Enacting POA

cbishop0220

My mother has undiagnosed dementia. Recently she is having significant paranoia and delusions. She refuses to go to memory care clinic for evaluation and diagnosis. She lives on her own with my brother living about 20 minutes away. We are her HCP's and POA's but only if she is considered not legally competent. What do we need to do to have her labeled and not legally competent?

Judide65

following - as I have the same situation with LO.

Cosmic

I would suggest a neuropsycologist evaluation to get her on record with paperwork and test results. Copies of the test results and reports can be used to enact the POA. Her primary care physician can refer to the psycologist. She could consider this just another doctor appointment. The evaluation and test results will be many pages but will be invaluable in doctor and legal records.

If her primary care physician is in a network organization they have neuropshcologists on staff and more that likely be covered by insurance or medicare.

Stuck in the middle

I would take the POA to an elder care attorney and get legal advice.  From what you posted, it sounds like a Court will have to declare her incompetent before you can make her do anything.  Someone who knows the law in the State in which your mother resides needs to read the POA and tell you what to do.

MN Chickadee

Some POA do require a doctor to declare her unable to handle her own affairs. Not all require that. Make sure you get legal advice from an elder law attorney to know exactly what you need to spring the POA.  

If you have to get a medical opinion to spring it, sometimes this can be done with careful therapeutic fibs. She likely has anosognosia. It's a medical condition common with dementia and brain injuries where the damage to the brain makes it unable to recognize its own deficits and  condition. It's different than denial. To her she is fine and no amount of evidence or logic will persuade her. Like trying to convince her the grass is purple. So we use work arounds and therapeutic fibs. I would not mention dementia or the fact that anything is wrong with her, it will only cause suspicion and anxiety. 

Whether you need a letter from a specialist, a PCP etc may come into play. It's best to get our loved ones diagnosed by a neurologist to be sure of the type of dementia, but sometimes this is not possible for a variety of reasons. Any doctor is better than none. You will likely need to start with a primary care provider. They will do basic cognition tests and order lab work. Schedule the appointment yourself, don't give her warning. For any appointments send information ahead of time to the doctor detailing the delusions and behavior at home, this is an important piece for them to know that can be difficult to bring up in front of the patient. Even better if you can record some of the behavior or outbursts for further proof she needs help.  Email or mail your letter ahead of time and bring a paper copy to slip to the receptionist if the provider hasn't received it. Put in there how difficult it will be to get her to see the doctor and that they should use a light touch regarding details that may upset her. Then use whatever means necessary to get her there. Maybe it's an appointment for you and she is just along. Maybe it's a quick check of her blood pressure, insulin, or any other medical thing that might be plausible. Therapy for that bad hip. Checking out that weird mole. Maybe it's a new requirement by insurance or Medicare that everyone has an annual check up. Down play the severity, no big deal. This kind of working behind the scenes and fibs become a way of life with our LOs. If you are able to get her seen and establish a relationship with a doctor it sounds like some medications may be in order for the paranoia and delusions to improve her quality of life and ability to be cared for. 

Discuss with the attorney what happens if you cannot get her to a doctor. They can let you know what the legal route would look like in your state to get the courts involved. 

Jo C.

When I had a similar problem issue, I read the POA to see what the legal documentation was for setting the POA into motion.   We needed two physician letters to state my LO was no longer capable of formatting her own plan of care.

To do this, of course we had to see the doctors.  I did NOT mention dementia or memory loss to my Loved One, (LO), as to do so caused her to dig in her feet and refuse everything.  Instead, I kind of groomed and wooed her without talking about healthcare for a couple of weeks and when she was in a better mood, I sprang into action.

In this instance, I finally and softly got her to consent to an appointment with her primary physcian.  I clued him in as to what the problem issue was; we needed two physician opinions re her being no longer competent to format her own care needs and was unable to conduct her own business.  At the appointment, the primary care MD fibbed and told Mom that she had a back problem that needed a specialist, (she did have on and off back pain.)  The physician then referred her to a good Neurologist who sees dementia patients as a routine part of his practice. Neuro went along with the fib that the back was why she was coming to see him; but he also conducted his "usual physical as Medicare demands it," and that took care of the other part of the exam not related to the back pain.  That was such a relief.  He did diagnose the dementia and prescribed.   We also then had a letter from each physican which enabled the POA to get into play.

Once, when my utterly controlling and agitated mother refused all doctor's appts. whatsoever, and her physical condition badly needed to be tended to, I used the doctor's office staff to get her to an appt.

My mother highly valued her blood pressure medication; she was obsessed by having it.  So; I contacted the doctor's office and spoke to the nurse explaining the situation and why she needed to be seen.  We cooked up a scheme.  The nurse called my mother and said that doctor was reviewing charts and he saw Mom had not been seen for a very long time AND she was so sorry, but the doctor could not renew the blood pressure pills as it was against the law to do so if she was not seen every so often.  Well; my mother was stunned.   The nurse not missing a beat said, "We just happen to have a couple of appointments open, would you like to take one of them so doctor can continue prescribing you blood pressure med?"   Would she!  She took the first one available.  In the course of the conversation, the nurse told my mother how everyone at the office missed her; how much they enjoyed her coming in as she was a "favorite" patient.  Mom was delighted.

I realize how dishonest this sounds, but the needs were crucial.

The things we end up having to do sometimes are so "out there," and sometimes it does not feel positive to have to take such measures; but any of the dementias can be fraught with such problems and when it becomes critically necessary, we have to do whatever we can in order to get much needed care.

Just one person's story;   wish you well and hope you are able to find your way through this very soon.

J.

cbishop0220

Thank you all. My mother is 72, widowed and not a pleasant person. She lives independently in rural Vermont. We started getting her worked up for dementia prior to COVID but then COVID hit and she received a breast cancer diagnosis. Breast cancer was caught early, treated and now we're trying to get back to her dementia. My brother recently took her to her yearly physical where she did terrible on her MoCA exam. She's been referred to a local memory care clinic, but is refusing to go. Her perspective is that nothing is wrong and we're all trying to steal her independence, her house, her non-existent money. It's such a challenge and our options seem limited. We will definitely look into the details of the POA.

harshedbuzz

There's a lot of good advice here.

In your shoes, I see 2 scenarios to a conclusion if what's been mentioned has been tried or wouldn't work with a rural, resistant person with anosognosia. 

From Alzheimers.net--

Anosognosia is simply a word that means a lack of awareness that you have an impairment. This can be part of the brain damage that occurs with dementia.

As the brain changes physically, the part of the brain that would be able to understand that there is a problem is damaged.

If your parent has anosognosia they can’t understand the presence of dementia. That is just what it is. You will not be able to convince your parent of the dementia symptoms that you see.

The one into which a friend was forced by his dad and the one into which I was forced by my parents.

My friend's dad was a retired scientist who lived in a carriage house on his older son's property in retirement helping with the kids and keeping busy with church and hobbies. Dad had a lot of cognitive reserve but was clearly slipping around memory, hygiene and reasoning. They went into his home to get some stuff when he was admitted to the hospital and discovered a nightmare-- insect/mouse infestation, rotted food, filth and a layer of dust in bathtub. While in the hospital he developed some psychosis which docs blew off as normal for 80. He and his brother (both doctors themselves) tried to get dad to a neurologist for an eval and he fought them. Instead they were forced to seek guardianship through the courts which forced a neuropsych exam to determine competency. Dad had enough on the ball to hire an attorney at the time, but the pictures friend's wife took of the house and the exam results/neuropsych opinion was enough to have the brothers awarded guardianship. The weird thing in this, is that during the process and immediately after, dad didn't act in a way that telegraphed anger. He continued to join them for dinner in the main house, tag along to the grands baseball games and school functions. 

I was forced to wait until the other shoe dropped. This took years and didn't happen until my mom almost died with her HWD acting as her caregiver-advocate. I tried mightily to convince her to at least arrange a screening with a PCP but she blew me off. So I drafted a Plan B and waited. I found a Memory Center for a diagnosis and made an appointment. I even started to tour MCFs in case she died first. After she recovered she agreed to get the ball rolling on a diagnosis and even took him to the small town hospital during a psychotic episode- they ruled out stroke and sent them on their way. Mom left town for a funeral and returned to dad who was even worse. Friends had been looking after him and called her home asap. The house looked like there'd been a battle- pictures off the walls, glass broken, trails of blood and dad cowering in the bedroom believing he'd murdered the dead guy he pointed to in the garage. There was no body. I convinced her to load in into the car and drive north where I met her at the Welcome Center on the state-line and drove them to the ER associated with the medical system affiliated with the Memory Center. He was admitted for a few days, giving a working dx and follow-up sooner than I'd been able to get and turfed to rehab for 6 weeks which gave me time to set them up in an apartment near me. We did the POAs and such while he was in rehab; he showtimed for the CELA who deemed him competent. Otherwise we were looking at guardianship. 

While I wouldn't suggest guardianship as a first move with a parent, but if she's unable to cooperate with her care and well-being, it might be your only option. The CELA can advise you.

HB