Transitioning To A New Community
For most individuals, placing a loved one in a sheltered community (nursing home or personal care home) is a long and difficult road. For some, it was difficult to determine what care was needed and where to find it. For others, it means promises to keep the loved one at home can no longer be kept. For still others, it means being on the receiving end of the loved one’s anger over the move. For everyone, it means a time of adjustment. The following are some ideas to help during this time of adjustment.
• Try to learn who the caregivers for your loved one are; recognize that they want your loved one to have a successful transition to the new community; be open to ideas they may have on how to help your loved one during this transition.
• Look for ways to compliment the staff caring for your loved one. Establishing a good relationship with the staff will make it easier to deal with any difficulties that may arise in the future.
• Remember that no place is perfect; focus on the common goal you share with the staff for your loved one to receive good care.
• As a family, appoint a representative to be the contact between the facility and the family. By having communication between family and facility go through one person, you are helping the staff to have more time to provide care because they do not have to answer the same questions for multiple family members.
• Learn the process to address any problems or concerns that arise. Getting any concerns or problems to the proper person can expedite their resolution.
• If your loved one wants to know how long he or she will be in this new community, focus on their functional limitations that require the care he or she is receiving. Explain your goal is to make sure he or she receives the care needed for as long as the care is needed, but you do not know how long this will be.
• Recognize that a promise to keep someone at home is really a promise to make sure that loved one has the care he or she needs and that he or she will not be abandoned. If we could see into the future, we would know when a promise is unrealistic, but since we cannot do this, we need to focus on the intent of the promise. Feeling guilt in this situation helps neither you nor your loved one. With conscious effort you can choose not to feel guilty because you have kept the intent of the promise, and therefore you are better able to support your loved one.
• It is difficult to be on the receiving end of anger, but it helps to have an understanding of the whats and whys of anger. At its root, anger is born from frustration. If a person feels that things should be different than the way they actually are, there is a perception of being wronged, and frustration and anger is a likely result. Unfortunately, that anger is sometimes directed at loved ones, even though they have not wronged the person. In these situations it is helpful to follow a Biblical proverb, “A soft answer turns away wrath.” By speaking in a calm, quiet voice you may defuse that person’s anger. You may also find the person will calm down after being allowed to express (vent) his or her anger. Once the person has calmed down, you may then be able to rationally discuss how realistic the person’s expectations are. But what can you do if the person has dementia and cannot respond in a rational manner? Calm, quiet voices are still helpful, but instead of trying to reason with the person, try to redirect the conversation to a different topic. If possible, focus the conversation on something that person has loved to do or talk about in the past. Above all, let your loved one know you care, through both words and actions. Smiles and hugs are hard to ignore.
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REGISTER HERE for LONG-TERM CARE PLANNINGPower of Attorney
A Power of Attorney can be used to give another person the right to sell a car, home, or other property in the place of the maker of the Power of Attorney. A Power of Attorney might be used to allow another person to sign a contract for the maker of the Power of Attorney (the person who makes a power of attorney is called the “principal”). It can be used to give another person the authority to make health care decisions, do financial transactions, or sign legal documents that the principal cannot do for one reason or another. With few exceptions, Powers of Attorney can give others the right to do any legal acts that the makers of the Powers of Attorney could do them themselves. A General Power of Attorney gives the “power of attorney Agent” or simply “Agent” (the legal name of the person who is authorized to act for the principal) very broad powers to do almost every legal act that the principal can do. When Elder Law Attorneys draft general Powers of Attorney, they still list the types of things the Agent can do but these powers are very broad. People often do general Powers of Attorney to plan ahead for the day when they may not be able to take care of things themselves. By doing the General Power of Attorney, they designate someone who can do these things for them.
Normal Powers of Attorney terminate if and when the principal becomes incompetent. Yet many people do Powers of Attorney for the sole purpose of designating someone else to act for them if they cannot act for themselves. It is precisely when persons can no longer do for themselves that a Power of Attorney is most valuable. To remedy this inconsistency, the law created a Durable Power of Attorney that remains effective even if a person becomes incompetent. The only thing that distinguishes a Durable Power of Attorney from a regular Power of Attorney is special wording that states that the power survives the principal’s incapacity. Even a Durable Power of Attorney, however, may be terminated under certain circumstances if court proceedings are filed. Most Powers of Attorney done today are durable.
Yes. At the time the Power of Attorney is signed, the principal must be capable of understanding the document. Although a Power of Attorney is still valid if and when a person becomes incompetent, the principal must understand what he or she is signing at the moment of execution. That means a person can be suffering from dementia or Alzheimer’s Disease or be otherwise incompetent sometimes but as long as they have a lucid moment and are competent at the moment they sign the Power of Attorney, it is valid even if they do not remember signing it at a later date. At the time it is signed, the principal must know what the Power of Attorney does, whom they are giving the Power of Attorney to, and what property may be affected by the Power of Attorney.
Any competent person eighteen years of age and older can serve as an agent. Certain financial institutions can also serve. There is no course of education that agent must complete or any test that Agent must pass. Because a Power of Attorney is such a potentially powerful document, agents should be chosen for reliability and trustworthiness. In the wrong hands, a Power of Attorney can be a license to steal. It can be a big responsibility to serve as an agent.
For Medicaid
Medicare is health insurance and covers medical services such as physician appointments, therapy, blood tests, x rays, medical procedures and hospitalization. Medicare will sometime pay for rehabilitation in a long-term care facility for a period of 20 to 100 days, but not longer. In long-term care, Medicaid covers the cost of ongoing support services for daily functioning, such as room and board in a nursing home.
Medicaid is a federal program that is overseen by the Center for Medicare and Medicaid Services (CMS). In Pennsylvania, Medicaid is called Medical Assistance and is administered by the Department of Human Services (DHS).
In Pennsylvania, Medicaid funds are not available to pay for assisted living or personal care.
For Medicaid to pay for care in a nursing home, an individual recipient must be determined to need a nursing home level of care by a physician and the local Office of Aging. An individual whose income is not greater than three times the poverty level may keep up to $8,000 of total resources, but may otherwise keep only $2,400. The cash value of life insurance counts as a resource, but one car and a residential home does not count as a resource.
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Empowering Clients with Holistic Planning at
Keystone Elder Law
At Keystone Elder Law, we believe that the physical, social, legal, and financial considerations of our clients all intertwine. We utilize an interdisciplinary approach to evaluate each area, which allows for the creation of a plan that addresses the concerns of the individual as a whole as well as the family. To this end, our model of practice includes a Care Coordinator (usually a nurse or social worker), whose expertise complements our team of attorneys.
When the road of life is smooth, decisions about legal and financial matters are easy to push aside for “a rainy day.” Planning ahead, however, will allow for more options as you view the map of where you’ve been and where you want to go. Don’t let a crisis limit your choices or derail your plans.
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