Am I mean for thinking this way?

alan_s_thefirstDecember 19, 2009

My wife has a close relative in her 80's who has been living by herself in an independent retirement place for over 10 years, ie no medical or other assistance apart from the alleged 'cleaner' she has who has been robbing her blind inasmuch as the place is filthy. I don't think she has been able to see well enough to tell. She doesn't take care of herself, really, and eats all the wrong stuff for a diabetic, pretty much lost the will to care for herself 'because she still feels bad' but bemoans the fact too. She's kind of bitter and not always nice to be around, can be quite manipulative and demanding, and does not seem to realise that she won't get much in the way of visitors if she is such a downer...basically.

A couple of months ago she had a accident (she is kind of a danger to herself and others, thankfully she stopped driving a couple of years ago) that resulted in various broken bones etc - amazing she is still alive. She is diabetic and has not looked after herself, being in the hospital she's actually looked better and been breathing better, since she's actually back on all the medication she is supposed to take. Despite this, she had a small heart attack a few days ago, but is ok.

She is entitled to extra benefits etc because of her former government service...and has been keen to speak with her advocate. I found out the reason why, is she wants them to hire help for her, so she can return to her apartment! I didn't disguise my amazement very well. Keep in mind this is a small place and she will need to be in a wheelchair for at least several months, can't really use her hands (can't hold a book for example) and the place is not really set up or furnished suitably.) She thinks if someone (hired by govt I suppose) visits four times a day, she'll be fine. I don't know how she thinks she will cook etc and if she even can - she had a pet which she quickly lost interest in and neglected, we have been nursing it back to health, an animal I really don't want but hate to see neglected....

Her sister lives a few doors up and I fear the reality is, if the hospital etc are foolish enough to let her go home (she has a rather bold way of talking people into all sorts of things) the burden is going to fall onto her sister's shoulders - she's getting on herself, has grandkids she's very close to, and very busy, plus her son's been diagnosed with a terminal illness plus they may have to move because of a projected rent increase they can't afford so she has a LOT on her plate, and I really don't think it's fair that this burden will fall so much on her, plus the rest of the family.

She's procrastinated for years about getting into a facility more suitable for her, and, even if she hasn't said it or thought it, the only way for her to get her way is for the whole family to do it for her....that may sound callous but whilst yes, family should help each other, she's made a lot of selfish choices that have put her in this position, now everyone else has to pay for them.

I know inwardly I sound kind of angry, and I am, because of the impact/future impact that will have on my wife, her mother, et al but it just seems unfair and unrealistic and I am frustrated there has been no reality check thus far. I know it's probably better for her 'morale' to allow her to continue in this delusion, but I don't think it's right that the message "you can't move back to your place, you will need an extended care facility" (and I can't see how it can be any other way) should come from the family...she will hold it against them/us. It has crossed my mind that she's not entirely cognisant but she sure seems that way.


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Not at all - it can be extremely frustrating to deal with elderly who refuse to acknowledge their growing limitations. And frankly, it can be extremely hard to diagnosis dementia - which has many, many causes and at least 15 of which are nutritional - when one isn't living day-to-day with the elderly person in question. We would probably not be so aware of my MIL's issues, for instance, except that she has been now been living with us for 3 yrs and the decline is starting to pick up.

The most difficult issue for your family is the legal one. If this person has not signed a Power of Attorney document it is going to be costly and difficult (e.g., possibly incurring much bitterness/resentment) to go to court to get the POA over her objections.

Without the POA and a durable healthcare POA, the family has no right to talk to her doctor(s) or the retirement association. Assuming one of the family is willing to go the extra lengths to become her agent as verified by the court system and her doctor, then the issue of choosing the correct care for her can be settled.

I place this problem in a legal context because you have indicated there are numerous family members who might wish to become involved, one way or another. Any time you have multiple people to satisfy that 'XX is being properly taken care but not taken advantage of', I strongly feel one's position as agent should be verifiably legal and clear-cut to avoid any future accusations of breaching fiduciary duty. Many families have quarreled bitterly over elderly care; it's a difficult and emotional issue.

    Bookmark   December 19, 2009 at 5:50PM
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JKOM is so right about having the legalities in order before trying to set things up for your wife's relative. Otherwise, with such a large extended family, you'll encounter all sort of conflicts and complaints. However, it sounds as though the relative herself is unwilling to let go of any of her independence and power. If that's the case, then you & your wife need to step back, take a deep breath, and caution yourselves before you jump in to take any action.

No matter what you think (or know), as long as the relative makes decisions for herself, you don't have many options. Cajoling, lecturing, advising probably won't make a difference. If other family members jump in to try and help or rescue her from herself, you may be able to dissuade them. But that's about it.

Honestly, it's important now, before the real crises have started, that you & your wife are in agreement about what you will and will not do for the relative. You need to set some boundaries and limitations now, before you get dragged too deeply into the situation. It wouldn't hurt to talk honestly and openly about your fears with the sister and your wife's mother. They need to understand the ramifications if they try to help the relative. They may end up taking on more of a challenge than they can handle -- financially, emotionally, and physically.

As difficult as it may be to accept, the relative has a right to live the way she wants. As JKOM mentioned, trying to gain guardianship, etc. is a long, costly, & difficult procedure. It would be wise to find out about it before proceeding.

    Bookmark   December 19, 2009 at 8:10PM
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In reality, in the absence of written POA, the hospital and doctors can and will talk to immediate family about planning care etc.--each state has rules about who can give consent for procedures in the absence of POA (ie here it is next of kin in this order--adult child, parent, sibling, and so on) but usually in practice not so strict about discussing discharge planning. Of course the person can always give verbal consent to include or allow someone to be involved.

Even if they feel that they can't give you information, there is no restriction upon *you* giving *them* information--like her apt. is unsuitable for her convalescence and why, lack of family resources etc. They have a duty to take those factors into consideration with discharge planning, no matter what the patient may say, especially if they suspect that the patient is not fully in touch with reality.

Unfortunately, I can't assure you that the hospital will actually send her to an extended care in the end--but without your information, they might when they wouldn't if they knew what you are telling us.

Other than that, jkom and shambo are sooo right about the issues and pitfalls. The time to talk--to the whole family--is now.

    Bookmark   December 21, 2009 at 8:50PM
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DH had a similar situation with his uncle who was a multimillionaire but didn't want to pay for a retirement facility where he would be well taken care of so he stayed in his home.

Three times he fell in his house and was taken to a facility where he had physical therapy and regained his physical mobility. But would he stay there? Oh, no, he insisted in going back to his house where he lived in squalor (it was never cleaned, papers were everywhere and there was an aisle between the furniture to get around. Kitchen had a one-burner gas stove which he lit with a match. House was a fire hazard)

The doctors and occupational therapists at the various facilities stressed the fact that he should stay there and not go home. The OT even went to his house and checked it out. She was appalled at the condition, as were we all.

So he lived there in the dirty house until finally he had to go to a nursing home where he died. I feel that he would have lived longer if he had stayed at the retirement facility where he would have had good meals, companionship and health care. But since he was compos mentis, he couldn't be forced to move.

    Bookmark   February 10, 2010 at 1:24PM
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