Surround Care Surrounding a Life with Care: The Right Sized Care Throughout the Stages & Ages. Lifecare Innovations, Inc. 1

Transcription

1 Surround Care Surrounding a Life with Care: The Right Sized Care Throughout the Stages & Ages Lifecare Innovations, Inc. 1

2 Looking for Friends in All the Wrong Places: The Fine Line Between Incompetence and Poor Judgment By: Martha Kern Lifecare Innovations, Inc. 2

3 Objectives Examine the meaning of competence Explore poor judgment and possible causes Review the Guardianship process Identify possible remedies that do not remove rights Lifecare Innovations, Inc. 3

4 Defining Competence 1 Competence = Ability to Make a Decision 2 But does the decision have to be what we consider sensible? Lifecare Innovations, Inc. 4

5 The Story of Eleanor Referred by her attorney Independent at the age of 84 Lives in a high rise Lifecare Innovations, Inc. 5

6 Red Flags Eleanor cannot walk Surrounds herself with caregivers More help needed? Hang a sign in the hallway An effective system of care Lifecare Innovations, Inc. 6

7 But There Are Problems One of the caregivers might be in jail The other caregiver took the credit card to Louisiana Cash is missing Problems The door is unlocked to permit access Drugs are missing People come and go in the night Lifecare Innovations, Inc. 7

8 Incompetence or Poor Judgment? Are these good decisions? Is Eleanor Incompetent? Lifecare Innovations, Inc. 8

9 How to Assess Competence revolves around decision-making ability Must recognize that a decision needs to be made How complex is the decision? What are the consequences? Lifecare Innovations, Inc. 9

10 Necessary Components of Decisional Capacity The ability to communicate choice Understanding the relevant information Appreciating the situation and its consequences Manipulating information rationally (Applebaum) Lifecare Innovations, Inc. 10

11 Open-Ended Questions.and Answers Yes or No choices can be expressed even by the overtly demented Ability to weigh options and contemplate consequences Lucid rationale requires more cognitive ability Open-ended questions addressing the reasoning behind a choice Lifecare Innovations, Inc. 11

12 Depth of Consequence Grave decisions require more 1 2 Rational manipulation of information 4 3 Changes to a will/estate plan often require 2-3 meetings Consistent reasoning over time Lifecare Innovations, Inc. 12

13 Eleanor s Reasoning Liked living alone Unlicensed caregivers are cheaper Rejected caregiver who used credit card These people are her friends Lifecare Innovations, Inc. 13

14 Benefits and Risks For Eleanor, the benefits outweigh the dangers Unspoken needs may be met Competent, but poor decisions Lifecare Innovations, Inc. 14

15 Lucy 1 2 The Role of Loneliness/Social Isolation Loneliness may cause the suspension of customary caution 3 Lucy s Situation Lifecare Innovations, Inc. 15

16 Lucy s Story Contacted by the police 3 1 Bank concerned about recent money wires 2 Lucy is in her 80s, lives alone Lifecare Innovations, Inc. 16

17 The Scam Wellness checks when phone unanswered Lottery winnings at stake The gentlemen from Nigeria Probably a scam It s my money and I can spend it as I please True? Lifecare Innovations, Inc. 17

18 Other Salient Facts 1. Lucy s home is immaculate Lucy is well-groomed 3. She eats well and has a full refrigerator 4. Spotless driving record 5. Bills are paid Lifecare Innovations, Inc. 18

19 Incompetence or Poor Judgment? Incompetent? What needs are being satisfied? Attention may be flattering and exciting Romance? Lifecare Innovations, Inc. 19

20 Loneliness May Influence Customary Thought Process Lots of older adults fall for scams Costly friendships Otherwise functional Loneliness may inspire risk, social thrills Lifecare Innovations, Inc. 20

21 Red Flags Poor judgment and dementia But a declaration of incompetence? A sign of mild cognitive impairment Decisions that compromise safety warrant concern Lifecare Innovations, Inc. 21

22 Signs of Mild Cognitive Impairment (Mayo Clinic) You forget things more often You forget important events such as appointments You lose your train of thought or the thread of conversation Lifecare Innovations, Inc. 22

23 Signs Continued Family/friends take notice 1 You feel increasingly overwhelmed by decisions 4 2 You become impulsive or show poor judgment 3 Trouble finding way around Lifecare Innovations, Inc. 23

24 Other Factors Lifecare Innovations, Inc. 24

25 How is Incompetence Determined? Not necessarily one appointment Physician determines whether or not a person is incompetent Open-ended questions Willing to complete a report for court Lifecare Innovations, Inc. 25

26 The Risks Stakes are high 2 3 Guardianship involves loss of rights Cannot be used to halt decisions we don t like Lifecare Innovations, Inc. 26

27 George 1 George and his daughters 2 3 Taking girlfriend to church, spending time with her Called us about seeking guardianship Lifecare Innovations, Inc. 27

28 About George Met with George on another matter Lucid, alert, oriented Daughters did not like his having a girlfriend Worried about inheritance? Lifecare Innovations, Inc. 28

29 Definition of a Disabled Adult in Illinois A person 18 years or older who (a) because of mental deterioration or physical incapacity is not fully able to manage his person or estate, or (b) is a person with mental illness or a person with a developmental disability and who because of his mental illness or developmental disability is not fully able to manage his person or estate, or (c) because of gambling, idleness, debauchery or excessive use of intoxicants or drugs, so spends or wastes his estate as to expose himself or his family to want or suffering. 755 ILCS 5/11a 2 Lifecare Innovations, Inc. 29

30 The Guardianship Process Physician report Determination of whether or not there are Powers of Attorney Petition for guardianship Contestable Hearing before a judge Lifecare Innovations, Inc. 30

31 Removal of Personal Rights Own Weapons 6 Marry/Divorce 1 2 Vote Work 5 4 Contract 3 Drive/Travel Lifecare Innovations, Inc. 31

32 Type of Guardianship Temporary Limited Guardian of Estate Plenary Guardian of Person Lifecare Innovations, Inc. 32

33 Definitions Temporary Used in an emergency situation and can last no longer that 60 days Evidence must be shown for the need of the immediate protection Limited Person with disabilities can make some, but not all, decisions regarding his/her person or estate or both Plenary Used when an individual s mental, physical, and adaptive limitations necessitate a guardian who has the power to make all important decisions regarding the individual s personal care and finances Lifecare Innovations, Inc. 33

34 When to Seek Guardianship Guardianship is a last resort Poor judgment professional assessment Risk? A marked change from customary behavior? Lifecare Innovations, Inc. 34

35 Until Guardianship is Warranted Introduce professional support Care managers Municipal/township services Caregivers Lifecare Innovations, Inc. 35

36 Friends Who Support and Protect Provide guidance, monitoring No loss of rights Manage/reduce loneliness Support for decisions Lifecare Innovations, Inc. 36

37 Determination of Capacity is a Slippery Task Sometimes abundantly clear, sometimes not Physician evaluation Assess in the home (telltale signs) Lifecare Innovations, Inc. 37

38 Guardianship Removes Rights.But Also Protects Self determination is the ideal Protection from harm Undue influence/financial devastation When in doubt, seek professional assessment Lifecare Innovations, Inc. 38

39 Resources Lifecare Innovations, Inc. 39

40 Corporate Office 8330 S. Madison St. Suite 90 Burr Ridge, IL (630) d North Shore Office 100 S. Saunders Rd. Suite 150 Lake Forest, IL (847) Denver Office 304 Inverness Way South, Suite 135 Englewood, CO (303) Lifecare Innovations, Inc. 40