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I've had POA for my mother for 7 years. I handle all of her affairs. She is in the early stages of dementia with short term memory loss only and last Fall I had to put her in a locked down Asst Living facility because she was literally running away from home. She is in excellent health and only requires medication management. I manage her healthcare and she still sees her own Drs. The facility recently asked her to sign a form authorizing them to provide care for her. I was very upset and thought they should've sent the form to me for review and signature. Is it reasonable for an AL facility to ask a dementia patient who has a legal advocate to sign anything? My mother said that she was forced to sign the form. I'm thinking of seeing an Elder Care Atty. Not the first thing they've done that ticked me off. Thanks in advance for feedback.

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I work for a SNF and you are right that the form should have been sent to you as a
person with even the mild dementia cannot sign their own paperwork nor can they be held responible. Do they have a copy of the POA and does the POA cover medical. Talk with the Director of Nursing for the facility and if you are still not happy call the local ombudsman. As the POA you can revoke and papers she has signed. Good luck to you.
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Thank you for your response. I was appalled when the CFO told me that a lot of their residents sign their own paperwork. Most of the people in the section of the facility where my mother is located can't even utter a comprehensive word. She is probably in the best shape of anyone else and after she signed the form she panicked and called me. I think she was having an anxiety attack. I offered to go o the facility but she said she was OK. I was on the phone with her for over an hour calming her down. I gave the facility a copy of my POA when I put my mother in the facility. There was no excuse for what the CFO did. I plan on speaking with an elder care attorney about what my rights are where the facility is concerned and maybe having them writer them a letter. They also quit giving my mother one of her prescriptions because they said it was giving her diarrhea without my or her Doctor's permission. Th Rx was to keep her ammonia levels down because high ammonia levels cause dementia. She was on it months before she went into the facility and did not have diarrhea. There was probably another cause for it but they didn't even bother telling me. My mother mentioned it in the Doctor's office and I was quite upset about that too. That happened the first month or so she was there. I think they overstep their boundaries and want to make sure it doesn't happen again. I would like to move her but I can't afford to do that right now. Thanks again.
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Merrylou, We have a Pharmacuial (not sure if I spelled that one right) anyway, a tech comes to our facility and looks at all the charts and then he will recommend sometimes changing the meds and sometimes deleting it all together. So I would question this also as you stated.Ammonia levels also can be an effect of liver problems so I really think you are on the right track. I would contact the local state
ombusman for the area, believe it or not they really do come out and check out concerns and we really listen to them as they will report to the state if need to, reports to the state can cost the facility big money, so they really listen.
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Thank you diavalon12. My mother sees her on doctors outside of the facility. She has a heart dr, a primary care dr and a neurologist who found the high ammonia levels. She has no liver issues and I was told by the Drs that this can sometimes be hereditary and occur for no obvious reasons. She has liver panels done twice a year.
I honestly don't want Asst Living managing her care. She isn't sick anyway. I can't prove this happened although I did talk to the person who administers the meds and he said he did quit giving the lactulose to my mother. I was shocked that this happened and it made my radar very sensitive to the liberties the facility seems to take without permission. I visit my mother 3 times a week and keep an eye on things. Thank goodness she is together enough to tell me what goes on. I wonder about the other residents that can't communicate. I will check on the ombudsman. I have a co-worker whose mother is there also. She is concerned that her mother may have signed the same thing my mother signed without her or her brother's knowledge and is going to follow up on it. I definitely intend to make inquiries and I really appreciate the feedback. My daughter thinks I'm a control freak and over react but I want the best care for my mother and take responsibility for her very seriously. However, her comments make me wonder if I'm off base. The feedback really helps. I don't want to run the place just make sure they're on the up and up! Thanks again.
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Merrylou - what are the ratings like for this place? Not the ones on YELP or other on-line ones in which you can seed it with happy reviews but from CMS (Centers for Medicaid and Medicare) and then the state governmental reviews. Are there significant citations and for what?

The having her sign off on stuff, well, that can be somewhat plausible as it is AL so in theory they should be still competent and cognitive. But if you made it know that you are her DPOA and expect for all documents to be signed off by you......and they consistently ignore this, this is red flag. But the taking it upon themselves to change or stop medications, is a giant red flag to me. I'm going to take a guess that the facility really is not happy with any outside providers. They want it all within their system which probably has intertwined ownership (and profitability) going on. I'd venture a guess that this AL is all about a captive referral system. Your mom with her outside docs are just messing that up. There is actually whole case law on this - Stark Regulations or Stark Law. The bad thing about Stark is that it takes a time to build a case and it applies only if there is Medicare or Medicaid payments. Stark is pretty serious investigation process as it's federal charges.

What about looking for another facility for her, perhaps one in which her other do's recommend. Or have her seen by a gerontology group and their recommendation.
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Thanks you igloo572. This is AL but the residents are locked in and do not have free range of the entire facility because they all have some kind of mental incapacity. Her mental state was made known to them when I put her there & I signed her in. She did not go willingly. I agree that they want full control but she has other insurance in addition to Medicare and there is no reason why she can't see her other Drs. for care. She isn't sick and I don't trust them with her medical care. I am sure that they would prefer to have that so they could bill Medicare for anything and everything they want. I also pay her bill and supplement her care so they do not have any financial assignment for her. The agreement up front was that I would take care of her medical. I find that most families don't want to be involved in Medical care. It's a lot of work. But I am not that trusting and get a bad gut feeling about that part of their care. I did search for user reviews on the internet and didn't find much but I will look further. I thought about taking her to a gerontologist but didn't hear good things about them from other caregivers. Her Drs seem to be in touch with her needs and she did see a neurologist for a full comprehensive and physical workup and he prescribed the medication she takes to slow down her short term memory loss. I would love to move her but that would entail an expense that I don't want to take on right now. I filed for VA benefits for her and am hoping that will work out and I can then mover her. She is not unhappy there because she is in so much better shape than anyone else and that makes her feel better about her situation but I don't care for the place. I contacted the ombudsman for them and he recommended I write them a letter and formally ask them to contact me for anything that requires a signature and I've done that. I never saw this coming since they knew her history or I would've gone this route up front. I do agree with you that they want full control but my mother isn't sick and doesn't have any physical problems and I'd like to keep it that way as long as possible. Thanks again for your post.
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In IN, the AL facility does have the right!. You said beginning stages of Dementia and depending on what type of POA you have, it varies. I would call an attorney. I got my information from an attorney. I was told that most POA, take them for granted and really the POA gives them no authority over that person. The POA, is more for transferring money, making payments, taking care of everyday financial obligations.
THE ONLY WAY THIS CAN BE CHANGED, IS IF YOU HAVE CUSTODY.....OR IF YOUR MOTHER IS CONSIDERED INCAPACITATED!
That is what I was told by an atty in IN, who is now a Federal Judge. To be on the safe side....I would call an attorney. Good luck, God Bless!
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My Dad's Trustee took him to sign legal papers (changing his Will to a Trust) at age 92 (he was declared incompetent at age 93). The papers were and remain legal.
A lawyer is supposedly required to ask an elderly person several persons in order to access his understanding as to what he is signing. If that person answers those
questions appropriately, he can then sign anything put in front of him LEGALLY.
Believe me, his signature can't be changed.......yet. I plan to contest that particular signing because it turned everything over to the Trustee when Dad was declared incompetent the next year. Dad had a stroke in '09 and between then and sometime else, the doctor wrote he had Multi-infarct Dementia...I'm hoping that diagnosis will hold up in Court when I contest the Trust. I have gotten rid of the Trustee (he resigned) and Dad now has a Professional Trustee and Guardian but the Trust remains as it was until I can go to Court.
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THAT IS CrAzY! My dads atty required letters from his Family Care Dr. And his neurologist before she would even change the POA. There are some atty's out there that are rats, and I am so sorry that happened. It is not suppose to. What the attorney told us is that in order for someone to get custody or guardianship....it must go through the courts. This is in IN. I wish you well, it sounds like you have record of where your father was really taken advantage of. ={
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To kpas6185- I have full POA and that covers more than one area. I have medical POA. I also have a statement my mother signed for the VA assigning me power to manage her benefit because she is incompetent. In addition, I am paying for part of her care and managing her healthcare so I think that should give me some leeway. I've talked to Mom about the form she signed 4 or 5 times and she also read it. She still doesn't know what she signed. The beginning stages of dementia include loss of comprehensive skills. Of course an attorney would tell you you need guardianship because that is very expensive and puts money in his pocket but I've been told by many including an ombusman that I don't really need that with a medical diagnosis of dementia.
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There are MANY TYPES of POA's. Medical would suffice. If you have a standard POA, I never said MEDICAL, it is a different story. I said your typical financial POA.
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This attorney has nothing to gain, he is employed as a Federal Judge. If nobody has custody or guardianship, he will become a ward of the state! So, it is much better for the patient to have this done before .....not after they become incompetent.
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The ombudsman I talked to works for legal aid and he specifically said I did not need guardianship. There is no reason form my mother to need a guardian or become a ward of the state because I have been taking care of her for 7 years with no problems and helping her financially. She is not unhappy with me but she is upset about being forced by the Asst Living facility into signing a form she didn't understand. She asked me 7 years ago to help her and that's when she gave me full POA to take care of all of her affairs. I have been told that it's difficult to prove even an incompetent person incompetent. My mother has cognitive problems but she's not really incompetent. I'm sending the facility a letter as the ombudsman recommended. Hopefully, this will solve the problem. If it doesn't, I will probably end up moving my mother somewhere else with an understanding up front of how things will work.
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