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Elderly parent refuses outside help


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I decided to start my own elderly parent thread. I am hoping that someone will have a suggestion that I haven’t thought of yet.

What can be done with/for an elderly person who refuses needed care? My dad has decided to move to assisted living. He is moving next week. My mother refuses to move, but is also refusing any home health services which she does need. She wants to have family members provide her care, but that cannot happen for a variety of reasons that I won’t list all here now, but I can add more details later if requested. Here is one example though. She will not allow anyone but me to help her bathe, and she will not attempt to use her shower even after modifications. I live over 12 hours away, so me come ing regularly to wash her is not an option even if I was willing. 
 

So I guess I am asking for legal options. Should I force a mental health evaluation, have her declared incompetent, or report her situation to Adult Protection? Tell my sister who owns the house Mom is  living in to evict her? Leave mom alone until something bad happens and 911 has to be called?
 

I truly believe that this is a mental health issue. Anyone who would rather have streaks of her own waste down her legs for weeks on end rather than allow someone to help her wash has a mental health issue.

Money is not concern at this time. There is plenty of money to pay for people to help, she just refuses. One person was already hired to help her with the original Intent that she would help with personal care. The lady tried and tried to get Mom to bathe, but Mom would not agree so eventually the lady gave up trying.

I am planning to call Mom’s doctor this afternoon to share my concerns and see if they can offer any suggestion on next steps. I have also found an Attourney in the area that specializes in elder issues that I plan to call. I found the regional Agency on Aging as well that offers caregiver support so maybe they can give me suggestions. 
 

I am open to any and all suggestions.

Edited by City Mouse
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I'm sorry. I've been there, with different details but similar need for change. It's very, very hard.

About the bathing... Is she embarrassed? What's the origin of the problem, do you think?

I was told (correctly, I think) that it was very difficult to have someone declared incompetent. Certainly at the point that we had to make changes for my mother's safety, it would not have been possible. We did eventually convince her to move when a house very close to me and her young grandchildren went on the market, but that only solved some of the problems.

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I think the first step is talking with her doctor. Any advice beyond that is going to vary so much by state there’s not much you can do. 

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do you have power of attorney for her?   is she "hard" refusing - or refusing because she's refusing  as a knee jerk reaction? 

is there enough support for her where your father lives?  Will they be able to provide more extensive care?   once he is settled, is taking her to "visit" an option?  then she can see it's not the horrible situation she's probably imagining.

my mother was falling, and getting confused on her meds so double dosing or skipping doses - and still super resistant to moving.    She was also having TIAs.  Her health finally gave me the option to put my foot down and refuse to allow her back to her apartment.   

is there a medical issue that would require her to be hospitalized?   with feces on her legs -  you've got a good case to have her hospitalized for a mental health evaluation.  which is usually a few days..  At that point - you can speak with the hospital social workers about what your options are, and about sending her to another location that has more support.

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Just now, Katy said:

I think the first step is talking with her doctor. Any advice beyond that is going to vary so much by state there’s not much you can do. 

This.  Call her doctor first and see what they say.   

it does sound like a mental issue or maybe just extreme embarrassment.  


Has your dad talked to her?    I wonder if seeing him doing well in assisted living will make her want to go, too.  

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Different legal system, but unfortunately I had to wait for a crisis (a health crisis in this case) that forced the change.  Once she was in hospital, the doctors, paramedics who retrieved her, social worker and local police who checked the house after she moved out created a case book that, without actually declaring her incompetent, was used to more-or-less enforce her moving into another situation.  She could have refused, but at that point the weight of authority was too much for her to resist.  I'm sorry.  It's hard.

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8 minutes ago, Laura Corin said:

I had to wait for a crisis (a health crisis in this case) that forced the change. 

Yes, if she ends up in the hospital, that can bring about change.

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I agree with calling the doctor.  And also the local agency on aging - ours has been incredibly supportive and helpful.

The bathing has been an issue here, too, and even in assisted living - elders can refuse bathing (here, anyway).  We have found that trying different aides and helpers can help, as our reluctant bather responds differently to different people. That might be one small idea to try - change up the home health aides who assist with bathing. Some more very practical ideas that may/may not help... making sure the bathroom is warm (the dread of being cold after getting wet could be part of the aversion), preserving privacy and dignity as best the aides can, finding the right time of day when she is most energetic, and promising a reward afterward. Those are things I’ve tried, with varying degrees of helpfulness.

Is there a dementia diagnosis? 
 

I’m sorry, it’s really hard.

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I agree talk to her doctor.  And would your dad join forces with you to get her declared incompetent ?  

Would help to have an intervention and try to really impress upon her that what she wants (you to drive 12 hours to bathe her) absolutely cannot happen and another choice has to be made so she can be cared for and safe.

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51 minutes ago, Laura Corin said:

Different legal system, but unfortunately I had to wait for a crisis (a health crisis in this case) that forced the change.  Once she was in hospital, the doctors, paramedics who retrieved her, social worker and local police who checked the house after she moved out created a case book that, without actually declaring her incompetent, was used to more-or-less enforce her moving into another situation.  She could have refused, but at that point the weight of authority was too much for her to resist.  I'm sorry.  It's hard.

In the US and this is what is having to happen now for a close relative.  Unfortunately, it has taken multiple hospitalizations for anyone ( not family) to help us. 

Edited by itsheresomewhere
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Could where your dad is going accommodate her? Some assisted living places don’t handle medical needs beyond checking on someone, lightweight house care, pill distribution. 
 

What is your dad’s insight?

A reasonable person would want family care but recognize, with a 12 hour distance, that that is not doable. Frankly, with a 12 minute distance, elder or disabled care is too much for one person. I’d really lean towards taking your dad’s thoughts and suggestions into account, but I suspect of being in her own waste still doesn’t persuade her, that there is mental disability here. I’m so sorry. This has to be so hard for you. 

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Depending on the state and whether her doctor is on board, having her declared incompetent may not be a heavy lift. But, it is often easier to force things after a crisis, even though that’s the worst way to go about it. I’m sorry. Elder care is so very difficult. 

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I'm so sorry.  I have no advice, but wanted to offer support. 

I was also wondering if she would be able to go where your dad is going (if she is willing) and live with him, or if there is another location where they can live together.  

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Posted (edited)

Just to add more details.

We had all hoped she would agree to move when dad does. The place he choose has a suite available that has two separate complete large rooms, each with kitchenette, large closet, and nice large bathroom for each room. It is like two i divvy rooms with a connecting door. The base cost was priced out for them to both move. The place only has the one suite open, so he has decided to rent both rooms for now which the hope that she will change her mind once she is truly alone. That would be the ideal situation at this point. Luckily, my dad did a good job of financial planning, and worked as long as he could, so they have a large savings and combined get a very large SS payment monthly. Not million(s) but enough for them to be comfortable for a long time. Because he is a disabled veteran (10% disabled) and served during war time, there is VA benefits that will go toward assisted living if there savings gets low enough. 
My sisters and I do have some concerns now with protecting their money. My dad admits that he does not monitor the accounts so that any fraudulently activity might not be detected until a lot of damage is done, and we don’t trust mom not to do something out of spite. We know that will take help from a lawyer, and one sister that lives close is will to take that on

The assisted living place does there own assessment of the resident after a couple of weeks to determine the level of extra care need and the price for that extra care. Right now she doesn’t need anything medical, just daily care stuff. They did say that hygiene help can vary from someone standing outside the door just in case to full washing, it just depends. 
 

So yes, I will start by calling her doctor today, and then the Agency on Aging. I am thinking that I will have dad request to put her back on the meals on wheels daily delivery. Part of the meal delivery is a quick wellfare check with the delivery. That would at least be someone outside of the family to check in on her in case she has fallen. Then if she refuses the service, that will be documented.  I guess now, we are in the stage of collecting documentation should the court need to be involved.

No dementia, but there are other issues that are impacting her decision making. She is extremely obese and a hoarder, so I think some of her behaviors fit with addiction type behaviors, also lots of untreated anxiety. 

 

 

Edited by City Mouse
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Hopefully she will move with your Dad, or soon after.

One more thought: about that untreated anxiety ... would she be willing to see someone for that?  I know it’s a long shot, but it could be helpful. My mother’s anxiety impacted her decision making, and once she was medicated for that (among other things) her decision making improved. She became easier to live with, as well. It could be worth discussing with a doc but there are drawbacks, in that some meds can exacerbate dementia, so I’d never just say someone should medicate.  Definitely a doc decision, my mom had a psychiatrist who does elder care, not just a family doc for this.  Could be hard to find one like that, but might be worth investigating.

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I’ve left messages with the doctor and a lawyer, but I’m  not expecting to get a call back until Monday at least.

I did talk with a person at the Agency on Aging who needed to check with other staff member, but she quickly called me back. If the person is considered competent, then that person as the right to refuse any and all services. Her only suggestion was to call Adult Protective Services to check on her if I think there is a problem. In Texas it is not easy to get a person declared incompetent, not that it should be easy, but it sounds like Texas may be harder than other places.
 

Because this is not a case of abuse or neglect,  but a case of personal choice, I don’t know how much good that will do, but I will most likely call at some point.

I have talked to both of my sister at length, and our plan for now is setting boundaries and limits. (Taking advice that is frequently given on the hive). I made sure both of my sisters who are local to Mom have my support to set their own limits as to what they are willing to do, and that they know that I do not expect them do take on additional tasks. I am practicing my own response. “You said you do not need any help, so I am not going to help you with that.”  and “I do not think it is safe for you to stay here, and I am not willing to do anything else to help you stay.” 

We are going to look into getting one of those wearable alarm things for Mom to wear in case she falls or does need medical assistance. She should probably had one of those a while ago anyway. One sister takes Mom’s weekly grocery order and does Walmart pick up. She will continue that. The other sister helps mom with a weekly meal order from one of those mail order services, and that will continue. 

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Will she wear the alarm?
 

 One suggestion that might work is an Apple Watch and/or using Amazon alexas in each room.  Newest Apple Watch has fall detection and she can call out for Alexa to call for help ( or call you if they are stubborn and you can figure out if calling for more help is needed). These devices are slightly more accepted than wearing the alert system. 

Edited by itsheresomewhere
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DH and I are dealing with our own elderly medical crisis and I don't have anything to add to what's been said.

But...I wanted to send BIG HUGS!!!  It is a hard road to travel...

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1 hour ago, itsheresomewhere said:

Will she wear the alarm?
 

 One suggestion that might work is an Apple Watch and/or using Amazon alexas in each room.  Newest Apple Watch has fall detection and she can call out for Alexa to call for help ( or call you if they are stubborn and you can figure out if calling for more help is needed). These devices are slightly more accepted than wearing the alert system. 

That is a good idea!

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I’m sorry.  That sounds hard.  

Maybe her doctor would consider anti-anxiety meds for her?  

Will she visit your dad and do an overnight visit with him?   And then she goes back home?maybe she’d discover that she enjoys the meals or the social atmosphere.

my mom preferred male aids to do her bathing 😳.  She said they were gentler and less hurried (not in a weird way, but not making her feel like a nuisance kind of thing)

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15 hours ago, Laura Corin said:

Different legal system, but unfortunately I had to wait for a crisis (a health crisis in this case) that forced the change.  Once she was in hospital, the doctors, paramedics who retrieved her, social worker and local police who checked the house after she moved out created a case book that, without actually declaring her incompetent, was used to more-or-less enforce her moving into another situation.  She could have refused, but at that point the weight of authority was too much for her to resist.  I'm sorry.  It's hard.

This is very often the case, sadly it does have to get worse before it can get better. That period of watching and waiting is very hard. 
 

Hopefully she will change her mind on her own and agree to a move. It seems cruel, but your sister ceasing to allow her to live in the house may be helpful. Personally if I knew my elderly parent was unsafe living alone, and would not permit home health care professionals into the house, I would come up with a reason to need her too move (ie, I need to sell the house, the house needs major renovation, I need to rent it out for income, something). If she would refuse to leave, then... the watch and wait. 

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Re financial fears - your dad can probably set up some separate accounts (possibly with his POA/heir as a joint owner) and redirect his funds into the new accounts. Her SS could continue to go into an account she has access to. He could always transfer funds to her, should she have true needs that exceed her SS income. 
 

Does she handle any financial business on her own now? One problem my elder had was the inability to keep up with regular payments - utilities, telephone and television services, flood insurance premiums, vehicles they may no longer drive but still owe on. By the time our crisis intervention opportunity arose, we had to foreclose on the house ASAP and allow a vehicle to be repossessed. It was...messy. 

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