Backstory is Long. September 2023 my 82 yo uncle was found unconscious in his home. To the best of piecing the story together, he had Covid and collapsed from a fever. He layed there for 2-3 days before a wellness check found him. He sustained severe dehydration and pressure wounds to his back and hip. The pressure wounds needed to be debreed. It was determined he needed a pacemaker and told he is in CHF. After 9 days in the hospital He went to sub Acute rehab. Did very well in the 20 days medicare would pay and released to live independently. Only with Wound care nurse and 4 weeks PT Later, I found out he told the SW I was caring for him. I am his POA and healthcare proxy that was established on 2003.
I ordered a medical alert watch and a on the go alert pager. He seemed to have cognitive awareness that allowed him to remain in his house. But refused additional aides or support for him or household chores.
He has had two falls that needed 911 assist lift one in November 2023 and January 2024. Never pressed the medical alert and layed there 3 and 8 hours respectively because he didn't want to be a bother. My father found him while checking on him daily since October 2023.
February 2024 he fell backwards onto concrete and suffered a decompress fracture Below a previous farming accident that required plates and rods to fuse his spine (that was in 2022). He has been in and out of the hospital due to infection three times. He currently in rehab and on a 6 wk IV antibiotic for a chronic incision site infection. He suffer sundowning. Every time his infection flares he has hallucinations and deleriums. He is diagnosed with mild dementia and I have noticed decline cognitive awareness every time a hospitalization occurs.
My father and his Goddaughter (no blood relation) are very hopeful he will be able to go home. And, of course, that Is all he wants as well. Before his second hospitalization rehab was very close to considering him not progressing and Long term care was imminent.
This Wednesday I have a meeting with his rehab medical care team, me and uncle to discuss his progress. They are not even considering he will be able to go home. Home is nowhere able to be converted to wheelchair accessible and he is not able to live independently.
As POA, I have retained an Eldercare attorney. Currently getting all the documentation to apply for Medicaid long term care. Spending down his liquid assets for funeral, dentures, clothing for him.
So my questions
Is there any advice you can give to help a transition to a NH? It isn't feasible to have 24/7 care because he is a two person assist and he lives in a rural area where aides are very short to come by.
As POA, how can I notify family of the decision that needs to happen? How do I counter the questions about the fact since I am POA They think It includes being medical hands on caregiver. I am not skilled mentally or educational to do that.
How do I handle the sketchy 10,000 dollars withdrawal (2 total since October 2023) that he gave to a IMO scheming God daughter?
If in his medical file it is stated he has mild dementia can his Goddaughter legally change herself to POA? this just happed today so the attorney is unavailable on Sundays.
Thank you for taking the time to read and give advice.
SHE can not change POA he is the only one that can make a change. And if he is not competent then any change would not be recognized as legal.
As to informing family you do not have to justify your choices when making decisions for his care.
If family does not agree with you and they think they can do a better job they can retain an attorney and petition to become Guardian. I doubt the petition would be successful if you are doing everything you can to care for him and make the best decisions for his safe care.
You don't have to inform family of anything or bring them in on decisions. Those are for YOU to make for the betterment of uncle. He chose YOU. If I were you, I'd keep family away from any decision-making. That usually only means trouble because everyone has a better idea of what should be done, and then they argue and that takes up too much energy.
After YOU have made the decision, inform others that based on his doctors' advice, blah blah blah. Keep it short. Write a group email rather than calling each one. You're busy doing what needs to be done, is what you say.
Then get on with it, and don't count on any help from anyone else. You have a good head on your shoulders, and you've got this. You don't need Aunt Maybella calling you at 10:00 p.m. and sobbing that you can't do this to poor Unc and he'd get well if only you'd feed him rutabaga. (I had something like this with an aunt.) Don't get tied up in their kooky anxiety issues! And good luck.
Don't tell/share unless it helps. Answer questions accuratly, but quite short. A headline.
Eg Uncle has higher care needs. He is moving into an appropriate place to meet them.
Aunt Maybella & rutabaga LOL 🤣
I know what you mean!!!
What you can tell family is that the doctor recommends LTC.
I agree with SS that the elder care attorney is key.
I hope it’s a certified attorney. One very experienced with Medicaid in your uncles state.
The $20,000 is going to be the issue. Does the attorney already know about this?
What is it you just found out today? That she wants to be POA or that it was entered on his file that he has mild dementia? Or something else?
No. The goddaughter can’t assign herself as his POA. Only he can do that but she does seem to get what she wants from him and it is possible he could change the POA, especially if she dangles living at home vs the NH.
If it helps at all, deep breaths. It will all work out.
POA is a tool not a power. It helps you to help him by taking care of his finances. When gone, then u find resources to help him. I would hold off spending any of his assets until you find out if there will be a penalty for the 10k. He may have to pay privately until the penalty is met. Actually, paying privately for the NH can spend down his assets. Also, the lawyer fees Uncle pays for. You should have no out of pocket.
The God daughter cannot get POA. Uncle has to be able to revoke yours and assign her and he can't if found to have Dementia.
You are the POA and what you say goes. Family has nothing to do with how you handle this. Uncle made u POA for a reason, not ur Dad. Goddaughter has no legal right. (Purpose of a Godfather is only to make sure that the God child gets religious training) So, you need to keep telling yourself "I am POA". You do not give anyone info on Uncles finances nor do you need to inform them about health decisions. Uncle assign u the responsibilty not them.
regarding the withdrawal. It was two withdrawals for a total of $10,000. My uncle is very generous (most times it can be construed as taken advantage of). In his words it is an inheritance. In retrospect I should have realized that because it was 4 days after getting home from his October 2023 rehab stay it was cognitive awareness inability and the early sign of dementia.
Up until his September to October 2023 health deterioration I have let him use his discretion for finance. He had been fiercely independent. I feel bad and guilty for not looking out for his best interest better. I even discussed with her that his saving were not as good as he says and she still took the money. I guess I resent her for that so I need to get over that because what is done can not be revoked.
Once this is done you are HONEST about this 10,000 gifting. This means he is responsible to paying at least that much on his own before Medicaid pays, so that will spend down as well. Until you speak with attorney do NOT do funeral.
Secondly, big decision. Do you feel qualified to do all this. If you do not, resign the POA and let the state handle this. You cannot afford to worry about how to make files, do the legally required bookkeeping, and keep a nosey and grasping family away from the door.
Ask the elder law attorney about how to do this.
I think if there is family interference in all this to be honest it is a lot to ask of you. It is hard enough to get an uncooperative person into the needed care, let alone having a family at you. As POA you not only can refuse to discuss this but you SHOULD. It is legally not their business and privacy rights mean you should not be discussing this with them.
So trip number one and spending down begins with you in an elder law attorney's office this week asking all these questions.
Also ask to speak with social worker where uncle is ASAP. THIS MONDAY. They can also guide you. Show them this very question you wrote. Ask for their help and guidance, because as I said, before you make any steps here you want to know/find out if you can/should be doing this onerous and VERY DIFFICULT job.
I served as POA and Trustee for my brother. He was cooperative, wise, very well organized and it was STILL hard. I advise against taking all this on as it will take many hours from you and make you very very anxious.
I hope your uncle doesn't currently have ANY access to his accounts or checkbooks.
I am so sorry and I wish you all the luck in the world.
It's not "you" who's decided uncle belongs in a SNF, it's his chronic health conditions combined with dementia which prevent him from knowing to push a button to get help after falling. It's the doctors who have determined the need for his placement in LTC, so as POA, you are the person to take action to fulfill that need. Period. Nobody has to like it or agree, but that's old age for some of us.
Have the elder care attorney coach you on these matters in depth, these are just suggestions from forum members on the internet. This is a stressful situation for you, compounded by vultures coming out of the woodwork who smell money they can take for themselves, I'm sure. People who've never lifted a finger to help this man before, but suddenly are so concerned about him going into a SNF that they deem themselves POA. 🙄
1) Is there any advice you can give to help a transition to a NH? It isn't feasible to have 24/7 care because he is a two person assist and he lives in a rural area where aides are very short to come by. - THIS IS YOUR NUMBER 1 REASON to give to family who will question the decision to go to assisted living/ Nursing home scenario . Tell them that getting 2 person assist at home is impossible as enough people are not avail, and even if they were, cost of 2 aides 24/7 at home is prohibitive except for the super rich. (in my area 2 people 24/7 at home would cost about $50,000 a MONTH)
As POA, how can I notify family of the decision that needs to happen? How do I counter the questions about the fact since I am POA They think It includes being medical hands on caregiver. I am not skilled mentally or educational to do that. - Since things are moving quickly, I think you can make decisions, act, and tell them after the decision is made. Its often smoother that way. If there are family members who are cooperative, will give you constructive suggestions, but they realize you have the final decision making ability, then you can ask their advice before deciding if you want. If you dont think its possible that he can stay home, then that;s that. You are POA so decision maker, person in charge of getting him placed. there is NO OBLIGATION to you to do hands on care at home!
How do I handle the sketchy 10,000 dollars withdrawal (2 total s ince October 2023) that he gave to a IMO scheming God daughter? - You didnt provide much detail on this. But since you have an attorney involved , can run this by the attorney
If in his medical file it is stated he has mild dementia can his Goddaughter legally change herself to POA? this just happed today so the attorney is unavailable on Sundays. - In general , for someone who has already written a POA (who is you), to change the POA requires that he re-write the POA along with his attorney, switching it to the Goddaughter. The attorney will need to determine if he is of sound mind to do this, and if he is doing it of his own free will. If he does do this with Goddaugther somehow, and his attorney lets him , but you dont think he is of sound mind, you can take it to the courts to argue it.
Key aspect - lean on the eldercare attorney to run all these questions by. You can ask the attorney all 4 of these questions. I have asked similar types of questions to my attorney, and its been reassuring to do that, even if their answer was that I already had the right approach.