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My dad and I have a medical and durable POA on file. His DPOA says that it needs a Dr. to certify in writing that he is mentally incapable of managing finances. This was done 7/2021.
About 3 weeks ago he had a fall and I called EMS. He had an infection that turned septic and was taken off his Clozaril (major psych med). He was put on Abilify and about a week after this fall he became nonverbal. He had been on/off the Clozaril the last 2 weeks and is in a total catatonic state. Trying to speak, in and out of awareness and following commands. Usually unresponsive. The hospital has both on file and have enacted the MPOA. They call me for major decisions like a feeding tube, etc. and I call for updates every day and they provide information. However, I am 100% getting the run around when it comes to getting a certification on his incapacitation so that I can enact the DPOA, go to the bank, and start handling his finances. In the last 3 weeks I have asked his usual psychiatrist in the same hospital network, the current psychiatrist while he is in the hospital, 2 attending physicians, and 2 social workers, as well as his PCP who should likely be getting updates. All in the same hospital system. No one gets back to me. The original psychiatrist’s office did say that because there is no release of info on file they cannot disclose information despite having the MPOA. I reiterated that they have and have been utilizing the MPOA and that my dad cannot consent to anything right now. Even the current psychiatrist seeing him daily said she is documenting incapacitation in her notes, but then never called me back after promising she would get some answers in what to do about providing documentation several days ago. I worry the longer we go, the poorer his prognosis gets and more behind he gets on his bills.
Also, at this point the attending and psychiatrist says that the next steps will be trying ECT (shock therapy) to help him come out of this state, but that requires guardianship as the MPOA will not allow consent for this type of treatment, which of course can take weeks to implement. I don’t understand the bureaucracy and it feels negligent. Any insight on where to go or what to ask for to get the necessary paperwork? Hire a lawyer and go straight for guardianship? Will the hospital even talk with the lawyer since they won’t help with the document certifying mental incapacitation?



Thank you for any thoughts.

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Since time is of the essence I would take you PoA docs and start by consulting with a certified elder law attorney, who may need to write a "forceful" letter to get some action. I can't imagine you'd need guardianship in this situation but there might be some underlying legal issue at work.
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In addition to Geaton's excellent suggestions, consider getting in touch with the Patient Advocacy office at the hospital. Ask what they would do if YOU weren't around.
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Are you on Dads accts. If so you don't need to have POA to pay bills. Me, I would pay the bills with POA at the end of my name. I never had anyone come back and question my authority.

All you need is a letter stating that his Dr. feels he is not competent.
"The original psychiatrist’s office did say that because there is no release of info on file they cannot disclose information despite having the MPOA." IMO they don't know what they are talking about. First, you are not asking for his info. Your asking that his doctor write a letter saying Dad is incompetent to make decisions on his own. And when that is done, your POA is in effect and then you can ask for his info. You are Dads representative.

I would see the SW. Tell her that no one seems to understand that all you need is a letter saying Dad is incompetent at this time.

How old is Dad?
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BrianneB Oct 2022
Thank you for your response. He is 69. I am not on his accounts, and live an hour away, 7.5 months pregnant, 2 littles, and a job. It is a lot! The sw has not been helpful other than indicating she’d send a message to the psychiatrist to call me. Ugh! I am thinking of contacting his bank providing his social, sending the dpoa and just seeing if they’ll accept it. My cousin works in a bank and consulted her legal team and was told at their institution they just need a copy of the dpoa. My concern is the line that says it it needs an assessment, but maybe it could still work! He has no online profiles, so I think I could just set it up and monitor/pay that way. Worst comes to worst, I do have at least his credit card # and can call and make a payment from my checking account.
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I would agree that you need some support outside of this facility. Either contact an Ombudsperson or an attorney (preferably the latter if you can find someone to intervene). And I would add to Geaton's suggestion for legal involvement that you explore the possibility of focusing on an elder law attorney with litigation experience (ust in case a restraining order becomes necessary (to prevent shock treatment).

You could also demand that a meeting be scheduled to address all the outstanding issues, prepare a list of them but also consider that providing a list too soon could allow them to close ranks and come up with other "options."

This is where your good insights could come in; think of options, raise the issues that apparently aren't being considered by the staff, and provide solutions from which they can choose. It wouldn't hurt to bring in an outside person(s) knowledgeable (or expert) on these issues involved, so the staff can't reject your questions and solutions out of hand.

Chills ran up and down my spine when I read that ECT might be considered.
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Sadly, a threat of legal action might be all that gets some action. Put it in writing yourself before spending money on an attorney that should you not receive the requested paperwork in X days, you will be forced to take legal action against the doctors and the hospital. Send it to the doctors, the hospital's legal department, ombudsman, and administrator.

Frankly, I'd think that if your medical POA has been activated, then your DPOA should have been activated for the same reasons. By what means did the hospital decide to activate the MPOA?
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BrianneB Oct 2022
Thank you for your response. Honestly, I am not sure at what point the MPOA went into effect. He was still competent when I was talking with the 1st hospital and they were releasing info to me and transferring him to the rehab facility. I sent the rehab facility the MPOA for good measure and they did start asking me to make decisions about his care. They called ems and he was subsequently sent to another hospital and I assume they sent a copy of the MPOA with him, but not sure. Once I found him (it took time bc the SNF thought he was at one hospital and he was oddly sent to another (different from the 1st) I told them I had MPOA and they just went with it and consulted me about his care. I assumed they also had it. It wasn’t until his usual psychiatrist in the same hospital network said they didn’t have it in his chart that I had to travel to the nearest one and upload both MPOA and DPOA into his chart. There is a line that says he consents to an examination for the purposes of this doc with release to a 3rd party, but the attending says he has no experience and it would come from psych or the usual PCP, neither of whom return my calls. Social worker doesn’t know and sent messages to the current hospital psych, no responses. I did tell the attending that this is a form of financial abuse to their patient through the irresponsibility of being delayed. Luckily, this weekend he has taken a turn for the better! Very weak, slightly more awareness. He said “yes” when I went up to visit and say I am trying to get on his bank and credit card accounts. NOT well enough by any means to manage his finances. To me, that is still a form of incapacitation, but worry that it is going to further this process along. Thank you for your thoughts!
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"a Dr. to certify in writing that he is mentally incapable of managing finances. This was done 7/2021."

If this is what the DPOA lists as making it go into effect, and it has been done as per your OP (or was the DPOA created on 7/2021?? - that's not clear to me), I'd take both papers down to the county clerk office, pay to file both as one document, pay to get a certified copy and then hand it over to the bank stating I'm now in charge of my father's finances. Any financial location should accept that the requirements of the POA to be active have been met and let you do what needs to be done.

That takes care of the financial.

If the MPOA lists something different for you to take over his medical decisions on his behalf then those requirements must be met as well. What exactly does the MPOA list as requirements to be activated for decision on his behalf?

It might be faster to get an emergency temporary guardianship -- on average 24 - 72 hour turnaround and in some cases just have to show a more harm evidence and not full incapacitation-- to stop the electric shocks and then go for a full guardianship later. That is much more expensive but the most expedient in the name of time.
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Looks like a financial emergency if your dad cannot manage his finances. What health insurance does he have?? See an elder attorney immediately and do not use your own money to pay his bills.
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Sounds like you need to boil this down to where the doctors, hospitals and anyone else that requires payment from your dad understand that if they want payment then you will be the one that pays them. If your dad can’t execute the payment then they can’t be paid. It’s hardball. Sounds like a scared bunch of doctors.
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In my experience the banks don’t ask to see a letter from the doctor. They will just need the DPOA which usually is a individual page separate from the details of what “activates” it. My father has the same stipulation in his trust. It’s common. In my father’s case it is required that 2 doctors declare him incapacitated, but the DPOA is signed and can be found on the last page of his trust after the MPOA. It does not state the “activation” requirements on the DPOA. Those are in the trust document itself and so far nobody has asked to see it, they just want a copy of the DPOA. I was able to get one letter but the 2nd doctor just wrote that he has significant memory loss due to Alzheimer’s Disease, but did not mention incapacitation to conduct financial matters. I didn’t wait for the doctor to change it. I took the POA to the bank and sent it to his attorney that was handling a settlement case for him and that was all they asked for. My advice, just act and don’t wait. If they ask for the letter, deal with it then, but get on the accounts as soon as you can. The other option is if you know where his checks are just write a check for his bills and sign it as POA. In my experience they don’t often care if you are paying them, it’s when you are tryin got get money from them that they care ;)

Edit: I just read your comment that it does say you need a declaration on the POA document, but your dad has no on line profile. Go that route while you wait for the letter. My father is the same, no online profiles for anything. He doesn’t even do email. As soon as I started seeing bills not being paid and confusion with finances I created profiles for him so I could monitor all the accounts and pay the bills until I was able to get clarification from his attorney about my DPOA.
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babsjvd Oct 2022
Correct durable POA is able to function anytime …except I see there is a clause on dads…
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First do you also have POA? I know in CT for instance these are not two separate documents. A POA can also be a DPOA with certain requirements being met. A MPOA is a little different in that it’s always in effect you just couldn’t make a decision against your mothers wishes if she is awake and competent to make them, as I understand it this is really determined by the hospital or medical professionals. If your DPOA is also a POA meaning you can handle his financial stuff for him at his direction I would just take that to the bank. If you have access to his accounts remotely I would just use that in this case since you are simply taking care of his affairs while he is incapacitated.

The guardianship for shock therapy is another thing entirely. At first I was thinking how did he get from a fall to needing shock therapy? Then I reread and thought about it more and it sounds as though your dad has had some psychiatric issues so perhaps his needing to be taken off his meds created this need, either way your dad was obviously preparing for a scenario like this by setting up DPOA and MPOA so I’m not sure why they are requiring guardianship if this is something they really feel needs to be done and believe in. Guardianship is usually an expensive and somewhat lengthy process, again your dad was trying to avoid this for you and I might ask them what they would do if you weren’t around would they go get temporary guardianship of him so they could perform this procedure, just do it because in the absence of someone authorized they can or leave him somewhat catatonic and move him to a facility? Make sure you get all the facts from them before deciding to jump through extra hoops for them, they may simply be trying to pass the buck so to speak. Unless of course you don’t want this and they do or vice versa, then yo are at odds and they are covering their bases.

I have found that doctors are very reluctant to put in writing that a person is cognitively unable to make financial decisions they even dance around a diagnosis of dementia deferring to a neurologist for some reason so maybe you are running into a form of this? Though it doesn’t sound like dementia is the issue so perhaps simply go to the bank with your DPOA and tell them he is catatonic in the hospital and you need to pay his bills. If they insist on a doctors note call the attorney who drew the papers up and ask them what you need to do in this instance instead of trying to chase down doctors who don’t want to do this for some reason. Know where you stand and what you need from whom before making waves with his doctors and giving yourself extra stress and work.
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Make sure you are checking his apartment for mail (bills, etc.) and if he has online accounts, try to find his logons. Speak with the social worker at the hospital where he is and ask for help expediting the signoff for his POAs. Did he have an attorney who executed his POAs? If so, speak with his attorney. Good luck!
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I am so confused here. I thought you said that you already have, and have had this enacted since 2021? Why would you need to do it again??? I would see an attorney. Your POA pays for this. Take all your documents with you, the fact you have been acting as POA all this time, your records, your original letter designating him incapacitated. That attorney will let you know what else you need, and yes, you may need to go for guardianship, but the fact is that you would STILL need this documentation. Which as I understand it you only need ONCE. I am confused by all this and hope your attorney can guide you. One hates to spend on them, but when needed and paid by the hour they are invaluable.
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Dealing with reluctant doctors is a skill we need to acquire. I think the solution is to fire them and find a new one sympathetic to your cause. My wife’s doctor keeps throwing up road blocks to the point her nurse caregivers are baffled. It is also costing me money for things that should be covered. I know it is a lot of work and is very time consuming but you need to find a new doctor. I need to take my own advice.
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What does your Elder Law Attorney recommend?
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Call the hospital your father is at and get in tough with the case manager or social worker for your dad. He/She can help expedite this process.
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BrianneB: I am unsure what you're asking as you had already gotten Power of Attorney in July of 2021.
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Countrymouse Oct 2022
I think the DPOA was drawn up in 2021 but is not yet in force, that's the bit he's now trying to get done.
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You can have an attorney file an immediate energency motion for guardianship. Ibtaining guardianshio will trump everything, including all forms of POA, so you take care of everythig to help your dad and make the best decisions for him.
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