My mom is 84. She cannot ambulate at all without a wheeled chair and someone to push it. She is of sound mind and generally pretty sharp. Her cognitive skills are good other than financial stuff, medication organization, forgetfulness. She has hired caregivers for most of the day with small gaps in time(she generally takes naps during the gap times). Her last caregiver of the day puts her to bed and then she is alone overnight until the next caregiver wakes her up in the morning. My older sister and I are responsible for her care decisions, but she is very independent minded and strong-willed and participates in discussing care decisions too. My sister spends a lot of time with my mom, with extended stays lasting weeks. When my sister is not there, my mom strongly does not want a caregiver staying overnight. But some extended family members have suggested she should never be left alone for extended time and have been giving us a hard time. I am wondering what the legal ramifications are. I have always thought that if my mom did not want anyone overnight, then we should honor her opinion. But now I am wondering if my sister and I would be held legally at fault if something were to happen overnight when no one is there (like a fire or my mom falls out of bed, etc). I've looked up elder law attorneys but it seems like they are very expensive, have a long waiting period for consultations, and my questions are pretty limited to just this (we already had power of attorney and similar paperwork done for financial things). How can I get my legal question answered simply and timely? Does anyone know the legal ramifications? Do we have anything to worry about? My mom would not want us to get in trouble of course.
I'd die trying to get us out, but that would pretty much be the end for both of us. This final scene would be pretty gruesome, but you know, we've both had a good run.
I also find the discussion ageist. Maybe a bit sexist, too.
(Imagine the movie Rear Window except now Jimmie Stewart is legally required to have a full-time babysitter. Blech.)
People in this thread are gathered around a campfire telling scary stories. Every one of us posting here will be dead of something or other before long, and many of these deaths will be drawn-out horrors in places that are happy to cash in on run-amok safetyism.
You know what else isn't safe? Cycling. Horrific stuff happens to cyclists all of the time. Maybe we should get all of these people assessed for mental impairment and have them institutionalized.
There is no perfect safety.
We are all going to die, some more horribly than others.
Deal with it, people. And stop indulging your own death denial by stripping older people of their civil liberties.
👏🏻👏🏻👏🏻👏🏻👏🏻👏🏻
If your mother stays in bed all night you need to make sure she has good working smoke detectors and any other alarm you feel is appropriate for her home, as well as wearing her call button to bed. Until you are her legal guardians or she lives with one of you, you are not liable for what happens in her home.
I think the difference would be leaving someone mentally incompetent. That shouldn't be done.
If you are competent and bed ridden and a fire starts you call 911 like everyone else.
You must understand that someone unable to act or react to castrophic occurance because of dementia cannot safely be left alone?
Just as you would not put a child to bed and go out for the evening just in case something happened. 99.99% of the time that child would sleep through the night and nothing would happen...
It is that small % that will be the problem if something happens and she can not call 911, can not get help in time. And I can almost bet in an emergency she would call one of you to help her rather than call 911.
I do not even think placing cameras to monitor her would make it any safer.
And I am thinking she is not as competent as you think she is. The list of cognitive skills being good "other than..." and you list several important items.
As far as cognitive skills and sound mind, which several people have brought up, I can elaborate some.
Financial stuff--My mom has never handled the financial aspect of things, so it would be a brand new thing for her to pick up and learn at this point. The finances are also rather complex at this point, making it harder for her to learn. I even find it challenging at times.
Medication management--The hired caregivers keep the medication organized, so there is no need for my mom to do anything with medication overnight when she is alone. So I'm not sure it is relevant since we have this taken care of. A lot of elderly people need help with medication but don't need 24/7 care necessarily.
Forgetfulness--A lot of elderly people find their memory is not as good as it used to be. I'm not sure that is a good determination of needing 24/7 care. Her level of forgetfulness seems similar to many elderly people I know who live at home and do not have 24/7 care.
I feel like the most relevant thing is that she cannot ambulate on her own. I agree with everyone that says that seems to point towards needing someone there. But it will make her soooooooooooooooo unhappy and right now she is very happy and thriving despite a lot of serious health conditions. I'm just worried that her emotional and mental health is what's keeping her going in many respects, and forcing 24/7 overnight care is going to cause her to become unhappy or depressed and then have a negative effect on her overall well-being and health.
If we were to find out that legally we should have 24/7 care, I think she would be more accepting of it, as it would just be a matter of fact, not something she could try to convince us is not right or needed. I think she'd have a different reaction and be more agreeable and adaptable.
Hopefully that makes sense.
I want her to be happy because I want her to be healthy. But I also want her to be safe of course.
The legal aspect came up recently with an extended relative, and I thought it would be good for all of us to be informed, including my mom as it would affect how she views the situation.
If you are satisfied that in an emergency (fire, burglary, storm);she has the wherewithal to call 911 or you all, then I don't see an issue.
If your mom gets diagnosed with dementia or other cognitive impairment, then, as POA, you may need to re-think.
If your decision is based solely on "mom doesn't want..." with no regard to the realities of her situation--(can she get out in a fire? Does she have the ability to assess if she's in danger?), then you are approaching to his the wrong way.
Staying at home on her own was what she wanted, and she was very capable of most self-care. Some people would say this is far too old for her to be so much on her own, but it worked for us. You need to look at your own LO, because we have people aged less than 70 who need more supervision than Dora needed at 90.
You will be amazed at how expensive it is to hire somebody for the overnights, That is the most difficult shift to fill.
She's also not of sound body, and she can't ambulate herself.
My friend Marianna was considered of sound mind but was confined to bed due to lung disease (smoked all her life; don't do it). Caregivers came in and out on a schedule. Her family believed as you do that she was okay to stay alone for short periods. One day she was alone in her bed as usual, and the caregiver had left the dryer running and gone out to run errands. The lint that had built up in the dryer caught fire, and the house burned down with Marianna in it.
It was a horrific way to die.
Bedbound. So I presume/hope setup by care staff for nightime;
Telephone & alarm pendant on bedside table (or wearing a watch style). Water, tissues, spare blanket etc within reach. Continence pads worn or on bed.
Fire risk? If the home is usually neat & well maintained, no oxygen tanks, no smoking, then risk is probably low.
Burglary risk? Normal or a high risk area?
Natural disasters? If in any high risk zones for hurricane, wild fire, river flood, earthquake, blizzard?
You can't remove ALL risk.
You can just use what you know to assess likelihood of severe problems with dire outcome.
Moderate/low risks with moderate/low outcome can be planned for eg feeling unwell in the night can mean press the alarm button or call family.
Then add in extra safety. You already have care staff & falls alarm. Great.
Some people like to use cameras. They may offer some peace of mind if that is what you need. Otherwise the old fashioned check-in call every morning can work well.
Re-access every now & then.
Things I'd use as red flags for change are;
- Mom starts getting fearful alone in the evening/night
- Mom is getting poor with telephone skills
- Mom is frequently getting unwell or uncomfortable overnight
- Double incontinence frequently overnight
Regarding the Backseat Drivers;
"But some extended family members have suggested she should never be left alone for extended time and have been giving us a hard time".
Thank them for their concern.
Ask why they hold that view.
Thank them for sharing it.
Carry on.
I really don't know how you would get a legal opinion on this. I have heard that being charged for neglect takes both 1. holding duty of care plus 2. taking (or enabling) risks that most regular people in that position would not.
Your Mom is deemed competent to make her own decisions, therefore the duty of care is her own (to my thinking).
You just described someone whose cognitive skills are NOT that good.
I am PoA for my Aunt who is 104.5 yrs old. She still moves about with a walker, pays her own bills and deals with home issues and repairs with a tiny bit of help from my local cousins. She is not forgetful. She doesn't have overnight help. We feel comfortable with this, so far.
Her sister, my other Aunt who used to live with her, one night "forgot" she couldn't walk with assistance and got out of bed, fell and broke her hip then died in rehab.
I get why your Mom doesn't want a "stranger" hanging out in her house every night (which is what my Aunt says), but maybe start getting her used to it in increments: have someone stay 1 night a week, or later and later into each evening, until it doesn't bother her and she sees the benefits (which may never happen).
Forgetfulness is a dangerous thing. It is progressive and gets worse with every passing month and eventually, week. You can't see it, you only see the havoc it wreaks. I live in MN and it's winter here. At least once a winter there's a news story about a senior who left their house in the night and froze to death. Sometimes their own family was in the house at the time. It only takes 1 time for her forgetfulness to become a disaster.
To answer your question in your post, there is no legal ramifications unless your sister was actually abusing your Mom or severely neglecting her in some provable way. What you're describing is not abuse nor neglect.
Is anyone PoA for your Mom? If not, she still has capacity to assign this important legal protection for herself.
"I have always thought that if my mom did not want anyone overnight, then we should honor her opinion."
The problem with cognitive decline and dementia is the person progressively loses their skills of logic and reason and empathy. They should no longer be calling the shots because their judgment is broken and they aren't cognitively able to care how it stresses out or impacts the people who are orbiting aroung them trying to keep them safe.
FYI if your Mom is basically bedridden she may qualify medically for LTC and therefore Medicaid. She will then need to qualify financially. One strategy would be to transition her into a good, reputable local facility that accepts Medicaid. Once she qualifies, she gets first dibs in the facility (no waiting lists) and then at least she's in a place that you trust.