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Medical Forum / Diseases and Disorders / Alzheimer's / June 2004

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Convincing your mother she can't go home

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hal@nospam.com - 15 Jun 2004 21:08 GMT
My mother is presently in a nursing home for recuperation of lung
surgery, but is also almost certainly an AD patient.  Her mother was
diagnosed with AD, and spent the last 10 years of her life in a
nursing home unable to recognize family.  My mother is exhibiting all
the classic symptoms, and her brothers recognize all the exact same
issues in their sister that their mother went through.  Now the
problem is this:  my mother is a fiercely independent type, and giving
up your independence is hard for anyone.  She was traumatized by what
her mother went through, and is terrified of ending up like her
mother, so is in denial about being an AD patient.  She is physically
recovering from her lung surgery and insists that she will be able to
go home after a short stay in the nursing home.  The family, including
her brothers, and their wives, and my sister and myself, all know that
this is not the same woman we used to know, and her periods of
confusion and even paranoid behavior are increasing in severity and
frequency, and we are very concerned about her leaving the nursing
home and trying to live on her own.  Prior to her last admittal to
nursing care she fell twice, the last time she was very fortunate that
a passing neighbor spotted her laying in the driveway and stopped to
help.  So what is a family to do?  We have requested AD assessment,
but even if that proves our conclusions, what power does family have
over determining a patients care if the authorities don't feel they
can judge her incompetent.  My sister and I have legal power of
attorney, and my uncles have medical power of attorney.  My mother's
lawyer at this point feels she is competent to make her own decisions.
Does anyone have any advice on how to proceed?

thanks,

Hal
Tumbleweed - 15 Jun 2004 22:35 GMT
> My mother is presently in a nursing home for recuperation of lung
> surgery, but is also almost certainly an AD patient.....

<snip>
> So what is a family to do?  We have requested AD assessment,
> but even if that proves our conclusions, what power does family have
[quoted text clipped - 7 lines]
>
> Hal

IANAL, and not in the USofA either, but how can a lawyer decide if she is
competent to make her own decisions? Wouldnt that be a medical(psychiatric)
issue? When my father was placed in care against his wishes, it was doctors
who made the decision. That had to be backed up by the law but it was the
doctors decision.

Signature

Tumbleweed

Remove my socks for email address

Darryl - 16 Jun 2004 03:58 GMT
>> My mother is presently in a nursing home for recuperation of lung
>> surgery, but is also almost certainly an AD patient.....
[quoted text clipped - 13 lines]
>
>IANAL, and not in the USofA either, but how can a lawyer decide if she is

IANAL = I Am Not A Lawyer?  These acronyms are getting more difficult
to understand by the day.  ;-)

>competent to make her own decisions? Wouldnt that be a medical(psychiatric)
>issue? When my father was placed in care against his wishes, it was doctors
>who made the decision. That had to be backed up by the law but it was the
>doctors decision.

I agree with Tumble--the lawyer is not qualified to give a medical
opinion as to her competency.  I'd guess a psychiatrist or
neurologist; preferably one who specializes in neurodegenerative
disease.

Talk to the doctors about your concern, contact your local AD
association and see Evelyn's suggestions.  If the assessment confirms
your feelings, the road will become much clearer and you won't have to
play "what if's".  Are your uncles supportive of your direction?  

Take care,
Darryl.
Florence A - 16 Jun 2004 16:16 GMT
Could It be possible the attorney, by stateing your mom is competent, is
giving the family time to take care of some legal things.  You might be
turning all of her estate over to the NH.  
Evelyn Ruut - 16 Jun 2004 18:52 GMT
> Could It be possible the attorney, by stateing your mom is competent, is
> giving the family time to take care of some legal things.  You might be
> turning all of her estate over to the NH.

Yes, that is true.
It is very important to get some estate planning in place at this time as
well as some serious diagnostics.
Signature

Regards,
Evelyn

(to reply to me personally, remove 'sox")

Evelyn Ruut - 15 Jun 2004 23:07 GMT
> My mother is presently in a nursing home for recuperation of lung
> surgery, but is also almost certainly an AD patient.  Her mother was
[quoted text clipped - 26 lines]
>
> Hal

Hal, your mothers lawyer is only able to see that she is competent to write
him a check, not that she is competent to live on her own.   Only a medical
doctor who has tested her thoroughly would be able to decide that.   Even
still, alzheimers is a progressive disease that keeps on getting worse.   We
sometimes say around here, "this is as good as it is going to get".... for
that reason.

My mother in law asks when she can go home too.   We tell her "not just yet,
maybe tomorrow if the doctor says so".... and she just says "Okay" and
another day goes by.

The real truth is that she is never going to be able to come home.   We
cared for her for three years through incontinence and constantly falling
down, till we were both exhausted.   But it certainly cannot hurt to say
"maybe tomorrow" so she doesn't feel like her life is totally over.

If YOU know that she is not capable of coming home and functioning on her
own, you would be doing her and the whole family a very great unkindness if
you allowed her to do so.

If I were you, I would press strongly for a full assessment, and based on
good medical advice tell her lawyer and anyone else who needs to know, what
you have decided would be the best course of action.

Sometimes it is very hard to have to make decisions on another persons
behalf, but it has to be done when they can't think clearly anymore.

Signature

Regards,
Evelyn

(to reply to me personally, remove 'sox")

Mary Gordon - 16 Jun 2004 19:59 GMT
Hal, given that she really can't go home, I think your best tack to
stop arguing with her about it. Sooth, reassure, distract, divert,
change the subject. You can't reason with a person with a damaged
brain, so you might as well give up now. She is cognitively incapable
of recognizing her own condition - its not just denial. She really
CAN'T see that she is too ill and confused to live independently, and
all the logic on the planet won't alter that reality (i.e. she is
never going to look at you and say "I see what you are trying to say,
and I agree! You are right!". It may be blatantly obvious to everyone
around her, but all you will accomplish by arguing with her is getting
yourself frustrated and her wound up. Every time you have the
discussion with her, its probably new information for her, so there
isn't much point. Her reasoner is broke. Its like arguing with 2 year
old about why they can't play in the knife drawer or with the fishing
tackle.

So - you put your arms around her, you tell love her and isn't it
lousy that she's not well, and you wish you could whisk her off to
Hawaii - and then you change the subject and distract her to get her
onto some other subject.

From what you are saying, it is unlikely she would be able to leave
where she is on her own (i.e. she may ask to go, but is incapable of
organizing herself to actually get there alone), so she may want to
leave, she may carp and complain, and chew, but she can't actually go
anywhere without someone to get her there.

I'd do what Evelyn suggests, and gently put her off by telling her
whatever little white lie you have to, or using whatever distraction
and diversion tactic works best (Dr. Jones is wants to wait for more
test results ...or we'll see how you are feeling next week) followed
by a generous dollop of soothing affection - and vigorously pursue
getting her properly assessed for cognitive impairments.

Mary G.
Adelle D. Stavis, Esq. - 17 Jun 2004 02:07 GMT
I'm going to take a longshot and say the atty is venturing an opinion based
upon his/her experience with local judges and how your mother sounded to
him.

The medical definition of incompetency is actually a legal one. Not sure I
can remember all of it offhand. Does she know who she is? Can she understand
her actions?

If you can catch someone having their only lucid minutes in a twenty four
hour period and have them sign at that time (with witnesses to verify her
saying, "yes I want to do x. I know it will mean y..." then they are
competent for those few minutes and the legal document stands. Of course,
lawyers know how to lead someone through those questions so you get
responses of, " yes"

Can you her get doctors on board to say she cannot live at home anymore?
After a cardiac episode, my FIL's doctor simply refused to release him to
any place other than a nursing home because he kept insisting he didn't have
Congestive heart failure and didn't need the medication. One way to qualify
for commitment is if you are a danger to yourself or others. If she cannot
care for herself to the extent she endangers herself, you might be able to
get her certified incompetent. Not an easy road, but possible.

Signature

Adelle D. Stavis, Esq. (a family law atty in that incarnation called 'before
kids')

> My mother is presently in a nursing home for recuperation of lung
> surgery, but is also almost certainly an AD patient.  Her mother was
[quoted text clipped - 26 lines]
>
> Hal
 
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