Aging parent issues

[DawnM]

My aunt is probably in the early stages of Alzheimers.  She is becoming very forgetful and it is a bit scary.

 

She is also getting more and more belligerent.  Long story short, she needs to sell her house and move to an apt. near one of her daughters who can watch her a bit more.

 

But she is very upset about selling the house and losing money on it and having to give half to her sister (even though sister says she doesn't want it, it isn't computing with the Aunt.)

 

The daughters are at a loss.  I figure they can get power of attorney and force the issue, but other than that (and probably having the mother furious at them) what other suggestions are there?

[DawnM]

Oh, and she is long divorced and alone.  She has some estrangement from her siblings, so that won't help.

[Laurie4b]

I would suggest consulting an elder care attorney for practical issues like money, house, etc.  Has she seen a specialist for her cognitive issues? 

[JonesinIndiana]

I agree about seeing an attorney that specializes in elder care. From my families experience, someone needs to be power of attorney and they need to look at what money she has if/when she needs to go to an assisted living or nursing home. There are ways to spend down her assets that the government won't come back (3-5 years?) to collect if she gets on Medicaid or goes into a ALF or NH, unless she is private pay. It is very difficult to deal with this and can tear families apart.

 

If she will go to a doctor, there are meds that might slow the progression of the disease. My dad was not able to take any meds for Alz because of the severe side affects. Going to a doctor might be difficult for her due to admitting and realizing she has Alz.

 

An extended family member is dealing with her father, (not Alz, just stubborn!) that wouldn't listen and now is in a NH and all his assets are going to pay for his care and his 3 children will get none of it. He kept saying, "I don't care! Let the government get it!" Well, that's what's happening and he's not happy about it but it's too late.

 

Good luck. If I think of more ill post later.

[Orthodox6]

We (my family) don't care squat about inheritance; we just wanted resources to stretch sufficiently to care for my parents. Mom (sixteen years with Alzheimers) now is with the Lord, and Dad still needs his resources to stretch for his own needs. Without the services of a highly experienced eldercare attorney of good reputation, this would not have succeeded.

Durable Power of Attorney and Medical Power of Attorney are best obtained before the woman is incapable of making her own preferred choices. Same for DNR and Advanced Directive.

Unfortunately, the suspicions and hostility are common for some (but not all) Alzheimer's patients.

The meds don't do much. More hopeful hype than genuine help.

[Anne in CA]

If Alzheimer's is the problem moving into an apartment is a band-aid on the situation. She may be a genuine danger to others if she decided to drive and make a mistake, ect. She will then have to move later. I really would get professional advise on this situation.

[Orthodox6]

If Alzheimer's is the problem moving into an apartment is a band-aid on the situation. She may be a genuine danger to others if she decided to drive and make a mistake, ect. She will then have to move later. I really would get professional advise on this situation.

 

. . . as well as a danger to herself.  If she were to develop into "a wanderer", for example, she could stroll down the street and never be seen again.  She could suffer severe burns while in the kitchen.  Etc.

[Innisfree]

I'd suggest the daughters talk with their mom's primary care doctor and give specific examples of the problems they are seeing. The doctor may not be able to say much to them without their mom's permission, but should be aware of what's going on.

 

Next step should be an appointment with the doctor for a complete physical, including a review of all medications, and possibly a referral to a specialist for a diagnosis. Hopefully there is someone she trusts who can be given permission to receive medical information.

 

Then (or possibly concurrently with these steps) consultation with an attorney specializing in elder care. If she really doesn't trust anyone to act on her behalf, they can advise on how to proceed, and their advice will be valuable in any event. Someone will need to have durable power of attorney, etc.

 

I agree that an apartment would only be a stopgap. Researching assisted living places or nursing homes which have memory care units would be more useful. Why make her move twice?

 

The really difficult legal point (in my experience, I'm no lawyer) is if she isn't really capable of making good decisions, resists advice from others, and yet is not sufficiently clearly impaired that a judge would declare her incompetent. Her daughters really, truly need a very good attorney, for her sake, not just theirs.

[DawnM]

Thanks guys.  This is really hard on them.

 

The daughters make appts with doctors for her and have a friend take her but then she refuses to go at the last min.

 

One daughter lives 1000 miles away and even flew up twice to help take her to the doctor and she still refused.

 

The other daughter works a very blue collar job where she gets 5 vacation or sick days per year and if she doesn't show up she doesn't get paid.   Her husband is on disability.

 

They do have medical power of attorney over her but that only goes so far when she is refusing to go or breaks down at the doctor's office so badly they send her home.

 

Then they are worried about what to do if they forcer her to leave her house.  Neither is in a good position to take care of her and she gets very angry when they mention "a home." 

 

 

[Orthodox6]

It is not our business to understand the back story; however, I do wonder why proceeds of selling the house are to be split with her sister, as well as wonder why your aunt assumes that she will sell "at a loss."  Don't answer us because, again, none of our business.  Just keeps popping into my mind!  If your other aunt has no plans to accept any of the sales money, then it sounds like "an Alzheimer's problem" rather than a real problem.

 

Although it sounds horribly callous to say this, as the disease escalates for your aunt, she will cease to remember what it was that made her so mad in the first place.  This, with reference to selling the house.  HOWEVER:  If neither daughter (or no other individual) holds a durable power of attorney for your aunt, selling the house is a moot point.  It is not going to be sold save by someone with the legal authority to sell it. 

 

Distressingly, the scenario sounds as if you all are going to have to wait until something serious happens, serious enough that she can be declared legally incompetent and guardianship awarded.  Or, whatever is advised by an eldercare attorney.  Please encourage your cousins to secure the services of one as soon as possible. 

 

:grouphug:  to everyone -- including your aunt, who is suffering from a cruel illness. 

 

 

[DawnM]

Is there a difference between dementia and Alzheimers and can someone diagnose the difference?

 

Orthodox6, it is ok to ask.  Aunt and her sister are both on the deed.  Aunt put her on as a "just in case something happens to me" which she shouldn't have.  Her daughters were too young to care for themselves when she did it.  It is a bit of a long, involved story, so don't ask more details, I don't have the time to write it all out, but that is the short of it.

 

As for power of attorney, don't you have to prove incompetence?  

[Innisfree]

Alzheimer's is one form of dementia; there are also others.

 

Proving incompetence is not necessary for obtaining a power of attorney. In order to grant someone power of attorney, though, I believe a person needs to be fairly rational.

 

Proving incompetence is different and more complicated. If a person's decision-making ability is substantially impaired they may no longer be able to grant power of attorney to someone else. A doctor would need to testify to their impairment so a guardian could be appointed.

 

Again, sadly, your cousins need a good elder-care attorney. They also need to start researching memory-care units, realizing that there may be waiting lists and not all can or will handle patients who are combative. This isn't an easy road, but educating themselves will help them make the best decisions possible. (((Hugs))) to them and you.

[Orthodox6]

Is there a difference between dementia and Alzheimers and can someone diagnose the difference?

 

Orthodox6, it is ok to ask.  Aunt and her sister are both on the deed.  Aunt put her on as a "just in case something happens to me" which she shouldn't have.  Her daughters were too young to care for themselves when she did it.  It is a bit of a long, involved story, so don't ask more details, I don't have the time to write it all out, but that is the short of it.

 

As for power of attorney, don't you have to prove incompetence?  

 

I don't want to overload you, so here is just one link to information summarizing the basic types of dementia:

http://www.alz.org/dementia/types-of-dementia.asp

 

Both of my parents, while fully competent, drew up their individual Medical Power of Attorney and Durable Power of Attorney documents under guidance of a generic lawyer.  My mother subsequently developed Alzheimer's (and died this past March).  My father (now 93) still is fully competent.  Two years ago he rewrote both of his powers of attorney documents, along with his will, with the guidance of a high quality eldercare attorney.  These documents list specific people to "serve", in order of preference.  As my father now has lived with my family for the past 3-1/2 years, and as my brother (living five hours away, and holding a night-shift job that prevents him from managing business tasks for our father), my brother -- who was listed prior to me as the person to act -- voluntarily signed legal paperwork removing himself from the "chain of command", which sends all "power of attorney" directly to me, after our father.  My father has the legal right to "excuse himself" from anything he chooses, in order to allow me full freedom to act.  In actuality, he does so routinely.  I discuss everything with him, but he does not have to bother with the phone calls, correspondence, and/or everything required to accomplish something.  For example, I just finished setting in place a new property insurance policy on his own home. 

 

In your family's case, your aunt may refuse to allow DPOA (durable power of attorney) to either of her daughters.  If so, train stops there.  Until and/or unless a judge (I guess -- ?) formally decides that she is legally incompetent to handle her own affairs. 

 

I have not had to deal with anything so awkward and potentially argumentative as your family's situation, which is why my instincts urge your cousins to consult an eldercare attorney. All of the steps or actions I have mentioned cost money.  Someone will need resources to pay for them.  I have no idea how much it might cost to take your aunt to court, seeking classification of "mental incompetence", followed by an award of guardianship.  Eldercare attorneys can be expensive.  (Classic truth of one gets what one pays for, is our experience so far.)  Residential care facilities can be wildly expensive.  A good-quality eldercare attorney will navigate the very tricky waters of applying for Medicaid, if appropriate for your aunt.  We were blessed and relieved that ours successfully and legally secured Medicaid coverage for my mother, two years in a row, without endangering my parents' house..  (She died during the second year of Medicaid classification.)   Medicaid is NOT something to tackle alone, without a lawyer.  We spent hours and hours, days and days, locating every possible document and planning for every possible pitfall.  

[texasmama]

Does anyone have a General Durable Power of Attorney for your aunt?  This covers everything but medical decisions - basically legal and financial ones.  It can be pre-arranged and signed at any point prior to the person becoming incompetent.  I would do that prior to getting an official diagnosis if possible.

 

She really needs to see a neurologist, but if she refuses, no one can make her.  A neurologist can evaluate her for dementia or other cognitive issues.  If she refuses now, then perhaps she will be more compliant at some point in the future.  At that point, if a diagnosis of dementia or Alzheimers is given, the PoA will be in effect as needed.

 

This is a very difficult situation, and our family has just gone through about five years of managing an elderly relative with increasingly severe Alzheimers until we brought her to live with us until she passed away in June.  Dementia is a horrible illness, as it prevents people from participating meaningfully in their own medical care and does not allow for them to make decisions in their own best interest.  You lose them before you lose them to death and, in the meantime, you are taking care of a full grown adult with a toddler's mind but no understanding that they are not completely competent.

 

 

[DawnM]

No, no one has DPA, but I honestly don't think she will agree to it.

She has her 3rd or 4th Neurology appt for this week.  She has refused to go at the last min. the other 3-4 times, so we don't know if she will go this time or not.

 

 

Does anyone have a General Durable Power of Attorney for your aunt?  This covers everything but medical decisions - basically legal and financial ones.  It can be pre-arranged and signed at any point prior to the person becoming incompetent.  I would do that prior to getting an official diagnosis if possible.

 

She really needs to see a neurologist, but if she refuses, no one can make her.  A neurologist can evaluate her for dementia or other cognitive issues.  If she refuses now, then perhaps she will be more compliant at some point in the future.  At that point, if a diagnosis of dementia or Alzheimers is given, the PoA will be in effect as needed.

 

This is a very difficult situation, and our family has just gone through about five years of managing an elderly relative with increasingly severe Alzheimers until we brought her to live with us until she passed away in June.  Dementia is a horrible illness, as it prevents people from participating meaningfully in their own medical care and does not allow for them to make decisions in their own best interest.  You lose them before you lose them to death and, in the meantime, you are taking care of a full grown adult with a toddler's mind but no understanding that they are not completely competent.

 

[texasmama]

No, no one has DPA, but I honestly don't think she will agree to it.

She has her 3rd or 4th Neurology appt for this week.  She has refused to go at the last min. the other 3-4 times, so we don't know if she will go this time or not.

Does she have no one she trusts?  This is a fairly routine matter.  Perhaps a visit to an attorney can convince her of the need for one, if not now then at some point.  I have been my dad's assigned PoA for years now, long before he needed it.  He is still independent, though I have had to help him here and there though the years.  Once a person needs a designated PoA, it is kind of too late to assign one, you know?  This sounds like a difficult situation.

[Jamee]

From my grandparents' experience, rather than moving her into an apartment, I'd look into assisted living with Alheimers unit. My grandma had her own "apartment" but was looked in on and had meal service available as well as recreational facilities. When her dementia became too much, she was moved into an IDENTICAL room where care and supervision was 24/7. She was so gone, she didn't realize anything had changed, because everything was the same.

 

Wishing you the best of luck and hoping you can get it all worked out.