Chronicles of a Professional Guardian

 

Serving the community as a Professional Guardian for over 20 years, I’ve had to discover unique solutions to many difficult problems. I’ve decided it is time to give back, and share some of my knowledge. It is my hope that this information can help others provide better services and care to our elderly and disabled population.

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Aging Gracefully – Planning for Life’s Changes as we Age

 

Life is supposed to get simpler as we age, but many times this isn’t the case, especially when faced with challenges surrounding physical and mental deteriorations and illness.

 

One large challenge looming in the distance for many is Alzheimer’s disease. It is currently estimated that as many as one in eight adults over the age of 65 has Alzheimer’s; what’s more that projection is estimated to increase drastically in coming years.

 

The Alzheimer’s Association predicts that when the first wave of the baby boomers reach 85 years old (2031), an estimated 3.5 million people aged 85 and older will have Alzheimer’s. The rate of increase of Alzheimer’s in Florida alone is projected to increase to 65% by 2025 (Florida was at a rate of 25% in 2010).

 

With projected rates such as these, there is a high likelihood that you, or someone you know and love, will be affected Alzheimer’s or some other age related disease. Taking the time to put a plan in place now, before these challenges occur, can help alleviate family stress, preserve funds, and can ensure continuity of care for ever changing care needs.

 

When faced with the challenges of cognitive loss, creating a plan of action early, while the individual can still voice their concerns, needs and wishes, can be an important and powerful ally.

 

Here are just a few of the many things which need to be considered.

 

Health Care & Financial Decisions

 

Who will make health care and/or financial decisions when the individual is no longer able to do so?

 

Get the individual’s wishes on paper as early as possible. This information will be invaluable when the time comes and the person can no longer voice these wishes themselves.

 

Consider meeting with an elder law attorney to make sure that affairs are in order. An elder law professional can help you understand your various options. While you’re there, discuss having a will, living will, health care surrogate designation, and power of attorney drawn up.

 

If the individual loses capacity completely, is there anyone in the family / support circle that is willing to become the Guardian for that person?

 

Care Needs

 

What is the plan when the individual cannot provide adequate care to themselves? Is there a spouse capable of providing care? If not, are there family and friends who can help provide care?

 

It is important to realize that taking on the care of someone with ever changing mental and physical needs is a huge responsibility and a complicated full time job. If possible, no one person should be burdened with this responsibility.

 

If there are not enough people to provide adequate care coverage, then a plan needs to be put in place. Hiring a caregiver to provide care can be a good solution, but is costly.

 

Living Environment

 

Is the current living environment suitable if a decline occurs? Are there stairs or other obstacles which may be impossible to navigate with a wheelchair or walker? Are the doorways of the home wide enough to accommodate a wheelchair or walker?

 

Does the individual live at home? Is the home the most appropriate care environment? Will this be a safe, long term solution? Is the home the most cost effective care environment (remember to factor in the extra costs of caregivers, transportation to appointments, and other services)?

 

While often preferred, remaining at home is not always the safest and best alternative for someone with mental or physical limitations. When evaluating whether it is a better plan for the individual to stay at home, or move into a facility, remember to consider the complete costs of staying at home, including the cost of increased care through caregivers, transportation costs for doctors’ appointments, and more, along with the base amount it costs to keep the house running (mortgage / rent, bills, etc.).

 

Depending on the individual and their needs, it may be far more cost effective to consider a move to a facility where care is provided in house. Facility living often includes the value of increased socialization, too.

 

These are just some of the many things to consider when planning for an elderly and/or disabled loved one. And while you may not have a crystal ball that shows you the future, planning for drastic changes now, while the individual is still able to voice their needs and concerns, is one of the most important things you can do now (and it has the added bonus of preserving your sanity later).

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Tip of the Month

 

The Florida Department of Motor Vehicles has an Emergency Contact Information system where you can add emergency contact information to a person’s driver’s license or state ID.

 

Once setup, law enforcement will use this information if there is ever an accident or emergency involving that person. This is great for all drivers, but is particularly helpful to setup for elderly or teenage drivers.

 

To setup your emergency contact information, or for more information, please visit https://www8.flhsmv.gov/eci/

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Did You Know?

 

You can use a found credit card to request a copy of the client’s credit report.

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Upcoming Events

 

As active members of the community, you can often find us around town speaking and educating professionals and the public on Guardianship, and caring for the elderly and disabled. Here’s where we’ll be next.

• 2/02/12 Presentation for Chai Steppers at the JCC Rosen Campus

If you would like Theresa Barton to speak at one of your events, contact us at 407.786.6033. Don’t delay, call today as her schedule fills up quickly!

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Do What You’re Great At and Love —   Let Us Handle the Rest!

Guardian Care Management & Benefits Services, Inc. provides:

• Professional Guardianship Services
• Private Case Management
• Benefits Consulting & Medicaid Applications
• Full Guardianship Support Services

We can help, call us today!

407.786.6033

Chronicles of a Professional Guardian

 

Serving the community as a Professional Guardian for over 20 years, I’ve had to discover unique solutions to difficult problems. I’ve decided it’s time to give back, and share some of my knowledge. It is my hope that this information can help others provide better services and care to our elderly and disabled population.

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Associating Alzheimer’s

 

Throughout the day, you may forget little things, like where you left your car keys or glasses, and that’s okay. In fact, it’s normal to forget these things from time to time. And, as you age, small declines and changes in your memory are considered normal too. It is only when these declines and changes are significant that there may be reason to be concerned.

 

But how do you know when your memory loss is normal, or a sign of something more serious, like Alzheimer’s disease?

 

Normal age-related changes are slow, gradual, and most importantly, occasional. It is okay to forget something like paying a monthly bill or misplacing an item, as long as it happens every once in a while. Similarly, it’s okay to forget things like today’s date, or the proper word in a conversation, as long as it is infrequent. With normal age-related memory loss, items like these will often be remembered later in the day, or the next day.

 

In contrast, Alzheimer’s disease is more than just misplacing your glasses and finding them on your head later. With Alzheimer’s, there is no “remembering later.” Abnormal and serious memory loss means that when you misplace an item, you are unable to retrace your steps to determine where you lost the item in the first place.

 

The Alzheimer’s Association estimates that in 2011, over 5.4 million people have Alzheimer’s disease. What’s more, they estimate that 1 in 8 American’s over the age of 65, and nearly half the population aged 85 or older, has Alzheimer’s.

 

In light of these numbers, they have put together a list of the 10 early warning signs of Alzheimer’s disease.

 

1. Memory Loss Disrupts Daily Life: Forgets recently learned information, including important dates or events; asks for the same information over and over again; relies on memory aids (reminder notes, electronic devices) or family members for items they used to handle on their own.

 

2. Challenges with Planning / Problem Solving: Has difficulty following a familiar recipe or keeping track of monthly bills; has difficulty concentrating and takes much longer to do things they did before.

 

3.Difficulties with Familiar Tasks: Difficulty completing familiar tasks at home, work, or leisure like driving to a familiar location, or remembering the rules to a favorite game.

 

4. Time / Place Confusion: Loses track of dates, seasons, and time. May have trouble understanding something if it’s not happening immediately. Forgets where they are, and how they got there.

 

5. Difficulties Understanding Visual Images & Spatial Relationships: Vision problems, including difficulties with reading, judging distance, or determining color and contrast.

 

6. New Difficulties with Speaking / Writing: Difficulties joining or following a conversation; stopping in the middle of the conversation and forgetting how to continue; repetition of words; having problems finding the right word; calling items by the wrong name.

 

7. Difficulties Retracing Steps: Inability to retrace steps after misplacing an item. Frequently accusing others of stealing items the individual misplaced.

 

8. Decreased / Poor Judgment: Changes in judgment when it comes to money (such as giving large amounts of money to telemarketers), difficulties with grooming; difficulties determining the need to bathe / groom.

 

9. Social Withdrawal: Withdrawal from social activities and hobbies; inability to keep up with and follow a favorite sport or complete a favorite hobby.

 

10. Changes in Mood / Personality: Drastic changes in mood or personality; becoming increasingly confused, suspicious, depressed, fearful, or anxious; becomes easily upset at home, at work, or with family and friends.

 

Of course, these are the typical signs and individual changes and warning signs may vary. If you or someone you know is experiencing changes in memory, mood and behavior, please consult with your physician as soon as possible.

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Tip of the Month

 

When you go to the hospital may not be considered admitted for treatment until the doctor writes the order admitting you, even if you are receiving services such as labs, x-rays, or surgery. Even an overnight stay at the hospital can still be classified as outpatient for observation until the admittance order is written. Hospital physicians can perform observation services as an outpatient service to decide whether or not the individual needs to be admitted.

 

The problem is observation services can have far reaching insurance ramification, and drastically affect how much you pay out of pocket for hospital services, particularly if you are on Medicare. If you are in the hospital for more than a few hours, ask your doctor or hospital staff whether you are classified as inpatient treatment or outpatient observation.

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Did You Know?

 

That you can request the exam committee see the alleged incapacitated person in the location they are found. You may also request that each committee member see the individual separately.

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Upcoming Events

 

As active members of the community, you can often find us around town speaking and educating professionals and the public on Guardianship, and caring for the elderly and disabled. Here’s where we’ll be next.

•  1/19/2012 What is Guardianship / Care Management Presentation / training for Comfort Keeper’s Caregivers
• 1/28/12 Lake Mary Shred-a-Thon Sponsor – Lake Mary Senior Center
• 2/02/12 Presentation for Chai Steppers at the JCC Rosen Campus

 

If you would like Theresa Barton to speak at one of your events, contact us at 407.786.6033. Don’t delay, call today as her schedule fills up quickly!

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Do What You’re Great At and Love —   Let Us Handle the Rest!

Guardian Care Management & Benefits Services, Inc. provides:

• Professional Guardianship Services
• Private Case Management
• Benefits Consulting & Medicaid Applications
• Full Guardianship Support Services

We can help, call us today!

407.786.6033

Chronicles of a Professional Guardian

 

Serving the community as a Professional Guardian for over 20 years, I’ve had to discover unique solutions to difficult problems. I’ve decided it’s time to give back, and share some of my knowledge. It is my hope that this information can help others provide better services and care to our elderly and disabled population.

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Giving Back

Image Credit: S_H / stock.xchng

 

December is in full swing, and while most of us are gearing up for holiday feasts and celebrations, there are many seniors in Florida (and all over the country) who won’t know the joy of the holidays.

 

For these seniors the holidays can be a cold and lonely time. They see everyone else in their facility visiting with family and friends, and receiving presents, yet they’re sitting in the corner, watching out the window for family who will never appear. They wait longingly for the mail, hoping to receive a card, letter, or package from someone showing they care, yet day by day they end up empty-handed and broken-hearted.

 

And then there are the seniors who don’t have any family, the ones who have no one to share the joy of the season with. In a season meant for giving, can’t we find it in our hearts to give a little more to someone who desperately needs it?

 

The holidays do not need to be this lonely for seniors. There are many ways that we can give back to the generation that has sacrificed so much for us.

 

Donate Gifts

 

If you are short on time this season, one of the ways you can give back to the seniors in our community is to pick up something extra when you’re out shopping, and then donate it to an organization running a senior gift drive. You may also donate them to Assisted Living Facilities and Skilled Nursing Facilities, for the staff to provide to their less fortunate residents.  *Important note: Do not just drop items off at random facilities. Call to inquire if they could use the supplies before delivering.*

 

Common items needed by seniors include:

• Blankets
• Robes / Pajamas / Slippers
• Sweaters
• Toiletry items such as shampoo and conditioner, soap, and lotion
• Gift cards to grocery and retail stores for food and personal supplies
• Treats like holiday chocolate and candy (This is more of a want, but is still nice to receive!)

 

Volunteer

 

If you have a little free time to spare, volunteer at an organization that helps with seniors in need. There are many community organizations aimed at helping seniors, who need help to provide these services.

 

Meals on Wheels – Meals on Wheels is a program which most counties have, that delivers meals to at-home seniors in need. They are often in need of drivers. If you have reliable transportation, and a few hours (regularly) that you can volunteer, this may be a good match. Contact your county’s Meals on Wheels program today to inquire about how you can help.

 

Hospice – Hospice is an organization that provides end-of-life care, whose aim is to make people comfortable during their last days. Many hospice organizations need volunteers to spend time with these individuals, and their families. Contact your local Hospice organization today to see how you can help.

 

Local Skilled Nursing Facilities – Skilled Nursing Facilities (SNFs) are facilities that provide a high level of medical care to their residents. The people in SNFs are often there because they require extensive care (such as with bed bound individuals), or because they are staying for rehab and recovery (such as after a fall / broken hip). Sometimes SNFs use volunteers to run social activities, like BINGO. Contact your local SNF today to inquire about their volunteer needs.

 

Websites for Volunteer Opportunities

http://www.volunteermatch.org/

http://www.handsonorlando.com/

http://www.seniorsfirst.org

 

Spend Time

 

The best gift of all requires no money – the gift of time. Spending a little time with a senior can make a big impact in the quality and longevity of their life.

 

This can be as simple as reaching out to an elderly neighbor, and visiting with them more often. Or, if you know they are going to be alone for the holiday, invite them over for dinner. There is usually more than enough food to go around anyway, so what is one more person at the table?

 

Also, many of the organizations mentioned above (and more) need volunteers to socialize and spend time with seniors. Often, this requires little more than just having a conversation with a senior, or spending some time walking around outside with them (if they are able).

 

These are just a few ways you can help seniors in need this holiday season. But, you don’t have to wait until the holidays to spread some much needed cheer and love to a senior. These suggestions for showing love and compassion can (and should) be used throughout the year to help bring joy and cheer to seniors in the community.

 

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Tip of the Month

There are 10 common medications with patents that expire in 2011 and 2012. Once the patent expires, companies are allowed to make generic versions of the same medication. This could mean big savings for those taking these drugs.

 

The list includes Lipior, Zyprexa, Levaquin, Seroquel and more. For a complete list, visit:

http://www.dailyfinance.com/2011/02/27/top-selling-drugs-are-about-to-lose-patent-protection-ready/

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Did You Know?

 

The Medicare donut hole can be filled totally and permanently (and not with raspberry-cheese filling) when dual eligibility of both Medicare and Medicaid is obtained, even if the individual is over income and/or over assets?

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Upcoming Events

 

As active members of the community, you can often find us around town speaking and educating professionals and the public on Guardianship, and caring for the elderly and disabled. Here’s where we’ll be next.

 

• 12/9/2011 – Seniors Christmas Banquet hosted by the Seniors Intervention Group – Table Sponsorship – Timacuan Country Club, Lake Mary, FL

 

If you would like Theresa Barton to speak at one of your events, contact us at 407.786.6033. Don’t delay, call today as her schedule fills up quickly!

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Do What You’re Great At and Love —   Let Us Handle the Rest!

Guardian Care Management & Benefits Services, Inc. provides:

• Professional Guardianship Services
• Private Case Management
• Benefits Consulting & Medicaid Applications
• Full Guardianship Support Services

We can help, call us today!

407.786.6033

Chronicles of a Professional Guardian

 

Serving the community as a Professional Guardian for over 20 years, I’ve had to discover unique solutions to difficult problems. I’ve decided it’s time to give back, and share some of my knowledge. It is my hope that this information can help others provide better services and care to our elderly and disabled population.

 

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How to Remove Your Client’s Shoes (Or Anything Else They Can’t Have)

Image Credit: nkzs / stock.xchng

 

Working to serve and protect the elderly and disabled population, Guardians have to regularly make difficult decisions regarding the safety of their clients.

 

Sometimes these decisions are easy, such as the decision to move a client from a facility when they are receiving substandard care. Other times, the decision can be downright difficult, particularly when it involves something the client doesn’t want to do in the first place, like giving up something they have loved for years.

 

We once had a client who loved high heeled shoes. For her, these shoes were a part of who she was and how she presented herself to the world. She simply could not imagine wearing any other kind of shoe.

 

One day during a podiatry appointment, the podiatrist informed us that due to fall risks our client would no longer be able to wear high heels. Judging by our client’s reaction, you would have thought that we told her we had to remove her foot (and maybe to her it felt this way).

 

After the appointment, a small battle ensued – the battle to remove the high heeled shoes. For a while, it truly was a battle, because no matter what we tried, the client always found a way to get her hands on the shoes she loved the most.

 

We tried removing all the shoes from her room. She convinced her caregiver to take her out to buy more. Once we got the caregiver to understand the issue with heels, and the client realized she didn’t have this ally any more, she found other ways to buy them, like during facility outings. She even tried to reason with us, “these aren’t heels, they’re platforms. That’s different.”

 

In the end we were able to switch the client to flats, and help protect her from fall risks, but it was not easy. It took every trick in the book, and then some, to finally get the change to stick.

 

Here are the four big lessons we learned from this client, and many others, about making a big change easier for all involved.

 

1.      Is the change really in your client’s best interest?

 

When removing potentially harmful items from the client, the first thing you should assess is whether or not the change is really in the client’s best interest.

 

If you are removing something because of a known and eminent danger, such as with an increased fall risk with high heeled shoes, you are probably acting in the best interest of the client.

 

However, if you are removing something because of your own beliefs, you may not be acting with the client’s best interest in mind. A good example of this is with clients who smoke.

 

Yes, it has been proven that smoking poses long-term health risks. However, if your client has smoked a pack a day since they were 15, and you’re making your client quit because you don’t like that they smoke, are you really acting with the client’s best interest in mind?  What would your client choose if they were still able to make these decisions on their own?

 

2.      Try to Explain the Situation

 

Regardless of the client’s mental or legal status, it is important to remember that your client is a person with their own needs, wants, and desires. It is common, human decency to have a conversation with the client and explain why the change is necessary, particularly when they are able to have a conversation such as this.

 

A conversation also allows you to gauge the client’s reaction about the change, and could give you some important insight into how difficult the change will be for the client. You may find that the issue is a hot button that causes them to react every time it’s mentioned, or you may find that they readily accept what is happening. Every client is different, and as such, every reaction is different.

 

3.      Create Reminders

 

Removing something your client loves and has always used (like high heels) can be a daunting and difficult task, particularly for Alzheimer’s or dementia patients. Creating signs and reminders can be a good way to help clients remember what they cannot have, and why.

 

Signs are helpful for clients who mostly accept the change, and can act as a gentle reminder, guiding them to what they should be doing.

 

However, signs can be problematic for those clients who are angry and upset about the change. Use your best judgment when determining if signs and reminders will be helpful to your client.

 

Signs should be straight forward and to the point. A sign with too much writing or unnecessary information can confuse the client. Keep it simple!

 

4.      Get the Support Circle Involved

 

One of the most important aspects to ensuring a smooth transition is to make sure that everyone in the client’s support circle is aware of the change. The client’s support circle includes their caregivers, facility staff, physical therapists, family, friends, and anyone else who spends time with the client.

 

It is important to inform people within the support circle of the change, what it involves, why the decision was made, and how the client feels about it. Giving them this last bit of information can be particularly helpful when the change is a hot button for the client.
When the client’s support circle is in the know, the transition becomes smoother because they are aware of the potential issues the change could cause. It also helps people know how to react when the client brings this issue up.

 

 

For many clients, guardianship often brings big changes into their lives, changes they may not be prepared for. Charged with their care, it is our responsibility as Guardians, and as elder professionals, to help make these changes as painless as possible when we can. It is our hope that these tips can help make the change a little easier for someone out there.

 

What about you? What steps do you take to make big changes easier on your clients? Is there a trick we didn’t mention that you’ve found works well for you?

 

On a side note, this story was inspired by a wonderful client of ours (G.G.) who passed away in early October. We had the honor of knowing and caring for her for over five years. Despite the challenges, she taught us a lot. She will be missed.

 

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Tip of the Month

 

New rules with Wachovia will require that you must list the Estate as a beneficiary in order for the IRA to payout to the Estate after the individual passes away.

 

Due to Wachovia’s rules, if there are no beneficiaries listed on the IRA, the IRA custodian can designate one, and it doesn’t have to be the Estate. This can cause big issues in cases where the IRA custodian is not the Personal Representative of the Estate and designates the funds to a person other than the Estate.

 

Wachovia isn’t the only bank with these rules. The information about IRA payouts can be found in the disclosure paperwork.

 

However, it is generally wise to make sure that your beneficiaries are listed properly and are up-to-date on any account or policy with a payout. You should do this every couple of years, or after a major life change such as divorce or death of a spouse.

 

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Did You Know?

 

An estimated 55 million Social Security recipients will receive a 3.6 percent increase in benefits starting December, 2011 (payable January, 2012). This is the first increase since 2009, and is a cost-of-living adjustment (COLA). This increase is estimated to help one in five U.S. residents.

 

Click hear to read more about this increase from SSA.

 

Click here to read the Associated Press article about this increase.

 

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Upcoming Events

 

As active members of the community, you can often find us around town speaking and educating professionals and the public on Guardianship, and caring for the elderly and disabled. Here’s where we’ll be next.

 

• 11/09/11 Access Charter School along with Florida Bank of Commerce – Presentation to Autistic Parents
• 11/12/11 Central Florida Paralegal Association – Presentation about Guardianship
• 12/09/11 Senior’s Intervention Group Seniors Christmas Banquet – Sponsor for Event

 

If you would like Theresa Barton to speak at one of your events, contact us at 407.786.6033. Don’t delay, call today as her schedule fills up quickly!

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Do What You’re Great At and Love —   Let Us Handle the Rest!

Guardian Care Management & Benefits Services, Inc. provides:

• Professional Guardianship Services
• Private Case Management
• Benefits Consulting & Medicaid Applications
• Full Guardianship Support Services

We can help, call us today!

407.786.6033

 

Chronicles of a Professional Guardian

 

Serving the community as a Professional Guardian for over 20 years, I’ve had to discover unique solutions to difficult problems. I’ve decided it’s time to give back, and share some of my solutions. It is my hope that this information can help others provide better services and care to our elderly and disabled population.

 

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The Cat Has to Go!

Image Credit: hisks / stock.xchng

 

Remember our 98 year old lady who swore she couldn’t live without her cat, “Lovely.” (If you don’t remember you can read last month’s story here.)

 

We placed the woman and her cat at a facility and everything was fine for a year. However, a staff change resulted in two new caregivers, sisters, who come from a culture that believes cats are the devil reincarnate. Their beliefs caused the client’s care to suffer.

 

We were faced with a dilemma – what to do in this situation?

 

A few readers pointed out that regardless of the caregiver’s beliefs, the facility contract outlines the stipulations for care for both the client and her room, and the facility should uphold their agreement.

 

While this solution is great in theory, life isn’t always black and white. The facility is a small facility with only two or three caregivers total. They could not easily shift the care responsibilities to another caregiver the way a larger facility could.  Trying to change the caregiver’s perspective about the cat wasn’t going to work either, because of the deep-rooted nature of their beliefs.

 

Additionally, we didn’t want to move the client because her rent was a fair rate, and the care was good outside of this new cat issue. And since the client had called the facility home for over a year, we didn’t want to move her because big changes can be detrimental to Alzheimer’s and dementia patients.

 

So what did we do?

 

In the end, we decided it was best to keep the client at her facility, so we tried an experiment. We arranged to have the cat stay away from the facility for a few days, to see how the client would react.

 

Since our client was adamant that she would not go on living without her cat we expected the worst – an outcry about the cat being removed, daily phone calls from the client, something. Instead, there was no reaction.

 

As it turned out, our client’s dementia had progressed to the point that she wasn’t even aware that Lovey was gone. Instead, she thought that the stuffed kitty on her bed was her real, live kitty.

 

But now that we had solved this issue, we had one more hurdle to jump – what to do with Lovey long term?

 

Turning an animal over to a shelter should always be a last resort. As animal lovers, shelters are never an option for our client’s pets. Instead we turned to the client’s family, friends, and once those were exhausted, our staff. Eventually we found Lovely a perfect place, and now there’s one more at the Barton home!

 

Our simple quick test turned out to yield the perfect results. In what ways do you experiment to obtain the best possible outcome for your clients?

 

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Tip of the Month

 

Due to increased fraud, the Social Security Administration (SSA) is now performing Centenarian Reviews for individuals 100 or older.

 

Typically, the SSA will contact the Representative Payee to request a face-to-face meeting (if possible). If the centenarian cannot speak for themselves, a representative is allowed to attend the meeting to speak on their behalf.

 

For more information about the scheduling process and SSA’s procedure, click here.

 

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Did You Know?

 

Palm Beach County’s clerk, Sharon R. Bock, recently announced the creation and launch of their Guardianship Fraud Hotline.

 

This service was setup to protect the elderly population of Palm Beach. They urge “anyone who suspects a guardian, family member, attorney or caregiver of improper activities such as stealing money from a ward’s account, selling off a ward’s property, or making suspicious loans or money transfers is urged to report it to the hotline.”

 

The service allows people to make reports via phone, email, or by reporting it online. Click here to read more about this service.

 

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Upcoming Events

 

As active members of the community, you can often find us around town speaking and educating professionals on Guardianship, and obtaining care and services for the elderly and disabled. Here’s where we’ll be next:

 

10/06/11 Rotary Presentation – Wyndham Lake Buena Vista Resort

10/08/11 New Life Church – Health Event, Speaking Engagement

11/12/11 Central Florida Paralegal Association – Presentation

 

If you would like Theresa Barton to speak at one of your events, contact us at 407.786.6033. Don’t delay, call today as her schedule fills up quickly!

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Do What You’re Great At and Love —   Let Us Handle the Rest!

Guardian Care Management & Benefits Services, Inc. provides:

• Professional Guardianship Services
• Private Case Management
• Benefits Consulting & Medicaid Applications
• Full Guardianship Support Services

We can help, call us today!

407.786.6033

 

Chronicles of a Professional Guardian

 

Serving as a Professional Guardian for over 20 years, we’ve decided it’s time to share some of our tips when it comes to caring for the elderly and disabled.

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Clients and Pets: A Dilemma

 

 

Clients with pets have their own unique set of challenges. Can the client care for the pet themselves? Do you need to hire someone to care for the pet? What happens to the pet if the client can no longer take care of it, or if the client passes away?

 

While pets bring about their own challenges, these challenges are further complicated when it comes to finding appropriate residential placement for both the client and the pet.

 

When a pet is involved, especially in a facility setting, it is crucial to create an additional plan of care which highlights who is responsible for the care of the pet and when. Here are just a few things to think about when considering placement:

• Does the facility allow pets, but has a hands-off policy when it comes to caring for the pet?
• Will the facility provide any care to the pet? If yes, what and when?  To what extent will they care for the pet? Get specific answers as to what days and times the facility will be responsible for pet care.
• Does the facility have an extra charge for pet care?
• Will you need to hire an agency caregiver to help with pet care?
• Are these plans within the client’s budget?

Some other important questions include: what happens when the care promised isn’t equal to the care received or needed? What is the back-up plan for the client and the pet when all else fails?

 

Imagine this scenario:

 

You are the Plenary Guardian of a 98+ year old elderly woman, who has a 12-year-old kitty. The woman is very attached to her cat, so much so that she swears she will not go on living without “Lovey”.

 

You place the client in a small, family run ALF that will allow the cat, but will not provide any pet care. A contingency plan is created which involves hiring an agency caregiver to provide pet care, including: brushing the cat, cleaning the cat box, and taking the cat to the groomer and vet as needed.

 

With a plan in place, the client moves into the small ALF, and all is fine for one year. Then, during a visit, you notice both the client and her room are in horrible condition.

 

You discover that the facility has just changed a majority of their staff. The new facility caregivers are sisters from a culture that considers cats to be agents of the devil.  They are very scared of the client’s black kitty, and will not enter the client’s room if they know the cat is in there. Because of these beliefs, the client’s care, as well as the cat’s care, is suffering.

 

So, what do you do? Share your thoughts by commenting below. We would love to hear how you would handle this situation if this were your client.

 

Remember to stay tuned for the answer, which we’ll send out next week, so that you can see exactly what we did in this situation.

 

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Tip of the Month

 

Effective August 15, 2011, the Social Security Administration (SSA) announced a nationwide reduction in its public hours by 30 minutes each day. Offices typically open until 4 pm will now close at 3:30 pm.

 

This is part of an overall budget strategy by the SSA to reduce worker’s overtime. Read the SSA’s press release for more information: http://www.ssa.gov/pressoffice/pr/fo-close-early-pr.html

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Did You Know?

 

That there are at least one million cases of shingles in the U.S. every year? And that the likelihood of contracting the virus increases over the age of 50?

 

A shingles episode can be extremely painful, particularly for our elderly population. But should you push for your clients to be vaccinated?

 

Dr. Ivan Castro, named Central Florida’s “Top Doctor” of Internal Medicine, addresses what shingles is, proper treatment, and the pros and cons of vaccination throughout different age groups, in his most recent article: http://privatehealthmd.com/news/?p=248

 

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Do What You’re Great At and Love —   Let Us Handle the Rest!

Guardian Care Management & Benefits Services, Inc. provides:

• Professional Guardianship Services
• Private Case Management
• Benefits Consulting & Medicaid Applications
• Full Guardianship Support Services

We can help, call us today!

407.786.6033

 

Chronicles of a Professional Guardian

 

Serving as a Professional Guardian for over 20 years, we’ve decided it’s time to share some of our tips when it comes to caring for the elderly and disabled.
 

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The Changing of the Guard: Changing Representative Payees

 

The Tip of the Month for July provided information regarding Social Security and becoming a Representative Payee. If you haven’t read this information, please do so now before continuing with this month’s story.
 
While being a Social Security Representative Payee for someone can be a good thing, it can also be problematic, especially after the client dies, or when there is a change of legal authority. When events like these happen, do you know who is responsible for the client’s funds?
 
You are, as the current Rep Payee. At least until a new Rep Payee is recognized by Social Security, and the funds are re-routed to the new Rep Payee.
 
This process can take time, up to a month or two, if the new representative is not quickly recognized as the Rep Payee by Social Security (for whatever reason). During this time you are responsible for the client’s funds, including the spending and reporting of funds.
 
One suggestion for expediting the change of Rep Payee is to make the change yourself as soon as the event happens. This means as soon as the client passes away (and you know someone else is going to be the personal representative of the estate), or as soon as a change in legal authority happens, you take the direct action and notify Social Security.
 
Making the change yourself has several benefits. First, you maintain peace of mind knowing the change has been made. Second, you have a concrete date of notification, which gives you a rough idea as to when the change will happen (typically within one to two pay cycles). Third, you don’t have to wait around assuming the new Rep Payee made the change.
 
To make this change, send a letter Return Receipt Requested to the Social Security office defining the reason for the change. Remember to include proof of the reason for the request (death certificate and name of the estate’s attorney, successor guardianship order, restoration of rights order, etc.). Representative Payee changes cannot be made without proof.
 
Ultimately, it comes down to responsibility. As someone’s Representative Payee, you are responsible for their Social Security funds, regardless of whether that person is alive or not, until a change or reimbursement has been made with Social Security. Being proactive now, at the onset of a large change, ensures that in the event anything happens, it doesn’t happen “on your watch,” for Social Security will already be notified of the pending changes.
 

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Tip of the Month

 
Some hospital stays are now at risk of not being covered by Medicare, depending on how the stay is labeled. Observation admissions, versus Treatment admissions, are being denied by Medicare.
 
To protect you, and / or your client, from being denied, make sure any hospital admission papers state “treatment” or inpatient admission. If the word “observation” appears on any paperwork, do not sign.
 
Instead, see everyone involved in the patient’s care, from the floor nurse all the way up to risk management, and push for a new assessment to get a Treatment admission.
 

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Did You Know?

 
Anytime a client owns real property, but does not reside within the home, a letter should be sent to the property insurance provider, return receipt requested, informing of this change.
 
However, the wording that you use in the letter is tricky. Works like “occupied,” “intent to return home,” “home place,” “homestead,” and “vacant” are all great words to use, depending on the client’s situation.  Ask your attorney for the appropriate wording to use for this type of letter, to ensure that you don’t jeopardize the client’s insurance coverage.
 
This letter should be sent the insurance company every twelve (12) months to protect the client, and you.
 

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Do What You’re Great At and Love —   Let Us Handle the Rest!

 
Guardian Care Management & Benefits Services, Inc. provides:

• Professional Guardianship Services
• Private Case Management
• Benefits Consulting & Medicaid Applications
• Full Guardianship Support Services

We can help, call us today!

407.786.6033

 

 

Secrets From A Professional Guardian

Serving as a Professional Guardian for over 20 years, we’ve decided it’s time to share some of our secrets when it comes to caring for the elderly and disabled.
 

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Multiple Birth Dates Part 2 – How Multiple Dates Can Have Disastrous Results, Even After Death

 

In the June Newsletter, we discussed the difficulties of trying to correct a date of birth with Medicare and Social Security.

 
An incorrect date of birth is not only problematic while the client is alive, but has far reaching consequences which can affect the client and their family long after the client has passed away.
 
Let’s revisit this same lady, the one who has 4 different dates of birth depending on the document. After deciding not to change her date of birth within the Medicare and Social Security systems, and after setting up an internal system to use the proper date of birth depending on which agency was being utilized, everything was running smoothly, until the woman passed away.
 
Upon her passing, the reporters – the nursing home and hospice – informed the funeral home that the woman’s date of birth is 1926 because that’s what they had on file. They were unaware of the issue with multiple birth dates. The funeral home then adds this information to her death certificate, which is ultimately forwarded to her family.
 
Later, the family, who is also unaware of her multiple birth dates, files a life insurance claim. The life insurance company denies the claim, because the date of birth on the death certificate is not the same as the date of birth on the policy. The family is baffled. They appeal the denial with the life insurance company and are informed that the death certificate must be corrected to the date shown on the life insurance policy.
 
Amending a death certificate can be a difficult and lengthy process, depending on what information needs changing. When a change is major, such as this, it may require original documentary evidence. Unfortunately, this evidence could not be obtained because the year used on the original life insurance policy – 1925 – was not on any of the woman’s documents. In the end, the family was unable to file a successful life insurance claim.
 
The lesson learned was a good reminder about the general understanding of guardianship – no amount of preparation can equip you for all the unforeseen hurdles.
 

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Tip of the Month

 
We have made it our practice to (almost) always become the recognized Representative Payee for the client’s Medicare / Social Security benefits. There are definite advantages and disadvantages to this practice.
 
The main advantage is that all of the Social Security funds (SSA, SSI, SSDI) can come directly to you, at your address as the rep payee. This also allows funds to be deposited to the client’s financial institution via direct deposit. Similarly, any correspondence from Medicare, or Medicare administrators such as CMS, will also be forwarded to your address.
 
This is of critical importance in our current, volatile Medicare environment which is constantly changing so that important notifications and deadlines are not missed.
 
One disadvantage is the reporting requirements for a Rep Payee, such as the yearly rep payee report, which may be time consuming depending on the client.
 
If you would like help with Medicare, Social Security, or any other benefits needs, please contact us today! We are well versed in these systems and can help you navigate the confusing and complicated requirements.
 

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Did You Know?

 
When making a hurricane claim with an insurance company, there are some words you should avoid using, such as: water, flood, tidal, serge. These can cause problems filing your claim.
 
Instead, an insurance adjuster tipped us off to better words and phrases to use when reporting storm damage.

• Do not say, “Trees floated against house by tidal surge.” Instead, try “Trees are blown down by wind.”
• Do not say, “Structural collapse caused by flooding.” Instead try, “Structural collapse caused by twister” (when tornadoes are present during storm).
• Do not say, “Mold caused by rising water.” Instead try, “Mold caused by driving rain after wind blew out windows.”
• Do not say, “Water exploded the electrical system.” Instead try, “Lightning exploded the electrical system, split the foundation.”

 

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Do What You’re Great At and Love —   Let Us Handle the Rest!

 
Guardian Care Management & Benefits Services, Inc. provides:

• Professional Guardianship Services
• Private Case Management
• Benefits Consulting & Medicaid Applications
• Full Guardianship Support Services

We can help, call us today!

407.786.6033

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Come See Us at the FSGA
24th Annual Conference

 

July 28 – 30th 2011

Buena Vista Palace
1900 Lake Buena Vista Drive
Lake Buena Vista, FL

 

 

Secrets from a Professional Guardian

 
Serving as a Professional Guardian for over 20 years, we’ve decided it’s time to share some of our secrets when it comes to caring for the elderly and disabled.
 

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Multiple Birth Dates – Which Date is Which?

 

It is not unusual to come across conflicting pieces of information for a client, after all, information is often obtained from multiple sources so there’s bound to be a conflict every now and again. But what happens when that conflicting piece of information just happens to be the client’s date of birth?
 
We once had a woman who had 4 different dates of birth, depending on which document we reviewed. Medicare / Social Security showed her year of birth as 1926; her Driver’s License had 1928; birth records and census documents showed 1921 (which we believed to be her actual year of birth); and her passport listed her year of birth as 1927. With so many different dates of birth for one person, how do you know which one to use?
 

We used to believe that it was important to correct the date of birth in all government systems, starting with Medicare and Social Security. We quickly learned this was a bad idea, because of all the problems this could cause.
 
Changing a date of birth in any government system is difficult, but changing a date of birth in a system as large as Medicare / Social Security is not only complicated, but has far reaching consequences, including:

• All benefits could be recalculated – this includes retiree benefits, along with current and future benefits.

• If Medicare / Social Security had paid her too early, or had paid her too much, she could end up in a situation where she would have to repay these funds.

• Furnishing original documents can be problematic depending on the client and their history.

Furnishing original documents was the difficult part for us in this situation, because we didn’t have any of originals for her. To make matters worse, we could not have a conversation with the client about this, because she claimed that she was born in 1928. This was something she was truly stubborn about, because she wanted to be younger than she actually was, and changing her year of birth accomplished this in her mind.
 
After attempting to change a date of birth this first time, we learned a valuable lesson: do not rock the boat. It is better to setup your systems so that you can access the date of birth on file for the specific entity you are working with at the time (Medicare, DMV, Pension Company, etc.). That way you don’t have to guess as to what your client may have told them, instead you’ll have the information readily available.
 

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Tip of the Month

 
Speaking with health providers can be problematic. Often they don’t understand your legal relationship to the client, what an Order of Incapacity represents, or that it may not be appropriate to provide health information to family and friends who have a questionable need to know.
 
Next time you’re in this situation, try using these words: “This patient is the equivalent of a minor. If a 12 year old cannot consent for this treatment, then neither can this patient.”
 
A statement like this is very effective at getting the point across as it puts the client’s situation in a simple context which health providers can (hopefully) understand.
 

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Did You Know?

 
Using “registry” caregivers or home health agencies may leave you, and your client, at risk for workman’s comp, payroll taxes, and general liability issues. This is also the case when hiring independent or private caregivers from the community.
 
If you are ever unsure about you, or your client’s, protections, consult with your attorney.
 

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Do What You’re Great At and Love —   Let Us Handle the Rest!

 
Guardian Care Management & Benefits Services, Inc. provides:

• Professional Guardianship Services
• Private Case Management
• Benefits Consulting & Medicaid Applications
• Full Guardianship Support Services

We can help, call us today!

407.786.6033

---

Come See Us at the FSGA
24th Annual Conference

 

July 28 – 30th 2011

Buena Vista Palace
1900 Lake Buena Vista Drive
Lake Buena Vista, FL