There were so many issues hitting us all at once that I resorted to purchasing a binder to keep track of everything. Admittedly, it took countless hours of typing data for every facet of Mildred’s life in the appropriate sections: phone numbers, names of contact people, addresses, account numbers, I.D. numbers, subscription information, medications, allergies, date of birth, and her mother’s maiden name. There are also copies of faxes, letters, and expenses. Every time we spoke to someone I recorded their name, the date, and notes regarding the conversation. This has proved to be an invaluable reference tool.
You’d be astonished to discover what it takes to just make a change an address if the person you are caring for is incapacitated. A simple change of address form with the post office forwarded cards and letters to Mildred, but we chose to have important mail delivered in our care rather than risk having her do something ‘creative’ with them. Evidence of past and continuing cognitive problems forced this decision. Many businesses will ask if the person is with you and can give verbal permission for you to have unrestricted information or make an address change. Putting the patient on the phone is unethical if she is heavily medicated, confused, or too ill to speak, besides perhaps feeling angry and uncooperative regarding the changes in her situation.
Some companies accept the change in status without conflict after asking a few questions to confirm your identity and relationship. Others not so much; even if your reason is not to have access to records protected by HIPAA regulations, but merely to be able to receive and pay bills. Make arrangements with each doctor, optometrist, dentist, pharmacy, and insurance provider to get a HIPAA Waiver in place ahead of time so that you’ll have authorization for disclosure for information.
When it came to paying bills, we were in for a shock. Her checkbook was a disaster. We had no idea she had been struggling with balancing her finances. It was filled with errors and cryptic notes, much of it illegible. It took two months to accurately reconcile the balance with the bank statement. One thing Aunt Mildred did ahead of need that helped was to add the names of future caregivers on her bank account. It’s a simple enough thing to do and even came in handy long before the situation got this serious.
Let me state clearly that I do not claim to be an expert when it comes to legal documents, although I have learned more than I ever expected (or wanted) to know. Hire a legal professional to help you evaluate your situation. It’s also important to understand that there may be different versions of legal documents in the state where you live. Question the distinction between an ordinary Power of Attorney and a Durable Power of Attorney. Also be aware of the significant differences between medical and financial powers of attorney and why you may need both.
The Durable Power of Attorney that Mildred had in place turned out to be a Durable Power of Attorney for Health Care, which is one type of a health care directive. So are a Living Will and an Advanced Medical Directive, which will outline what decisions a person wants made for them if they are incapacitated and who they trust to make those assessments. Some people also have a DNR (Do Not Resuscitate), which needs to be on file with the hospital, nursing facility, doctors, and even in retirement communities. Unfortunately, Mildred did not go the extra step and prepare a Durable Power of Attorney for Finances, which gives someone the authority to take care of everything from paying bills, to overseeing investments and retirement accounts.
Here’s the problem, however, as we have experienced it. In the months before she was hospitalized, Mildred became confused and believed she had not paid her medical insurance premium. She couldn’t decipher her own checkbook and months later, neither could we. All attempts to phone the company to simply find out the status of her account were met with rigid regulations protecting the client. No matter how much information was provided, from those I.D. and account numbers to her shoe size and favorite color (there were days it truly seemed that bad), they would not disclose if the account was paid up, or delinquent and in jeopardy of having her medical insurance cancelled. We were instructed to fax our copy of the Durable Power of Attorney (for Health Care, as you recall). It was lost. We faxed it again. It got hung up in their legal department for months. Eventually we deduced that in Aunt Mildred’s bewildered mental state, she made multiple double-payments and was in no danger of losing benefits.
While one might assume that the Durable Power of Attorney for Health Care would be appropriate for communicating with a medical insurance provider that may not to be the case, because this is technically a financial issue. They aren’t interested in who has permission to make a decision if Mildred should have a major medical emergency and be placed on life support. They want to know who has permission to handle her monthly insurance premium. As strange as that may seem, that includes having permission to change the address to insure the bill safely arrives at our address. It took six weeks to accomplish that one seemingly simple request.
Since then, another question came up and subsequent phone calls have revealed that the Durable Power of Attorney for Health Care, which had apparently been approved with some limitations at least, had again fallen through the cracks of cyber space and disappeared. Nearly a year has transpired since that first phone call and the Durable Power of Attorney is still floating around their legal department, impeding our access to her basic information whenever a quandary arises (which is disturbingly frequent).
Suddenly being uprooted from one’s kingdom and relocated into an assisted living facility, not by one’s own choice, can be an emotional experience. The main facet is feeling that you have lost all control over your life and destiny. I absolutely sympathize, but there are some options. Take control now by making decisions while you can and lessening the burden as much as possible for your family and caregivers. If there is anything positive in this experience, it’s that my husband and I have taken a critical eye to our own affairs and are proceeding accordingly. I shall forthwith aspire to be remembered as the Empress of Organization.
Illustration from Wikipedia: A card from the Rider-Waite-Smith deck published in the US in 1909
©2013 Roberta McReynolds for SeniorWomen.com
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