legal documents

smosby17

my mom was recently diagnosed with alz. My sister and I are wondering what legal documents we need to make sure that as things progress we will be able to make decisions for her? Please leave any helpful information you have

Battlebuddy

The two most important documents are the DURABLE Power of Attorney and the Health Care Proxy. I suggest going to an attorney to do it properly. Durable is important because the POA will keep going once a loved one is not able to make decisions for themselves. The Health Care Proxy is very important too so you can make all medical decisions for your loved one. Our appointment with the lawyer took a couple hours and was 500 dollars I think. The POA was 12 pages long. Money well spent.

Emily 123

Hi smosby,

You can't go wrong consulting an eldercare lawyer, who can gather all the threads together, take a look at the financials, and discuss plans for the future. This website has articles as well. https://www.elderlawanswers.com/elder-law-attorneys

Ideally as your mom's needs increase you might want to have most of her money in trust, with a checking account that pays her monthly bills. Social security can be direct deposited into the checking account with the trust 'topping off' the checking account each month so bills are covered. At some point she may run out of money, in which case medicaid comes in to play.

Usually one family member is appointed by the person to be their power of attorney in case they become incapacitated. That person will act in their best financial and medical interests. POA can be split up so that one person is the healthcare POA and another is the fiduciary POA. In that case the healthcare POA would make medical decisions according to what the person wanted, in the event they became incapacitated, and the fiduciary POA would handle the finances (taxes, bills, etc). That can work well if you have one family member living nearby who handles the day to day care and will be the one going to the hospital with the loved one--they can be HCPOA, while another person handles the finances, but on the other hand it can be a hassle to split it up. In either case, it's helpful if mom has completed a living will/advanced directives that lay out what their medical wishes are. Most hospital web portals have this paperwork available, and many states have forms online.

Banks generally have their own paperwork for identifying who is the POA. Doctor's offices like to have a list of family that they can share healthcare information with. Someone should set up mom's online accounts so that they're recoverable, ie, maybe change the contact info for them to a family member's cell # if mom's in danger of locking herself out of her accounts.

Battlebuddy

To further explain, we had done a very simple POA at my local bank when my husband was first diagnosed. The POA is for financial . Then a few years later, we moved to a different state, and it was suggested to us to do a more involved Durable POA with signatures from the state we were in. They give you different issues covered. In the POA you authorize all kinds of things : real estate sales , bank accounts etc. I hope that’s helpful. I’m sure a more knowledgeable person will comment too

towhee

Welcome to the forum.

The DPOA and HCPOA are absolutely the two most important documents. It is also good to have a HIPAA release form done (lets you transfer medical records and lets doctors talk to you). Very occasionally a doctor or facility wants this instead of or in addition to a Health Care POA. Make multiple copies. Check with your LOs banks, annuities, other financial institutions. Sometimes they want their own POAs filled out instead of a general one and can be persnickety about using one if it is not theirs.

Be very careful and never comingle funds. When the POA adds their name to an account, they must always use the POA title. Check with the lawyer about how to do that. And keep good records.

I know it is difficult to think about these things, but this is also a time to take stock of finances and think about the cost of care. If medicaid might be in the future, you need to learn about it and what you can and cannot do with your LOs money and property so that she would be/remain eligible.

M1

Hi smosby, one other (less important but still important) point made above is that a lot of financial institutions will have their own poa paperwork that they'll want you to fill out. And at the bank, you may not need a poa at all if you are a signatory on her checking account. I was already a signatory on my partners account and this made accessing her day to day funds easy, and i did not have to go through the paperwork of becoming a representative payee for her social security, since it was direct deposited to her checking account. But to access her investment funds at charles Schwab, they had their own sets of paperwork for poa and signatures that we both had to sign. Very important to do these things early while she still can.

harshedbuzz

The documents you need are a DPOA and Health Care Proxy. You can get these done by a Certified Elder Law Attorney.

National Elder Law Foundation (nelf.org)

You'll want to do a deep dive into mom's financials so you know about her assets, debts and if she has LTC insurance ideally ahead of the appointment so you can discuss Medicaid planning if that applies to your situation. I found all of my parents' financial institutions honored their POAs after vetting by their legal department but their POAs were written with an eye towards me stepping in to manage the logistics of house sales, moving and managing investments. I've heard of others having issues with banks and investment firms especially when downloadable boilerplates were used. Mom could add one of you to certain accounts as well.

You didn't ask, but I am going to throw this out there anyway-- IMO, it is generally best to avoid naming co-POAs when there is more than one sib. It's a rare sibling group who are 100% in lockstep about medical care, spending down money vs preserving assets, bringing in in-home aids and when or if it's time for placement in a facility. Unless both sign off, nothing can happen and that means the person with more teeth in the game is screwed over. Another thing some families do that ultimately sets families apart is assigning one person (often the son) to manage finances and one (usually a daughter) to take the PWD into their home and act as caregiver. What can happen is bro is looking to delay spending money for care because he's not doing the yeoman's share of the work-- maybe he wants an inheritance or maybe he just wants to honor mom's wish to stay at home despite her never making a plan to make that possible-- while the sister is struggling without help. I personally would not accept the responsibility as a caregiver without the right to make all decisions.

It's best to do this now. Otherwise, you may find your option becomes guardianship/conservatorship which is more time consuming and expensive.

It's also important to make sure you have HIPAA forms signed with any doctors she sees. Signing her up for the patient portal where possible is very helpful for managing care as well.

If she's been diagnosed with dementia and is still driving, you will want to contact her insurance agent/company to make sure her insurance will still cover her with the diagnosis. Dad's insurance specifically denied coverage for those with dementia.

HB

​NorthWoods

The main alz.org site has an excellent “navigator “ which was invaluable to me in terms of figuring what needed to be done from there I was able to figure out what resources I needed.

https://www.alz.org/help-support/resources/alznavigator/welcome

jfkoc

This too;

Legal Documents | Alzheimer's Association

The more you learn online the easier doing the documents will be.

T57

Emily 123

Very helpful advice for many of us. Thank you for sharing your wealth of information!

ButterflyWings

Echoing all the excellent advice above.

Also, just a caution on timing: when everyone says to do this urgently, please do. The Dr's emphasized for DH that he'd want to make his own decisions binding while still able to do so and because no one can predict the pace of progression. As hard, sad, and scary as that time was immediately post-diagnosis when we both were suddenly grief-stricken with this death sentence, their advice resonated with DH so he followed through almost immediately on "getting his affairs in order". Some do not, due to suspicion, paranoia, anosognosia etc... many aspects of dementias in the early-mid stages especially. So hard.

What they did not say is, "and do this NOW; document POAs carefully in multiple places; and HIDE the originals because you may have family or others who will claim they don't exist, and/or will challenge your POA decisions in the future, claiming you did not have capacity to determine your own choices so they need to be overturned". Yes, it probably happens more than we realize, once the PWD advances enough to not be able to defend their prior actions.

So, the date that your durable POA documents are executed and notarized, can become very important in comparison to any medical records verifying capacity (based on MMSE scores, etc). if a random judge is given authority to decide your LO's fate, say in a predatory guardianship challenge. Ask me how I know.