You’re welcome! We never talk about these things until we find out that everyone is either dealing with it in their family or knows someone who’s dealing with it.
You can check the difference with her neurologist, who’d probably tell you that neurologists can prescribe medication while neuropsychologists do not. One of them might cost more than the other, too. There are probably more differences that I’m not aware of.
These distinctions might not make a difference if her neurologist can do a similar assessment to get the long-term care insurance claim approved.
I remember that in 2011 the neuropsychologist asked my father to answer the classic dementia screening questions:
- Draw an analog clock face, label the hours on the face, and put the clock hands at 3:25 PM.
- Count backwards from 100... by 7s.
- Spell a verbal list of words... backwards.
- Use a phone to demonstrate calling the fire department (especially if the patient has to dial a 1 for an outside line). This question might have been rendered obsolete by smartphones.
Dad failed miserably at all of these questions, although he joked about spelling his last name backwards and drawing Mickey Mouse’s hands on the clock face. Yet at the same time he could easily pass the MMSE.
I remember the neuropsychologist also wrote a paragraph noting that Dad had several bruises, burns, and scabs from injuring himself around his apartment. Dad dismissed it as clumsiness.
The neuropsychologist told Dad up front that his assessment was to see how well Dad was recovering from recent surgery and to assess his competency for living independently. He said that his writeup would be used for Dad’s long-term insurance claim, to have my brother take care of Dad, and to have me take care of Dad’s finances. Dad agreed with all of that (and signed the consent form) without actually understanding any of the conversation... but he did a great imitation of comprehension.
Dad was also at a stage where he could carry on a coffee-shop conversation with random people for up to 30 minutes before he began to repeat himself, or before the other person noticed that something seemed off. During his first year in the care facility (with early-stage Alzheimer’s) he was the “street mayor” who asked all of the new residents what caused them to be staying there, how they were doing today, how was their family, and so on. He did it well enough that many of the new residents (and their families) thought he was a volunteer on staff instead of another resident.
Well, good luck with that-- it’s up to the financial institutions and they can always change their minds about whether the POA is still valid.
Technically, a general power of attorney is considered invalid when the grantor is not mentally competent. (This includes comas and some medical treatments as well as dementia.) Of course there are many spouses and family members who have all of the logins and passwords (and can imitate their voice on phone calls, and can possibly forge their signatures) to take care of business without any legal permission. Most authorities wouldn’t object (let alone prosecute) if the helper was acting in a fiduciary manner. If there’s a personal relationship with the business then they may even be willing to overlook the cognition situation until their corporate lawyers step in.
The legal permission for a dementia caregiver is a durable POA (signed before the grantor is no longer mentally competent), or a conservatorship (for finances), or a guardianship (for personal care). Each state has their own versions of these laws.
The legal permission for handling title to real estate (selling the grantor’s home or signing a lease as a landlord for a tenant) is a revocable living trust. Title companies (and title insurers) have been burned too many times by real-estate owners who were deemed mentally incompetent, but who later regained their competence and sued to reverse the real-estate decisions made by a caregiver. A RLT is considered a legal entity that can transfer title without calling its legitimacy into dispute, although the trustees of the RLT might disagree over what’s been done.
If your POA is declared invalid or simply declined (for whatever reason), and you do not have a DPOA or a RLT, then your only legal recourse is to petition a probate court for guardianship/conservatorship. In Denver during 2011 this cost us nearly $6000 in legal fees. Even worse, it took nearly nine months to gather the paperwork and get on the court calendar. I had to pass a judge’s interview (with a professionally certified conservator), complete a background screening & criminal-records check, and even agree that I could be extradited from my home (Hawaii) to the Denver probate court if they thought it was necessary. I then spent the next six years under the benevolent oversight of the probate court, filing annual financial reports & plans along with answering any questions and responding to their helpful suggestions. When Dad passed away I had to file eight more reports to formally end my conservancy... even though the court already knew that Dad had passed away.
My spouse and I are in our 60s, and we had no idea of our pandemic vulnerabilities. We knew that we didn’t want to make our care any harder on our family than it already might be.
We’ve done the DPOA and RLT planning for our disability, mainly so that our daughter doesn’t get bagged with the same situation that I had with my father:
https://militaryfinancialindependence.com/2019/10/31/family-estate-planning-for-your-disability/
With what I’ve learned from caring for my father, if I was in this situation with someone again then I’d set up the DPOA (and possibly the RLT) right now before anything changes for the worse.
