Power of Attorney v. Guardianship

Two
types of Power of Attorney:


      1. Standard
Power of Attorney

·       A standard power of attorney document
provides the authority for another person (the agent or attorney-in-fact) to
make decisions and take actions on the principal’s (the person needing
assistance) behalf when he or she is unable to do so.
·        
If the principal becomes physically
incapacitated, then the power of attorney document would authorize the
principal’s chosen agent or attorney-in-fact to; For example – sign documents,
receive/pay bills, and make banking transactions on the principal’s behalf.
·        
A standard power of attorney would become
invalid if the principal became mentally incapacitated.
       2.    
Durable
Power Of Attorney

·        
A Durable Power of Attorney document would
authorize the principal’s chosen agent or attorney-in-fact to: For example –
execute documents, receive/pay bills, and make banking transactions just like a
Standard Power of Attorney, but would
remain effective if the principal became mentally incapacitated.
·        
The Power of Attorney document can be drafted
to be broad, giving the agent or attorney-in-fact the authority to make any and
all property, financial, and personal decisions for the principal or can
be drafted to authorize the agent or attorney-in-fact to perform very limited,
specific duties.

Guardianship:

·        
A guardianship is a legally binding
relationship where a Probate Court authorizes a Court appointed Guardian (Professional
or Family Member) to make all personal and/or financial decisions for the
incapacitated person as determined by the Court.
·        
The Court could determine that the person
only requires a Guardian to make decisions regarding his or her finances and property
(Guardian of Property), or health and medical decisions (Guardian of Person),
or both (Plenary Guardianship).
·        
The Probate Court decides on the extent of
the person’s incapacity at a hearing.
·        
The hearing is to determine what rights the person
should retain, if any, and what needs the person is able to meet for his or her
health, safety, and well-being.

Power
of Attorney v. Guardianship:
   
  •     Incapacity (Medical Status)
    •        The inability to make decisions that affect
      personal health, welfare, and safety, as initially determined by the attending
      physician, and if disputed, by a court.
    •       If a judge determines that someone is legally
      incapacitated, the court has the authority to appoint a guardian to manage the
      person’s property and ensure their daily needs are being met.
  •      Incompetency (Legal Finding)
    •      Incompetency is a finding by the court that
      an individual lacks the ability to make all decisions, including health care
      decisions and decisions about creating a health care proxy. A person is
      considered physically or mentally incapacitated.
    •     Incompetency can also refer to a lack of
      legal qualification of a person, not measured in terms of mental ability but to
      act. For example, a person deemed legally incompetent does not have the power to
      enter a legal contract.
When a Person Cannot Consent:
  • Florida recognizes that the following
    individuals (in particular order) may consent to medical treatment on behalf of
    the incapacitated person:
    •  Surrogate
      (competent adult expressly designated by the patient/individual to make health
      care decisions on behalf of the patient). Designation should be in writing.
    •  Court
      Appointed Guardian (in the absence or a Surrogate, or where a court revokes the
      authority of the Surrogate). All persons who have been adjudged incompetent
      should have a judicially appointed guardian.
    • A
      person holding a valid power of attorney (durable POA) which contains language
      giving the right to make health care decisions for a patient.
    • A
      proxy (in the event the patient is incompetent or incapacitated) Pursuant to
      Section 765.401 a proxy may consent (where the patient has not executed an
      advance directive, or designated a Surrogate to make health care decisions).

What
is a Proxy?
  •  A substitute, competent decision maker in the
    following order of priority:
    •   Patient’s
      spouse
    •  An
      adult child, or if the patient has more than 1 child, a majority of the adult
      children reasonably available for consultation.
    •  A
      parent of the patient
    •   The
      adult sibling of the patient (if more than 1, then a majority of such adult
      siblings)
    • An
      adult relative of the patient who has exhibited special care and concern for
      the patient and maintained regular contact with the patient.  
    • A
      close friend of the patient
    • A
      licensed clinical social worker (LCSW)

By: Julie DiSalvatore and Lory Smeltzer, MPH, CMC, CDP

What is an Advance Medical Directive?

Every state
has enacted advance medical directive legislation, but the laws vary widely.
Advance medical directives are documents that are made at a time when a person
has full decision making capabilities and are used to direct medical care in
the future when this capacity is lost. Many statutes are narrowly drawn and
specify that they apply only to illnesses when death is imminent rather than
illnesses requiring long-term life support, such as in end-stage lung, heart,
or kidney failure; multiple sclerosis; paraplegia; and persistent vegetative
state.
Patients
sometimes use living wills to direct future medical care. Most commonly, living
wills specify steps a patient does not want taken in cases of life-threatening
or debilitating illness, but they may also be used to specify that a patient
wants aggressive resuscitation measures used. Studies have shown that living
wills often are not honored, despite the fact that federal law requires all
hospitals, nursing homes, and other Medicare and Medicaid providers to ask
patients on admission whether they have executed an advance directive. Some
reasons living wills are not honored are medical personnel’s fear of liability,
the patient’s failure to communicate his or her wishes, or misunderstanding or
mismanagement by hospital personnel.
Another way
individuals attempt to direct medical care is through a durable Power of
Attorney. A durable power of attorney, or proxy decision maker, is a written
document wherein a person (the principal) designates another person to perform
certain acts or make certain decisions on the principal’s behalf. It is called
durable because the power continues to be effective even after the principal
becomes incompetent or it may only take effect after the principal becomes
incompetent. As with a Living Will, such a document has little power to compel
a doctor to follow a patient’s desires, but in the very least it serves as
valuable evidence of a person’s wishes if the matter is brought into court. A
durable power of attorney may be used by itself or in conjunction with a living
will.
When advance
medical directives function as intended and are honored by physicians, they free
the family members from making extremely difficult decisions. They may also
protect physicians. Standard medical care typically requires that a doctor
provide maximum care. In essence, a living will can change the standard of care
upon which a physician will be judged and may protect a physician from legal or
professional repercussions for withholding or withdrawing care.
Source: West’s Encyclopedia of American Law, 2008,
edition 2

The Common Issues of Aging

Due to new
medications and surgical procedures, people are living longer these days.
However, the body we had when we were 35 will be very different from the body
we will have when we are 75. Many issues, both genetic and environmental affect
how we age.
The most
widespread condition affecting those 65 and older is coronary heart disease,
followed by stroke, cancer, pneumonia, and the flu. Accidents, especially falls
that result in hip fractures, are also common in the elderly.
Most of our
elders are dealing with at least one of the following conditions:
  •          Heart
    conditions (hypertension, vascular disease, congestive heart failure, high
    blood pressure, and coronary heart disease).
  •          Dementia,
    including Alzheimer’s disease.
  •          Depression
  •          Incontinence
  •          Arthritis
  •          Osteoporosis
  •          Diabetes
  •          Breathing
    problems
  •          Frequent
    falls, which can lead to fractures.
  •          Parkinson’s
    disease
  •          Cancer
  •          Eye
    problems (cataracts, glaucoma, macular degeneration).

As the body
changes, here are some other issues to be aware of:
  •          Slow
    reaction time, which is especially important when judging if a person is
    capable to drive.
  •          Thinner
    skin, which can lead to breakdowns and wounds that don’t usually heal quickly.
  •          A
    weakened immune system, which can make fighting off viruses, bacteria, and diseases
    difficult.
  •          Diminished
    sense of taste or smell, which can lead to diminished appetite and dehydration.
    This is most common in smokers.

The list can seem
frightening, but with proper care, elders can have a life filled with joy.
Reference: www.agingcare.com/articles/common-issues-of-aging

Alternate Living Options for Seniors

There are
three primary alternate living options. They are independent senior living,
assisted living facilities, and skilled nursing facilities.

Independent Living Facilities
Independent
living facilities are exactly that. They are usually set up like an apartment
and house a large number of seniors. These are unrestrictive facilities that
allow a person to maintain complete autonomy. This type of facility is a very
good option for those that can still do most things for themselves but need
contact with other people. Senior independent living facilities usually have
on-site staff members that provide minimal supervision and also offer
activities for their residents.
Key points to
remember about senior independent living facilities:
  •          Allows
    a person to maintain independence.
  •          Less
    social isolation than living at home.
  •          Some
    supervision from management staff.
  •          Activities
    are often arranged for residents.
  •          Inexpensive
    compared to other options.


Assisted Living Facilities
Assisted
living facilities (ALF) are designed to help those that have difficulty caring
for themselves to the extent that they can no longer live in their own home.
These facilities are staffed 24 hours a day. Employees of an ALF are trained to
assist residents with their needs and provide supervision. A typical person
living in an ALF may need help managing medication, bathing, or getting
dressed. ALF’s are more regulated, which make them more restrictive than
independent living.
Key points to
remember about ALF’s:
  •         Direct
    assistance to those that may need it to perform everyday tasks.
  •         More
    restrictive than independent living but still an environment that promotes independence.
  •         Can
    be expensive.
  •         Trained
    staff available 24 hours a day.
  •         Nurse
    on staff.


Skilled Nursing Facilities
Skilled
nursing facilities, also known as nursing homes are designed to house and
assist people who have health conditions that require monitoring and the
availability of medical personnel. The facilities are considered very
restrictive due to the high level of monitoring that they provide.
Important
points to remember about skilled nursing facilities:
  •          Provides
    an invaluable service to those who have medical issues that require constant medical attention and/or high levels of assistance.
  •         Very
    restrictive.
  •         Can
    be very expensive.

There are
other types of living facilities like family group homes that are designed as a
step in between living in your own home and living in an ALF. There are also
different types of assisted living facilities that focus on the needs of
specific populations. An example would be an ALF that is designed to meet the
needs of the individuals with Alzheimer’s.

      Resource: www.agingcare.com

Evaluating Senior Living Options

Aging can
bring challenges that sometimes make staying in the home you love difficult.
When a person faces these challenges, knowing where you need to live is not
easy to figure out.
Sometimes
despite all efforts, the decision to move a person into a setting that is
better equipped to meet their needs has to be made.
Many times,
it is not the individual, but the caregiver, that is making the decision to
move their parent or loved one from the home that they have lived in for so
long and have made many memories in. This is not an easy decision for the
caregiver, especially when they have been made a promise to their loved on to “never
put them in a home.” Feelings of guilt and the belief that they failed to keep
that promise to their loved one can be overwhelming.
The decision
for a person to move out of their home is never an easy one, but it can be made
less difficult. As with many things in life, things usually go much easier when
you plan and research ahead of time.
The living
options for seniors needing assistance grows every year. There are assisted
living facilities (ALF), family group homes, independent senior living
facilities, skilled nursing facilities, home care, and continuing care
communities. The first part of planning for an alternate living situation is to
become aware of the various options available in your area.
The second is
to understand not everyone is the same. Everyone has different needs and that
certain living options are dependent upon individual needs. Living options are
not “one size fits all.”
The third
part of planning is researching each type of facility. There are facilities
that are least restrictive like a person’s home and one’s that are most
restrictive like a skilled nursing home.
When thinking
about less restrictive settings you should consider the future needs of your
loved one. You want to make sure that the setting is one that will be able to
accommodate the person’s current and future needs.
Reference: www.agingcare.com

UTI’s in the Elderly Cause Behavioral, Not Physical Symptoms

Urinary Tract
Infection (UTI) symptoms in the elderly cause behavioral symptoms rather than
physical symptoms.
The elderly
are most likely to experience UTI’s. The elderly are more vulnerable to
UTI’s for many reasons, including susceptibility of infections due to the
suppressed immune system that comes with age.
Younger
people tend to empty the bladder completely upon urination, which helps to keep
bacteria from accumulating within the bladder. But elderly men and women
experience a weakening of the muscles of the bladder, which leads to more urine
being retained in the bladder, poor bladder emptying and incontinence, which
can lead to UTI’s.
The typical
symptoms of a UTI are:
·        
Urine
that appears cloudy     
·        
Bloody
urine
·        
Strong
or foul-smelling urine odor
·        
Frequent
or urgent need to urinate
·        
Pain
or burning with urination
·        
Pressure
in the lower pelvis
·        
Low-grade
fever
·        
Night
sweats, shaking, or chills
Elderly
people with serious urinary tract infections do not exhibit the sign of fever
because their immune system is unable to mount a response to infection due to
the effects of aging. Often most elders do not have any of the common symptoms
or don’t express them to their caregivers.
UTI’s in the
elderly are often mistaken for the early stages of dementia or Alzheimer’s
because the symptoms in the elderly are:
  •    Confusion,
    or delirium-like state
  •       Agitation
  •      Hallucinations
  •     Other
    behavioral changes
  •        Poor
    motor skills or dizziness
  •        Falling

Sometimes,
these are the only symptoms of a UTI that show up in the elderly and there
won’t be any pain, fever, or other typical symptoms if a UTI.
The following
conditions make the elderly more susceptible to UTI’s:
  •          Diabetes
  •          Urinary
    retention
  •          Use
    of a urinary catheter
  •          Bowel
    incontinence
  •          Enlarged
    prostate
  •          Immobility
  •          Surgery
    of any area around the bladder
  •          Kidney
    stones

Caregivers
play an important role in recognizing a UTI. Be on the lookout for the symptoms
and if you think your elderly loved one might have a UTI, see your doctor right
away.
Reference:
http://www.agingcare.com/Articles/urinary-tract-infections-elderly

Tips on how to cope with Caregiver Stress

What is Caregiver Stress?
Caregiver stress
is the emotional and physical strain of caregiving. It can take many forms. For
example you may feel:  
  • Frustrated
  • Angry
  • Guilty
  • Lonely
  • Exhausted
  • Worrisome

Caregiver
stress appears to affect women more than men. About 75% of caregivers who
report feeling very strained emotionally, physically, or financially are women.

Although
caregiving can be challenging, it is important to remember  that it can also have its rewards. It can give
you a feeling of giving back to a loved one. It can also make you feel needed
and can lead to a stronger relationship with the person receiving care.

What can you do to prevent or relieve
Caregiver Stress?
Care giver
stress can lead to serious health problems and you should take steps to reduce
it as much as you can.
Research
shows that people who take an active, problem-solving approach to caregiving
issues are less likely to feel stressed than those who react by worrying or
feeling helpless.
Some tips for
reducing stress are:
  • Find
    out about caregiving resources in your community such as:
    • Transportation
    •  Meal
      delivery
    •  Home
      health care services like nursing or physical therapy.
    •  Non-medical
      home health care services such as housekeeping, cooking, or companionship.
    • Home
      modification (Changes to the home that makes life easier for your loved one to
      perform basic daily tasks, such as bathing, using the toilet, and getting
      around).
    •  Legal
      and financial counseling.
    • Ask
      for and accept help. Be prepared with a mental list of ways that others can
      help you, and let the helper choose what she would like to do. For example, one
      person might be happy to pick up the person you care for on a walk a couple of
      times a week. Someone else might be glad to pick up some groceries for you.
    •  If
      you need financial help taking care of a relative, don’t be afraid to ask
      family members to contribute their fair share.
    • Say
      “no” to requests that are draining, such as hosting holiday meals.
    • Set
      realistic goals. Break large tasks down into smaller ones so you can do one at
      a time.
    • Exercise
      regularly. Your body can fight stress better when it is fit.
    •  Get
      enough rest and sleep. Your body needs time to recover from stressful events.
To find out
about caregiving services in your community contact your local Area Agency on
Aging (AAA). AAA’s are usually listed in the city or county government
sections of the telephone directory under “Aging” or “Health and Human
Services.” The National Eldercare Locator, a service of the U.S. Administration
on Aging can also help you find your local AAA.
References: 
           

Preventing Hospital Delirium

Delirium can set in suddenly when your loved ones are hospitalized.
It is an unfortunate and costly complication of hospital stays. It leads to
longer stays and longer post hospital treatment. The cost is astronomical,
$143-$152 billion per year, according to a study in The Journal of American
Geriatric Society. This makes prevention crucial.
Dr. Sharon K. Inouye, Director of the Aging Brain Center at
Hebrew Senior Life in Boston, has created a program to pre-vent and reduce
delirium incidence. The program is called HELP (the Hospital Elder Life
Program) and is being used in 200 hospitals worldwide. How can you HELP your
elderly friends or relatives to ward off disorientation?
1. Get the patient
moving (with help from nurses) at least 3 times a day.
2. Bring what they need to see, hear, eat and stay oriented:
glasses, hearing aids, dentures and doctor approved favorite foods.
3. Maintain a list of all medical conditions, allergies and
medications.
4. To help remind them who they are, bring familiar items
from home like a sweater, photos, relaxation tapes or a radio.
5. Stay close by, and take notes, to be able to explain to
the patient in simple terms what is going on. Hospitals are confusing places.
Anything you can do to help your loved one stay present will help them in the
recovery process. For more information on this ground breaking program, go to
the HELP website at www.hospitalelderlifeprogram.org.

Did you Know – Nutrition Facts

Asparagus:
  •        Asparagus is high in glutathione, an
    important anti-carcinogen.
  •    It also contains rutin, which protects small
    blood vessels from rupturing and may protect against radiation.

Avocado:
  •       Avocadoes are rich in monounsaturated fat,
    which is easily burned for energy.
  •    An avocado has more than twice as much
    potassium as a banana.

Bananas:      
  •    Bananas are high in sugar, so they should not
    be eaten if you have blood sugar problems.
  •    Green-tipped bananas are better for you than
    over-ripe ones.

Broccoli:
  •         Broccoli contains twice the vitamin C of an
    orange.
  •     It has almost as much calcium as whole milk-
    and the calcium is better absorbed.

Cilantro:
  •     Cilantro may be useful to treat urinary tract
    infections.
  •     Both the leaves and seeds aid in digestion,
    relieve intestinal gas, pain, and distention.
  •    They also treat nausea, soothe inflammation,
    rheumatic pain, headaches, coughs, and mental stress.

Onions:  
  •       Sulfur compounds in onions help to detoxify
    the body.
  •      Onions aid in cellular repair.
  •    To obtain the maximum nutritional benefits,
    onions should be eaten raw or slightly steamed.

Parsley:
  •       Useful digestive aid.
  •    Contains three times as much vitamin C as
    oranges, and twice as much iron as spinach.

For more nutrition facts on some more well known foods go to: http://www.mercola.com/nutritionplan/foodalert.htm

Senior nutrition: Feeding the body, mind and soul

Remember the old adage, you are what you eat? Make it
your motto. When you choose a variety of colorful fruits and veggies, whole
grains, and lean proteins you’ll feel vibrant and healthy, inside and out.
Live longer and stronger – Good
nutrition keeps muscles, bones, organs, and other body parts strong for the
long haul. Eating vitamin-rich food boosts immunity and fights illness-causing
toxins. A proper diet reduces the risk of heart disease, stroke, high blood
pressure, type-2 diabetes, bone loss, cancer, and anemia. Also, eating sensibly
means consuming fewer calories and more nutrient-dense foods, keeping weight in
check.
Sharpen the mind – Key
nutrients are essential for the brain to do its job. People who eat a selection
of brightly colored fruit, leafy veggies, and fish and nuts packed with omega-3
fatty acids can improve focus and decrease their risk of Alzheimer’s disease.
Feel better – Wholesome meals give you more energy
and help you look better, resulting in a self-esteem boost. It’s all connected—
when your body feels good you feel happier inside and out.
Reference:
http://www.helpguide.org/life/senior_nutrition.htm