My 92 year old father fell about 5 weeks ago and was in bad shape for awhile. My sisters had him declared incompetent before he had a chance to recover saying they needed to sell the house to take care of him. It was done so quickly that he never had a chance to get better. I am the primary caregiver for him and have been for the last two years. He wants to go home now and the doctors are lying to him at my sisters' request telling him that he is going home, however the truth is they are sending him to a board and care and have already had realtors out to look at the house. Has anyone ever been successful in getting a doctor to re-evaluate their loved one? I am not the power of attorney for healthcare and have been told there is nothing I can do. Any advice would be greatly appreciated.
My husband's PCP at the time of his "meltdown" said, "He appears to have dementia. Here is a prescription for a walker which might help prevent some falls. Good bye and good luck." No referral to a specialist, no suggestions for any drugs (not even aricept) no advice about support groups, nothing. She did not expect him to improve and he was off her radar even before we left the room.
Thank heavens that the Mayo Clinic doctor (Brad Boeve) had a very different attitude. He was clear about the disease having no cure, but he assured us that the various symptoms could be addressed, one by one, and set about doing that.
Yes, caregivers need to know the possibilities to be prepared for, and false hope is a painful trick. But no hope at all is worse, in my opinion, and does become self-fulfilling.
I know that a guardianship can be contested, but that's not what you are going for here; and if there is a question that POAs are not acting in the best interest of the person, they can be removed...but if something is really being done improperly, it sounds like you need to lawyer up and pronto.
BTW I'm very glad your husband was able to recover from his hospitalizations, but as you prob know, a certain number of older people never do recover to their baseline :(
I often tell my patients and families that we want to hope for the best but be prepared for the quite possible. Dementia and illness have such variable courses and I think we often don't do a good job of supporting families through the uncertainty. Most docs don't have the training and almost everyone is short on time.
I imagine your husband's recoveries were in no small part due to the supportive and loving environment you helped provide. I've had a few patients get much better once their families took them out of rehab (even against-medical-advice, once).
I just wish society offered more resources and support for caregivers, and also for medical care at home. Things are improving, but it still feels like slow progress.
It is really too bad that not all medical professionals understand that healing and recovery can take a very long time in the elderly, especially with dementia, but that it is still possible. My husband's wonderful neurologist (Mayo Clinic) understood that and so did his geriatrician.
Thank you for your participation in this thread.
As others have pointed out, it's very common for older adults to be confused and lose a lot of mental capacity right after an illness or injury. It often takes weeks to fully recover, and I've seen people slowly get better over a year.
Doctors are NOT supposed to make permanent assessments of mental capacity at this time, we're supposed to give people time to get better. (But many docs don't know this.) Now, there are decisions that have to be made while people are impaired, like how to manage a safe discharge, and so in the hospital if someone doesn't seem to have capacity to manage that, we have to turn to family/surrogate decision makers.
You can and should point out to your sisters, the realtor, the doctors, etc, that an assessment of your dad's mental state in the weeks after injury cannot be grounds for taking away his rights permanently, or making major changes such as selling his house.
You can also remind them that taking away rights and declaring global incompetence usually requires courts and more proof.
You can point out to the realtor that a hospital doc's opinion is not enough to give your sisters legal authority to sell his house. Even without having a lawyer, if you express concerns that the sale may not be legal, this will probably give the realtor pause and buy you some time.
You did mention a trust, and you may want to find out what are the criteria specified for letting another person take over the trust...could be a little different than your state's standard for a person losing their rights. I have occasionally submitted opinions on a person's cognitive capacities and given it to people involved in a trust.
I personally always specify in my opinions what the deficits are, what the circumstances are, and how likely it is that the problems will persist or worsen. But many doctors write very vague letters saying "so-and-so cannot manage their affairs." This is very sloppy but it's considered the historic norm so I think we can't fault docs too much for this.
However, you CAN ask docs to reassess, and you can ask them to specify in writing just what problems they are observing, what they think the cause is, and whether they think it's permanent or temporary.
I would involve APS if you haven't already done so. They are usually understaffed but it should be free for you, and they might be able to offer you some useful advice.
You also mentioned Kaiser; if your dad is a Kaiser patient then I would also see if you can get any help from their social workers or maybe an ethics consult. (altho the ethics consult often only seems to be for hospitalized patients facing end of life quandries)
good luck!
Your dad's health and mental status could change in a heartbeat. On the surface, if I were your sister, I'd want his home sold as well. Time to consider 24/7 caregiving for him.
Secondly, your sisters can sell the house, but those funds will have to go to dad's care --you and sisters are ill informed if you think they can just split the estate and keep the funds for yourselves. It doesn't work that way.
Apologies if I've missed some of the useful things people have said in the responses. Just wanted to mention that "competence" is usually determined by the courts, and that on their own doctors are just supposed to assess a person's ability to make medical decisions. We are occasionally asked to provide a letter or opinion to someone else, like a bank or a court or an assisted living facility, but as far as I know, on their own doctors cannot make someone globally "incompetent" and allow family to take over all their rights. (That said, when an older person is obviously very impaired, everyone will act as if family has the right to take over decision-making, but that can be contested.)
If you have the time and energy for a fairly technical resource, the American Bar Association and the American Psychological Association collaborated on creating "Assessment of Older Adults with Diminished Capacity" resources. One is a guide for lawyers, and the other is a guide for psychologists who are asked to weigh in re competence.
http://www.apa.org/pi/aging/programs/assessment/capacity-psychologist-handbook.pdf
Believe it or not, psychologists and doctors are often not familiar with the law, or the "best practices" on how to handle these situations.
Everything kind of varies state-by-state, but the info might help you think of how to frame the questions.
Unfortunately I haven't yet come across a similar resource that's written for family caregivers...maybe someone else can speak up if they know of one.
good luck!
I hope your Dad can once again return to his own home, and live there for as long as he is capable.
Just in case, though, don't get excited until you hear back from your father's GP. I hope it'll be good news, but you don't want to count your chickens. Let us know how it goes?
As for selling the house, the closing/title company will ask for a Power of Attorney that says the person representing the owner has permission to sell the house on behalf of the owner. If the POA isn't written correctly, everything comes to a stall.
But it seems to me that your basic question is legal, and you need to have proper legal advice regarding it. Do your sisters have the authority to sell your father's house? Do they have the authority to place him in care against his wishes? In turn, those answers may depend on whether your father is now competent to make his own decisions. You may have the right to contest the house sale until a current opinion can be obtained regarding the competency question. I don't know. I am not a lawyer. But it seems to me that is the kind of advice you need.
When my mother broke her hip she was delirious in the hospital. It was clear to anyone that she could not even understand the questions about her treatment. The hospital turned to her family for answers. She did recover to her former level of functioning. That the hospital treated her a (temporarily) incompetent to make medical decisions did not confer on us the authority to sell her property (for example) after she recovered. If your sisters are acting on the basis of Dad's incompetency, see a lawyer about if you can insist on a competency hearing.
Doctors avoid telling patients the truth all the time, if they think it is in their best interest. My mother's doctor, for instance, has never told her that she has dementia. Or by "going home" the doctor may have meant "to your new home." Or even just "Out of the rehab place." I really don't think pursuing the doctor's "lie" is worthwhile. Just focus on whether your sister have the authority to do what they are intending to do.
Also realize that selling the house is NOT similar to getting their inheritance early. Your father is not dead. That is his money and must be used solely for his needs and care.