Tag Archives: caregiving

Caveats for Caregivers (8)

This is my eighth essay on caregiving, first published on another website on February 3, 2013.

As may be inferred from the title to this diary entry, this is my eighth essay in this series about the problems I had to deal with when my mother went into a nursing home, along with some advice that I have to offer regarding those problems.  In general, this essay presupposes much of what has already been written; in particular, it is especially connected to my seventh essay recently published.  That diary entry covered my desire to keep my mother in a private-pay nursing home as long as possible, before transferring her to a Medicaid facility, which I knew I would have to do when she ran out of money.  My reason for doing so was that private-pay nursing homes are for rich people, while Medicaid nursing homes are for poor people, and, as is invariably the case, rich people are treated better than poor people.  That previous essay also discussed my efforts to protect my mother from noise, which meant finding her a roommate that was relatively quiet or paying extra for a private room. Although I touched on some of the financial aspects already, they will be the principal focus of this essay.

The monthly cost for a private room was $7,800; for a semi-private room, $6,500.  The rates were about the same at the private-pay facility as they were at the one that accepted Medicaid. Then there were the extras: telephone service; cable TV; beauty parlor; dentist; podiatrist; optometrist; the cost of an attendant to accompany us when she went to the doctor, in case she had to use the restroom; supplies not paid for by the nursing home; medicine not covered by insurance; and so forth, all of which averaged out at about $500 per month.

Given my mother’s income and assets, I knew she would be able to afford a private room for a year, or a semi-private room for eighteen months.  After her money was gone, there was always the possibility of my using my own money.  There would be no way I could pay all of her nursing home costs, but there was the possibility of my using my money to supplement Medicaid in order to keep her in a private room.  In other words, Medicaid will only pay for a semi-private room, but if I could kick in an extra $1,300, I could keep her in a private one.  That, plus the $500 worth of extras, would run me $1,800 per month.

If I had known for certain that my mother would live, say, one year after getting on Medicaid, I could have afforded to pay the difference, without too much of a dent in my net worth.  But there were no such guarantees.  I met a woman whose husband was a patient at the nursing home where my mother was staying.  She said that when her husband was first diagnosed with some kind of brain disease, the doctors told her he had three months to live.  “And that,” she said, “was seventeen years ago.”  With that kind of uncertainty, I knew that in order for me to start paying for a private room, I would have to go back to work to make sure I did not impoverish myself.  The daily visits to my mother, lasting four-and-a-half hours each, would then no longer be possible. My visits would have to be fewer and of shorter duration.  As my mother was extremely dependent on those visits, the option of my paying extra for a private room once she got on Medicaid was out of the question.

Because any extra money I could get for my mother would allow me to delay the day when I had to transfer her to the Medicaid facility, I applied for the Aid and Attendance benefit through the Department of Veterans Affairs, which I discussed in my fifth essay.  Unfortunately, it took the VA ten months to approve the application, and by that time I had already transferred my mother, since I was not sure she would get it.  In any event, after I had moved her to the Medicaid facility, the benefit was finally approved for $1,700 per month, which she started getting immediately. However, since it took them ten months to approve the benefit, they owed her for that period, which amounted to $17,000. For that, the VA said I would need to become my mother’s representative payee, which I also discussed in my fifth essay. They said that would take about forty-five days.  After a couple of months, I called them, but they said they were still processing the application.  A few weeks after that, my mother died.  I notified the VA, and they told me that as a result, the $17,000 was no longer payable.  If I had been a spouse or a dependent child, the accumulated benefit would have been paid. Or, if I had spent my own money taking care of my mother, and had the receipts to prove it, the money would have been paid. But none of this applied to my case.

Let me say at the outset that I really did not care.  The main reason I wanted the money was to keep my mother in the private-pay nursing home as long as possible, and once I had moved her to the Medicaid facility, it really did not matter anymore.  Although I would have inherited the $17,000, which ain’t hay, I humbly confess that I have enough money to last me for the rest my life regardless, and I have no real need of more. Besides, as far as I am concerned, the money never really belonged to me to begin with, so it is not as though they took something away from me that was mine.  However, I thought it might be important to relay this information, since others may not be as financially independent as I am, and they might find themselves counting heavily on something that may suddenly vanish.

Therefore, anyone who applies for the Aid and Attendance benefit should be aware of the situation regarding the accumulated amount.  If the VA had approved the application in the forty-five days they said it would take, the money would have been deposited in my mother’s bank account.  When she died, I would have inherited it.  But since they did not finish the application before my mother died, the money was no longer payable. Normally, this does not happen.  If Smith owes Jones money, and Jones dies, the debt does not die with him.  Smith still owes the money to Jones’s estate.  If Corporation XYZ is sued, and before the suit can be litigated, the plaintiff dies, his heirs may pursue the case.  With regard to the Aid and Attendance benefit, however, the government saves money by being inefficient.  I do not say that anyone intentionally used dilatory tactics to avoid having to pay the claim.  But the fact remains that the longer it takes the VA to process an application, the less likely they are to have to pay it.

When I reported my mother’s death to the VA, I was informed that I could apply for a $600 death benefit to help cover funeral expenses.  By that time, I was so tired of dealing with the VA that I decided it just was not worth it. However, the woman I spoke to on the phone assured me that it would be no problem, and so I filled out the form and sent it in.  I still have not heard from them. I doubt if I ever will.  I don’t care.

Because my mother died before she ran out of money, I never had to apply for Medicaid in her behalf.  Nevertheless, in anticipation of making that application, I did become aware of a few things that might be of interest.  In particular, there is the matter of qualifying.  In order for my mother to get Medicaid, I knew that she would have to run out of money, which means that her bank balance would have to drop below $2,000, and her income would have to be deposited in a qualified income trust, also known as a Miller trust.

In anticipation of this eventuality, a lot of people decide that it would be a shame to let grandma’s money go to waste.  Rather than allow the nursing home to deplete her assets, they decide to do it themselves.  With a little encouragement, grandma signs a few checks, reducing her substantial bank balance to the more modest amount of a few hundred dollars.  Then, they figure, when she does go into the nursing home, she will immediately qualify for Medicaid, inasmuch as her bank balance will be below the required ceiling. Needless to say, the government does not approve of such cleverness.

When the application for Medicaid is made on grandma’s behalf, an investigation is made of her finances, covering a look-back period of five years.  If there is any hint that she has given away her money, they want it back.  In other words, any large cash withdrawals that cannot be justified will be disallowed.  So, if grandma gave away, say, $100,000, then her children will have to pay for $100,000 worth of nursing home costs themselves before Medicaid will begin making the payments.  I read a story about a woman who applied for Medicaid on behalf of her mother.  When the civil servant handling the case looked over her mother’s bank statements, he found a $10,000 cash withdrawal.  The woman explained that her mother had had her roof repaired a couple of years ago, and she had paid cash.  But she did not have a receipt.  So, the $10,000 was disallowed, and the woman had to pay that amount of nursing home expenses before her mother could qualify for Medicaid.

Because neither my mother nor I have ever itemized expenses on our tax returns, the standard deduction always exceeding whatever could have been realized by itemizing, neither she nor I have ever worried about keeping track of expenses.  Income, yes; but expenses, no.  So while we each had records regarding such things as wages, interest, dividends, capital gains, and annuities, neither one of us really had any records regarding expenses. Since, like me, my mother preferred paying cash, and since, like me, my mother saw no need to hold on to receipts after the warranty period expired, there were almost no receipts for the five-year look-back period she would soon be facing. Fortunately, she had no really large cash withdrawals, like that of the woman whose mother had had her roof repaired, but only routine withdrawals that could easily be justified as money paid for groceries, sundries, gasoline, and the like.  At least, so I hoped.  Since I never had to find out, I cannot be for certain. Therefore, when it comes to nursing homes, keep in mind that justifying cash withdrawals is as important to Medicaid as reporting income is to the Internal Revenue Service.

Because of the importance of satisfying Medicaid that grandma has not given any of her money away, I advise you not to have any joint accounts with her. I know that it is tempting to do so, because it makes things easier.  A friend of mine had a joint checking account with his mother, with whom he lived. When she became incapacitated, he was able to pay her bills simply by writing checks.  As a result, there was no need for him to have power of attorney.  But if she had had to go into a nursing home and apply for Medicaid, distinguishing between his money and hers in that account could have proved messy.  I did not have a joint checking account with my mother, but we did have a joint safe deposit box.  We originally got the box for important papers, and there was no need for us to have two separate boxes. During the 1990s, I started buying gold coins, and as the average cost of those coins was only $350 each, I just stored them in a jar in my apartment. But as the price went up after the turn of the century, their increased value began to worry me, and so, without giving it a thought, I put the coins in the safe deposit box.  When I started anticipating the day I would have to apply for Medicaid, I looked at the application form, and naturally there was a question as to whether my mother had a safe deposit box, to which I would have to say, “Yes.”  Then they would want to know if she had anything of value in it.  They might even want to look inside, just to check.  If so, I wondered if I would be able to explain, to their satisfaction, that the gold was mine and not hers.  Now, I know what you are thinking.  Why didn’t I just take the gold out?  The answer is, they would probably ask me if anything of value had been removed from the box.  Maybe you could look them right in the eye and deny that you had removed the gold, and then sign a document testifying to such, under penalties of perjury, but I have been cursed with an inability to lie in such circumstances.  Oh, I can lie to be polite, or to protect a lady’s honor, but when it comes to lying to the Feds, forget about it.  I knew I would start channeling my inner George Washington:  “I cannot tell a lie.  I took gold out of the box.”  I consulted an eldercare attorney, and he told me just to be honest about it, tell them it was mine, and everything would be fine. Although I was glad to hear such reassurance, I was unable to be equally sanguine in the matter, and thus I continued to worry. As it turned out, I never had to find out if he was right.  But the moral of this tale should by now be clear:  do not have any joint accounts with grandma.

Even if all went well, I knew that from the time my mother qualified for Medicaid until the application was approved would be two or three months. The woman I talked to at the Medicaid office said it only took forty-five days, but every social worker I talked to said it would take two or three months. Now for the catch-22: During the application period, before Medicaid started paying, my mother would be responsible for the $6,500 per month it cost her to stay in the nursing home. But since her bank balance would have to be below $2,000, and since her income would not even come close to paying that amount, her being able to make those payments would be arithmetically impossible.  I asked the woman at Medicaid if I could get the application approved in advance, so that everything would be ready to go when my mother finally ran out of money.  Now, I know that you know that the answer to that silly question was “No,” but I was tired that day and not thinking clearly.

For someone like me, the obvious solution was that I would pay for the nursing home costs until Medicaid approved the application, at which point I would be reimbursed.  But it was my good fortune to have the financial resources to bridge that gap.  Many were the times that I asked myself along the way, “What do poor people do?”  In this case, I suppose that people who are really poor are already on Medicaid, and so there is no problem.  But there must be plenty of people who are not already on Medicaid, and who do not have children with enough money to make those payments, or possibly have no children at all, and thus are left in the lurch.  One woman, whom I got to know at the nursing home where her mother was also a patient, wondered about this problem as well.  “What if I were to just walk away?” she asked, theoretically speaking, of course.  I speculated that her mother might then become a ward of the state.  More ominously, there was the possibility of being sued by the state under filial-support laws, which can be used to compel children to pay for expenses incurred by their parents. These laws vary from state to state, the worst of which is Pennsylvania.  Although there do not appear to be such laws in Texas, where I live, this may change. When the politicians begin cutting Medicaid funding, more laws of this nature may be enacted. When they are, I can almost hear the politicians waxing nostalgic of the way things used to be, when family members took care of one another, and speaking glowingly of how these filial-support laws will help bring back those good old days.

In any event, one thing a poor person might do is avail himself of a nursing home that accepts Medicaid pending, in which the nursing home allows a patient to stay in a room until the application is approved, at which point it is reimbursed.  But none of the nursing homes I considered offered such.  It is my guess that the ones that offered Medicaid pending were either 150 miles from where I live, which would have made frequent visits impossible; or they were located in a part of town I would not have wanted to drive through in the daytime.

Some of these problems can be handled by eldercare attorneys. They can set up a Miller trust, help you apply for Medicaid, and arrange for allowable transfers of money that can then be used while waiting for the Medicaid application to be approved.  But all this costs money.  So once again, I ask myself, “What do poor people do?”  I hope I never have to find out the hard way.

Caveats for Caregivers (7)

This is my seventh essay on caregiving, first published on another website on February 1, 2013.

After my mother died last September, I wrote what I thought would be my final essay in this series, discussing palliative care and hospice.  I remember thinking at the time that there were one or two things that I wished I had covered in the earlier essays, but I dismissed them as not important enough to worry about.  At a time like that, not much else would seem important. But it keeps coming back to me that these remaining pieces of information would have been very useful to me at one time, and it was no fun having to learn them the hard way.  Having thus reconsidered, this will be the first of what I believe will be my last two remaining essays.

We have all seen those reports on the news or on some show like 60 Minutes that reveal how horrible conditions can be in nursing homes, with patients being neglected or physically abused. Fortunately, in my experience with nursing homes, I never saw any problems like that.   The situation reminds me of my father’s experience after World War II.  My father was in the navy, and in the early months of the war, his ship went down. He spent the next three-and-a-half years in a Japanese prisoner-of-war camp, where disease and starvation resulted in the death of all but just over a hundred men out of a crew of over a thousand (about half died when the ship went down). When he got back home, he had to listen to his family talk about how rough they had it during the war, what with Meatless Mondays and sugar rationing.  So, with apologies to anyone who has ever had real problems with nursing homes, I will now venture to discuss a relatively minor problem that I encountered.

When it became clear that my mother would have to go into a nursing home permanently, I had already had some experience with such facilities, and so I picked the nicest one of the bunch. It had only one disadvantage:  it did not accept Medicaid.  Except for the patients that were there for only a few weeks of therapy, which Medicare paid for, everyone else was private-pay.  My mother was not rich, but she had enough money and income to pay privately for about eighteen months. So, I decided to start at this private-pay facility, and use it as a base of operations, as it were, from which I could take my time investigating Medicaid facilities in the area.  Then, when she finally ran out of money, I would know where to transfer her.

I would have preferred to have her in a private room, but that would have cost about $7,800 per month, as opposed to just $6,500 for a semi-private room (plus about $500 worth of extras). Since the latter would allow me to stretch her money further, thereby keeping her at the private-pay nursing home as long as possible, I went with that option.  And this leads me to the problem that gave me the most stress, the one that used to keep me up at night:  the problem of noise. Imagine being in your living room, with a curtain down the middle.  On one side of the curtain, your half of the room, you are watching television.  On the other side of the curtain is your roommate, watching another television, but tuned to a different station. Since the sound coming from each television interferes with the other, there is a tendency to escalate, each set being turned up a little louder in order drown out the other.  And when you turn your set off, deciding to go to sleep, the other set remains on. That is what it is like to be in a semi-private room.

In the hospital, it had been different.  There she had a remote that allowed her to do everything: adjust the bed, call for assistance, control the television.  More importantly, the remote had the television speaker in it.  So she could turn the volume up loud enough for her to hear it, but without disturbing her roommate, and vice versa.  But not a single one of the nursing homes that I toured had that set up.  In every case, there were just two ordinary televisions, with regular speakers.  I suppose that the primary reason nursing homes do not have that kind of setup is that most nursing homes, to keep costs low, do not supply televisions.  You have to bring one in yourself. Headphones naturally suggest themselves as a solution, but they would have to be wireless, or else people would be tripping over the wire; and wireless headphones are a little too complicated for people in nursing homes.  By “complicated,” I mean, among other things, you have to turn them off to make sure the battery does not run down.  In any event, I never saw anyone in any of the nursing homes using them.

When I would go to visit my mother, she would tearfully plead with me to get her out of there. She said that her roommate’s television was driving her mad, because it was on all night long. Since my mother was suffering from dementia, I could never be sure of anything she told me.  At lunch, however, she used to sit at the same table as her roommate, who casually mentioned one day that she never got more than four hours of sleep at night, which meant that the television was probably on twenty hours per day.  After one long, miserable month, I moved my mother into a private room, which meant that her money would only last her about a year.  When she did run out of money, she would have to have a roommate, because Medicaid will not pay for a private room.  But at least this would postpone my mother’s nightmare a little longer.

In a way, it could have been worse.  At least my mother’s roommate did not have any hearing problems.  Being old, a lot of residents in nursing homes cannot hear, and the television is so loud that it is earsplitting.  I walked by one room where the television volume was up full blast.  Inside was a man, wearing a hearing aid, sitting right next to the TV in his wheelchair, and leaning slightly forward, presumably so he could hear better. Being in that room would be like being in Guantanamo, subjected to what some are pleased to call harsh interrogation techniques, but which I call torture.  I half expected to see a couple of CIA agents in there, demanding that the man’s roommate tell them where the weapons of mass destruction were.  In another room, with a television playing equally loud, the resident would often leave and wander down the hall, without bothering to turn the set off, while his roommate, who was confined to his bed, had to just lie there.

The second major source of noise was raving.  Some of the residents would cry out for help, and then scream to be left alone when the caregiver went in to see what they needed.  Others would beg forgiveness from God, sorry for whatever sin they had committed.  Others still would cry for their mothers. Unlike the problem with the televisions, raving only occurred occasionally. But when it did occur, it was unnerving.

And so, I said a little prayer to the politicians of Texas, to please have mercy on my poor mother and those like her, to change the Medicaid rules, and allow everyone to have a private room, for just a little peace and quiet at the end of their lives.  But I fear I prayed to a heartless pantheon, who are more likely to cut Medicaid than supply it with more funding, which will only make things worse.  As a harbinger of a grim future, one of the nursing homes I checked into had four patients to a room.  I did not even bother to tour that facility, and I shudder to think what four televisions must sound like.  As our politicians wax virtuous about the need to cut the entitlements, of which Medicaid is one, I fear that a Merciless Providence will eventually ordain a return to the wards: large rooms with twenty beds each, and a couple of minimum-wage caregivers running back and forth, trying to attend to the patients who occupy them.  Of course, each bed will have its own television.

Through a circuitous process that I covered in my fourth essay, my mother eventually ended up in a semi-private room with a roommate who slept all day.  As a result, she never played her television, and, equally important, my mother’s television did not seem to disturb her roommate. After all, my mother was not completely innocent in all this, for she liked to watch television too, and being hard of hearing, she tended to play it a bit loud herself.  So I had to worry about the noise problem both ways.

At any rate, the problem being temporarily solved, I began investigating the Medicaid facilities, for which purpose I found the website Medicare.gov extremely useful.  By typing in my zip code, it would tell me which nursing homes accepted Medicaid and which did not, and how many certified beds they had.  Unfortunately, no distinction is made on the website between beds that are certified for both Medicare and Medicaid, and those that are Medicare certified only.  That information needs to be obtained with a phone call.

Although a nursing home with a small number of beds may sound cozy, suggesting that the staff will find it easier to care for an equally small number of patients, I realized that there was a distinct disadvantage in selecting such a nursing home.  If my mother ended up with a noisy roommate, the option of moving her to another room would be limited. When I checked out a nursing home that had three hundred beds, however, the woman in charge of admissions mentioned, without my even having to ask, that they would work hard to find my mother a compatible roommate should that be necessary.

There is another reason why big is good.  When I said that my mother had enough money to pay privately for about eighteen months, that did not mean I could keep her at the private-pay nursing home for the full period. Most nursing homes have waiting lists, so I knew that I would have to put in an application to a Medicaid facility at least six months before she ran out of money, and even that might be pushing it.  I finally decided on nine months, just in case.  In any event, the larger the nursing home, the greater the turnover, resulting in a shorter waiting list.  If the number of certified Medicaid beds is small, however, getting one of those beds may not be possible.  One place I called, which only had six beds, told me not to even bother getting on the waiting list, for it might be years before one was available.

So, I went with the big nursing home when the time came for me to transfer my mother, and the good news is that the roommate my mother ended up with had good hearing, and thus played her television low.  And as my mother had reached the point where she no longer watched television, because she no longer understood what was going on, I did not have to worry about the noise problem on her end.

Running parallel to my effort to protect my mother from noise were problems concerning money: her money, my money, and the government’s money.  But that is for another essay, which I expect to publish soon.

Caveats for Caregivers (6)

This is my sixth essay on caregiving, first published on another website on September 21, 2012.

It had almost become routine.

My mother had frequent urinary tract infections, and they often resulted in her becoming even weaker than she already was, and more confused than usual.  So, when the nursing home where my mother resided called me early in the morning to tell me that my mother had become unresponsive, and that they were sending her to the hospital, I was not surprised.  I went straight to the emergency room, arriving there just before the ambulance did.

But then something happened that was not routine.

Shortly after my mother was brought into the emergency room, the nurse asked me if I had spoken with a social worker.  “Well, not today,” I replied. In all the previous times that I had been to the hospital with my mother, the social worker was someone who showed up the next day to discuss whether my mother lived alone, and what kind of care she would need, or whether I needed help selecting a skilled nursing facility.  I had never talked to one in the emergency room, especially before a doctor had even seen my mother. But five minutes later, a social worker showed up, and the first question out of her mouth was, “Have you considered palliative care?”  As the name would indicate, palliative care focuses on making the patient comfortable rather than on treating the illness.  It is like hospice, only you don’t have be diagnosed with a terminal disease with only six months to live to qualify for it.

Clearly, they had come to the conclusion that my mother’s health had declined to the point that ordinary treatment was no longer appropriate. They didn’t have to convince me.  I had come to the conclusion that hospice was the best thing for my mother almost a year earlier. However, my mother was not ready, psychologically speaking.  In her mind, hospice was a halfway house to euthanasia, and I was of the same opinion.  It is for people who want to die as quickly and as painlessly as possible, and if that is not your attitude, you are not ready for hospice.  Every social worker will deny this. “People in hospice often live for years,” they will tell me.  “It’s just a different approach to end of life care.”  But I knew better, and so did my mother.

She would sometimes tell me that she hated her life, that she wanted to commit suicide, but that she couldn’t figure out how to do it.  “Well, Mom,” I would say, “if you are really tired of this, I can put you in hospice.”  She would become silent, and then, after a couple of minutes, she would begin talking about something else.  Nevertheless, such thoughts persisted.  I usually was the one who gave my mother her medicine in the morning, explaining each pill to her as she took them.  “And this one is your stool softener,” I would say, while holding it in my hand. “Suicide pill?” she would ask.  “No, Mom.  Stool softener.”  This happened on at least three different occasions. So, clearly it was on her mind.  And yet, not surprisingly, she could not quite bring herself to go into hospice.  Once, when she was really sick, she just barely managed to get the words out, “I can’t take this anymore.”  “Do you want me to put you in hospice?” I asked. Without hesitation, she said, “No.”

But palliative care was different.  At least, it was a different term, one without the connotations of a death sentence.  Of course, my mother already knew that she was dying. But it is one thing to accept the fact that you are going to die, and it is quite another to give up.  Perhaps, with this concept of palliative care, I could get for my mother all the benefits of hospice without the disturbing connotations.  As it turned out, however, my mother declined to the point that I realized she probably would no longer know the difference.  So, notwithstanding my mother’s wishes, I decided hospice would be best for her.  I had already signed a do-not-resuscitate order on a previous occasion, but now I signed a do-not-hospitalize order as well.  I felt as though I was signing a death warrant.

Is there a term for the opposite of “control freak”?  Some would suggest “easy going” or “laid back,” but that is not what I have in mind.  It is not merely that “control freak” is a substantive, whereas “laid back” and “easy going” are modifiers that makes them inadequate. It is the fact that these latter terms fail to capture that strong aversion I have always had to deciding what is best for others or telling them what to do.  I once refused a promotion to manager for that reason.  Instead, I recommended a coworker who was younger than me by a generation.  He became manager, along with a raise, and I took my orders from him, which suited me just fine.  I never wanted to be responsible for anything but my own actions or for anyone but myself. Well, whatever the term for it might be, for the past year, I had been forced to make decisions for my mother, in some cases, contrary to her wishes.  For starters, I had put her in a nursing home.  On many occasions, at the end of a visit, she would ask me, “Can’t I go home with you?”  Saying “No” was a soul-crushing experience.  And now I had made a life and death decision for her.

Two weeks later, she became unresponsive again.  But this time she did not go to the hospital. For a day and a half, she received nothing but morphine. And then she died.  If I had let her go to the hospital, she would have received fluids intravenously. They could have intubated her to help her breathe.  And I could have had a feeding tube installed.  She might have recovered again, and then returned to the nursing home, after which she might have lived several more weeks, months, or even years.  But she received none of those things, because I denied them to her.

Now I have dreams that I forgot about my mother and left her somewhere—how frantic I am that she is lost, and how relieved I am when she manages to find her way back to me.

Caveats for Caregivers (5)

This is my fifth essay on caregiving, first published on another website on July 12, 2012.

In my first essay in this series, I wrote about my discovery that the federal government does not recognize power of attorney as having any legal standing, and that for each agency, office, or department from which my mother receives a check, it would be necessary for me to become her representative payee.  They each have their own set of conditions, but especially challenging was the Office of Personnel Management, who said that their preference was that I be my mother’s court appointed fiduciary. Their alternative conditions I was unable to meet, and so I called a lawyer and began the process of becoming my mother’s legal guardian.

My mother had direct deposit for each of her checks, and so there was no immediate need for me to become her representative payee.  There was, however, the problem of her mail.  Having shut down her apartment, I had the Post Office forward her mail to my apartment as a temporary measure. Then I called Social Security and had her mailing address changed, no questions asked.  The Office of Personnel Management, on the other hand, required a letter from my mother.  So, I typed one up and got her to sign it. Owing to her dementia, she did not know what she was signing, but I guess the federal government would rather have the genuine signature of an incompetent person than that of someone with power of attorney.  Moving right along, when I called the Department of Defense, the woman I spoke to asked if my mother was present, so that she could talk to her and get her approval for me to discuss her affairs.  I told her that she was not present, but that even if she were, she would not understand what was being asked of her.  As a result, the woman said I would have to become a representative payee before she could even talk to me about my mother’s mailing address. I learned long ago that if you call the federal government, and you do not like the answer you get, call back the next day.  There is a good chance that you may like the second answer better.  Consequently, the next day I called the Department of Defense again, and the man who answered changed my mother’s mailing address without further ado.

At this point, you may be wondering why I would need to do anything else. Her checks were being directly deposited in her bank account, and the bank recognized my power of attorney. Now that her mailing address had been successfully changed, it would seem that I could just coast.  However, it would be just a matter of time before my mother would run out of money and need Medicaid.  My mother’s three checks would not be enough to pay for her nursing home expenses, yet they give her an income above the limit allowed by Medicaid.  To bridge this gap, many states have qualified income trusts, often called Miller trusts.  Once I set up the Miller trust, I will have to direct her checks to this new account, and in order to do that, I will have to be her representative payee.  So, it had to be done.

Since I would have to become my mother’s legal guardian to satisfy the Office of Personnel Management, I decided to wait until I had that document before dealing with Social Security or the Department of Defense. The elder care attorney that I had talked to about the Miller trust did not do guardianships, but he recommended someone else.  The someone else was actually a divorce lawyer who had done guardianships in the past, but was reluctant to take my case. The fact that my mother had already given me power of attorney, coupled with the fact that I was an only child, precluding the possibility of there being a challenge to my case from one of my siblings, persuaded my attorney that a trial would not be necessary, and that my situation would present no difficulties.  So, she agreed to take my case, and I wrote her a check for $3,500 (damn that Office of Personnel Management anyway!).

My lawyer had a busy schedule, so nothing happened for the first two months.  Eventually, however, I signed some more forms, and the application was filed.  A few weeks later, while I was visiting my mother in the dining room of the nursing home, my mother was served papers, notifying her of my attempt to become her legal guardian, and advising her of her rights, should she have any objections.  Of course, my mother was not able to understand the papers, and I was the one who actually took possession of them, but otherwise, all was in order.  An old woman sitting at a nearby table looked at my mother, gave me the evil eye, and then looked back at my mother, and said, “Whatever you do, don’t sign anything!”  My mother was engrossed in her soup and did not hear her, but it sure made me feel as though I was doing something sneaky.

A couple more weeks passed by, and a court investigator showed up.   I guess I should mention that since I am retired, I am able to visit my mother between 10:00 A.M. and 2:30 P.M. every day, which accounts for how I happen to be there when these people show up unannounced. She talked to my mother about the legal guardianship, and my mother sort of understood and approved of it, so all went well.  But as can be seen from the dire warning of the old woman of the previous paragraph, some patients in nursing homes will vehemently resist the guardianship process, which can necessitate a trial by jury.  Three weeks later, my mother’s attorney ad litem showed up.  She is the attorney assigned by the court to represent my mother’s interests.  As with the court investigator, all went well.

Technically, I was my mother’s adversary.  Now, it only made sense that her attorney’s fees would be paid for by her.  But the $3,500 I paid my attorney was also paid for by my mother, thanks to my power of attorney.  In other words, my mother was forced to pay for the attorney of her adversary. Strange, but apparently legal.  Then I had to put up a bond of about $500, against the possibility of malversation on my part.  No problem, Mom paid for that too.

While all this was going on, however, the Department of Defense got wind of my mother’s situation.  My mother’s Navy annuity is based on my father’s service.  Every year, she receives a Certificate of Eligibility form, asking about her marital status. Apparently, if she were to remarry, she might no longer be eligible for the annuity.  If this seems like an intrusion into my mother’s private life, be reassured.  At the bottom of the page, it clearly states that “disclosure is voluntary.”  It also states, however, that “failure to provide information will result in suspension of annuity payments.”  At the time that my mother received this annual request for voluntary information about her marital status, she had recently fallen and broken her hand. Moreover, her dementia had progressed to the point that she would not have been able to sign even with a good hand.  Consequently, out of the expedience that comes with exhaustion, I just signed the dang thing with my power of attorney and sent it in.

Now they knew.  And now they wanted me to become her representative payee.  For this purpose, I had to send in a doctor’s letter stating my mother’s incompetence, and I had to sign an application.  I couldn’t believe it.  Unlike the conditions required by the Office of Personnel Management, these requirements by the Department of Defense were simplicity itself. Well, there was this one snag.  My signature had to be witnessed.  The employees at the nursing home could not witness my signature, but there were many patients there who were mentally sound, not to mention the visitors who were always about.  I asked a several different people if they would witness my signature, and they each looked at me as though I had asked them if I could sleep on their couch for the next two weeks.  So, I gave up on that and went to a notary who witnessed it for free.

In any event, the day of the hearing finally arrived, five months after I started the process, and I was made the legal guardian of my mother’s estate and person.  I sent a certified copy to the Office of Personnel Management, along with their forms, and hopefully that will do it.  I thought maybe I could do the same with Social Security, but they want a doctor’s statement anyway, and I have to go to their office in person for an interview.

In the meantime, the Aid and Attendance benefit that I had applied for my mother, based on her wartime service as a Navy nurse, was finally approved, after ten arduous months.  As part of the application for the benefit, I had sent in a doctor’s statement to the effect that my mother was totally incompetent. Therefore, the Department of Veterans Affairs wants me to become her representative payee.  For this purpose, my legal guardianship document was as worthless as my power of attorney.  The Office of Personnel Management might regard my status as a court appointed fiduciary as being of significance, but the Department of Veterans Affairs has higher standards than that, by George. What they require is my mother’s signature on a form appointing me as her representative payee.  In other words, they require that I be her representative payee, because they know she is incompetent; but her signature on a document, however incompetent she may be, is worth more than the court document that states that my mother is incapable of handling her affairs, which includes such things as signing documents.  My mother has since regained her ability to sign her name, but she has become uncooperative of late, so I am unable to get her to sign anything.  The VA says I can get her fingerprint on a document if she won’t sign, but it has to be witnessed.  I don’t want to go through the degrading process of having people rebuff me when I ask them to witness something, and I don’t want to drag my mother to the notary to have them witness it. I have heard there are mobile notaries that will come to the nursing home, but if my mother refuses to sign her name, she will probably fight any attempt to fingerprint her as well.

I don’t mean to end this essay with a cliffhanger, but I have gone on long enough, and how all this turns out will be revealed in my next essay, if I haven’t completely worn the reader out this time around.

Caveats for Caregivers (4)

This is my fourth essay on caregiving, first published on another website on May 4, 2012.

You know you are getting old when you hang a pendant around your neck with a button on it. Now, I know you have seen that commercial where the woman falls in the bathtub and lies there, unable to move, until her daughter shows up four hours later.  As horrible as that prospect sounds, there are two reassuring features about that commercial:  first, it was not her son that found her in that situation; and second, at least there was someone, daughter or otherwise, who had the key to her house and came over to see her that same day.  If I fell in the bathtub and broke my hip, no one would find me until the landlord decided to evict me for not paying the rent.  And so, around my neck the pendant hangs.

On the one hand, a medical alert system allows us to keep our independence, in the sense that it allows us to continue living alone instead of moving in with our children (if we have children, that is).  But on the other hand, it is an acknowledgement that we need some kind of assistance, even if it is only from the operators who are ready to help us should we fall, something that never crossed our minds when we were young.  By hanging that pendant around your neck, you are made aware of the fact that you are losing your independence in the very act of trying to preserve it.

But that we can joke about.  The real loss of independence begins when we give up the keys to the car, knowing we will never drive again.  Then what? Setting aside the question of cost, a not insignificant consideration, the next logical step in trying to preserve some degree of independence is having people come to our home to provide us with various goods and services, such as transportation to the store, help with bathing, and Meals on Wheels.  Or, we can move into an independent living community, which is essentially an apartment complex replete with all sorts of amenities for the elderly, such as a shuttle to take people to various stores, bathrooms that have grab bars, and a cafeteria on the premises.  When it is no longer safe for us to be around an oven, or when we cannot remember to take our medicine, we can move into an assisted living facility.  And finally, when our mental or physical limitations become severe, we give up the last vestige of independence and move into a nursing home.

I once imagined that my mother would proceed through each of these stages in just that sequence, in what might be thought of as a natural progression. However, because she had me to help her, she never needed to be in an independent living facility, and then, all of a sudden, she went to the hospital, and from there to the nursing home.  For the next two months, a nursing home was exactly what she needed.  But then she got better, at which point, putting her in assisted living became a genuine possibility.  Not only would the cost be less, but also she would have a private room.  And, inasmuch as my plan met with the approval of the nurse practitioner and other professionals in the nursing home, I decided this was the thing to do. What may be critical to what follows, however, is that this was the reverse of the natural progression.

I cannot, of course, speak for all assisted living facilities.  I can only relate my limited experience in this matter, which you may regard not as laying down a set of absolute truths about all such facilities, but as something to be aware of as a possibility.  First, there was a fee to “enter the community,” which was a thousand dollars at one place and two thousand dollars at another I considered. Second, they required thirty-days notice in case my mother should need to move out.  To put these two items in context, it must be borne in mind that at this stage of life, a lot can happen in thirty days.  In other words, I might have paid the fee and moved my mother in, only for her to undergo a sudden decline in health two days later, necessitating a move back to the skilled nursing section, forgoing the fee and a month’s rent in the process.

Then I found out that the rooms were not furnished.  Maybe I should have known better, but I thought the rooms would come with a hospital bed, a dresser, a chair, a lamp, and so forth, just like the rooms in a nursing home. They did not. Fortunately, the manager had a lot of donated furniture in storage that he let me borrow at no charge, or else I would have had to spend a lot of money setting it up.  The bed could have been a real problem.  My mother needed more than just a twin bed; she needed a hospital bed. Fortunately, again, the administrator was able to get Medicare to pay for a rental.

Then I had to buy sheets, towels, wash cloths, and the like.  In other words, stuff that was supplied automatically in the skilled nursing section would have to be supplied by the tenant in an assisted living unit.  At the department store, as I was about to buy three sets of sheets for my mother’s bed, I had the good fortune to be waited on by a woman with experience in such matters (she had been a caregiver for her father).  She informed me that a hospital bed needed extra long sheets, since hospital beds are slightly longer than twin beds.

As for the towels and wash cloths, you may be wondering why I didn’t just use the towels and wash cloths that my mother had had in her apartment. The answer is that I had already let go of her apartment, and had found it necessary to throw away a lot of good stuff that was simply impossible for me to stash in my own place.  So now I was going to have to replace much of what I had just thrown away.  One of the CNAs (certified nursing assistants) told me that I would need towels not only for my mother to dry with after bathing, but also for the CNA to wipe up the water on the floor that would inevitably be there when she used the handheld showerhead to wash my mother.  Without giving it a second thought, I bought a bunch of white towels.  When she saw them, the CNA announced, in a manner that would brook no exception, that I would have to buy colored towels, because white towels must never be put on the floor.  I was so awed by the gravity of her demeanor that I accepted this pronouncement without question.  As I had already put my mother’s name on the towels with a marking pen so that the laundress would know to whom they belonged, it was too late to return them.  So I bought a bunch of colored towels, and put them in the cabinet next to the white ones.  Three days later, I saw another CNA, who had just bathed my mother, wiping up the water on the floor with one of the white towels.

Then there is the toilet paper.  Even that had to be supplied by my mother, which is to say, by me.  Now, I was not worried about the cost of the toilet paper or other sundry items (facial tissues, soap, toothpaste, etc.).  The problem was that even with the availability of a shuttle to go to the drugstore, my mother was not really capable of handling money or remembering what to buy.  And while I visited her every day, and would normally be able to buy the items myself, I do get sick from time to time.  A mere cold can incapacitate me for a week.  What would happen if I got sick just when my mother needed more toilet paper?  In fact, I had surgery scheduled for myself the next month, and I could not be sure how long I would be convalescing.  In other words, when my mother was in the skilled nursing section, the room was furnished and supplied automatically, and even should I be sick for a month, I would know that she would be completely taken care of.  In the assisted living section, the situation was somewhat more precarious.

After about six weeks in assisted living, my mother fell twice, each time in the middle of the night.  Since the assisted living section is less staffed at night, I was told I would have to hire a sitter for her during the nighttime. This additional cost would have completely defeated the purpose of having my mother in assisted living, and so I moved her back to the skilled nursing unit, where, with hindsight, I guess she really belonged.

I hope that I will not be misunderstood.  Assisted living is perfect for many people, and the one where my mother briefly stayed was excellent.  I simply was not prepared for all that was involved in placing my mother in an assisted living facility, the result, no doubt, of backing into it from a nursing home, instead of following the natural progression.

Caveats for Caregivers (3)

This is my third essay on caregiving, first published on another website on April 25, 2012.

Having just put my mother in a nursing home the previous week, I was anxious to get over there to console her, since she was positively distraught. However, I had to make a deposit, so I was standing in line at the bank, thinking about all the things I needed to do.  I would have to empty out her apartment, which meant deciding what to keep, what to give away, and what to throw away.  I needed to drive across town to get help applying for the Aid and Attendance Benefit from the Veterans Administration. Unfortunately, I did not have much faith in the car I was driving, which the garage had lent me, because my old heap needed to be in the shop for extensive repairs (seven weeks worth, as it turned out).  Moreover, I had just discovered that I would have to become the representative payee (see “Caveats for Caretakers (1)”) for each of her three government checks, and I was wondering how involved that would be.  And, as the pièce de résistance, I had just found out I would need to go into the hospital for some minor surgery.

“What next?” I asked myself.

“Your driver’s license is about to expire,” the bank teller informed me, as she proceeded to record my deposit.

At this point, I guess I should mention that I live in Texas.  I don’t know how it is in other states, but from the time I arrived at the driver’s license office until the time I renewed the license and was heading out the door was three hours and forty-five minutes. Considering all the other problems I had to contend with, this was an inconvenience indeed.  “Oh well, at least that’s over with,” I said to myself as I got to my car.  And then it hit me. Since my mother has dementia, I carry her driver’s license around with me.  I looked at it, holding my breath.  Sure enough, her license would expire in four months.

Now, obviously, she would never drive again.  But she would need a photo ID, since that is one of the first things they want to see when you go the doctor, a hospital, or a nursing home.  I could see the ordeal unfolding before my eyes. I would have to get wheelchair transportation.  I would have to hire an attendant to help my mother go the restroom, which she would surely need to do during a four-hour wait.

“There must be some kind of exception made for people like my mother,” I thought.  And since this must happen all the time to people in nursing homes, I asked one of the administrators at the nursing home if she knew what usually happened in such situations.  She did not have the slightest idea.  The head nurse had no experience in such matters, and I even drew a blank with the social worker.

I went to the appropriate website, but my question was apparently one that is not frequently asked, and nothing seemed to fit my particular problem.  I looked at the contact number. You know you are in trouble when the contact number is not toll free.  It’s not the cost of the call that worried me, but the attitude that this phone number represented, that they were really not interested in hearing about my problem or helping me solve it. The woman I spoke with, however, was quite helpful, and she had some good news.  For people who are homebound or in a nursing home, Texas has a policy of sending someone out to photograph the person and do all the paperwork. Unfortunately, the woman informed me, I would have to go out to the driver’s license office in person to set it up.  “Don’t bother to try to get them on the phone,” she cautioned me.  “It’s impossible.”  I tried anyway.  It was impossible.  So, back I went to the driver’s license office.  For this situation, which could have easily been handled over the phone, I only had to stand in line for forty-five minutes (not to mention the commute, which was the better part of an hour).  I was told that someone visits homebound people or those in nursing homes once a month, and that I would be contacted sometime next month.  I asked for a contact number, just in case.  I did not get one.

All’s well that ends well, I suppose.  I was contacted, and a couple of state employees came to the nursing home. They took my mother’s information, took her photograph, and then tried to get her to sign the form. Unfortunately, my mother was too confused to sign her name or even to make a mark.  So, one of the state employees told me to sign for her.

“Do you want me to sign with my power of attorney?” I asked.

“We don’t accept power of attorney,” she replied. (There it was again, the government’s mantra.) “Just sign her name for her,” she said.

And so, I signed my mother’s name, and within a few weeks, my mother received her photo ID, with my version of her signature right there at the bottom. “If I need to forge my mother’s name on some document,” I thought to myself sardonically, “the signature will be a perfect match with the one on her photo ID.”

As noted above, none of the employees in the nursing home were aware of this service provided for people that are homebound.  For this reason, I have told this tale, to make the reader aware of a service that may be available, depending on the state in which one lives.  I would only add that one should not wait until the driver’s license is about to expire.  As soon as you are sure that your mother will never drive again, start making arrangements right away to get her a photo ID to take its place.

In the opening paragraph, I referred to the Aid and Attendance Benefit that is available to veterans who have served in wartime and their spouses.  The benefit may be as much as $1,700 per month.  If you think your mother may qualify, ask the social worker at the nursing home about it.  She will probably be able to give you a contact number of a government employee who can assist you with this.  My first effort was with someone at the VA, but the nursing home directed to me to a county employee, without whose assistance I would have long since given up. Unfortunately, it takes a long time for the claim to be processed. The odds are very good that you will have to put your mother on Medicaid before she ever receives anything, at which point she will no longer be eligible for the benefit (it will be reduced to $10).

Caveats for Caregivers (2)

This is my second essay on caregiving, first published on another website on April 16, 2012.

“We don’t accept cash.”

She must have misunderstood me.  When I offered to pay cash, she must have thought I was about to reach into my pocket, like some character from Mad Men, pull out a fat money clip, and begin peeling off hundred dollar bills until I got what I wanted.

“What I meant was,” I said, anxious to reassure her, “I could write you a check for the difference.”

“We wouldn’t know what to charge.”

“Well,” I continued, still not fully appreciating what I was up against, “I could put up a big deposit, and you could refund whatever you don’t use.  Or I could just give you my credit card.”

“We don’t accept cash.”

Maybe I should start at the beginning.  A little more than a year ago, my mother had to go to the hospital.  After she was there for about a week, she was still not well enough to go home, but neither was she sick enough to stay in the hospital.  So, a social worker stopped by my mother’s room to help me select a skilled nursing facility.  A skilled nursing facility provides care or therapy for people who have been released from a hospital, but are not ready to go home.  Medicare will pay most of it for 20 days, after which there is a co-payment for about 100 days.

The social worker suggested three such facilities, and I picked the one closest to where I lived. What I did not realize at the time was that a temporary stay at a skilled nursing facility is an opportunity to try out a nursing home.  In other words, the typical nursing home, providing long-term care, is often combined with a skilled nursing facility, providing temporary care.  In many cases, the rooms are the same:  someone who goes into a skilled nursing facility for therapy, but then undergoes a serious decline in health, requiring long-term care, will not even have to change rooms.

Medicare, of course, does not pay for long-term care.  I knew that if my mother should have to stay in a nursing home, she would soon run out of money, at which time I would have to get her on Medicaid.  When I happened to mention this to the woman in charge of admissions, she informed me that they did not accept Medicaid.  As I had naively supposed that all nursing homes accept Medicaid, this came as a surprise.  Moreover, I realized that an opportunity had been lost.  I had inadvertently selected a skilled nursing facility that would not be suitable for my mother, financially speaking, should she ever need long-term care.  Had I selected one that does take Medicaid, then from my mother’s temporary stay there, I would have known whether to bring her back when she needed to stay somewhere permanently. With this in mind, if you want to find out which nursing homes in your area accept Medicaid and which do not, I recommend medicare.gov.

After about a month, my mother was released, and she returned to her apartment.  As it was close to my apartment, and as I was retired, I was able to spend a lot of time over at her place attending to her various needs, like shopping, cooking, and cleaning.  But after a few months, she had to go to the hospital again.  As before, she needed to be released to a skilled nursing facility, and this time I selected one that would accept Medicaid, especially since it appeared that this time she might have to stay for good.

However, the admissions coordinator informed me that GEHA (Government Employees Health Association), the insurance my mother had in addition to Medicare, was not a supplemental policy, but rather a secondary one, a distinction I have yet to fully grasp.  The practical consequence was that GEHA would not pay for the portion that Medicare did not cover.  “I’m sorry,” she said, “but we will not be able to admit your mother.”

I had already been through this with the previous nursing home, but in that instance, I was simply told that I would be responsible for paying the difference.  All I could figure was that the woman I was now talking to must be used to dealing with poor people, who cannot afford to pay anything out of pocket.  “Oh, that’s no problem,” I assured her, “we can pay cash for whatever Medicare does not cover.”

“We don’t accept cash.”

And thus began the surreal conversation with which this story opened.  I called the social worker at the hospital.  She offered to call the nursing home herself.  Ten minutes later, she called me back to tell me that the situation was exactly as I had described it.  I selected another nursing home.  In this case, the woman in charge of admissions did not even bring up the subject of payment.   After my mother was released from that place, I received a bill and paid it.

Hopefully, the cash-refusing nursing home is just an anomaly.  But it is something to be on guard against, in case it turns out to be the beginning of a trend.  In particular, in selecting a supplemental insurance policy, it might be a good idea to find out how much it covers of skilled nursing care.

There is one more thing you need to know about skilled nursing facilities.  A lot of nursing homes have waiting lists.  If you are hoping to get your mother into a nursing home, it may take months to get her admitted.  And I am not just talking about the really nice nursing homes for rich people, the ones that do not accept Medicaid, like the first place my mother stayed in. I once took a tour of a nursing home that looked like a cheap hotel where they rent rooms by the hour.  And they had a waiting list!  But if your mother enters a nursing home directly from the hospital, by way of the skilled nursing unit, she will move to the front of the line.  In fact, once she has a room there, they are unlikely to ask her to leave, should it turn out that she needs long-term care.

Officially, everyone is treated equally.  It is whispered, however, that when it comes to waiting lists, preference is often given to those who can pay privately for a while.  The reimbursement from Medicaid is not generous.  A Medicaid bed is better than an empty bed, but not that much better.  With too many Medicaid beds, a nursing home may end up having to close its doors.  It needs a certain proportion of the more remunerative private-pay beds in order to cover its costs.  Therefore, a prospective applicant who can pay privately for many months is more desirable than one who needs to get on Medicaid right away.  So, if you need to put your mother in a nursing home, and she can pay privately for a while, you should casually mention this fact when talking to the person in charge of admissions.

Now that I think about it, it might not be a bad idea to have one of those Mad Men money clips after all.

Caveats for Caregivers (1)

Beginning in 2012, on another website, I wrote a series of eight essays based on my experiences in taking care of my mother in the last years of her life.  I have decided to publish them here as well, with very few changes from when I originally wrote them.  One change is that I have replaced the word “caretaker” with “caregiver,” which seems to be the preferred term today.  Although one may be a caregiver for different family members or even for a friend, in giving advice to other caregivers, I will assume, for convenience and ease of expression, that the loved one is the caregiver’s mother, as will often be the case.  This first essay was originally published on April 10, 2012.

 

Seventeen years ago, my mother and I decided to take the advice one so often hears about getting one’s affairs in order.  We went to a lawyer and had her draw up a will, medical power of attorney, directive to physician, and durable statutory power of attorney for each of us.  Regarding this last document, it requires a physician’s statement attesting to incapacity or incompetence for its execution.  This turned out to be very difficult to get.

A little more than a year ago, my mother had a seizure, which permanently affected her physically and mentally.  I decided it was to time to execute the power of attorney document. The attending physician in the hospital expressed reticence about providing the necessary letter.  My mother’s bills needed paying, so the next day I brought in a couple of checks made out to the cable company and the electric company.  The nurse said that owing to my mother’s mental state, she was not allowed to sign documents.  So, I whipped out the power of attorney and asked her if she would have the doctor put that in writing so that I could execute the document and sign the checks myself.  She referred me to the doctor who was there for the weekend. He said I would need to wait until Monday to speak to the aforementioned attending physician.  On Monday, I spoke to a third doctor, who said that the attending physician had gone on vacation, and she also refused to provide the needed letter. “What about these bills that need to be paid?” I asked. “Just have her sign the checks,” she replied.  So, my mother, who didn’t know what was going on, and was having hallucinations, signed the checks and the bills got paid.

A question occurred to me:  Was this legal?  I doubt it.  I am not a lawyer, but I suspect that it is illegal to knowingly get a mentally incompetent person to sign a check or other document. What I have discovered, however, from this and subsequent incidents, is that there are things that are illegal but acceptable, though no one will ever come right out and say so.  To qualify for this category, two conditions must be met:  (1) You must not be doing it for your own personal gain; and (2) you are only trying to get for your mother that to which she is legally entitled.  Meet both of these conditions, and there are many health care workers and civil servants who will look the other way, because they know you are in a catch-22 situation.

The next time my mother went into the hospital, I decided to try again.  I asked the attending physician on that occasion for the necessary letter.  He referred me to my mother’s neurologist. The neurologist opined that the letter should come from the attending physician.  So, I gave up.  Fortunately, my mother continued to sign whatever I stuck in front of her.

Eventually, my mother’s cognitive ability declined to the point that I was able to get her primary care physician to provide me with the necessary letter.  From my first attempt to obtain this letter until I finally succeeded was nine months.

When I went to my mother’s bank, which is also my own, and gave one of the bank officers a copy of the power of attorney, accompanied by the doctor’s letter, the bank officer looked at the power of attorney document and said, “Oh.  It’s too old.”  “But the whole idea,” I replied, somewhat stunned at the remark, “is to have this drawn up in advance, while you are still mentally sound.”  After discussing it with the manager, she accepted it, possibly because my mother and I had been doing business there for twenty years.  In general, you should speak to the financial institutions in which your mother has money to find out if they have special rules or forms to fill out before you contact a lawyer about drawing up a power of attorney document.

The power of attorney document that my mother signed clearly states that I have the power to handle her Social Security checks and any other federal benefits or pensions.  It might just as well have stated that I have the power to jump over the moon.  Now, my mother is a triple dipper.  She receives a check from Social Security, the Office of Personnel Management, and the Department of Defense.  They all have one thing in common: they do not accept power of attorney.  Instead, they each require that I become her representative payee.  Not one person in a hundred has even heard of this expression, including, apparently, my lawyer.

You might suppose that there would be one procedure for becoming a representative payee, which would then apply to each agency or department. But that would require the application of reason and common sense. Instead, each agency or department has its own rules, regarding which there is no coordination or reciprocity.  Of the three, the Office of Personnel Management proved to have the most onerous conditions.  They sent me a letter saying that in lieu of my being my mother’s court appointed fiduciary, I could become her representative payee by sending in a doctor’s statement and two affidavits from two people stating my mother’s condition and incapacity.  As I am a bachelor and an only child, there is no one else in my family who could sign such an affidavit.  The only people who know firsthand what my mother’s condition is are the nursing home employees where she presently resides, and nursing homes have a policy of not allowing their employees to sign affidavits.

As an added obstacle, each affidavit would have to state why it is that I have not become my mother’s court appointed fiduciary. When I read this letter, I thought to myself:  “How is anyone supposed to know why I have not become my mother’s court appointed fiduciary, when I don’t know the answer to that myself?”  I suppose the answer would be that I thought my power of attorney would be enough.  But how would a prospective affiant know that unless I told him?  And my telling him would not provide the independent information that the affidavit is supposed to represent.

The result is that I am now in the process of becoming my mother’s legal guardian.  This will allow me to become her representative payee, which will give me the power to handle her Social Security checks and any other federal benefits or pensions.  At least, that is what my lawyer tells me.  Maybe this time she is right.