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They are in process of a trust, one has CHF, one dementia. For several years my stepDad has been putting together a trust for both himself & my Mom. She has dementia and he has heart issues, basically congestive heart failure -- CHF. Recently, I helped them move into Assisted Living, both of them fairly stable medically until yesterday. His CHF is causing excess fluid and they admitted him to hospital for treatment, saying it should just be a couple days to get fluid retention down to normal levels. I've seen copies of their wills and trust paperwork, but I am fairly clueless as to what paperwork I need to ensure is taken care of? I live 1400 miles away, so at this point, if this situation repeats, what needs to be in place so I can call and get updates directly from the hospital? My mother's dementia means an update from her is non-existent. In fact, I'm worried about my step Dads condition, and worried about her confusion levels at the AL when she forgets that he is in the hospital. I'm scheduled to visit within the next six weeks and want to know what items I should request copies of, or have taken care of. StepDad's mind is sharp, so I've let him steer things, however, this recent turn of events has opened my mind. Had he not been alert & coherent yesterday I would still have no idea why he was being admitted to the hospital due to my Mom's condition and limitations.

I should mention that there exists a first trust and the amended trust has yet to be signed by them, so I assume the first one is the official version until they sign the amended one?

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Update: stepdad back home after being at hospital for two weeks, everything settling down somewhat. Ended up hiring a sitter to help keep my mom occupied and not worrying during his hospital stay, and I think they might turn that into a weekly scheduled event for smaller amounts of time as they need.

I'm headed out there in approx. two weeks, and I started my list of documents and items to gather while I'm there. thanks so much for your help!
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J, what counselor is it that advised you to come to the hospital? Was it a social worker from the AL, or was it someone from the hospital? And what was the justification for suggesting the sudden visit?

This is what I would do: call the hospital again, ask for the specific floor or wing your stepfather is on and ask to speak to her nurse for today. You may have some difficulty if they're sticklers for privacy and don't know you.

In that case, call your stepfather, explain the situation, and ask him to tell his nurse for today as well as the charge nurse that he's authorizing you to speak with them. He can also ask for a HIPAA notice that he can complete, authorizing them to provide information to you.

We've been through CHF a number of times. Depending on the level of fluid, it can make a person tired, and movement is more cumbersome because of the excess effort expended. The excess fluid in the lungs makes breathing more difficult and tiring; usually the person is put on oxygen to assist with breathing.

Usually a diuretic such as Lasix is administered. Bumex can also be administered but my niece who's a nurse told me it's 40X as powerful as Lasix. It does flush out the excess fluid though.

Ask also if there are any other issues, especially with his lungs. Has he been diagnosed with any chronic lung condition, such as COPD, emphysema? If so, how are they treating it? Does he have any bronchitis, pneumonia, anything else, and again, if so, how are they treating it?

It helps to be knowledgeable about the conditions beforehand, otherwise you sometimes get the brush off and just the verbal hand pat that everything's all right. So do a bit of research on CHF, COPD, atelectasis, bronchitis and pneumonia before you call. If they think they're speaking with someone who's more knowledgeable about the conditions, they generally will so as well.

If you do get the verbal hand pat, explain to them that you're miles away, very concerned, and need to have a frank status report to make decisions if you have to.

Then ask them if there is anything else about which you should be concerned, and if you should be present with him, if his condition is serious and if there are plans to move him to an ICU. If the nurse if "iffy", you can mention the pending storm and the distance involved.

You might also ask her to have the pulmonologist or cardiologist call you. That's a reasonable request. Make sure to give them contact information and ask that they call you if there's ANY change for the worse.

Do you have any relatives or friends in the area who could visit your parents to check on them?
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Thank you Gardenartist, Windy, FF & Pams. I appreciate your input and advice. I spoke to my parents again yesterday. Stepdad sounded tired, but very aware of what was going on. Mom sounded fine, she was with her counselor running some errands. The counselor suggested I get on a plane right now (it's snowing there and forecasted to only get worse). When I pressed her for reasoning, she made it sound like stepdads health was worse then he was letting on, but try as I might I couldn't get a hold of the nurse, much less a doctor. Two days before Christmas...the hospital staff is probably overwhelmed. I suspect she was also worried about Moms level of confusion. For right now I have to take my stepdad at face value, although I did talk to the nurse at AL and she set some fears to rest, saying he looked fine to her the other day, and mentioning this hospitalization for excess fluid was not uncommon. I also talked to her about keeping an eye on Mom, and possibly even holding on to the car keys, which she was agreeable to do. I can't tell you how worrying and frustrating it is to be so far away and unable to help either one. I tried to get them to move to my town, but to no avail, and now that they just moved into AL I can't imagine that either one would be up for another move anytime soon. So while I'm worried and wondering if I need to drop everything and get on a plane, I am also frustrated and angry that I'm put in this position. I'm sure some of you can relate! I plan on calling both of them again this morning and will ask my stepdad again if he thinks I should come right now. When I asked the first time he said no, but maybe after two nights in hospital he will have a different perspective.

Thanks for listening to my rant. P.s. My birth dad passed away 10 years ago and there should be no agreements or papers that would pose an issue now.
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Copies of a Will are no good for probate. Find the originals. See the lawyer when you get to town and get a DPOA done for both parents, so the lawyer can talk to you about the details.
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JJ, adding to what Windy and FF wrote:

1. Yes, the first Trust is the valid one now; anything that's not signed is still in draft form, as Windy states. And as FF states, your mother's confusion would prevent her from signing a Trust Amendment, or Restated Trust.

There may be a way your stepfather can fold into his Trust provisions that he might want for your mother, by converting his Trust to a marital trust, but I'm not sure how this would be done, given her dementia. I think marital trusts have to be executed by both partners.

His attorney could address this issue to ensure that your mother is cared for, especially given the advent of her dementia.

2. You would need a Living Will, or Advanced Directive, addressing options to be taken in medical emergencies or end of life situations. This would be for short and long term planning.

For ongoing access to medical records, your stepfather would need to sign a HIPAA waiver, authorizing medical personnel to speak with you about your stepfather's condition, as well as get copies of his records.

What I don't know is if as husband your stepfather would need a DPOA to sign on behalf of your mother, to then extend to you the option of getting access to her medical records and making decisions on her behalf if your stepfather were unable to.

Frankly, it often depends on the hospital as well. I've called for information on my father for years, but there was only one time I was asked to provide a copy of the DPOA so I could make decisions, and that's when he was intubated. Many of the hospital personnel know us by now.

3. What our preferred hospital does now is provide me with a card with a 4 digit number that I use to get updates when I call during any hospitalization. It's merely for info on that hospitalization though and doesn't convey anything beyond access to information.

4. What our attorney also provided in Dad's Estate Plan were:

a. Bill of Sale transferring the various household goods, identified by category, but not enumerated specifically, into the Trust. This would include clothing, appliances, tools, etc.

b. A Certificate of Trust Existence and Authority, which I presented to banks, which summarizes the Trust provisions but does not address any division of assets. That way, the institutions don't know who gets what, but they have documentation of your authority to act on behalf of your stepfather.

c. You may know that any financial or physical assets need to be "funded" into the Trust, which means they have to be retitled into the name of the Trust. You should ask if all assets are subject to the compressed rate of taxation, which increases the level of taxation on funded assets. This particularly applies to financial assets. This is one area where people can slip up and transfer certain financial products that might otherwise be best handled outside the Trust.

The house needs to be transferred via Quit Claim Deed to the Trust; however, there would be an issue on how to do this if it hasn't already been done, given your mother's dementia, assuming she and your stepfather hold title to the house jointly.

d. If you're not named as successor trustee, or joint trustee with your stepfather, it's a good idea in case he's ever in a position that he's not able to handle the responsibilities of the trust.

5. Not to be nosy, but is your birth father still in the picture, and are there any estate plans that were executed by him and your mother, and which could possibly conflict with plans your mother and stepfather made before she developed dementia?


As to his condition, with a history of CHF, he might qualify for cardiac rehab. I know it's available in our hospital, post heart attack, but I don't know if it's available for chronic CHF. I would ask about that.
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JJGood, the first Trust is the only Trust that the family can use right now. Your Mom wouldn't be allowed by law to sign anything due to her advanced dementia. Your Step-Dad could amend his own Trust.

Who is your parent's Power of Attorney? If your parents have a Will and a Trust, surely they must have a medical and financial Power of Attorney. Only that person named as Power of Attorney can make decisions for them if they are incapable of doing so.

Your Step-Dad can asked that you be allowed to view his medical information via a form that the hospital has for such use. Your Step-Dad can view his wife's medical records and possible tell the hospital to add your name as a concerned party if the hospital can't reach your Step-Dad.

Elders will drag their feet on legal papers. Thank goodness I got my parents into an Elder Law attorney to get new paper work updated as their old Will was a landmine. But Dad is still doing the paperwork for the Trust and he's been chiseling away at it for over a year... it will never get done :P
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I would think the first trust is the legitimate one. Are you responsible for their care? Does anyone have POA?
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