Legal Issues when someone has Dementia – The Spouse’s Advance Directives

This week’s blog continues the discussion of Legal Issues when someone has Dementia.  The introductory installment (April 30, 2015) put forth the issue of “Who can speak for someone with dementia?”  The May 14, 2015 installment discussed the situation where the person with dementia has Advance Directives in place.  The May 21, 2015 installment discussed the legal issues in determining whether a dementia sufferer can choose to have new Advance Directives prepared.  The May 30, 2015 installment discussed options in preparing a Health Care Power of Attorney.  The June 4, 2015 installment discussed how to decide whether to prepare a Living Will.  The June 11, 2015 installment discussed some of the basic issues in preparing a General Power of Attorney.  The June 18, 2015 installment discussed the importance of making the General Power of Attorney “durable.”  The June 25, 2015 installment discussed the importance of NOT making the General Power of Attorney “springing.”  The July 2, 2015 installment discussed revoking prior Powers of Attorney.  The July 9, 2015 installment discussed Do Not Resuscitate orders.  The July 16, 2015 installment discussed the Right of Disposition designation.  The July 23, 2015 installment discussed the Will (or Last Will and Testament.)  The July 31, 2015 installment discussed beneficiary designations on life insurance policies, IRAs, annuities, etc.  The August 6, 2015 installment discussed whether to pre-plan a funeral.  The August 14, 2015 installment discussed choosing a final resting place.  The August 28, 2015 installment discussed pre-planning the funeral ceremony.  The September 3, 2015 installment discussed when and how to pay for the pre-planned funeral.  The September 10, 2015 installment discussed medical insurance choices.  The September 17, 2015 installment discussed long term care insurance.  The September 24, 2015 installment discussed how an elder law attorney can help.  The October 1, 2015 installment introduced the concept of guardianship.  The October 8, 2015 installment discussed the application process for guardianship.  The October 22, 2015 installment discussed the family disputes that can arise during a Guardianship proceeding.  The November 12, 2015 installment discussed the Probate Court’s examination of the alleged incompetence of the proposed ward in a guardianship proceeding.  The November 19, 2015 installment discussed the Probate Court’s examination of “less restrictive alternatives” to guardianship.  The December 4, 2015 installment discussed the Probate Court’s examination of who should be the guardian.  The December 10, 2015 installment discussed the difficulties that a family member might face if appointed guardian.  The December 17, 2014 installment discussed the difficulties that a family might face if a professional guardian is appointed for a loved one.  The January 14, 2016 installment discussed the termination of a guardianship.  The January 21, 2016 installment discussed alternatives to guardianship.  Today’s installment will discuss the need to revisit the spouse’s Advance Directives and other planning issues.

Someone who has a disease that causes dementia often is married.  The dementia of the one spouse might leave the other spouse without someone to make decisions in an emergency or in the event of his or her own cognitive decline.

Most married couples, if they have prepared Powers of Attorney, have named each other the Agents in those Power of Attorney documents.  The spouse that now suffers from dementia is no longer the appropriate person to have as the Agent for the “well spouse.”  That “well spouse” should have new Power of Attorney documents prepared, if possible.

The “well spouse” may have successor Agents named in his or her Power of Attorney.  If so, that makes new Powers of Attorney less urgent but no less important.  If something were to happen to the “well spouse” that made it necessary for an Agent to start making decisions, there could be a delay in accepting the successor Agent while awaiting confirmation (from a doctor, perhaps) that the primary Agent (the spouse with dementia) cannot act as Agent.  That delay can’t be good for the second spouse.  So, when someone suffers from dementia, the spouse of that someone should redo his or her Powers of Attorney and name someone other than the “ill spouse” as Agent and the successor Agents.  With the new Powers of Attorney, the spouse who does not have dementia should also prepare a HIPAA release and a living will (if wanted.)

If the “well spouse” has new Advance Directives set up, he or she should also at least consider the other preparations that have been discussed in this series:
– Long Term Care plan,
– Do Not Resuscitate Order (if appropriate,)
– Right of Disposition designation (naming who is in charge of funeral implementation),
– Last Will and Testament,
– Updating beneficiary and “transfer on death” designations on assets and financial accounts,
– Pre-planning a funeral and final resting place,
– Medical Insurance,
– Consider Long Term Care insurance,
– Designate someone whom the “well spouse” would prefer to be guardian, if one should be necessary (sometimes included in a General Power of Attorney document,) and
– Talk with an Elder Law Attorney about what planning for the future.

These new Advance Directives and other preparations aren’t necessary the next day after learning that one’s spouse has dementia, but the sooner the better.  Certainly, a month should be long enough to have the new Advance Directives prepared.

(Ed. Note:  This is the end, for now, of the series on Legal Issues when someone has Dementia.)

Legal Issues when someone has Dementia – Alternatives to Guardianship

This week’s blog continues the discussion of Legal Issues when someone has Dementia.  The introductory installment (April 30, 2015) put forth the issue of “Who can speak for someone with dementia?”  The May 14, 2015 installment discussed the situation where the person with dementia has Advance Directives in place.  The May 21, 2015 installment discussed the legal issues in determining whether a dementia sufferer can choose to have new Advance Directives prepared.  The May 30, 2015 installment discussed options in preparing a Health Care Power of Attorney.  The June 4, 2015 installment discussed how to decide whether to prepare a Living Will.  The June 11, 2015 installment discussed some of the basic issues in preparing a General Power of Attorney.  The June 18, 2015 installment discussed the importance of making the General Power of Attorney “durable.”  The June 25, 2015 installment discussed the importance of NOT making the General Power of Attorney “springing.”  The July 2, 2015 installment discussed revoking prior Powers of Attorney.  The July 9, 2015 installment discussed Do Not Resuscitate orders.  The July 16, 2015 installment discussed the Right of Disposition designation.  The July 23, 2015 installment discussed the Will (or Last Will and Testament.)  The July 31, 2015 installment discussed beneficiary designations on life insurance policies, IRAs, annuities, etc.  The August 6, 2015 installment discussed whether to pre-plan a funeral.  The August 14, 2015 installment discussed choosing a final resting place.  The August 28, 2015 installment discussed pre-planning the funeral ceremony.  The September 3, 2015 installment discussed when and how to pay for the pre-planned funeral.  The September 10, 2015 installment discussed medical insurance choices.  The September 17, 2015 installment discussed long term care insurance.  The September 24, 2015 installment discussed how an elder law attorney can help.  The October 1, 2015 installment introduced the concept of guardianship.  The October 8, 2015 installment discussed the application process for guardianship.  The October 22, 2015 installment discussed the family disputes that can arise during a Guardianship proceeding.  The November 12, 2015 installment discussed the Probate Court’s examination of the alleged incompetence of the proposed ward in a guardianship proceeding.  The November 19, 2015 installment discussed the Probate Court’s examination of “less restrictive alternatives” to guardianship.  The December 4, 2015 installment discussed the Probate Court’s examination of who should be the guardian.  The December 10, 2015 installment discussed the difficulties that a family member might face if appointed guardian.  The December 17, 2014 installment discussed the difficulties that a family might face if a professional guardian is appointed for a loved one.  The January 14, 2016 installment discussed the termination of a guardianship.  Today’s installment will discuss alternatives to guardianship.

When someone has dementia and he or she seems to no longer have the ability to make decisions necessary to prepare powers of attorney and, for whatever reason, a guardianship is not appropriate or not wanted, options for having one person specific person able to make decisions have become limited.

Now, even though the person seems to longer have the ability to prepare powers of attorney, he or she might have some lucid moments in which to make such decisions.  The family can seek the help of an estate planning attorney.  If the attorney is satisfied that the person can decide to sign powers of attorney, the attorney can prepare them.  These new powers of attorney designate who can make decisions when the person’s lucid moments have gone.

In the absence of the person’s own ability to make decisions and the absence of someone appointed to make decisions (ether through a power of attorney or a guardianship,) the caregivers for someone with dementia have to rely on guidance from the next of kin (which can be very tricky if the family disagrees.)

If even input from the next of kin isn’t available, the caregivers are left to their consciences.  They must do what is necessary for the person with dementia and do what they know in their hearts to be the right thing to do.

With the difficulties, inconveniences, and sometimes strife that can come from a guardianship proceeding, some families in which someone suffers from dementia might choose to forego guardianship and, instead, muddle through as best they can.  I can’t fault families that make this choice.

Unfortunately, some people with a disease that causes dementia will not have a designated decision-maker.  In such cases, caregivers are forced to do their best with only their own caring hearts and their experience to guide them.

 

Legal Issues when someone has Dementia – Terminating a Guardianship

This week’s blog continues the discussion of Legal Issues when someone has Dementia.  The introductory installment (April 30, 2015) put forth the issue of “Who can speak for someone with dementia?”  The May 14, 2015 installment discussed the situation where the person with dementia has Advance Directives in place.  The May 21, 2015 installment discussed the legal issues in determining whether a dementia sufferer can choose to have new Advance Directives prepared.  The May 30, 2015 installment discussed options in preparing a Health Care Power of Attorney.  The June 4, 2015 installment discussed how to decide whether to prepare a Living Will.  The June 11, 2015 installment discussed some of the basic issues in preparing a General Power of Attorney.  The June 18, 2015 installment discussed the importance of making the General Power of Attorney “durable.”  The June 25, 2015 installment discussed the importance of NOT making the General Power of Attorney “springing.”  The July 2, 2015 installment discussed revoking prior Powers of Attorney.  The July 9, 2015 installment discussed Do Not Resuscitate orders.  The July 16, 2015 installment discussed the Right of Disposition designation.  The July 23, 2015 installment discussed the Will (or Last Will and Testament.)  The July 31, 2015 installment discussed beneficiary designations on life insurance policies, IRAs, annuities, etc.  The August 6, 2015 installment discussed whether to pre-plan a funeral.  The August 14, 2015 installment discussed choosing a final resting place.  The August 28, 2015 installment discussed pre-planning the funeral ceremony.  The September 3, 2015 installment discussed when and how to pay for the pre-planned funeral.  The September 10, 2015 installment discussed medical insurance choices.  The September 17, 2015 installment discussed long term care insurance.  The September 24, 2015 installment discussed how an elder law attorney can help.  The October 1, 2015 installment introduced the concept of guardianship.  The October 8, 2015 installment discussed the application process for guardianship.  The October 22, 2015 installment discussed the family disputes that can arise during a Guardianship proceeding.  The November 12, 2015 installment discussed the Probate Court’s examination of the alleged incompetence of the proposed ward in a guardianship proceeding.  The November 19, 2015 installment discussed the Probate Court’s examination of “less restrictive alternatives” to guardianship.  The December 4, 2015 installment discussed the Probate Court’s examination of who should be the guardian.  The December 10, 2015 installment discussed the difficulties that a family member might face if appointed guardian.  The December 17, 2014 installment discussed the difficulties that a family might face if a professional guardian is appointed for a loved one.  Today’s installment will discuss the termination of a guardianship.

When the person’s disease has taken away the decision-making ability and the person has not prepared advance directives appointing someone else to make decisions, the next legal alternative is guardianship.  The guardianship can be terminated if the ward has few enough assets that a guardianship of the estate seems no longer necessary or advisable.

When considering the termination of a guardianship, the probate court must find that the termination of a guardianship is in the best interest of the ward before terminating.  I must admit that I feel this “best interest of the ward” seems, to me, an impediment to the termination of almost all guardianships except where the ward has gotten “better” and is no longer incompetent or has passed away.  For a ward that remains incompetent, the termination of a guardianship takes away the person who can make health care decisions for the ward.  That seems, to me, an overriding reason not to allow a guardianship to terminate.

If the ward passes away, the guardianship ends automatically.  The guardian will need to prepare a final accounting of the now-deceased ward’s business affairs, but the ward’s demise ends the need for a guardian.

Also, if the ward no longer needs a guardian, the probate court can end the guardianship once the court is comfortable of the ward’s renewed ability to handle his or her own affairs.

A guardianship can, theoretically, be terminated upon a demonstration that less restrictive alternatives have been put in place since the commencement of the guardianship.  (This one is unusual because the probate court has every reason to wonder why these alternatives were not in place before the guardianship application.)

A guardianship that became necessary because the ward repeatedly tried to elope from a care community can be terminated if the ward’s health deteriorates, taking away the mobility necessary to elope.  (A termination for this reason is unusual because the deterioration of the ward’s health that took away the ward’s mobility also makes the life expectancy short, making a change in the guardianship status seem not worth pursuing.)

A guardianship can also be terminated if the ward’s assets fall to a low level (in Ohio, that amount is $25,000.)  At that level, a ward has very little with which to pay the guardian for services.  This possibility of terminating a guardianship because of poverty disturbs me.  The guardianship of the person is at least as important as the guardianship of the estate, but the ward’s need to have someone look out for his or her health and bodily welfare does not end because of poverty.  I can’t see how terminating a guardianship because of poverty is in the ward’s best interest, but it does happen.

 

2016 Ohio Medicaid financial standards for long term care

Note:  There were no blog posts the last two weeks (Christmas and New Year’s Day.)  Happy 2016!

The Medicaid program helps pay for long term care (nursing home, assisted living, or in-home care) for many seniors.  The Medicaid rules allow the patient and the patient’s spouse to keep certain amounts of their savings and certain amounts from their monthly income.  As of January 2015, Ohio’s Medicaid program allows the following amounts:
Savings patient can keep: $1,500
Savings spouse at home can keep: $23,844 – $119,220
Monthly income patient can keep: $50
Monthly income allowance for spouse: $1,992 – $2,981
Monthly housing allowance for spouse at home: $598
Monthly utility allowance for spouse at home: $510
What Medicaid pays nursing homes each month: $6,327
Limit on equity in home:  $552,000

Note:  Because this information is an update of the Medicaid “financial standards,” it also appears on my website’s Medicaid page.