When elderly relatives refuse help....anybody had this problem?

[K8-EEE]

OK so I have this aunt. She has always been both fiercely independent and "a character." She had limited education but she is smart and moved here from rural NV and managed to become a paralegal, she worked for a Fortune 500 company in L.A. until she retired 15 years ago. She never married or dated anybody to my knowledge.

After retirement when the "eccentricity" slowly started to become something else. Not Alzheimers, she is still pretty sharp and in fact I send her DU links and we discuss them, she loves reading about politics and discussing. But she became more and more of a recluse. She stopped attending the weekly Sunday bbq's at my house a few years back, she used to come occasionally, but she still came to Christmas dinner (I am sort of "the entertainer" of the clan.)

Well last Christimas she sent regrets, said her knee was bothering her. Her knee had been bothering her. But it had been "bothering" her for years and she never went to a Dr. and always claimed it was "90% better."

Well fast forward, she had to call 911 because she let her physical state deteriorate to where she literally could not get up off the chair. She ended up in the hospital and then a nursing facility. No one had been invited to her apt for years so it was shock to my mom, who had to go get some stuff, that it was such a mess; she had always been an immaculate housekeeper.

Now she's been released and insists on going back to her apt. even though it has stairs to her front door and she BARELY could get in the place. And now in -- she can no longer take the stairs down unassisted. :-(

I have been researching independent senior living places by me -- apartments that have elevator access and easy access bathrooms and somebody downstairs 24/7 if she needed assistance. If she rented out her condo it would cover the rent. My sister and I are willing to paint, clean and fix up her place and deal with renting it and moving. But she won't hear of it. She won't even get one of those "I've fallen and I can't get up" deals even though she has mobility issues and now uses a walker. She refuses our offer of a cell phone.

I am just so sad and worried about her but it is hard to help people who can't/won't accept help. The only thing she accepts from me is food/groceries but she wants me to leave them outside her door which I think is so sad. Today I brought her some of her fave things to eat b/c she hated the nursing home food, but it's so sad having to have them dropped off at the door and knowing the reason she wouldn't open the door to anyone. It's just very sad :-(

My parents are very like "well what can you do?" about it but my sister and I are wondering about an intervention?? We did one on my dad years ago (alcohol) and it was successful so why not do it with her too? She is definitely in denial about needing help.

[pscot]

1. People have a right to decide

how they want to go out. She clearly doesn't want to be institutionalized. You could try to have her declared incompetent, but from what you say, she wouldn't thank you for it. Maybe a local senior center could provide some advice.

[K8-EEE]

2. Well my suggestion is not really

"institutionalized" but it's moving to a senior apt., meaning, there aren't stairs and she can access the bathroom and kitchen which she is struggling with in her place.

She is just to the place where she hates change; but where she is, it is multi-levels and not "walker friendly." They sent her home with a walker, but in a condo that won't really accommodate that.

[hailhydra]

3. It may sound silly but

try Binging geriatric counseling in your home town. My aunt went through a similar ordeal and this really helped. The therapist specialized in older people and he helped make the transition from living on her own to living in an assisted living community (which I think it what you're looking for). My aunt was a very wonderful woman and she was very spirited. But we started getting worried when we discovered that she started hoarding things like used toilet paper...

Good luck. This situation is not easy but I think a counselor who specializes in geriatric therapy could really help. I'll keep your family in my thoughts and send some good vibes.

[murielm99]

4. Welcome to DU.

Your advice is very sensible.

We are starting to worry about my parents, too. My dad should be in an assisted living situation, but we can't force anything on them. At least my mother goes to a caregiver's support group, and they have a home health aide. Change is not going to be easy for them.

[K8-EEE]

6. That's a great suggestion!

I will look into that! Have never dealt with this issue before, that makes sense that there would be geriatric counselors.

Thanks and welcome to DU!

[snagglepuss]

17. Good advice. Welcome to DU hailhydra.

:hi:

[Bryn]

5. Your aunt sounds like my mother

My mother was diagnosed with moderate dementia in December 2008 at age of 78. Now she has advanced dementia. I became her sole caretaker which she didn't like, but her doctor said she can no longer drive, cook, live alone, etc. so I had her moved in with me so I'd take care of her. It hasn't been easy. Some days she's fine and some days she's way off... like switching back and forth.

Yes, it's sad. :(

[K8-EEE]

9. She is lucky to have you!!

Wow that is a lot to take on, she did a good job raising a nice person!

[quakerboy]

7. Some people stay able and independant to the end

others do not. Some are happy to start letting someone else finally take care of them, others fight it tooth and nail.

You can try to reason with her. You can try "intervention", but it has no more strength than it would with any other adult who is free to listen and accept or walk out halfway through the discussion and stop returning your calls. And if you have reached a point where she won't even open the door to you, that would seem to me to speak volumes about how much she is willing to listen right now. But you know her far better than I do.

You are not the boss of her. Unless you follow the law and apply for (and are granted) guardianship or some other similar legal status, you do not get to make choices for her unless she wants to follow your advice.

If it is your intention to force the situation, you can contact social services in your area. They often have teams they send out to examine homes for safety. Fire hazards and getting those cleaned up are a big one, but some levels of unsanitary situations also can trigger further action. If the denial has an immediate personal safety risk attached to it, that can also result in some action.

That's a damn hard line to toe. At what point does eccentricity devolve into mental illness. Where does a natural preference for the safety and comfort of home cross over into a dangerous situation due to a lack of competency. Only you can decide if you think the line has been crossed, and if you do decide it has and you have to follow up on it, you will have to live with the consequences of doing something about it. Or conversely, if you decide to do nothing, you still have to live with any potential consequences of your decision.

Personally, I tend to err on the side of personal freedom in this. As long as their actions are only a threat to themselves, and there is potential that they are doing what they do by choice, I will let it be. When my grandpa decided not to sell his house, even though its a death trap and he was being offered a generous price for it and needed the money, that was his choice. But when he started seeing "well endowed" orange "gnomes" and crashing his truck into things, I called DMV to report that.

[K8-EEE]

8. Well endowed orange gnomes!!

Wow!! Well as I say she has been retreating more and more that last few years and the last 2 years really prefers to communicate by email.

One of the nurses at the hospital said something like "she seems to have bouts of dementia but is good at covering them." I wonder if that's why she doesn't want people to come over, or to come to the family dinners? Because she is afraid of being "found out?"

One huge issue is that she cannot physically use her shower. It is a tub/shower and she can't get in it. I know there are people who refit bathrooms to where you have a shower you can use a walker to get in, and that have seating. But she is overwhelmed by the thought of construction or anything. My sister wanted to do it while she was in the nursing facility but she was like "I CAN'T THINK ABOUT THIS RIGHT NOW!" She is very easily overwhelmed.

[quakerboy]

10. Fair warning

I work with a lot of older people in tough situations. I have a fairly dark view of the whole thing.

My first job out of college was stopping by an apartment shared by and older couple and their adult(older than my parents) developmentally delayed son. the wife was older, and stooped. The husband was very nearly catatonic. He had been moved to a hospital bed that dominated the living room. He rarely spoke, and seemed unable of lifting or moving himself at all. My job was to come in several times a week and manually lift him into a wheelchair so he could be handfed toast at the table rather than gruel in bed. The one time we spoke when his wife left the room, he made it clear he did not want to be in this life. But his wife hung by him until live became a biological impossibility.

I see lots of people in tough situations, where they are mentally deficient to deal with the circumstances they are in. Unfortunately people do deny where they are, and it ends up with a third party stepping in to make decisions that are nothing like what the person would have chosen when they were still competent to choose. But without planning, the choice has to be made by "independent" criteria.

I also have wishy washy family, and it kills me. I figure you have to make a decision and live by it. If grandpa does not want to follow any advice or accept help to better his situation, I cannot force him. And I respect myself enough to not be abused by a grumpy old man. So I step back. Others are unable or unwilling to do so, and step in, receive the abuse, and complain because he wont listen. He has paranoia and a lifetime of drinking. Of course he is secretive and abusive. People are as they are.

With your situation, there may be some dementia. There is testing that can be done to try to prove this. But you would likely have to force the situation to get that to happen. I am surprised with her recent hospitalization that was not done(or was it?). But another possibility is that she just doesn't like some of the people at gatherings, is embarrassed about the state of her home and her self, and generally finds going out to be overwhelming or physically uncomfortable. In my experience none of those is especially uncommon.

If it was me, I would look at it and see three possible basic courses of action. You can do nothing, in some variant(continue as is). You can call in higher authorities (report a fire hazard, call a mental health crisis line to report physical endangerment, mental incapacity, etc). Or you can attempt to be the authority. Sometimes family members just "do". Instead of asking "do you want a cell phone" they say "here is the cell phone we got you". "We hired this guy to come and look at refitting your bath so you can use it". Any one of these courses could be right, any one of them could backfire. I do not know your family member or your situation. But that is how my mind breaks these type of situations down.

I don't know if that is at all helpful to you in your situation. I have a million stories, from cute to horrific, many of which I will never tell anyone. And each time I see a tough situation I realize the importance of pre-planning for the eventuality of my own potential incapacity, and that for each question I can answer, there are a dozen more that may never have a good answer.

[quakerboy]

11. Another thought

Along the lines of hailhydra's.

You might consider hire a licensed social worker who specializes in the elder field to do an assessment and provide advice. If you have the money to put into it (depending on the area, I have heard anything from 40-120/hr) they can be an invaluable resource. If you pick a good one, they will be able to give you an objective assessment of the situation, along with advice tuned to your particular situation. They should also have a good handle on what resources that are available in your community, as my experience is these vary quite drastically from county to county.

[K8-EEE]

15. Unfortunately

If we did that it would have to be by force. She refused to have anyone in the family have access to any of the staff in the facility she was in. I do agree though that such an assessment is exactly what is called for however she is in extreme denial about her needs.

[quakerboy]

16. Then you have a tough choice to make

Do you feel the situation (her capacity) is bad enough to justify the use of force to get an assessment? To you trust your own ability to fairly judge the situation?

If the answer to either of these questions is no, then you have no avenue to do anything at this time. You are effectively locked out of the decision making process, and all you can do is wish her well, and continue to offer your help if you feel it appropriate.

If the answer to both is yes, then you have to decide if you are willing to completely alienate her by pushing this issue.

I will say it makes a HUGE difference if all the rest of the family are on the same page. When there is family in opposition, it complicates situations massively.

What I see happen too often is a family member who pushes the issue inter-personally, without the fortitude to take things to the next level. In my experience this only causes the person to clam up and cut others off(without attempting to be mean, but it kinda sounds like you may have already reached this point), resulting in a worsening of the situation.

Its hard to be cut and dried in these issues, but when it comes down to it, either you have reason to try to bring official intervention or you do not. And you either are willing to take the consequences of that, however it plays out, or you are not.

[K8-EEE]

22. My husband says

She KNOWS she is not getting better even though she won't admit as much to us or anybody. She sees it as a matter of dignity not to be in a "an old folks home." Really it's starting to look like it's a question of, us preparing ourselves for bad news and not feeling guilty that we didn't intervene because notbody has the guts to REALLY do what it takes (declare her incompetent.)

I'm kind of thinking -- I will check in with her by email every day and drop off what she needs and make suggestions/offers of maid service and the like.

[Rhiannon12866]

13. After my mother had hip replacement surgery, she had a special seat that fit in the tub

That she used to shower. They have all sorts of helpful things like that which most of us are unaware of. The counselors that were discussed here would probably know about that. If she needs part time medical care, there are visiting nurses who can come in to give meds or help with other medical issues. I have an older friend with numerous health problems who has one come in on a regular basis and she maintains her independence that way. Good luck with this and kudos to you for being willing to take responsibility with this. She's lucky to have you and you're getting some good advice here... :hug:

[sohndrsmith]

12. Heck. A lot of issues here. I worry about my independent mom, so I'll share my thoughts:

Sounds like there is no diagnosed dementia, so your aunt could very well be picking up on your sense of what you think is right for her - hence her closing off to you socially.

From what you describe, the LAST thing she wants is to lose her sense of self and power of choice. Even at the expense of a potentially risky environment that is also overwhelming - she can't keep up with it.

My mom is 76, has had over 5 heart attacks, lives in the woods - alone, has to deal with snow plows, shoveling her car, driving *forever* to get to a store (the EMTs, fire dept and 911 responders know her by name for the number of times they've had to come to the house. One time THREE ambulances got stuck in the long muddy driveway. The first got stuck, the called the second, etc.)

A few years ago, several diseases from a tick bite left her in the ICU for 11 days and nearly killed her. I broached the subject of maybe thinking about different living conditions. (She also has no patients for the personal alarm, either).

It stressed her out so much that I still feel guilty about it.

But I learned something from it. While I was doing and saying everything I could to be helpful and loving to her and she understood that, but she taught me that being elderly, more fragile, more forgetful and less able to care for a HUGE house the way she used to...

She is still a full-fledged adult human being and she wants control over her own life like everyone else. She has directives in place in the event she becomes incapacitated - mentally, physically or both, so she's been far more responsible than a lot of people.

I wonder if you might be more helpful to your aunt if you go to her and ask her what SHE wants, and if she wants things as they are, that's her right. Prove to her that you respect the fact that she's her own person - just as you are. Just because people make choices that we don't like or consider them dangerous or unhealthy doesn't give us the right to take over and force them to do otherwise. Not unless they're minors or legally deemed unable to think/act for themselves.

I'd avoid someone too if they obviously thought they knew better about my life than I do.

People are allowed to make bad choices. Help your aunt with things SHE wants to have happen, not with things you expect of her (even with the best intentions you obviously have).

If she's sharp as a tack, an "intervention" could devastate her. Help her live the way she wants to live. She, my mom, any of us... deserve nothing less.

Good luck - its a really difficult issue, I know, and it KILLS to let go and let someone do what they want even when it's riskier and more difficult. But it's their choice, not ours.

Take care. (sorry for the long post).

[K8-EEE]

14. Well there are definitely some mental issues going on

Thanks for your thoughtful post.

I do think the one nurse was correct and that there is some kind of intermittent dementia happening, but she is still sharp intellectually.

One issue is that she & my mom had a lot of shame and covering up with their mother's mental issues when they were growing up. They had lots of secrets re: the crazy mom and never wanted their friends over and that kind of thing. Their mom did end up institutionalized, shock treatments the whole nine, maybe that is her fear.

Also the things she worries about are kind of strange. She is obsessed with her condo neighbors finding out about her problems and was telling 911 when she called them to sneak upstairs with no lights or sirens and when she returned home she wanted a time when all the neighbors were at work. Her isolation really has reached an agorophobia type level b/c there is not one person in this world that she would open her door to, not even delivery people.

Her father lived to be 97 and insisted on living alone in a very remote area, which people got on his case about but I agree, he had a right to live as he wanted and he ended up dying peacefully in his sleep. He was happy and competent though his whole life. He didn't have this downhill slide I see with her, or the isolation.

[mzteris]

34. there are different kinds of dementia -

not just "Alzheimers" that present differently.

Or it could be Mental health issues - depression, anxiety, agoraphobia, hoarding?, ocd. Or there could be other physical health problems that are causing the mental health behaviours - thyroid comes to mind, etc.

She needs a complete physical. She may need to have a guardian assigned. You may need to move her whether she wants to move or not. Being intellectually sharp is no guard against setting the house on fire, falling down the stairs, or having a stroke and no one finding you for a week (which is what happened to my former mother-in-law) . . .

My grandmother "refused to move", too - but she was absolutely incapable of taking care of herself. The family took her to visit one her daughters several hours away for a few days, emptied out her house, (which wasn't fit to live in) and when they came back they took her to the nursing facility. She had no where else to go - though she did contact the old landlord - who had been threatened by my uncle he'd better not dare rent her anything!

Sometimes you have to do what is "right" even though you might not like it. She sounds ill, she needs help - whether she wants it or not.

[hunter]

18. It took the police and paramedics to get my grandma out of her house.

After a very long standoff they dragged her out kicking, hitting, biting, cursing, screaming all the way.

She was a hoarder (and a lot of other things) and definitely a danger to herself. But it has to get really, really bad.

My family tree is full of people like that.

:scared:

I should probably teach my kids how to use a tranquilizer dart gun to minimize the fuss when it's time for me to leave my car, my shack in the woods, or wherever it is I'm calling home.

[MiddleFingerMom]

19. I tried to get a cellphone for a friend of mine in a wheelchair, but he refused.

.
.
.
One night, on the way home from the grocery store, his power chair ran
out of power... and he was stuck. Darkness was coming on and a storm
was threatening. He told me that several people saw his dilemma, but
"pretended not to"... ostensibly so they didn't have to get involved.
.
.
LUCKILY, a young couple came along and, with great effort, pushed him
home.
.
.
If not for their help, he very well might have actually died out there.
.
.
The next day, I shoved a pay-as-you-go cellphone in his hand -- fait
accompli -- and told him that since it was already paid for, he might
as well just hang on to it... even if he were never going to use it.
.
.
He did (to my surprise) and, though he didn't use it much, LOVED it.
.
.
Your case doesn't sound so simple. If he had refused to use it, that
would have been his right and I wouldn't have pushed it any further.
But... sometimes... on very rare occasions, it can be good to be
"inconsiderate" of another's "freedoms".
.
.
.

[K8-EEE]

23. I might do that!!

She is stalling about the Life Alert, hell I might just set her up with one and say "well I know you think it's silly but look it's all paid for so you'll have to humor me!" My biggest fear when I break it down, is her falling and not being able to get up, just like that commercial says!! Hell she can barely get up from a chair as it is, and complicating matters, she is severely overweight.

[struggle4progress]

20. Loss of independence must be psychologically very hard. I knew one woman who

fell at 3AM with one of those alarms around her neck and refused to use it: she didn't want to bother her aide, who showed up the next morning around 9AM to find her on the floor: wonderful stubborn woman in her nineties back then, badly bruised, but with her sense of pride and personal dignity intact. It's tricky to talk to folk about thyese things: nobody wants to be told what to do or to be pushed too hard; there's an art to making suggestions, and then allowing people time to absorb their options and make their decisions.

What can you do in the way of giving her real choices? Could you take her out to dinner and offer to help her apartment shop? Or maybe all she wants is somebody to talk to her on the phone regularly ...

[K8-EEE]

24. Hi, well it's like this....

She will only communicate through email with me. My sister she has cut off totally for "being pushy" (ie, making quite forceful suggestions about remodeling her apt or moving.) She will not go out to dinner with anybody b/c she literally cannot get down the stairs from her apt but will not admit it. I suggested moving to Senior Apts by my house -- her own place, just built to be wheelchair and walker accessable! But she did not respond to the email and that was that. It's like the idea of moving, renting out her place and all it just overwhelms her and she is so independent (like he lady you reference here) that she refuses to accept her family's help, we would all do the heavy lifting for her not a problem!! That is what is so frustrating.

[grasswire]

29. If the resources were there, you could...

...go ahead and rent a place for her and tell her "you might as well go live here; I paid for it." Have you shown her pictures of the facility near to you? That might help.

Your comments about her family situation about hiding the mental illness of a parent -- I think that's quite important. I would talk to a social worker specializing in senior issues. If you can't hire one, you can probably be assigned one through your local county senior services.

[struggle4progress]

32. I might guess she's stuck in her apt, alternately lonely and depressed and angry. Her most immediate

need may not be for somebody to solve her living problem but for relationship -- some regular contact with people she trusts: that might mean she knows they won't embarrass her with comments about her living conditions or physical condition but who will wait to discuss such issues with her on her terms

If you're bringing her groceries, have you thought about leaving brief notes with the groceries? Or, if she has an answering machine, have you considered leaving a pleasant message on the machine regularly? Can she get a part-time aide to help her with stuff?

[K8-EEE]

35. Yes I do write notes and exchange emails daily

My sister and I are a little "good cop bad cop" because she was pushing the accessibility issue hard (she wanted to put grab bars in the bathroomm before she got home) and was told off in no uncertain terms and is now not getting any communication back from her. So I am really walking on eggshells. She knows we have dinner her every Sunday so I emailed her that I will have tons of leftovers if she would like some (she would.) I am trying to not let on that I know the dire situation because that tends to make her push people away.

[Biker13]

21. Make A Deal With Her.

She moves into assisted living for six months. During that period, you will NOT rent her place, just clean it up. If, at the end of six months, she wants to move home, you will move her back, no questions asked.

It worked for me, and my Aunt never wanted to go back to her old place.

Biker's Old Lady

[K8-EEE]

25. That's a really good suggestion

Thank you I might just try that! My fam is coming over for dinner tomorrow I will tell that that.

[K8-EEE]

26. DU-ers you are just the best

Thanks for all the really thoughtful and intelligent responses and PMs to this thread!! I am going to print them out b/c my family is coming over for dinner tomorrow and we will take all these great suggestions into consideration. I feel much more at peace about it today than I did yesterday and largely because of all of you, you're all just great people to take the time and share your knowledge and experiences. I REALLY APPRECIATE IT AND IT'S REALLY HELPED A LOT!!

:grouphug:

[Biker13]

27. I Agree!

I love this place too! We screw around a lot here in the Lounge, but when the chips are down, there's no place better to find support and friendship!

Keep us updated, please!

Biker's Old Lady

[alarimer]

28. Maybe she just doesn't want to be a burden on anyone.

I've told myself for years that I will NEVER, EVER depend on anyone else for anything. I will NEVER allow myself to be "taken care of". I will die by my own hand if that ever is in the offing. Take a long walk off a short pier or whatever. I do not now or ever want anyone to feed or bathe me for example. Or worse. It is humiliating to have to accept that kind of help when you are used to doing for yourself. I would sooner die than live like that.

So perhaps your aunt feels similarly.

[csziggy]

30. We are trying to figure out what to do about my parents

Mom just turned 90, Dad 88. Dad has mobility problems and has to use a walker, has a cracked vertebrate in his lower back and constant pain, and he is profoundly deaf. Dad has fallen several times and Mom has had to call 911 to get help to get him up.

Dad fell the other day, the EMTs came and insisted on taking him to the hospital. He had a cut on his head that needed stitches. The doctor insisted on keeping him overnight for observation. Then they kept him for three days more. Now Mom admits the doctor told her Dad had a heart attack - he didn't just fall because of his walking problem.

Mom does not want strangers in her house; she thinks she can take care of Dad since she was a RN when she worked. Dad is an irascible old codger who barely tolerates visits from his own children anymore. They have both always been very private and independent. Heck, they BOTH still drive, which is a very scary thought!

When Dad's mother fell from a ladder (at the age of 83) and broke her hip, her doctor arranged for a nurse to come take care of her. It got to be a joke in our family - not one of the nurses lasted a week. Grandmother always argued with them then fired them if they did not quit. It was struggle to keep her from getting up with a broken hip. So this is not new in our family.

I think Mom is ready to accept someone coming in a few times a week to help out, but she is adamant that she will arrange for it when she is ready and will not let any of her daughters step in to help her set something up.

Since they are both still pretty sharp mentally, I don't see stepping in to interfere with their choices. My sisters and the oldest granddaughter disagree and think we should take over for them. I think that would destroy the family - Mom and Dad would fight it, everybody would argue. If the people who want to interfere won, Mom and Dad would likely decline because of a loss of confidence.

Part of my reluctance is that I don't want to get in an argument in the family. And I really don't know what is best for them. As long as they are mentally capable, I think they should be allowed to run their own affairs.

[Akoto]

31. I can only relate a vaguely similar experience ...

After my grandfather died, my grandmother managed to live alone for a while. She spent time at the community center with people her age, and generally did well. Time went on and she naturally became a bit too feeble to be on her own, so she moved in with my aunt. Then, she fell and broke her hip, necessitating a stay in a rehab facility.

Unfortunately, the hip break made it quite difficult for her to walk. Just surviving it at her age was a bit of a feat. My aunt could not watch her 24/7, and the in-home nurse was only there during certain hours, so there was no alternative left but assisted living.

It honestly was not a controlling or degrading environment, at least where she was. Grandma had her own apartment, access to various activities and services, as well as the attention of a caring staff who could be there to watch out for her safety. Transportation was available for her to get where she needed to go, so she wasn't a prisoner. At first, she was not happy. I think she considered it something of a betrayal that her kids had 'chosen' to not look after her. However, as time went on, grandma's requests to come home - which could never be granted - became fewer and fewer. The new lifestyle had grown on her.

So, if that's the route your aunt has to take, it may not be all that bad. The deal suggested in an above reply may be a good way of convincing her to think about it.

Unfortunately, my grandmother fell and broke her hip yet again, because she refused to use her walker and ask for help. I believe it's a pride issue associated with the generation, as well as the idea that she shouldn't be a nuisance or a burden (even though neither would be true). The second break was harder on her, and she now lives in a nursing home, rather than assisted living. Just had her 94th birthday.

[UTUSN]

33. Lots of great info & suggestions in the thread, especially quakerboy's experience

Just to streamline, simplify, and consolidate:

1- There are legalities and legal terms that have specific meanings: "Mental capacity." "Mental competence/incompetence." "Least Restrictive Alternative". First there have to be diagnoses, then the legal procedures, then the finding of the court.

2- So long as there is no activity done in #1, forget about tossing around words like "dementia" and "Alzheimers." Also forget about trying to "reason" and performing "interventions." Those things are only workable with somebody who is reasonable, or reasonable enough to comprehend consequences, like all the things (below) that are going to happen if he/she doesn't agree. Plus the results of agreement usually only last as long as it takes to get rid of you.

3- Sometimes plain old malnutrition is involved. Just a thought.

4- Who is the person with the best relationship with the person, relative or not. Barring that, who cares enough to take responsibility?

5- Many of the in-home solutions will work so long as the person ACCEPTS them: Provider; Meals on Wheels; Lifeline ..... stepping on up to Assisted Living.... (the Least Restrictive Alernative, in steps)

6- So long as the person has not been declared Incompetent by a court, the person technically has the right to be presumed Competent, and if so, the simplest instrument is a Power of Attorney that will allow the designee to pay bills, sign agreements for in-home care arrangements, almost everything. Might be called "the poor man's Guardianship." It can be limited to financial management, or medical care, or whatever specified activities. Or it can be everything.

7- Guardianship is the whole monty: The caring person petitioning the court (forms can be obtained from the State; otherwise, hiring a lawyer) to declare the person Incompetent and naming the caring person as the Guardian, meaning taking some (Limited Guardianship) or all of the person's Rights away from him/her and giving them to the caring person to exercise in the person's stead. It can be Limited in all sorts of ways, just financial, just medical, or Full Guardianship, the whole monty. The person is supposed to have somebody representing him/her, AGAINST the removal of Rights, but for the best interests of the person, meaning that this attorney (appointed by the court or otherwise) might AGREE to the Guardianship. The court will require medical and psychological assessments and diagnoses, one way or the other, with the court then finding/declaring. If the Guardianship is granted, the Guardian then exercises whatever Rights of the client's, Limited or Full. If there is no relative or friend to be the Guardian, the court can appoint (really, ANYONE) but there is usually a State program.

The down side is when bad people, interested in the client's resources for their own enrichment, become Guardians and exploit the person. It is fair for the Guardian to have a fee, and all costs of the person's care come out of the person's resources.

8- Somebody said above that it was all right to leave the person to his own outcomes so long as he/she was "only" harming himself. Nope. It can get that far, but that's the point to start the involuntary solutions.

[K8-EEE]

36. What we will be discussing tonight is our thoughts about #1

We have all got to be on the same page with it if we decide to do it. Malnutrition, that's not it as the family has been and will be taking turns bringing her tons of healthy groceries (but we have to leave them at the door!) She is enjoying the food because she emailed me to say that when she was in the nursing facility she never had an avocado or tomato or a decent salad or even strawberries, the food was so disgusting there from the soounds of it.

#1, she would never agree to cede any control to anybody so it would have to be involuntary. Given her condition when she was picked up by he paramedics (she cannot access her shower and she was filthy) plus some "rambling" episodes in the hospital, and the fact that she can't leave her apt. unassisted I think we could make the case but I also think that it would be so traumatic for her that it might just break her down worse than her current circumstances will.

[UTUSN]

38. Thanks for listening. If she was "filthy" we're in THAT territory.

As for the remedies being "traumatic" - uh, YES, but it's not a matter of "breaking her down WORSE." Really, what could be worse?!1

I thought the thread was over so I didn't post something, but since you're listening, here's this:


There are GOOD and BAD caseworkers, doctors, psychologists/psychiatrists, lawyers, and judges. Everybody's just people. Beware of anybody who says, "Well, there's NOTHING WE CAN DO." There's always something, even just watching and waiting.


What really matters to me in your thread is that it is CLEAR to me that YOU CARE. Thank you.

[kimi]

37. Very interesting thread

I anticipate the same type of problems with my mom soon, so I sympathize, and it's been enlightening. You've done such a caring job with your aunt, and all of your family should be commended for that.

quakerboy and UTUSN made some great points, and everyone has good ideas. Starting with a social service organization, as several people have suggested, or a LCSW who specializes in geriatric issues, might give you a basic frame of reference to start from. I'm not sure, but laws and especially, access to care, probably differ quite a bit from state to state - heck, county to county.

Respecting your aunt's wishes is definitely a concern, and I think that any professional who works with older folks would be aware of that, and appreciate it. And as well, know how to deal with it effectively.

Best wishes to you and your aunt. You're a lovely person to care so much. I hope your aunt knows that, and I bet she does. :)

[krispos42]

39. My grandmother is that way

She had had diabetes for years but it was under control until a few years ago. Then she got bad, and wasn't able to take the medication as needed to keep it under control.

She could no longer drive and had trouble walking because of neuropathy in her legs. Her marriage had never been that good, and now she was basically trapped in the house with him. She began living in the past, blaming him for things had his mother had said to her back before I was born. She would not listen to him when he told her it was time to take her pills (because a) it came from him and b) she was in denial of her need to be dependent on medicine) so her body chemistry was all over the place. She became dazed and confused. Even buying prescription sticks with timers and beepers didn't work; she was taking the pills sporadically. Even a visiting nurse didn't work.

She had a lot of pride and simply wouldn't accept that she was getting old and disabled. She didn't want her friends and such to see her like this, so she withdrew. And their relationship deteriorated to the point that the police were called once.


This went on for about 5 years. She didn't want to leave her house that she had lived in for 40 years, even though it was unsuited for an elderly couple such as them. Steep stairs to get to the washer/dryer. Steep stairs to get up to the front door. In the mountains, so the roads are narrow, steep, winding, and poorly-lit. And far from shopping and emergency help... no public transportation.

She would fall all the time because she wouldn't let her husband do the laundry, and he would have to fight her to let him help her back up. Now, my grandfather is something of an asshole, but he was absolutely right on these issues. I mean, she would risk life and limb to carry down 3 shirts to put in the washer!!!

Her children begged them to sell the house in NY and move to CT, in a ranch with no stairs and nearby to my parents, her sister, and my brother. But they never did, until about a year ago.
And by then the housing market had collapsed, so they lost 20-30% of the value of the house they could have gotten in 2005. And she was way to bad to be living in a house by themselves, so now she's living in an assisted living facility and he's living about 3 miles away in a studio apartment in a senior housing complex.

It's a nice place, costs over $4,000 a month for a small, one-bedroom apartment. But they give her all of her pills when they're due, and she's much better. But now it's too late. So it's costing over $50,000 a year just for her, when if she had let her husband and the visiting nurses take care of her they could have bought a house in, say, Stratford or Derby or Shelton and had a very small mortgage and retained their independence, because the disease wouldn't have had 5 years to ravage her body and mind unchecked.




It sounds like she's in denial over how serious her situation is. The problem you face is that if you let her live there, one day, maybe soon, you'll the knock on your door. You know what that is and who it's from. You'll hear the circumstances, and feel guilty, especially if it was drawn-out.

Or, you can browbeat an old lady into moving... and aside from the guilt from ripping her our of her beloved house, you'll get the "why did you put me in this awful place? I hate it here! Why won't you let me live where I was happy?" for the next few years.

And the fantasy will build... oh, her house will get larger and better furnished as the months go by. Her life there will get happier and more pleasant, until you forced it from her so you could sell it for money.



You're in the classic no-win scenario, I think. Until she has a really close brush with undignified death, you might not be able to do anything except that you don't get a knock on the door one day. :-(

:hug: