What do I need to know as a DPOA? The doctor wants to place aunt in nursing home.

One step at a time.

No, if you're aunt is in a NH for 30 days the bank doesn't freeze anything. Her Medicare will pay for it. Continue to pay for her utilities and for the upkeep on her home just as if she were there. I think the $50,000 should cover it.

However, you instinct is right that she may not come home after that 30 days. The "you can go home when you're stronger" speech is what people say to the patient to get them to agree. Sometimes people DO go home but in healthcare this is a universal comment to keep people calm at the thought of maybe never going home again.

If, when that 30 days is coming up, you are approached by the social worker or someone else at the rehab that your aunt may need to stay you'll need to discuss with them your aunt coming home. If you up and decide to take her home against medical advice Medicare won't pay a dime and you don't want to find yourself in that situation.

Also, if it turns out that your aunt has to stay past that 30 days you will have to either private pay each month (and this will amount up to tens upon tens of thousands of dollars) or find a way to get Medicaid for your aunt. But if your aunt has $50,000 she's not going to qualify for Medicaid. Then you get into a whole thing about spending down her assets and such which I'm sure the social worker will walk you through.

But before any of that happens just get through this 30 days. Don't worry about anything past that. Take care of your aunt's house and her bills and the rest of her business. Don't worry about what happens on that 30th day. I mean it. You'll drive yourself crazy. You're not going to wake up all of a sudden and have to accomplish everything in 1 day. It's a process and you're at the very beginning. Your aunt may get stronger and may be able to go home, you don't know. So don't fret right now. Things are fine.

You pay the NH first, that is the law for a DPOA. You draw money out of her savings to pay all the other stuff. You sell her car and use the money to pay for her care. If she ends up staying in the NH, you agree to make them the representative payee for her SS check, they get the whole thing. You secure the house so no one can break in or take things. Whatever you sell, keep records and put the money in her bank account. Take nothing for yourself, a POA or DPOA cannot do that. You won't need Medicaid unless she gets down to her last $2000.

Lots of questions, and probably a lot of anxiety for you. Take a step back, have a cup of tea, or something that relaxes you.

First, meet ASAP with the nursing home staff to discuss their plan for rehab. Was the UTI cured or is your aunt still on antibiotics? Is this issue part of the recovery period? If not, exactly what is the intent? And what was the specific referral for? Be firm on this; the more you stand your ground the more they'll realize you'll be insuring that things happen as they should.

We've had care conferences about half way through an initial 30 day period. Ask when you can expect the first care conference and at that point ask about her progress and their recommendations for discharge. Don't ask about staying - ask about discharge.

Confirm with the nursing home administrator (or someone else in a capacity to make decisions), that Medicare will pay. Don't worry at this time about their seizing her assets. If it comes to that, get an elder law attorney involved ASAP, but first focus on the rehab and discharge plan.

If your aunt isn't getting proper care or you're dissatisfied with the nursing home's plan (or lack thereof), you do have the right to remove your aunt or place her in another home.

When my father broke his hip the first time, I chose a SNF after interviewing two, but unfortunately I interviewed the chosen one on a weekend and wasn't able to observe how poorly they handled patients during the week when I subsequently discovered staffing levels were inadequate. I moved him 3 days later as soon as I could make arrangements for a transfer.

Doctors, social workers and discharge planners try to be helpful, but I've discovered that they will continue to recommend facilities that are unsatisfactory. After my father's first leg/hip fracture, the discharge (nurse) planner suggested a home which had a bad reputation. I confronted her and told her I would never consider it and made it clear I planned to interview each potential home and it would be MY decision. Don't let medical personnel intimidate you into making decisions with which you're uncomfortable.

I would make arrangements to have the lawn mowed but I would probably turn off the water just in case any leaks occur. I don't think I'd shut the utilities off because your aunt may actually come home sooner and you don't want to have to finagle to get them turned back on if you have short notice of her discharge.

If you aren't joint signatory on her checking account, take your DPOA to the bank to get your name added so you can pay her bills. You'll want to keep up her home in her absence, but I wouldn't even consider renting it out.

First, it's a hassle to find a good tenant - you'd have to do a background check - and you don't know for sure that your aunt isn't coming home. If she is, it doesn't make sense to rent the home for just a month.

You'll need to review the DPOA carefully to determine exactly what you can do, but if it was drafted by an elder law attorney, it generally would give you a wide range of powers. If you're uncertain, call the attorney.

Attorneys typically use "pleading paper" with the law firm's name along the left side. And the attorney who drafted the POA would typically also be a witness.

I wouldn't even raise the issue of signing title of the car over to your aunt now; she's probably distressed enough as it is. When she's released, you could raise the issue but don't press it and wait until she's clear headed enough to make a cogent decision.

Without knowing more about her medical condition, I think it's hard to judge what will happen after the 30 days. The DPOA likely would provide that you could sell the home but as I said, read it carefully and consult with the attorney to make sure you have the capacity to do so.

I assume you're the only heir designated in the Will and that your aunt doesn't have a trust. If it does appear that she won't be coming home, you would be best off talking to an elder law attorney to protect your aunt's assets. With $50K, I doubt if she'd qualify for Medicaid and you can't do a spend down because of the look-back period. At that point legal advice is really important.

Every state's rules and regs will be a little different, so the advice you will get here is not 100% correct, but some of the basics are. Medicare is party consistent as it is federal though, and they will cover a limited number of days in rehab (it's not 100 anymore though) as long as progress can be documented. A couple specifics though...if she gives you the car rather than selling for fair market value, you could have a Medicaid penalty period for gifting. In all states, your primary home and car are exempt assets and not counted against you. That 50k probably won't last much more than a year and a few months in skilled nursing, might be longer if assisted living is possible instead. Medicare pays for neither, but if your assets and income are lowered enough, Medicaid will cover the nursing home, and if the assets are down to the limit but the income is a little over, there is something called a Miller trust. Some states have eldercare waiver options that will cover in-home services in lieu of institutionalizations. If you rent out the house, Medicaid would consider that countable income. Not saying you can't do it - if rent, plus income plus a little from savings covers the costs and you ever need Medicaid at all, so much the better! If you sell the house, that money would then be spent down for her care too. That's where a good eldercare attorney or reputable financial planner, who could be paid with Aunt's funds, will be worth their weight in gold, to run the numbers.

From Medicaid's point of view, if Aunt says she plans to return home, that's good enough for them; but you would want to visit more privately with the docs and rehab team and get candid information on her chances of returning to her home with or without support. They tend to assume people in your spot and mine are objective enough about their loved ones to realize if that's not in the picture, but I can tell you even with some medical background, for me that was not the case. I had to see for myself that my mom was losing touch with reality and going into delirium with every minor infection before I realized her dream to go back home and live alone again was just a dream, and I had to have a PT flat out tell me that she would not be achieving min assist car transfers again before I had a vehicle modified for her.

You have a lot of shots to call, and are doing the right thing to get enough information to call them wisely. Lots of misconceptions and pitfalls out there, and it's one steep learning curve. Best wishes to you and your Aunt, and I hope she knows she has a blessing in you as someone who cares and will help her through whatever comes next!

PS the other thing you are thinking about is called "estate recovery" and means that if she does go one Medicaid, they expect repayment from her estate if anything is left... a it is not the nursing home per se that goes after her assets as long as you make sure bills are paid. It is brutal in a sense and it did not used to be this way, but Medicaid can't afford to be in the business of preserving inheritances, unfortunately. I ended up taking good care of my moms house and yard and the money that went into that, both hers and mine, I'm sure helped get a better price when we finally did sell as it no longer made sense to keep paying taxes and upkeep and worry about the insurance company finding out the home was mostly left vacant...I ended up spending the money on her care, and it worked out that we never needed Medicaid for her, and did not have to repay for my Dads care under Medicaid for a few years when my mom was the "community spouse." That meant no inheritance for me and my family other than life insurance policies, but that was fine in our situation. Mom had good care and we would have been able to cover it indefinitely with her income plus Medicaid if we had needed to.