Published on: August 7, 2016
by Carolyn Rosenblatt for Forbes:
Adult children see their parents aging and losing the ability to manage their lives as they once did. They are not taking care of themselves. It is a cause of alarm, but can anyone stop a parent from living dangerously? Here at AgingParents.com we hear from the adult children, asking if there is anything they can do about Mom or Dad. They tell us about the aging parent neglecting their normal food needs, their hygiene, they’re isolated they can’t get around, and they can’t drive anymore. Anxious kids offer to help, urge moving to assisted living, or with a family member but the elder refuses. Can you make them get help, they ask?
Usually the answer is “no”. Unless the aging parent is an immediate danger to herself, such as starting a fire, having a home so poorly maintained that it is rodent infested, the plumbing is not functioning, or some other horrific situation, the authorities will not force an aging person to be safer. Even hoarding, which I have personally witnessed more than once as a visiting nurse, may not be enough to get the law involved in forcing a change. What usually happens is that loved ones beg, cajole and urge the elder to move or get help or otherwise give up their living situation. The elder wants to stay where he is, either out of fear of losing control over his life, or because he is so cognitively impaired that he does not perceive the real danger. But he is not so “out of it” that he can’t express what he wants. He chooses to live with a lot of risks. The crisis that everyone fears, e.g., a devastating fall, often does eventually occur.
What about the law? The law generally considers a person to be competent until they are judged to be otherwise. Competency is a legal question, and courts and lawyers looking at the issue are aided by medical evidence. But if an elder refuses to see a doctor for any examination or testing to find out specific data about their capacity to make safe decisions, everyone is somewhat stuck. The question of an elder’s safety may be addressed by Adult Protective Services, which, upon receiving a report of self-neglect, can send a social worker to the elder’s home to investigate. If the elder puts on a good show, assures the worker that everything is fine, takes the brochures or other information about community resources like Meals on Wheels, the senior center, and home care workers, the social worker is not likely to take further action. If on the other hand, the social worker sees obvious danger, such as rodents running around, the stench resulting from plumbing that does not work or lack of any food at all in the house, that worker may refer the matter for legal action. Specifically, a request for a guardianship can take place. The county’s legal counsel would then collect evidence, approach the court with the paperwork, a lawyer for the elder would also be appointed and the matter then is up to the judge. Typically a hearing is required. If the judge is convinced, a guardian is appointed. The fees for all of this come from the elder’s own assets, unless they do not have them. In that case most counties use a public guardian to do the job of overseeing a self-neglecting elder’s life. And that person has to be appointed by the judge who first heard the evidence available to decide the matter.
Most elders do not present such a danger that their situation is going to end up with a guardianship case before a court. Rather, they are frustratingly stubborn and just refuse help, which pretty much drives their kids crazy with worry. Is there a solution?
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To me the best way to approach the communication with an aging parent who does not want to look at the danger around her is to start when you see the very first signs of trouble. Describe how YOU are worried and ask your loved one if she wants to keep burdening you with that worry and fear. Most parents do not want to be a burden to their children. Do this in person, even if you have to travel to do it. Offer to help with everything possible in a most respectful way. Acknowledge that she is fearful of losing control and reassure her that you are not trying to take anything away and that you want her to keep her independence as much as possible. You usually can’t force help on anyone who doesn’t want it, and that’s the most important takeaway. But you can show up more often, get in touch with your parent’s neighbors and friends and ask them to look in on her regularly and monitor anything you can from a distance if you don’t live nearby. Stopping an aging parent’s neglectful ways altogether may not be possible. The goal then becomes to minimize it as much as you can.
People all age differently. Some are more accepting of the need for assistance than others. Some were always stubborn and stay that way until the end of life. What we adult children need to embrace is that we have to accept them, complete with what might be certain dumb choices about how they live. We may not approve, but we can seek to understand.
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