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Many people want to know what assessments cover and what can be expected from one. Below, is an example of a recent one. This one doesn’t cover some things that might come up in other situations (ie; survey of residential possibilities, specific entitlement opportunities, etc…). Also, I’ve had to change or redact to maintain confidentiality. Still, this gives a good picture of the report I write. This comes after completing a six page data form and a 1-2 hour home visit. Enjoy!!!
Assessment For Mary Jones
1)
Issue: Need for Will. I understand that your mother has begun the process of drafting a Will. I, understand, in fact, she has paid for it already. I understand that she seems resistant/reluctant complete the process. As I’ve stated it’s very important to complete this process as without a will something called intestacy is used upon her passing. This means that, distribution of assets will follow a state prescribed formula. This may well not be consistent with what she would like to have done with her money.
Resolution: Firstly, I would suggest beginning with the attorney about setting up a trust that could avoid probate. In addition to avoiding probate, if you are made one of the trustees on the trust it is much simpler for you to manage her money if and when she cannot or will not when she’s alive. Additionally, concerning your mom’s reluctance/resistance to follow through, I suggest you discuss with her your strong concerns that if things are left as they are now, it’s likely to lead to a lot of friction and conflict for a long time with your brother in California after she’s gone. I imagine she doesn’t want that. And that might help motivate her to follow through. Finally, if you would like to work with a different attorney, I’d be happy to provide you with several referrals.
2)
Issue: Lack of internist. You informed me that your mother at this point in time only sees an oncologist and a cardiologist. It would be in her best interest to have an internist to watch over her overall health. In addition, that internist would be best if he or she were a geriatrician. A geriatrician is a specialist who specializes in treatment and care for seniors. I think the issue of possible depression in your mother might be taken up as well as a possible onward referral to a geriatric psychiatrist.
Resolution: I like to recommend the following geriatricians for consideration. Elaine M. Holt, MD, 352 Godwin Ave., Ridgewood, NJ 07450, 201-493-9311 and Dr. Anne-Marie Gracia
59 Main Street, Suite 204, West Orange, NJ 07052, (973) 243-0220
3)
Issue: Lack of health care proxy. As we discussed the health care proxy is a document which will allow an individual selected by your mother to make health care decisions for her when she’s not able. It would come into effect if your mother were to have something happen to her (as in the case of a stroke). Or as a consequence of the progression of an illness like dementia. It would allow that person to make medical decisions which could include determining where she lives. Absent such a designated person, leaves open the possibility that public agencies, attorneys acting as guardian, a court, etc. would make these decisions instead of a person she might prefer. A person that she might prefer would know better her preferences vs. a stranger.
Resolution: As we discussed I do understand the difficulty in addressing this with your mother. I understand how she has responded in the past. I also suggested, and will again now, that you take advantage of her being in a rehab facility, and request staff to attempt to get her to sign a health care proxy. I’m also going to provide the link here where you can download the document (http://www.state.nj.us/health/healthfacilities/documents/ltc/advance_directives.pdf) . It’s fairly simple to execute. It’s possible I might be able to be of assistance in discussing with her the matter. It’s often more effective to have a third-party involved.
4)
Issue: Lack of person designated with power of attorney. As we discussed the document known as a durable power of attorney is something that allows for the individual designated to make/take a wide range of financial decisions/actions. It is very powerful and useful. For example, this individual could pay bills, withdraw money, sell property, apply for government benefits, etc. Because it is a durable (vs. springing, which I don’t recommend) its power remains in effect even when your mother would be unable to make decisions for herself. Different than the health care proxy, it also is in effect when your mother is able to make decisions for herself. This has a great deal of value as a convenience. For example, you’re in New York City and you need to fill out some paperwork. You don’t have to travel to New Jersey to get her signature. You can read a lot more about this document at http://www.nj.gov/ooie/helpful/durable_power_attorney.html. It’s also going to allow you to legally monitor accounts online. This is important to make sure that nothing undesirable is going on with her finances. It helps you monitor for someone financially abusing her.
Resolution: Consult an attorney to draft a power of attorney. I’d like to recommend…
5)
Issue: Medications. When I visited your mother’s apartment, it was difficult to determine what your mother was taking. It was difficult to determine if she was taking them properly. You also told me that you’re aware that she’s taking a range of vitamins but we couldn’t say what and when. You told me that you had discussed with your mother how important it is for her to tell her doctors what vitamins she was taking as they could be potentially problematic with her conditions and other medications. Of course you’re correct about this. It’s important to know what she’s taking. It’s important to know if she is taking them and about how much. Knowing this, the doctor can know whether or not these medications are effective and perhaps why not.
Resolution: I make two suggestions here. One is that you tell your mother that on your weekly or biweekly visits you’re going to make her life easier by pouring her medications. When I say pouring, that means you’ll need to purchase containers available at most pharmacies that allow for distribution of medications in small compartments labeled by date and time of day. Your mother might appreciate the convenience. You will be able to readily know how much and if she had taken the medications up to that point. I would stress the convenience. You might even volunteer to take over the actual refilling of the prescriptions. I stress making her life easier and more convenient as a way to gain her cooperation. In addition, I also suggest that you be in contact with her doctors about what you discover in terms of her compliance with taking medications as well as informing them about what vitamins, over-the-counter medications, etc. she has consumed. As we discussed, under the law, medical professionals are not allowed to discuss confidential medical information unless they have been explicitly allowed by their patient to do so. I would imagine your mother would not have any objections. However, in what I’m recommending, you’re not asking the doctor to give you information. You are giving information to him her or her. They don’t need your mother’s permission to listen. If you should get resistance from the doctor about this matter, I would mention this point. In most cases, doctors are very interested to have more information and the involvement of family. What they don’t really like to do is have to speak to multiple members of family repeating the same information. Therefore, for example, if your brother wants information I would have you be the one point of contact with the doctor to avoid what I just talked about.
6)
Issue: Kitchen floor. Your mother’s kitchen floor is covered with broken and loose tiles. These put her at risk of falling and all the problems that might ensue from a fall.
Resolution: Replace kitchen flooring. I’d like to recommend Frank’s Carpet in Union City, New Jersey. Their telephone number is (855) 763-8325. I personally used them in the past and found service to be very good and price to be very reasonable.
7)
Issue: Gas stove. You mentioned that your mother doesn’t seem to be having a problem with memory. You mentioned there was one incident of a burnt pot. Nonetheless, this could change over time. And I would like you to be prepared with a possible technical solution.
Resolution: There exists devices that attach to the stove top that can automatically put out a fire. One such device can be found here: http://amzn.to/15DtgPu
8)
Issue: The bathroom. As your mother just had a fall and seems to be experiencing recent weakness, there is a need for some safety modifications in the bathroom. Firstly I recommend grab bars installed in the shower. In addition, pending the recommendation of the therapists that she’s receiving care from at The Harborage, I might recommend the removal of the shower doors, installation of a shower seat, shower curtain, and hand held shower head. I’m not sure she’s going to need this. In addition, something that raises the toilet seat might be a good idea, in order to reduce the difficulty in rising. I would recommend putting a commode over the toilet for this purpose. This has the added value of putting arms that she can leverage herself up. I would defer to the opinion of her therapists. But I think it should be considered.
Resolution: Grab bars can be found here: http://amzn.to/13M6S2k. It is important that during installation they be securely attached to studs in the wall. Shower seats can be found here http://amzn.to/11DnLzz. Hand-held shower heads can be found here http://amzn.to/14qTwQi.
9)
Issue: Bedroom modifications. Similar to the bathroom, pending what her therapist recommends, it might be necessary for her to have some assistance in rising out of bed. There are a wide range of devices available. I don’t think she needs the kind that is designed to protect someone from rolling out of bed. I believe the kind that offer a bar that is elevated above the bed level that can function as additional leverage is what she needs. These are generally the type that rest on the floor and slip between the mattress and bed spring so that they are secure. In addition, I’m concerned that she has easy access to make phone calls from her bed. I know that you purchased a wireless telephone. But this is going to require that she remember to place telephone back in its rechargeable base. There exist wireless phone jacks into which a standard phone can be connected. Frankly, I prefer simply calling the phone company and having a jack installed. My preference for this is that there is the issue of blackouts. I think every home should have at least one telephone that plugs directly into the telephone line and does not require electricity to operate. This would be my preference for your mother.
Resolution: Here is a link for bed rails http://amzn.to/1ejv9mf. Here is a link for a wireless phone jack http://amzn.to/14qTO9R. Here is a phone that has several features that could be of additional use and will also operate in the event of a blackout: http://amzn.to/17r3jRp
10)
Issue: Poor lighting. As people age, their vision diminishes. In addition, your mother’s floor is stained dark brown which absorbs a great deal of the light.
Resolution: You might consider actually having the floor sanded down and leave the natural wood color, which would increase the light levels considerably. Additionally, sanding floors down to the natural surface would remove the finish that is on now that I feel makes the floor, more slippery than I like. Or, the application of some skid resistant coating might be advisable: http://amzn.to/11Dp9lS. In addition I’m going to recommend that you replace bulbs in every fixture with the maximum wattage that fixture can handle. You might also consider additional lights that would bounce the lights off the ceiling. Finally, I think that putting in nightlights in a number of the outlets would be in her best interest.
11)
Issue: Getting help after an emergency. Unfortunately, as you just experienced, because your mother lives alone, she’s vulnerable to not getting help after or during emergency. Most recently she had a fall, and was unable to get help for many hours. Fortunately, the outcome could have been worse. There is a strong relationship between mortality and morbidity and length of time a senior might be on the floor waiting for help. I’d encourage you to read this http://www.medscape.com/viewarticle/585763.
Resolution: I recommend for your mother something called a personal emergency response system
(PERS). However, I’d like to recommend one in particular that has the advantage over its competitors that it can detect falls automatically. One of the problems with the standard systems are they require that the individual press the button to get help. Obviously the problem with this is the person may be unconscious. Additionally, some are confused and don’t remember. The device is manufactured and serviced by Philips detects falls. The service involves the installation of a receiver with a loud amplified telephone. Upon pressing the button or were a fall detected, calls an individual monitoring it and they attempt to communicate with your mother. Mother can either say she’s okay or she needs help. If they get no response, they will call automatically for emergency assistance. In addition, they can be left with instructions to call other people. As well in their database can be her medical providers, her current medications, the location of the key to her apartment, etc. I can’t recommend this service enough. You can find it here: http://www.lifelinesys.com/content/lifeline-products/auto-alert. You should realize though, that this is still not perfect. If there is a slow fall or if a person might be sitting in a chair or in her bed and start to have a stroke, heart attack, etc. they may not be able to press the button or be detected. There does exist other systems that are more involved that rely on sensors that detect movement or lack of movement that could answer this problem. You can read about one here http://www.sengistix.com/index.php/what-sengistix-provides.
12)
Issue: Need for home health aide. We discussed this issue when I was making the home assessment. It does seem that your mother, based on previous conversations, would be receptive to this. Home attendants could have many advantages. They could ensure that she gets proper nutrition on a daily basis. They could make sure that the previous cluttered state of the apartment doesn’t recur. They could provide valuable company and stimulation. They could accompany her to various social and recreational opportunities in the community. They could be a valuable source of information in the care of your mother for you. They can help with shopping, laundry, transfers, medication reminders, transportation, walking, bathing, dressing, and grooming. I do not recommend that this person assist your mother with anything financial (i.e., bill paying).
Resolution: Hire a home attendant. There are basically two ways of doing this. You can go through a licensed agency. Or you can hire one directly privately. Some people perfer the latter as they can save some money, perhaps get somebody with greater experience, and feel better that the home attendant will likely be getting paid more herself. I generally don’t prefer this approach. It’s true you can probably save some money. But you’re going to have to, in order to be legal, set up payroll system for taxes to be deducted. This can definitely be done but it’s more work. In addition, if and when the time comes, you don’t want this person to work for you, you have to fire them. This is not always pleasant and the fact that it isn’t may cause you or your mother to avoid taking that step when maybe you should. When you have an agency it’s very simple. You simply call them and tell them I don’t like this person. I want somebody new. Also there’s the matter of when they get sick and can’t show up. An agency will send a replacement. Agencies generally also have nursing oversight, which is a value, added. You can arrange for interviews to meet different potential aides. All in all I think it’s a better way to go.
13)
Issue: Asset preservation and entitlement eligibility. Your mother has considerable resources. Nonetheless, it makes sense for you to seek the best way to preserve them. For example, eligibility for Medicaid varies from state to state. There may be ways to preserve your mother’s resources by taking advantage of services that come from Medicaid. But the regulations are rather complex, and as such I recommend a consult with an elder law attorney to see what, if any, opportunities exist.
Resolution: Consult with an elder attorney.
Mark Zilberman, LCSW
August 3, 2013
