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Save John and Gina

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CharlesTownsend

Junior Member
EDIT: It seems I was under the mistaken impression that anonymity is par for the course on this site. I do want to protect my identity in this case, and I apologize to anyone who read the whole giant block of text assuming that the real situation is exactly the same as the situation I describe. I made changes to protect the identities of the people involved. But to repeat, I am not Peggy or James. I'm just someone who loves John and Gina.


This is a real-life, ongoing dilemma from Maryland. Any help you can offer will be appreciated greatly.

Gina and John have been married for over six decades and both are over 80 years old. They are inseparable. They have three children named Peggy (61), James (57), and Rosie (55). I am a close friend of Peggy's.

John and Gina's finances are being handled by a third-party and are not at issue here.

Two years prior and without notifying her siblings, Rosie took her parents to sign health care advance directives (one for each parent) naming Rosie as health care agent. Store that away for a moment.

A year ago, Gina and John were living alone. They began to have difficulties performing ordinary daily activities such as making appointments, taking medications in the proper doses, and driving. Serious discussion about what to do with Gina and John began among Peggy, James, and Rosie. As Gina and John lived at James's home for eight years (2001-2008) and are very comfortable there, James and Peggy began to promote the idea of their parents moving back to James's house. Gina strongly agreed and began discussing plans to move back to James's house. John also agreed, though his condition is such that he can be made to agree to anything.

When James and Peggy proposed moving the parents to James's house, Rosie refused. She then relocated John and Gina to an assisted living facility (ALF). She did not give any advance notice to her siblings.

James attempted to take Gina and John back to his house one evening, but quickly realized that without access to medications his parents' health might be jeopardized. The ALF would dispense medications only to a person authorized by the health care agent (Rosie). James was forced to return his parents to the ALF on an indefinite basis.

Everyone agrees that John's dementia has reached the point where John cannot consent to any financial or medical arrangements. Over the years John has had multiple strokes which have left him mostly unable to learn new environments or make sense of new stimuli. John does much better in familiar environments and his long-term memory is mostly intact. By contrast, Gina is quite clear-headed and has consistently and strongly opposed John's and Gina's “incarceration” at the ALF.

Peggy and James began to prepare a petition to the county's circuit court for guardianship of the persons over both John and Gina. In the process of preparing the petition, they encountered an ethical difficulty. Peggy and James did not truly believe that Gina was incompetent. In fact, writings of Rosie's from a few months prior stated unequivocally that Gina was consistently lucid, drawing a contrast with John. But if James were only to acquire guardianship over John, then Rosie would still be able to force Gina to stay at the ALF. As John and Gina are inseparable, this was unacceptable.

While Peggy and John were deliberating, Rosie beat them to the punch. She contacted her preferred M.D. and psychologist, told the evaluators that both her parents were incompetent, and requested documentation. This was easy to do since Rosie was in control of all medical decisions for both parents. No notification was given to Peggy and James.

Peggy and John acknowledge that Gina's mind is not as sharp as when Gina was 60, but they still think that guardianship represents too much power over such a sharp-witted individual. Gina is aware of her surroundings, knows who she is, knows who the people around her are, knows what she wants in life, and retains the ability to express preferences about her life.

Rosie submitted a petition to the local circuit court for permanent guardianship of the persons for both John and Gina. Rosie alleged that her parents were both afflicted with severe dementia and provided two “certificates of capacity” for each parent. She also alleged that James taking his parents out to his house constituted an emergency (as defined in the MD Code).

The circuit court judge who reviewed Rosie's petition neglected to hold a hearing or to otherwise consult with family and immediately appointed Rosie as temporary guardian of the persons for both John and Gina. The temporary guardianship grants Rosie all the rights, duties, and powers of a permanent guardian of the person. After five months, the temporary guardianship is still in effect. James and Peggy quickly filed a counter-petition, which triggered a hearing date. Due to court backlog, the hearing date has been set for November, and we are all worried that John and Gina will not make it that long. We believe we will win the case.

John has fallen three times since being placed in the ALF. He has broken his leg and his hip as a result. The rest of the family is powerless to intervene in any way. Rosie banned multiple members of the family from visiting at the ALF on the grounds that these family members are “disruptive”. Rosie's evidence for this claim is a poorly written note by a low-level ALF staff member who has been working hand-in-hand with Rosie.

John's condition worsens by the day as he gets no stimulation or family interaction in the ALF. We are worried that Gina and John will not survive until the November hearing. We believe that Rosie does not care if her parents die. Perhaps she wishes their death.

Consistent with the MD Code, the court did appoint an attorney to represent John and Gina. The attorney has tried to mediate between the two factions rather than attempting to effect real change. Under the attorney's mediation, the situation has stalemated. The attorney has failed to see the exigency of the situation despite John's rapid decline and Gina's constant demand to be moved to James's house.

Question: how do we save John and Gina? Everyone has retained attorneys but nothing is changing.
 
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tranquility

Senior Member
You recognize there are many different thoughts on the matter and let your attorney handle things. John and Gina are not one entity, but two. Rosie does not seem to have any ulterior motives as stated in your very long posting of facts and seems to be handling things in a medically appropriate manner. That you have a different opinion is just that, a different opinion. I have no idea who is right, but it seems like Rosie is doing things properly. I don't think you're going to get an accelerated hearing for an exigency absent other factors and expert testimony. Sorry.
 

CharlesTownsend

Junior Member
You recognize there are many different thoughts on the matter and let your attorney handle things. John and Gina are not one entity, but two. Rosie does not seem to have any ulterior motives as stated in your very long posting of facts and seems to be handling things in a medically appropriate manner. That you have a different opinion is just that, a different opinion. I have no idea who is right, but it seems like Rosie is doing things properly. I don't think you're going to get an accelerated hearing for an exigency absent other factors and expert testimony. Sorry.
Thank you for you input.

One important fact that I neglected to mention:

The advance directives that Rosie used to put Gina and John into the ALF to start with explicitly state that Gina and John did not want to be put into a nursing home or similar facility under any circumstances, even if it means exhausting their assets to pay for full-time nursing care at home. It is this home-based option that we are proposing.
 
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OHRoadwarrior

Senior Member
Sounds like John and Gina are where they need to be. It also sounds the like two siblings are trying to remove them for some financial gain.
 

tranquility

Senior Member
Thank you for you input.

One important fact that I neglected to mention:

The advance directives that Rosie used to put Gina and John into the ALF to start with explicitly state that Gina and John did not want to be put into a nursing home or similar facility under any circumstances, even if it means exhausting their assets to pay for full-time nursing care at home. It is this home-based option that we are proposing.
One does not always get to choose what is best. I remember when my then physically frail but mentally alert mother backed out of the garage one day hit the side on the way out. As a joke, I reached out and grabbed her keys while saying "Dad told me to take these." My frail mother's hand whipped out so fast and grabbed my wrist in a vice like grip I had no time to react before feeling 70 years of fury flowing through my body. Since it was a joke, I dropped the keys and apologized. Of course, I remembered that moment when I had to take them for real a few years later and made sure I had control of them before discussing the matter with her. She did not agree--at first. But funny how things changed when I visited her much more because of having to drive her places. She got over it.

Some of the things you talk of are not appropriate for an advanced health-care directive and are no longer valid as sister now has guardianship. (Examples of the things such a directive usually cover are at http://www.oag.state.md.us/Healthpol/adirective.pdf )

How rich are your parents? I have many wealthy clients who's resources are rapidly depleted in a 24 hour care situation. It is expensive. With differing levels of health, unless there is a lot of wealth, it is irresponsible to impoverish one spouse for something that is an exceptional luxury. A guardian has to make decisions on what is best for all the parties they conserve.
 

commentator

Senior Member
this whole post sounds just almost exactly like some of the homework in my Elder Mediation courses. If all the parties have lawyers, as you say, you need to back out. You're not involved in any way anyhow. It makes absolutely NO sense that a third party would have complete control of the couple's finances, and yet not have control of their health care decisions. How did they manage to get that Assisted living facility paid for? How could she have put them there "unbeknownst to the others"? Does not this third party who controls their finances have to contact the children and give some accounting about what is going on? This sounds very strange.

And I can't, I'm sorry I find it very hard to imagine an assisted living facility that could ban family members from visiting at the behest of one family member. Is there a court order to this effect? Have there been disruptive situations that we're not hearing about? It almost sounds like your brother there staged a kidnapping, but then realized he didn't have mom and dad's medications, etc. Very reasonable on his part, if you ask me. Perhaps keeping them in the home isn't the best situation. Why do you feel so sure that the assisted living is going to be the death of them? Are you sure Dad wouldn't have fallen three times at home?

You are making some pretty evil accusations about Rosie for an outside observer there, "perhaps she doesn't want mother and father to survive" so, is there a payday there, or something? Why would she take upon herself this whole task of throwing mom and dad into assisted living, assuming their total health care management herself, forbidding brothers and sisters from visiting them, and even going to court to keep the others away?
 
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OHRoadwarrior

Senior Member
The real stroke of genius was Rosie doing such a good job to find a home that would torture the old folks needlessly with broken bones and stuff.
 

Zigner

Senior Member, Non-Attorney
Blue Meanie,

I really don't want to say. This case is gaining some notoriety locally and I don't want to give it away. I hope you can understand.
In that case, it's up to the (many) attorneys involved. I wish everyone luck. Good day.
 

CharlesTownsend

Junior Member
One does not always get to choose what is best. I remember when my then physically frail but mentally alert mother backed out of the garage one day hit the side on the way out. As a joke, I reached out and grabbed her keys while saying "Dad told me to take these." My frail mother's hand whipped out so fast and grabbed my wrist in a vice like grip I had no time to react before feeling 70 years of fury flowing through my body. Since it was a joke, I dropped the keys and apologized. Of course, I remembered that moment when I had to take them for real a few years later and made sure I had control of them before discussing the matter with her. She did not agree--at first. But funny how things changed when I visited her much more because of having to drive her places. She got over it.

Some of the things you talk of are not appropriate for an advanced health-care directive and are no longer valid as sister now has guardianship. (Examples of the things such a directive usually cover are at http://www.oag.state.md.us/Healthpol/adirective.pdf )

How rich are your parents? I have many wealthy clients who's resources are rapidly depleted in a 24 hour care situation. It is expensive. With differing levels of health, unless there is a lot of wealth, it is irresponsible to impoverish one spouse for something that is an exceptional luxury. A guardian has to make decisions on what is best for all the parties they conserve.
Thanks again for the response and nice anecdote.

Rosie put them in the most expensive facility in the region. The ALF is costing them approximately $12,000/month. They will be able to afford this for about 30 months before all their assets are dissipated. A professional analysis has been performed showing that home health care would be less expensive.
 

CharlesTownsend

Junior Member
Thanks for your response.

this whole post sounds just almost exactly like some of the homework in my Elder Mediation courses. If all the parties have lawyers, as you say, you need to back out. You're not involved in any way anyhow.
Suppose this happened to two elderly people you loved. Would you still recommend "backing out"? I am an observer very close to the situation. I am not Peggy nor am I James. I am trying to keep this anonymous because I can imagine Rosie or people affiliated with her seeing the post. I hope you can respect that.


It makes absolutely NO sense that a third party would have complete control of the couple's finances, and yet not have control of their health care decisions.
Respectfully, you are wrong. In MD, the state often appoints third party fiduciaries to handle the financial affairs of elderly couples. Under the current arrangement, the fiduciary is authorizing payment for all expenses requested by the temporary guardian.


It makes absolutely NO sense that a third party would have complete control of the couple's finances, and yet not have control of their health care decisions.
How did they manage to get that Assisted living facility paid for? How could she have put them there "unbeknownst to the others"? Does not this third party who controls their finances have to contact the children and give some accounting about what is going on? This sounds very strange.
Here you make a good point. The fiduciary was appointed after Rosie put them in the ALF. This was arranged by the court-appointed attorney in an attempt to limit squabbling.


And I can't, I'm sorry I find it very hard to imagine an assisted living facility that could ban family members from visiting at the behest of one family member. Is there a court order to this effect? Have there been disruptive situations that we're not hearing about?
The ALF's position is that the temporary guardian has control of the social lives of Gina/John. If the temporary guardian requests that a visitor to John/Gina be removed, then the visitor will be removed. This is consistent with my understanding of the MD Code. Do you disagree? No, there is no court order to this effect. The "disruptive situations" take the following form: Gina likes to talk to certain family members about hiring an attorney to get out. The other family members engage her on that topic, but tell her their hands are tied and that Gina will have to work through her court-appointed attorney. The staff member mentioned previously, close to Rosie, reported this as "agitation".

It almost sounds like your brother there staged a kidnapping, but then realized he didn't have mom and dad's medications, etc. Very reasonable on his part, if you ask me. Perhaps keeping them in the home isn't the best situation.
"Kidnapping" is too strong a word given that no temporary or permanent guardian had yet been appointed. I can't really say what was going through his head. All I know is that he is an intelligent family man who loves his parents. This is taking a big toll on him.


Why do you feel so sure that the assisted living is going to be the death of them? Are you sure Dad wouldn't have fallen three times at home?
Good questions. I have witnessed a rapid decline in John's state at the ALF. Of course it is impossible to untangle causation and correlation in terms of emotional well-being, but the falls were unquestionably the result of negligence on the part of temporary guardian. After the first fall, 24/7 supervision should have been instituted. Instead, John subsequently had two more serious falls.

You are making some pretty evil accusations about Rosie for an outside observer there, "perhaps she doesn't want mother and father to survive" so, is there a payday there, or something? Why would she take upon herself this whole task of throwing mom and dad into assisted living, assuming their total health care management herself, forbidding brothers and sisters from visiting them, and even going to court to keep the others away?
Power. Kids have been fighting since they were, well, kids. This is the ultimate power struggle. Rosie has never been a compassionate person and certainly isn't going to start being one now. This is her way of getting back at her parents and her siblings for supposed past mistreatment starting in childhood.
 
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