For Families With a Loved One Who Can No Longer Make Important Decisions
by Phyllis Mensh Brostoff, CISW, CMC, Aging Life Care Association™ Member and Fellow of the Leadership Academy
There might come a time when someone you love becomes unable to continue making their own decisions. At that point, they need someone to step in and act in their best interests. You may have noticed changes in a parent’s behavior, appearance, physical health, daily routine, or eating habits. A simple way to assess their current decision-making capacity is to answer these questions:
- Has your father (for example) lost any substantial amount of weight in the past six – eight months without dieting?
- Does he keep appointments you have made with him?
- Is the housekeeping the way it has always been?
- Does he call you or someone else frequently, asking the same questions but forgetting that he had just spoken to you?
- Has his personal grooming deteriorated?
Ability to decide: If you observe significant changes in your family member’s personal care, memory, and thinking, ask yourself these additional questions:
- If my father faced an important decision that he had to make, could he comprehend and consider the facts necessary to make the decision?
- Can he deliberate about the facts in a manner that is consistent with his own past ways of thinking about things?
- Can he communicate his decisions to me?
If he does not seem to be able to comprehend the facts about decisions he needs to make, or seems to be making decisions that are inconsistent with similar decisions he has made in the past, you should arrange for an assessment by an Aging Life Care Professional™, a physician, or a psychologist. In most states, health care decision-making passes to the person who has been identified as the Health Care Power of Attorney when: Two physicians or a physician and a psychologist have examined the individual, and state in writing that the person is unable to receive and evaluate information effectively or to communicate decisions to the extent that the person lacks the capacity to manage their own health care decision-making.
Having your father choose a Health Care Power of Attorney early is an important step. When a Health Care Power of Attorney is determined early, before a crisis, your father has the opportunity to discuss his preferences and health care choices and decisions. The Aging Life Care Professional can help facilitate this conversation making sure important questions are answered, such as desires to be pain-free, accepting or avoiding life-prolonging interventions under various circumstances, and even answer if your father would like to be buried or cremated. Having these discussions before they are needed will help ensure that your father’s wishes are followed and opinions known, saving you from the added stress of assuming you know what your father would want.
The Rogers’ Family’s Story
Sarah Roger’s adult children – Josh and Karen – were distraught at the meeting with an Aging Life Care™ Manager. They needed to decide how to proceed with their mother, who was in the hospital due to dehydration and a urinary tract infection. The discharge planner had told Josh and Karen that their mother was ready to leave the hospital. But Sarah lived alone and her children could not agree on whether she should return to her home or move to a facility. Karen, who spoke to her mother daily, thought Sarah was “getting senile,” since her mother recently had begun to repeat herself and couldn’t remember appointments they had arranged. Josh thought his mother was fine and could get along with just a little more help, which he was willing to provide. Neither of her children had asked Sarah what she wanted to do. The Care Manager arranged for an assessment of Sarah Rogers’s cognitive functioning before she left the hospital.
After examining Sarah, the psychiatrist and the Care Manager met with the whole family. The psychiatrist explained that the memory and thinking problems that Karen had observed might have been caused by her mom’s acute illnesses. While she had some loss of mental functioning, Sarah was still capable of making her own decisions. The Care Manager explained the purpose of a Power of Attorney for Health Care and Sarah signed the form, designating her daughter as her primary agent and her son as her secondary agent.
The family agreed that it would be helpful to have an agency provide Sarah with some home care so that her children did not feel overwhelmed. Since she lived in an apartment near a shopping center, and had no steps to climb, she could return home safely, with a shower chair and bars installed in the tub and near the toilet to increase her safety. Josh agreed to help her balance her checkbook, and her daughter agreed to do the food shopping. The Rogers family left the conference feeling that they had a workable home-care plan with which everyone was comfortable.
The Aging Life Care Association™ offers an online directory of Aging Life Care Professionals at aginglifecare.org. Find an expert near you or your loved one today.
About the author: Phyllis Mensh Brostoff, CISW, CMC, is a social worker and co-founded Stowell Associates 31 years ago in Milwaukee, Wisconsin providing Aging Life Care management and home care services. She has written numerous articles and presented seminars across the country. Follow her on Twitter at @CareManagerMilw, Facebook at Stowell Associates Inc, or email her at firstname.lastname@example.org.
This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™ and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.