A Helpful Question for Guardians Working with Doctors

Doctor greeting patientAs Guardians who are often involved in tough health care decisions, we want the very best for our clients.

If you’re like us, sometimes you’ve wondered how to connect with a doctor when big decisions need to be made.

I have found that a simple question can break down barriers and create a connection that best serves our clients.

“Doc, if this was your mother (father, grandmother, grandfather, brother or sister) what would you do?”

This simple question can help stop all the madness of the spinning plates and just get to the heart of the question. It has worked well for us. Good luck. TB.

Marijuana Could Be An Effective Treatment For Alzheimers

Brett Levin

Image via Brett Levin

A trip to the dispensary for your Alzheimer’s clients might be on your to-do list in the near future.


A study published this month in Aging and Mechanisms of Disease suggests marijuana might eventually be an effective treatment for Alzheimer’s disease. The study, published in Popular Science, studied the effects of THC on lab-grown neurons.


Researchers found that the cannabis compound hampered the plaque buildup that is associated with Alzheimer’s. The buildup, caused by the amyloid beta protein, can cause inflammation of the cells in the brain, hampering communication between neurons.


The study reports that THC reduced the amount of amyloid beta proteins in the neurons and prevented inflammation. The THC worked similarly to the effects of physical activity. By affecting the same receptors in the brain, Alzheimer’s can be slowed.


In addition to showing marijuana could be used to treat Alzheimer’s, it may clarify the connection between amyloid beta proteins and inflammation.


Read the full study— Amyloid proteotoxicity initiates an inflammatory response blocked by cannabinoids— here.

The Risks and Difficulties of Selling Ward’s Cars, Boats, Trailers and More

Vintage Car, image via Riley

Vintage Car, image via Riley

It looks like selling some titled property in Florida may be getting a bit more complicated– especially if it was not titled in Florida.

In the past I have written stories about the many pitfalls with selling cars, boats, trailers, and other property as a guardian.

These stories range from having a potential buyer attempt to steal a ward’s SUV during a test drive, to making sure (by going to the DMV with the buyer) that the title immediately transfers out of the ward’s name, to the risk of accepting a cashier’s checks from a buyer.

This twist is a requirement that I was not aware of, and you may not be either. This could cause a real struggle with one of these sales.

First let me say that the best way to resolve most all of these issues is to sell the car, boat, trailer, or other property in person (with you, the vehicle and the buyer) at the Florida Tax Collector/DMV office. This location provides extra security as there are usually law enforcement folks around to protect your personal safety as well as the property. Even better if it is a cash transaction to be fairly public.

This scenario may be very difficult if the buyer is from another state, if the vehicle is located in another state, if it does not run, if it is not insured or if it cannot be moved. Then what?

 

Form 82050

Florida DMV is becoming less willing to accept a Bill of Sale on any format other than their own form: form 82050. If this is true for other states as well, then that may make this really difficult to resolve.

Form 82050 requires a copy of the seller’s drivers license. First you have to first determine the answer to the question: who is that? You or the ward?

Let’s assume the DMV determines it is you, as the guardian. Then you have the concern of giving your personal and private info (printed on your driver’s license) to a buyer, before they give it to their home state’s DMV.  Bad idea.

The 82050 form is relevant for all used motor vehicles and trailers not currently titled in Florida and with a net weight of 2,000 pounds or above.

 

Form 82042

Then there is the HSMV 82042 form. This is a bit easier to deal with, as long as you deal with it while the vehicle is in your possession.

The 82042 form is an owner’s affidavit. Again, you have to deal with the “who is the owner” with your local DMV office.  You have to get the current odometer reading (sometimes hard to do with a dead electronic dash). You’ll need a law enforcement officer, notary or dealer to do this in person with you. If the car runs, has a tag and has current insurance, you can do this at the DMV.

Hope this gives you just a bit of food for thought if you are faced with selling a ward’s property. There are certainly a lot of “if this, then that” situations to consider…

SNF + ALF: Law vs. Reality

Laws, image via Woody Hibbard

Laws, image via Woody Hibbard

 

In the world of guardianship, elder care and advocacy, there are laws. Tons of them! While I am not an attorney, I have learned that there are laws, and then there’s how things work in the real world.

Here are two commonly-broken laws that you can be aware of:

 

 

 

 

 

 

 

Discharge From a Skilled Nursing Facility (SNF)

While SNF’s don’t have to accept all applicants, the law does say that they can not 911 a difficult or non-paying client to the hospital just to get them out the door. Unfortunately, it still happens. To be prepared, know your client’s rights in a SNF: http://buff.ly/1WH1Gxn

 

Honoring Contracts at an Assisted Living Facility (ALF)

While most residents checking into an ALF might expect to spend the rest of their days there, sometimes plans change and they need to leave the facility. The Agency For Health Care Administration rules limit the amount of days an ALF can require residents to give notice when they want to move out. Currently, that is 30 days. We now are seeing contracts from some ALF providers with closer to 45 and 60 day terms. Buyer beware.

 

How to Approach a Doctor’s Appoint as a Guardian

doctor in lab coat

Image via Ilmicrofono Oggiono

We recently attended a neurologist appointment with one of our young guardianship clients. In the past she had a history of seizures, but they had been successfully under control for an extended period of time. During her annual appointment, the doctor started to talk to the client about her interest in driving, considering that her seizures were well-controlled.

This was a very difficult situation, as the client had been determined to be totally incapacitated and had her right to drive removed by the probate courts many years ago. She was so confused – here a neurologist, a high level doctor, started to ask her if she wants to drive. Then here we are, trying to explain to her that the guardianship courts had removed her right to drive. We spent a good bit of time trying to calm her, and to help her to understand this complicated circumstance about her right to drive.

We were also frustrated with the physician. He did not think about the ramifications of what he was saying to her, maybe because he did not recall that the client was in a guardianship, maybe because he was trying to give her some hope and help in being able to drive. Whatever the cause, it was very hard for this client to grasp this. After this, she was distrustful of many of our conversations – regardless of the subject– and she continued to refer back to the doctors’ discussion for a long time afterwards.

So how do we prevent this from happening in the future?

To be fair, doctors and their offices, and frankly ALL of the health care providers in the U.S., are dealing with mountains of shifting sands in our new “Affordable Care Act” health care system each and every day. Each day they are trying to figure out (just like we are) how to work within this new system of moving deductibles, elusive co-pays,  codes that don’t match the diagnostic procedures – all this while trying to focus on their real job – which is providing quality health care to their patients.

To prevent such a mistake happening in the future, remind the office and the doctor (privately, with dignity) before the appointment, or just as the doctor is about to come in. (We often wait for the doctor just outside of the exam room.) Remind the doctor of the legal status of the patient that they are about to see. This may help the doctor to recall this small detail as he/she is seeing the patient and save you loads of work later.

July 2016 Newsletter – The Risks and Difficulties of Selling A Ward’s Cars, Boats, Trailers and Such

The Risks and Difficulties of Selling A Ward’s Cars, Boats, Trailers and Such

Vintage Car via Riley

Vintage Car via Riley

It looks like selling some titled property in Florida may be getting a bit more complicated– especially if it was NOT titled in Florida.
 
In the past I have written stories about the many pitfalls with selling cars, boats, trailers, and other property as a guardian.
 
These stories range from having a potential buyer attempt to steal a ward’s SUV during a test drive, to making sure (by going to the DMV with the buyer) that the title immediately transfers out of the ward’s name, to the risk of accepting a cashier’s checks from a buyer.
 
This twist is a requirement that I was not aware of, and you may not be either. This could cause a real struggle with one of these sales.
 
First let me say that the best way to resolve most all of these issues is to sell the car, boat, trailer, or other property in person (with you, the vehicle and the buyer) at the Florida Tax Collector/DMV office. This location provides extra security as there are usually law enforcement folks around to protect your personal safety as well as the property. Even better if it is a cash transaction, there again it is fairly public.
 
This scenario may be very difficult if the buyer is from another state, if the vehicle is located in another state, if it does not run, if it is not insured or if it cannot be moved. Then what?
 
Form 82050 
Florida DMV is becoming less willing to accept a Bill of Sale on any format other than their own form: form 82050. If this is true for other states as well, then that may make this really difficult to resolve.
 
Form 82050 requires a copy of the seller’s driver license. First you have to first determine the answer to the question: Who is the seller? You or the ward?
 
Let’s assume the DMV determines it is you, as the guardian. Then you have the concern of giving your personal and private info (printed on your driver’s license) to a buyer, before they give it to their home state’s DMV.  Bad idea.
 
The form 82050 is relevant for all used motor vehicles and trailers not currently titled in Florida and with a net weight of 2,000 pounds.
 
Form 82042
Then there is the form HSMV 82042. This is a bit easier to deal with, as long as you deal with it while the vehicle is in your possession.
 
The form 82042 is an owner’s affidavit. Again, you have to deal with the question of “who is the owner” with your local DMV office.  You have to get the current odometer reading (sometimes hard to do with a dead electronic dash). You’ll need a law enforcement officer, notary or dealer to do this in person with you. If the car runs, has a tag and has current insurance, you can do this at the DMV.
 

Tip of the Month:

Utilize a Face Sheet

Face sheets hold almost magical powers. If you are a medical decision maker, such as a guardian, HCS, or DPOA, and are involved in giving consent for medical care, the face sheet is for you.

 

It directs everyone for who to contact, and who can (and should be) consenting for care. We make it our practice to meet with admin staff to make the necessary changes to the face sheet. Then we have them print us that new page and walk it to the nursing area to see that all the old ones are removed and the new one is placed in the medical chart. While this is not foolproof, it does help most of the time.

Did You Know?

We post weekly informational videos in The Guardian Network Facebook group?  
The Guardian Network is a Facebook group for families, caregivers and health and legal professionals to easily connect, share and learn when assisting or caring for elderly or disabled folks.
 
Join this free community for informational, short videos with Guardian Care’s own Theresa L. Barton and advocacy expert guests.
 
Visit the group here.

Recent Blog Posts

We learn so much great information in our profession that we want to share with as many people as possible.

 

You can check out our blog at blog.orlandoguardian.com, or follow us on FacebookTwitter or LinkedIn and never miss an article or newsletter again.

 

May 2016 Newsletter – What is a Medicare Set-Aside?

Chronicles of a Professional Guardian

Dear Colleague,

Serving as Advocates, Care Managers, Elderly & Disabled Life Care Plan Assessors, and providing Professional Guardian services in Central Florida for over 20 years, we have discovered unique solutions to many difficult problems.

We are continuing our tradition of giving back by sharing our knowledge in the hopes that this information can help others to better serve and care for our elderly and disabled population.

What is a Medicare set-aside?

What is a Medicare Set-Aside?
A new client of ours went to the hospital from his ALF after suffering a suspected stroke. We got notified from the hospital and from the rehabs (who were assessing him for admission) that there is a problem from an unresolved Medicare claim. As it turns out, he was involved in a slip and fall lawsuit three years back. We contacted his (then) P.I. attorney to try to get a clear answer on this. Our fear was that this issue may cause trouble with his Medicare-covered stay at the rehab, especially, if they would not accept him when he was ready for discharge from the hospital, while we were still working to resolve this.

A Medicare Set-Aside, in layman’s terms…

In the past, Medicare had been paying for medical bills where there was a personal injury claim without any kind of reimbursement. Now, the concept is that Medicare is often involved as part of the personal injury settlement process, asking for a bucket of money to be “set aside” to pay the current and future medical bills (that relate to the injury/illness). This is a guessing game of what those current and future costs will be. The money is put into a Medicare Set-Aside Account (MSA), like a trust account. There are VERY specific rules on how these dollars are to be spent. So there are providers popping up who administer these accounts.

If there is reason to believe that there may have been a P.I. settlement in the past, it might be wise for a fiduciary (POA, Guardian, Trustee) to request something from Medicare to know where that stands.

This information would be great to know before there is a problem.

Medicare Set-Aside Accounts Moving Forward

Apparently, we’re going to be seeing these more frequently now as Medicare has become very savvy on not getting stuck with medical bills for beneficiaries that were from a personal injury situation.

Have you run into Medicare Set-Aside issues yet?

Tip of the Month:

Work Around Multiple Birth Dates

Be very careful of a client that has more than one documented birthdate. In general, stick with whatever date that specific agency has used.Example: If social security thinks she was born 1.27.27, leave it like that and use that date whenever communicating with Social Security or Medicare. If her drivers license shows 1.27.31, leave it like that and use that date whenever communicating with DMV. Her passport shows 1.27.33? Same plan. After all, a gal might want to shave a few years off. Can you blame her? ;-)

We have learned that trying to change these things, decades after they occurred, can cause big troubles.

Did You Know?

If you drive on Central Florida toll roads and use an E-Pass transponder, you could be getting a bigger discount starting May 1.

But the expressway’s move is bad news for drivers with SunPass transponders, who will no longer be eligible for any discounts when traveling on area toll roads.

Learn more here.

Recent Blog Posts

We learn so much great information in our profession that we want to share with as many people as possible.

You can check out our blog at blog.orlandoguardian.com, or follow us on FacebookTwitter or LinkedIn and never miss an article or newsletter again.

 

Quick Test: What Kind of Advocate-Entrepreneur Are You?

elderly man reading

Image via simpleinsomnia

What kind of advocate-entrepreneur are you? Or are you maybe a combination of these?

 

A – Analytical-Entrepreneur: You perform deep analysis of any new client to determine profitability of that case before accepting the client. You are a pessimist in thinking that there will not be enough funds to care for the client.

 

B – Risk Taker-Entrepreneur: You accept cases where there are no immediately available funds to care for the client. Or where the major assets are a mess, there are title problems or are in unsellable condition. You are optimistic that there are benefits or assets that will be found to pay for the client’s care and needs.

 

C – Administrator-Entrepreneur: You have created and keep a current, detailed written Policy & Procedures for the whole system you have created.

 

D – Social Worker-Entrepreneur: You have brought a client to your home for a night during an emergency or for a holiday meal.

How far back and deep should you delve ?

Image via hobvias sudoneighm

Image via hobvias sudoneighm

As the years have gone by, we have learned the many twists that can come up when becoming the guardian for a person who has had dementia for years or decades. It is often surprising how deep and far back we need to go to resolve issues.

Case in point — we became the guardian for a windowed gal, Cynthia, in 2013. She was a retired civil servant who had worked for decades as a government contracts-comptroller and in an H.R. pension support position.

She was very astute to the business world, to how pensions worked and how life and health insurance worked. She was a very detailed bookkeeper who had appeared to be organized, disciplined and methodical in her personal business affairs by the old records we found.

However, we also found that in the more recent years, she wrote reminders to herself,  hundreds and hundreds of reminders, for the same actions: pay a bill, call the tax office, file a claim form. But it appeared that she did not take those actions,  she just kept reminding herself to-do’s, still leaving them undone.

So after many months of fighting with the pension provider to accept the letters of guardianship, we finally got a copy of her pension check stub with the gross amounts and the details of the amounts being withheld from her retirement check and for what.

We were shocked to find that there was an ongoing deduction, each month, for a spouse’s life insurance policy.

Why were we shocked? Her spouse had been deceased since 2005, and she had never remarried.

In speaking with her friends, they could not understand why she was still paying life insurance premiums for her husband, who had been dead for 8 years. Since she worked in H.R and in pension support in her career, she would have understood how this all worked.

This made us wonder: had she ever filed the claim on his life insurance(s) when he passed? We dug in and, as it turned out, NOPE.

So we filed the claim for $ 25,000, and then we started the fight to get the years of premiums (paid on a dead fella) back from the federal government.

So, back to the question: how far back and deep should you delve? You decide. :)

Tales of Guardianship: Where to Look

OGpapersWe were the guardian of a fella who lived in an independent  community. He had agency caregivers most days and many nights.


It was a common problem that he would “lose” his spending money (his mad money authorized by court order for his personal spending). Sometimes he would say the caregivers took it; other times he would hide it for later; and sometimes he did spend it.


As his condition deteriorated, we slowly stopped giving him cash because of this lost/stolen pattern.


After we moved him to a memory unit, we cleaned out his apartment. To our surprise, this empty cell phone box was where we found the hidden cash.


As a reminder, some clients can hide stuff in very ingenious places. You have to open each box, every envelope, each bag, look under every drawer, in AC vents, in curtain’s hems, in the oven pan drawer, under loose carpet corners, in ice cream cartons in the freezer, in dog food bags, in toilet tanks, in a box of old rags in the shed… this list is just a short sample of some of the cool-creative places we’ve found hidden stuff.