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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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!
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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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.
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.
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