Eldercare Questions and Insights

by Joy Loverde

As the author of The Complete Eldercare Planner and online elder care columnist geared toward people who are caring for aging parents, I’ve been asked some interesting questions. The depth of where our caregiving journeys will lead us never ceases to amaze me. This blog offers insights into the complex elder care process.

Question: My grandfather has Alzheimer’s.  While he exhibits all of the symptoms of this horrible disease, he seems to be physically okay for an 84 year old man with a fragile body and more often smashed spirit.  He can be and is quite the challenge for anyone to manage on a daily basis. However, that someone is my grandmother…she is 81.

She is becoming sick trying to care for him.  She is stubborn, scared and physically incapable of taking care of her now very needy husband.  However, having lived a sheltered life of not planning for her (their) future and never really having to make major decisions in life, she has been thrown into a situation that she is not equipped to manage.  He is beginning to decline fast and so is she. Here is the most frustrating part, she has not named an executor or made any future plans for herself or my grandfather.  She completely lives day to day in the situation as if she has 50 years left or possibly that the situation might improve.

Don’t be mislead, if she talked to you or anyone right now, one would get a sense that she understands what needs to be done but nothing ever changes. She goes right back to her same pattern—almost immediately. However, she is NOT crazy by all means…perhaps it’s a serious case of denial?!  That part will never be clear as no one can truly understand it from her perspective. It’s heartbreaking.  The situation has become extremely sad and dangerous, especially, given their living conditions/environment.

They have six children…but they are mostly estranged from them and each other.  At least 2 of them try really hard to assist (live nearby) and they bear the burden on a daily basis to do what they can. It is wearing them down as well.  Decisions need to be made.  Someone has to make them.

I believe the children think the idea of declaring my grandmother incompetent is cruel… (well maybe one of them won’t as she thought of this idea awhile back). Frankly, it could be the saving grace that both my grandparents need. Perhaps then he would get the appropriate care needed and she could regain some quality of life for the remainder of her years if they were in assisted living.

How do you go about declaring a person (my grandmother) incompetent in this  situation?  Do all of the six kids have to agree?  They are an odd bunch who have seemingly not liked each other for years (the whys have become a moot point but the grudges and negativity are held on to tightly like security blankets). However, a few of them, maybe 3, might be rational enough to understand that declaring the incompetence could be a wonderful opportunity for both my grandparents, instead of it being a bad thing.

Answer: The sentence that jumped off the page for me when I read your letter was… “The situation has become extremely sad and dangerous, especially, given their living conditions/environment.”  Declaring incompetence is one thing. Getting your grandparents out of that situation immediately is another; and that’s exactly where I’d like you to start.

Are the siblings who live nearby willing to take the time to research local assisted-living communities and befriend the professionals who work there? The crisis situation you describe is one that they encounter day in and day out and consequently can offer advice on ways to get your grandparents to consider moving into this safe and caring environment. The physical move into assisted-living may not happen overnight, but beginning the communication process will help carve the way.

Also, if things are as bad as you describe, your grandparents also may be candidates for a visit from a third party. Would the siblings be willing to arrange a home visit from a geriatric case manager? These professionals will conduct a formal assessment and offer an objective opinion on the next level of care and course of action.  Getting your grandparents to agree on such a visit may not be easy, and again, let the case manager offer suggestions and strategies to develop a tailored approach to your grandparents.

Typically, the assessments are conducted in an informal manner. They get the needed information in a more relaxed atmosphere where they observe the person’s functioning over a period of time in several home visits.   For example, for a parent who is fearful of being placed elsewhere, they might have the family tell the parent we are care managers who are going to assess their needs and try to keep them safely at home as long as possible. Call the local area agency on aging for recommendations on geriatric case managers.

Finally, the idea of declaring a person incompetent certainly qualifies in this case. It’s not a matter of getting two or more of the children to agree that “he is incompetent.”  That determination can only be made in a Probate court proceeding; and will generally be so ordered if the Petition is supported by a written report/opinion of Grampa’s physician or psychiatrist.  So, if he is physically incapable of taking care of his own personal needs (guardian of the person) or of managing his fiscal affairs (guardian of the estate), a guardian (or conservator, depending on the term used in his particular jurisdiction) will be appointed.  Then, the burdens will no longer fall on Gramma.