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

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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, I’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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Rising Above Limitations

 
The Eldercare profession, in particular, draws those with big hearts and a drive and commitment to care for others. It is this level of commitment which makes it hard to hear that you cannot do something, particularly when it is in your client’s best interest.
 
So what do you do when the community tells you no, you can’t provide that service? No, you can’t accomplish that task? No, that’s not in your client’s best interest (when you know that it really is)? Do you give in, and listen to what is being said, or does it make you dig your heels in harder, to find a way to accomplish what needs to be done?
 
For us, the answer continually is: get creative. Our clients come first, always. When it is in their best interest, we will find a way to make it work.
 
Take this scenario for example:
 
We were appointed Emergency Temporary Guardian (ETG) of a woman whose husband had passed away just before appointment. He still had not been cremated four weeks later. We felt pressured to authorize and pay for his cremation using her funds.
 
Part of this pressure came from knowing that it would be a huge emotional benefit for the client to know that her husband’s arrangements were finally handled. However, the courts sometime have an issue with using a client’s funds for anyone other than the client.
 
While at a hearing about other topics, we inquired as to the court’s perspective on this subject. The judge said he was unaware of any law that allowed the Guardian to use the assets of the surviving spouse to pay for the deceased spouse’s final arrangements, and that any time or expense spent in an effort to accomplish this task should be billed to the deceased spouse’s estate, not the client herself. However, the judge understood the dilemma, and the benefit to the client, and instructed that if we could find a way to accomplish the task, while staying within the limits of the guardianship laws, he would authorize it.
 
Our office set to work scouring guardianship laws. Florida Guardianships are governed by Florida Statue 744, and within the chapter we came across section 397, which pertained to this very scenario.
 
Statue 744.397 is the Application of Income of Property of Ward, and states: “(1) The court may authorize the guardian of the property to apply the ward’s income, first to the ward’s care [...] and then for the care, support [...] cost of final illness, and cost of funeral and burial or cremation of the parent, spouse, or dependents, if any, of the ward, to the extent necessary.”
(http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0700-0799/0744/Sections/0744.397.html)
 
After our attorney showed this section of the chapter to the judge, he signed the order right away and we were finally able to handle our client’s spouse’s final arrangements. Not only were we able to take care of a looming problem, but we were able to provide a benefit to our client by alleviating worry about her spouse.
 
Had we accepted “no” for an answer, we wouldn’t have been able to do what was right for our client. Furthermore, our research later went on to help another client who had a parent in a similar situation.
 
Next time you’re trying to do what’s best for your client, don’t listen to the naysayers. Where there’s a will, there’s a way. And, if in your research you can’t find an answer, call us. We specialize in creative solutions.

 

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Tip of the Month

 
Be careful what you sign for your clients. Lately service provider’s contracts are becoming more “legal,” and have more provisions in them which are risky to the client and guardian if signed. Be particularly aware of Arbitration clauses, which may give up the civil right for you, or your client, to initiate a lawsuit.
 
Contracts, from transportation service agreements to ALF fall risk forms, to SNF elopement policies and more, should be reviewed by your counsel in prior to signing (if possible) to ensure the contract does not put you, or your client, at risk.

 

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Did You Know?

 

There is a real property background report that can be requested on real property that your client owns, which can reveal current and/or past claims. It is similar to a credit report, but for a home.

 

 

 

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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, I’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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Small Talk Can Reveal Big Information

 

Small talk, by its very definition, alludes to conversation that is trivial and meaningless. But small talk can reveal volumes of information, if you really listen to what is being said.
 
In our professional lives, it is easy to get swept away with productivity. Everything we do must be accounted for and must be productive in some way. Even when visiting clients, we often have an agenda, or a set of questions we feel must be answered, so that our time is productive. However, limiting the scope of your conversation with the client can have unintended consequences.
 
While we think it’s nothing important, information from likes and preferences, to fears and obsessions can be revealed during a conversation we thought was meaningless small talk. Without small talk, we wouldn’t have solved a very big, and very real, problem for one of our clients.
 
We were trying to find placement at an ALF for one of our higher functioning clients. After compiling a list of what we believed were appropriate facilities, we took her to tour several locations. She didn’t like any location, but was unable to provide specifics as to why. She simply didn’t like them.
 
After the 4^th location, we were out of ideas. Finding a facility that was not only appropriate for her needs, but that she liked as well, was looking slim.
 
Then, a clue emerged. During the drive to a doctor’s appointment, while making small talk unrelated to the move, the client looked out the window and said, “I don’t like lakes, because in Florida that is where sinkholes happen, and I am afraid of them.”
 
Bells and whistles went off. Each facility we had looked at were lake-side because we found them to be beautiful locations, and thought that she would too. Little did we know of her fear of sinkholes.
 
That day we learned a valuable lesson: it is important to know a client’s fears, for fears can shape preferences. Had we never had the opportunity to talk, unscripted with the client, we may never have known that one little fear that kept her from successful placement.
 
Next time you’re pressed for time, and find yourself rushing through a visit with a client, stop. Take a deep breath, and then make time for some unstructured, unguided small talk. You never know what little clue might be revealed that could make a huge difference in how you care for your client.

 

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Tip of the Month

 
Hospice care isn’t just for the last few days or weeks of a terminally ill person’s life. Hospice provides amazing benefits and support to the patient, their family, and any support staff in their life.
 
Anyone facing the complicated path of a terminal illness, no matter what the stage, should talk to the caring folks at hospice sooner, not later.
 

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Did You Know?

 

Federal retirement health coverage, and some secondary coverage provided through private employers, is often very limited in Skilled Nursing Facility (SNF) coverage compared to standard Medicare secondary A – J Policies.
 
This can create significant financial hardship during an extended SNF stay lasting more than 10 days, even when the patient continues to meet the Medicare Skilled Needs criteria.

 

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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

 

 

Secrets From a Professional Guardian

 
Serving as a Professional Guardian for over 20 years, I’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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Missing Persons -What to do When Your Client Goes Missing

 

It’s 4:30 PM on a Friday, and your phone rings. It’s the facility, frantic.
 
“Help! We can’t locate Mr. Smith! We’ve been looking for hours and we think he’s missing.”
 
When a client is missing, leaping into action only helps when you know what to do. Without a good plan, you could be left paralyzed. Even worse, the longer you take, the more at-risk your client becomes.
 
According to AARP, over 300 people with mental conditions, like dementia, go missing each year. If not found within 24 hours, their risk for suffering serious injury or death rises drastically (AARP Bulletin, February 14, 2011).
 
Items to Have on Hand
 
Being prepared now can save precious time later. Here are a few things to do now to minimize the impact of such a situation. Assess whether or not you have these items for your clients. If not, use this as a check list.
 
Current Photo: Take a picture of all your clients at least twice a year, or more. That way there will always be a current photo available should the need arise.
 
Authority Documents: Have spare original documents available, outlining your legal authority for your client.
 
Client Demographics: Little clues about your client’s past, likes and interests can often help locate them should they go missing. Do they know their current area well? Do they have any family or friends who live in the area? Did they talk about going anywhere recently? Knowledge like this may provide some insight as to where your client may be going.
 
ID Bracelet: If your client will tolerate it, place a medical ID bracelet on their wrist. For clients with thin skin, consider ordering a soft, plastic hospital-style bracelet. If your client likes a bit of bling, try something that looks more like jewelry. Your client will be more likely to wear an ID bracelet if their needs and lifestyle are considered.
 
Remember to have important contact info printed / engraved on the bracelet. We have found the best balance between privacy and safety by simply using the phrase “Emergency Contact <phone #>,” with our after-hours number listed on the bracelet.
 
GPS Units: While great in theory, personal GPS units don’t work well for locating lost individuals, so don’t spend the client’s money on one just yet. We have tried GPS products a few times in recent years, and the field trials have been disappointing. Eventually technology will catch up with these products and will become a big part of locating lost individuals.
 
Questions to Ask
 
We hope it never happens, but should you ever receive that call — “your client is missing” – remember to stay calm and ask a few crucial questions:

• What time was the client last seen?
• Where was the client’s last known location?
• What was the client wearing?
• Was the client alone or with someone else?
• Was the client on foot or in a vehicle? If in a vehicle, what was the tag number?
• What steps have already been taken?
• Has anyone else, such as the police, already been contacted?

Remember to give the facility extra ways to contact you, such as your cell phone number or after hours emergency number, should the situation change.
 
What to Do
 
Now is not the time to deal with blame and cause. Find the client first. Deal with the “why and how” of the situation once safety is no longer an issue.
 
Most importantly, stay calm. Panicking isn’t going to help. Instead, call the police and begin your search.
 
Call 911, immediately: If the facility hasn’t done so, call the police. Remember to call both city and county sheriff’s offices. If the facility has called the police, make a follow up call, informing them of your legal authority to the client. Continue calling at each shift change, usually at 7 A.M., 3 P.M., and 7 P.M.
 
Also remember to:

• Inform of any medical conditions or life-threatening needs (such as medication needs) your client may have.

• Request a BOLO Alert. A BOLO informs many authorities in the area to “be on the lookout for” your client.

• Request a Silver Alert. A Silver Alert is like an Amber Alert for children, but for missing elderly or at-risk individuals. It uses the radio, television, and highway signs to inform the community of the missing person.

• Obtain a fax number and / or email address for forwarding over a current picture of your client.

Prepare for the Search: Print extra color copies of your client’s photo. Gather your authority documents. Then hit the road with as many helpers as possible, and join the search for your client.
 
Where to look? Most missing persons are found within a few miles of their starting location. Go to the facility, and begin your search from there. Don’t just check the main road, check neighborhoods too. And don’t forget to stop by local shops and ask if they’ve seen your client.

 

Having been in this horrible situation a handful of times in 20 years, we understand the terror and frustration that a missing client can bring. By staying calm and following the tips outlined, we were able to successfully locate our clients each time and return them safely home.
 

 

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Tip of the Month

 
If you haven’t already, it’s time to start thinking about taxes. Don’t forget these important forms:

• Use form 56 to notify the IRS of Guardianship Status.
• Use form 4506-T to Request a Tax Return Summary.

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Did You Know?

 
A patient is NOT required to have a DNR in place to be admitted into Hospice?

 

 

 

 

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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

 

 

Secrets From a Professional Guardian

 
Serving as a Professional Guardian for over 20 years, I’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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Just Say No! …
To Test Drives

 
“One more light, and I would have lost my client’s car forever.”

When selling a car, test drives are an assumed practice. But the potential for danger can be high, particularly if the interested party is allowed to drive the vehicle by themself. Don’t be tempted! Always drive during a test drive, no matter how trusting the individual appears.
 
This common scenario can have far reaching consequences. Your client needs funds. They happen to have a car which has been problematic to secure and selling it is a good solution.
 
However, a simple car sale can take months. Despite all your best efforts, you’ve had no interest locally. Finally, a woman from out of state calls you, wanting to purchase the car. “Great,” you think, “problem solved,” and you quickly schedule a date for her to purchase the vehicle.
 
She arrives with a cashier’s check and driver’s license in hand, but she wants to drive the car first. No problem — you were expecting that. You begin to discuss the most appropriate route, “we’ll go just down the street to the stop sign, then turn around and come back.”
 
As the woman climbs into the car, your cell phone rings. It’s the hospital wanting consent for a different client. Knowing it will be an extended conversation and wanting to preserve confidentiality, you tell her to go ahead and test drive the car without you.
 
While talking to the hospital, you watch as the woman drives down the street. She gets to the stop sign, and keeps going. Your stomach drops when you realize she’s not going to turn around and come back.
 
You scramble to your vehicle and begin following the woman. After 4 or 5 U-turns, she starts making her way back to your office. That’s when it hits you, one more light and the woman could have been out of your life forever, with the client’s vehicle.
 

The moral of the story: Allow test drives only if you drive, even if the person seems nice enough, because you never know if that will be the last time you see the car.

 

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Tip of the Month

 
Have concerns with the care of an individual residing in a licensed care facility? In Florida there are many ways to resolve these concerns.

• First, request a care plan with as many facility department managers as possible and practical. Often, issues arise due to lack of communication between departments or individuals. A care plan can often solve a communication issue.
• Second, request the facility aid with creative solutions. Do you have a client with roommate issues? A simple move within the facility can often solve the problem.
• Third, know your options. Understanding the level of care provided at the different types of facilities, and under different types of licensing, helps you know your options, and allows you to assess the appropriateness of the location against the client’s needs.

Out of options? Request help from Florida’s Long-Term Care Ombudsman Program.
 
An Ombudsman is simply an advocate. In this context, they are an advocate for individuals who live in nursing homes, assisted living facilities, and adult family care homes. You may contact the Ombudsman program at: 1.888.831.0404 or 1.850.414.2323.

 

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Did You Know?

 
That there is a difference between an observation admission and a treatment admission at the hospital?

 

 

 

 

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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

 

 

If you would like to learn more about how 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