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Have any of you had to do guardianship for a relative with dementia? I would be interested to hear anything you think we would need to know if this might become necessary for Spouse’s mom. Thanks, friends. Chris.
Chris, I have no advice but want to wish you the best in dealing with this.
Michael, thank you. Chris
I’m sorry you’re going thru this with your mother-in-law- it’s an extremely difficult decision to make, and each situation is very different. I went thru a similar thought process a few years ago for a relative that was in a facility, but I was POA (and getting multiple calls a day from the facility and relative), as well as day to day care giver from an out of state standpoint (the relative refused to move closer to family). As the relative started getting somewhat abusive verbally, I had started researching agencies (state certified guardians) that provided guardian services that were recommended by our family’s Elder Law attorney, as well as the facility case manager. In my situation the guardian would have been a buffer for me to some extent from the relatives calls, though it was somewhat murky how that may have played out. We never ended up engaging a guardian, as the relative passed before engaging the guardian. Good luck with your decision.
Bill, thanks, I didn’t know about state certified guardians. I am not sure Spouse and siblings would go for that, but it might help others who are reading this. I am sorry you have had to go through a rough time too. Alzheimer’s is a terrible disease. Chris.
Ah, I think I misunderstood your post- thought that ‘s what you were looking for. If you’re looking to appoint a family member or friend as guardian, I would think a durable POA as someone else mentioned may work, in lieu of a guardian appointment. The main issue may be that if the POA was not in place before the Alzheimer’s diagnosis, you may have to seek guardianship. An Elder Care lawyer should be able to guide you on this.
The decision to seek guardianship or conservatorship is filled with complexity requiring emotional capital, patience, experts in law, medicine and ethical issues.
In my experience, when patients’ families inquired about Conservatorship, I always encouraged them to seek alternatives first. The process, which involves legally stripping an elderly person of their rights and control, may not ultimately guarantee the desired quality of life or preserve the patient’s dignity. This dilemma became personal when my siblings and I faced the situation with our own mother. Though wheelchair-bound and showing signs of dementia, she resolutely refused our care plan, insisting she would live out her life alone in her own home, accepting the associated risks. Geriatricians are understandably hesitant to certify legal incapacity, particularly when a patient can clearly articulate their wishes regarding their lifestyle and residence, no matter how unwise those choices may seem. The doctor’s certification of a patient’s incapacity to make decisions is, in fact, just one significant barrier among many others when applying for a conservatorship
Considering “alternative solution” begins with defining the problem to be solved. There will be layers upon layers of questions from the doctors, Adult Protective Services, County Social Agencies, and the Court about the wishes of the mother. Her dignity and the right to say no would trump all safety and economic considerations.
Quan, I appreciate your reply. We have been very careful to consider her dignity and let her be independent as long as possible. We have found that her “no” trumps DPOA, you are right about that. We have tried everything we can to help her without getting the courts involved. We would rather not do that if at all possible, but I am not sure we can avoid it. Chris
Chris, I wish to be more helpful despite not knowing the situation, but the following steps are usually well-recommended:
1) Call 911 at first sign of imminent danger – unattended stove, trip/fall, wandering, paranoid behavior at sundown. Official independent records and outside professional help needed here.
2) Adult Protective Services (APS) would establish the family’s concern for severe self-neglect behavior.
3) Check for evidence of physical / emotional / financial abuse by anyone whom the mother had contact with and provide that to APS.
4) Seek geriatric psychiatric evaluation to establish capacity to make decision (ask her primary care doctor for referral).
5) Elderly Care lawyer would need all above to proceed with conservatorship application.
The conflict between ensuring our mother’s safety and respecting her dignity is profoundly difficult yet following these necessary steps ensures you fulfill your duty with compassion and diligence, leaving no room for regret.
Thank you for these additional thoughts, Quan, they were helpful and we will explore. We are trying to be compassionate as well as diligent, but it is difficult, as you know. Chris
Chris, I am sorry you are facing this issue. For anyone that has personal experience with this disease you quickly realize that you don’t know what you don’t know. I expect there is great worry by Humble Dollar contributors about offering advice that could cause more damage than doing good.
I would also follow the earlier suggested advice to consult an elder law attorney for the best way to proceed and further recommend an attorney familiar with local and state law where your souse’s mother is a resident. Jonathan left us words of wisdom on this topic which may help.
I would also point to to a 2018 White Coat Investor post written by Dr. Margaret Curtis who is a general pediatrician living in Vermont and her cautionary tale when father was diagnosed with Alzheimer.
Bill, thank you. Your comments in the HD posts are always important to me. I will check the links you provided. And I appreciate you taking the time to find them for me. And we have consulted an elder care attorney in her state, no worries there. Chris
I was a guardian for my father due to Alzheimers. He had a diagnosis early, so I did have some time to prepare (almost four years). I did not use that time wisely.
– Do a very detailed review of the finances. I knew my Dad’s various accounts and locations, but when the time came, I didn’t know from what account the mortgage payment was being made. Where was social security being deposited? What allotments are in place for his pension? Also expect that you will find odd things that they may find embarrassing. Be careful not to judge.
– Something very helpful is to have an account at the same bank or financial institution as your relative. You know how things work and it is easier for the banks to authorize you.
– Get a Power of Attorney (POA). This is critical. My Dad did not have one, so I had to get an appointment by the court. This came with very strict limitations. I had to do annual accounting. I could not commingle funds and had to have a separate guardian checking account. Everything had to be by check, not credit card. I could not be a payable on death beneficiary for any accounts (in my state). I had to get permission from the court to sell any property over $500. Additionally, businesses are familiar with POAs. They likely are not familiar with the court documents making you a guardian.
– Along the same lines of a POA, some financial institutions do not recognize POAs and require you to use their form, or submit the POA with their form for advance approval signed by the account owner. Check with the institutions you will be working with.
– Have a plan for the future when you are in complete control of the finances. Does it make sense to move accounts to a more user friendly institution? Do they have estate accounts that you can set up if necessary after death? Can you consolidate for simplicity?
– For property, once you are in control and if the person is in assisted living and never coming home, start the process of selling off the car and preparing the home for sale. I was lucky in that there was no spouse and I had no siblings. I should have sold the home, but for reasons waited until after he died. Understand that home insurance intends for the place to be occupied, and if not may not cover vandalism or other issues. Also, change the locks on the house – you never know who has a key.
– Get to know your relative’s neighbors. Give them your contact info and tell them why they are concerned. Helpful neighbors were critical to knowing what was going on at the house. They can also let you know about behavior you aren’t seeing.
– Social Security will be a pain. Technically you need to apply to the SSA to get their permission to manage the Social Security funds of someone you are caring for. They don’t care about the Power of Attorney. You will have to provide accounting of how the money was spent (as if they give so much you will have anything left over from assisted living costs). If the individual is going into an assisted living situation, the facility can also apply to control the Social Security.
– Make sure you have an Advanced Medical Directive on file. This will be critical when such decisions need to be made.
– Research assisted living or home health care options. Do this now as you will have little warning when and if you need them. Research options if paying for this is a problem.
– If you have siblings (i.e. beneficiaries of the relative’s estate), talk to them and get buy in or objections to your plan. Better to have everything out in the open than to get the FedEx envelope from their attorney.
Unfortunately, there will be a some urgency required in these preps. You will never know when the decline becomes such that you can’t get a legitimate signature on a POA. A family doctor or relative could contest it. Life will also get in the way. My process was very sudden with the County Protective Services involved. You rarely will have the relative come to you at a convenient time asking for full time care.
Great list. Thanks for providing. Just one nit. Anyone seeking to do this needs a durable power of attorney (DPOA), not just a POA. A DPOA enables one to assume responsibility for the affairs of someone who is ruled no longer competent, whereas a POA does not. You probably know this but I wanted to clarify for those who read this.
Agree with the Durable POA. More or less opens all doors when needed with service providers of different types.
Two other minor things regarding my court appointed Guardianship:
What an amazing list. Many thanks for collecting your thoughts here.
Hathaway, thank you so much for taking the time to write all of this good advice. It was so helpful and I was nodding along while I read. We have done some of what you mentioned, but you also mentioned some things we hadn’t heard about. Your comment was a real help. Chris
My mom and aunt had to do this with my grandmother. Following a fall and hospitalization, she slipped into full-blown dementia and had to be in residential care. To pay for this, they had to sell her paid-off home, which was her primary financial asset. In order to do this, they had to establish guardianship.
Hopefully you and your spouse have your MIL’s power of attorney both for medical and financial matters? If not, you might have to be appointed her guardians. I’d consult an elder law attorney for the best way to proceed.
Dana, thanks. Luckily the POA is in place, but in her state is useless if she says “no”. This is what we learned from the elder attorney. Chris
Chris, I’m not qualified to offer specific advice on this. What I do know from my mum’s experience with serious dementia is that in the UK, the equivalent of guardianship is an expensive and time-consuming legal process that’s typically used only as a last resort. The better approach is to arrange a durable power of attorney before someone loses capacity to make their own decisions. I’m sorry I can’t be more helpful. Watching a loved one slip away bit by bit is incredibly difficult and heartbreaking. You’re in my thoughts.
Thank you, Mark. The POA is in place but in her state it is worthless if she says “no” to anything. We had no idea. Chris.