Within 5 days of delivering the report, Mrs. B asked me to come to her home. She was shadowed by another woman who she sponsored at AA and who was there at our first meeting. We will call this woman, her shadow. At first I was suspicious. It is not just that I have an inherently distrustful nature, it is that I have seen these types linger around frail older adults with assets many times and THEY HAVE DONE BAD THINGS TO MY CLIENTS. In time, I came to not only trust the shadow, but because Mrs. B’s daughters were out of the country, I came to rely on her for doing the things that a daughter would do.
When I arrived, Mrs. B was sitting up in her bed upstairs eating a peanut butter and lettuce sandwich. Because she had to sleep in an upright position, she developed stenosis. She complained of pain. Overall she seemed determined and strong. Mrs. B again reiterated her desire to move her husband elsewhere and the conflict she felt about “institutionalizing” him. The consensus was that she would tour a facility by her home that I recommended. I asked her to articulate her wish list, and certainly regaining her strength was primary. However, it was clear that her mental attitude was an impediment, so we discussed anti-depressants. Being the stoic person that she was, she had stopped taking them.
I spoke with Mr. B, he was bored. Every day that I spoke with him he said he was bored. He had very bad hygiene, could not make his own meals, pick his clothes out or do his own laundry. I came to feel that placing him was the right and kind thing to do. He sat and sat and sat all day without any social interaction.
We had a plan. Mrs. B. would tour the assisted living facility the following Monday. By the time I left, she was up and about and demonstrating her new lift. She looked happy and hopeful. The next Monday when I met her at the facility, she looked like she was knocking on death’s door.
What happened? I kept asking myself this question. Just two days before it seemed like you could swim in her eyes. When I saw her that Monday, she did not look spry and her lids were heavy over her big blues. She could barely get out of the car and I needed to get wheelchair assistance. She had fallen the night before. There was no one there to help her.
The next morning I got phone call after phone call from one of her many friends “Mrs. B… keeps saying she is dying and she won’t let us take her to the hospital or the doctor.” I rushed back from my appointments and cancelled my day. Both she and her husband had fallen the night before and this time she was in terrible pain and scared. He was oblivious. She could barely breath. She was gagging on her coughs.
I gave her two choices I would either bring her to the hospital or I bring a doctor to her. She told this doctor, (a geriatric concierge medical doctor who did her residency in geriatrics) was accused of being a quack while conducting a bedside examination and dismissed her. Now what?
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This story begins 7 months ago when an attorney colleague asked me to call one of his clients who was frail. He knew that I was the person that had the skill set to ensure that she was getting her needs met and that she had a plan to stay healthy and safe. This person was the Magnificent Mrs. MB. Her daughter came in from Canada to assist her after she had a minor heart attack in the hospital after being hospitalized for a bleeding ulcer. One year earlier, Mrs. MB had an extensive and highly invasive surgery because she had esophageal cancer. They used her stomach to re-construct her esophagus and now, for the rest of her life, she must sleep in an upright position. She had COPD and now emphysema and used oxygen.
Mrs. MB is 76 years old and for almost her entire adult life was the care taker for her husband who in the 1980’s was in an automobile accident and suffered minor brain damage. Now in his 80’s he has a rather well entrenched case of dementia. I conducted a mini mental status examination and other standardized test on him that confirmed this diagnosis.
I did not meet with MB then. She did not want to hire me. Distrustful and afraid of change, she rejected her daughter’s pleas.
Exactly one month ago she called me. I went to meet with her. She had the biggest, bluest most alert eyes I have ever seen. They said I can size you up in a second and swallow you. I took her history. I found out that she was a retired psychiatric registered nurse. I found out that she wanted her husband out. She wanted her husband out. She had had enough. She was too frail to care for him and any suggestion of in home care for respite relief or getting him out of the house to an adult day health care center was not going to cut it. As time went on and as will be revealed later, I came to find out why I was being hired to be this seemingly affable man’s henchwoman.
As for her, she wanted her life back, she wanted to be social again and herself entertained moving into a nice assisted living facility. She had been an alcoholic and for the last 20 years a valued mentor to many suffering from that disease. Her social life centered around those functions. In order for her to accomplish that, it was clear that she needed major nutritional counseling. She was very thin. She needed a lift put into her home to assist her with the 15 stairs to her room and grab bars installed. And, her legal affairs had to be put in order. Her estate plan was woefully outdated.
This seemed like a very easy case, one that my initial retainer could cover. I went back to my office, wrote a report with my recommendations and findings and summarily delivered it. One of my recommendations was that she re-consider moving her husband. I thought that she was underestimating the value of having a routine every day suddenly evaporate. It could be lonely and isolating. Certainly she could get some relief through the adult day health care center or in home care. However, I would come to find out that there were people lining up to be at this woman’s side, every day, all day.
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You can bring a horse to water but you can’t make it drink
Here’s one for you. She fell, and then she fell again. She has fallen so many times that it would be more efficient to list the times when she didn’t. But she doesn’t need help. She’s not, as she has said, “an idiot.” Wait a minute. Now I am not a judgmental person, but I will play the role of devil’s advocate, yes, aunt of a client whose name shall remain safe with me, YOU are an idiot.
Why? Because you have at your disposal many nieces and nephews ready willing and able to help you find the care that you need, and you can afford it, but you are not one of those old people. Yet, you lay on your floor for 7 hours with a towel over your head until someone, I mean some people—plural, picked your 300 pound body off of the floor. You have cracked your head open twice from falling and you are bound to break your hip and die. That’s what often happens to 76 year old women who break their hips.
I know that this sounds a bit ungerontologist like, but I adopt this demeanor to make a point, as ineloquent as it might sound….You can take a horse to water, but you cannot make it drink. She may be an idiot, but she is not delusional. Or is she?
Where is that line? It is the same question I have when I ponder the criminal defense not guilty by reason of insanity. Isn’t everyone who kills another person insane? Isn’t every person who chooses to live life on their terms when those terms mean self neglect insane? O.K., maybe it is a bad analogy, but we as a society and our legal system are going to have to seriously start thinking about this right to self determination.
Is it her right to break her hip and die on her floor? Is it the right of a person suffering from Alzheimer’s to be euthanized if that is a wish communicated when that person was as lucid as Albert Einstein, who as I might remind you, was the genius among geniuses who discovered, merely by thinking about it, that the universe was not as it seemed?
Is it the right of an older adult to slam the door on me when I come to see how they are doing upon being hired by an adult child? Is it my right to call those people idiots (even though it was in my non-judgmental role as devil’s advocate)?
I say, yes, yes and yes again. I believe in the right to self determination, period. HOW ABOUT YOU?
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Raise your hand if you think that you should buy a worthless piece of property for $50,000 off an infomercial. Well if you are 85 years old, live alone and forget to take critical medication than the answer is, I guess.
That is precisely what a client’s father did this year. That was just a couple of days before he went into the hospital because of severe dehydration. Thereafter, he ended up in a nursing home to rehabilitate for three weeks.
When he got home and learned of his shopping spree, he was outraged and in complete denial. There was just no way that this fiscally responsible man would have done that.
Ahhh, those pesky IADLs (Instrumental Activities of Daily Living)—medication management, what a drag. This gentleman is on seven medications all of which have to be taken at different times throughout the day.
How could this have been avoided? Continue reading Not Taking Your MEDS…Can Be Expensive!
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The other day something unusual happened. I received a call from an 88 year old woman who needed my advice about her daughter in law’s pushy (for lack of a better word) behavior.
Fearing that she would be institutionalized against her will, she wanted to know what her rights were. When I got to the woman’s house, she and her middle aged care-giver, greeted me with a warm smile and a welcoming gesture.
As she spoke of her daughter barging in, her eyes began to tear. The daughter, the wife of a son who passed away in his twenties, had begun a campaign to rid the home of the caretaker and the cat that the caretaker brought in and to place my client into some form of assisted living.
The daughter had even gone to a doctor’s visit where she made not so subtle illusions to the house being in a state of filth and disarray and run over by pets.
Concerned, the doctor had a social worker come to the home. The social worker reported that the house and living conditions were in perfect order.
Later that day, the grandson barged into the home and removed the cat that my client had come to love, insisting that my client had allergies and that she simply forgot about them.
My client was afraid that she would be snatched and institutionalized when she went to put her garbage out. Was this a paranoid delusion? Was the care giver up to no good?
Or, was this a case of elder abuse?
My findings were that my client’s mental capacity was very much in tact. Furthermore, she was very happy with her caretaker and wanted a pet. I spoke with my client’s doctor who agreed.
To this day, I do not know what her daughter in law’s motive was. Although she was in the will, placement of my client into an institutionalized setting would deplete her inheritance. My suggestion was two fold.
First, I could have the family participate in a family mediation to have everybody’s concerns aired and my client could assert her right to independence and autonomy, she could make her 80 year old sister a proxy under a durable power of attorney for health care or she could voluntarily submit to a conservatorship over herself. Short of that, she could get a restraining order.
That seemed a bit extreme. When I followed up with her she told me that she suggested to her daughter in law a cooling off time. They will meet in a couple of weeks to smooth things over with or without my mediation.
Empowered by two professionals assessment that she is not incompetent, I suspect that my client will now be in a position to assert her boundaries that she created over 88 years on this planet.
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