends. Some believe that as the world ages we grow apart. They see the world as tribal warfare, disconnected crimes and people simply tuned out. I believe the opposite. If we can find more common languages, our world shrinks. Math is universal. It is the basis for technology. It allows the foundation of the explosion of social networking. It allows a guardian in Alaska to check the medical records of her ward in a flash who was treated in Texas. It allows this blog. Technology is a unifying force. And the people who are engaged in the most noble of professions will use it to bring their care closer to those who need it.

Attorney David Engler
Phone: 330-729-9777
http://www.DavidEngler.com Attorney Engler’s website
Areas of Practice: Family Law, Elder Law, Domestic Relations, Bankruptcy, Criminal

Upcoming Holidays: Good Advice for Visiting Loved Ones with Dementia

“I read this great article about holiday visiting in the Columbus Dispatch” – Attorney David Engler

THE COLUMBUS DISPATCH:
Good Advice for Visiting Loved Ones With Dementia
By Misti Crane
mcrane@dispatch.com

This upcoming holiday season of gathering, reminiscing and tradition also can bring sadness and uncertainty for those who love someone with Alzheimer’s disease or some other form of dementia.

To make the most of holiday visits, caregivers and other relatives and friends should accept what can’t be fixed and learn to offer support and bring joy to those affected by the disease, experts say.

During visits, “you have to learn to suppress any feelings that you have, put a big smile on your face and try to be as cheerful as you can,” said Dr. Leopold Liss, medical director of the Columbus Alzheimer Care Center.

One in 10 Americans 65 and older suffers with dementia. It affects almost half of those 85 or older, according to the Alzheimer’s Foundation of America. Alzheimer’s disease is the most common form of dementia.

People are prone to over-explaining reality when an evasive, yet truthful, answer would be best, Liss said.
Laralyn Sasaki, who lives in the Short North, said that her visits with her grandmother, who had dementia, improved significantly when she learned to answer questions that way.

“When she asked where her husband was, who had passed away several years before, we’d say, ‘You know, we haven’t seen him today’” said Sasaki, whose grandmother, Thelma Townsend, died three years ago at 97.

Learning to avoid correcting the person with dementia is essential, said Mari Dannhauer, program director at the Alzheimer’s Association of Central Ohio.

“We tell caregivers they’ve really won their last argument, because the person with dementia is not able to be rational in our world so, we kind of have to jump into their world.”

Insisting that someone remember your name is useless and potentially damaging, Liss said.
“You have to respect the fact that this is their reality. Don’t try to jerk them out of it because it might have negative results,” Liss said.

Helping also can mean avoiding things that create frustration.

Sasaki said she and her mother learned to tune into nature shows or old, happy movies rather than channels featuring current events and political candidates her grandmother didn’t recognize.

Her advice to others dealing with dementia is to visit loved ones rather than staying away out of fear of awkwardness or tension.

Sasaki was part of a team of people who volunteered their time recently to produce DVDs and CDs that feature Liss and offer caregivers advice.

At the holidays, caregivers should know that things don’t have to be perfect, nor do they have to be the same as every other year, Dannhauer said. Changing a home-cooked holiday party into a potluck can ease anxiety. And having family members visit in shifts rather than all at once can help, Dannhauer said.

She recommends involving the person with Alzheimer’s disease in activities such as singing carols or wrapping presents rather than assuming that they can’t or don’t want to participate. Interacting with children can be uplifting, and smiles and embraces are almost always a good thing, Liss said.

For information about central Ohio support groups and other resources for friends and family members of someone who has Alzheimer’s, call 1-800-272-3900 or visit http://www.alz.org/centralohio/

For information about The Art of Caring DVDs, go to http://www.theartofcaring.net/

Attorney David Engler
Phone: 330-729-9777
http://www.DavidEngler.com Attorney Engler’s website
Areas of Practice: Family Law, Elder Law, Domestic Relations, Bankruptcy, Criminal

Let Grandma Facebook

By Attorney David Engler

Five years ago at this time Facebook had 12 million users. At the beginning of 2009 it had 150 million users. Today, Facebook has over 750 million users. The fastest growing demographic is users over 35. It’s time to put grandma and grandpa on Facebook.

We need to teach them the skills and create applications for ease of use. At first they might not understand what a Wall might be and perplexed if someone asks them to accept ‘chickens for their farm’. But the one thing Facebook can do for seniors is allow them to socialize.

There is nothing more important in maintaining a healthy lifestyle than continuing to socialize. Too many of our wards, our parents, aunts and uncles become isolated by physical immobility and the loss of friends to death and the movement of families from home communities.

The lack of socialization can slowly give way to earlier onset of dementia and Alzheimer’s. Studies have shown that the healthiest seniors are those that continue to lead busy and interacted lives. It’s not on Facebook yet but we can create social groups built around military units or ships or graduating nursing classes from the 40’s and 50’s.

A welcome expenditure is to buy your mom a laptop and set her up on Facebook, Also if the grandkids accept her as a friend, then maybe they will be less likely to post compromising pictures of themselves that they would regret later.

Attorney David Engler
Phone: 330-729-9777
http://www.DavidEngler.com Attorney Engler’s website
Areas of Practice: Family Law, Elder Law, Domestic Relations, Bankruptcy, Criminal

Who You Calling Sweetie?

By Attorney David Engler

Have you ever taken an aged client or your parent to the Doctor’s office and the doctor or nurse refers them as sweetie or sugar or some other term of endearment?

I know the doctor is trying to show compassion and connection but the opposite often occurs. It is a way of saying I don’t take you all that seriously and need to address you in a patronizing way; seniors get offended by health care professionals who treat them like children. A male doctor would not refer to a 36-year-old female client as sweetie and he should not refer to an 83-year-old female any differently. It is the subtle use of words that convey a relationship that is not equal.

The people we bring to their doctors might be frail and fearful but most are of sound mind and understand that they are being talked about in their presence.

I am suggesting to all well-intentioned professionals to refer to the elderly in the more respectful manner of Mr., or Mrs. or by their first name if they have a solid relationship.

Never ask the son in the room if the Mom is acting confused when the Mom is sitting right there. It feeds into their sense of hopelessness that their guardian or child is the only one that can be trusted with medical questions. There may be a time for such questions but they should be done outside of the presence of the patient.

You might order your eggs at a roadside diner and call the waitress sweetie, but you should never call an aged patient sweetie. They know as much about their condition as the doctor does and they have seen more of life, like the ravages of war, like raising a family, or making tough decisions at work. Always err on the side of treating our elders with respect.

Attorney David Engler
Phone: 330-729-9777
http://www.DavidEngler.com Attorney Engler’s website
Areas of Practice: Family Law, Elder Law, Domestic Relations, Bankruptcy, Criminal

Is That A Size 18 Dress You are Wearing?

By Attorney David Engler

Last week I saw an old friend who was wearing the stress of the morning on her face. Now my friend is a well-educated and savvy professional who rarely finds herself flummoxed. However, take this 60-year-old woman and have her Alzheimer’s-diagnosed mother ask her the same question everyday about her dress size and she gets reduced to a 12-year-old school girl remembering a disapproving mother.

It is remarkable how a parent who is ill from dementia or Alzheimer’s can cause such severe stress to the caregiver. All of the family fault lines are exposed. The siblings who live out-of-town can make a call and be seen as the good child and the parent will let you know it. Once the decision to move them from their home is made, the parent will hold the decision maker responsible. I asked her if her mother knew what day it was and she responded that she knew because a new day was every morning when she stopped at her care home before going to work. It takes true love and a sense of responsibility to shoulder this task.

Moreover, the family needs to understand the emotional and financial toll it takes on the family. It is exactly this toll that goes in to our change basket and adds up as we develop resentments for the other family members who we believe get off easy and do not understand the commitment.

In advance, if possible, or with the help of a neutral party like a family counselor or attorney experienced in elder law issues, a family should call for a retreat to strategize the needs of an aging parent. We come together to celebrate births and we should come together to celebrate and plan for the remaining years of our parents. There are many issues that need discussed, like the cost of care and what documents are necessary to provide for Medicaid eligibility.

The first meeting should be without the parent unless they are clearly competent and understand that the goal of the meeting is to plan for an uncertain future. All of the baggage needs to be checked at the door of the meeting room and fully examined for explosives (figuratively). The professional can help with the communication tools that seem to be so elusive when dealing with family.

The goals for all, needs to be focused. I like to start with a positive reinforcement of the 3 most beautiful things we can say about our parent. We then need to have everyone list what 3 goals they would like to take away from the retreat. In advance, an assessment of finances is prepared and an understanding of the condition faced by the parent.

Once again it does not seem to matter how many degrees a person has because when it comes to dealing with a person with Alzheimer’s, rationality goes out the window. When your 86-year-old mother says your butt looks big, we lose perspective. That is why it is important to create a situation where the family can seek an agreement with each other, understanding, and an appreciation for the caregiver at the bedside.

By the way my friend is half of a size 18 dress.

Attorney David Engler
Phone: 330-729-9777
http://www.DavidEngler.com Attorney Engler’s website
Areas of Practice: Family Law, Elder Law, Domestic Relations, Bankruptcy, Criminal