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My brother is a doctor. He lost his license for 3 yrs. due to unethical actions while my Dad was dying. He is now a danger to my mom. What options do I have to help her? She has dementia and worships my brother. He and she hid my father's very legally drawn up Advanced Directive. My father suffered horribly for over 8 months and had requested no intubation. He had a DNR. My brother intubated him behind my back. I would have stopped it. My brother broke AMA Ethic 8.19 which forbids a doctor making decisions for or treating a family member except in an emergency. As I watched the poor decisions being made by my brother, was asked to stop him by his hospital, and was told an ethics committee was being formed, I understood why such an ethics violation is a felony in Georgia. In the end, the hospital located Dad's advanced directive. My father was mentally capable and assigned the health POA role to me. I was alone when he died. Now my mother is still struggling with a TBI that resulted when an umbrella pierced her neck and almost ripped off her head while she was on a windy beach 7 years ago. She is not taking care of herself, her house is dirty, she will not allow me to help because "i allowed my father to die" , and she is being treated by my brother for medical issues. The treatment is not appropriate. She fell recently, hit her head, appeared to have a broken arm, had sore ribs, and started with dizziness. He and she refused to obtain medical help. I would have. She has rages that are dangerous. My brother hates me because he blames me for the loss of his license. I am a retired special needs teacher after 35 years of working with students of normal intelligence who were very sick children. I could and did take care of many of my father's more simple medical needs. My mother does not like illness and would barely touch him after 63 years of marriage. My older sister died of an alcohol related illness three years ago.. Our small town is supportive of me, mother has gone against everything my father requested regarding family property and houses. I now have COPD due to constant pneumonia, I never smoked , and I have an immune disorder.I am disabled by the standards of the Social Security Office. I miss teaching. I was planning to teach until I was 65. I am 60. Each day is worse. Should I just give up, should I report this to elder care abuse, or does someone have a kinder suggestion? My father warned me it might be like this but asked me to take care of my mother. My mother's rages frighten me. She has a gun.

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Guns and dementia do not mix.

I live in a suburb. Cars are a tool. We all need them. But that didn't mean my husband with dementia should be allowed to drive.

That is just common sense.
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Trying to sum up the situation, I see a brother who doesn't have either the practice specific experience or emotional distance to handle care of his mother, who has been disciplined (presumably by the medical profession) in the past, and a mother who is deteriorating and not getting proper health care or medical treatment by someone who should not be treating her as his patient it to her in the first place.

It would be an easy decision to put Mom's welfare over that of the brother's. If you don't, you'll regret it. I get the impression from your posts that brother has more problems than are mentioned.

I'd call APS; at least see what they can do. But do it anonymously, although your brother will probably suspect you of it. That may in fact bring out unacceptable behavior on his part that convinces APS to act.
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I have nothing against guns - own several myself. But you don't have to be a tree hugging passivist to know guns and dementia do not mix. Call me an ignorant city girl, but I can't make an argument for living
on a farm reason enough to let that combination continue - unless that is, you're afraid mom is going to be assaulted by a cow. If it's the rural isolation that's justifying the gun - mom must be in her 80's, right? What are the odds mom will be able to effectively aim and shoot an intruder? More likely the electric company meter man is gonna end up shot one day. Go to the local sherif and explain your mothers mental instability and having a gun in her possession. The sherif may or may not be able to get mom to turn over the gun - but most likely they'll pay mom a visit and at a minimum you'll have another set of eyes on her living conditions, should you need to gain guardianship.
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Thank you for understanding and giving me the courage to do what I feel I should do. You have been a blessing !
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That is a good clarification. 90 year olds should not have to take care of 70 year olds. It sounds like your brother lost his medical judgement and should not be going back to work as a doctor in any event - I can understand wanting to practice even if practice is restricted to your own mom, but he needs to give it up permanently. You can love him but not want him going back to active medical practice. I sure would not want him as a primary or ER doc for any of my patients.
From your desciption, I am not sure his judgement is even good enough to be her caregiver or to manage his own affairs. Yes, I'm hinting that maybe he has at least mild cognitive impairment himself...he won't be jalied then.

That said, he and your mom can both be fully expected to have a really hard time with giving up control even though they are clearly making a muck of things. You probably need to have Mom get a serious, comprehensive, eldercare legal evaluation. YOU didn't fail your father. Your brother, when you and he both thought he could and was functioning as a physician, made bad medical decisions, maybe in good faith, and I don't see how you could have overridden them other than exactly as you did, making sure your father's health care directive was found and followed. Just my $0.02. And, I'm glad you have friends.
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My heart goes out to your brother as well as to you - I would sense that he could not see a life beyond practicing medicine for himself and could not begin to see his way clear to giving it up when his mind began to fail him. It could be a chicken or the egg thing, where he started to have problems and then started using the controlled substances rather than the other way around, but there's no telling. It sounds like a lot of people thought the world of him and wanted to stop the train wreck they saw coming but your brother had already become unable to reach for his own better judgement and listen. You absolutely do have to keep up with paperwork - it is at least as serious as the 8.19 thing as your billing becomes fraudulent without documentation. I watched a good colleague recently forced to give up her career and retire early because of this; the stress of trying to do something she could no longer do was not helping her brain function either, and she is a bit better now but still diagnosed. StillTrying, you can't un-wreck this train and the crash was not your fault; if they could not stop him, how did they think you could?? - but there you are, still cleaning up at the scene, doing the best you can. Bless you!
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Sorry - hit the send button by accident. So to continue - based on the three options you feel you have, it looks like it comes down to walking away of reporting - which could still lead to a family war but one you have a better chance of winning if you had agency support. A lot depends on how far you are willing to go. If you report your brother and succeed in getting him removed from your mothers care decisions, all of that could end up in your lap. If mom is going to get angry over you doing that she could fight you tooth and nail on every decision and every attempt at assistance. It's tough enough trying to look after an elderly loved one even when they are compliant. The walk away option would only work if you could truely do it - without continually looking into how your mother and brother are doing. This seems unlikely based on your current level of concern and it sounds like you live near by - and would always have a glimps of how mom is coping. Perhaps setting a meeting with someone at APS could give you a start at better accessing your legal options. Keeping in mind, of course - that if you mention anything illegal/ abusive regarding your brother APS will be obligated to act. No easy answers here - but you know that.
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I agree with rainmom. A middle road will be a lot of ongoing difficulty and stress and probalby will not lead anywhere good. Unless you can tiptoe around and be allowed to make things better to the point where you can live with them, you probably should do one of two things:

1. Let your mom and your brother have each other. That's what they want. They made stupid headstrong decisions that cost your father his life, ruining the last few months of it, and they blame you and don't want you involved.

2. It is not about kindness any more. If you see your mom as a true victim, OR you see yourself as being blamed for her deterioration, then a report to Adult Protective Services should be made. I don't know what you would lose by reporting. If they realize that you called in the report, they will go on hating you irrationally. If APS sees the situation as dangerous, they may take steps to change things, or supervise them being cleaned up. And if they then shut you out even more thoroughly than they have, at least you have tried and are not responsible for whatever happens next.

Whatever does happen next, focus on taking care of yourself and your own pulmonary condition and get the best treatment possible. Don't be exposed to filth, fumes, etc.

And - would you be at liberty to explain exactly what your brother actualy did? Did he prescribe narcotics and appropriate them for himself or to sell? What is he doing for an income without his license - you know, most of us docs simply are not good for anything else besides practicing medicine. If he is a criminal and ends up in jail or prison or more optimistically in rehab, and your mom then needs guardianship and facilitly care, that's a better outcome than you are looking at with things as they are.
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This is for vstefans: My brother and mother hid my father's legally created advanced directive when he was entered into 8 facilities. Dad told me he had created one and what was in it. I didn't have a copy until Dad and I were leaving the ICU for the second time and the staff came out to say farewell; the chief of staff handed me a copy. They had found it in an old file. My brother has been having severe difficulties for years. His medical colleagues and ex-wives called me to see if I could help him. He was not functioning, answering texts, hiding from phone calls, and was 5 years behind in Medicare paperwork. He had created a wonderful medical center with a group of friends during the seventies. They voted unanimously to fire him ( with one friend refusing to vote) two years before Dad became ill. He seemed to be not sleeping and using medications meant for ADD. Our state takes the AMA's 8.19 ethic very seriously. It is a felony if pursued by a patient or medical hearing panel. My brother was warned repeatedly to stop over-riding the decisions made by specialists - he is an excellent family practitioner but is not a specialist in all areas. I was approached by hospitals to stop him. He had rarely been around my father for about 40 years. My father was treated by his cardiologist at a well known teaching hospital in another city when he had a heart attack 15 years ago. Everything went well. Basically, my brother was used to be held in great esteem and wanted to be in charge. My father removed all power from my brother and my mother about a month before he died. He gave it to me in front of medical professionals and told them I was the only one of his children who was strong enough to allow him to die. My son and I saw him almost everyday. My mother did not want to see him over once a week. My brother's decisions were very harmful to my father on at least four occasions. I have spent 35 years of my life teaching and working with emotionally disturbed or neurologically impaired people. My brother scares me.
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I am answering several questions at once. My brother will never be allowed to make ANY medical decisions for me. I have already dealt with that. I live twenty minutes away from my mother, and use a totally separate set of physicians. I don't know that Mom is truly incompetent. She needs knowledgeable medical assistance, medication she took for two years for anxiety and anger, and was much better when my father was alive because she was taken to the appropriate doctors. She is my main issue here. The small town she lives near is full of my friends. They did not know my brother or sister well. We had a house in a nearby large city and used the farm for weekends and summers. I taught in the county, and most people believe I was born there and are shocked when I explain. I go to the same church as my mother. It was my church until I married. I could cause a huge amount of chaos, but that is exactly what I want to avoid. I don't want my brother to lose his license on a permanent basis, and he would. It is a 3rd class felony in our state for him to be my mother's (or any family member's) regular medical caretaker. He could have served up to ten years due to my father and was warned from the first day Dad was admitted to the hospital by his peers. His friends prevented a felony for him. I don't like my brother and never really have. He admits he is a bully and his two ex-wives call him that. He almost appears to have have entered a mental illness that distorts reality. BUT, I love him and feel a great deal of empathy for him. I feel the same way for my mother. The people in the small town she "works in " called me about her arm. They helped me by insisting she have it x-rayed. The arm looked infected and she could not move it in some places. My brother read her x -ray and did not send it on to a radiologist. ( Protocol for any doctor) I am going to let the county help me with this, I think. I will not get involved. I am worn out and I feel like I have failed my father. One of my best friends is a state judge and cattle farmer. He cannot stand my brother anymore due to my brother's arrogance. Ray and Mom need help. He is close to reaching seventy. Mom is almost ninety. I have just turned sixty. Most women in our family live independently until they die. Mom wants to do that. I hear all of your suggestions and you have been kind. However, they both need help. I can take care of Mom unless my brother fights me. I still volunteer when I am well enough to do so. Mom has enough money for a caretaker, and I have a list of people who want to help her. With that help, I could clean up the house, rent a pod for her papers so she could go through them at her leisure, and try to bring joy
back into Mother's life. She has told me she resents taking care of my brother. It is just sad. Thank you !
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