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e are going to put together a case study that any member can package and take to
any location. e will all run into a difficult situation and the way to put the pieces
together may not be clear or easy to figure out and that is the point of the study. The
responses we are looking for are not to give a summary of what we do. e want to
know, if you we ran into this client, what would your first steps be?





 
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Ô ë year old retired PhD scientist living alone in Baltimore County

Ô Ôn a single family home where she has lived for last 45 years.
Ô Divorced many years ago, no contact with former husband.
Ô nly sister lives in North Carolina and; has been asking her to move to a
retirement village near her home.
Ô Client has two grown children with busy families of their own, closest child 1
½- hours away, and they have not been to her house in over 5 years.
Ô She usually goes to them because of the large number of people involved.
They have busy lives and visit together only every 4-6 months, although they
maintain regular phone contact. She has begun to limit her driving, but still
has car, and occasionally uses it. Not sure if she feels safe venturing to
daughterǯs house anymore, as itǯs near DC and; unfamiliar, congested area.
Ô Her children have no idea of her financial situation, and have let her take care
of her own finances/affairs up until now. They are noticing cognitive decline
which concerns them, confusion and forgetfulness at times, and they are
wondering if she can safely stay home by herself. Family has asked, with her
permission, for GCM to do assessment.
Ô Minimal medical treatment, and has blood pressure issues and heart
condition

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Ô Hoarding for years! Stacks of newspapers, trash and discarded household
items in every room of the house. nly small path from front door to living
room chair, through kitchen, and to bed, only ½ of which is clear to use.
Ô She has a Dznice coupledz down the street who is now taking her to store in her
car weekly. Recently, she has said they can just keep the car at their house,
since sheǯs not using it anymore.
Ô Dnendorsed checks sitting around the house, in plain view of visitors
Ô Stacks of opened mail in piles, and sheǯs verbalizing that she has no idea what
it all means. (much of it junk mail, but some investments, retirement package
info etc)
Ô Getting late notices and collections calls on bills due.
Ô Dish of crackers and milk on kitchen floor to Dzfeed the poor, hungry micedz
Ô No P , no advanced directives and no clear idea of benefits available in
medical package. Needing medical evaluation/follow up for heart condition
and blood pressure matters.
 Ô Confusion that is noticeable upon assessment, but hard for outsiders to
detect.
Ô No support system locally, doesnǯt really know neighbors well. Young teen
boy will shovel her walkway or take out trash. She prefers to Dzkeep to
herself,dz and has always been that way.

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The initial assessment was done by this geriatric care manager and a number of
issues identified were outlined in the case study. The assessment took just over
hours and the senior was showing signs of fatigue, so the meeting ended shortly
thereafter. Ôt was to be followed up with another meeting to gather further
information.

The initial findings, concerns and safety issues were discussed with senior and
family and a report with recommendations was provided outlining:
immediate/acute concerns, short term concerns and longer term considerations.
plan was created and the GCM coordinated services needed to address the concerns
and provide an immediately safer environment for the senior, while other
professionals were called in to assist with their piece. The GCM worked closely with
senior and family to ensure that all concerns were addressed, while working toward
the longer term goals of the senior and family.

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From the perspective of an elder law firm with a life care planning background, the
first step that we would recommend (with input from the firmǯs RN/Care Manager)
would be to ask the Geriatric Care Manager, who has been to see the potential client
and conducted the assessment:
1. Did you do a mini-mental exam and, if so, what was the score?
. hat was the result of your fall risk assessment?
3. hat was the result of the depression screening?

The second step would be to answer the question Dzho is the client?dz Dp to this
point, the GCM has had cooperation from the senior and the family in conducting the
assessment, but things could certainly start to change. Ôf the older adult has
sufficient capacity to make her wishes known, to understand the purpose and intent
of documents being presented to her to sign, etc. then the attorney-client
relationship would most likely be with the older adult. Ôf it is obvious that this will
be a case where one or more of the family members will need to take charge
because the older adult lacks capacity, then the answer is different.

The third step would be to try to arrange a meeting (in person if at all possible) with
the adult children as well as the potential client to discuss goals and objectives, to
gather information about what is already in place in the way of legal documents,
financial resources and the available alternatives.



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Ô would try to see if a meeting can be arranged that includes not only the client Ȃ but
some of her busy family members as well so that all of us are working together. e
would attempt to put together an inventory of her assets and try to piece together a
financial profile, which would include her insurance coverage. Ô would then want to
review if she has any estate planning documents (ills, Trusts, etc.) and make sure
they are up to date, or draft documents if none are in place with proper power of
attorneys and health care directives. Ô would then work with the geriatric care
manager to assist the client and her family with determining the options available
for the clientǯs living arrangements Ȃ -she may be able to continue to reside at home
with home health care support services or possibly services provided in a long term
care setting such as assisted living. Ôf the clientǯs funds or insurance coverage are not
enough to provide such additional support, Ô would consider whether medical
assistance (Medicaid) could be available.

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The outcome of the assessment would determine if homecare was a possibility or if
the client needed to move to a facility.
ur RN, Director of Nursing would complete a health history and assessment to
develop a plan of care. The assessment would determine the level of care required:
Companion/Homemaker or Certified Nursing ssistant to help with DLs (activities
of daily life). Several alternatives would be explored to determine what was
appropriate in the situation. written plan of care would be created.
) Ôn-home care to help the client keep organized and safely get through the
day/day and night. Hours, schedule and level of care all dependent upon
assessment
B) Decision that it was not safe or possible financially for client to remain at home
with one-on-one care

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 can help. The borrower can use the monies received to pay for
the services needed. For example; in home health care, medical costs, property taxes
and others. P ǯs are acceptable if necessary.


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From a financial planning view Ȅour first question is alwaysȄ Dzwhat do you want
to do with your moneydz? No one asks this question because they are too busy telling
clients what to do with the money. The next questions areȄ are there any special
considerations Ȅ needs, care, legacy etc. that you need to deal with?

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hile Ô think there are several issues that need to be handled before getting to her
mortgage, the mortgage in this case can play an important role in helping her to

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  % Ôt doesnǯt say whether or not she is still making a
mortgage payment but Ô would venture to say she is not since she has been in the
home for 45 years and she is not in foreclosure. This would give her a lump sum of
money to help her pay for some of the other services, such as in home care, medical
alert and organizing and moving. This could also possible give her funds to get the
house in better condition for her to remain in Ȃ such as adding ramps if she needs
them, installing a better bathroom to help ensure she wonǯt fall or anything else
that could help her age in place a little more comfortably.

The second option for her is to sell the home she is in and move to be closer to one
of her children. Ôf she owns the home free and clear, she could sell the home and
either buy another home outright and not have a mortgage payment at all, go to a
retirement village (as her daughter hopes) so she gets the attention and care she
needs and use the funds from her sale to pay for it or use a reverse mortgage for
purchase option so that she can keep some of the proceeds from the sale of her
current home and use them for services that she needs to live alone.
Either of these options would help this woman free up funds to pay for some of the
other services that she needs and it would be a personal decision for her, if she
wants to stay in the home she has been in for 45 years or be closer to family.

 
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My emergency response system would definitely be a help to the safety of the

resident and peace of mind for the family. However, again, Ô stress, in this case,
unless someone is appointed to pay the bills, it wonǯt work!

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Move Matters LLC would be able to assist this client in several ways. 
 
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% Second, if it is determined that the client will be aging in place, downsizing
and more in depth clean out would probably need to be done as she has lived in this
house for 45 years. Realizing her cognitive decline issues, the downsizing could be
done over time, that is by scheduling sessions of , 3 or 4 hours of time (or full days)
for sections or rooms to be downsized. Ôtems to be disposed of are then taken away
after each session. This is a much less overwhelming way to downsize. Third,
should our client be moving to an assisted living or retirement community, my
company would be able to provide moving assistance including but not limited to
packing, unpacking and set-up of her new household.

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The rganizer would collect and put into order, all bills and other important papers
and create an easy to use filing system.

Ôn a comfortable and non threatening manner, Ô would help her to get rid of the stuff
not really needed any more. hile doing so, explain how much more healthy it
would be without the dirt and chaos. ll checkbooks and important documents
would be put safely out of the sight of others.

Ô would *
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 and create a list of all important information Ȃ insurance, bank
accounts, investments, any medical directives or Powers of ttorney.



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Senior Handy Services could help our retired PhD in many ways. The level of our
assistance and the extent of repairs and or modifications would be dictated by the
course of action chosen by the family and or the client. e would suggest a no cost
evaluation/meeting with the client (possibly including a geriatric case manager or
other interested party) to see if we could undertake minor modifications to make
the home safer in the near term. This might include grab rails, moving furniture to
open space for mobility (this would be a challenge due to the hoarding that was
discovered), installing fire, smoke & C detectors,
installing additional hand rails on stairways, moving throw rugs that have become a
trip hazard, installing additional lighting and maintenance on just about any system
in and around the house that could become a hazard if ignored. e could &

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if this was the
wish of the client. The only limits to the extent of modifications is a desire (and
ability) of the client to remain in the home and available funding.
Ôn the event that the home would be offered for sale, we could assist in making the
home Dzmarket readydz for sale by making all desired and or required (mandatory for
certain types of mortgages) repairs.


(photo lesfemmes-thetruth.org)

http://www.aginginplace.com