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Posted: May 02, 2005

Practical Caregiving

Next Steps With Mom as She Changes Before Our Eyes

It's so hard to face the fact that our parents' health is deteriorating. Once vibrant adults -- our parents, in fact! -- begin to change, physically and mentally before our eyes. We try to say the doctors don't know what they are doing with their diagnoses, but -- sadly -- most of the time they do.

Dan is facing this dilemma with his mother, and in fact seems to be wrestling with himself on what degree of change is occurring and the next steps in caring for his mother. His story is one of the latest pulled from my e-mailbag.

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Dear Jean:

My mother is 85 years old and has lived alone since Dad died 18 years ago. In the past few months, she has shown a decrease in her ability to take care of herself. She isn't very clean, misses meals, and sometimes forgets to pay her bills. She also has started having minor hallucinations.

Her doctor put her on an anti-psychotic medicine to stop the hallucinations, which helped. But a short time later, she had to be hospitalized because she was hallucinating again and not taking care of herself. She was dehydrated.

After being in the hospital a couple of days, she was admitted to the psychiatric ward. They performed the normal psychiatric evaluations and decided again that her mind had deteriorated so much that she was unable to care for herself. She has trouble remembering things on a short-term basis. She doesn't remember what day it is, the date, where she is, or several of the other questions they asked her.

The doctors now insist that we, my two sisters and I, petition the courts for guardianship. They say she is a danger to herself as well as others.

We do not think this is necessary! Since being in the hospital, she has improved considerably. She constantly asks us if we are taking care of her bills and her house. We believe that if they adjust her medications correctly, she will be able to take care of herself again.

Our questions are:

1.                   Do we have the legal right to disagree with the doctor?

2.                   Can the doctor petition the courts to take over guardianship without our consent or knowledge?

Dan T., Portland, Oregon

Dear Dan:

It sounds like your mother does need someone to make her decisions for her when she is unable to do so. Asking about the bills does not mean she would start paying them if she is in control of her day-to-day affairs. When she can't remember the day or date, she will probably miss paying bills, taking her medicines on time, and other things -- some of which can be very dangerous for her.

Guardianship does not mean that you have to "put your mother away" in a nursing home, or some other institution that may not be appealing. It means that you have control of things -- including making a judgment of whether she is capable of making decisions. It is similar to a parent and child relationship. When a child makes the right decisions, the parent usually lets them.

I am not a lawyer -- and especially don't know the laws in your state -- but I don't think a doctor can force you into petitioning for guardianship of your mother. If there is a problem with your mother being a danger to herself, and if you don't petition the courts for guardianship, this might be considered (at least morally) as neglect. In this situation, the doctor might petition the courts to take control of her life.

If your mother hasn't signed papers giving you control when she needs it, then state laws take effect. Whether you would have any input to your mother's care would depend on the state laws where she lives. I asked about this point when, as caregiver, I was traveling with my parents in different states. It turned out that the only reason I could make decisions for my parents was that I physically lived with them. If I would have lived 10 feet away from them in a different house, the doctors could not have abided with my wishes. State law -- wherever I was -- would have taken over and the decisions would have been made according to the law. That's why guardianship is important to you, not just a parent.

You are facing something that all of us have faced in the past, or will face in the future -- your own very natural feelings about your mother's deteriorating health. She, like others before her, is changing into someone different from the parent you have known all your life. It sounds like she was always stable, always on top of things, always there for you when you needed her. Now she is losing that ability. Your mother doesn't want to lose that ability, but she doesn't have a choice. You and your sisters need to get control of your emotions and try to look at the situation realistically rather than emotionally.

Here are my suggestions.

1.     Contact a different doctor and have that doctor evaluate your mother. You need to make sure the current physician isn't overlooking something.

2.     Contact an elder-law attorney and ask him the questions you asked me. If there is a financial problem, call your local legal aid office.

3.     When your mother is thinking well enough to make decisions, have her sign a power of attorney, medical power of attorney, living will, and any other documents the elder-law attorney recommends. Have her put one of her adult children's name on the house, car, bank accounts, etc. You may need a couple witnesses, but you could get friends who have known you for a long time to witness it. Do it when your mother is at her best so they can honestly say she was capable of making that decision. No one will want to witness a signature when they question the person's ability to make decisions.

4.     If you can't get your mother to sign the papers, you may need to apply for guardianship. As I said above, that does not mean you have to "put her away" in a nursing home. It just means that you are to watch over her and make sure she is safe and well taken care of.

Good luck. It is so hard to watch our parents lives deteriorate. You do need to step forward and do what is necessary for your mothers health and safety.

For more on guardianship, you can also check out my October 11, 2004, column on the topic.

© 2005 Pederson Publishing, Inc. All Rights Reserved.
Commercial use, redistribution or other forms of reuse of this information is strictly prohibited without the prior written permission of Pederson Publishing.

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Please send me your questions, comments and issues regarding the practical side of caregiving at ASKJEAN@caregivershome.com, and remember to take advantage of our professionals and experts in the Ask an Expert section of our website. You'll find it in the left column on our homepage.

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