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HomeMy WebLinkAbout12-19-12 ANNUAL REPORT OF Cl) rn GUARDIAN OF THE PERSON W J r-~ G'3 Ell COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ` i' Estate of Mildred M. Sitlinger , an Incapacitated Person No. 11-0976 1. INTRODUCTION Janell R. House was appointed ❑ Plenary [Limited Guardian of the Person by Decree of Honorable M.L. Ebert Jr. , J., dated December 2, 2011 A. This is the Annual Report for the period from December 2 2011 to November 30 , 2012 (the "Report Period"); or ❑ B. This is the Final Report for the period from to (the "Report Period"), and is filed for the following reason: 1. The death of the Incapacitated Person. Date of death: 2. The Guardianship was terminated by the Court by Decree of J., dated For a Final Report, omit Sections II through IV. Form G-03 rev. 10. 13.06 Page 1 of 4 04 i Estate of Mildred M. Sitlinger an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person: 83 Date of Birth: 10-8-1929 III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: 413 Park View Drive Harrisburg PA 17110 B. The Incapacitated Person's residence is: ❑ own home / apartment ❑ nursing home ❑ boarding home / personal care home ❑ Guardian's home / apartment ❑ hospital or medical facility ® relative's home (name, relationship and address) Mary J. Anthony, Daughter 30601 Dagsboro Road: Salisbury, MD 21804-2178 ❑ other: C. The Incapacitated Person has been in the present residence since June 27,2012 . If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: Moved from Rest Haven Nursing Home; Schuylkill County 12/09/2011 to Country Meadows: Trinity Road; Mechanicsburg, 12/10/11 to 6/27/2012. Form G-03 rev. 10. 13.06 Page 2 of 4 Estate of Mildred M. Sitlinger an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: Mary Anthony; 30601 Dagsboro Road; Salisbury, MD 21804 Shady Pines Adult Day Service; Shore-Up Inc. Adult day care Monday - Friday 520 Snow Hill Road; Salisbury, MD 21804 IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: See Attached; Discharge papers from Rest Haven & current progress note from Adult Day Care B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: See Attached: V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: 0 continue ® be modified 0 be terminated Form G-03 rev. 10. 13.06 Page 3 of 4 Estate of Mildred M. Sitlinger an Incapacitated Person The reasons for the foregoing opinion are: Her mental and physical condition continues to decline B. During the past year, the Guardian of the Person has visited the Incapacitated Person 60 times with the average visit lasting 1 hours, 30 minutes. The report of a social service organization employed by the Guardian to oversee and coordinate the care of the Incapacitated Person for the period covered by this Report may be attached to supplement this Report. I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties of 18 Pa. C.S.A. § 4904 relative to unsworn falsification to authorities. December 19, 2012 U--~ ~C 4-4-~ Date Signatu Guardian of the Person Jan R. House Name of Guardian of the Person (type or print) 413 Park View Drive Address Harrisburg PA 17110 City, State, Zip 717-979-4208 Telephone Form G-03 rev. 10. 13.06 Page 4 of 4 Addition comments for Annual Report of Guardian of the Person report # 11-0976 For Mildred M. Sitlinger; III. Living Arrangements part C: Moved from Country Meadows on 6/27/2012 to Mary J. Anthony; 30601 Dagsboro Road; Salisbury, MD 21804-2178 to present. Reason: Moved to Country Meadows an assistant living environment after the Courts appointed guardianship. Moved to her daughters home after Incapacitated persons request/question why she couldn't she live with one of her daughters, and the cost of assist living when up. We decided to give her the home care until her physical or mental health would require care beyond our ability. V. Guardian's Opinion part B: 4 times with the average visit lasting 6 to 8 hours since she is out of state. Rest Haven Nursing Home 12109/11 14:10 Page: 1 Discharge Summary Name: Sitlinger, Mildred M ID: 431 Form Date: 12/09/2011 12:52 pm Admitted: 11108/2011 Unit: 408A Gender: Female Birthdate: 10/08/1929 Age: 82 SSN: 177-24-5631 Planned Discharge Summarv Discharge Date 1219/11 Discharged Against Medical Advice N Discharged To Country Meadows Retirement Communities in Mechanicsburg, PA Medications/Treatments Prescriptions Written For Discharge 0 See Attached Coordinated Services Office of Senior Services (Meals on Wheels, Attendant Care) ❑ Home Health (Therapy Services, Attendant care) ❑ Hospice ❑ Name of Orgainzation & Phone Number MAR sheets being sent to Country Meadows Retirement Communities in Mechanicsburg, PA Follow Up Appointments none scheduled Rehabilitation Potential Cognitive Status Good 0 Fair ❑ Poor ❑ Alert 0 Comatose ❑ Short-Term Memory Problem 0 Long-Term Memory Problem H Assistive Devices & Equipment Cane ❑ Walker ❑ Braces/Prosthesis ❑ Toilet Rails ❑ Wheelchair ❑ Bed Bound ❑ Raised Toilet Seat ❑ Discharge Dietary Instructions house diet Admission Diagnosis #1 Alzheimer's disease, moderate severity #2 paranoid psychosis #3 generalized anxiety disorder #4 Major depressive disorder Rest Haven Nursing Home 12/09/11 14:10 Page: 2 Discharge Summary Name: Sitlinger, Mildred M ID: 431 Form Date: 12/09/2011 12:52 pm #5 disruptive behavioral disorder #6 HBP #7 hyperlipidemia #8 osteoarthritis #9 constipation #10 vitamin D deficiency #11 anemia #12 status post TAH/BSO #13 status post appendectomy Discharge Diagnosis Same + bleeding external hemorrhoids Brief Medical History 82-year-old white widowed woman admitted 11/8/11 from SMC, East, SBU where she was voluntarily committed under the protective services of OSS because of alleged abuse by family members, purported to be both physical and financial. She was declared incompetent by the Cumberland County court on 12/2/11 and is being transferred as per her guardian's decision today to Country Meadows. Pertinent Lab Findings 11/11/11 reticulocyte count 1.3% hemoglobin 11.3 hematocrit 32.5 MCV 89.2 serum iron of 58 iron saturation 28% 12/2111 B12 383 folate 10.5 Allergies NKDA Q Doctor's Signature Herbert C. Rubright,Jr MD Date 12/9/11 Nursina Assessment —SECTION TO BE COMPLETED BY NURSING- Please check the appropriate box to indicate the resident's ADL status Self Supervision Needs Assistance Total Assistance Comments Personal Hygiene Wash Hands & Face I7 ❑ ❑ ❑ Showering/Bathing ❑ H ❑ ❑ Oral Care © ❑ ❑ ❑ Toileting D ❑ ❑ ❑ Dressing Rest Haven Nursing Home 12/09/11 14:10 Page: 3 Discharge Summary Name: Sitlinger, Mildred M ID: 431 Form Date: 12/09/2011 12:52 pm Upper Extremities 0 ❑ ❑ ❑ Lower Extremites 0 ❑ ❑ ❑ Prosthesis/Splint ❑ ❑ ❑ ❑ Transfers Sit to Stand 0 ❑ ❑ ❑ Ambulating 0 ❑ ❑ ❑ Stairs 0 ❑ ❑ ❑ Tub/Shower ❑ 0 ❑ ❑ Toileting 0 ❑ ❑ ❑ Dietary Teeth Own ❑ Dentures Y Uppers 0 Lowers 0 Adaptive Equipment Sensory/Physical Impairments Hearing Impaired ❑ Deaf ❑ Hearing Aid Right ❑ Left ❑ Vision Impaired ❑ Glasses 0 Blind Left ❑ Right ❑ Both ❑ Communication Ability Able to Make Needs Known Y Can Speak Y Clear Y Unclear Can Write Y Uses Comminication Board N Understands Spoken Word Y Understands Writing Y Understands Gestures Y Toileting Bladder Continent 0 Incontinent ❑ Bowel Continent 0 Incontinent ❑ Rest Haven Nursing Home 12/09/11 14:10 Page: 4 Discharge Summary Name: Sitlinger, Mildred M ID: 431 Form Date: 12/09/2011 12:52 pm Vaccination Dates ****`*Please inform your healthcare provider on your next follow up appointment of any new vaccinations you received while in our facility.-- Mantoux (tst) Dates 11/09/2011 111611 Reaction Influenza Date or Refusal 09/30/2011 Pneumovax Date or Refusal refused Other Explain Medication/Treament teaching has been completed and goals met and understood N Medication Adminstration Self ❑ Set Up ❑ Assistance ❑ Total Assistance H Special Post Discharge Instructions Dressing Change ❑ Colostomy Care ❑ Diabetic Instruction ❑ Insulin ❑ Other The above instructions have been explained and are understood y Discharge Arrangements (Accompained by/Transferred by) Janelle House daughter Your follow up appointments and coordinated services and their contact information have been provided to you. Should you need any additional assistance or ahve any questions, please contact the Rest Haven Social Services Department at 570-385-0331 Discharqe Instructions Discharge instructions have been reviewed wtih me in a language I understand. All questions have been answered to my satistaction Signature of Resident or Representative Date Signature of Staff Member uiscnarge *ummary Name: Sitlinger, Mildred M ID: 431 Form Date: 12/09/2011 12:52 pm Date ****Copy of this page to be given upon discharge*** ❑ This form was inputed by error ❑ Wrong Resident ❑ Duplicate ❑ Other Signature of person making error Created By: HERBERT C RUBRIGHT JR MD 12/09/2011 2:09 pm Locked By: December 7, 2012 To Whom It May Concern: Please except this letter as a nursing progress note for Mildred Sitlinger. M.S. has been in attendance at Shady Pines Adult Day Services sine July 10, 2012. M.S.attends the daycare five days per week for staff provided care and socialization while her daughter works. M.S.'s need for care is related to a diagnosis of Alzheimer's Dementia. Although M.S. has a diagnosis of Alzheimer's she is alert and able to make her needs known, she is oriented to person and place. Initially M.S. ambulated with assistance of a rolling walker and supervision of staff, however, since a fall on 10/20/2012, M.S. is wheelchair fast due to ambulatory dysfunction. M.S. is learning to propel herself adlib through the facility. M.S. presents each day to the facility clean and neat, absent of odor, hair clean and neatly styled, glasses in good condition and dressed appropriately. M.S. eats mostly 100% of all meals unless she does not like something and her weight has remained steady with the exception of a loss during her hospital and rehab stay. M.S. is incontinent of bladder and occasional bowel incontinence and wears protective undergarments, M.S. has remained free of skin breakdown and has not presented with irritated or chaffed skin. Since M.S. has attended this facility she has received two head-to-toe assessment by the facility RN with no significant findings or concerns. M.S. does have high blood pressure and receives daily medication for regulation, clients daily B/P readings are WNL as is her heart rate. While at the center each day, M.S. interacts well with fellow clients and staff, she participates about 50% of the time in facility activities and is cooperative with care and any task at hand. M.S. appears to have adjusted well to the facility; she is able to rest as needed in a recliner throughout the day. Daily she present without voiced complaints of pain and she has had no signs or symptoms of distress. This nurse observes her interactions with her daughter, Mary Anthony, whose care she is in and offers no concerns. Theresa Clagg, LPN Shady Pines Adult Day Services