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’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.

Making Difficult Decisions

Image Source: José Goulão

Being a professional guardian is both a privilege and an honor, but the job also comes with some heavy responsibilities – including making difficult final decisions with options that are less than optimal.

When I became the guardian of a 96 year-old woman, and her 62 year-old developmentally disabled son, I knew that any end of life decisions I may have to make for her would greatly impact him as well.

I also knew it was only a matter of time before I would likely have to make these important decisions.

The call came when I was at the movies. Ester had fallen, and was headed to the ER with a suspected broken hip.

While surgery would fix the problem, both the attending ER physician and the consulting Orthopedist were concerned about her ability to make it through surgery due to her frail condition.

Without surgery, she was unlikely to live more than a few days, and would be in terrible pain.

I was suddenly faced with that difficult decision I knew I would have to confront – whose interests to keep in mind, Ester or her son?

Putting Ester through the surgery was a risk, but if she pulled through, she would have more time to be with her developmentally disabled son, Ralph. However, that plan wasn’t really in her best interest, only his.

But not doing the surgery, while maybe in her best interest, wasn’t in his best interest as it left him with no one. Ester was his only family and primary caretaker for his entire life.

This decision was further compounded by Ester’s status. While she had been on hospice for months, and was very gradually declining, she was still fairly high functioning. Before the injury, she was still walking (with assistance), dressing elegantly for meals with Ralph in the dining room, and continuing to be the lifelong companion to her son.

Now I was faced with this difficult decision. What to choose?

When I became the guardian for Ester and Ralph, I knew this day would come. After all, that was the point for Ralph being under guardianship as well – so that there was a plan when his mother could no longer care for him.

Previously, I had many conversations with Ester about her fears worrying that Ralph would be left alone, since they had no known family. Not only was she concerned with where and how he would live when she was gone, but she was very worried about being able to pass away, knowing she was leaving him behind.

Now we were facing that very decision.

Ester was in bed in the ER. She looked horrible, was in and out of consciousness, and was in severe pain. When she was conscious, she would open her eyes and ask about her son.

“Is he okay?”

“Where is he?”

“Does he know where I am?”

“He should not be alone…”

I had her living will, which outlined her wishes for her life to not be prolonged. I knew what her end-of-life wishes were. And then there was Ralph.

I had the choice to attempt the surgery; after all, she might make it through, even though the odds were slim.

In the end though, I made the decision that surgery was not the best choice for Ester.

She told me she was ready to go, and I told her that I would continue to care for Ralph, that she did not have to worry. She died a few hours later.

I was able to make that difficult decision even though it had less than desirable options.

This is just one of the many difficult and challenging decisions that professional guardian’s face on a regular basis.

When people ask me why I continue being a guardian, despite the many issues and difficult decisions I face on a regular, almost daily basis, I am reminded of these times and these difficult decisions.

Clients like Ester are the reason I am able to keep going, even on the tough days where everything seems impossible. Knowing that I made a difference in Ester’s life, and that I was able to help her move on and pass peacefully without worrying about Ralph or his care – that’s what keeps me going.

Tip of the Month

Be aware of the “white coat” syndrome. Many people have negative emotional and physical reactions when in a medical care environment. Consider monitoring symptoms at home, and reporting to the physician to determine if the issue is truly a concern.

Example: A client with low blood pressure (BP) at home could have high readings every time they are in the doctor’s office. Instead of starting them on medication immediately, consider requesting a month long BP read where readings are recorded 2 to 3 times per day, in the residential setting, to show what the client’s normal BP readings are.

Did You Know?

Running background searches on your clients, especially when they are new clients, can yield a tremendous amount of information.

Guardian Care’s Upcoming Events

As active members of the community, you can often find us around town speaking and educating professionals and the general public on Guardianship and / or caring for the elderly and disabled.

Want us to speak at your next event about Guardianship, Private Care Management, or Benefits Consulting? Feel free to contact us at 407.786.6033.

Here’s where we’ll be next:

• April 27^th – Booth at 50+ Spring Expo at Renaissance Senior Center in Orlando

Here’s what we’ve been up to recently:

• March 11, 2012 – Present to Williamsburg Post 475 Jewish War Veterans Group
• March 15, 2012 – Booth at Apopka’s 5th Annual Senior Fun & Fitness Fair
• March 27, 2012 – Booth at Casselberry Senior Fair

 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 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.

Clients and Money – Who’s Rules Do You Use?

Image Source: flickr.com / 401k

What do you do when you have a client who is both physically and socially active, and has a need for spending money in the community?

It may be tempting to quickly solve the problem by giving this client spending money straight from their account, but this can cause a whole range of problems.

That’s because many of the government support programs and services typically utilized by elderly or disabled individuals often have requirements when it comes to spending money for the client, and each program’s rules can contradict another program’s rules.

Here is a typical example:

Joe Tester is a 70 year old widow. He is under plenary guardianship of the person and property. He receives social security retirement, VA Aid & Attendance, and has a small private pension. He has a homesteaded home and assets of around $50K in multiple bank accounts including CD’s and savings accounts.

He is a physically and socially active individual who lives in an ALF and likes to go on facility shopping trips. He has requested money for these outings.

If you give him spending money, what harm could you be doing? Let’s look at the different rules for each different program type.

Probate

Guardians are required to follow probate rules and statutes when it comes to Guardianships. Under probate rules, unaccounted funds may only be given to a ward when there is a specific court order in place authorizing this transaction.

This type of court order recognizes that you are giving funds to an incapacitated adult, and as such you are not required to track the specific spending of these funds.

In general, it may be best practice to petition the courts for a court order for allowance for any client who is capable of managing this small amount of funds and spending the money on themselves.

On its own, the probate rules don’t cause any problems. However, the problem comes in depending on where the funds originate from – Social Security, VA, State Pension, Private Pension, Railroad, etc.

Special Needs Trust

Typically, a special needs trust (SNT) cannot pay cash directly to the client, for their own spending, as it can affect the client’s Medicaid eligibility. This is because Medicaid takes the position that giving funds to a beneficiary directly from their SNT can jeopardize their Medicaid eligibility.

If Joe Tester has a trust, you cannot utilize his trust to obtain his spending money. Instead, the trust can only pay to vendors, suppliers, his facility, etc.

Social Security Rep Payee

As the Rep Payee, you have a responsibility to annually report how SSA or SSI funds were spend, or saved.  This includes funds given to the client, regardless of the court order received from probate. Social Security, as a federal entity, pays little attention to county probate court orders.

If you give Joe Tester spending money out of his primary checking account, and this is the same account used to receive his SSA or SSI funds, you could be creating a reporting problem.

Medicaid / Social Security / SSI

These types of programs typically require a certain amount of money be spent on the client for their personal needs. For example, ICP requirement is $35.00 for Skilled Nursing Facility residents.

A good policy is to have this amount (or more) spent on the client each month. However, if the client has access to these funds, such as through a facility trust account, you will need court order to comply with probate rules, because it may be difficult to accurately account for how each dollar was spent.
 

VA Fiduciary

There are lots of nuances with VA, but in general the VA may not recognize probate court orders. Again, the problem of accountability occurs when trying to prove which specific “bucket” that dollar came from.

The Solution

In a perfect world, the solution would be to have separate checking accounts for each type of funding / program group. Unfortunately, this solution is totally impractical, and is time and cost prohibited.

Take our sample client, Joe Tester. In a perfect world, he would have 3 separate checking accounts, where each of his separate income types would deposit into, and where funds could be spent from each of the accounts, ensuring that funds don’t mix with one another, don’t mix with any other assets, and where the funds spend match each of his program requirements for that income source.

Talk about an administrative mess. So what do you do?

For us, it means having detailed tracking and reminder system in place to ensure that the clients are receiving their funds from the appropriate income sources for the appropriate amounts and that those funds are being spent on appropriate expenditures according to the multiple set of rules for the programs they are on.

What is your solution for managing the complicated program requirements which contradict each other? Leave us a comment and let us know.

Tip of the Month

Medicaid applications submitted through Access Online are due by 3 pm of the last day of the month to be considered for the current month. Any applications submitted online after 3 pm will be counted for the following month.

Did You Know?

There is no separation between Medicare and Social Security from the perspective of being the Representative Payee. You cannot get one or the other, only both, by being the Rep Payee, and there can be only one Rep Payee.

Upcoming Events

As active members of the community, you can often find us around town speaking and educating professionals and the general public on Guardianship and / or caring for the elderly and disabled.

Want us to speak at your next event about Guardianship, Private Care Management, or Benefits Consulting? Feel free to contact us at 407.786.6033.

Here’s where we’ll be next:

• March 11, 2012 – Present to Williamsburg Post 475 Jewish War Veterans Group
• March 15, 2012 – Booth at Apopka’s 5^th Annual Senior Fun & Fitness Fair
• March 27, 2012 – Booth at Casselberry Senior Fair

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 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.

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

Image Source: Flickr.com / garryknight

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).

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/

Did You Know?

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

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!

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.

Associating Alzheimer’s

Credit: Flickr.com/Vince Alongi

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.

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.

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.

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!

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.

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.

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/

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?

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!

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.

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.

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.

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.

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!

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.

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?

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.

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.

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!

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.

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.

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

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

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.
 

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.
 

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.
 

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.
 

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