Limited Conservatorships for the Developmentally Disabled may be useful for families who have a child who is: near or at legal adulthood; in need of help with decision making; in need of an advocate; or incapable of giving consent.

Following are some commonly asked questions and answers about Limited Conservatorships:

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The California Department of Developmental Services has published a workbook entitled THINKING AHEAD, My Way, My Choice, My Life at the End. This workbook is a simplified version of an Advanced Health Care Directive which can be used by some developmentally disabled persons to plan end-of-life choices.

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ncreasingly, we are seeing families who feel forced to delay placing an elder in assisted living or skilled nursing facilities for economic reasons. The elder’s resources may have declined due to the recession, or the family’s overall financial situation may be compromised so that others are unable to contribute to the cost. This may result in increasingly difficult care situations at home, sometimes leading to a decline in health or even injury. For example, if Mom is falling in her home and really needs a supervised setting, a delay in placement may place her at risk for fall injuries. If Dad is repeatedly hospitalized for dehydration because he is not eating properly or consuming enough fluids, some difficult decisions may need to be made. But how is the cost to be met?

Medi-Cal pays for skilled nursing only, and then only when the resource limits are met. Many facilities do not take Medi-Cal at all. Even if the preferred one does participate in the Medi-Cal program, it may expect a period of private pay initially. As for assisted living, private resources must pay. Especially in a dementia situation, this can be quite expensive.

Rather than hope nothing drastic happens, we encourage clients to seek the help of a good placement service or care manager to assist in considering the options. Facilities with empty beds or rooms may be quite willing to negotiate about costs. A needs assessment will start identifying places that may be appropriate, given the resources available and the location preferred. Going with family members to visit those places, and asking questions that the family may not think about, the placement consultant or care manager can make the process much less stressful, and may be able to reduce the monthly cost.

In one recent case, the placement consultant identified three places, visited them with the son and daughter-in-law, negotiated some cost reductions, and helped the transition by suggesting that the new room be set up exactly like the mother’s bedroom at home, down to pictures on the wall and the rug on the floor. The transition went very smoothly, and the family was happy to have a professional member on their team at this critical time. The care is still expensive, but the cost of the consultant was more than justified by the negotiated monthly savings and the stress reduction all around.

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n November 12, 2009, television station CBS 5 revealed an alarming string of thefts from elderly customers by a bank employee.

In one incident, an employee ordered duplicate ATM cards when an 86-year-old customer reported his card lost. The employee had friends use the duplicates to withdraw $8,000 from the customer’s account. The customer was unaware of the theft until he was notified that his account was overdrawn, which had never happened to him before.

In another, an employee befriended a customer and was writing checks out for her to sign, some of which were for legitimate bills and others of which were payable to the employee.

Larson said an employee at this Bank of America branch in Lafayette befriended her mother [77-year-old Frances Saimons]. “He was more than very nice. He was charming,” Saimons said.

Saimons said he helped her manage her finances. “Always, he always wrote my checks out,” she said. “He would say sign there, and I would sign it.”

The customer did not realize that $28,000 in checks had been made out to the employee until a bank investigator visited her daughter. The employee claimed that the checks were loans, although the victim denied this and the bank has a policy forbidding such a practice.

Family members are often reluctant to interfere in the personal business of an elder, which is understandable. But polite inquiry about their opinion of the bank, whether they find the bank employees helpful and how, might be acceptable. Sometimes the elder will permit a family member review bank statements. The sooner problems are spotted, the more quickly damage can be limited and, hopefully, remedies sought.

Financial elder abuse can be a crime, and banks are mandatory reporters to Adult Protective Services (APS) when they become aware of such behavior. Notify the bank and APS immediately if you suspect abuse. To obtain more information or to report adult or elder abuse call APS at (510) 577-3500 or toll free at (866) 225-5277, 24 hours a day and all referrals are confidential.

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lacing a relative in a nursing home is a stressful experience by itself. Add to that the complexities of the Medi-Cal system, which pays for nursing home care under certain circumstances, and it’s easy to feel overwhelmed. Here are some basic concepts that should be helpful.

Concept One: Medicare or Medi-Cal

Medicare and Medi-Cal, although they sound alike, are very different, and it’s important to understand what each does in the nursing home context. Medicare is what comes with Social Security and is not “means-tested” (explained below). It does not pay for nursing home care unless the condition is one from which a person might recover, and s/he is making progress toward recovery. Very few residents of nursing homes are covered by Medicare, and even then only for brief periods while rehabilitating from conditions such as broken hips and strokes.

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Specializing in persons with disabilities, autism, mental illness, and dementia, they offer house calls and “The One-Sleep-Visitâ„¢”. We’ve heard a glowing report after a first hand experience.

Unconscious sedation involves the use of I.V. sedation or general anesthesia, which produces complete sleep during which you will be free of pain and will have no memory of the procedure.

Phone: (800) 395-1152
Link: Blende Dental Group
Updated: Nov 2009

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Services offered, contact information and some downloadable forms.

Phone: (510) 251-2400
Link: Phillips Bonding Company
Link: Application Forms
Updated: 10 Sep 2010

“The ACBA provides many services for the public, including: Referrals to experienced, pre-screened attorneys through our Lawyer Referral Service; Pro bono legal assistance for those who meet income guidelines; Alternative Dispute Resolution — informal, consensual dispute resolution methods instead of traditional litigation; Assistance in resolving attorney-client fee disputes; and Oversight of the conflicts programs — the Civil & Criminal Court Appointed Attorneys Programs — for the Superior Court of California, County of Alameda”

Phone: (510) 302-2222
Link: Alameda County Bar Association (ACBA)
Updated: 1 Sep 2009

Information about the Contra Costa County Superior Court.

Link: Contra Costa County Superior Court
Updated: 1 Sep 2009

“The Academy seeks to provide support to other organizations serving seniors and people with disabilities. NAELA also examines and advocates on public policy issues facing seniors and people with special needs, but does not provide direct legal services. If you are seeking legal advice, please contact an Elder Law Attorney in your community. You can access a list of our members here.”

Phone: (520) 881-4005
Link: National Academy of Elder Law Attorneys, Inc. (NAELA)
Updated: 1 Sep 2009

“Free legal advice and representation, Medicare health insurance counseling, and community education presentations.”

Phone: (510) 832-3040
Link: Legal Assistance for Seniors
Updated: 1 Sep 2009

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reader of my article Special Needs Trusts Fundamentals inquired about using a Special Needs Trust (SNT) to supplement a parent’s Medicaid, while avoiding having to reimburse the state for those payments at the parent’s death. Of course, its beyond the scope of this web site to offer legal advice specific to anyone’s personal situation, but there are issues here I’d like to address.

Let’s presume that you are anticipating a parent will be entering a skilled nursing facility and wants the Medicaid program to pay the cost of that care. In California, where I practice, the Medicaid program is called “Medi-Cal” and it is the Medi-Cal program that I will be talking about.

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Includes a detailed description of many aspects of conservatorship and a link to the Conservatorship Handbook.

Link: California Superior Court’s conservatorship page
Updated: 1 Sep 2009

“CEI’s program is specially designed to offer an alternative to those elders who prefer to remain in their own home, but whose medical problems make it impossible for them to live at home without assistance from doctors, nurses, social workers, and other caregivers. Your care is planned and provided by a interdisciplinary team of specialists working together with you. When necessary, services may also be provided in your home, in a board and care or other group housing, in a specialist’s office or in a nursing home. Our primary care physician will manage your hospital care.”

Phone: (510) 433-1150
Link: The Center for Elders Independence
Updated: 1 Sep 2009