We all rely on friends for so many things: social engagement, support during a difficult time, encouragement when we try something new, feedback for new ideas and so much more. You, like so many others, require at least one friendship to feel emotionally happy, connected to caring people, and socially fulfilled. For the last 10 years Friendship Month – highlighting the importance of friends and celebrating what friendship brings to our lives – has been celebrated throughout September.

Friendship Month is something you can acknowledge by spending more time with friends or connecting with people with whom you have lost touch. We’re never too old to make new friends. For the senior or infirm, maintaining, reviving or establishing friendships can be challenging. Fortunately, 21st century tools – Facebook, facetime, skype, texting – can ease the lack of live interaction. Yet, for some, more signs of friendship are necessary, even when not immediately appreciated. The friendship you deliver to the beloved seniors in your life will most likely take new forms of expression; at their stage of life, new priorities take center stage and while they can be difficult, there are ways your friendship will become even more precious.

During the last quarter of the year, we commonly start a planning process on behalf of declared goals; you and your family may want to engage this process for the seniors in your life on behalf of their physical, financial, emotional and mental health as well as helping them shift into many changing situations. Patience will be a strong way to express friendship for the senior whose life is changing so quickly.

Friendship can be expressed through advocacy. Taking on the role of fiduciary, power of attorney, or guardian may come as your loved one’s ability to manage their own care and funds declines. However, much earlier, you may wish to communicate with their physicians, attending appointments when possible. Seniors, older than boomers, have been raised to respect authorities, such as doctors, and may not bring the questions that need to be raised on their behalf:

  • Why are they on this medication?
  • Are you aware of another doctor’s prescriptions?
  • What family member has been describing mom’s changing behaviors?

Sometimes, as a friend to your loved one, you need to make difficult decisions. Being able to determine when forgetfulness has drifted into the beginnings of dementia can be most painful. Or, convincing an older adult s/he is no longer capable of driving or handling their affairs. Added stress to this, making your role as friend even more critical, is when your loved one is resistant to having you take over; it’s a loss of their independence and a huge life change. Here’s a simple way you can assist with their desire to continue participating in their life decisions as you gradually get more involved: place a large bowl where all mail – bills, bank statements, advertisements, reminder notices, etc. – will be collected by the senior. During your visits you’ll review them all for the necessary actions. Be a friend by continuing to respect their need to express their dominion over their own life until they gradually come to see you as a capable partner rather than a bulldozer.

And, even if others have been assigned legal roles for your loved one, they may not have the time to manage some of the day to day needs – shopping, preparing meals, handling laundry – so you might pick up that role as ‘team leader’ among those who’ve stepped up to handle the varied and necessary tasks of a continued life of quality.

Speaking of new roles, as a friend to your senior you may need to decide to bringing in a member of a growing profession, the Aging Life Care Professional or Manager. Often known as Geriatric Professionals, the size of our current aging population has brought this profession to the forefront of care. And, whether minor issue or crisis, this profession is capable to help in a range of needs: it’s a holistic approach that provides answers for worried families, healthcare management, guidance to make choices that will reduce time needed away from working. Often, at an advanced stage of life the senior might have married more than once and has a blended family where priorities and stresses make clear decisions difficult and fraught with conflict. The Aging Life Care Professional is an objective and unemotional voice to help make the difficult choices easier.

Perhaps the most involved form of expressing friendship for your aging parent is when you decide to have them live with you, bringing into your family nucleus a new set of problems and needs which may overwhelm your love for your parent and bring conflict to your own siblings or other involved family. How can you best handle this?

Margaret “Peggy” Graham is an elder law attorney who firmly believes that families should get their agreements about their parent’s care in writing. Typically, family caregivers run into problems because they don’t know what their parent needs now, what they will need down the road, or what their parent or other family caregivers expect them to do.

It is best to have open and honest talks about this, even though it is often an uncomfortable subject. To start, have a transparent meeting where you seek to understand what your parent will actually need, depending on their conditions and cognitive ability. Discuss how your expectations, your parent’s expectations, and other family members’ expectations match up to those needs.

Once you have that understanding, you can start to make a plan that will suit everyone, or at least your parent and the family members who will act as caregivers. Don’t shy away from the financial aspects of this discussion. Talk about if and how the caregiver will be compensated for their time.  Then discuss how mom or dad’s money will be managed.

Ideally, getting these details in writing ahead of time will mean that you avoid family conflict, resentment, and financial stress down the line.

Michael Ferraina, CEO of JEV’s Care at Home in Philadelphia advises that families should be patient and take time to get comfortable with one another. Schedules take time to get right, too.  He argues that the demands of home care expand as people age. Typically, family caregivers don’t know what they don’t know, which means there are areas of their loved one’s health that they could better support, but recognizing the gap is a challenge. To address this, you should reach out to resources available in your community; examples are:

  • Home care agencies: They should be able to answer questions and give referrals to other experts, too. Home care agencies may help you get the right medical equipment, or even help you handle insurance claims.
  • Doctor: Your parent’s doctor can help, especially if they are a geriatric doctor.
  • Other family: Not only can they provide moral support; family members can step in with unique perspectives to help your parent.
  • Medicaid: Through Medicaid there are programs that can help manage your parent’s care.
  • Veteran’s Affairs: Veteran benefits include some support for elders in home care.

Before any of this, you obviously must have a conversation with your parent, one that will be extremely difficult. Yet, with the goal of maintaining or expanding your friendship, you’ll need to call on skill: patience, direct language, planned remarks, prepared for a difficult response. Whether it’s about giving up the car, moving from their home, turning their legal and financial affairs over to another, there’s so much underlying emotion here, for you both. You’ll want to express your concern for them, the risks you believe they’re now likely to experience. ‘Ammunition’ that will assist making your case will be observed evidence, doctor’s notes, mistakes in their recent banking, decline in the state of their home or personal appearance. If the most difficult of decisions – to move your parent from her/his home – is what’s necessary, it makes good sense to have that discussion before their decline puts them in a crisis mode; a professional residence with healthcare will be better able to provide ongoing care if they have a history with you and a patient and got to know them in a healthier or more tranquil state.

Friendships come in so many expressions; yours on behalf of a beloved senior as they approach end of life may be the most difficult and most heroic at the same time. There are, as mentioned throughout this article, many resources available for you. Perhaps the easiest way to access them and learn of others, relevant for your situation, will be a phone call to our office.

DECADES: the 40’s

During World War II many seniors came out of retirement to help with the war effort. Their employment income probably kept many of them off the welfare rolls during the war, but they had to retire once again when servicemen returned home and needed jobs. The war also added to the size of the disabled population who needed long term care, and created many new widows and orphans who needed financial assistance. In 1939, the Social Security Act had been expanded to include survivors and dependents benefits, and the war greatly increased the number of people covered under the system. After the war, the Veterans Administration added new benefits for newly-disabled veterans or surviving spouses.

The size of the elderly and disabled population was growing, and many of them were now eligible for government payments of one kind or another, including veterans benefits, old-age assistance, Social Security, and unemployment assistance. Many of those payments could be used to pay for nursing home care, further encouraging the development of care facilities. In fact, Old Age Assistance benefits doubled to over $400/month by 1947.

Resources:

Catherine F. Rowlands, MBA, NHA, CMC, FL-RG, MT

Sue Fernandez, Community Educator for the Alzheimer’s Association

Liz Barlowe, MA, CMC, former president, the Board of the Aging Life Care Ass’n

Michael Ferraina, CEO JEV’s Care at Home

Margaret Gram, elder law attorney

Library of Congress

 

 

 

All throughout July I hear fireworks, see red, white and blue and hear advertisements that feature ‘Independence’ as a theme. For many in the aging life community – practitioner, protector, senior adult and concerned child – ‘independence’ is a challenging concept. Diminishing skills tend to take seniors’ independence while the senior adult fights against its loss.

Perhaps no sign of a change in a senior’s independence causes more upset than moving – or actually, being moved – from one’s home to a care facility, a combination room or apartment with a professional care staff that takes over responsibility for a senior’s life. According to AARP research, nearly 90% of seniors want to stay in their home. Often referred to as “aging in place,” this option can be possible depending on the senior’s need for care and their financial resources.

If aging in place is a real option, a strong financial plan is necessary. For example, it’s important to explore all benefits that might be available, both at the state and federal level. Veteran’s Administration aid is often overlooked yet typically provides benefits for both veterans and their surviving spouses. National programs like PACE (Program for All-inclusive Care for the Elderly) help people stay out of nursing home care and, if the senior can’t age in place, they can help find a Medicaid-covered group home with several other seniors living in a familiar, home-like setting.

Another option is to investigate any existing long-term care insurance policies. While older policies may imply they cover nursing homes only, it is worth having someone contact the insurer and advocate for home health care, a much less expensive option unless the senior needs round-the-clock care. Insurance often include an opportunity to approve payment for several hours of in-home care per day vs. the expense of a nursing home facility.

There are also life insurance companies that will help cash out the face value of a life insurance policy to pay for care. Reverse mortgages can also be helpful if your loved senior is committed to staying at home.

As far as the safety of aging in place, technical advances in equipment help people keep their independence. For example, you’ve most likely seen TV advertisements for Life Alert; it is motion-sensitive and automatically sends its alert if there is a fall. And, a bath tub can become a low-entry shower to make bathing safer. Bed alarms and mats are available to place next to the bed, sending an alert if there is the appearance of wandering. And there are devices at this link which you can install on the stove burners to ensure they shut-off automatically, preventing fires if your mother forgets to turn them off.

You can install safety features like grab bars and non-slip mats in the bathroom and sturdier handrails on the stairs. You and your parent may feel more comfortable with her/him at home alone for a longer period of time with safety gadgets like these.

Through Medicare, an Occupational Therapist or Care Manager can come to the home and review all safety hazards. This way you can know exactly what changes are necessary to create a safer environment.

From the standpoint of maintaining personal pride for the senior who’s capable of staying home with some supportive family or the occasional visiting professional, let mom be part of scheduling or writing her checks, going over the mail, or creating shopping lists. The person who often takes the lead on these tasks is the Power Of Attorney. Perhaps there other people – a neighbor, frequently seen handy man, friend – who can influence mom’s behaviors, keeping her on track to maintain healthy habits?

Engaged family can take advantage of gerontologists, social workers, and the previously mentioned Care Manager to facilitate needs and perhaps divide up roles among those in the senior’s life who are able (or paid) to step up. For example, use others to maintain your senior’s health: keep her/him off ladders, let someone take garbage to the curb, walk the dog, move oft-used items from high shelves; the goal here is to prevent falls and accidents.

If you can afford to have someone come in to help your mother once a week then do it! Their help can go a long way to keeping your senior independent and in her own home. For example, a weekly housekeeping visit can do the tasks your mother may find exhausting or forget to do, which will keep her from overexerting or hurting herself. Weekly visits from a physiotherapist may help keep your mother physically capable.

Often the first step to keep your independent senior at home is to help mom/dad age well with a plan. Part of this is simply talking about the process of aging, something we don’t typically do before the parent loses her authority role and child becomes care giver. Have the conversation with your parent – what do you want to happen and when? Home care? Assisted living?

Another form of protection to hold onto independence is to put mom’s money in a trust, preventing the tragedy of sophisticated scammers who find so many ways to prey on someone’s fears or sympathies.

Use this link on our sister site, Aging Life Network, to find a tremendous range of resources to assist, using the values that are critical to your aging parent and family. The sooner these conversations happen, the easier the shift and ongoing care will be.

While the solutions above will lessen the sting, or even the need, for drastic changes in the life of your beloved senior, the time may come when more serious changes are needed. Yet, more than the loss of independence, much more is at play in their mind, preventing easy acquiescence with your best intentions: pride, role reversal, depression, guilt over the memory of how they were forced to care for their parents are all swirling around their brain, along with the loss of authority, credibility and autonomy I mentioned initially.

The role of guardian ad litem may represent the best interest of the senior who fears all of the above. How to determine if the time has come? Medical records, doctor’s notes, the potential risks to the senior if no intervention is taken must all be considered. Too often, by the time the guardian is called in, a desperate situation exists: rotting food, empty pill boxes, dishes piled high, no clean laundry are all signs of a need for immediate intervention.

And, when likely resistance shows up, it’s important to distinguish: is the senior simply stubborn, cognitively impaired, or under undue influence by an acquaintance?

In some cases, engagement with former hobbies or life enrichment programs can help. A strong tool is art therapy. Shown to be a powerful tool, art therapy can help your aging parent reconnect with the world.  Painting, drawing, sculpting, paper crafts, writing, poetry, music, and even dance can all be part of an art therapy program. There are many reasons to design some art therapy for your parent, or to encourage them to participate in art therapy offered by their retirement community, if, in fact, that’s where they land.

Art therapy has a variety of cognitive and emotional benefits including slowing of memory loss, combating boredom, loneliness and depression, increasing self-esteem and even having physical benefits. Art forges new neural pathways in the brain and strengthens existing connections. Calling on past events to create art improves memory. Using a variety of colors, materials and textures increases sensory stimulation and using art to convey religious beliefs can reduce depression and anxiety. And, of course, when creativity is shared with others it increases social interaction, personal expression and relaxation.

Overall, art therapy is a powerful tool to keep your parent engaged with those around them and with their own story and experiences. There are art therapists who can help you develop a program suited to your parent. Alternatively, you can find many ideas online about art therapy.

What happens if your parent has been diagnosed with mild dementia? Is it safe to leave her/him at home? People with mild dementia usually do well if they are in a stable environment they’ve lived in for a long time, especially when they maintain their established routine. When they forget things, a system of reminders can help them stay on track. For example, if you’re worried because your mother is struggling to recall your number when she wants to call you, writing it out on a sticky note and leaving it next to her telephone can solve the issue.

However, if dad can’t recall emergency numbers when he needs to, that’s more serious. The emergency number in his area has likely been the same his whole life, so forgetting it is also a sign of growing memory issues. Leaving the number on a note pad on the fridge can be helpful, but it is still a sign dad shouldn’t be living alone.

Other ways to extend senior independence? Reminders can be set-up to help navigate day-to-day tasks. You can set up reminders to pay bills with her bank, or add them to her monthly calendar. If your mother can use a cellphone you can program reminders for anything she needs, including reminders to eat dinner or to take her medication.

It’s a must to check-in on your dad regularly, as you never know when dementia may become too serious for him to be alone. It can also help your dad maintain his routine if you or another family member call on a set schedule. For example, if you find your dad is forgetting to lock doors at night you can call every evening at around the same time to prompt him to do so.

Eventually, some incidents will remind you it’s time to re-evaluate your parent’s situation. Falling, getting lost, leaving the house at night, and giving money away are all serious indications that your senior may not be safe to remain at home alone.

If you feel that despite all these support tools your senior would be best served with a guardian, please reach out to me directly for the best and healthiest way to proceed.

Celebrating Decades: the 20 teens

In October of 2017, bipartisan legislation was passed by Congress and signed by President Trump to protect seniors from financial exploitation.

The Court-Appointed Guardian Accountability and Senior Protection Act passed Congress as part of the Elder Abuse Prevention and Prosecution Act. The legislation, authored by U.S. Senators John Cornyn, R-Texas and Amy Klobuchar, D-Minnesota, strengthens accountability and oversight for guardians and conservators.

Under the new law, state courts may apply for funding from an existing program created to protect older individuals, and use the funding to assess the way the courts handle proceedings related to guardians and conservators, so that improvements can be made. Examples of potential improvements include electronic filing systems to keep tabs on guardianships and conservatorships, and the institution of background checks for guardians and conservators.

Resources:

National Council on Disability

Aging Life Network

American Association for Retired Professionals

Thiscaringhome.org

attorney Cristy Carbon-Gaul

The needs of an aging LGBTQ population is a topic that is so often not discussed yet the unique risks endured by these diverse Americans – depression, poverty, isolation, fear of authenticity, less willingness to approach institutional resources – make it an important one. One of the unique challenges is that the LGBTQ population is very much aging single; more likely to be single, without children, dependent on friends for care giving needs who, themselves, are aging at the same rate.

When older adults need care, they typically turn to a child, spouse, or other relative for assistance. LGBTQ older adults are 4 times less likely to have children and twice as likely to be single as their non-LGBTQ peers. They may also be estranged from their biological or legal family members if those people do not accept their sexual orientation and/or gender identity.

And, all the while, this diverse population has endured institutionalized discrimination and ignorance, smaller communities than the hetero-normalized adults, and fearing persecution. In 1973 the American Psychiatric Association removed homosexuality as a mental disorder and it was only very recently, in 2019, that the World Health Organization no longer classified transgender identity as a mental health issue.

So, we have LGBTQ individuals who’ve lived the vast majority of their lives in isolation, fear, legalized persecution; stigmas that have transferred to today and have created a great deal of difficulty as they age.

Some fear their connections to their family of origin; their careers, finances, and opportunity to save for retirement are likely to be less secure. And because of all the stigma of the past, thinking or being treated as ill, members of this population fear government agencies, healthcare providers and the likelihood of less than relevant treatment they’ll experience when they do reach out to available services. This can lead to a delay in care, premature institutionalization, and even premature death

The result is vastly higher risks for illness and many older LGBTQ are concerned about their healthcare and access to resources as they age; here are some alarming statistics:

 

  • Forty percent of LGBTQ adults in their 60s and 70s, as well as 43% of single, older LGBTQ individualsaged 45 to 75 years, state that their healthcare providers are not aware of their sexual orientations.
  • 65% of transgender adults aged 45 to 75 years believe that there will be limited access to healthcare as they grow older.
  • In a different survey of LGBTQ adults aged 50 to 95 years, 21% reported not disclosing their sexual or gender identity to their physicians

 

As providers and as members of a society that’s aging overall, we need to understand these obstacles, the history of a lifetime. As a result, LGBTQ individuals, who largely go into their senior years as single adults, are at higher risk for physical and mental health challenges – depression, anxiety, poverty, poor coping skills, while, at the same time, they fear accessing the resources and established systems that could mitigate these severe problems.

And it’s obvious why: History of prejudice has led to high levels of LGBTQ distrust for mental and physical health providers, social services, meal services. And, if they have to access these services, they fear expressing their needs, culture and personal history, thus living inauthentic lives with declining abilities and resources when they’re needed most.

We should all have the confidence to know we can access available resources with dignity yet to age as an LGBTQ individual is typically to deny this sense of entitlement after a lifetime of contributing to society. The result is a unique burden on this population and, in fact, a larger burden on an overall aging American society to find ways to address it.

Younger LGBTQ people are less cautious and benefit from changing laws and acceptability in growing swaths of the population. Yet, those who lived through the 1950’s- 70’s with violence and tremendous trauma found their careers were stunted, they were shunned. In fact, as I pointed out above, a large percentage have never shared their gay identity with their doctors and this alone diminishes some relevant aspect of their health care.

It’s hard for younger people who’ve seen an opening in acceptance and equality to understand the life experience of older LGBTQ Americans. And, for an aging population we need to change the focus in care communities and facilities to incorporate gender and preference inclusivity. We need to acknowledge the status of partners and caregivers of choice who may not have the traditional legal status to make choices on behalf of their companions and friends.

As a professional member of the health or caring communities, if you have not yet worked with older LGBT communities, it is recommended that you implement some best practices to make your agency generally welcoming to LGBT older adults before you move on to specific programs.

  • Improve your organization’s knowledge of LGBTQ issues
  • Consider going through formalized LGBTQ cultural competency training in order to best understand the history, language, and social and political context of the community.
  • If your organization could use a refresher, if you have never had a formal LGBTQ cultural competency training, or if you would like to learn more specifically about LGBTQ aging, request a visit the National Resource Center on LGBTQ Aging to find resources.
  • Promote inclusivity in your hiring and training policies.

On the other side of the aging population, LGBTQ caregivers make up 9% of the 34.2 million Americans caring for adults over age 50. Interestingly, LGBTQ people also become caregivers at a slightly higher rate than their non-LGBTQ peers: 1 in 5 LGBTQ people is providing care for another adult, compared to 1 in 6 non-LGBTQ people.

LGBTQ caregivers come from a variety of different backgrounds and provide care in a variety of different relationship structures, but there are some common themes in the unique needs and experiences of most LGBTQ caregivers, as well as those who are caring for LGBTQ older adults but may not be LGBTQ-identified themselves.

LGBTQ older adults, caregivers themselves, are more likely to be caring for one another in isolation, without other people involved to share the burden. Only about half of all caregivers have another unpaid caregiver to help them, and about 2/3 of family of choice caregivers, many of whom identify as LGBTQ, provide sole care (43%) or are the primary caregiver (25%).  Having just one caregiver means that the person receiving care lacks a safety net, and that the caregiver is likely to experience an increased burden, both of which could ultimately jeopardize the care recipient’s ability to age in place.

For many LGBTQ people, families of choice are the cornerstones of caregiving. These chosen families provide social, emotional and physical support, and often serve as advocates when medical needs arise. However, most families of choice are not afforded any legal recognition or protection, and service providers may not think to inquire about or include these people in their work. It is important to recognize these relationships, and to provide support in completing paperwork that ensures the wishes of the care recipient are recognized.

As you can see, special circumstances and historical discrimination have placed enormous burdens on the LGBTQ population that will continue through old age. Here are a sampling of legal aids to utilize; Decades Group can assist you with all.

The CARE Act:

In 40 states plus the District of Columbia Puerto Rico and the U.S. Virgin Islands, some version of the Caregiver Advice, Record and Enable Act is in effect. While varying from state to state, its basic premise is that hospitals are required to ask patients at admission whether they’d like to designate a caregiver.

Once named, regardless of that person’s relationship to the patient, the hospital is general required to record the name of that caregiver in medical records, inform the chosen caregiver when the patient is being discharged and give the caregiver adequate training on how to perform any medical tasks needed at home.

For our topic, it’s important to note that the Act makes no stipulations about who may be named as the caregiver – relative, friend, chosen family, etc – and the hospital must formally recognize that person as the caregiver. This link to AARP will take you to a wallet card you may wish to have with details of the Act in those states/territories where it’s been enacted.

Advance Directives

Advance directives allow an individual to ensure their wishes will be honored should they become unable to communicate or make decisions for themselves. While relevant for all adults, these are particularly important for people whose caregivers or closest loved ones are not legal relatives, often the case for LGBTQ people.

The following documents are recommended for anyone for whom their primary caregiver is not their legal next of kin (see more at Lambda Legal’s ‘Take the Power’ toolkit). Of course, Decades Group will assist and guide you with any and all these important documents:

  • Medical Power of Attorney (or Health Care Proxy)
  • Living Will
  • Hospital Visitation Directive
  • HIPAA Waiver
  • Financial Power of Attorney
  • Will
  • Written documentation of an individual’s wishes upon their death, i.e. funeral arrangements, disposition of remains, organ/tissue donation, obituary, etc.

Is it possible the current aging LGBTQ population will begin to shift attitudes and awareness when their chosen families can no longer act as care givers? Will their presence in typically hetero-normalized care facilities open awareness and attitudes? Awareness, acceptance and appropriate responsiveness to diverse populations with varied histories, cultures and needs can only serve to improve care for us all.

For more information about any of the varied forms of legal protections mentioned here, we welcome your call, no obligation is implied:
Santa Fe
505.983.7787
Albuquerque
505.345.5529

Celebrating Decades: The 70’s

June became Gay Pride Month after the Stonewall Riots, a series of violent confrontations between police and gay patrons of the Stonewall Inn on June 28, 1969. This began to build cohesive communities of LGBT New Yorkers, leading to similar organizations around the U.S.A. and the world. In June the following year, a first march for gay rights covered 51 blocks of New York City and, within 2 years, gay rights groups existed in every major American city as well as Canada, Australia and Western Europe. Throughout the ‘70’s gay activism had significant successes including the American Psychiatric Ass’n. invitation to activists to speak at the 1972 conference and the deletion of homosexuality as an illness by that group in 1973.

Celebrating 2 Decades of Service in the New Mexico Community

Resources Used:

Karen McPhail, BSN, MSN, CDP, Aging Life Network Podcast w/Nancy Oriola
Daniel B. Stewart, MSG and Alex Kent, MPA, “A Guide to Engaging and Supporting LGBT Caregivers through Programming”
Aliza R. Grossberg and George T. Grossberg, MD, “Aging LGBTQ Patients and Barriers to Care”

Jesus Ramirez-Valles, “Queer Aging”

AARP

https://psychiatryadvisor.com

It’s shocking but true: more than half the reports of elder abuse or neglect that were investigated (most recently in 2018) stem from self-neglect as reported by the Department of Health and Human Services. That’s more than the next most numerous categories— financial exploitation, emotional abuse, physical abuse and sexual abuse—combined. Self neglect can be one of the saddest circumstances that call for emergency guardianship of an elderly parent.

Surprisingly, the concept of guardianship dates back to ancient Greece and Rome yet, to this day, remains uneven in its implementation. And, while guardianship can be applied on behalf of people of any age, when it comes to guardianship of an elderly person, especially emergency guardianship of an elderly parent, a court decision may intervene. This can happen should family conflicts preclude you, as the adult child, taking on that role.

So, what is guardianship and how does it differ from other legal relationships that are designed to provide care for an elderly parent unable to provide it for her/himself? It’s often seen as a last resort option, resulting from a court hearing that confirms a medical opinion of incapacity of the elderly parent.

In New Mexico, guardianship deals with a person: their mental or physical health, nutrition, religion, education. In an emergency guardianship of a parent, it’s often recognized as a need during a holiday when adult children have arrived to discover all is in disarray – mail piled up, rotting food in the refrigerator, dirty dishes strewn about and all is just a mess. Sadly, this is not a unique situation but, in fact, quite common. The kids will then approach an elder care attorney who, when approaching the court system, will appeal for guardian ad litem who then begins an investigation into the parent’s state of mind or ability to care for her/himself.

The goal is to determine what is best for that parent’s continued health and ability to manage their living needs; a doctor, guardian, social worker will assess capacity. Essentially, the decision rests on this: the parent is in dire emergency straits and, unless something is done immediately, is vulnerable to injury or death.

And, ironically, while this position exists to avoid what could be tragic results, its implementation can be tragic as well in its upset and cost. To minimize adding additional upset, especially when deciding to implement emergency guardianship of an elderly parent, consider these steps:

 

  • Consider your own future needs when you may rely on others for care; planning can ensure that you’ll have a say in who will look after you if you ever need help.
  • Make peace with your loved ones. Judges often appoint professional guardians, so try to effect peace before problems escalate. Whatever the cost, it will likely be cheaper than a professional guardian. And, despite the feuding that may be in place now, your goal is for peace among loved ones in future, when you may depend upon them for your continued health.
  • Create one durable power of attorney for finances and another for medical care. One person can fill both roles, and you can also name your POA designee as your guardian of choice.
  • Do you know in advance who you’d like to fill this critical role? Explain to your designee how to do the job; some good insight, especially when someone else will handle your funds, can be found here.
  • And, be prudent – create checks and balances by requiring your appointee to provide a periodic accounting to another trusted friend or relative.

 

So, to be clear: with full guardianship of an elderly parent, a judge transfers the individual’s civil rights — including the right to sign contracts, make medical decisions, and choose with whom to associate and where to live — to the guardian. And, while the vast majority of guardianships maintain a conscientious relationship and responsibility to their clients, there are disasters that lead to fraud, embezzlement and conspiracy with an audience sadly vulnerable to this unscrupulous behavior.

When it’s time to place mom or dad under the care of a guardian, emergency or otherwise, here are the steps you’ll need to take:

1. Obtain a Physician’s Certificate or Doctor’s Letter

If you have a parent who you think needs emergency guardianship, you must obtain a physician’s certificate or letter. This form is a document that attests to the patient’s mental acuity and physical ability. Before that step, you might need to assess your parent given clues found throughout their home; you can learn more about this here.

2. File the Application for Guardianship

Filing the application in a probate court for guardianship is a pretty standard procedure. If the elderly person has refused medical examination you can always ask the court to order one later.  The court will undertake guardianship proceedings to determine whether you are fit to be guardian.

3. Give Notice to the Proposed Ward & Relatives

When you file the application for guardianship you will also notify the proposed ward of the application, as well as any family members or others with the legal right to know about the petition of guardianship. You can see why it’s important to make peace with family long before this emergency need arises.

4. Seek Least Restrictive Alternative to Guardianship

Are there alternatives that are less burdensome than a guardianship? One of them, Power of Attorney, is fully discussed in our free report; you’ll find it here on our home page.

If you have evaluated alternatives and have found them to not be feasible then it may very well be that guardianship is the best solution for your loved one.

5. Attorney Ad Litem / Guardian Ad Litem

If you file for guardianship, no matter what, the court has to appoint an attorney to represent your loved one, the proposed ward.  This is the Attorney Ad Litem. Their job is to do what the proposed ward, their client, wants.

If the court, or the attorney ad litem, believes more investigation is necessary, a Guardian Ad Litem may also be appointed. This person is not the guardian but is a court-appointed person who acts as the court’s eyes and ears. They are involved in the process and their job is to determine and make recommendations on what is in the ward’s best interest.

The decision to wrest complete control from the person who’s had such a controlling influence over your own life can be wrenching. When it’s not planned and is, instead, an emergency guardianship of your aging parent, it’s life changing. And then, it can become worse when conflicting interests – personal, medical or legal – feel compelled to do battle with you. It’s costly both in terms of money and state of mind for all parties which, ironically, can degrade the ability to make good choices on behalf of the aging parent whose decline was the impetus for this changing scenario.

As a long-time professional guardian, I’m one of fewer than 100 Certified Master Guardians in the United States. I welcome your call; no obligation is implied:

Santa Fe
505.983.7787
Albuquerque
505.345.5529

Celebrating Decades: The 80’s

The first guardianship symposium was held in 1988, leading to the National Guardianship Network. Professionals who recognized the problems of aging adults, unable to properly make decisions or care for themselves, combined with a huge boomer population destined to become elderly, led to this historic event. Over time, the Network has tackled standards, reform and federal responsibilities to an aging population. To learn more, click here. If you wish to explore this role, either for yourself or a loved one, please connect with me, either at the phone numbers above or here.

Resources Used:

National Guardianship Network, Aging Life Network podcast

https://aginglifenetwork.com/national-resources/

AARP

For Attorneys

Are you a senior or older adult with questions about how the Affordable Care Act may affect you?

The Affordable Care Act requires everyone to have health insurance coverage. If you are already enrolled in Medicare, Medicaid, or if you have employer-based health insurance, you already have coverage and don’t have to make any changes. If you are not currently enrolled in any of these programs and you don’t have health insurance, you will need to obtain coverage or pay a penalty.

You can purchase insurance through the Health Insurance Marketplace, and depending on your income you may qualify for assistance to pay your monthly premium. Premium assistance is only available to those not eligible for Medicaid who purchase health insurance through the Marketplace.

There are four ways to apply for Marketplace coverage:

  1. Paper Application. You can fill out a paper application and mail it in. You will receive an eligibility notice by mail. The paper application is available at healthcare.gov
  2. Apply Online. While the Marketplace website experienced technical issues when first launched, you can now apply online in four steps. Visit healthcare.gov to get started.
  3. Apply by Phone. To apply by phone, call 1-800-318-2596, 24 hours a day, 7 days a week (TTY: 1-855-889-4325). A customer service representative will work with you to complete the application and enrollment process.
  4. Find in-person help. In all states, there are people trained and certified to help you review your coverage options and enroll in a Marketplace plan. Visit LocalHelp.HealthCare.gov to find help in your area. Additionally, Decades can provide in-person help to clients and their families.

Three important dates to keep in mind are January 1, 2014: All individuals are required to have health insurance by this date, December 23: The deadline to file an application for coverage starting in January and March 31, 2014: Marketplace open enrollment ends.

If you have more questions about what the Affordable Care Act means for you, Decades can help. Our team offers free consultations so you can learn about the services that we offer, including medical advocacy and care management.

Have you noticed that your parent or elder adult in your family is acting differently lately? In some cases, changes in behavior can mean that an elder loved one suffered an Acquired Brain Injury. Understanding and recognizing the warning signs can help ensure senior family members receive the care they need.

An Acquired Brain Injury (ABI) can happen in day-to-day life from:

  • Falls
  • Motor vehicle accidents
  • Motorcycle accidents
  • Heart attack-respiratory arrest
  • Stroke

More unusual causes of ABI can include gunshot or knife wounds, near drowning and anaphylactic shock (a serious allergic reaction). An ABI can effect an individual’s memory, ability to execute tasks, and can prevent them from taking appropriate initiative, like paying their taxes on time.

Early signs of behavioral changes include restlessness, tardiness, and increased confrontational or argumentative behavior. These warning signs can escalate to more dangerous behaviors including property destruction, pushing or shoving, increased use of alcohol and refusal to do normal tasks or activities.

If you notice these behaviors in a senior family member, it’s time to ask for help. There are many options available to families. One place to start is with a Decades professional geriatric consultation. Coordinated by a licensed professional, consultations can take place in the home or at the Decades office. Following the consultation, Decades will provide a detailed written report covering options, local resources and services that are most appropriate for the individual situation.

To learn more, read about our consultation services here, or contact us.

National Guardianship Conference LogoHeld annually by the National Guardianship Association, the National Conference on Guardianship is the largest gathering of guardianship organizations in the United States. Decades participated in the 25th annual conference in October, attending cutting-edge presentations and bringing back knowledge on today’s top concerns in guardianship.

While we attended many informative sessions, the highlight of the conference was an interactive Guardianship Scene Investigation where we “walked in the shoes” of a person under guardianship. One of the most challenging aspects of serving as a professional guardian is gathering information about the person under guardianship. The more we know about a person’s history, the better we can ensure we make decisions that are both in their best interest and reflect their wishes.

During the Guardianship Scene Investigation, our team learned how to obtain knowledge from items found among a person’s property, when they are unable to speak for themselves. By taking clues from items like documents, medical equipment, hidden treasures, cultural indicators and lifestyle objects, we can build a better picture of the person.

Scene investigation skills are vital when we work with elder adults who have become mentally or physically incapacitated. It’s also important for families and elder adults to be educated on the options available to them before a situation arises where they can no longer speak for themselves. One way to ensure your wishes are followed is through the Decades Springing Care program. You and your family can establish a plan that Decades will execute on your behalf in the event of a serious medical condition or other emergency. To learn more, download our Springing Care flyer here.

by Paula Span, New York Times

The chilling dilemma of “the unbefriended elderly,” who don’t have family or close friends to make medical decisions on their behalf if they can’t speak for themselves, generated a bunch of ideas the last time we discussed it.

One reader, Elizabeth from Los Angeles, commented that as an only child who had no children, she wished she could hire someone to take on this daunting but crucial responsibility.

“I would much rather pay a professional, whom I get to know and who knows me, to make the decisions,” she wrote. “That way it is an objective decision-maker based on the priorities I have discussed with him/her before my incapacitation.”

Elizabeth, it turns out other people have been thinking the same way.

A few years back, Elena Berman, a retired administrator at the University of Arizona, was trying to put her own paperwork in order and wondering about her health care proxy. She’s single and has no children, and her only sibling lives halfway across the country.

“When I tried to think whom I might ask to fill this position, no relative came to mind,” she told me in an interview. Two friends agreed to be her decision-makers, but they are about her own age. “That’s great if I die in five years or so,” said Dr. Berman, who is 66. “But after that, it’s up for grabs.”

With people living longer and families having fewer children, she pointed out, “I see this as a growing population.”

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Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”