Familial accountability

[KalipsoRed21, BSN, RN]

So I got in an argument with my sister and would like some opinions. My sister and I conflict frequently, so no worries on long term repercussions as debate is pretty much a standard for us.

Our grandfather is currently living in an assisted living facility and paying ‘extra’ for help because he is demented and incontinent of both bowel and urine. He is not strong enough to get up and help with cleaning up and such.

This is all pretty fast as he was Ax0x3 last June, then had AV repair surgery and was put in this assisted living for rehab and just has been going down hill since. He is 86. He was fairly financially okay having about 500K when we last talked 2 years ago. But you and I know how fast all that can go.

So as his decline has been steady and rapid, I have told my aunts that he really needs to move closer to one of them, my dad died 2 years ago. He lives in Texas, one aunt lives 6 hours away in Texas, the other lives in Michigan. Somehow they decided the best plan was to move him to Michigan. I disagree, but whatever, it’s their dad. My issue is that I saw him last in the beginning of April. He is really needing SNF and I know he doesn’t want to go. My aunts are not really caregivers, but he lives so far from everyone that my one aunt is only seeing him once every other weekend. They are leaving all planning (MD appointments and such)and care up to my demented grandfather and the assisted living. I’m really kind of beyond ticked that they haven’t moved him closer to one of them yet.

They are giving my sister some sap story about how his cardiologist won’t sign off on mental capacity papers until his follow up appointment in 2 more months and they can’t move it up. And they can’t convince him to sign the papers himself because he technically is not mentally capable of doing so.

I say bull. There isn’t a facility or person I have ever worked with that wouldn’t allow some sort of papers to be signed by a demented person if it was in their best interest. It is in his best interest to be closer to one of his daughters. So really the deal is that my aunts are lazy and I think they are doing this whole ‘letter of the law’ B.S. to delay having to attempt managing him or watching him get worse. I’m sorry, I have no respect for people who don’t take care of their family. My sister says they are trying, I just don’t see how important following the law is.

I’m not asking that they do the physical care, just check in on him a couple times a week and be close enough to be there when the end comes. At his rate of decline I’m not sure he is going to make it to Christmas. So now he is going to die alone. Makes me sad.

So how do you feel about familial responsibly in elder care? Do situations like this frustrate you? This is my own family, but I’ve got plenty of patient examples where it seems like the ‘kids’, people 40/70 years old, can’t be bothered to even just regularly check in on their parents. I personally find it disgusting.

My Mom was/is a shining example of an accountable kid. She didn’t even get along with her mother and moved her in with us for 10 years until she couldn’t do it anymore and then still went daily to the nursing home to make sure her mom was okay. My mom was a superstar, I don’t really expect others to be able to do that, but to check on them 1-2 times a week? I really kind of feel like that is a minimum.

I am more than willing to understand estrangement situations and abusive parents....that would not be the kind of situation I am referring to. You know the run of the mill, we got some family issues based on personalities but my parents fed us, kept us clean, and we had some stuff kind of parent/children relationship.

[MunoRN, RN]

What are the "mental capacity papers"?

[KalipsoRed21, BSN, RN]

Apparently they are papers to certify that my grandfather cannot make his own decisions and my aunt is his guardian.

It is not that I don’t think these papers need to be done, just that getting him as close to one of them as soon as possible more important than dilly dallying around waiting for them to get completed. My grandfather would agree to go to MI on his own. He agreed to it in April.

[MunoRN, RN]

Typically declaring that someone lacks capacity to make their own medical and/or financial decisions is a legal finding, often by a judge. A physician can determine someone lacks capacity but only in the short term.

What is he able to understand?

[KalipsoRed21, BSN, RN]

He is pretty bad off. Alert and oriented times self mostly.

And as such I don’t see why it would take months or more to get him closer to one of them in a SNF. Frankly in situations such as his I would tell the family to check him out of the assisted living he is in. Tell him he is going on vacation....he isn’t going to tell them no...drive his booty up to MI and then take him in to the ER for a shortness of breath or something and then get him in the system in MI. Is it the ‘right’ way to do things? No. Is it best for the patient? Yes!