As a Certified Guardian, I am often asked to act as a senior’s Power of Attorney for Health Care when s/he doesn’t have a family member who is willing or fit to act for him/her. Simply stated, the Power of Attorney for Health Care grants the designated “agent” control over the senior’s decision-making, including end-of-life decisions if the senior lacks the capacity make the decisions on his/her own. As a Power of Attorney For Health Care, you should be thoroughly familiar with a senior’s personal, financial, and medical history before accepting this serious responsibility. Please read the following real life story that makes my point.
REAL LIFE STORY
Five years ago, I was called at the last minute to act as Power Of Attorney (POA) For Health Care for an 85 year-old woman. It was the day before she was to move to independent living at a retirement community. Independent living used to mean that the senior can basically function on their own with some assistance with meal preparation and housekeeping. Now there are a lot of ala carte services that can be brought to the senior’s independent apartment, allowing him/her to remain there without changing to the assisted living level of care. The woman’s former POA had moved out of state and had written her a formal letter of resignation. A trust company had been appointed to act as her Power of Attorney For Finances.
Upon meeting my new client, I was told that she was beginning to have serious short-term memory issues, was incapable of handling her finances, and needed help with housekeeping, medication reminders, and meal preparation. Arrangements had been made for her to move to an independent living community by the former POA. The community had only one higher level of care to offer which is assisted living without a memory care component. When I asked what sort of criteria had been utilized to select the retirement community for her, I was told that the community was the cheapest. The Admissions Director had offered her a very significant discount for the first six months in order to attract her to the community. When I saw the memory issues she was experiencing, I had serious misgivings about the community that had been selected for her especially since there was no memory care available. However, it was very evident that she needed to move and she was already starting to resist. The moving company was coming the first thing in the morning to move her. I decided to step in and stop the move would not be in her best interest at this point. I decided to let her take a trial stay at the community to see how she adjusted.
Subsequent to the move, I have been informed that she had some adjustment issues, but was able to attend the meals and some of the activities. Yet, she has continued to call her attorney and the front desk of the community on a frequent basis (sometimes up to 8 times a day). She continued to take walks outdoors near a pond, which was a great concern for me considering her memory issues. I brought my concerns up to her doctor. Her assured me during the appointment that wandering wasn’t an issue and prescribed some Aricept to assist her deteriorating memory.
I was not hired to assist with the initial placement and was not made aware of my client’s financial realities until after a conversation with a trust company representative. I was told that once the discount was no longer effective at the retirement home, my client had only about three years worth of money to pay for her care at the current independent level. If she moved to the assisted living level, the cost would be much higher and she would exhaust her funds much more quickly. This community accepted private pay only.
Since the initial move, I had been informed that she has not been keeping herself clothes or clothes clean. She needed three medication reminders a day. There had been necessary escort services ordered to assist her to get to the meals. When she didn’t feel like going to the meals, she ordered tray service, which carried an additional charge. During a Christmas Eve visit, I saw a children’s choir performing in the lobby of the community. My client loved children and so I expected to see her attending the activity. She wasn’t there. Upon entering her apartment, I found there was an odor permeating the area. As I suspected from the sheets and bed clothes drying on the various pieces of furniture, there were issues with incontinence. The apartment was a mess, as was my client.
If I had handled this situation from the beginning, I would never have selected this community for her. Nor should the staff at the community allowed her to enter after the assessment. It was an inappropriate facility for her, and the charges were beginning to resemble those similar to assisted living. I never like to move a person with memory issues when they have become familiar with his/her surroundings. However, I knew of better communities that would meet her current and future needs, and would allow her to stay once her finances were exhausted.
I decided after the last incident that the trial stay was over and that she needed to be taken to the nearest behavioral unit to have an evaluation. After a three week stay and medication adjustments, I moved her to an assisted living community with a memory care component care component. After her funds were funds were exhausted and her physical condition deteriorated, she was able to move to the skilled nursing area with her expenses covered by Medicaid.