Iowa Elder Abuse

I live in California. My concern is for an elderly aunt and uncle in Burlington, Iowa. He is 85 and she was 79, she passed away this Sunday in a nursing home.
Approximately 4 years ago my aunt was diagnosed with Parkinson's and mild dementia. My uncle cared for her as best he could for 2 years, then hired a caregiver recommended by a neighbor. This caregiver is a 45 year old woman who has been married 5 times and is not licensed, and she accepts only cash payments. She was supposed to be taking care of my aunt, but it seems she made more of a friendship with my uncle. He feels sorry for her and even gave her bonus cash for her duties. In September of 2006 the caregiver hurt her back and convinced my uncle to move my aunt to a nursing home. She at that time obtained durable powers of attorney for both of them. This was done through an attorney who purports to represent all three parties, my aunt, the caregiver, and my uncle. Long story short, my aunt did not like the caregiver and when she continued to be involved in their lives after she was rushed into a home, she refused to eat. She began to hate my uncle for continuing to see this woman and bring here around. She has involved her daughrter and grandson in my uncles life. I last saw my aunt 3 weeks ago at the home and she informed me that the caregiver had taken over and she just wanted to die. She was frail and skinny, but not looking starved. She was completely lucid and used exceptional language skills. She was not terminal. Last week the caregiver called in Hospices and took her off all medications, she died a week later. My uncle believes this caregiver is a wonderful woman, and she is now moving into his home to take care of him. He has spent a lot of money repairing her car, paying her and her daughters rent and apparently paying for her son's college. She is aware of his financial position. He has spent over $150,000 on non care items in the past two years. We have called the local police and they have interviewed her, but they say they can do nothing. I am at a loss. Not only do I feel this woman killed my aunt, but I feel she is robbing my uncle blind, and that he will be dead in a year. Any suggestions where to start? We have filed a complaint with The Department of Heath Services, and are putting together some info to look at a complaint against the nursing home, but we are in CA. Tough to follow up personally.

Unfortunately, as long as your Uncle is competent there is little you can do without his assistance. Remember Anna Nichole. Your best option is to convince him to come stay with you.

Death cirtificate question

I have now obtained a copy of the death certificate. Some irregularities appear. My aunt died at 1:45 on a Sunday morning August 5th. She was cremated on Sunday afternoon, still the 5th. The death certificate states the time of death, but is dated August 6th, along with the cause of death being Ahlzheimers. My question is:
Is it legal to cremate a persons remains prior to the death certificate being signed? I understand that a permit must be issued prior to cremation. How could this happen? Also, the doctor who signed the certificate told me personally three weeks before her death that he had no diagnosed her with ahlzhemiers. Why would he put this on the death certificate and should not the certificate show the real cause of death (respiratory failure, cardiac arrest, infection, drug overdose etc.)?

That so-called care giver should be executed. People like that make me want to puke.

I have now obtained a copy of the death certificate.

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Without any legal authorization, you obtained a copy of the death certificate in less than 2 days?

Also, the doctor who signed the certificate told me personally three weeks before her death that he had no diagnosed her with ahlzhemiers.

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Why would a doctor violate HIPPA?

Death Certificate

The death certificate was provided to me by the mortuary. I just called and asked for a copy. Today I called the medical examiner and got a copy of the cremation permit. The permit was done prior to her cremation, but the death certificate is definitely signed the following day. Is it correct that the death certificate and the permit must be obtained prior to the cremation? The cremation permit states cardiac arrest as the cause of death, the death certificate states ahlzheimers. Additionally,on the advice of the Elder Abuse people in the Department of Health Services, we had called the police the night prior to the death and asked them to investigate and if she were to die, to hold off the cremation until the medical examiner could determine if an autopsy should be performed. I have a copy of the police report stating this and giving an account of their interview with the caregiver. It appears all the call to the police did was to alert the caregiver and cause her to hasten the cremation without all the facts in. Reports from family who visited for the 2 weeks prior indicate my aunt was looking more and more heavily drugged as the days went on. I want to call this a murder, but can't prove it because there was no autopsy.
We have involved the State of Iowa Department of Inspections and Appeals, and the Wrongful Death Institue, so now we wait. Should we be doing anything else?

I hope you nail this woman to the wall big time**************.....Go for it....

MMWS said:

The death certificate was provided to me by the mortuary. I just called and asked for a copy. Today I called the medical examiner and got a copy of the cremation permit. The permit was done prior to her cremation, but the death certificate is definitely signed the following day. Is it correct that the death certificate and the permit must be obtained prior to the cremation? The cremation permit states cardiac arrest as the cause of death, the death certificate states ahlzheimers. Additionally,on the advice of the Elder Abuse people in the Department of Health Services, we had called the police the night prior to the death and asked them to investigate and if she were to die, to hold off the cremation until the medical examiner could determine if an autopsy should be performed. I have a copy of the police report stating this and giving an account of their interview with the caregiver. It appears all the call to the police did was to alert the caregiver and cause her to hasten the cremation without all the facts in. Reports from family who visited for the 2 weeks prior indicate my aunt was looking more and more heavily drugged as the days went on. I want to call this a murder, but can't prove it because there was no autopsy.
We have involved the State of Iowa Department of Inspections and Appeals, and the Wrongful Death Institue, so now we wait. Should we be doing anything else?

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Where was the body of the deceased to when removed from the nursing home?

Why didn't you answer the following question: Why would a doctor violate HIPPA?

BlondiePB said:

Where was the body of the deceased to when removed from the nursing home?

Why didn't you answer the following question: Why would a doctor violate HIPPA?

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The body was picked up by the mortuary and taken to their establishment, where the body was prepped then it was delivered to the crematorium by the mortuary. All this in less than 12 hours from the time of death.

Sorry, this is a long complicated story, much of which I have not posted, and I didn't connect with the HIPPA issue because:
I don't think the doctor violated HIPPA. I went to the doctors office with my aged uncle after we had been to the attorneys and the paperwork started to make me DPA for my aunt and my uncle. The doctor was totally comfortable discussing her condition with us. This was also after we went to the nursing home and my uncle informed them I would be my aunts DPA and I gave them all my contact info. The paperwork was never completed because the attorney delayed 2 weeks and by that time my aunt was too far gone to sign the DPA. The doctor is NOW claiming patient privacy and will not return my calls or answer any questions on her state of health or diagnosis.

Let's uncomplicate the story & get to important facts

The facts are:

1) Hospice stopped giving all meds to your aunt, even meds for pallitive relief.

2) No one authorized moving the deceased from the nursing home to the mortuary.

3) No one authorized the mortuary to prepare the deceased for cremation.

4) No one authorized the mortuary to send the deceased to the crematory.

5) The crematory, without any proper legal authorization, cremates the deceased on the same day as the death.

6) You obtain a copy of the death certificate in less than 6 days with no legal authorization from the mortuary.

Is all the above correct?


BTW, a deceased can be cremated/interred prior to the death certificate being signed. Without any legal authorization, you, yourself, cannot obtain medical info about your aunt.

BlondiePB said:

The facts are:

1) Hospice stopped giving all meds to your aunt, even meds for pallitive relief.

2) No one authorized moving the deceased from the nursing home to the mortuary.

3) No one authorized the mortuary to prepare the deceased for cremation.

4) No one authorized the mortuary to send the deceased to the crematory.

5) The crematory, without any proper legal authorization, cremates the deceased on the same day as the death.

6) You obtain a copy of the death certificate in less than 6 days with no legal authorization from the mortuary.

Is all the above correct?


BTW, a deceased can be cremated/interred prior to the death certificate being signed. Without any legal authorization, you, yourself, cannot obtain medical info about your aunt.

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Blondie, you are heading in the right direction, but because I try to post this succinctly all the information is not here; who had authority for her health care decisions is up in the air, we know that. If there was no DPA, the authority would revert to my uncle. SO:
No, all the above are not correct; the facts are:
1) Hospice stopped giving all meds to my aunt, even meds for pallitive relief. She was not even given Oxygen and labored breathing for over 18 hours.
2,3,4,5) My uncle negotiated a direct cremation contract with the mortuary to care for my aunts remains. I still do not yet know when that contract was negotiated, but it was after my aunt was placed in the home. He may have been her DPA at the time of the contract or he may not have been. He was replaced as DPA by the caregiver 4 months after she was admitted. I did not get involved in this until 3 weeks prior to my aunts death, 10 months after she was admitted. She revoked the caregiver's DPA while I was there ( Iowa law states she can do this regardless of mental or physical capacity and without it being in writing) and asked that I take care of her affairs. That instigated the appointments with the attorney, the nursing home and the doctor. The attorney did not complete the DPA paperwork prior to my aunts death (see my last post). The caregiver insists that since the new DPA paperwork was not completed, she was still the attorney in fact. Because the paperwork was not completed and I returned to California, none of the providers were notified in writing (although the nursing home and doctor were made aware the change was in progress and they took my contact info). I have yet to find if the new DPA (or any other for that matter) was recorded in her medical history.
6.) I obtained a copy of the death certificate from the mortuary upon telephone request 2 days after her death. I also received a copy of the cremation permit yesterday from the medical examiner by telephone request.
7.) (I will add one more if I may) The caregiver was a volunteer for Hospices while she was also had my aunts DPA. She was also her caregiver when she obtained her DPA and she is not related to my aunt by blood, marriage or adoption.

NOW, thank you for answering my question . This is the first question I have had answered in this forum. You state that it is legal to cremate a body prior to the death certificate being signed. That is what I wanted to know.
However, here is a question I asked the Iowa Department of Health Services and the answer I received today:
Question:
How soon can a body be cremated in a direct cremation?
Answer:
Cremation must take place within 48 hours of the time of death for a direct cremation. All certificates, authorizations and permits must be obtained prior to cremation.

So are you sure about your answer?

The question still remains as to who was my aunts DPA, everyone is in CYA mode now and no answers are forthcoming. We are still trying to obtain information on the chain of events that happened here, but there is good news: The Iowa Department of Of Inspections and Appeals has begun an extensive investigation into this matter. Today they entered the nursing home and took custody of my aunts medical records. Also today I was contacted by the Burlington Police Department and they are still investigating. Maybe there is some hope. The State Elder Abuse Ombudsman is on the scene of the investigation. Iowa law requires a report within 20 days.

Originally Posted by MMWS
...You state that it is legal to cremate a body prior to the death certificate being signed. That is what I wanted to know...

...So are you sure about your answer?

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Yes.

Please clarify the following:

How did Hospice get involved?

The caregiver, a Hospice volunteer, obtained POAs.

The nursing home does not have a copy of the POA for your aunt.

The caregiver waived the POA to the nursing home staff & the staff followed her orders.

The caregiver took care of the imminent care for your aunt.

The mortuary made the death certificate.

The caretaker ordered the mortuary to immediately have auntie sent to the crematory for cremation using her POA for auntie.