QUESTION: My 75-year-old widowed mother recently gave a friend a $30,000 loan with no legal agreement on payback. She does not have his address and doesn't seem concerned. While she is in good health, can take care of herself and pays her bills on time, I feel her judgment is poor. I'm worried that she may be losing the modest financial security she and my father worked for. Any suggestions?
ANSWER: Your situation is a touchy one that is not easily resolved. The conflict between ensuring your mother's privacy, autonomy and independence and protecting her financial future is not easily balanced. It is possible that this is an isolated incident and only a temporary lapse in judgment. You need to be sure of the length and degree of her financial mismanagement.While she may have difficulty recovering the loan, there are a few options that you can explore to minimize future financial losses. Approach your mother with sensitivity, letting her know your concern for her. Ask her where she could use your assistance and offer your time to help work out her financial affairs.
If she is agreeable, you may discuss the option of establishing a "durable power of attorney." This legal document allows your mother to designate you or another trustworthy family member or friend to make decisions for her in the event she is unable to do so. This would be desirable if her judgment problems become permanent, as this is the least restrictive option.
If you find that your mother is unwilling to try the power-of-attorney option, you may want to apply for conservatorship. The laws vary from state to state, but basically a conservator is appointed by the state to manage the financial and property affairs of a person who is unable to do so. With conservatorship, there is no requirement or implication that the person is incompetent in other areas of his or her life.
Your mother's freedom to make decisions about her own money is as important to her as it is to society and the courts. As long as she has the capacity to make sound decisions, she should be encouraged to do so. Yet if you are reasonably certain that this is a permanent rather than a temporary problem, you should try to adopt a plan of financial management that is the least restrictive of your mother's autonomy and personal freedom.
QUESTION: My mother was recently released from the hospital after a hip replacement operation. My sister and I were shocked at how soon she was sent home. She had a home-health aide assigned to her, but after a few days my mother developed pneumonia and was back in the hospital. What can we do if this happens again?
ANSWER: Dr. Jacqueline Kosecoff and colleagues at UCLA and the RAND Corp. recently reported in the Journal of the American Medical Association about the prospective-payment system (PPS) and impairment at discharge. In the prospective-payment system, hospitals are paid a flat rate per Medicare admission for each of approximately 470 diagnoses.
Kosecoff and colleagues examined results of this system, which took effect in 1983. Generally, the researchers reported that the PPS system has cut hospital costs without lowering the quality of care. One alarming finding of the study, however, had to do with post-hospital discharges. After PPS was introduced, unstable medical conditions increased - primarily among patients discharged to their own homes. Prior to PPS, 10 percent of patients discharged home were unstable; after PPS was implemented, 15 percent were discharged unstable.
Patients discharged in an unstable condition are at higher risk of dying after discharge than those released in a stable condition. The researchers focused on five diseases: congestive heart failure, acute myocardial infarction, cerebrovascular accident, pneumonia and hip fracture. The highest risk of death was for patients discharged in unstable conditions who suffered hip fractures. The most frequently reported unstable conditions were high white blood-cell count, new incontinence and confusion.
The important thing to remember is to be an advocate for your parent. Sometimes an adult child may not want to intervene on behalf of a parent for fear of breaching the doctor-patient relationship. But if your parent, spouse or friend is being released from the hospital, Dr. Lisa Rubenstein, one of the study authors, says that families should understand the discharge plans.
They should be especially mindful if the patient being discharged is confused or suffers from incontinence. Rubenstein advocates paying careful attention to what medications are to be taken and at what intervals. Also important are following the diet the hospital suggests and knowing the plans for walking and physical mobility. Families should know what problems to look for if a family member is not doing well after discharge.
Send questions about growing older to On Aging, P.O. Box 84256, Los Angeles, CA 90073. Questions of general interest will be answered in the column; individual answers cannot be provided.