Demystifying Medicine One Month at a Time

Probate Mysteries

This article in the Halloween edition of the NY Times reminded me of something I’ve wanted to learn more about.

Maybe you can help me.

Who'll sign on the dotted line when you can't?

I call it Probate Mysteries. [Not a sexy enough title to land a cable drama slot, but OK for a blog.]

You see, once every so often, a patient comes into the hospital in terrible shape, and there’s no one attached to them.

No family. No friends. No neighbors.

The next of kin on their demographic form is invariably unreachable.

When I say terrible shape, I mean terminal. Either with dementia so advanced that she doesn’t know who or where she is, or in some type of coma from which she’ll never wake up.

It’s time to get her affairs in order.

Only, there’s no one from the family to help with decision-making.

And if you guessed that this patient had no advance directive regarding her health care, you’d be right.

It’s not an accident that folks who have no relatives living or are estranged from them tend to hide from the health care system until it’s too late. [No judgement implied.]

Our fantastic hospital social workers work like private investigators to find someone who can help with the “disposition” of the patient–and by that I mean help with a placement (not always immediately to the morgue, mind you) and a more suitable living arrangement. And help to start untangling the patient’s finances.

Medical school teaches us nothing about these types of situations, other than efforts to help us figure out who an appropriate surrogate decision maker should be. But when there literally is no surrogate we can find, we rely on the hospital’s lawyers to find a guardian ad litem, a court-appointed fiduciary to help facilitate matters of the estate.

Once I was involved in such a case, and rumors swirled that the patients in question were a couple of ample means. Tragically, the husband and wife were both severely affected with Alzheimer’s, and totally incapable of making any decision, medical or financial. And they’d had no children. They’d outlived their siblings.

I will admit that I thought about volunteering as an heir. They wound up in a nursing home, where I think their ample funds were “spent down” to care for them in their final days.

I’ve always wondered how many stories there are out there like this. And with an aging population, it’s conceivable we could hear more such stories….


  1. mary

    The folks who deal with this stuff often are the adult or elder protective services investigators – different terms and laws in different states. Sometimes you find these elders all alone, but often they have been ‘befriended’ by one or more predators who help the elder and help themselves to the elder’s resources! The boomers need to understand now that they are not going to all stay sharp and lovely and completely independent until they drop dead on the tennis court at 100 years old, and start realistic planning for the period of time that includes progressive disability before death.

  2. dollarsdownthedrain

    I think all primary care physicians should encourage (strongly encourage) their patients to file a “living will” and ” advanced directives” with their primary hospital. (The Tea Party may take issue with this) These documents can then be scanned into the electronic medical record. Unfortunately the EMR at the Glass Hospital I work for has no such capability. If the situation changes a new “directive” can be scanned in and the physican can then document in “notes” that a new health directive was filed. This directive will include contact info for relatives etc. and specific directives. This would make things much simpler for all concerned. As the “boomers” slide into the twilight years this will become a larger issue.

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