Unsure of how to proceed

kristitanner

i am my 76 year old grandmother’s only family and caregiver. She lost her husband (my pop) 5 years and and her son (my dad) 30 years ago. She has always been hyper independent and very successful. Last year she noticed some changes in her memory and sought treatment from a neurologist. In September she scored a 21/30 on the Moca, lab work then revealed APOE: E2/E4 and ATN profile positive beta amyloid and pTau (a+t+n-) from what I understand that means she has the genetic markers and at least one of her parents had it as well, and she currently has 2/3 of the biomarkers of Alzheimer’s. She’s officially been diagnosed with cognitive decline. Anytime the test results are mentioned she gets extremely aggressive and will deny taking the tests, claim it’s not possible because her parents didn’t have anything, and swear that she knows her body and if she felt like there was anything to be concerned about she’d address it. One of the problems we’ve ran into is every doctor that says something she doesn’t like or agree with (like test results or valid concerns) she gets very combative and then refuses to see them again. Since September things have progressively gotten worse. This month she paid multiple bills twice, she’s bought no exaggeration 4 new tvs because she keeps forgetting how to change inputs and when I’ve tried showing her they work she doesn’t care, even bought a new microwave and fridge this past month because she refused to accept nothing was broken. She lives alone and refuses to have any sort of conversation about accommodations or anything related to her care. At her most recent appointment 4 days ago her cognitive decline was brought up along with concerns (like driving) she once again got extremely combative and refused to have a conversation, tried to blame me for the doctors concerns, made excuses (for example the Moca test results were because she didn’t like the lady who administered it) and tried to place blame. She refused to take another Moca test that day and canceled her appointment to retake it in a few weeks. My goal has always been to help her maintain as much independence for as long as possible but unfortunately I think that’s coming to an end. I have durable power of attorney but I need 2 treating physicians to sign an affidavit in order for it to go into effect. I’m at a loss as to what the next step is. I have been in contact with the attorney and she’s aware of what’s going on, but in order to invoke the power of attorney we’ll need 2 affidavits from treating physicians. I’m not even certain we have an official diagnosis (although it’s been discussed privately with me). Any guidance or advice would be greatly appreciated.

H1235

Welcome. Do you need an actual diagnosis to activate the DPOA or does she need to be deemed incapable of making medical and financial decisions for herself? It’s my impression it’s usually the latter. My moms DPOA didn’t require this, but the neurologist seemed to think it was important I have this letter. I don’t think the letter stated her actual diagnosis anywhere. If that is the case, it seems like the doctors would have enough evidence already. Have you discussed this with the doctor? If bringing it up in front of her will be an issue there are a couple of ideas. You could call her doctors office and explain the situation, it might be better to write a letter to the doctor and in that letter explain the symptoms you are seeing as well(then drop it off at the office), if her doctor has a patient portal available that is a great way to communicate with the doctor without involving her (if she hasn’t set one up, even better, set it up yourself). If another visit is necessary tell her the doctor needs to see her to check (cholesterol, blood pressure, blood sugar….) anything other than her memory. I would let the doctors office in on the ruse. Many with dementia have anosognosia. This is an inability to recognize their symptoms or limitations. Even with an activated DPOA she is not going to give in and suddenly accept her limitations and hand you the car keys and credit cards (it sure would be nice though). Your number one goal is keeping her safe. I would disable the car! You might even tell her “you need to bring it in for repairs”. This may help with the crazy purchases as well. I would consider taking her credit cards. I know this might be difficult. She may call the bank for a replacement or get upset and anxious about it being lost. Once you have an activated DPOA you are going to need to get her somewhere safe. Assisted living facilities can have a waiting list. Have you looked at your options? I would get her on a waitlist now to speed things up. We are all taught to be honest. It can be very difficult to get used to being dishonest and doing things behind her back. Therapeutic fibs are ok if it allows you to keep her safe and causes her less stress and anxiety. Speaking of anxiety, you might want to mention this to her doctor. Medication can help. I will attach a few resources. I hope something here is helpful.

Anosognosia and Dementia - AgingCare.com.pdf

DBAT.pdf

https://www.consumerfinance.gov/consumer-tools/managing-someone-elses-money/

kristitanner

to activate the poa she needs to be deemed incapable. I’ve been struggling immensely since September with this situation, I want to respect her and her wishes but at the same time I’ve let it go for too long now and I’m worried she’s going to either hurt herself or someone else and not have any access to help. According to her medical records her only diagnosis is cognitive decline. I’m thinking a phone call or message/letter would be easier with her doctor, but I’m not sure exactly what to say or how to start that discussion. I worry about coming off the wrong way. Thank you so much for your reply and the resources. She most definitely has anosognosia..I didn’t even know that existed

H1235

I think I would just be honest and straightforward with the doctor. You are concerned about her safety and well being and I think that is the approach to take with her doctor. How can concern for a loved one be taken the wrong way. Tell the doctor you have noticed xyz and believe she is a danger to herself both physically and financially. Explain that you have the DPOA and the requirements for activation. You might even attach a copy of it. I think you are placing too much emphasis on the diagnosis. Her ability to function/or not is what matters (in terms of the DPOA), regardless of what is causing the issues. In the letter the doctors wrote for my mom, I don’t even think dementia was mentioned. It simply said she was not capable of making medical and financial decisions for herself. To be honest other than ruling out treatable causes (sounds like this would have been done already) there is not much that can be done and a specific diagnosis might not even be necessary. It is so hard to take the independence away from someone we love. I felt so overwhelmed with the responsibility, concern that I didn’t know what I was doing and guilt that I was making mom so angry. Try to remember that dementia is taking her independence away, you are keeping her safe.

Victoriaredux

"My goal has always been to help her maintain as much independence for as long as possible but unfortunately I think that’s coming to an end. "

Since she is hurting herself financially, safety should now be the goal. She may never understand her situation, you'll have to work around it .

I assume the lawyer you've been talking to is the one who drafted her documents. They owe her representation, you may ,as named DPOA need to get a lawyer to represent you . When you are appointed you can usually pay those fees from her assets.

Old school lawyers would realize the danger she is in and kind of lay down the law to her - today it's more difficult . Have you written the Doctors ,listed your concerns - usually her primary and a neuro for a letter saying she can't manage her affairs anymore? Doctors usually have a stock letter they use .

Did your GM name you her healthcare agent?

Some good steps to take - freezing credit , taking car and cards have been mentioned BUT until the DPOA is triggered you have no legal standing to do so and if her lawyer goes to court you'll look bad.

You may have to go the conservatorship route if her lawyer decides to fight triggering the DPOA. Judges don't like to see the same cases over and over and its not unheard of if there are assets for them to appoint an outside fiduciary and/or guardian. That person will have their lawyer charging your grandmother's assets.

Right now you need to move fast and legally to get the documents triggered and then do not hestitate to "marshall her assets."

We had a feisty relative who turned against their named DPOA/healthcare agent - dementia was new to us at the time and to try to maintain a relationship we deferred and that was a massive 6 figure mistake. After control was regained in the courts ,I decided there was the person to love and care for and then there was the job of DPOA/HCA for her-I called it Mom Inc.

Mom Inc had to be run like a business , if an asset was at risk- it needing protecting , a prof fiduciary wouldn't say ' oh she may not like it if I do this' - they owe a duty to protect the assets, so we had to. Mom didn't need to know what Mom Inc was doing . Those decisions weren't hers to make anymore.

Getting her into a home may be more difficult , states and judges vary on how much independence they think an impaired person may deserve , even if they are in danger. An independent lawyer can give you info on how your state works. Remember , your GM named you when she was mentally intact , and staying out of court is the best way to go. A consult will let you know more about the steps that need taking.

Don't delay ,as the person named DPOA you have a duty to step in since you know her assets are at risk.