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My mother has been diagnosed with moderate to severe dementia. She lives by herself and won't get out of her house. She is incontinent and sits in her urine soaked clothes. She won't take help from any health aides we've had go over and won't open the door and let them in. Her neurologist said we may be able to have a psychiatrist deem her unfit to be in the house instead of having to pay a lot of money for a guardianship. Has anyone ever heard of this situation?

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As far as I know, deciding the competency is a legal issue. However,the attorney most likely would need input from a neuropsychologist. This person is licensed to perform a battery of cognitive test in order to assess a person's mental status including the ability to make decisions. A psychiatrist may be able to assess competency as well but their evaluation may not be as comprehensive as the neuropsychologists.' It might be a good idea to speak with an elder law attorney. They should be familiar with state law.
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He can also Involve Adult Protective Services if Need Be...
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I agree with Llamalover - get adult social services involved - this, and a good Elder Care attorney consultation. They should be able to guide you. I'm guessing you either don't have POA or can't use it to get your mom to move because she's still deemed 'competent' and she's refusing. Even with a POA you can't force a person to do something they don't want to do. My dad is very stubborn, but your mom sounds like she's in a situation that will eventually rob her health or allow her to harm herself.
Don't go it alone. Adult Social Services would be my first call.
Good luck and wishing you the best on your caregiver journey!
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Seek out Adult Protective Services.
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What exactly is the goal? I have read through your other posts just now. Clearly this issue has been on the radar for a while now and isn't going to get any better. If the goal is to get mom moved to MC and take over financial/medical decisions, how you proceed may depend on whether you have POA.

Having a letter from a doctor (sometimes more than one) is often needed to activate a POA. Having letters from her primary doctor and specialists WILL assist in the guardianship process - saves some time for fact-checking and costs for testing, perhaps. Having a letter from this or any doctor may OR may not get her into a place, however here are where the questions come in:

**If no one is her POA or guardian, who is going to sign the paperwork for the facility (and there ARE a lot to sign!)? If one of you signs, you are likely signing that YOU are agreeing to make payments. Not an ideal situation. If you don't have POA, you are not signing FOR her, you are just signing. BEWARE

**If you don't have POA or guardianship, how will you be able to manage her finances, sell her home or make ANY decisions for her? You can apply to be rep payee for SS, but when you apply it takes a while AND they will notify your mother - mom was already in MC, so she didn't get the letters. This could raise a stink if you try this now. Even with POA, we had to get mom's signature on the deed (this one baffled me, but we managed to get it done) to sell her condo.

Legally, without the POA, you are up the creek. Even if you have POA, it does not, EVEN WITH A DOCTOR'S NOTE, grant you the power to force her to move. Been down that road. No POA, no move at all. POA, move *may* be possible, but usually involves some trickery. POA is NOT full power over anyone, it just allows you to make some financial/medical decisions and sign some paperwork for her.

I *would* suggest you make a consult appointment with an EC attorney (or two) ASAP and discuss this issue. If you or one of you have POA, you might be able to avoid guardianship. Even with POA, our EC atty told us we couldn't "drag" mom out of the house (she was refusing to move anywhere or let aides in.) Your mom's assets should pay the court/legal costs, but if she has none, discuss this with the attorney as well. If she owns her home, perhaps an arrangement can be made to sell it after the move and use the proceeds to cover the legal costs.

Generally the attorneys will all give you a 30-60 minute 'freebie', so have all your questions and concerns drafted ahead of time. They should be able to give you an estimate for the fees associated with guardianship - the actual can vary, but they should be able to target it. Do this ASAP - the longer you wait, the worse mom will get.

If none of you want the responsibility (there are rules and requirements, including keeping good financial records and reporting them to the court), you could ask about having a guardian appointed, but they are not cheap and it will take ALL assets and control, including where mom lives, out of your hands.
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I am a bit confused. Your mother has dementia and her behavior is horrible and is obviously not good or safe for her and it is playing havoc on you and your sanity. It is obvious she cannot live alone in a proper manner. Start inquiring what legal things need to be done to get her into a proper care situation in a facility or how to get a caretaker involved to care for her. There are ways it can be done and this must be done now. Then tell her this is the way it is going to be because......and there are no if's, and's or but's. She has to cooperate or else. Let her rant and rave but walk off if she does. She has no right to abuse you and make you feel guilty. She must be made to see that - one way or another. Do not allow her to live with you - you will be destroyed.
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disgustedtoo Sep 2019
"Start inquiring what legal things need to be done to get her into a proper care situation in a facility..." She IS asking how to get this done, but her method isn't likely to take care of that issue or all the subsequent issues (financial, assets control, etc.) Instead of pointing in a general direction, some specifics?

"... or how to get a caretaker involved to care for her." They tried this. Mom refuses to let them in. You can't FORCE mom to do this. Sure, you can try ways to get them in, like being there/arriving with them, but that likely is NOT going to change mom's refusal and it won't work if the OP and other family are working and cannot be there during the day.

"There are ways it can be done..." Such as? Just saying it is so is NOT helpful. She's looking for guidance, not platitudes.

"Then tell her this is the way it is going to be because......and there are no if's, and's or but's. She has to cooperate or else. Let her rant and rave but walk off if she does." This method does NOT work with dementia and in general it WILL backfire. Walk off? What, the pier? What exactly is THAT going to accomplish?

" She has no right to abuse you and make you feel guilty." I see nothing in OP's post that says mom is abusing her or making her feel guilty. She DOES have rights, with or without dementia, and that includes refusing to move, to do things she doesn't want to do, etc. Staff at mom's MC place AND the EC attorney clued us in there - EVEN with POA, they still have rights. EVEN with guardianship, they still have rights.

"She must be made to see that - one way or another." Can you clue anyone in on any of these 'ways'??? Dementia usually involves short-term memory loss dear. You can TELL her she MUST do X, Y, Z and within minutes (or less) can forget you even said it. You can tell her 10,000 times a day and she will forget you even said it once. There is no way to "make" someone with dementia "see" anything that you deem reasonable and responsible.

Go read up on dementia. All those college classes you took didn't cover this topic (nor did any of mine, neither degree - I had to learn by looking it up and reading about it when mom started down this "path." It WAS enlightening...)
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I made my Mom scrambled eggs, she chewed them for an hour. . She had some dementia...She fell earlier in the morning and couldn't get up. I called an ambulance, they took her to the hospital, did an evaluation. After 4 days in the hospital, she was put in a rehab home, she couldn't live alone... rehabilitation didn't work and she was moved to long term nursing home.
If something doesn't look right, call an ambulance...
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Her neurologist could write a letter saying she couldn't make decisions, only her POA. He should have sent her for neuropsychological testing. Get another doctor if he won't.
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Adult Protective Services may be the way to go, but try to be there when they visit so you can cue them in to ALL the problems.
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I have POA for my 102 year old mother. We have gone through a very long summer with broken hip,surgery,rehab ,and now home with care 24/7. My mother doesn’t want anyone in the house and is making my life very difficult. Having POA doesn’t allow you to make living arrangements. My mother thinks that I am forcing her to have help at home and is furious at me. I remind her it was her care team who made it a condition of returning home. I have spoken at length with her attorney how to go forward. We too have discussed invoking a protective order and having a guardian appointed.
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APS must come out once I call is made. Explain the situation. They will be able to help.
i have POA for my dad and not guardianship. He was the same way- resistant to help, and he never wants to see a doctor. He’s fully incontinent and sits in his dirty clothes. I told him if he didn’t allow me or his aide (who just started 3 days a week) to change him, then APS would send him to a NH.
It is a tough situation, but the law states that senior citizens are allowed to make their own decisions no matter how poor their choices may be. You can’t force anyone to live the way you want them to. I had to let go of that idea.....
I figure that if my dad gets an infection because he is sitting in wet clothes, then we will need to address the infection. It is heartbreaking to watch, and I completely understand that you will end up with a lot of laundry, steaming carpets three times a week, cleaning up after the mess, but if this is the way a senior chooses to live, then there’s really nothing you can force them to do unless you have guardianship.
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DiamondAngel14 Sep 2019
Call an ambulance.... he'll get evaluated...after 3 days in the hospital he can be put in a nursing home. They all say they don't want help or anyone in the house. Remember, you are the one in charge, not him.
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Who did the diagnosis of moderate dementia? Because HER psychiatrist deeming her unfit still gives no one else the right to make decisions for her and will do no more than the regular neurologist or MD giving the diagnosis. She would need some kind of guardianship, whether court appointed or not is the question. Were I you, unless you want a good deal of trauma and angst in your life going forward, I would not accept guardianship, but would rather have the court assign same. And I agree with others here, that this is a case for Adult Protective Services.
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DizzyBritches Sep 2019
Yes. I would think there would have to be some sort of adjudication by a government agency if you’re talking about putting him where he doesn’t want to be.
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Joanne, if you’re having trouble getting her out to any doctor, have you tried contacting APS as the posters here have suggested since your queries in May?
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I agree with ctcaregiver - her own doctor should be able to identify her inability to live alone. But, if the neurologist made this suggestion, ask neuro dr for the name of one and to let him know why you are bringing her.

You probably still need someone with Power of Attorney to handle her personal affairs.
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cherokeegrrl54 Sep 2019
OP states she wont leave the house to go to a dr.....APS needs to be called in these circumstances.....if the elder person wont or cant take care of themself and/or refuses any and all help, whether from family or caregiver, time to report it to the appropriate authority
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Joanne, have you reported Mum's circumstances to your local APS? It really sounds like she needs full time care and APS may be another option to getting the ball rolling.
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joannc60 Aug 2019
Thank you. I will need to contact them to see if they can be of assistance.
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If there is no POA you will very likely need some solid documentation to sell property and use funds.

I find it somewhat worrisome that you describe her as having “moderate to severe dementia”, then stating that she “won’t take help”, “won’t open the door” “won’t get out of her house” etc.

If the neurologist has given you a written statement about the dementia, you are certainly on solid ground to have her physically removed to a safer environment. Her condition indicates that she is no longer equipped to manage her own welfare.

Who writes checks for her bills, shops for her, addresses household concerns? Does that person have POA?

If you are attempting to find a peaceful resolution to her current circumstances it will tragically most likely not happen. The process of rescuing her may well incite a number of startling behaviors. You will need to make your mantra “safe, human needs met, protected”.
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If you don’t already have a POA It’s probably too late to get POA from this women as she would have to be mentally competent.

Check the admit policies of your local assited living and nursing homes. Many will accept new residents based on a letter from a MD that the person cannot live at home and take care of themselves. The place I got my parents in was like this. It was obvious to anyone they should not be home alone.
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I have not heard of a psychiatrist having to deem her incompetent. My mother’s primary care physician offered to write a letter stating she was unsafe I her own home. My mother is not as advanced as yours, however. She now lives with me. You may want to contact your local Agency on Aging for suggestions. A family member can be a guardian as well, but a court appointed one should not be that expensive if it goes through the court system.
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Isthisrealyreal Aug 2019
The court appointed guardians are expensive and work hourly. They are not discounted because they are not family. If anyone chooses this route they should be aware that they no longer have any say about their loved one, their property or their placement. If there are assets they will go towards care and paying the guardian as much as 225.00 an hour, depending on where you live. Cheapest I found was 165.00 hourly. Just a heads up.
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It may be possible. Doctors are mandated reporters and they have to report to APS adults at risk who are living in what could be dangerous situations, which it sounds like your mother is.

Does anyone have Power of Attorney for her? What concerns me is that since she owns her home, if you do put her in a facility and then need to sell her home and handle other financial obligations, you might run into roadblocks with all this if no one has power of attorney over her. You may need to get guardianship anyway.
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