Mental health and Elderly/Hippa

[Furwillfly]

My father was discharged from the hospital as 'gravely disabled' adult, whom had a psych consult while there, and i found out he had been diagnosed with schizophrenia prior to the admission; don't know when. He has always been a loner/hermit. He was a sick man who just had surgery on his neck, and was discharged with(as psych guy says) "no plan for follow-up treatment for neck or mental health care". Come to find out elder care services knows him very well ,they say, they knew he had children, but none of us knew he was in hospital, and/or gravely disabled. Or we would've stepped in. They didn't call us. And he's not enrolled in mental health services....why? And why were we not called? I know all about HIPPA, but when you have a gravely disabled, schizophrenic man don't you need to do what is best for them and see if their is family who wants to help? This mans health has now deteriorated severely as his growth on neck is now Cancer. He had gone into elder care office 6 years ago with a small growth to get help, and they did nothing. Isn't that wrong or is it just me??

Me and my sister are now going to get guardianship over him so that his health care and financial needs are being met. I really want to file complaint against this elder care woman, but I want to make sure there are others out there who think this was wrong. Now the elder care woman calls my sister to see what we have done for him, and is going to call in a month for a follow-up!!! That really ****** me off! Sorry. Please give me your opinion.

[elkpark]

This is a v. difficult, painful situation for families. As I'm sure you know, the law says that healthcare providers can't release info (including contacting family members) without the consent of the (adult) client. I would imagine, based on my professional experience, that the hospital staff would have loved to contact family to make arrangements for your father, but, if he won't give consent for them to do so, their hands are tied. Do you know if that was the case with your father, that he was asked about family but didn't give them the information or refused them consent to contact you? The only other option, as you note, is for the individual to be declared incompetent (if the person truly meets the standards for incompetence) in court and a guardian appointed. For better or worse, unless people have been ruled incompetent by a judge, they have the right to self-determination. Just making bad decisions for yourself, decisions that others disagree with, is not, by itself, incompetence. Diagnosed mental illness, even schizophrenia, is not, by itself, proof of incompetence.

I'm not in a position to comment on whether any of the individuals involved in your father's care did anything wrong. I do understand that this is a v. painful situation for family members, and you are certainly doing the right thing by seeking guardianship. If it's any comfort (I'm sure it's not ), the laws are this strict because there were such blatant, outrageous abuses of people's rights and persons in the past.

Best wishes to you and your father.

[Furwillfly]

Thank you for your insight! I don't know if he was asked if he wanted his family called, as I don't yet have priviledge to that information. Like I said I understand HIPPA, but they weren't making sure he was taking care of his needs. They couldn't have done a house visit.....we now have pictures. AWFUL! No hot water on, mold in the bedroom he was sleeping in, no furniture, refrigerator unplugged, no cooking utensils of any kind, and filthly, and he had been heating his home with propane tanks inside the house....(they knew about that one)_ So it goes further than them not calling us. It's more what the heck were they doing for him if they considered him 'at risk'.

[elkpark]

Again (and I'm not trying to be argumentative at all), did they not try to do a home visit, or did he not allow them to? They can't force interventions of any kind on him unless there is a court order. I live and practice psych in a rural community in Appalachia, and can tell you there are older people in this area who live in what most would consider horrible conditions -- but they are living the way they always have, the way they choose to, and they have a legal right to do so. There are still some people in my area who don't have electricity or "indoor plumbing"! -- by their own choice, and they get along just fine. Legally, they have a right to live as they choose (within legal limits), even if it seems like a bad idea to the rest of us, unless they are found incompetent by a judge. I will say that people (family members and professionals), in my opinion/experience, are probably not as aggressive as they could be about seeking guardianships for people -- most people seem to just grit their teeth and hope for the best. But then, contesting a family member, seeking to remove their rights, in court is a v. emotionally complicated, difficult, painful prospect for most of us.

Again, I don't have enough info to either defend or condemn the agency and personnel dealing with your father's specific situation; I'm just speaking generally.

[Furwillfly]

I am not at all offended by what you're saying. I appreciated it. And you have a point, I don't know if they tried a home visit and he didn't allow them in. Quite possible, knowing my father.

I also work in psych/geriatric in rural community, and if I'm concerned about an adult who can no longer care for self, despite how he/she wants to live; I have the legal responsibility to call APS. And check to see if perhaps they shouldn't have a guardian appointed by state.

And you say "they have the right to live as they choose (within legal limits)" what are those legal limits? Shouldn't elder care make sure those "legal limits" were ok or not? We could have a wonderful debate :) about this. I do appreciate your time and insight! And you do have very valid points. I will step down my anger until I have the 'facts'. thank you!

[Whispera, MSN, RN]

I would imagine the legal limits fall into some sort of rubbing against the rights of others, but don't know exactly where the line would be. People have the right to live as they choose unless they are a danger to themselves or others, or unable to care for themselves (not just not interested in doing it).

Adult Protective Services probably attempted a home visit, IF they had an address. They might have gotten there and your father wouldn't let them in. They might have offered lots of help and he refused it.

Schizophrenia is very difficult for both a patient and his/her family. One big symptom is the patient is likely to disbelieve there's any problem and will fight to maintain what he/she sees as normal.

I don't know about your state, but in Indiana, a family member can go to court to be given the right to a mentally ill family member's psyc/medical/social-work-related information, even without the patient's consent. If you have a Mental Health Association or a branch of the National Alliance of the Mentally Ill, they could likely give you information about it. All this assumes one knows there's information to ask for. Since you didn't know about your dad's psych disorder at first, there's no way you could have asked early-on.

I empathize with what you're going through. Keep you chin up. We're with you!

[Furwillfly]

Thank you for your insight. No, he doesn't believe he is schizophrenic. And the family isn't as much concerned about his schizophrenia, 3 of the 4 kids are nurses...we are a statistic from a dysfunctional home. So we know the illness. My sister and I are going to get guardianship of him with or without his consent. He evidently has reached the point of not taking care of himself.

[RaspberryTX, RN]

I'm going to play the devil's advocate here and show you what the elder care woman is seeing from her side of things. She couldn't contact you or your sister because it would be a HIPAA violation. She is also probably wondering why you never checked up on your father. You said yourself that he was living in horrible conditions and you only found out about these horrible conditions when you saw a *photo* of it. I'm sure there is a valid reason for this, you said he was a hermit and maybe he didn't let you see his house or maybe you and your sister live out of state. But, the elder care woman did nothing wrong. She probably looked after your dad to the best of her ability and as much as the law would allow her to.

[Furwillfly]

As previously mentioned, I know all about HIPPA. I also already said that perhaps she did try to check on him, or he refused to have her in his home. I will give her that one. However, if someone is gravely disabled and you are concerned, you get the courts involved if you can't call the kids.

If I'm concerned about someone and my hands are tied to get family involved....I call APS. That is what they are there for. Even if she wouldve started steps with APS and gotten a court appointed guardian........I would have been happy. Even 'difficult' people need care. This is why they have mental hospitals.

If you see a child is being neglected.....and you can't call family......you call CPS. The elderly are at risk. And people feel because they are older and have their rights they can care for themselves. Incapacitaion is just that. They are also the ones who fall through the cracks.

Looks like HIPPA and the state didn't protect my father, just gave him the right to be gravely disabled.

[Whispera, MSN, RN]

I can't remember...did YOU call APS? Even APS can't force themselves into a person's home if they aren't allowed in. Their hands are tied too. Sad, isn't it? I have an elderly cousin with schizophrenia, so has no indoor plumbing or refrigerator. APS has tried to get into the house but my cousin refuses to let them. So, since she answers the door all pleasant-like, they have no evidence other than family reports to go by, to get her hospitalized. Family even brought her a refrigerator and she wouldn't let them bring it in...at last visit, it was on the porch, WITH FOOD IN IT!

It's so complicated and so awful. My heart goes out to you!