Not me, but a relative of mine. Her husband has dementia that’s advanced to the point he needs to go into a care facility. She simply can’t care for him at home, even with in-home help. Though he’s on meds, he no longer recognizes anyone, doesn’t know where he is, can’t process her answers to his incessant questions, and has hallucinations and delusions most of his waking hours.
The problem is, what’s left of his mind gets infuriated at the idea of going into a care facility, and he’s said he’ll never go. Because dementia has trashed his executive functioning, he doesn’t recognize he has dementia and thinks he’s fine. He’s a frail, 82-year-old man, but if he refuses, then what? Even if she got him there, the facility can’t keep him if he refuses to stay, right–even if he doesn’t know where he is and thinks he’s a boy, right?
Does she have to get him declared incompetent? From what I understand, that’s a lengthy and expensive process, and money is tight for her, plus the need is urgent. Also, I read if the person is momentarily lucid enough to say, “I don’t want this,” judges won’t award guardianship to the spouse.
This must be a common problem. I’d be grateful for any advice, insights, experiences Dopers have to offer and will pass them on to her.
My understanding is a doctor can order it. Don’t know the legalities( I’m sure it varies). But my FIL had a ankle monitor to keep him from wandering. He wasn’t completely unaware of who he was or why he was there. But he could make unsafe decisions, not realizing the danger. The memory care center asked for and got permission from the family to put the monitor on. There are procedures in place. She needs to talk to his doctor.
Once the dementia has advanced so far the person is deemed incapable of making decisions for themselves. Spouses or others can take on the role (without consent from the person, obviously) and all decisions re care and finances are out of the hands of the person with dementia.
Social Services should also be able to help. They should know the legalities of it better than a doctor, as that is the kind of process in which they are heavily involved. Make sure to get information on all options: sometimes people tend to get into a “default” mode of work and another option turns out to be more adequate.
My mom was in the same position as the OP, except that my dad wasn’t aware enough to resist going into a care facility. But she kept him at home because she knew that once he left, he’d get worse care, and that would mean his demise. She finally couldn’t deal with his violence, and put him in a home. Sure enough, three weeks later he was gone.
My husband and I had relocated back here from NYC to help take care of him. But by that time he had become violent, and it wasn’t safe to be around him.
As people do in fact experience impairment (some people temporarily, others irreversibly), there has to be a mechanism in place for substituted judgment. In my opinion it should be constructed so as to always honor whatever decisions the individual is still capable of expressing. The underlying notion here being that, of all the ills that a person should be protected from, the one that constitutes the greatest injury to a person is the denial of their self-determination.
This is the philosophy endorsed by the disability rights activists and it is popular within the psychiatric rights community.
I’m aware that you’re seeking practical rather than philosophical advice here (or at least it appears that way); but I would warn against approaching this matter from a perspective of “the outcome that we want is that this individual be placed in an institution he doesn’t want to be in; there are legal protections for his right to refuse; what’s the easiest path to get around that, insofar as he doesn’t know what the heck he wants a good portion of the time?”
This is true but (at least here) it requires a legal procedure. You can’t just take over control of somebody’s life by finding a doctor willing to go along with it.
The OP was specifically asking whether they were going to have to go through that procedure.
I don’t know how difficult it is, or how expensive, to do so. I’m just really glad that my mother finally agreed to go into assisted care.
Please let’s not do that: that he was dead three weeks later doesn’t necessarily mean he was getting worse care. My great-aunt was moved from her home to a group-home after her third heart attack in two weeks: she died two weeks later, of the sixth one. If she’d stayed at home the count might not even have reached six.
The problem is when what the person wants is at odds with their physical well-being. Or, if that person is acting out/violent and potentially endangering others.
My late spouse certainly didn’t want to go to a nursing home - but I was physically and financially unable to provide proper care for him at home anymore, and attempting to keep him there, no matter how much he wished for it, would have physically endangered him. Possibly me as well, given how run down and debilitated I was getting from stress and lack of sleep.
Once he was being properly cared for and I could get some sleep I was able to be there at his side for 12-14 hours a day and keep an eye on his caregivers. I realize that’s not always a desirable or even possible solution for everyone, but sometimes you have to make choices when there’s not really great alternatives.
Sorry to hear of your situation. Yes, you need to have him legally declared incompetent. Until you do so, he is presumed competent to handle his own affairs. Sorry, I don’t have specific experience, but I don’t know why it would be terribly long or expensive.
Look about - there are MANY organizations to provide help with this sort of thing at little/no cost.
(Full disclosure, I have little to no sympathy for the “wishes” of someone who is no longer competent - if those wishes impose costs on other people.)
Truth be told, I do have some sympathy for the guy with dementia, but I’m angry about his refusal to go into a care facility. He’s sponged off his wife for their entire marriage–barely worked at first and then quit entirely. She’s a genial soul and would never tell him not to put her in a facility. I know she has medical power of attorney and legal power of attorney, but I don’t think they’re applicable for this.
Maybe when couples make out their will, etc., they should sign a paper authorizing the spouse to determine if they should go into a care facility. If there were such a paper, I’d sign it right now so my kids could put me in a facility if need be, even without my consent. Obviously, I trust them.
Why wouldn’t they? The Spanish equivalent of power of attorney certainly would; while they can be drawn with specific limitations (and this is often do when the PoA is court-ordered), normally they allow the recipient to do anything the person they represent would legally be able to do. Consult a local lawyer.
It’s just that it sometimes isn’t possible to fulfill them. When my mother started wanting me to be available 24 hours a day, sleeping only in catnaps whenever she happened to be napping and never getting out of hearing: I couldn’t do that. When she was in her right mind, she never would have expected that; but her mind wasn’t working right any longer.
In the USA a power of attorney can be withdrawn at any time by the person who granted it. And it doesn’t allow the person who holds it to do anything the person who granted it is objecting to. It just allows acting on that person’s behalf when the person’s not there or is unable to express their wishes.
Declaring that a person has become legally incompetent to express their wishes and have them honored is a legal process. It most certainly doesn’t go automatically along with granting a power of attorney.
When it’s a case of autonomy vs physical well-being, I value autonomy more.
My valuing of autonomy would, under certain circumstances, including respecting someone’s choice to get themselves mired in legal problems rather than either modify their own behavior or agree to some constraints upon their situation. Prison, of course, is also destructive of a person’s autonomy, but it’s set up to incarcerate people for what they’ve actually done (brought it upon themselves) rather than what people think they might do.
Another penalty of being autonomous and destructive is that one loses one’s support network. One cannot insist on doing as one wishes and at the same time being way too much wear and tear on other people without consequences of some sort, and they are likely to be that the other people will withdraw for their own protection and well-being.
There are plenty of solid sound reasons to agree to go into a nursing home (etc) and if a person doesn’t embrace doing so until all of those reasons are clearly on the table, I don’t regard it as “taking away their freedom” to tell them “we won’t make you go but if you don’t go you are on your own because you are ruining our lives”.
In my state, under present law, the proper remedy would be to seek a conservatorship. A new law goes into effect next year that will change the process considerably.
Here, the putative ward must be examined by at least two doctors who are willing to certify that the putative ward is unable to manage their own affairs. In theory, the ward could contest the proceedings, and that’s where things can get messy.
Start by contacting an attorney that handles family and/or probate law to discuss how such things are done in your state.
With my grandpa, my mother and aunt had to basically trick him into it. He’d had a fall, then I can’t remember what the claim was, it might have been that my aunt had a bug or was going away, and as no-one else lived close enough to come round daily, he’d just have to go stay in this place for a week, maybe 2 weeks, until she got better/came back. He’d have never agreed to a permanent move, but he reluctantly agreed to that.
By the end of two weeks, he was saying he’d go back home later, but he liked the food and the staff, so he wanted to just stay a bit longer. By the end of a few months, he’d stopped even talking about going home. When anyone took him out for the day, he’d be going on about being back in time for dinner 'cos they were cooking him his favourite today, or saying he didn’t want to miss some evening activity, and calling the place home.
It was a really nice facility, with lots going on and graduated care levels for declining dementia patients so they could keep their own bedroom for as long as it was safe, for continuity, then just move to the other side of the building int the secure section when they really did need round-the-clock care (my mother’s advice; find a place that doesn’t have set visiting hours, they’re less likely to be putting on a good show just while everyone has visitors then neglect residents the rest of the time). I doubt it was cheap, but nice care homes do exist.
