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Getting Organized

Getting Organized

Tracy
Okay, the next thing that we’re going to cover is called case management. Now I know that sounds pretty clinical. Of course, what I mean is how you manage or coordinate the care that your family member receives. Now a big part of that is how you organize their medical and their military records. 

I cannot stress enough the more organized you are, the better. Being organized will help you have so much more control when you’re making those decisions, and it will ensure that you have access to accurate information. It’ll also help reduce your stress by having you know all that care-related information that you need just in one place.

Julie
It took us awhile to get organized with all of Sam’s paperwork. At first we were… we were a mess. Now, we’re much better at it. We keep a notebook or file for everything.

Carl
Every time Sam gets a new medication, they give us a sheet that lists the side effects and all of that. That goes in the medication slot. Every time he has surgery, that information goes into the surgery slot. Julie actually created a file on the computer of every surgery that he’s had, and what they’ve done, and the dates. And I’ve documented every seizure that he’s had. We carry that information with us so that when someone asks about Sam’s medications, or about his surgery or seizure history, it’s right there.

Tracy
That’s really excellent, Carl and Julie. I knew that your experience would be helpful to the others.

Now you may end up with several notebooks and file folders to help keep the information together. Just be sure to keep all medical information, and like Julie, you may want to enter information into a computer file. That’s a great idea.

Megan
So what else should we have in the notebook? I mean, are there certain things that we might need, or that we’re likely to be asked for?

Tracy
Well absolutely. I mean that’s a really good question, because your notebook should include sections for the personal and military information, emergency contacts, any allergic reactions that he might have had to any medications.

Another really important thing to have is to include Clayton’s medication log. Be sure to write down all the medicines that are taken, the dosages, the dates, any side effects, any problems. You’ll find a form that you can use in your Guide for Caregivers.

You’ll also want to keep copies of all of his medical records, including all the reports, tests, scans in a section of the notebook. Now you’ll need to ask your care coordinator how to get copies of those test results. But you… you can put your CT and the MRI scans of the brain on a CD, you can keep them right there and you can share with future providers. 

It’s also a good idea to include three-hole punched paper right in the notebook. And that way, you can use it to take notes and then insert the sheets right in the right place.

And your notebook should also include a resources, information section, that’s where you can keep the forms and the information you receive at appointments. But and finally, you’re going to want to keep a calendar of appointments in the notebook, and you’re going to want to have that with you at all times.

Michelle
I’ve also started to accumulate paperwork about benefits and stuff. Should I put that in the notebook, too?

Tracy
Oh yes. Yeah and you may want to keep another notebook for medical and family benefits or Medical Evaluation Board and the Physical Evaluation Board information. You’ve probably heard these boards referred to as MEB and PEB.

These benefits files are important because it will help you when you apply for financial aid, or a job, or more medical care. So you’ll want to keep a back-up copy of that file too just in case it ever gets lost. 

Now your benefits file could include things like Social Security numbers, military records, insurance cards, Power of Attorney, driver’s license, birth certificate, oh and your marriage certificate that should also be included. It’s also a good idea to keep school records, work records, tax returns, a list of assets in the second file. We’ll talk more about benefits in a later session.

Megan
This is going to be so confusing. I don’t know how I’m going to keep all of this straight. I mean we don’t have family around here, so it’s just me.

Tracy
Oh Megan, I know this can be overwhelming, just try to keep in mind that there are so many sources of support. You’ve got the doctors, the therapists, caseworkers, counselors…all the professionals that are there to help you every step of the way. You’ve got friends, the chaplains, support groups like this. You know part of what we’re here for is to establish a support network. But we’ll talk more about that later as well.

Now one more thing that I wanted to cover today, and that’s… well paying the bills, handling the finances. If your family member with TBI was responsible for those things, you should make sure that your name is on all the accounts, that you’re authorized to make transactions. That can be challenging sometimes. You know it might be necessary for you to obtain legal assistance to do this. But one other thing that you might want to consider is online banking and bill paying that can definitely streamline things, especially when you’re away from home.

And streamlining things…making things easier for your loved one with TBI and for yourself that’s … that’s such an important part of being an effective caregiver.

Megan
Tracy, right now, it just seems like during the day I’m always with Clay and the doctors. I mean do I need to pay all the bills and deal with the accounts right now?

Tracy
Well, this can be very time-consuming, but it’s important. You need to get started right away. Just see if you can set aside a block of time each day, make those calls, complete the paperwork that you need to. Just… just do the best you can that’s all you can do.

Look I know that you have so much going on right now, but I ask that you try to take some time this week to take care of yourselves. Get plenty of rest, you’ve gotta be as sharp as you can to take care of that family member. Now hang in there. Okay.

So are there any other questions? Nothing else. Okay. So I’ll see you next week. You take care! Call me if you need me. Okay.

Legal Issues

Legal issues to protect your family and your service member/veteran with TBI include:

  • Guardianship 
  • Power of Attorney (POA) 
  • Medical POA, medical directives 
  • Trusts 
  • Life trusts, life insurance, and listing beneficiaries on life insurance policies 
  • Living wills

You may need to consider these issues to make good decisions about your family’s future. It may also seem hard at first.

Take your time to read this section carefully. It provides the basics of each legal concept. Discuss your personal situation with an attorney or social worker/case manager who has experience with legal matters.

Each state has its own set of rules regarding these legal documents. You will need to find out what the rules in your state are from someone with legal expertise.

Guardianship

If your service member/veteran is severely injured and unable to manage his or her own affairs and property, you may need to be appointed guardianship.

There are three categories of guardians:

  • A Guardian of the Person ensures the physical care and rehabilitation of the disabled individual.
  • A Guardian of the Estate (also called a conservator) manages the financial affairs and property of the disabled person.
  • A Plenary Guardian does both.

Guardianships are covered under state law. To obtain guardianship over your family member with TBI, you will most likely need an attorney to represent you in court.
You will be required to submit periodic reports and a doctor will need to periodically re-certify that the guardianship is still needed.

Power of Attorney

Because of decreased cognitive and functional abilities, your family member with TBI may need you or another person to be named Power of Attorney to act for him or her in legal and financial issues. Check to see if your family member has already created a Power of Attorney (POA). A Power of Attorney (POA) is a written document in which a competent person, the principal, appoints another person, the agent, to act for him or her in legal and financial matters. In legal terms, a person is competent when he or she is able to reason and make decisions.

There are different types of POAs:

  • A general power allows the agent to do any act or exercise any power on the principal’s behalf. Only use a general power when a special power is insufficient.
  • A specific or special power limits the agent’s authority to only the act or acts listed in the POA document.
  • A durable power of attorney permits the agent to continue to act on the principal’s behalf if he or she is incapacitated.

A Power of Attorney is created when the principal (your family member) signs a notarized document that legally authorizes another person to act on his or her behalf.

Most POAs last from a definite start time to a specific end time, but they may be created to last for an indefinite period. A POA can be revoked at any time for any reason. There are two ways to revoke a POA:

  • By destroying the original document; and/or
  • By executing a “Revocation of Power of Attorney” form and sending a certified copy to any financial institution or company where your agent has conducted business on your behalf. A Guardian can override or revoke a POA.

Medical Power of Attorney

A durable Power of Attorney for Health Care is also known as a medical Power of Attorney or health care proxy. It appoints a primary and secondary agent to make decisions about medical care, including end-of- life issues, in the event that the principal is unable to make those decisions.

Living Will

A Living Will is often called an Advance Directive. A Living Will provides a person’s written instructions on providing or withholding life-sustaining care or procedures when he or she is in a terminal or permanently unconscious condition. It is not required to have a living will to receive medical care.

Many people use a living will, along with a medical Power of Attorney (also called a health care proxy), to make their wishes known about medical treatment and health care.

Wills

If your family member with TBI is your spouse and is unable to make decisions regarding your estate or the care of your children, you may wish to consult your lawyer and make changes to your will.

This may involve naming a guardian for your children and/or assets in the event of your death.
You may also wish to discuss creating a trust as an alternative estate planning tool.

Trusts

A trust is a document used in estate planning. A trust is a written legal agreement between the individual who creates the trust (called the grantor, settlor, or creator) and a trustee, the person or institution who is named to manage the trust assets.

The trustee holds legal title to the assets for the benefit of one or more trust beneficiaries. The ideal trustee has personal knowledge of the grantor and investment expertise. A trustee team—composed of an individual trustee who knows the grantor well and an institutional trustee with investment knowledge—is a workable solution for some people.

There are different types of trusts. The basic categories include:

  • A revocable living trust is one that can be changed or cancelled at any time.
  • An irrevocable living trust cannot be changed. 
  • A testamentary trust is one that is irrevocable upon the person’s death.

Within these basic categories are a number of types of trusts. Two that may be of interest to families who have a service member/veteran with TBI are:

  • A “special needs” trust is one that is created by a parent or other family member of a person with a disability who is the beneficiary of the trust. This can be either a living trust or a testamentary trust. The trust may hold cash, personal property, or real property, or can be the beneficiary of life insurance proceeds. The disabled person cannot have any control over these assets.
  • A Qualified Income Trust (“Miller Trust”) is used in states where there is a limit on the amount of income allowed for Medicaid nursing home eligibility. Some nursing home residents may have retirement incomes at or above the level that disqualifies them for Medicaid, yet do not have enough money to privately pay for a nursing home. Section 1396p of Title 42 of the United States Code permits the creation of an income diversion trust that allows pension, Social Security, and other income to be placed in an irrevocable trust. Upon the death of the beneficiary, the state receives all amounts remaining in the trust equal to the total medical assistance paid by Medicaid on behalf of the beneficiary.

My Legal Documents


Military Resources

You can find more information about trusts, powers of attorney, and advance medical directives in the Estate Planning Tool Kit for Military Family & Members www.jagcnet.army.mil

The Armed Forces Judge Advocate General’s Corps is comprised of the Army, Navy, Marines, Air Force, and Coast Guard Judge Advocate General’s Corps. The Corps provides legal assistance to all active duty service members, reservists on active duty for 30 days or more, and retirees from all branches of the service, and their lawful dependents, based upon available resources and personnel.

To locate a legal assistance attorney, consult the Armed Forces Legal Assistance Web site at legalassistance.law.af.mil/content/locator.php. U. S. Army Judge Advocate General’s Corps maintains a Web site to inform military members on personal legal affairs and preventive law. The site www.jagcnet.army.mil/legal contains links to many legal resources.

The U. S. Army Judge Advocate General’s Corps maintains a Web site to inform military members on personal legal affairs and preventive law. The site www.jagcnet.army.mil/legal contains links to many legal resources.

The American Bar Association has a standing committee on Legal Assistance for Military Personnel (LAMP). Its Web site:
www. abanet.org/legalservices/lamp/home.html contains useful legal information. It also includes a link to Operation Enduring LAMP which recruits volunteer lawyers across the country to assist military families with legal issues.

Related Information:
Planning for the Future
Organizing Records
Organizing Information
Paying Bills
Medication Log
Glossary
Frequently Asked Questions
"He really won’t tell me the whole story because I think he doesn’t want to scare me. But, he brought me a piece of metal back home that was embedded in the wall right behind him. He said it missed his head by a few inches. He said that he thanks God every day that he’s still alive, and that’s why he brought the piece of metal home, to show me that that’s how close he had come to dying." -  Lynn C-S.

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