HomeMy WebLinkAbout03-14-14 ANNUAL REPORT OF � �=� �
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GUARDIAN OF THE PERSON ,.-T��.,� � ��:i�?
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Cumberland COIINTY, PENNSYLVANIA D� � `��'�'`�'
ORPHANS' COURT DIVISION m° Q
Estate of Hazel A. Priest , an Incapacitated Person
No. 21-09-0878
I. INTRODUCTION
Jewish Family Service of Greater Harrisburg, Inc.
, was appointed
❑Plenary mLimited Guardian of the Person by Decree of J. Wesley Oler, Jr. J.�
,
dated January 4,2010
m A. This is the Annual Report for the period from January 1 � 2013
to December 31 , 2013 (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 Ii�
Form G-03 rev. 10.13.06 Page 1 of 4
Estate of Hazel A. Priest , an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: g� Date of Birth: 10/11/1926
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
Homeland Center- 1901 N. Sth st., Harrisburg, PA 17102
B. The Incapacitated Person's residence is:
❑own home/apartment
m nursing home
❑boarding home/personal care home
❑Guardian's home/apartment
❑hospital or medical facility
❑relative's home (name, relationship and address)
❑other:
C. The Incapacitated Person has been in the present residence since January 4, 2013
. If the Incapacitated Person has moved within the
past year, state prior residence and reason(s) for move:
922 Susan Circle
Enola, PA 17025 Client moved due to increased medical needs
Form G-03 rev.10.13.06 Page 2 of 4
__
Estate of Hazel A. Priest , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
Jewish Family Service of Greater Harrisburg, Inc. (JFS)
3333 North Front St.
Harrisburg, PA 17110
Limited Permanent Guardian
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
Hazel has progressive dementia and can not make financial/healthcare decisions for
herself. Hazel can no longer ambulate or assist in transferring herself so she is need
of a full assist for any movement in or out of her wheelchair and bed. Hazel also
has diabetes which has worsened over the past year.
B. Specify what, if any, social, medical,psychological and support services the
Incapacitated Person is receiving:
JFS serves as guardian of person and estate. JFS pays Hazel's bills,banking and any
other administrative needs. JFS attends Hazel's care plan conferences and makes
any healthcare decisions necessary on her behalf. JFS also provides psycho-social
support through monthly visits and advocates on her behalf when necessary.
Homeland Nursing Center provides housing, all medical care and nutritional needs,
transportation to appointments and socialization within the facility.
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
m continue
❑be modified
❑be terminated
Form G-03 rev. !0.l3.06 Page 3 of 4
Estate of Hazel A. Priest
, an Incapacitated Person
The reasons for the foregoing opinion are:
Hazel has continued to decline cognitively and physically due to her age and
medical conditions. Hazel does not have the capacity to take care of her own
financial needs or to advocate for herself.
B. During the past year, the Guardian of the Person has visited the Incapacitated Person
24 times with the average visit lasting 1 hours, 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.
3/14/14 `_�._....��/1� � _ �'•��¢����-�.
Date Signature of rdian ofthe Person
Marjorie E. Koch LSW-rep. of JFS-guard.
Name of Guardian of the Person(type or print)
3333 N. Front st.
aadress
Harrisburg, PA 17110
Ciry,State,Zip
(717)233-1681
Telephone
Form G-03 rev.10.13.06 Page 4 of 4