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Scbluheron Asked April 2023

Conflicting doctor suggestions for care. Any advice?

Hi. I've been reading the forum blogs for over a year now. Thank you to everyone for thoughtful insights. I'm finally in need of some suggestions myself.


 


My mother lives alone in a different state. She has been diagnosed with dementia to include short term memory issues, delusions, impaired decision making etc by her primary doctor. She strongly recommends assisted living or memory care.


 


Mom was admitted to the ER after she was found at a local store confused and unable to find her car (she still drives herself to a long know grocery store.) She was admitted overnight and I'm flying there today. The doctor there wants to discharge her with home health aid assistance stating that she is competent to advocate for herself. They even allowed her to execute of medical POA listing me as such.


 


My mother is adamantly against ASL or strangers in her home. I had hoped to use the ER visit as a springboard to memory care but getting discharged will make her believe that she's fine.


 


Am I once again stuck trying to convince her that MC is best and getting nowhere? And waiting for the next shoe to drop? I'm waiting to talk to the inpatient doctor too.

MJ1929 Apr 2023
Her doctor knows her -- the ER doctors do not. Trust me, ER doctors have to make diagnoses with virtually no real information, and they're frequently incorrect as they likely are this time, too.

Be glad they got a POA done so take full advantage of it, and for your mother's safety decide to place her or not. If she does indeed have dementia (and it seems pretty clear that she does), she cannot make a decision on this, so don't try to convince her -- it won't work.

Scbluheron Apr 2023
Thank you everyone for the advice and support. Mom has agreed to move into AL and will be moving next week while I am still here to help. She was and is still cognitively well enough-I guess-to realize that this is for the best. I basically told her she cannot drive anymore and cannot live alone. We have a trusting enough relationship that she believes me.

It was the hardest conversation of my life and her understandable reaction is something that I will never be able to forget. The next week will be tough but my head knows it's the right thing to do even if my heart breaks for her.

The journey continues but at least I know she'll be in a safe location.

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AlvaDeer Apr 2023
Do you have a letter saying your mother is unsafe and not competent in her own care from her primary? If so this letter can be used with your POA to admit her to care. However there ARE PROBLEMS here.

I would suggest while visiting that the evaluations need to be done by a good neuro-psych so that you will have the primary doctor's letter and the evaluation letter of a good neuro doc. You will then need to admit your mother to memory care if she is not safe and competent in her own care.

The PROBLEM I see, however, is a BIG ONE. She made you MPOA AFTER one doctor already said she was not competent to do so.
And there is no general POA which means you needs social services help to get emergency guardianship. A medical POA often is not enough to get a patient admitted to MC if she doesn't wish to go there.
And yes this would have been much easier from the medical facility.

You may be forced into the ER Dump situation:
When you arrive there it will be clear to you whether she is competent or not.
If not, call EMS. You can lie like a rug for all of me: tell them you arrived by flight and found your mother confused, that she needs transport to the ER to be checked for stroke or whatever. this will get her transported over her protests.
Once she is there you go let them know they discharged her home and you found her in dire unsafe circumstances. Ask for social services. Tell them she was found unsafe at home and use the specific works UNSAFE DISCHARGE OF A CONFUSED ELDER which you are considering reporting to JCAHO (the hospital joint accreditation board).

Get her admitted. Get a neuro psyc consult. Get papers and letters. Get a guardianship (temporary) with the help of Social Services (they can often do with a call to a judge). Can be made permanent later. And get Mom safely placed.

If you find your Mom competent when your visit it is a whole other story. I sure do wish you the very best. It is dreadful to try to manage any of this from out of town. Near to impossible. Hope you'll update us.
Igloocar Apr 2023
You may be making the medical POA situation more difficult than necessary. Your mother's primary care physician might well be willing to write up her assessment of your mother again with a date after the date your mother made you her medical POA. However, my understanding from this forum is that even with medical POA and durable financial POA (which the OP apparently does not have), she cannot force her mother to leave her home. For that, my understanding is that guardianship is needed.

I also think it's risky to make up a story about what happened; so doing might come back to haunt you. It may take some waiting, but a legitimate ER dump should be possible.
Fawnby Apr 2023
I had a friend with a similar issue. He lived alone, went out and couldn't find his way home. His sister in another state was called and she arrived as soon as she could. She was aghast at the way he had been living because in their weekly phone conversations, she'd had no inkling that he wasn't competent. It was clear from the state of his home that he'd been in dire straits for some time. His doctors were mostly orthopedic doctors at that point and apparently had no clue because he seemed fine when he came to their offices.

Sister took action right away to get him to memory care. It was a matter of support from his doctors and documenting how he'd been living. I shudder to think what might have happened to him if he'd been allowed to keep living at home with no aides.

I don't believe that talking to your mom about this is going to help. She has dementia, and you can't reason with dementia patients. Be prepared. Stick to your guns.

Mom is no longer the boss. You are. The dynamic has changed, and her brain disease will keep her from understanding the situation. She may say that she hates you, etc. etc. etc. That's the disease talking, and you'll need to do what's best for her.

Good luck with this difficult problem.

Grandma1954 Apr 2023
The first thing is that must make clear is that to discharge her to home would be unsafe.
If you know that she will not allow aides to come in and help and that is one of the recommendations from the doctor at the hospital.
Her Primary Care Physician would be the one that I would trust to know mom. She has more contact with mom, she knows how much she has declined.
Others will give you more info but....
If the doctor thinks mom is competent why the POA? As far as I know the POA is active only if/when the person can no longer advocate for themselves either long term as in a situation like dementia (or other medical reason) or in short term like going under anesthesia or other temporary situation.
I would think if her primary does not think she is competent, she is unable to safely live at home you should be able to place her in Memory Care. (Not sure if you need more than 1 Dr to state that she is not competent.)

MeDolly Apr 2023
Honestly, some doctors are not qualified to deal with dementia and old people. They play let's pretend with the patient, after all there are miracles. Live and let live, keep in mind they do not have to care for the elder.

My brother and I had to swoop up his father and wife, she had dementia, although not doctor qualified, he had more wrong with him than I can list, including cancer.

We just laid it out to them clearly, if they wanted our continued help this is what had to happen, he was the boss and said yes. We moved them into AL in AZ (we live in Fl) as a bridge, cleaned out their house, no easy feat as they were hoarders, got it ready for sale in 8 days, sold it in three. Went back to Fl and found them an AL near us, moved them.

He died a year later, she is now in MC, exactly where she needs to be.

The roles change, we had to take over for our mother as well, another ultimatum, she fought us for 10 years about going into AL. She had a very slight stroke and was afraid to be alone at night, lived 700 miles from us. That was it, we swooped her up, cleaned out her house, sold it. That was when she was 94, she is now 98 and love being in AL. Who knew!

With dementia, the child becomes the parent, the parent becomes the child. Not my rules, just how it works.

Best of luck to you, hope that you can get it all worked out, doing what is best for your mother.

Caregiverstress Apr 2023
I would call her primary doctor and have her get involved in this. Meanwhile tell the ER doc that she will be sent home alone with absolutely no help from aids as she will not allow them in her home, and she has no family who will care for her. Ask for the social worker. This is exactly the scenario that many of us on here wait for to get our loved ones placed when they refuse to go. It’s your chance to get her someplace safe. I also live very far from my father who has Alzheimer’s. He also refuses any type of care. If he ever ends up in the hospital I have the memory care place all picked out to transfer him to and he is going.
AlvaDeer Apr 2023
Exactly the method. Only thing I would add is to use the words "unsafe discharge" to the doctors and social workers. and mention JCAHO, which is the Joint Commission accreditation of hospitals. They are responsible to dinging the hospital's licenses. THEY LOATH restrains and the loathe unsafe discharges and they loathe pressure sores. As an RN who represented our team for the Commissions visitations I can tell you a threat to report a hospital to JCAHO is taken seriously.
KPWCSC Apr 2023
You said "The doctor there wants to discharge her with home health aid assistance stating that she is competent to advocate for herself."

Most providers don't have a clue what that means. Even if he gives a referral, it often means limited to possibly 3 hours or so a couple times a week to help her bathe, etc. Definitely use the reason she was brought to the ER in the first place as the reason she should not be sent home alone unsupervised. I'm not sure about ER discharge, but I believe you can appeal to Medicare that she is being discharged inappropriately. Be thankful she did the Healthcare POA if that was not in place before.

NancyIS Apr 2023
Are you looking for an AL facility near you so that you can visit often? When you move her to AL, don't pack any valuables or personal papers. Take them to your own home and have all of her bills and statements sent to your address (or go paperless). You should take over her finances now. It's best to downsize so that she has everything she needs for daily living, but not to bring a lot of collectibles or photos, or books. Just take a few. Also, while she can still sign legal papers, ask for a credit card on her account with your name on it so that you can purchase things for her. Also, if she's willing to do it, make all of her accounts joint with your name on them. This makes things much easier. While you are with her, also make sure that your are on file with Social Security and Medicare to be able to speak on her behalf. You can do this with a phone call with her also on the call. All the best to you and your mother.
Scbluheron Apr 2023
Thank you. She will stay in CO. I tend to move for my job every few years so it's not practical to move her near me. Downsizing is difficult as she is extremely attached to her stuff. I'm learning to make most of the choices for her.

Most of her financial stuff and her house are in a trust and I'm the executor. I've got most of her bills squared away but thank you for the reminder about SSA and medicaire. I'm also her POA and MPOA.
BarbBrooklyn Apr 2023
Scblueheron, thank you SO much for your update. That mom has agreed to go to AL is spectacular news!

Best of luck to you both!

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