Five months ago my husband's older sister fell, broke her leg, and was not discovered in her home for at least 3-4 days. Since then she has been in and out of the hospital and SKN facilities, with multiple pressure wounds and increasing debilitation. He has another sister who cannot drive and is mentally disabled, but at least she lives in the general area - we do not, and have been trying to assist from a distance.
His sister has repeatedly and emphatically refused to pay for her care. She does not have Medicare Part B, which means that her copay for the SNF started accumulating on day 21. The Billing Director tried, and we tried repeatedly, to explain that she did not have insurance coverage for her skilled nursing care. She absolutely refused to discuss it. After two months the SNF sent her back to the hospital with infected wounds. The hospital discharged her to another SNF. She would not pay her copay there as well, and after a month, she ended up back in the hospital, this time with pneumonia. She has been in the hospital for three weeks now and they are increasingly impatient with her refusal to prepay for yet another SNF. She keeps on insisting that she can walk and wants to go home. Unfortunately the hospital cannot safely discharge her, as she cannot walk, is incontinent, on oxygen, and - we are starting to realize - most likely suffering from dementia. The hospital has decided to evaluate her mental status as she is clearly unable to understand her current physical limitations.
She can easily afford the prepay amount required by the SNF. She owns a house worth around $300,000, with mortgage debt around $100,000, and medical debt most likely around $100,000. Her retirement income is too high to qualify for MediCal. When asked, she refused to sign up for MediCal LTC coverage, because all she would have to spend is $35 month. There is no POA and we have not been authorized to speak with any caregivers - only her mentally disabled younger sister is permitted to talk to them.
We are the only ones in his family with the monetary resources sufficient for the long term care she most likely needs. Frankly neither of us have ever been close to her - in fact, we actively dislike her, as she has abused and used her disabled sister for years. The one good outcome of this situation is that her absence has finally allowed us to support the disabled sister emotionally and financially.
Does anyone know what happens when a hospital patient is determined to be mentally incompetent due to dementia? Will her case be referred to a court, so that she is assigned a conservator? Should my husband agree to assume responsibility as her guardian, and what does that mean?
Thank you!
Disabled sister...I have a disabled nephew who I oversee. He can be on his own. I was able to get him in a State program that pays 70% of his rent and provides him with a coordinator who checks on him monthly. He gets an aide 1 day a week who runs him to the bank and shopping. Also, does some light housekeeping. He receives Social Security Disability and gets food stamps. He gets Medicare and Medicaid for heath. If he needed it, he probably could get Medicaid in home care.
There are ways to get your sister help without using your money. You do have to be careful when people are receiving help from the government. Leaving them money can affect the help they get. If you sister is not already getting help, start with Social Services and your County Disabilities Dept. What I personally do for my nephew is small. I drive him to appts when the aide is not available but he could take the Senior bus because he is disabled. When I pick him up something he needs, I don't charge him. I buy in bulk so I supply his paper products.
You could set up a special needs trust but they are very limited in how the money can be spent. You can't use them for housing or food.
I know an attorney who has been assigned the guardianship/conservator role by courts, and says it can be very demanding.
The older sister is a hoarder, who took over the family home. No one has been allowed inside, including the younger sister, for fifteen years (one of the reasons she wasn't found for a few days). She is incredibly controlling, secretive, and will go into a rage if she is contradicted in any way. My husband and his younger sister are both terrified of her.
My husband's younger sister has some brain damage from a childhood accident that affects her emotional stability and intellectual ability. She is receiving a small income from state disability programs, as well as medi-Cal and supportive food programs. Any attempt to assist her always led to conflict with the older sister - I think she saw it as a threat to her control. Now we can be more involved and are grateful for that, at least.
It does seem clear that the sister in the hospital, the one who is a hoarder, is not competent to make her own decisions and definitely not competent to live alone or hire aides for herself or certainly not competent to make decisions on behalf of others, such as the mentally disabled sister.
She can’t walk, and is incontinent, and yet refuses to acknowledge this? That’s classic anosognosia — lack of insight or understanding of one’s own condition. Anosognosia is a feature of dementia, mental illness, or brain injury. Most likely caused by deterioration to the frontal lobes per what I have read. (My father had frontotemporal dementia and no insight into it.)
It could be that older sister had mental illness and now also has dementia.
There is no way I would take on financial or legal responsibility for this person, blood relative or no. I didn’t see anything about her age. But with all her issues, infected wounds and pneumonia, I imagine she won’t be around too much longer.
I hope you, husband, and mentally disabled sister find peace.
You probably should not be financially helping the other either. Instead find resources that will help her rather than you being the crutch that holds her up. What happens when you and your husband need those funds for your care, for your later years?
I would not agree to take on Guardianship of someone that is refusing to agree to care that she needs.
If the do a cognitive assessment and find that she is not decisional then allow the Court to appoint a Guardian. You/ your husband should get a letter about the case and other relatives should as well. You can chose to appear or not but if your other sister in law does I hope that they see that she is not mentally able to be a Guardian.
The older sister is a hoarder, who took over the family home. No one has been allowed inside, including the younger sister, for fifteen years (one of the reasons she wasn't found for a few days). She is incredibly controlling, secretive, and will go into a rage if she is contradicted in any way. My husband and his younger sister are both terrified of her.
My husband's younger sister has some brain damage from a childhood accident that affects her emotional stability and intellectual ability. She is receiving a small income from state disability programs, as well as medi-Cal and supportive food programs. Any attempt to assist her always led to conflict with the older sister - I think she saw it as a threat to her control. Now we can be more involved and are grateful for that, at least.
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