Dear Lost in Caregiving:

Your plea really helps underscore the many difficult realities a caretaker can run up against: modern medicine that can both work wonders and create confusion and inconsistency in a patient and the complicated dynamics that can kick in when family members feel guilty, greedy or just plain misunderstand the needs of an aging patient. And you also are being forced to contend with translating the gibberish of the medical and legal worlds—both of which are well known for speaking in tongues.

I’m hoping I can help a little, at least with the translating part. That should take away some of the guesswork in your situation and assure you that you need not make a blind judgment call in deciding when your duties as patient advocate and power of attorney agent begin. Both documents that appointed you to act should contain some pretty good guidance—and best of all, allow you to get help from an unexpected source: the doctors attending your grandmother.

Most patient advocate forms specify that the advocate’s decision-making duties begin when “the attending physician and another physician” certify that it is necessary. And powers of attorney that take effect when a patient is considered disabled or incapacitated go into force “when a physician certifies in writing that the principal is incapable” of making his or her own medical decisions.

Given your description, it is likely that the attending physician and another specialist would be ready to make these written certifications. Their decisions should be based on whether your grandmother understands the subject areas covered by the documents, whether she understands their implications—and most importantly, whether they believe she can make and communicate reasoned choices.

If they believe it’s time to certify that the documents should take effect, ask them to do it in writing and in plain English. These simple signed statements may also be helpful to you in combating the doubts and suspicions of your grandmother’s other family members who are now questioning your role.

If you have difficulty in getting the doctors to cooperate, contact the patient representative or administrator at their offices or facilities. Some offices even affiliate with social workers or other professionals who may be able to facilitate a family meeting explaining the situation to all involved.

And finally, I see from your blog that you are well aware of a number of resources. But there are a couple of places to which you might turn for specific help with your current caretaking challenges.

• The local office of the Area on Aging[n4a.org] should be able to provide advice and direction to nearly resources.
• And the Patient Advocate Foundation[patientadvocate.org] publishes a number of resources to consult for financial and insurance help.

Dear Lost in Caregiving:

Your plea really helps underscore the many difficult realities a caretaker can run up against: modern medicine that can both work wonders and create confusion and inconsistency in a patient and the complicated dynamics that can kick in when family members feel guilty, greedy or just plain misunderstand the needs of an aging patient. And you also are being forced to contend with translating the gibberish of the medical and legal worlds—both of which are well known for speaking in tongues.

I’m hoping I can help a little, at least with the translating part. That should take away some of the guesswork in your situation and assure you that you need not make a blind judgment call in deciding when your duties as patient advocate and power of attorney agent begin. Both documents that appointed you to act should contain some pretty good guidance—and best of all, allow you to get help from an unexpected source: the doctors attending your grandmother.

Most patient advocate forms specify that the advocate’s decision-making duties begin when “the attending physician and another physician” certify that it is necessary. And powers of attorney that take effect when a patient is considered disabled or incapacitated go into force “when a physician certifies in writing that the principal is incapable” of making his or her own medical decisions.

Given your description, it is likely that the attending physician and another specialist would be ready to make these written certifications. Their decisions should be based on whether your grandmother understands the subject areas covered by the documents, whether she understands their implications—and most importantly, whether they believe she can make and communicate reasoned choices.

If they believe it’s time to certify that the documents should take effect, ask them to do it in writing and in plain English. These simple signed statements may also be helpful to you in combating the doubts and suspicions of your grandmother’s other family members who are now questioning your role.

If you have difficulty in getting the doctors to cooperate, contact the patient representative or administrator at their offices or facilities. Some offices even affiliate with social workers or other professionals who may be able to facilitate a family meeting explaining the situation to all involved.

And finally, I see from your blog that you are well aware of a number of resources. But there are a couple of places to which you might turn for specific help with your current caretaking challenges.

• The local office of the Area on Aging[n4a.org] should be able to provide advice and direction to nearly resources.
• And the Patient Advocate Foundation[patientadvocate.org] publishes a number of resources to consult for financial and insurance help.

Hi, I happen to be "best friend" to a dear talented person. We have been together (me, the caregiver and friend) for over 8 years. Family are in other states. When asked about friend's belongings, no one wants any. However, I have been warned that if friend passes away before me, there will be conflicts. I have been given power-of-attorney years ago, as has my friend, for me - in another state. Any thoughts about what could be done or needs to be done?

Hi, I happen to be "best friend" to a dear talented person. We have been together (me, the caregiver and friend) for over 8 years. Family are in other states. When asked about friend's belongings, no one wants any. However, I have been warned that if friend passes away before me, there will be conflicts. I have been given power-of-attorney years ago, as has my friend, for me - in another state. Any thoughts about what could be done or needs to be done?

A power of attorney is a good start, but it has limits. And the warnings you have heard are well-founded. Whether motivated by grief or greed or anger or guilt, there’s nothing like a death in the family to bring out the strangest of festering emotions in family members.

You intimated that the conflicts might arise over your friend’s property or money—even though the family members are now claiming not to be interested in this. You and your friend can buy some peace of mind by finalizing documents—either a trust or will or both—that specify who should get what property in case of a death. A power of attorney doesn’t cover that scenario.

A power of attorney is a good start, but it has limits. And the warnings you have heard are well-founded. Whether motivated by grief or greed or anger or guilt, there’s nothing like a death in the family to bring out the strangest of festering emotions in family members.

You intimated that the conflicts might arise over your friend’s property or money—even though the family members are now claiming not to be interested in this. You and your friend can buy some peace of mind by finalizing documents—either a trust or will or both—that specify who should get what property in case of a death. A power of attorney doesn’t cover that scenario.

Thank you. We are both seniors - we need some guidance and surely appreciate that you have this place to go to. You are appreciated!

Thank you. We are both seniors - we need some guidance and surely appreciate that you have this place to go to. You are appreciated!

I have joint ownership with survival rights and not regular co-ownership with my Mom. We bught the home in 1997 after her husband died and she put as very small downpayment $7500 on it and paid half the mortgage for one year and then never again. I also paid all the utilities so that in re best years she could afford to hae the lifestyhle she was accustomed to...bowling, golf, bingo, Reno, and fishing trips. She had a whale of a time. When I retired in 2007 I asked only for half the utilities and groceries due to her smaller pensions.

Now I am wondering if I have to have her placed somewhere due to dementia if I have to sell the house to support her there. It doesn't seem with joint ownership with survivor"s rights that I should have to nor in view of the money I have put out that her other daughters, who hae been completely uninvolved in her life should make claims afterwards.

They are not in the will regarding the property because the house is not part of the estate. I have kept very careful records of what this has all amounted to including ing her share.

I guess I have 2 concerns: Do I have to give it up if she goes to a care home and 2...I know that joint ownershhip becomes sole ownership after her death and all I have to do is go to lands claim but I am nervous about how her daughters may come calling for something !!!!

Workerpriest

I have joint ownership with survival rights and not regular co-ownership with my Mom. We bught the home in 1997 after her husband died and she put as very small downpayment $7500 on it and paid half the mortgage for one year and then never again. I also paid all the utilities so that in re best years she could afford to hae the lifestyhle she was accustomed to...bowling, golf, bingo, Reno, and fishing trips. She had a whale of a time. When I retired in 2007 I asked only for half the utilities and groceries due to her smaller pensions.

Now I am wondering if I have to have her placed somewhere due to dementia if I have to sell the house to support her there. It doesn't seem with joint ownership with survivor"s rights that I should have to nor in view of the money I have put out that her other daughters, who hae been completely uninvolved in her life should make claims afterwards.

They are not in the will regarding the property because the house is not part of the estate. I have kept very careful records of what this has all amounted to including ing her share.

I guess I have 2 concerns: Do I have to give it up if she goes to a care home and 2...I know that joint ownershhip becomes sole ownership after her death and all I have to do is go to lands claim but I am nervous about how her daughters may come calling for something !!!!

Workerpriest

My father has ESRD, is on dialysis 3x a week had chf and is eating less, less responsive and sleeping most the time. he does not want dialysis, but his curent wife who is power of attorney and is having medical problems herslef is forcing him to go to =dialysis and thinks he will get well again. He is at total max assist and can not walk. He was just rushed to emergency on monday with severe UTI that make him unresponsive. I am durable power of attorney if my step mother can not perform duties or chooses not to perform duties. However, she is delegating her authority to her duaghter who is a great person but is not a power of attorney or in AHCD or will. He is being robbed of his dignity and would not want to live this way. I can not bring up end of life issues with his wife or she cuts me off from getting information from rehab or hosipital since i live in san diego and he is in delaware. I am now in Delaware indefinately to make sure my dad has proper care. One other issue is they put my dad's name on the title of my step sister's home so she could refinance because she needed his income and my step mom;s\'s income to qualify for a refinance after she got divorcced. So money is an issue. I feel they will keep him on dialysis until the day he dies so they can collect the 3K a month from his pension. what can i do? My stepmother clearly is not physically able to take care of him, but is mentally competent to make decisions. they just are not what my father would have wanted. Help

My father has ESRD, is on dialysis 3x a week had chf and is eating less, less responsive and sleeping most the time. he does not want dialysis, but his curent wife who is power of attorney and is having medical problems herslef is forcing him to go to =dialysis and thinks he will get well again. He is at total max assist and can not walk. He was just rushed to emergency on monday with severe UTI that make him unresponsive. I am durable power of attorney if my step mother can not perform duties or chooses not to perform duties. However, she is delegating her authority to her duaghter who is a great person but is not a power of attorney or in AHCD or will. He is being robbed of his dignity and would not want to live this way. I can not bring up end of life issues with his wife or she cuts me off from getting information from rehab or hosipital since i live in san diego and he is in delaware. I am now in Delaware indefinately to make sure my dad has proper care. One other issue is they put my dad's name on the title of my step sister's home so she could refinance because she needed his income and my step mom;s\'s income to qualify for a refinance after she got divorcced. So money is an issue. I feel they will keep him on dialysis until the day he dies so they can collect the 3K a month from his pension. what can i do? My stepmother clearly is not physically able to take care of him, but is mentally competent to make decisions. they just are not what my father would have wanted. Help

I just wanted to say that my sister was given (most likely she forced my Father's hand by threats of putting him in a nursing home) a power of attorney and she stole everything my parents owned. My Mother passed away in 2003. My Sister had my Father place her name on all of his property in 2006 (2 houses, 2 pieces of land, 2 vehicles, 2 bank accounts, 2 coin collections, 2 safety deposit boxes, 2 of everything he owned - according to his and my Mother's wishes - one (1) for each of their 2 daughters). My sister as "Co-owner" of my parents' property became "Sole Owner" of everything upon the death of my Father this past January 5, 2010. My Father has not been "mentally" capable since before my Mother passed away in 2003 according to his personal physician (from 1979 to 2008). I lost my entire inheritance, I got NOTHING and I there is NOTHING I can do about it. My Father's Will has never surfaced or been Probated and with my sister as co-owner and according to "law" it does not need to be. The next step is to "prove" "real" property that he owned. Nobody can do that.

I just wanted to share this with all of you who have Powers of Attorney and are caretakers.

GREED & MONEY make your "loved" ones and the most unlikely suspects turn into ABSOLUTE monsters!

I just wanted to say that my sister was given (most likely she forced my Father's hand by threats of putting him in a nursing home) a power of attorney and she stole everything my parents owned. My Mother passed away in 2003. My Sister had my Father place her name on all of his property in 2006 (2 houses, 2 pieces of land, 2 vehicles, 2 bank accounts, 2 coin collections, 2 safety deposit boxes, 2 of everything he owned - according to his and my Mother's wishes - one (1) for each of their 2 daughters). My sister as "Co-owner" of my parents' property became "Sole Owner" of everything upon the death of my Father this past January 5, 2010. My Father has not been "mentally" capable since before my Mother passed away in 2003 according to his personal physician (from 1979 to 2008). I lost my entire inheritance, I got NOTHING and I there is NOTHING I can do about it. My Father's Will has never surfaced or been Probated and with my sister as co-owner and according to "law" it does not need to be. The next step is to "prove" "real" property that he owned. Nobody can do that.

I just wanted to share this with all of you who have Powers of Attorney and are caretakers.

GREED & MONEY make your "loved" ones and the most unlikely suspects turn into ABSOLUTE monsters!