As POA, at what point do you step-in regarding financial matters?
I am the durable/financial/ POA for my mother (72 yo), who lived alone and independently. She had a life-event (CHF) in mid-February this year, and I suspected that something else cognitively was going on as well since December 2020. During her hospitalization, I demanded that the doctors test her. Based on those initial results, they recommended further follow-up with a geriatric Internist.
Post-hospitalization, we followed up and had her more formally tested (MMSE). Her Geriatric Internist suspects other medical conditions may be a factor and does not want to formally diagnose her (with Dementia) until she is under treatment for 4-6 months then assess her again. During her hospitalization recovery, we have hired a 5-day week care-giver to assist her with treatment plans, health and medication checks, social, physical, and mental engagement. My brother and I support these activities on weekend (alternating) so that it is not such a financial crush while she can still somewhat make meals.
I had a chance to peek into her finances, and I am appalled. She has more credit card (CC) debt than she says (flagrant spender personality); There are clearly fraud charges on her account that she has not caught or realized they are hers. She easily thinks money has not been received, which I have shown her was deposited into her bank account. I believe she is spending more money than what is coming in. I have shown her the CC statements and asked her which ones are actually her purchases/charges so that we can submit fraud. We have even received notices from a few of the CC companies that they suspect fraud on her account, but she has not actioned on them (loss of executive function?).
She has never been one to be fiscally responsible. I would like to set her up on a sort of monthly budget to address the debt, and so that she is aware of where her money is going and what is coming in. She has resisted my attempts so far, and I have even suggest if she is not comfortable with me doing that she hires someone. I want to make sure she has the funds to support her for the long-term, as I am concerned that we will get that formal diagnosis of dementia and need MC/ALH. I think she believes I am trying to take over. I have read a few posts about others with family members with dementia and this disease appears to be a long one (12+ years), and we are fairly early in her situation.
Am I fretting about financials too early? What lessons have you learned during your caregiving time that you wished you knew sooner or would tell your younger self?
What you do next will depend upon what authority you do or do not have. I would not waste any time setting up a budget. 1) she has proven to not care or live in reality regarding her finances, and; 2) if she does have cognitive impairment a budget will be for you to manage, not her. She won't be able to follow it.
A PoA's power may be in force if she is temporarily cognitively incapacitated, so you may want to check the document and then decide to try to clean up her mess or not. No, it is not too early to have your finger on the pulse of what's going on since you'll be managing it eventually, anyway.
The lesson I learned was to take advantage of your mom being out of her house and look for other problems and struggles she's having. My MIL had countless cartons of checkbooks that she kept ordering because her short-term memory was fried. She'd write one check out of one book then open another carton (12 boxes of checks in a carton) and write another check and nothing was documented in her checkbook ledger. Other bills weren't getting paid, she was upside down on a ballooning 2nd mortgage, behind on property taxes, medications weren't being taken correctly, food was spoiling in her fridge, etc. It shocked us because she didn't seem "that bad". She was not even remembering to feed herself.
I took the opportunity to take pictures of her driver's license, Medicare card, SS card, bank account number, homeowner's and car insurance, and took possession of cc's that she wasn't (or shouldn't be) using. By doing this I opened up online banking for her so I could monitor her account for balance and fraud and set up BillPay for more important bills to be paid on time. I sorted through her mail first to find the bills and throw out tempting junk mail. I found any medical records and took pictures. In short, I saw a train wreck coming and all I could do was minimize its impact on the both of us by being preemptive.
FYI your mom should designate you as her Medical Representative so that her medical team can discuss her health issues with you without her being present. This is separate from medical PoA and has to do with HIPAA rules. Ask the clinic or receptionist at each doctor's office for this form for her to sign.
Finally, please be aware that unless she is very wealthy, she might need Medicaid to pay for her care and many states have a 5-year "look-back" period on the application. Please find out what it is for her state. I recommend you and her invest in a consult with an elder law attorney to understand the minefield of financial transactions that could easily delay or disqualify her. Even if she doesn't go, you should. My in-laws were selfish spendthrifts their whole lives and never learned their lessons from being in debt over and over. They put their entire family into a terrible position by never planning and going into their retirement not only broke but deeply in debt yet expecting us, with a young family and a business to run, to be their hands-on caregivers and retirement plan. Don't feel guilty if she winds up in a less-than-ideal care situation: this is what she planned for. She had her entire life to learn and save and chose not to do either. You are not responsible for her happiness. Just do your best and eat the elephant one bite at a time, especially if you start early. I wish you all the best!
Everyone should have a HIPAA draw up by an attorney that specifically says that it never expires and is intended to be valid in any jurisdiction that it is presented in.
The ones that you sign in clinic are only valid for 12 months. The time that you find this out, usually in the middle of a crisis and the office staff are happy to tell you that you don't have a valid HIPAA release.
It is worth the effort to get a lifetime HIPAA release for your DMPOA.
The doctor had her brain scanned, did a memory test and assessed that mom has normal aging as well as vascular dementia progressing to ALZ symptoms. This was not evident to mom other than she kinda knew she needed help. I was in the meeting with her and every meeting with doctors. I specifically asked the doctors for a treatment plan to help mom and they all said that there is no reversal. When I got mom home, I prayed for wisdom and early in the day (she is worse in the evening), I offered to set up her accounts to get the most benefit and reduce the negative impact of debt. Once I got her agreement, I got all her accounts in front of me, did a budget and let her know that she needed $$ to live (food, insurance, maintenance, bills). I showed her what was left over (after I pulled out a percentage for emergencies). I was serious and concerned and told her I wanted her to be as independent as possible and me handling her finances is what rich people do-except they pay for a bookkeeper!
Then, I went about reducing her debt. I got a DPOA for her and called each of the CCards and cancelled the card. I did not tell her this because she is not wise. I got her a debit card and asked her to keep all of her receipts and daily keep a record (on a calendar) of what she spends...every penny so she can see her outlays.
This effort showed mom that she was spending more than she thought and also that she struggled with doing this simple task.
Once the CC had cancelled accounts, I sent them a reduced amount (less than the minimum because she could not afford it with the explanation that there was a medical issue and no more money was available for payments. Eventually, the CC people negotiated with me and most settled for 50 percent of what she owed. She had these card for years and the interest was killing her. Prayer prepared my words and mom’s heart for all interactions and I am grateful that she is safe and her finances are in order.
That said, rather harshly, let me say this. Mom will deny forever that she has a problem, If dementia is a factor here, she will only be more and more confused or in greater denial about money. It is going to be natural for her to deny she needs help, not only because her abilities to handle money properly, but because she literally will not see what is happening. She believes/feels she is fine with all of it. Please understand, her reality is in her mind and she believes she is OK. Don't try to convince her otherwise, just take over.
This is not going to be an easy process, she will fight you every way she can. If you have signed the documents for POA, you have the legal right to take over. I would verify this with the Attorney, but that is what I found when I had to do this for my Mom. All I had to do was -- "do it". It is, in fact, what she wanted when she gave you POA.
All this is meant to say, in part, that when we are a "caregiver" for a parent/whomever we also find ourselves giving our own excuses for our inaction. That inaction being the taking over some of the necessary activities of living -- usually the financial dealings, activities that our loved one has always been able to handle. It is in some ways our own denial, seeing those parts of our loved one failing and we don't want to see nor accept this ourselves. In ways we are now the adult and the adult is now the child. Just a fact and does not need to be explained to them, they will not understand. Just give all the love you and no matter what the reaction. AND talk to someone, not family, someone who can listen, perhaps a counselor. You, too, need to be able to express your concerns, finding a way to help you understand all of your decisions. Someone not invested (Involved) in the situation.
Do all this with the love and strength you can gather. It is our love and acceptance of the loved one as they are today, not what we have been used to or with they still were, that will allow us to move ahead with grace. When our loved one has Dementia, it is never too early (NOR TOO LATE) to step in and take command. Do it with love and always tell them what you are doing. I did this until Mom was no longer interested (and she let me know when).
Stay Calm, Stay Safe, Stay Loving. It is a journey and not always a good one, but one that one day you will be able to say "I did the right thing". God Bless all of you!
You won't need to resort to the DPOA for this, your mother can give her permission for the company/ies to discuss her account with you over the phone.
She has been ignoring the situation intentionally, and that probably means it hasn't stopped her feeling sick with worry about it. Get it sorted and out of the way, and perhaps the relief will be a good basis for better management (and confidence in you) in future.
I have DPOA over my Mom (at the time, 2015, she had early stage Alzheimer’s).
She was sending checks to every piece of mail that looked like a bill (most were just junk mail trying to get you to buy things). She was paying bills twice sometimes, and logging the checks incorrectly.
she would dial 911 every time the power went out (in her mind, it WAS an emergency..!). These behaviors started to pile up, so I started a log with behavioral notes from every time I went to visit her.
I had to sneakily get her Credit cards away from her and with my DPOA, cancel them all. I told her that as POA, I needed to make copies of the CCs.
She even told me she had a CC somewhere but couldn’t remember what happened to it..!
maybe she could be given a Visa gift card as her official “credit card”?
it is tricky as they still have cognitive ability early on, and become more paranoid as the disease progresses.
I did take her to a well known geriatric neurologist to get her officially diagnosed, and to seek advice from her on how to best proceed with approaching these topics such as bathing (or lack of), money issues, etc.
good luck it is a long road. You have to remember to take of you first.
Now his kids have a father with no income. The stories are legendary.
My mother, for example, decided to close her main bank account, not realizing that all of her deposits went into it. When I explained that, she was shocked. "I don't get deposits," she claimed. She was clueless, typical of her generation but still a problem.
One thing I have learned in this role is that it is better to be little too early than a little too late. When you think it might be time, it is time.
How to do this? Be creative. You know her. Read up. There is loads of information. But make it happen. Take charge or regret it later!
Good luck!
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