Question about obtaining POA for aging parent

[jnette, ASN, EMT-I]

I had posted this on the Good Morning thread in the Breakroom this morning, but thought I might get some more input by posting it here as well... I really need some sound advice here, my friends! ?

Any input is much appreciated. While we have options available (assisted living, moving in with one of us, or sharing this responsibility 6 mos. with me, 6 mos. with sis, etc., my main question is how to go about persuading Mom to be agreeable. How to get her to agree to be "evaluated" without threatening her independence or causing her to totally flip out and never speak to us again or running off to Germany or something without letting us know?

At this point, we don't know WHAT she might be capable of ???

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OK Guys... this might be lengthy, but please bear with me, as I'm in dire need of some input. Perhaps some of you out there have been in my situation and could offer some much needed advice.

My dear old mom who is 84, is rapidly deteriorating in her mental status. Physically, certainly age has taken its toll, but she still walks (slowly) and is able to care for herself physically. But mentally, the past two years have shown a noticeable difference. We chalked this up to dementia creeping in, and the changes were slow and subtle. But now, things are moving at a much faster speed, and Sis and I are beginning to get concerned.

While she may be clear one day, the next she is not. She will talk with you on the phone one afternoon, the next day not remember ever having had the phone conversation. This also may happen from one hour to the next.

She is neglecting her bills and getting things taken care of around the house. While she was always meticulous about these responsibilities, they now seem to overwhelm her and she puts them off. Pati is driving up there on her days off just to make sure her bills are getting paid and in the mail, and things around the house are being tended to (sprinkler system, car inspections, basic everyday things that need tending to).

While she continues to drive, even this is becoming a huge concern. She can't remember from one day to the next where her car lights are, how to turn on the windshield wipers, etc., etc. Very scary.

Granted, she has been overseas for the past 4 mos., and hasn't driven her car, nor had to worry herself with any responsibilities... Pati made sure she prepaid all her phone and utility bills before she left.

So while she may be going through a readjustment period and may be overwhelmed right now doing things she was used to doing before she left, Pati says there is yet a very noticeable difference.

Mom has always been one who thrives on having people around her.. she does not do well at all (emotionally) living alone. But she has managed ok for the past eight years since my stepdad passed away and has kept herself active in all her music, singing, theater, and international social clubs.

The scary part is that now, she is losing interest in these, and these were her LIFE. This is what kept her going, kept her vibrant. Now it appears that even this is confusing to her, or that she must exert too much effort to attend them... she has NEVER been this way until now. Still hoping she just needs to acclimate herself to her daily living as she did before she left.. maybe she stayed gone just a bit too long this time.. don't know.

She has a hard time remembering scheduled appointments and activities.. although she keeps everything written on her fridge calendar. Now she looks at them and wonders why these are on the calendar. I can tell you that her "calendar" is a standing joke around the family... she would get depressed if it was not COMPLETELY FILLED with activities to look forward to. Now she gazes at it and can't remember why she needs to to what and when, or if she ever wanted to.

I talked with her yesterday on the phone. she begged dh and I to come out again after in January after Christmas as we have been for the past seven years (except last year.. couldn't make it out last year, so I've not seen her in two nearly years). I told her I really would like to see her, that it's been too long, and we discussed my flying out by myself, or dh and I driving out if the gas prices are reasonable enough.

Pati called this morning and Mom doesn't remember ever having spoken with me yesterday. But tomorrow might be another story.. she will very likely be clear as a bell.

OK... soooooooo....

How do we best go about establishing her mental/emotional competency???

We feel it may be rapidly becoming dangerous for her to continue living by herself in that enormous house, not to mention driving, or taking care of her bills, etc. Pati cannot make the two hour drive up there all the time, she has her own life and employment she needs to tend to as well. We tossed about the idea of assisted living, or even having her come stay with each of us, perhaps summers with me, and the cooler winter mos. with Pati in Tucson.

But that would mean she would have to be willing to sell her home, and everything in it, and take only a few items of clothing and personal effects, as our house is tiny, and Pati's as well.

She would FLIP, if we approached her with this. She is extremely stubborn and thick skulled, and we are struggling with figuring out how to do this.. especially if she were to refuse any of the above !

OY... the much dreaded time is upon us. We've had it in the back of our minds for the past several years, but now it is becoming a reality, and it's time to ACT. Pati told me this morning "ok, Sis.. it's time to step up to the plate and be a nurse!" Gee thanks. Of course she expects me to have all the answers, and I don't.

And so I come to YOU....

Any nuggets of advice?

Sure would appreciate anything you have to offer. The main thing is how to start the ball rolling and persuade her against her wishes to do what in in her own best interest. Oh dear... THAT is the million dollar question.

[rjflyn, ASN, RN]

Speak to your family lawyer.

[jnette, ASN, EMT-I]

rjflyn said:

Speak to your family lawyer.

We don't even have one... never had the need for one. But Mom has an atty who does a lot of her stuff.. should it be HE that we contact initially?

[QuilterLPN]

perhaps a good place to start would be with a "power of attorney for health care", (that's what it is called in Oregon anyway - your state may differ). The POAHC is one component of a living will, and you could bring up the subject by saying, "Hey mom, you know, if anything happened to you, how would you feel about life-sustaining measures like a ventilator, tube feeding, etc....". As a daughter, the health care providers would turn to you to help with making decisions anyway, if your mother was not in a position to do that for herself. So, POAHC would be more of a way of initiating that conversation. (Assuming of course that you and your sister agree on the course of care she should have. IF not, get that POAHC).

As far as the independence bit, would she be amenable to having a personal care aid come in for a few hours a day, to drive her around and supervise some things, like cooking? The fact that she is by herself and driving scares the daylights out of me. Another resource could be your family doctor. Tell him your fears, and perhaps he could help with that. Hopefully she doesn't get in a wreck and kill a carful of children, let alone herself. And hopefully she doesn't find herself on the floor for several hours -at least- after a fall and broken hip.

Assisted living would be great - bring up the discussion before its too late.

[jnette, ASN, EMT-I]

QuilterLPN said:

perhaps a good place to start would be with a "power of attorney for health care", (that's what it is called in Oregon anyway - your state may differ). The POAHC is one component of a living will, and you could bring up the subject by saying, "Hey mom, you know, if anything happened to you, how would you feel about life-sustaining measures like a ventilator, tube feeding, etc....". As a daughter, the health care providers would turn to you to help with making decisions anyway, if your mother was not in a position to do that for herself. So, POAHC would be more of a way of initiating that conversation. (Assuming of course that you and your sister agree on the course of care she should have. IF not, get that POAHC).

Assisted living would be great - bring up the discussion before its too late.

That would certainly be an opening, Quilter. Thanx !

A good way to start the conversation, and see how it goes from there. Yes, Sis and I agree with terms of care, and assume Mom is agreeable as well, so that part should be ok.

We'll have to tackle the rest one step at a time. She never drives out on the highway, stays within the walls of her retirement community, and there are NO kids living there.. but still.. she could wreck with another "oldtimer" or even familiy visiting... and of course herself.

We're hoping this is just temporary.. she hasn't driven for four mos. while she was overseas, and she might just need to reacquaint herself with her vehicle.

We'll just have to take things one step at a time.

Thanx for the input. Any one else?

[rjflyn, ASN, RN]

Yes I would start with the attorney that you mom has used. The other poster have brought up the issue of Powers of Attorney for Health care with is fine but you state that her mental status is declining which brings in the question of her even being able to agree to such a thing at this point. You definately want whats best for your mother, but you also dont want some one who may not know whats best for her, ie the courts at somepoint making decisions. I suggest you call first thing Monday morning.

Rj

[Blackcat99]

Your mother sounds like my mother so all I can say is "Good luck"-You're going to need it. I am the POA for my 84 year old mother who has Alzheimer's and my mother too is extremely stubborn. The first thing you want to do is talk to your mother's doctor. Tell her about your fears about your mom's driving. Have the doctor write a letter to the Dept. of driver's licensing so they can take away her driver's license. Do you have any relatives who would be willing to go and stay at your Mom's house? Does your Mom have any pets? I got my mom to agree to have a lady at the house by telling her that the cat has a serious heart condition and had to have a "specially trained cat sitter" with her. I don't know how you are going to get your mother to sell her house. I am living in my Mother's house because I couldn't get her to move. Contact an elder care lawyer. They will help you figure out what the best thing is to do. If she won't allow you to be her POA then you should file for conservatorship. Don't wait another day-Contact an elder care lawyer immediately. Don't wait until her symptoms get worse.

[DidiRN]

Man, I feel for ya...been through something very similar.

My mother would never sign POA to anyone while she was lucid, therefore my sister had to file for legal guardianship once she deteriorated. Apparently, this is much harder to get (you have to go through court) and it's a real PIA for my sister, who is now her legal guardian, who has to show the court every single penny spent for my mother when she was still at home. Mind you, I know why that is important, the courts want to protect my mom, but it stressed my poor sister out so much, trying to juggle working full time, two kids, and then dealing with this.

The advice about getting a lawyer involved in right on. I'll PM you later about how we got her into a home (wasn't pretty)

[jnette, ASN, EMT-I]

Thanx, BlackCat and Didi !

I actually thought of you BlackCat, as I remember you posting along these lines several times, and was hoping you'd respond. :)

I wouldn't go so far as to say Mom has Alzheimer's, but dementia is definately visible and audible... it has been subtle the past two years, but becoming quite evident now. So I just don't know if I'm over reacting here.. so many questions.

There are no other relatives other than myself on the other side of the country, and my sis who is two hours away.

She is going up on Monday again, and I will have her to have my mom drive this time when they run errands, etc., and that way Pati can gauge her driving skills and see if she has remembered where everything is in her car.. she's not driven for the past four mos., as she was overseas... maybe she just needed a little refresher.. we'll check that one out.

So would the Eldercare lawyer be preferable to her own atty?

I doubt that we could convince her to move until she feels she's ready, although she despises being alone... she thrives on having ppl aorund her 24/7.

And Pati can't move in with her and give up her job.. she has two more years where she's at to get her full retirement.. she'll be 100% vested then and cannot afford to quit now, or even transfer, as she has obligations of her own. Plus, Blackcat, she would not do well with this kind of stress with my mother, Mom is soooooooooooo argumentative... I think you know what I'm talking about !

Pati couldn't handle it.. actually I don't know that I could ! We'd be in the funnyfarm in two months !

She doesn't have pets, and is not the trusting kind, so there's no way she would have anyone stay with her other than me or sis. I can't just up and leave here to move there, either. AAAAAAAAAAAAAAAAAARGH !!!!!

What is conservatorship... the same as legal guardianship?

And how does one pay for all these lawyer fees, anyway? Heck, neither one of us has that kind of mula ! :uhoh21:

And what if she goes in to her doc and presents her sweet side? :rotfl:

All talkative and chirpy ... oh she is the ultimate actress, to boot !

Bless her heart... she's a real catbird.

Oh boy... I have a feeling we've really got our work cut out for us. :stone

[Ruby Vee, BSN]

We just went through this with my mother-in-law, and I can tell you what we did.

Mamita has been deteriorating for years, but it was hard to differentiate between her chronic games to get attention and her deteriorating mental status. It became quite clear last january. Her toilet broke, and a cousin found her sloshing around the house in ankle deep water (the third day after she called the cousin, a plumber, for help with her toilet). Yvonne took her to the hospital, where she was admitted for evaluation. At that time, the hospital told my sister-in-law that mamita couldn't live at home anymore; she either had to go to a nursing home or get 24/7 watching at home. Martha chose to take her home.

Mamita and martha lived in new orleans, and then katrina came. They went to an evacuation center. The noise, confusion, etc. Were too much for mamita. She walked away from the evacuation center and was missing for five days in a disaster area. Fortunately, she doesn't seem to remember those five days, because I can't imagine how horrible they must have been. She ended up being sent to my youngest sister-in-law in massachusetts.

Sandy had rather more foresight and planning skills than any of the rest of us, and took a day off work to consult with a social worker, medicare, etc. Before mamita arrived so she knew what to do. She was advised to take mamita immediately to an emergency room and tell them about the confusion, agitation, combativeness, etc. And ask for an evaluation. Sandy took her straight from the airport to the er. She was admitted to the hospital for evaluation. Care managers and social workers became involved, and mamita was placed in an alzheimer's care unit on tuesday after getting off the airplane on friday!!! There was talk of a guardianship hearing, but sandy was fortunate enough to avoid that by getting her to sign a poa during one of her good moments. I think mamita was so overwhelmed by everything that she just signed it. She was the last person in the world I would have expected to cooperate in any way with anyone who wanted her to do something she didn't want to do.

Mamita resisted signing anything for a long time, but sandy just kept bringing it back, and revisiting the options over and over, and the care manager was a enormous help. She was very patient and talked mamita through everything, evidently convincing her that it was her choice to sign the papers.

Long story, I know. But you may want to take your mom to the er for an evaluation on the off chance that an electrolyte imbalance or something equally fixable is causing her symptoms. If not, they'll rule that out and you'll be in a position to have help from a case manager or social worker to help you figure out your options.

My mother is headed down the same road, and that's exactly what I'm going to do when the time comes! Good luck! Let us know how things work out.

Ruby

[jetsetter]

My suggestion is ... go slowly. Try to get her to do one change at a time. the whole 'giving up the house, car , independence' thing all at once is what will make her plant her feet and refuse to budge. I'd suggest the POA (one for healthcare, one for financial, again..... one at a time). Both her dr and her lawyer need to be aware of these memory changes, and both will have her best interests at heart. They will realize you are well intentioned, and may have good suggestions.

Other than that, I say good luck, God bless, and hold on to your hat, 'cause life is bound to get very interesting!

[ktwlpn, LPN]

It sounds like she needs a good medical evaluation first to rule out a physical cause for her sudden decline-Get her physician involved-he (or she) make sure you voice all of these concerns.Get her to a neurologist too.....Input from her physician regarding her abilities may just be the impetus she needs to get moving.Then a lawyer with experience in elder law.The elderly get freaked over the DPOA/POA thing because they think it means they immediately loose control and that is not so.They only take effect when the person is incapacitated....If her doctor feels she is incompetent that's a whole other ball of wax..............If she won't agree to an evaluation you can always call the Department of Health-anonymously...They will evaluate the situation and you won't be the bad guy.Your sister needs to understand that your being a nurse does not make you immune from the grief you are BOTH feeling over your mom's decline...It's way different when it's your own family....

I think one or both of you (if you show up together she might feel invaded and threatened) should try to clear your calendar for a few days and go to her---honestly tell her the things she does and says-tell her how worried you both are about her health....I think she'll agree to let you take her to her physician right away.....I hope she agrees eventually to move closer to one of you-it's so hard to help them from a distance....good luck