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.
You will be amazed at how expensive it is to hire somebody for the overnights, That is the most difficult shift to fill.
A person who is unable to transfer from a bed to a wheelchair on their own cannot be left alone in a house. This is common sense.
Your mother is being stubborn. Normally, I'm all for letting a stubborn senior of sound mind rot in place because I don't play that game. This is different though.
Ask your mother what she would do if there's a fire? Or if an intruder breaks into her house?
She is bedridden and cannot transfer from her bed to a wheelchair independently. She can't get out of the burning house. She can't run or hide or try to defend herself in the event that she should have to. For these reasons alone she cannot be left alone at home.
Whether or not she is of sound mind as you say which I seriously doubt, she is still a vulnerable adult. The state can force her into care or force her to accept overnight help if she wants to remain in her home.
Don't be a fool and try to rationalize that her home is low-risk for a fire and that it's a "good" neighborhood and the risk of a home invasion is low. The Petit family in my state (Connecticut) lived in a very good neighborhood in a very nice town.
A fire can happen even in a very well-maintained home.
Your family members should be trying to help you, not criticie you. Either they are part of the solution or they are part of the problem. Let them know this.
Your mother may be more agreeable to having an aide for part of the overnight. Start with that.
for other aspects beyond legality - that’s a different question .
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).
Has a doctor said that recently ?
If not , Mom should have a cog test , so you know where she scores on that .
Bedbound and alone doesn’t sound safe to me , and if Mom is not of sound mind , she can not make the decision to be alone at night.
Even if you talk to a lawyer, I’m thinking he/she may ask to see a report of a recent cog test .
If her doctor agrees that she can be left alone during the night, then get the doctor to write that.
Then you’re covered. Boom. You followed doctor’s orders. She’s fine to be left alone for certain periods.
(This decision is not up to forum members here. This is a medical decision).
If I were you: I’d keep her happy the way she is. She’s happy having no caregiver at night.
The goal isn’t to live as long as possible. And there’s no point living longer, but unhappily. Let her be happy.
Later, in the future, the doctor might say: now 24/7 care (at home or facility) is necessary.
As for mental competence, one can - absolutely - be mentally competent, even though one’s memory for certain things isn’t good.
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.
I think you've just grown used to the slow slide.
Probably she should not be alone during the night.
IDK what the state laws are on this--honestly, b/c it's kind of obvious, isn't it? that she shouldn't be left alone?
Are you really only scared that the law will step in? If nobody but family knows she's alone all night, then there's about no chance it's going to get 'solved'.
Safest thing for mom is moving to a 24/7 place, and you know that.
We checked into overnight CG for my MIL--and it was going to be between $10-$12K a month. More than the NH the kids were looking at.
End result has been that she's alone about 22 hrs per day. No, she's not safe, by any means, but she's getting her own way.
By no means is she competent. Try doing the BIMS test on her--you may get a real wake up call.
Good Luck--I'm kind of where you are, too.
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.
You could tell your mom that you would feel better if she had an overnight caregiver with her. She may or may not be interested in hiring an additional caregiver for an overnight shift.
Why don’t you look at assisted living facilities in the area and compare prices against paying for caregivers in her home?
Often times, people will choose placing their family members in a facility over living at home.
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.
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.
When decision making is this bad I believe that the POA should act for the mom to have someone there.
The elder law attorney is paid by the principal who gave you POA> That is, your mom's funds pay for this.
Not to mention an elder who is bedridden is not able to function alone at all, and therefore, should never BE left alone.
Your mother needs a full medical and cognitive workup to determine where she scores on a cognition exam. Based on her number, which I expect to show dementia, she needs 24/7 care at home or placement in Assisted Living or Memory Care Assisted Living. It's more about you wanting mom to be safe and properly cared for than about "legal" matters, I would think. But whoever holds POA for her is expected to provide a safe living environment for her, legally and morally.
Good luck to you.
As regards the O.P.'s mother, IF she chooses to live less safely than the O.P. and her siblings would like, that does not necessarily that she now has diminished capability to make these decisions. As I have written in another reply, I think a better criterion of the reasonableness of these decisions is how consistent they are with how her mother has lived for the past 84 years!