any guardians using a case manager?

[Spock]

My brother and I are on the verge of having to take our 85yo father to court to get him declared incompetent.
Lllllooooong story, but the highlight (so far) is last month he tried to give away his house to his home health aid (who just happens to be registered with Adult Protective Services (APS) as having exploited a different victim 5 years ago. And no, APS will not remove the HHA because there hasn't been any assets actually transferred... yet!).

Since this is going to completely shred an already strained relationship with dad, it was suggested that after being appointed guardian, that we hire a case manager to "deal directly with dad", at least until his disease progresses to the point he quits fighting.



Has anybody out there who is guardian for a parent used a case manager?
Pros?

Cons (other than cost, which is guesstimated at $100-150/hr)?
Do case managers actually buffer all contact between the ward and the guardian?

And not to be rude, but I REALLY don't need a guilt trip from anybody who thinks I should just suck it up and deal with him myself... This isn't the only wheel falling off my wagon right now.
Thanks.

 

[Souschef]

And not to be rude, but I REALLY don't need a guilt trip from anybody who thinks I should just suck it up and deal with him myself... This isn't the only wheel falling off my wagon right now.
Thanks.

I think you are being very reasonable with your request. DW has told me of her struggles dealing with a father with dementia and trying to take care of her own family at the same time.

 

[Splash]

I didn't use a case manager when I was my mom's guardian so I can't answer your question. However, I sympathize with what you are going through. Becoming and being my mother's guardian was among the most difficult times in my life. Unless someone has been through this they cannot begin to understand the stress and heartbreak it brings. Best of luck to you and your brother.

 

[Spock]

I didn't mean to snarl and scare off any responses. Sorry.

Thanks for the replies so far.

 

[pb4uski]

Been a guardian two times but unfortunately can't help. In both my cases the wards were put in a nursing home and did not oppose the guardianship so I just visited them as grandson and great-nephew, respectively.

Will your dad remember the strife after a week or two? But if a case worker in between will make him (and you) more comfortable and he has the resources to afford it them by all means give it a try.

Perhaps you can smooth things by downplaying the guardianship thing and frame it as just paying his bills for him so he doesn't have to deal with it and can enjoy the rest of his days.

 

[ivinsfan]

I don't think you scared people off, but perhaps the majority have not used case managers so can't add to the discussion.

Having said that if and your agree and can afford a case manager, go for it.

Have you consulted an elder care attorney. Obviously they charge more by the hour but might have a list of preferred case managers and can walk you through the process.

 

[MichaelB]

My brother and I are on the verge of having to take our 85yo father to court to get him declared incompetent.
Lllllooooong story, but the highlight (so far) is last month he tried to give away his house to his home health aid (who just happens to be registered with Adult Protective Services (APS) as having exploited a different victim 5 years ago. And no, APS will not remove the HHA because there hasn't been any assets actually transferred... yet!).

Since this is going to completely shred an already strained relationship with dad, it was suggested that after being appointed guardian, that we hire a case manager to "deal directly with dad", at least until his disease progresses to the point he quits fighting.



Has anybody out there who is guardian for a parent used a case manager?
Pros?

Cons (other than cost, which is guesstimated at $100-150/hr)?
Do case managers actually buffer all contact between the ward and the guardian?

And not to be rude, but I REALLY don't need a guilt trip from anybody who thinks I should just suck it up and deal with him myself... This isn't the only wheel falling off my wagon right now.
Thanks.

Good thing you were able to stop the home giveaway. Exploitation of seniors in this type of situation is a real threat.

When my mother was diagnosed with Alzheimer’s we had to deal with her reluctance/ unwillingness to make needed changes in her routine and lifestyle, and, at the same time we had pretty significant disagreements among family members regarding how severe was her diagnosis and how to deal with it. It was a very tense time.

Because she was highly respectful of physicians, I built a care plan with input from her primary care, a neurologist, a geriatric psychiatrist, and a home health care agency. Not too different from what a case worker would do. For us this had four important benefits. Mom accepted more easily recommendations when they came from the health care professionals. My siblings couldn’t challenge so easily a plan that had been built with input from and signed off by those same people. It made our subsequent visits to the doctors more productive. Finally, it created a framework to communicate with everyone involved.

There’s no guarantee a case worker will help, but it has the potential to do these things. There is no substitute for your own involvement, which has to continue, but a case worker can “intermediate” and also give legitimacy to the recommendations and proscribed actions needed.

Good luck.

 

[pb4uski]

The other thing that smoothed the way in the two cases where I was guardian is that the court appointed lawyers for the proposed wards were really good at explaining things to the proposed wards and making them comfortable with the idea.

 

[OldShooter]

DW retired from megabank as an SVP in investments and trust. The business segment she ran was a high-touch, high-service typically for the frail elderly. Often it was widows without family or without local family. She frequently hired case managers because the bank did not want any health care responsibility. IIRC most were registered nurses. Some came from services she knew and trusted and some were free lances that she knew and trusted. There were no "standard" arrangements. Each relationship was tailored to the needs of the client in services provided and duration.

Probably more so than in most professional relationships, finding a good case manager is going to take work and multiple interviews. Good luck!

 

[Spock]

...

Will your dad remember the strife after a week or two? But if a case worker in between will make him (and you) more comfortable and he has the resources to afford it them by all means give it a try.

He'll remember this because it's emotionally charged, but it will be his version of the situation. Lately he seems to need to be the victim in every situation.

Perhaps you can smooth things by downplaying the guardianship thing and frame it as just paying his bills for him so he doesn't have to deal with it and can enjoy the rest of his days.

That was the glide path (albeit very bumpy) that we were on before the Home Health Aid came on the scene in Oct 2019. Since then Dad has fired his rental property manager and his accountant then hired replacements recommended by the HHA.

 

[Spock]

I don't think you scared people off, but perhaps the majority have not used case managers so can't add to the discussion.

Having said that if and your agree and can afford a case manager, go for it.

Have you consulted an elder care attorney. Obviously they charge more by the hour but might have a list of preferred case managers and can walk you through the process.

I've engaged an elder law attorney and "the daughter of my wifes friend who used to be an elder case manager".

The case managers are going to be hugely expensive. $100-150/hour and dad is going to be extremely high maintenance for awhile. Mentally I'm balancing/justifying that against the cost of losing the house if nothing was done. Hopefully the case manager hours would taper off over time...

 

[Teacher Terry]

Spock that puts you in a tough spot. I was guardian for a good friend of mine when her husband was dying and had to place her in a home. I visited regularly and kept on top of her care because hospice kept circumventing me and giving her medications that were harming her after specifically being told she couldn’t tolerate them. I finally fired them and found another one.

 

[Spock]

Good thing you were able to stop the home giveaway. Exploitation of seniors in this type of situation is a real threat.

When my mother was diagnosed with Alzheimer’s we had to deal with her reluctance/ unwillingness to make needed changes in her routine and lifestyle, and, at the same time we had pretty significant disagreements among family members regarding how severe was her diagnosis and how to deal with it. It was a very tense time.

Because she was highly respectful of physicians, I built a care plan with input from her primary care, a neurologist, a geriatric psychiatrist, and a home health care agency. Not too different from what a case worker would do. For us this had four important benefits. Mom accepted more easily recommendations when they came from the health care professionals. My siblings couldn’t challenge so easily a plan that had been built with input from and signed off by those same people. It made our subsequent visits to the doctors more productive. Finally, it created a framework to communicate with everyone involved.

There’s no guarantee a case worker will help, but it has the potential to do these things. There is no substitute for your own involvement, which has to continue, but a case worker can “intermediate” and also give legitimacy to the recommendations and proscribed actions needed.

Good luck.

The house isn't safe until he is ruled incompetent and a conservator named. The earliest appointment for a mental evaluation needed for a hearing is still 2 months out plus time to write the report after the appt and then schedule a court date. An emergency hearing would be 2 weeks after that, so we're at least 3 month out.

All of the medical staff down here are worthless in this matter. 2 Drs and 2 hospital social workers have all parroted the exact same line: "He's still making decisions, they're just bad decisions" all the while agreeing he is vulnerable to exploitation, cognitively impaired, etc. APS won't even remove the HHA because technically Dad hasn't been ruled incompetent yet. ARRGH!!

 

[Spock]

The other thing that smoothed the way in the two cases where I was guardian is that the court appointed lawyers for the proposed wards were really good at explaining things to the proposed wards and making them comfortable with the idea.

Thanks, I hadn't thought of his lawyer. I've already engaged his sister/my aunt. I haven't identified a person that he might listen to yet.

 

[Spock]

DW retired from megabank as an SVP in investments and trust. The business segment she ran was a high-touch, high-service typically for the frail elderly. Often it was widows without family or without local family. She frequently hired case managers because the bank did not want any health care responsibility. IIRC most were registered nurses. Some came from services she knew and trusted and some were free lances that she knew and trusted. There were no "standard" arrangements. Each relationship was tailored to the needs of the client in services provided and duration.

Probably more so than in most professional relationships, finding a good case manager is going to take work and multiple interviews. Good luck!

Thanks! does your DW have any suggestions of questions to ask/what to look for (or look out for) in case managers?

 

[pb4uski]

... That was the glide path (albeit very bumpy) that we were on before the Home Health Aid came on the scene in Oct 2019. Since then Dad has fired his rental property manager and his accountant then hired replacements recommended by the HHA.

Replacing the rental proper manager and accountant based on recommendations of a home health aide is crazy IMO.... IME home health aides tend to be pretty unsophisticated... in many cases they are changing diapers and cleaning up feces.... how would they even know property managers and accountants to recommend. Sounds fishy.

 

[pb4uski]

The house isn't safe until he is ruled incompetent and a conservator named. The earliest appointment for a mental evaluation needed for a hearing is still 2 months out plus time to write the report after the appt and then schedule a court date. An emergency hearing would be 2 weeks after that, so we're at least 3 month out.

All of the medical staff down here are worthless in this matter. 2 Drs and 2 hospital social workers have all parroted the exact same line: "He's still making decisions, they're just bad decisions" all the while agreeing he is vulnerable to exploitation, cognitively impaired, etc. APS won't even remove the HHA because technically Dad hasn't been ruled incompetent yet. ARRGH!!

Wow... that is very different from my experience. In both cases it was actually the medical professionals (doctors and nurses) that were advocating for guardianship.... but it may have been different because in both cases it was not safe for my grandmother or great-aunt to continue living alone. The process of a phsycological analysis and the court-appointed attorney interviewing the proposed wards happened fairly quickly as did the court proceeding. In fact, IIRC for my grandmother the court proceeding was in a conference room in the hospital and I was given a temporary guardianship and then it was made permanent later in court once we had gone through all the steps... for my aunt it was in court because she was already in a nursing home.

If your dad has the deed then you might see if you can get it and take it with you for safekeeping the next time you visit... it won't stop things but it might slow things down a little... at least he can't sign it over on the spur of the moment if he doesn't have it.

 

[OldShooter]

Thanks! does your DW have any suggestions of questions to ask/what to look for (or look out for) in case managers?

If you will PM me your name and a phone number she'll be happy to call you later in the day on Sunday. Probably after 4PM Central.

 

[firemediceric]

Thanks, I hadn't thought of his lawyer. I've already engaged his sister/my aunt. I haven't identified a person that he might listen to yet.

Although things vary from state to state, one route to take may be to document in list form with supporting instances why you have concern regarding the AIP's (Alleged Incapacitated Person) welfare. That can be from the standpoint of his being able to take care of himself to the threat of financial exploitation.

In Florida if you can make the case with a family law attorney that the AIP is incapable of managing their ADL's (Activities of Daily Living) such as medication management, food preparation, hygiene, toileting, or financial matters, the court may be petitioned to put in place an ETG (Emergency Temporary Guardian) to look after the AIP for up to 90 days while an attorney advocate/court appointed attorney is appointed to represent the AIP. A 3 member examining committee is also appointed to report their individual findings to the court. If at the capacity hearing the AIP is determined to lack capacity (incompetence is no longer the PC term) in any of the specific areas the court looks at, those rights are delegated to the guardian.

Those rights may be affecting the person such as the rights to determine where to live, who to socialize with, to travel, to marry or to drive. Financial rights may also be delegate such as to contract, to seek government benefits, or to manage finances.