Muddling along until I can secure Guardianship for DH

jmlarue

Jo C - Thanks for the nudge to let you all know how things are going after discharging DH home from the VA Psych Unit.

As I say, I'm muddling along with his psychotic behavior until I can secure legal Guardianship for him. It is necessary that I have this court order in hand should I need to re-admit him to Psych treatment without his consent. Without that, whatever Psych unit that admits him would need to seek a court order and Guardianship to hold him without his consent. I'm not willing to give up my rights and responsibilities as his DPOA to advocate for his health and financial needs going forward. Only I know what his health care pre-directives would have been if he'd completed those written instructions while he was competent to do so. Now, the responsibility falls to me to be sure no extraordinary measures are taken to prolong his life or attempt to resuscitate and initiate life support measures. All these things will be done to/for him if a government agency or a medical facility holds Guardianship for my DH.

I have an appointment to consult our CELA on Aug. 11 to begin this legal process. It will take time (probably several weeks) to get a judge's agreement to my petition. In the meantime, I have been given considerable help from the managing Psychiatrists at two VA Psych Units and their social workers to help me manage the meds for his behavior and to find emergency placement for his ongoing care. I also have an emergency procedure in place should his psychosis put either of us in dire danger of harm and I need to call 911 or take him to a local ER myself. I found that there are special Crisis and Commitment social workers available 24/7 that I can call on to assure that Medics will transport and ER docs will be required to hold and treat my DH if need be. I have no doubt that similar services are available within the state/county you live in, but it takes a heck of a lot of digging to find out who to call to get that help. My advice: keep digging to find this resource and don't take "no" for an answer. No caregiver should be left to cope with a dangerous LO alone or abandon them in order to remain unharmed.

Currently, my DH is continuing to be treated with increasing doses of Quetiapine (Seroquel) to treat the hallucinations, paranoia, and lashing out toward me. I've had two incidents where I needed to distance myself and leave him alone in the house. He attempted to elope both times. Fortunately, he headed for his brother's house in a straight line about a mile away and I was able to monitor his safety as he walked that distance. After the walk and a few minutes with his brother, all the anger was forgotten and I was able to drive him back home without incident. I was directed to increase his afternoon dose of Seroquel each time and there has been no bad side effects from that. Granted, his speech is a more slurred and unintelligible and he does check out for an short cat nap occasionally but, in general, he is still mostly awake, mobile, continent and functioning throughout the day. So long as this continues, I should be able to manage until such time as I have Guardianship to place him in a Psych Unit temporarily or residential care facility permanently.

I'm coping with the stress and seeing that DH and I stay safe. Thanks to everyone here for your care and concern. I hope that by detailing some of my experience, others may find help if they are struggling with this form of dementia that threatens both the LO and the caregiver.

Jo C.

Oh gosh, J.; I am so sorry for all that is happening.  How I wish it were simpler for you.  Out here, if a LO is said to be a danger to self or others; and self means unable to format their own plan of care, etc., and who gets out and wanders and is in danger by doing so, then no need for a court proceeding; especially with diagnosed dementia.  The LO would go to the ER, be examined and then once medically cleared, would be a candidate for the GeroPsych Unit and when accepted, be transferred to GeroPsych from the ER.  Sometimes the  primary care MD or the Neurologist, etc. will place a call to the GeroPsych Unit and make arrangements for an admission through the ER.   We do have PET Teams out here, (Psychiatric Evaluation Teams) to assess a person to see if they are candidates for an involuntary admission to Psych.   Interesting; if there is insurance, that will usually happen; but iif not, it often does not happen.  Usually they are used in psychiatric cases not so much with dementia.

The involuntary admission to GeroPsych is for 72 hours; then as needed, is extended.  This happened with my LO being admitted to GeroPsych through the ER with Neuro giving input; the GeroPsych RN, looking like any other RN, came to the ER and assessed and admission commenced.

I am sorry you are facing such a situation.  It seems all of your dynamics are being handled as if this is a straight Psychiatric Case and not as it would be for a person with Dementia.  It leaves me curious.  He is not a psychotic psychatric case such as a paranoid schizophrenic not on meds, it is a person with diagnosed dementia who medically has a physically damaged brain and is highly compromised.

My LO as said went from the ER into GeroPsych for a 72 hour involunary admission. The admission was extended twice for continuing need of psychiatric care. Then my LO was transferred to a NH, (no MC in the area), and was admitted there; it was all "involuntary."  At no time was the idea that my LO needing to have a Guardianship established even though all of the admission and transfers were "involuntary."  It was dementia, not a psychosis in which dynamics are very different.

It is sad you must go through this while trying so hard to maintain. Cannot that CELA give you an emergency appointment?  Such a wait under the circumstances seems inappropriate.

Let us know how you are doing; we will be thinking of you and you  know we care.

Big hug and hoping for the very best for you,

J.

jmlarue

Unfortunately, I could only bump up the CELA appointment to Aug. 11 because he's away on vacation this week. His secretary was surprised he returned the call as quickly as he did. I'm sure he understood the urgency.

I think you need to understand the political dynamics at play on the "Left" Coast of this country. Washington, Oregon, and California have some of the most liberal ideas about personal rights and much of it has been codified into law. The most recent addressed involuntary commitment for any reason. It absolutely requires an order of non-competency from a Superior Court Judge with witnesses and affidavits on both sides being presented. The county Prosecutor's office brings these actions, a Defense Attorney or Public Defender argues on behalf of the individual, a CELA often works in concert with prosecution to aid spouse or family, public health agency, or federal agency like VA in being granted guardianship. It really is very difficult to hold an individual for psych evaluation or medical treatment without their consent in our state. That's one of the reasons so many mentally ill people live on the streets. They simply check themselves out of treatment and disappear into the great unwashed society. The most recent law change occurred 2 years ago, making it more difficult to commit involuntarily and easier for the mentally ill to voluntarily commit to treatment (but check themselves out just as easily). File this situation under: "The road to Hell is paved with good intentions." You won't often find such laws in what the Left refers to as "fly-over country." States in the Northeast and New England often resemble the Left Coast states in the realm of civil rights such as this.

I have my fingers crossed that this whole process will be easier than I fear. I have no doubts about the sworn testimony of DH's psychiatrists to the facts that he is incapable of giving informed consent and does require the protection of a Guardian to make all decisions on his behalf. I just don't want that Guardian to be anyone other than me. I've been dealing with this psychotic behavior about 7 months now as it has gradually worsened. With effective drug therapy, I should be able to hold on a little longer and just pray I'll see the outcome I want without breaking the bank in legal fees. On the plus side, if we're broke there will be no questions about qualifying for Medicaid. So there is that. Depending on my CELA  to prevent that from happening.

Lynne D

Hang in there JM. One need only visit Portland or Seattle to see what these well-intentioned laws have done, not to mention the invisible population such as yourself dealing with the legal quagmire.

It sounds like you are keeping your head above water. I hope a lifeline is thrown to you soon.