At what point is an adult declared incapable of self-care?

Discussion in 'The Watercooler' started by gcvmom, Jul 5, 2009.

  1. gcvmom

    gcvmom Here we go again!

    When do you have a "loved-one" declared incapable of making decisions for themself? Is it reasonable to declare someone of unsound mind when they refuse medical treatment? At what point are you held responsible for someone's demise due to their own refusal for treatment?

    My dad is at it again. Mom called to say his leg edema is worse than she's ever seen it (he's already on diuretics and various other medications for his congestive heart failure), and to top things off, he now runs a low grade fever that spikes over 100 and he has a rash that is spreading from his legs on up. I'm thinking cellulitis, or maybe worse.

    He refuses to let her call the doctor and he certainly won't call the doctor on his own.

    She's tired of hearing him complain and obsess about the problem and not do anything about it, and get mad at her for even suggesting something be done about it.

    Is she to be held responsible for his refusal to seek help? At what point can/should she legally intervene and have him declared incompetent?

    I know he's scared and that's why he's such and SOB. But I also feel for my mom in this position. Any advice for her? Besides the divorce she should have filed for decades ago?
  2. judi

    judi Active Member

    I'm an advanced practice nurse in IL and at least in IL, you can't force someone that is awake, alert and oriented to take any medical treatment.
  3. susiestar

    susiestar Roll With It

    If it were us in that situation I would end up being the "bad child" and calling the doctor, or even 911 if it looks like cellulitis. I had cellulitis in my right thigh and spent almost a WEEK in the hospital on 2 different IV medications given 4 times a day - each. It was a total of 8 IV antibiotic infusions PER DAY.

    You can actually have cellulitis destroy, well the doctor used the word "eat", your muscles, and even the BONE.

    This will KILL him if it goes unchecked.

    Your mom needs to draw around the infection with a sharpie. Actually trace the outline with a pen and then check it every 6-8 hours. If it is growing, call 911. If it covers more than 1/3 of his leg, call 911.

    This isn't a joke, it isn't something his body can fight, and he is being totally irrational. This is a danger to himself.

    Will he hate you if YOU call 911 or emergency services in your area? Do you need to get a PINS petition? It might allow you or your mom to make the medical decisions.

    If you and your mom just can't get him into the doctor or a hospital, it is time to call his doctor and ask for support to get him admitted against his will. Baker Act, maybe, or PINS petition (Person In Need of Supervision).

    I don't know if she would be legally responsible, but I bet she would feel terribly if she ignored him and let him die. Chances are high that he will die if this continues unchecked. The sharpie would give a definite measurement and might help convince him.

    I am sorry he is so scared and sick and impossible. It sure sounds like time to over-rule him.
  4. Lothlorien

    Lothlorien Active Member Staff Member

    Is there anyway that you can go there and put him on a guilt bad it looks, how concerned you are for him and you are afraid he's going to die from know, the typical guilt stuff from a daughter?

    Other than that, I don't have any other suggestions. I'm sorry Dad is being such a pain in the rump.
  5. gcvmom

    gcvmom Here we go again!

    Judi, that's kind of what I feared.

    Susie, the sharpie idea is great -- I wish I'd told my mom about it, but I'll remember that for future. I'm going to talk to my mom about finding a mental health lawyer as a backup for when dad really starts to deteriorate. His obstinancy is only going to get worse, I fear. I hate to say it, but it would be a blessing if he would just go suddenly in his sleep. This lingering, chronic illness with an already mentally ill person just hoovers.

    Loth, husband said I should do the same.

    I called my mom's cell just now to find out what was going on they were on their way to the hospital ER... she's going to call me when they know more. If he gets admitted I'll be driving down there to check on them both.
  6. DammitJanet

    DammitJanet Well-Known Member Staff Member

    I think to legally cover herself, I would call 911 if he refuses to go to doctor. If he refuses the ambulance services well at least she has that documentation. Maybe they can get him to go though.

    Maybe while in the hospital, the doctors could convince him to sign a medical power of attorney. Or the hospital social workers. I know when I was in the hospital this past fall they talked to me about the living will and the medical power of attorney.
  7. gcvmom

    gcvmom Here we go again!

    I doubt my dad would EVER submit to signing over ANY amount of control of ANY portion of his life to ANYONE, Janet. But it's worth at least mentioning to my mom. My dad is uber paranoid and distrustful of everyone. Especially his doctors. He's been obsessing over which one to sue for his current state of poor health. Clearly it's THEIR fault (the doctors) for misdiagnosing him and not treating him properly. :hammer:
  8. Hound dog

    Hound dog Nana's are Beautiful

    If I were in either yours or your mom's place.......... (cuz it's probably Mom that is going to have to take this step)

    Have her call 911. Let the paramedics deal with talking Dad into going to the ER. They're usually pretty good about it, also just as good at determining if someone is competent enough to make the decision on whether or not to be treated.

    I'm wondering if your dad has decided that your Mom is not medical personel therefore has no clue what she is talking about, so is deciding to dismiss her concerns for his health. Especially since he seems fearful of treatment.

    Does dad have a living will? Does he have anyone appointed POA or MPOA should he need it? POA- power of attorney.......MPOA- medical power of attorney. If your Mom has either......honestly, she could kick it in against your dad if he is not capablt of making reasonable decisions for himself. Such as seeking medical treatment for what is going on right now.

    Truth be told, we could over ride mother in law's "comfort care" if we so wished and deem it unnecessary at this time. Of course we wouldn't as we are following her wishes. But honestly I would over ride for something of this nature.......he is suffering needlessly. That's why I'm so involved in mother in law's care. I'm there in case a decision needs to be overruled by family, and husband and I are the one's with the medical POA.

    Sorry dad's being such a PITA. Shame he is suffering needlessly. But this sounds like it has the potential to become serious fast. Mom needs to at least attempt to get him seen.

  9. Hound dog

    Hound dog Nana's are Beautiful

    Glad to hear he's on his way to the ER. :) Hope he cooperates.

  10. gcvmom

    gcvmom Here we go again!

    Lisa, he absolutely does not think my mom has a brain cell worth anything in her head. He has NO respect for her, and never has. Although in the last few years that his health has really declined, he has softened a bit towards her, I think realizing that she is the only person in the world that he has to take care of him. He so much as admitted to her his gratitude for not abandoning him. But that doesn't stop his paranoia and distrust of the world from making him abusive (verbally) towards her and a general PITA to live with.

    I don't believe he has a living will. Not even sure if he has a "regular" will. That would mean admitting that he IS going to die some day and that other people will then have control over his stuff (he's a moderate hoarder).
  11. susiestar

    susiestar Roll With It

    I am glad he is going to the ER. Call and suggest the sharpie thing if the docs don't do it. It was teh doctor who did it to my leg. And boy was I glad. By the time they did the third round of infusions I was showing HUGE progress. It made me feel better to be able to visually see it receding.

    Huge hugs to your mom for dragging him to the ER!!!
  12. goldenguru

    goldenguru Active Member

    The big question in my mind is, will your mom 'rock the boat' with your dad - or is she too afraid to do something drastic?

    I'm afraid there isn't much YOU can do, if mom isn't willing to back you up.

    I am in a very similar situation with my parents. My mom is very badly addicted to pain killers. It is so pathetic to watch. I have talked to them both, begged my dad, and begged him some more to get her some help, but he just enables her behaviors. There is nothing more I (or you) can do, if the spouse is unwilling to take a stand.
  13. gcvmom

    gcvmom Here we go again!

    Thanks Lisa, Susie. Mom just sent a reply to my text about marking the rash border. They haven't seen the doctor yet. She said the rash is already all over his arms, thighs and some on his belly. Sounds like a systemic infection to me...

    GG, my mom definitely suffers from codependent behavior, although she has gotten better in recent years. He intimidates the crud out of her -- I have to remind her that he is in NO position to do anything. She truly has all the power in this situation if she would only realize it and use it. I think she uses me as the little Jiminy Cricket voice to push her in the right direction when she is too afraid to take the first step.
  14. susiestar

    susiestar Roll With It

    I think they are both blessed to have you as your mom's Jiminy Cricket. I am sure you do a good job of motivating her and helping her to realize her power.
  15. klmno

    klmno Active Member

    I just wanted to offer support. The others have given good advice already- I would have just suggested that your mom talk to your dad's dr in private and see what he says. I'm glad they are on the way to having it checked by someone though.
  16. gcvmom

    gcvmom Here we go again!

    Thank you klmno.

    The ER doctor who's been in to see him thinks it's an allergic rash and has ordered tests to rule out whatever. I texted my mom whether he's eaten anything different or started new medications recently. And what about the fever? Also, I sure hope they address the severe leg edema while he's in there.

    husband was very nice and took the three kids out to run errands, and told me that if I need to go down to the hospital to just GO.

    Mom just texted back as I'm typing to say he's been drinking lots of milk with Nestle Quick lately... I could just smack him. ONE: he's sensitive to chocolate (as am I... it gives me a rash if I have too much). TWO: he's supposed to be trying to LOSE weight and the extra calories just make no sense at all to me.

    Tell me, are we ALL doomed to reverting in this way when we are old and in poor health? If so, just shoot me now.
  17. klmno

    klmno Active Member

    Yep- could be the chocolate if he's sensitive to it. But I personally would not be able to fault him on eating it. :)

    Another thought- has anyone considered a spider bite? Are there any red streaks on him?
  18. gcvmom

    gcvmom Here we go again!

    Not that I know of... Mom hasn't mentioned it. It sounds like a fairly diffuse rash.

    It could also be the milk. I notice that I get eczema when I drink milk. If I lay off dairy for a while, the rash goes away.

    Oh, and P.S. He has had issues with calcium-oxalate kidney stones for as long as I can remember... so drinking gallons of milk is probably not a great idea for him anyway.
  19. DammitJanet

    DammitJanet Well-Known Member Staff Member

    GCV.....i hate to tell you that I think we all get cranky and irritable as elderly folks. Well most of us. There are a few who just stay nice and calm and serene but they dont live in my My therapist says I should plan to get really gfgish in my old age and visit that period of life upon my kids so they get a good taste of what they put me 18 years a piece...hmmm...I better start now!
  20. susiestar

    susiestar Roll With It

    Janet don't you DARE start yet. You need to live to a ripe old age!!! Don't plan to start going yet, for Christmas sake!!

    I think that each of us has certain parts that become stronger as we age. My mom is much crankier now on many many things. My dad is far more easy going than he ever was. My bro can call ANYTIME and get instant babysitting, same for his ex (they only have 1 child together and her other 2 kids are grown. They moved out in their teens because gfgbro was trying to parent them". I can call and plan a day ahead of time for the kids to go over to my parents. But my niece is ALWAYS there. For the last six months it has happened every single time. Once they scheduled an overnight and she crashed it! But he always has some drama and conflama going on.

    The ONE thing my dad is crankier about is fire. He is always going on that if the hair dryer or any other electric device other than the tv and computers is on then the "house will burn down". I swear in a few years he won't let mom turn on the lights.

    Once I was in the attic of the house he grew up in. Now I know why he is that way. His dad wired most of the house. My aunt has done a major addition and remodel and ended up having to rewire every outlet and light switch in the place because it was SOOOO far out of code. It really IS a wonder the house didn't burn down.

    So we pamper him on this one thing. the rest makes my mom cranky.