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Long story short. My mother was taken into custody by DSS in her state. She spent a month in a psychiatric unit and then transferred to an assisted living facility where she has been for the last 2 months. I am in the process of requesting conservatorship which requires a physician affidavit of incapacity. Her internist, who has seen her for 20 yrs won't sign saying the psychiatrist at the psych unit should sign. The psychiatrist states he cannot sign unless he has visually seen her in the last 24 hrs and she would have to be readmitted for that to happen.


Everyone that deals with her recognizes the mental issues (she's 94). Must have the affidavit to proceed.


I feel like I've hit a brick wall. Any suggestions?

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Pay a psychiatrist to go to the facility where your mother presently resides. We paid about $300 for the assessment and subsequent document. It may cost you more, because we were dealing with psychiatric services that were provided on site.

There may may be additional fees, but the cost is worth having the document in hand. We were dealing with a contentious and non-productive family situation which was readily resolved when I had the document.

Bottom line-the cost of getting someone to assess her circumstances wherever they need to go to get to her, is WORTH the cost.

Hope the rest of your efforts go more smoothly.
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This sets my teeth on edge. Rather than you hitting a brick wall, wouldn't it be wonderful to get the internist and the psychiatrist in the same room and bang their heads together?

I think I'd probably start by sending an email, copied to both of these practitioners, inviting them to resolve this issue in consultation with one another. Once they have, perhaps they would be good enough to recommend next steps.

Fume. The whole thing reminds me of a political cartoon I once saw of a premier operating a remote control on a junior minister and swearing "No, right! I said go right! Not round and round in circles - God! - you really are a crap robot..."

"Crap robot" is quite a handy term for other types of people who are paid to solve problems but come over all helpless, too.
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Another option may be to check to see if AL has a neuropsychologist they work with who sees patients at the facility. They could do an evaluation; I think Medicare pays for it, and they give you letter of incapacity. It would have been useful for the psychiatrist to have done this while she was in that facility but that ship has sailed.
Go ahead and also talk to elder care attorney just to confirm all the steps and so that you get the proper paperwork the first time.
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Judysai422 Jun 2019
Would hospice be able to do this as part of their evaluation?
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I wonder if you could work with the Social Worker at the facility where she is currently living. There are Doctors that the facilities use, that make rounds there is it possible for that doctor to sign?
Is anyone POA?
How is the facility getting paid?
If you are paying bills for her but do not have the "legal authority" to do so at some point the facility will bend over backwards to do what they can to help you obtain guardianship so they can get what is owed to them.
If the facility Social Worker does not help or will not help next time your Mom is admitted to the hospital ask the hospital Social Worker and when she is brought in to the hospital even if she is not admitted ask for the psychiatrist to evaluate her then have him sign what he needs to.
I would think a court would accept the diagnosis in the patients file in place of an affidavit.

Have you consulted an Elder Care Lawyer? They might help in this matter as well.

Please keep us posted I am sure others have gone through this or will at some point and would love to know how this is resolved
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The important thing is that you yourself must NOT pay out of your own funds, because you will be unable to recoup this from her funds once you are in charge. It is the worst thing that happens to some people. Without pay, the assisted living will soon enough release or readmit your Mom for the proper papers. I am surprised that any assisted living took her without this all in place. Ask at your assisted living to speak with the social worker about beginning to get a guardianship for your mother. The first step may be an elder care attorney to get you into court to be assigned her guardian. This will get you the power of attorney you need to pay her bills. It is a long process and not without cost. Keep CAREFUL records of anything you spend on the Elder Care Attorney and the process to be made guardian so you can get those funds out of her estate.
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Is there a dr she sees at the ALF? Are her mental issues related to mental illness or dementia? If dementia, see a neurologist. Change pcp drs. My mother insisted on seeing a quack who refused to diagnose my stepfather as having any “dementia “ (neurologist considered him moderate to severe Alzheimer’s). I think it’s misguided “ sympathy “ that doesn’t help anyone and makes the whole situation worse.
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AT1234 Jun 2019
There are geriatric drs that see patients in facilities but even they are reluctant without a full psych evaluation. Since it’s been so long I’m not sure I wouldn’t go back to original psych dr. Have ct scans been done or maybe not needed or possible.
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Pay the psychiatrist to visit her in the ALF so that he has seen her - and get him to talk to staff to get a good picture of her mental state. Doesn't need to be re-admitted, he just needs to be offered sufficient inducement to go and see her where she is. Sadly money rules.
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AT1234 Jun 2019
That doesn’t happen here maybe in U.K., but most psychs here do not make house calls.
The facility has a dr on call get that set up, or transfer.
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My great-aunt was able to fool the doctors for the short time-frame for the testing for dementia. It took the intervention of a lawyer & his head nurse wife (friends of the family) to find a doctor to ask the right questions to prove incapacity.

In defense of your mother's internist - he has to protect himself from malpractice and also he is supposed to be "for" your mother and protect her rights.
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If internist won't sign declaration of incapacity is it because she isn't incapacitated? If so, she could appoint you poa/dpoa and your problems go away. In our case, hubby hadn't seen his primary for over a year (because there isn't anything else the matter with him and he only sees her once a year anyway). But I needed 2 letters. She wrote one for me without question and gave me a reference to a neurologist and I was able to make an appointment pretty quickly, the neurologist talked to him for about 10 minutes and wrote the 2nsd letter. It was obvious to him that hubby lacked capacity to make any decisions for himself.
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Is there a doc at the facility where she is at? One that oversees the facility? Maybe he can see her. Explain the situation. Im sure your not the first person to have this issue. You can always talk to the intake coordinator of the facility. See what they suggest.
Id also see if you can go to the head of the department in the psych unit. They saw her there at the time. How did she miraculously improve so much?

You need help and the docs keep pushing it off. You can always cry a bit, say your overwhelmed by this and no one will help, just passes the buck etc, etc.
Tell them you are out of state. You need help. They have her records. Its rediculious you have to take off from work and drive sev states to deposit her in the psych docs office. Which then he wont be there, or you have to re-admit.

Or just wait till she requires hospitalization or doc visit again.
Go to the head of the hospital if you have to and explain you need help. Good luck.

You can also ask the DSS for help, or call the dept of aging in the state and county she was in. Explain the situation. Good luck.
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