Tips

Face Sheet 2.0

 

 

If you have been reading our newsletter or social media stuff for a while, you have probably seen the issues with face sheets come up. So if I sound like a broken record, I am. We make it our practice to get a “PAPER” copy of a client’s face sheet – from EVERYWHERE, OFTEN — from hospices, group homes, hospitals, clinics, SNF, ALF, AFCH, Day Programs, physician offices, insurance companies, Pension companies…You name it.

 

 

The Face Sheet may have another name — Client Profile, Data Sheet, Demographics Record…Tomato – TOMAAATOE – Potato – POTAAATO. All the same concept — the problem is that what the computer shows on the screen, what you think is on that face sheet and what belongs on that face sheet, are OFTEN not the same as what is actually on it.

 

 

Case in point – we recently were with a guardianship client at an imaging center of a hospital. I, as her plenary Guardian, signed all the consent screens (screens – which by the way, I also require them to print ANY document that I sign electronically, but I digress). I also went over, verbally, the accuracy of the face sheet. At the end, I asked for a copy of that face sheet – and low and behold guess what is wrong? The face sheet – reading the face sheet in the waiting room, we see that I have (personally) been put on the field as Personally Reasonable for the bills of this client – NOPE, be VERY careful, not to become PERSONALLY responsible for any client’s bills.

 

So, big reminder: get the face sheet — printed — and read them. More often than not, there will be errors or outdated information that needs to be collected.

 

 

What Makes a Dog a Legal Companion or Emotional Support Dog?

15441512995_b02d07bee5_z

Image Source: swong95765

If you were to go online and look for certification for your dog as a companion or emotional support animal you would find a number of websites that offer certificates, patches, ID tags, etc. for a fee, but is it worth spending $69.95 to get your dog certified?  Many of these websites lead you to believe that with their certification, you will be able to take your dog anywhere, including airplanes and government buildings, but let’s look at the facts.

 

By federal regulation, a service animal is defined as a dog that has been individually trained to do work or perform tasks for an individual with a disability.  These tasks need to be specific to the individual’s disability; such as a guide dog for a visually impaired individual or a medical alert dog for someone with seizures or diabetes.  Service dogs do not have to be obtained through a service dog organization and registration of a service dog is not mandated by federal law.  The law does not require a service dog to wear any identifying vest or ID.  The law does specifically exclude dogs whose sole function is to provide emotional support.  State laws may allow for a broader definition; both in the type of animals that qualify and the service they offer, so you may want to refer to your state’s statute for clarification.

 

When a service dog is in public, a business owner has the right to ask the disabled individual (or someone accompanying them) what tasks the service dog performs.  It is very important that the individual is able to name tasks that relate to their disability or the business owner can deny access to the service animal.  A business cannot deny access due to fear of dogs or allergies.  This includes work and school.

 

When a service dog is in public they must be under the control of their handler at all times.  It is preferred that a service animal have a harness, leash or tether but they can be loose if using these items limits the animals ability to safely and effectively perform the tasks it has been trained to do.  In that case the handler must be able to maintain control of the animal through verbal commands and/or gestures.  If a service animal is considered out of control, a business has the right to ask that the animal be removed from the premises; but the individual has to be allowed to finish their business (without the presence of the service animal).

 

So how can an emotional support or companion dog be a legal service animal with all the protections that come with the title?  According to the Americans with Disabilities Act, one acceptable category of service dog is a psychiatric service dog.  By definition a psychiatric service dog aids individuals with cognitive, psychiatric, or neurological disabilities.  This opens the door for someone with PTSD or another severe emotional condition to qualify, if their physician can document an emotional condition that rises to the standard of a psychiatric diagnosis or the condition effects cognitive functioning.

 

Despite the exclusion of emotional support dogs in public, some airlines will allow an emotional support animal to fly with an individual if their primary care physician provides appropriate documentation.

 

Warning:  Some folks just put a vest on a dog and fake it. That may work, or it may fail.  There have been recent discussion with law makers for this to be a punishable offense.

 

Sources: www.thecenterforindependence.org; www.ada.gov; www.servicedogcentral.orgwww.nsarco.com and Florida Statutes 413.08

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.

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.

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.


 

Should l rent my loved one’s home while she is in a facility?

house for rent

Image via Brooke Raymond

Whether or not you should rent your loved one’s home while she is in a facility is a loaded question. Let’s look at just a few of the things to consider.

 

First, there is the emotional “cost” of this choice. If she is expecting to get back home as soon as her rehab stay is over, this may feel to her like she cannot ever go home and take away her hope. Then there are tons of financial, legal, insurance, liability and more pieces that factor into this choice. Please consider talking with the experts- her Attorney, CPA, Realtor, and Insurance Agent-  to get a full, clear picture about this decision.

 

Here are a few thoughts to mull over:

#1. What will you do with the personal property, personal memorabilia and her personal/financial records in the home? Consider the cost to sort, pack, move and store – and then potentially bring it all back to the home.

 

#2. What will happen to her homeowner’s insurance if you rent the property? Consider the cost of a proper policy to protect your loved one and the home.

 

#3. What will happened to her homestead property tax exemption if you rent the property?

 

#4.  How would this impact her future need for Medicaid?

 

#5. How will this impact her income tax status?

 

#6. Are there any HOA or condo rules that forbid the renting of the home?

 

#7. Are her insurances tied together – auto, home, umbrella, renters?

 

#8. Who will be the property/tenant manager ?

 

#9. What will happen if tenants cause damage, don’t pay rent or need to be evicted?

 

#10. If you don’t rent it, are you throwing away money that she needs to pay for her care ?

 

# 11. If don’t rent it, what are the problems of an empty home ?

Pill Crush Wednesday

pillcrush So what happens to all those discontinued medications at a residential facility?

 

How much does an ALF have to dispose of in a month?  Hint — The photo in this post is a month’s worth for an 80-bed facility.
Here are your options for disposing of discontinued medications safely:   

  • Ask pharmacies to take them and dispose
  • Dispose yourself properly so be careful, as we don’t want them getting in our aquafer
  • Check with your local fire station, as many will take them and dispose of properly.
  • See if your local homeless shelters or other charities may be able to use the  discontinued medications. For patient privacy, be sure that the patient’s info is removed (name and address) but do leave the medication’s name, dose of the med, date and other necessary info.

9 Quick Tips To Do an Inventory of a Safe Deposit Box

safe deposit box

photo via Jvl

Whether it’s your first or your fiftieth, sometimes inventorying safe deposit boxes is just part of the job. We share tips to make the process as efficient as possible.

 

9 Quick Tips To Do an Inventory of a Safe Deposit Box

 

#1.  Schedule for first thing in the morning. In case the box is very full, bring water and a snack. You might be in there for hours.

 

#2.  Use the bank’s inventory forms. After completion, witnessing and copying, make sure you take ALL the pages of the originals, they are generally required to be filed (in a guardianship) within 10 days of the inventory.

 

#3. Confirm with bank rep that together you will be able to copy the important papers. This is critical for documents like DPOA, Living Will, HCS or funeral arrangements. There are many other types of documents that you will want to copy as well – titles, pension info, ID’s, insurance policies, birth certificates, DD-214, marriage licenses, death certificates, passwords/log-ins, tax returns, professional service provider’s contact info (CPA, attorney, broker), beneficiary info – the list goes on and on.

 

#4.  Get a full copy of all signature cards and contract  – make sure that the L.O.G. are stapled to the signature card when you are done.

 

#5.   If the box is being drilled, you will receive two new keys. Remember you have to return two keys when you close the box.

 

#6.  For bonds, stocks or similar documents, record the serial number of each bond on the inventory sheet and copy them front and back.

 

#7.  When describing items, use words like gold color, red stone, blue stone, copper color, or silver color; avoid specific words like gold, diamond or ruby.

 

#8.  Try to record coins by face value and coin count. If they are hard to read, group them in like-coin denomination and take lots of photos of the piles of coins.

 

#9.  Photograph each group of items as you pull them out of the box. Set them on a blank piece of paper with the date and client’s name included in each photo.