Most everyone would say that they want to be independent and remain in their own homes as long as possible. This sense of autonomy can be kept in place longer than ever before due to medical advances, assistive devices, and in-home care provided by family members and private caretakers. However, what happens when an elder can no longer remain safely in their home and an adult child is trying to get them the help they need?
Esther is 89 years old. She has lived alone since the death of her husband 23 years ago. She gave up driving two years ago, but is regularly visited by her children and grandchildren, who take care of errands or drive her to handle things herself. Lately, she has been rather unsteady on her feet. Additionally, she has been very forgetful and once left the stove on all night. She is also having trouble remembering to take her medications. There were so many her daughter, Susan, sorts them every week into a pill box. Esther still forgets to take them and sometimes actually doubles up on doses. Susan can see its time for more help but Esther is adamant about not having strangers in the house and doesn’t want to end up in “one of those places…”
Many times, elders resent their adult children trying to help them. In the elderly parents mind, they are still independent and completely able to handle their own affairs. In the above example, Esther does not appreciate her daughter’s suggestion that they bring in some private home care, or that her mother visit an assisted living facility or rest home. She feels her children are being too pushy, and trying to take control.
But on the other side, Susan feels that Esther isn’t thinking clearly anymore. She is extremely hurt by her mother’s attitude and reaction. After all, Susan is just trying to help.
The parent/child roles have been reversed, except unlike with young children, the adult child does not have the automatic right to make decisions for the elderly parent. Unless the child seeks to declare the parent incapacitated through a court ordered Guardianship or Conservatorship, or has the parent’s Health Care Proxy and/or Durable Power of Attorney activated, the child has to realize that in the eyes of the law, the parent may make their own decisions. And, unfortunately, people are allowed to make bad decisions. However, it is important that the adult child watch the situation carefully and not get frustrated and leave the parent to their own devices. Assisting does not mean taking over against their parent’s will.
Too many children have simply given up when their “help” is not accepted. If one finds themselves in that situation, they can contact our office for assistance and suggestions for getting through to the parent, discussing the possible need for Guardianship, ensuring that the elder’s estate planning documents are in order, scheduling a medical evaluation, and/or perhaps referral to a geriatric care manager where appropriate.
The elderly years can be as challenging as the terrible twos, terrible terrible teens, and even the terrible twenties. Elderly parents must be respected by the adult child who is trying to help, even if the parent/child roles have truly been reversed.
The issue of hoarding has recently gathered a great deal of attention, particularly due to news reports and popular television shows. However, hoarding is not a new or a small problem. The problem of hoarding has been documented since the turn of the century and is thought to significantly affect nearly 15 million Americans, many of them elderly. A great article recently appeared in the Boston Hearald dealing with the clinical aspects of Hoarding. Unfortunately, research has been lacking in this area – until now.
On July 14, 2010, a Bellingham, Massachusetts couple and their dog were found dead in their home. The ultimate factor in their deaths: hoarding. Authorities deduced that 75-year-old Richard Lamphere tripped on a pile of trash, fell on top of his wife, 62-year-old Susan Abraham and one of their dogs. Lamphere died instantly from head injuries; Abraham was severely injured in the fall and died later from her wounds. Police confirmed that the couple were hoarders. They had trash and belongings piled everywhere inside their home. The conditions were uninhabitable and clearly unsafe. For the full story, see this article.
When assessing the severity of a loved one’s hoarding situation, several questions are important to remember:
Can the occupant access doors in case of an emergency?
Does he have access to the kitchen to prepare and store food?
Can he access the bathroom facilities? Can the bathtub/shower be utilized?
Can the resident safely reach their bed or have they made other sleeping arrangements?
Are the home’s mechanical systems in working order (electrical, plumbing, heating)?
Are pets being cared for?
What health hazards are present (mold, decaying food, bodily waste, etc.)
If the basic needs of an occupant cannot be met, then it is time to consider intervention.
The difficulty with trying to help a hoarder is that most of them do not seek or want any “help”. In fact, hoarders typically do not comprehend that they actually have a problem. Thus, attempts to “clean out” or assist a loved one in “tidying up” his or her home should be done with care and patience. And, although perhaps difficult, refrain from making judgments.
Tips to aiding someone who hoards include encouraging them and helping them establish new relationships. Gently remind them that their grandchildren will be able to come and visit if they clean their house. Perhaps it is time to participate in a local community activity for seniors. If they are busy with other activities or plans, then getting rid of “stuff” may seem less consequential to them. Many local companies specialize in professional, home organziation and cleanouts. Additionally, you may look into a hiring a certified home maker a few hours a week to keep up with housework and tackle clutter habits.
As a last resort, do not be afraid to contact the authorities or professional help. Let someone else be the “bad guy”. The story of a local hoarder who has made progress over the years can be found here.
Finally, a temporary or limited Guardianship may be necessary, at least until improvements can be made for the individual’s overall safety. For more information and advice contact your local Elder Services or area Agency/Council on Aging.
Some people think that Elder Law and Estate Planning attorneys are only useful further down the road. They think, “I’m healthy. I don’t need to worry about those things now.” Even while you are healthy, there is one document that everyone over the age of 18 should have in place: a Health Care Proxy (HCP). A health care proxy is necessary to ensure that someone, a health care agent, will be available to make medical decisions for you if you are unable to make them on your own because you are incapacitated. Currently, in Worcester County, another form is also worth considering: the Medical Orders for Life-Sustaining Treatment (MOLST) form. This medical order works with the HCP to inform your health care agent and your doctors what you actually want to happen in various circumstances.
In April 2008, the Massachusetts Health Care Quality and Cost Council (MHCQCC) issued its annual report recommending that Massachusetts establish a pilot program to improve communication between patients and clinicians, and other interested parties, regarding end of life treatments. The MHCQCC found that many patients nearing the end of life were unaware of the treatment options available to them, or, if patients had been aware of such treatment options and had discussed them with their doctors previously, nothing was in place to ensure that their preferences were honored. Therefore, the Massachusetts legislature enacted legislation in August 2008 establishing a demonstrative program for the MOLST process in one community in Massachusetts: Worcester. (Yay, Worcester!)
The MOLST form is fairly simple and easy to read; the most difficult part is actually making the decisions and putting them down on paper. The form is only two pages long, and only two sections must be completed in order for the form to be honored. These two sections are Section D (patient information – specifically who is signing the document on behalf of the patient) and Section E (physician information). In Section D, it is possible for the patient, the patient’s health care proxy, or the patient’s guardian to sign on his or her behalf. If a guardian is signing for the patient, the guardian must ensure that s/he has the legal authority under the guardian appointment to do so. This may require consultation with the patient or guardian’s Elder Law attorney.
If any other section of the form is not filled out, the health care agent is not limited in his or her decisions for life-sustaining treatment for the patient. Sections A, B, C, and F ask the difficult questions regarding resuscitation, intubation and ventilation, hospitalization, respiratory support, dialysis support, and artificial nutrition and hydration. It is critical that you speak with a physician before making these decisions so that you fully understand the meanings of the terms used and the potential consequences. Once these sections are filled out, they must be honored by all health care professions in Massachusetts, where clinically appropriate. The MOLST form is different from a Living Will or another document expressing your “final wishes” because it carries more authority and is more likely to be honored. A Living Will or final wishes document is only used by health care professionals to keep your wishes in mind when making decisions about treatment. While the MOLST form is not currently legally binding, health care professionals are strongly encouraged by the state to honor it.
Finally, Section G simply asks for the contact information of the health care agent. There is also room on the form for other treatment preferences, in which you can more clearly articulate your wishes. There is an expectation that the form will be reviewed throughout the patient’s life so that if his or her preferences change, those preferences will still be honored.
I see it more and more and it really saddens me: families unable to “get along” when it comes to decision making for elder loved ones. It can be as simple as whether Mom and/or Dad need to meet with an Elder Law Attorney, to concerns over finances and inheritance issues, to whether siblings agree on who should serve as primary caregiver, and/or to whether assisted living/nursing home care is necessary.
Often as family members age, family dynamics can become more complicated. Conflicts that have simmered below the surface can boil up and make conversation impossible. Sometimes the elders are involved in the discussions, but unfortuntately sometime they are too far gone to meaninfully participate.
Either way, even the most harmonized family can sometimes hit a bad note or two and require some assistance.
(Dun, dun, dun, dun!) Enter the Elder Mediator. Mediation provides an opportunity for the Elder and all concerned members of the family to participate in creating a thoughtful plan for future. In most cases Elder Law Attorneys can act as Elder Mediators with certain issues. However the scope of the disagreements can often rest in other issues that are not related to the elder law topic. An Elder Mediator, working closely with your Elder Law Attorney, is trained to assist families in identifying the real issues, separating them from the crucial issues of planning for elder care, and developing the best plan of care.
National Public Radio has recognized the usefulness of elder mediation for families dealing with aging issues.
As baby boomers age and options for their care increase, we will all face many difficult choices concerning how we handle transitions during our elders’ declining years. Families will have to be able to evaluate resources, options and develop flexible strategies to support their elders. Even when not legally competent to make decisions, it is important to include an elder’s wishes and expressed preferences when putting a plan into place. Elder mediation is a rational first step for families to help them address their changing needs while enhancing problem solving/communications skills and avoiding messy litigation.
While some clients book traditional consultations at my office, I always make myself available for home visits with my clients. While the idea of a housecall has gone the way of black & white televisions, I find that meeting clients in their home, on their “turf,” helps make what is usually an emotional process, a bit more comfortable. In their home, clients tend to be more relaxed and at ease. The conversation goes a different way and I can sense the pride they have in sharing their home with someone. Coffee and tea flow more easily and taste better from your favorite mug than a styrofoam cup.
As an elder law attorney, our conversation eventually moves to the business at hand and it’s much much easier for a client to get an idea of what they’ll be leaving behind if the items are right there. Important paperwork is never forgotten as it’s right where the client always keeps it. Clients tend to be more thoughtful and less distracted when in a familiar environment. With so much legal language to deal with, it’s better for a client to be relaxed and more attentive.
Ultimately, a home visit allows me to get to know my client and understand their needs better. It gives me the chance to be attentive to them without outside distraction. With seniors, I can also see their current state of living, if they have all the things they need and maybe attend to some previously unaddressed issues. What many might see as a bother – a housecall – I consider an honor and a blessing.
Vickstrom Law • Kristina R. Vickstrom, Esq. • 172 Shrewsbury Street • Worcester, MA 01604 508.757.3800 • View Disclaimer.
Vickstrom Law specializes in Estate Planning, Elder Law, Medicaid (MassHealth) Planning & Applications and Probate and Estate Administration and services Central Massachusetts including Worcester County, and Metrowest Middlesex County Boston area including Worcester, Marlborough, Hudson, Leominster, Fitchburg, Shrewsbury, Westborough, Northborough, Southborough, Stow, Bolton, West Boylston, Holden, Sterling, Spencer, Grafton, Brookfield, West Brookfield, and Sturbridge.
Esther is 89 years old. She has lived alone since the death of her husband 23 years ago. She gave up driving two years ago, but is regularly visited by her children and grandchildren, who take care of errands or drive her to handle things herself. Lately, she has been rather unsteady on her feet. Additionally, she has been very forgetful and once left the stove on all night. She is also having trouble remembering to take her medications. There were so many her daughter, Susan, sorts them every week into a pill box. Esther still forgets to take them and sometimes actually doubles up on doses. Susan can see its time for more help but Esther is adamant about not having strangers in the house and doesn’t want to end up in “one of those places…”
Conservatorship, Elder Needs, Family, Guardianship, Health Care Proxy, Uncategorized | Kristina | 
June 3, 2011 10:39 am | 
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