Q: My mother-in-law drinks because she feels entitled because she is a widow. She also refuses to leave her house that is full of stairs and too large for her to look after. She fell and broke her pelvis and in another couple of weeks is expecting to leave the hospital to return home. Her kids are worried and angry.
What are the alternatives for the family to get her to move? Can a doctor insist she has to go to a nursing home? She also has poor memory (gets lost easy) and needs a cataract operation.
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A: Unfortunately, this is a story that is becoming familiar due to the number of baby boomers that now have aging parents. The situation is less traumatic if the older relative has an enduring power of attorney, a living will, personal directive or some other type of legal document that appoints a trusted relative to act in her best interest when she is disabled and no longer able to make appropriate decisions for herself regarding her own health and safety.
The drinking only adds to the underlying problems of memory loss and physical disability. If alcoholism is the only health problem, and the individual is otherwise able to make her own decisions, it is virtually impossible to force treatment in a residential facility. Sometimes the courts order this as part of a sentence for impaired driving, in lieu of jail time, but if the person is not in trouble with the law, then it is up to her to voluntarily undergo treatment for a drinking problem.
Of course, some family pressure may be applied. Sometimes a group confrontation is helpful, where family and friends get together and try to get the individual to admit the problem and get professional help.
It sounds as though your mother-in-law may be suffering from early Alzheimer’s because one of the first signs is getting lost easily. A lack of judgment regarding the seriousness of her medical conditions (fractured pelvis, cataracts) could be another indicator.
The first step is to locate a social worker or nurse who works with elderly in the community and is trained to assess whether long-term care is appropriate for her. If this care is needed, there may be a waiting list to get in. I doubt if the doctors will admit her straight from the hospital and they will not want to use a hospital bed any longer than is necessary. They may agree to send her to some type of convalescent home for a few more weeks.
It is mental disability rather than physical problems that make the difference between someone being able to manage at home or needing long-term care.
If the nursing or social services assessment feels your relative does need care, and she is not willing to be admitted voluntarily, then you have other legal resources available. You may have to be appointed her legal guardian or trustee. The laws for dependent adults vary a little from province to province. In Alberta and Manitoba, there is the Dependent Adults Act. A guardian or trustee is only appointed after an application is made to the Surrogate Court of Alberta. There are several documents required to be filed with the court and served on all interested parties (usually family members) in order for an application to be heard.
A dependent adult not only includes the aging adult but a mentally handicapped person over the age of 18, or an adult who by reason of an accident or sickness is now mentally incapable of dealing with his or her affairs.
A guardianship order is needed for an individual who is continuously unable to care for him or herself and is no longer able to make reasonable judgments.
A guardian appointed by the court would make decisions for the dependent adult such as where she lives, social activities, education and training, health care and daily decisions.
This requires an assessment by two medical practitioners, one of whom should be a psychiatrist or psychologist, and a medical doctor. A form is completed and filed with the court. A guardian can then be appointed.
In Saskatchewan, the Dependent Adults Act has been replaced with the Adult Guardianship Act. Concerned individuals who have an interest in the affairs of an adult can apply to the court for an order that would allow them to either help the adult in question make reasonable decisions as a co-decision-maker or actually make decisions on the adult’s behalf as a guardian.
Clare Rowson is a retired medical doctor from Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding
medical questions and treatments.
