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.
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!
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.
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.
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.
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.
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.
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.
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.
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.
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 .
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).
for other aspects beyond legality - that’s a different question .
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.
You will be amazed at how expensive it is to hire somebody for the overnights, That is the most difficult shift to fill.
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.
It's apparently not only having someone there, as I was, but someone there who can actually rescue the patient. That would leave out a lot of family caregivers, I suspect.
(1) One year long ago I ran into Elsie and her husband in the grocery store a couple of nights before Christmas. They excitedly confided that they were giving their daughter a puppy for Christmas. They'd just brought it home and had left it in the basement. Daughter was visiting elsewhere that night. It's a good thing she was, because puppy gnawed through the cord of a small space heater they'd left in the basement to keep puppy warm. On the way home, Elsie and husband heard fire sirens. When they drove up in front of their house, flames were leaping toward the sky. The puppy died. They lost their house.
(2) Mom's friend Eleanor had downsized to an apartment recently. People were "checking on her" because she had a few "minimal" health problems. Mom didn't hear from Eleanor for a while, so she asked the people who were "checking on her" if she was okay, but they said she was fine. A couple of weeks later at a requested wellness check, Eleanor was found dead on the floor and had been so for some time. Those who were "checking on her" had been using the benchmark that if Eleanor's car was there, she must be fine. When she didn't answer the phone, they reasoned that she must be napping. This is not acceptable "checking on her."
(3) A lovely neighborhood where a family member lives. House burned to the ground a week or so ago. Not elderly people, a family lives there, and they're not likely to have left something flammable near a burner or to have an old-age dementia problem. We don't know the cause yet, and fortunately no one was home at the time.
Can bedridden patients be left alone?
The legality of this question varies by state, but generally, it is not considered safe to leave a bedridden person alone for any time. Any number of things could happen that would be especially dangerous for someone who is not mobile, such as a fire in the house.
Check with your state regulations about leaving your bedridden mother alone overnight every night because she wouldn't be happy with a caregiver.
Doesn't common sense answer this question? A person who cannot get themselves from a bed to their wheelchair independent of assistance, should not be left alone in a house all night long.
They can be left alone in their room. Not alone in the house though.
My FIL was still considered medically cognitively sound. But there were signs .
My FIL when he was still home - SWORE that he didn't need anyone helping him. He was way more physically impaired than cognitively - but it was when we started pressing him with things like this - that I really started to wonder about his cognition.
I asked him once what his plan was to get out of the house if his chair lift didn't work - say if the power went out and battery back up didn't kick in and there was a fire. He had about 20 STEEP stairs to navigate and he couldn't walk a single step on flat ground without a walker. For reference his domain was UPSTAIRS - so critical thinking would give an answer like "I'd go to the stairs and fall down on my butt and slide down the stairs and get the walker at the bottom and go out that way". Because if you are going to die in a fire you do what you have to do". And to be clear - a FIRE was a very real possibility because their home had a terrible fire right before DH and I got married - struck by lightning. And another tree was struck by lightning several years later. So this was a very real possibility.
His response was that the battery back up would never fail. I said humor me. What if it did? What would you do? "It won't". We argued and argued and he finally told me to shut up because he didn't need to worry about it.
It wasn't that he didn't need to worry about it, it was that he couldn't reason out any possible way except the way he knew. (I told him the only other option - with the possible exception of waiting for the firefighters was sliding down the stairs.)
There were many of these situations where he couldn't come up with a logical answer so he started just saying "We'll see" instead of answering us. He ended up new phone lines, new accounts, talking to scammers because he was smarter than they were. When I tried to talk to him about the scammers - he would tell me he KNEW they were scammers - and he was trying to teach them a lesson. I would tell him that there was a certain kind of scammer out there that literally just wanted him to keep talking because they just wanted him to say certain words so they could voice print him. He joyfully told me he just wouldn't say those certain words (facepalm).
When someone doesn't have to do certain things, and other people are doing so many other things for them - it is VERY easy for them to appear much more capable than they really are.
But put them in an emergency situation - things will NOT turn out the way you think they will - because they are NOT equipped with the critical thinking skills or ability to convert thought processes to tasks the way that you and I can. They are used to other people giving them a step and they do the step. They are not used to putting the entire process together , in order, to make it happen.
And very often - when faced with having to do that - they find that they no longer can.
You don't want to find out she can't do that anymore in the middle of the night in an emergency.
She needs to be assessed. In the very short term - get some cameras on her and see what she is doing at night. But you need to make sure she is safe to get out of that house in an emergency. And consider overnight caregivers or an alternate living situation - because if she does have dementia the progression can start out slow.
But then it can move - and it can move FAST.
Where did the fire start?
In the wall next to her bed.
She wasn’t home, thank God.
She was alerted about the fire, and ran home, and watched the house and everything she owned burn to the ground.
It sickens me to even think what would have happened, had she been home in bed at the time.
She is 35 and able bodied.
Your loved one would have been trapped.
Please do all you can to avoid that possibility.
I would add, finally--and I am sure there will be disagreement on this point--but I think it is probably not necessary to have the O.P.'s mother undergo cognitive and physiologic testing to determine if she is competent to make these decisions. If her decisions are consistent with the ways she has lived her life to date, then whether she currently has dementia is not a major question. It is not for the O.P. or her sister to make decisions that they think might save her mother from various perceived tragic endings that for her mother would not be tragic. (I am assuming here that the O.P. and her sister would not have legal liability; I would not have thought of that possible issue if it hadn't been brought up by the O.P.!)
Have you considered asking the family members what nights they would be willing to cover so she would not be left alone for extended times? That could help solve the problem…. If anyone would actually step up to help. If nothing else, they probably will back off while you decide the best way to handle the issue.
One thing you may want to consider about the legality of your issue… there may be nothing Illegal the way you are handling it, but may not prevent having to defend yourself in the event something happens.
Also the practicalities like home setup, alarm types & how fast help can arrive can be factors.
It's given me more to think on today.
I'm considering the differences:
'Meg', 'Bob' & 'Lee'
All alone overnight, bedbound (or poor mobility). Can use telephone ok, have falls alarm & smoke alarms.
Meg in a private house, bedbound
Falls alarm
Smoke detection alarms (beeps to alert, but Meg cannot evacuate)
Neighbours have keys
Family have keys & live close
Bob in an apartment, bedbound
Falls alarm direct to EMS.
Keylock to allow auto EMS entry.
Smoke detection alarm direct to fire brigade, which triggers automatic attendance
Lee in a house, poor mobility.
Falls alarm (pendant type)
Smoke detection alarm (beeps to alert, Lee not sure she could evacuate).
Family further away
No keylock
Many different factors.
I met 'Lee' this week.
'Lee' was not able to alert others to her fall. Family & EMS notified when cleaning staff arrived & no answer to doorbell. Hard for EMS to get in. Now has the complications of a 'long lie' on top of the fall injuries.
I went to the circuit breaker box and flipped the appropriate switch to OFF. The next day, an electrician investigated and found that the wiring behind the electrical outlet had melted inside the wall. There was no warning, and the house had passed the pre-closing inspection only weeks before.
Fire avoided. You never know.
And the legal liability issues! The justice departments must aching to get their hands on real crime, if they are reduced to prosecuting carers because they weren’t having elders watched all night, in case the next fire visits their house. Just when I thought there was enough serious crime in the USA to keep them busy, it seems that they are reduced to smelling out unintentional ‘elder abuse’??
This is starting to sound a bit over-the-top!
We had this couple living in a trailer. At least one, the husband was in a wheelchair. The head nurse had been telling the daughter her parents were no longer safe in the trailer. Seems the hallway to their bedroom just fit the wheelchair let alone be able to get it in the bedroom door which took a nurse to help him with. There were two hospital beds in one bedroom. The phone was almost out of reach and many times the Dad would knock it on the floor trying to pick it up. Our nurses would go in every morning and get both husband and wife dressed and out to the living room for the day. Getting them something to eat. The daughter would go by after work and get them dinner and into bed. They were alone the majority of the day. I think the wife was the better of the two but they needed more help then our nurses could give. My head nurse called APS. Told them if there was a fire the couple would not be able to get out. And told them about the phone. APS investigated and concluded that the couple had everything they needed and were being cared for appropriately. One day our Nurse went to get them up and out. The wife had died in her sleep. The husband was then taken to his daughters and we continued to see him till his death.
So, what I am saying, is APS does not always do what we feel tgey should.
Kasey, what I would recommend is getting APS or Office of Aging in there to evaluate Moms situation. If they feel that Mom is OK without night help, then ur off the hook. Get it in writing. If its found that Mom needs someone there during the night, then Mom will need to hire someone, a family member stay with her or she is placed. If this is not done, then you maybe held liable. A question for the person who evaluates the situstion or a lawyer.
APS, like many government agencies throughtout the country, is understaffed because it costs money to hire people and if they are government hires, the money for salaries and benefits comes from taxpayers and you known how people feel about paying taxes to begin with (until they or their family member needs help, then the tune often changes.radically). It is very possible that APS works differently in other states but I have a feeling that unless someone is immediate danger... not much will happen. I ready the APS statement on the NJ website about when APS could act and what they could do... not much.
Are the extended family members who are nagging you about your legal responsibilities volunteering to spend the night with Mom? I doubt it: however her immobility at night is worrisome particularly in the case of fire as other's have pointed out. Even with the strategic placement of alarms and detectors, most people have no idea how fast a fire can move and the toxic fumes that it can create. Her argument about the house never having had a fire is irrelevant. You've never had a baby until you have to push the first one out!
Perhaps you might consider this. Have her PCP give her a full body and mental exam. If he/she is really on the ball they will order MRIs and neurological tests of the brain. That's a good way to get her seen by a neurologist who specializes in gerontology ("oh, my associate Dr X should see your MRI") -- sometimes you have to manipulate and fib! Then you can get a dx regarding dementia. If she is deemed to be mentally sound (which can change within months) she has the legal right to say where she wants to live but maybe tell her the story that some else posted here about the poor woman who died in the fire. Not being able to move and being alone at night............... that just worries me regardless of her state of mind. Death by fire.......... even if you are lucky to be asphyxiated by the smoke first, is not easy.
If she is not competent, then the PoA needs to sit down and have a serious discussion. (by the way.... read the PoA document and see what type it is and if it covers medical health; does Mom have an advanced directive also?
Wishing you good luck and peace on this journey. Please keep us updated.