Have you ever been concerned about an older relative who seems to be making bad decisions?
Perhaps your elderly father insists he has no difficulties driving, even though he’s gotten into some fender benders and you find yourself a bit uncomfortable when you ride in the car with him.
Or you’ve worried about your aging aunt giving an alarming amount of money to people who call her on the phone.
Or maybe it’s your older spouse, who has started refusing to take his medication, claiming that it’s poisoned because the neighbor is out to get him.
These situations are certainly concerning, and they often prompt families to ask me if they should be worried about an older adult becoming “incompetent.”
In response, I usually answer that we need to do at least two things:
- We should assess whether the person has “capacity” to make the decision in question.
- If there are signs concerning for memory or thinking problems, we should evaluate to determine what might be causing them.
If you’ve been concerned about an older person’s mental wellbeing or ability to make decisions, understanding what clinicians — and lawyers — mean by capacity is hugely important.
In fact, the American Bar Association’s Ten Legal Tips for Caregivers lists “Understand Decisional Capacity” as tip #1. But so far, I’ve found very little information available online, to help older adults and families understand this important issue.
So in this article, I’ll answer some of the frequently asked questions that come up around this topic:
- What does the term “capacity” mean when it comes to decision-making?
- What is the difference between incapacity and incompetence?
- How is capacity determined?
- How do Alzheimer’s disease and other forms of dementia affect capacity?
- Does capacity have to be determined by legal professionals? Is it a “legal decision” whether someone has capacity?
- Do I have to have a legal or clinical determination of incapacity for a specific decision before I override the decision of an older person with dementia?
I’ll also share a list of additional resources and references at the end.
What does the term “capacity” mean when it comes to decision-making?
Let’s say you tell me that your 87-year old aunt Mary has been falling repeatedly, but she refuses to go see a doctor.
In this case, we might consider whether she has the capacity to decide whether or not she needs to see the doctor. It’s especially vital to do this if Mary has been showing signs of memory or thinking problems, or if she’s been diagnosed with a dementia such as Alzheimer’s.
When we ask whether a person has the capacity to make a given decision, we are asking whether the person can show us that he or she has the mental abilities necessary to make the decision.
Generally, capacity requires that individuals be able to understand:
- The situation they are in,
- The decision in question,
- The consequences of making a given choice.
The person should also be able to explain his or her reasoning, and express the choice to others. And the reasoning should not rely on anything that strikes most people as bizarre or delusional.
Experts have determined that capacity requires these four decision-making abilities:
- Understanding: Understanding the issue/decision and the available options
- Expressing a choice: Being able to state a decision
- Appreciation: Being able to explain how the information about the situation and available options apply to one’s personal situation
- Reasoning: Being able to compare options and understand the relevant consequences.
Different types of decisions require different types of mental abilities. Experts consider that these six civil capacities are of particular importance for older adults:
- Medical consent capacity
- Financial capacity
- Testamentary capacity
- Sexual consent capacity
- Capacity to drive
- Capacity to live independently
Legal standards for capacity are determined by state law. The specific requirements can vary, depending on the state and the type of capacity in question.
People sometimes assume that decisional capacity is an “all-or-nothing” type of ability: either you have it, or you don’t. This is sometimes framed as whether a person is “competent” or “incompetent” to manage affairs. (See below for more on capacity and competence.)
But the reality is more complex. Here are two essential points everyone should understand.
1.Capacity is decision-specific.
This means a person’s capacity should be evaluated in light of a specific decision to be made.
Why does this matter? Well, some decisions are complex and require a person to consider and weigh multiple pieces of information. For instance, the decision to sell one’s home, which may involve consideration of tax and estate consequences, is often quite complex.
In comparison, some decisions may be relatively straightforward. For this reason, it is possible for a person to lack capacity to make certain types of decisions while retaining the capacity to make simpler decisions.
2. Capacity can fluctuate, depending on a person’s health circumstances.
For instance, most people immediately after surgery are drowsy. In this state, most will lack the capacity to address anything more than a very simple decision. But, their decisional capacity should improve as the person mentally recovers from the surgery.
It is also common for people with vulnerable brains, such as people with a diagnosis of Alzheimer’s or another dementia, to experience fluctuations in capacity. When they are feeling well and are at their best, their mental abilities might be good enough for them to have capacity for many decisions. But if they are sick, or stressed, or otherwise not thinking at their best, their capacity to make decisions can be reduced, sometimes drastically so.
For these reasons, before concluding that a person lacks capacity for a given decision or task, every effort should be made to improve capacity if at all possible. Such improvements may be possible by treating an underlying health problem, or by mitigating any hearing or vision problems.
I explain a simple device that geriatricians often use to improve hearing here: Age-Related Hearing Loss: What to Know & What to Do.
What is the difference between incapacity and incompetence?
Capacity is often considered from a clinical perspective (i.e. by doctors, psychologists, and others) versus a legal perspective (i.e. by lawyers, judges, and courts).
Historically, the term “competence” was used in legal settings and the term “capacity” was used in clinical settings. The legal determination of competence related to whether a person had the legal right to make their own decisions, and was usually informed by a clinical assessment of capacity.
Hence many clinicians will still say that they cannot assess someone’s “competence;” they can only assess their capacity as regards a given decision or life function.
However, states have recently been moving away from global legal determinations that a person is “incompetent,” — which often meant the loss of virtually all control over one’s affairs — and are increasingly favoring determinations of incapacity for certain types of decisions or life functions.
Hence the old convention of using “competence” for the legal arena and “capacity” for the clinical one no longer works well.
Instead, it is more accurate to refer to “legal capacity” versus “clinical capacity.” These two concepts are distinct – albeit related — as explained further below.
How is capacity determined?
In most situations, we presume that adults have capacity. If concerns about capacity are raised by others, or if a professional notices anything to cause concern about capacity, then a process of further assessing capacity may be started.
Legal professionals are generally required (by state laws and by their professional code of conduct) to conduct a preliminary assessment of a person’s capacity to complete a given legal task. They may be required to take action if they believe a person may not have capacity for the issue at hand.
However, legal professionals are not trained to clinically assess capacity. Such assessments must be done by professionals with some type of healthcare — often psychology — background.
Clinical capacity assessments vary depending on the type of clinician involved and the capacity issues in questions. Generally, they include a more detailed evaluation of the person’s capabilities, and should also include the likely medical causes for any reduction in capacity.
This article describes a very practical framework for assessing capacity for older adults to make common decisions: Everyday Decision-making Ability in Older Persons with Cognitive Impairment.
A clinician’s evaluation of capacity will result in a clinical opinion regarding the capacity in question. Clinicians sometimes may state that a person appears to have marginal or borderline capacity for the decision in question.
This clinical opinion can then be used by legal professionals to help them complete their legal determination of capacity.
How do Alzheimer’s disease and other forms of dementia affect capacity?
Any disease or disorder that disrupts cognition — the brain’s memory and thinking processes — can impair a person’s decision-making capacity.
In early Alzheimer’s and dementia, people usually retain the capacity to make many types of decisions, but not necessarily all of them. It all depends on the decision in question, and also on which thinking processes seem to be most affected in a particular person.
For decisions that are complex or high-stakes (e.g. those related to property or large sums of money), it is a good idea to assess the person’s capacity to make the decision in question, before proceeding.
It would also be appropriate to consider or assess capacity if the person with early dementia is making questionable decisions that affect their health or safety.
As dementia progresses over time to a moderate stage, people will lose the capacity to make all but the simplest decisions. At this point, a family member or other trusted person will generally have to make most decisions on behalf of the person with dementia. For this reason, people diagnosed with Alzheimer’s and other dementias are highly encouraged to designate a power of attorney for healthcare and for general affairs, while they still have the capacity to do so.
Does capacity have to be determined by legal professionals? Is it a “legal decision” whether someone has capacity?
Yes, in principle capacity is a legal determination and should be made by legal professionals.
However, in most states, physicians and other clinicians are allowed to determine capacity for medical decisions, especially for the purposes of enabling a surrogate healthcare decision-maker to act.
In the real world, many people take action without fully understanding the laws and procedures related to capacity, or without consulting a competent lawyer. Such actions often proceed unless another person brings suit to contest the actions.
For instance, it’s fairly common for family members and others to take action based on a physician or other clinician opining that an individual has become “incapacitated” or “incompetent.” But such actions may be on shaky legal or ethical ground, especially if actions of major consequence (e.g. sale of property) take place. So if a family suspects loss of capacity, it’s best to seek legal assistance before proceeding.
Do I have to have a legal or clinical determination of incapacity for a specific decision, before I override the decision of an older person with dementia?
Yes, you should seek a clinical assessment of capacity if you are concerned about a dementia such as Alzheimer’s disease. This is especially important if you believe it has progressed to the point that a person has lost the capacity to make certain decisions.
If you feel you need to override the person’s decisions, for instance to protect the person’s physical safety or financial wellbeing, you may need a legal determination of incapacity.
If the person with dementia has completed a durable general power of attorney, the agent should be able to act on their behalf. To override decisions made by the person with dementia, the agent will often need to provide proof that the person has lost the capacity to make certain types of decisions. Many power of attorney documents specify the criteria for deeming the principal incapacitated, although some are pretty vague about this.
If the person who has dementia has not completed a durable general power of attorney, then you will probably need to consult with a lawyer, to determine whether the person still has the capacity to designate a power of attorney. If the person is lacking this capacity, then you may need to pursue guardianship in court, in order to override the person’s decisions.
Even if you have secured a legal determination of incapacity for certain decisions, it’s vital to act in accordance with ethical best practices that respect the person’s autonomy and dignity to the greatest extent possible.
Do I need a legal or clinical determination of incapacity before I take the car keys away from an older parent who has dementia and is an unsafe driver?
If you are concerned about dementia and driving, you should make every effort to obtain a clinical assessment of capacity to drive safely. A legal determination of incapacity to drive will also help ensure you are on sound legal and ethical footing.
It’s also essential to learn more about your state’s options and requirements when it comes to reporting potentially unsafe drivers. For instance, some states require clinicians to report moderate or severe dementia to the DMV.
However, many families find that the older person in question is refusing to see a doctor or attorney. In this case, you can still call the doctor and report your concerns. Privacy laws such as HIPAA do not require families to get permission to reveal details to the doctor; they only require health professionals to have permission — or other good reasons — to disclose a patient’s information to others. If the doctor has a good relationship with the older person, they may be able to persuade them to come in for a visit.
Or, you can try calling Adult Protective Services; they don’t take a person’s car keys away but they can sometimes encourage or even insist on further evaluation. You can also try to enlist others in the older person’s social circle, to see if it’s possible to persuade the person to give up the keys.
As a last resort, if you have evidence that driving poses a substantial risk of harm to the older person and to other motorists and pedestrians, it’s reasonable to conclude that this outweighs the harm of taking a person’s keys before legal incapacity is confirmed. Such evidence might be past crashes or near-misses, combined with other evidence that the person has reached a state of moderate or worse dementia, such as frequently getting lost or appearing confused.
Of note, the Alzheimer’s Association’s position statement on driving and dementia states:
“Driving privileges must be withheld when the individual poses a serious risk to self or others. Interventions to prevent driving in individuals who lack insight include physician oral or written recommendations, taking the keys, removing the car, changing the locks, filing down the ignition key, and revoking the license.”
Is neuropsychological testing required to assess capacity?
Not necessarily. Clinicians are usually allowed to use “clinical judgment” in conducting their evaluations and reaching their conclusions.
Especially if a person has a dementia that is at a moderate or severe stage, it is often possible for a generalist physician to provide evidence of a lack of capacity, simply by interviewing the person, documenting responses that demonstrate a lack of needed understanding or reasoning, documenting evidence from family members and other observers, and providing evidence that the medical cause of the thinking problems is not likely to improve.
However, if a person’s cognitive impairments are mild, subtle, or focused in certain cognitive domains, then neuropsychological testing is often very useful. Neuropsychological testing can also be used if a preliminary clinical evaluation by a physician yields borderline or uncertain results.
Resources & References to Help You Understand Capacity
Written for the lay public:
- Legal Planning (Alzheimer’s Association)
- Assisting a Person with Dementia in Planning for the Future (Alzheimer’s Association)
- Driving and Dementia (Alzheimer’s Association)
Written for professionals:
- Assessment of Capacity in Older Adults (American Bar Association/American Psychological Association)
- Includes links to free comprehensive guides for clinicians, lawyers, and judges
- Understanding Legal Capacity and Ethics (Practice Guide, National Center on Law & Elder Rights)
- Overview of Guardianship and Alternatives to Guardianship (National Center on Law & Elder Rights)
- Assessment of Capacity in an Aging Society (PubMedCentral)
- Clinical and Ethical Aspects of Financial Capacity in Dementia: A Commentary (PubMedCentral)
Note: I am not an attorney or a psychologist. This article is based on my review of the above resources, plus my own clinical experiences and conversations with attorneys and other experts.
This article was first published in May 2016 and was last updated in June of 2022.
elaine stratos says
Simply, my situation came about regarding a healthcare decision for my only sibling in emergency then
my having to ok a very serious brain operation where he never recovered only to be in a vegetative state
where no doctor or nurse would give me some information being an only heir…frankly the professionals
were all to blame as my brother was in a doctors care ten days earlier as well as having a persistent headache for 16 months only to succumb with 9 large brain absesses…..so point being here i was asked
or vaguely told to take brotheroff life support……..this was far trickier and maddening then whoops no healthcare proxy..i dont even have one……he was 69 years old and taking care of his 97 year old father
so what is the LAW here no talking but yes approving a life threatening operation where brother was at the end in emergency…….too far gone…..so is it the doctor who sent him home ten days earlier that took
the capsules in his brain to form………….how about that delemma……
Nicole Didyk, MD says
Hi Elaine and I am so sorry to hear about your brother. I didn’t follow every part of it, but I gather that you were placed in a difficult position of having to make serious decisions about his care when it was not clear if you had the power to do so, or even if there was really much choice of what course to take. Your story really emphasizes the importance of planning ahead and assigning a healthcare proxy or power of attorney, even before what we consider old age.
I also got the sense that you had difficulty obtaining information, and some of that may have been related to privacy legislation. Here’s a link to an excellent article: 10 things you need to know about HIPAA.
Deborah Lafountain says
Can a doctor say the person has capacity to name a Health Care Proxy Agent if the doctor has said they do not have capacity to make difficult health care decisions?
Leslie Kernisan, MD MPH says
In principle, I would say yes. Capacity is supposed to be decision-specific, and some decisions are easier (or may require different parts of the brain) than others.
In many cases, naming a health care proxy can be a simpler decision than making a difficult health care decision.
Doctors may also be more likely to conclude the person has capacity if the choice they are making is consistent with other choices or values the person has expressed over time in the past, and otherwise isn’t a “worrisome” choice. So if an older person is picking a POA, are they choosing a family member who has been involved for a long time or are they choosing a new companion who just recently arrived on the scene.
Many health providers will set a higher bar for determining the person has capacity to choose someone that seems surprising to the clinician or family. They may also set a higher bar regarding determining capacity if anyone has raised concerns about undue influence or someone “having an agenda.”
Angela says
Im medical POA for my 79 year old mother. She has been hospitalized four times the last few months for the same issue. The doctor now is doing a procedure immediately which I feel mom doesn’t understand the risks. The doctor says she is able to make decisions but I have noticed her inability to truly understand all medical benefits, risks and complications because of memory and stress both physically and mentally. Does doctor have right not to discuss with POA about plan of care? What rights do I have as POA to ensure mom truly understands what doctor has told her before the procedure takes place?
Leslie Kernisan, MD MPH says
It sounds like you are concerned about the health provider’s assessment of her capacity to provide informed consent. I think it’s certainly possible that the provider is over-estimating her understanding; many providers assess capacity in a fairly cursory way, whereas it sounds like you’ve been observing your mother carefully and so your concerns are worth taking seriously.
The doctor should be willing to discuss things with you if you are your mother’s POA, especially if she seems amenable. I would recommend communicating your concerns to the involved health providers, in both conversation and in writing. Be very explicit about what your concern is, and why you think your mother may not have capacity to consent to the procedure.
It may also help if you are explicit about what you are asking the provider to do. Are you asking for them to allow you to decide about whether to do the procedure? Are you asking them to get a second opinion re your mother’s capacity? What is it you want them to do?
If the provider is reluctant to engage, you could try being clear that you are concerned that they are proceeding without adequate informed consent, that you have documented in writing why you think your mother does not actually have capacity to consent (and/or why the procedure is not in line with her goals or care and/or truly necessary), and that if they will not engage with you, you will be notifying the hospital and/or the provider’s supervisor, because you need someone to take your concern more seriously.
Your mother has a right to provide consent or to have her POA provide consent if she lacks capacity. Determining capacity is a judgment call but I think you should be able to push for more careful consideration of her capacity, if you really think she doesn’t understand the risks and if you think the procedure may not be likely to serve her well. Good luck!
Karen Galvan says
My 88 y.o. mother has been diagnosed with severe advanced dementia. She has become a flight risk. Most all the time she doesn’t know where she lives, or that she lives with her mother in another town or thinks someone else owns the house she lives in. The caregiver hired has limited caregiving experience with mom’s diagnosis and has openly lied to me how Mom is doing, ie bathing, walking off.etc.
My brother Mike has been, behind my back, had my mother sign legal documents.
I am POA medical. My brother Mike has no authorities except has his name as ‘and/or’ on the trust papers. My other brother David, is POA and Advocate.
David and I are going to trial for guardianship and conservatorship.
Question: Can my Mom legally sign papers being this confused? She has been diagnosed by a neurologist.
Leslie Kernisan, MD MPH says
To legally sign papers and complete a valid transaction, the person has to have capacity for that particular decision, which means understanding what they are signing and the consequences. Generally people with early/mild dementia often have capacity for certain legal documents, but people with more advanced dementia who are chronically confused do not.
Now, an attorney is supposed to check that the client has capacity, but they may or may not do this.
If a person legally signs papers when they were in fact confused and had a well-established diagnosis of significant dementia, the transaction can probably be contested. However, doing this may require getting your own attorney and possibly filing a claim.
If your mom hasn’t yet signed, you could consider notifying the involved attorney of your concerns, however, they often feel they have to disclose to their client (your mom) that an adult child contacted them with concerns.
Since these concerns are quite common among people concerned about an aging parent, I interviewed an elder law attorney recently, you may find this podcast episode helpful: 097 – Interview: Common Elder Law Issues When Helping Aging Parents.
Good luck!
Kathy says
I have a very difficult 79-year-old Mom who lives by herself (Dad died 6 yrs. ago) and am her only child. She resists anything I have to say or suggest concerning her safety and sharing her medical information. She’s very private (with me), but freely tells others about her testing Dad’s gun five years ago and how it ‘went off’ in her home.
I see her progressively become worse (as others have too) in the past few years – not able to complete tasks that used to be easy for her, allowing a LOT more mess and piles of papers around her home (even when she knows her family is coming), having difficulty understanding how to turn on a/c at beginning of summer, difficulty understanding that when a/c is off AND her windows/doors are closed in the summer, she can cook herself, along with her defiance and anger that she’s being told what to do or if I ask anything about her.
All this I’ve detailed in two letters to her PCP since mid-July. I am having difficulty obtaining an assessment. Mom hasn’t signed HIPAA at PCP office, I’m not allowed to go with her to dr visits, I have Advanced Directives which my lawyer/Mom’s lawyer says is enough to view dr’s notes and also have POA. Front office staff suggest I go with Mom to her next appt., which they moved from December to November (I’m guessing because of the concerns I’ve detailed in letters). I told them how mad she would be to know we’ve talked and that she doesn’t ‘allow’ me to go to her doc appts.
To make bad things worse, her doc of three years left and is now practicing in another state. Mom says she will call her insurance company to find out where he’s practicing now and intends to follow him. Of course, I am NOT able to tell her that he is in another state (because I’m a know-it-all who always thinks I’m right).
My concern is Mom won’t go to another doc in the office that has her records, allowing MORE time to pass before she’s examined for a diagnosis or assessment of capacity.
Unsure what to do at this point. Thanks for you help. I do love your podcasts and have learned much from them AND your written articles on your website!
Leslie Kernisan, MD MPH says
I agree, these symptoms sound concerning, so I’m glad you are pushing to have her evaluated. You are doing the right things, but of course, these situations are complicated. From what you say, it sounds like you have POA documents that are already effective and don’t require your mom to first be documented as incapacitated. I believe does give you the right to request information from her health provider now. However there is no guarantee that they wouldn’t reveal this to your mother (although they would probably be discreet if you asked them to), and if she found out and asked them to not talk to you, technically she gets to override you, unless they conclude she’s impaired and it’s not in her best interest.
Since her PCP has moved away: could you ask the other doctor in the office to contact your mom and say that her prev PCP is asking her to come in to see a colleague?
I have other thoughts, but they are more than can fit in a comment. That’s why we started a membership for people like you, actually: so that I could provide ongoing support in navigating these situations, because they do take a while. You can learn more here: Helping Older Parents Membership.
Good luck!
Misty Luther says
My 85 year old grandmother has been duped by Nigerian scammers. They have her convinced she is paying taxes on 32 million dollars to be able to bring it to America (it is USD) (allegedly) She sends them pretty much all her Social Security and now she got a life insurance check due to my grandfather passing. She has been shown proof by myself, other family members and FBI that this is a scam. She refuses to believe this. Now I am worried she is going to send this money to these people and she is going to be right back where she was, hungry and broke. On top of the life insurance check she recieves almost $3k every month from Social Security…its all gone within days of receiving it. Everyone else in my family just enables this, and acts like they don’t see. I am the only one standing up about this. I am stuck feeling. I won’t stand by and watch her give her money to these crooks and watch her starve…what to do?
Leslie Kernisan, MD MPH says
Yikes, this does indeed sound worrisome. I have information on what to consider doing and resources listed in this article: Financial Exploitation in Aging: What to Know & What to Do.
Re refusing to believe it’s a scam: your explanations haven’t worked, so you may want to stop trying to explain as much, as this may be increasing her stress and you will be more likely to succeed in intervening if she feels less conflict with family. Good luck!
Kim I says
This is very good information but I still have questions. My mother in law is battling stage 4 lung cancer. In the past 6 weeks she has been in and out of the hospital for breathing issues. She is maxed out for radiation treatment and is now in an immunotherapy treatment that none of the family knows if it is actually doing anything to help. The doctors will not talk to the family and will not discuss “Prognosis” or “timelines” with anyone. She is on oxygen. She continues to smoke. She lives alone. She is managing her own medications (which one of the doctors in the hospital made the comment that she is not capable of managing her own medication). She isn’t eating or drinking like she should. She cannot (or will not) make herself anything to eat. She has a potty chair but refuses to get out of bed unless someone is there and makes her get up and has to help her get up. She refuses to go to a nursing home willingly. She doesn’t have the money nor does the family have the money to pay for in-home care, Hospice cannot be called to come in and help because she is still undergoing treatments. There is only 1 family member who lives close enough to come check on her but that person has a home and family and children to tend to as well so she cannot be there 24/7. Because she refuses to give up smoking, the family member is not willing to have her move in to her house. Volunteers were lined up to come help but she has run them all off with her mean and nasty attitude and the fact she poops/pees on herself without even saying anything to anyone that could have gotten her up to the potty. She will go hours sitting in her feces because she passes out from taking the medication. We are at wits end… we don’t know what else to do. I have thought about calling APS but from the way this article sounds they may not deem her incapable to do anything but take care of herself. If you catch her at a good moment she sounds lucid and competent, but if you catch her when her medication is kicking in then she talks crazy. What else can we do?
Leslie Kernisan, MD MPH says
Sorry to hear of your situation, it does indeed sound difficult. Well, it sounds like your family has tried to offer help but your mother in law is not cooperative. You don’t say how old she is. I imagine the illness and/or the treatments are affecting her mental function at times. And, you can only do what you can do. You could try calling APS if you are concerned about self-neglect. They may not do anything, but at least you will have taken an action and again made an attempt to help.
I also wonder if you might be able to help her get a palliative care consultation. This is not quite the same as hospice; a palliative care consult should be able to help address prognosis, her goals, and options for moving forward. Those options may or may not include hospice. (Hospice is really a particular type of palliative care service.) Most hospitals offer palliative care consults, and some cancer clinics do as well. You can learn more here: GetPalliativeCare.org.
Good luck!
Cathy says
we have just received bank statements from my mother in laws accounts she receives a lease payment of 21450 every 4 months and says she can live on it as she has to pay tax and she doesn’t think she should have to. Over the last 2 and a half years she has spent 440000 thousand dollars. She spends 400 a week on cloths and 300 a week on groceries. She now wants to sell family farm as she cannot survive this is worth 2 and a half million we have warned her about the tax she will have to pay as this was left to her 3 yrs ago. My husband has EPA and is worried that she will spend all the money within a few years and will not pay her Tax and will end up bankrupt. How can he stop this from happening
Leslie Kernisan, MD MPH says
Wow, this certainly sounds worrisome. Well, for these situations I generally recommend starting by asking yourself: are there signs that she has an ongoing problem with memory or thinking? If so, then explanations are not going to work, they will just antagonize her. And if you think she is impaired, then it becomes ethically justifiable to try to intervene, if she doesn’t want you to.
(If she’s not impaired and seems to have mental capacity, your mother in law (MIL) has a right to be financially irresponsible.)
If your spouse has power of attorney, the document will specify under what circumstances he can intervene. If he has the legal authority to intervene but she has different ideas, then he may need to consider a court action to take over her finances and prevent her from doing things she doesn’t understand that are detrimental to her financial safety.
You may want to consider consulting with an elderlaw attorney in the state where your MIL resides. good luck!
Camer says
My grandfather is 93yr old. He married a younger woman from Mexico. We live in a border town. She crosses the bridge every month to ask for money. She never takes care of him or wants to take care of him. My mother has been taking care of him and even made an extra room for him no rent nor utilities are paid by him. He is just worried to give money to the so called wide every month. What do you suggest to be done in this situation. He gets close to 1200 every month.
Leslie Kernisan, MD MPH says
That’s a tough situation. If his memory and thinking are generally ok and he seems to have decision-making capacity for this choice, then he’s allowed to do it. It’s still possible that the situation might qualify as financial exploitation, and of course, I see why your family is concerned.
This article might be helpful: Financial Exploitation in Aging: What to Know & What to Do
I will add that it was your mother’s choice to take him in and not ask that he pay rent or contribute. Especially if he’s not impaired and has capacity, she gets to choose whether she continues that arrangement. She could potentially tell him that she’s not willing to continue with the current arrangement, and that she needs him to make some contribution to the family’s expenses. But of course, once someone is 93, it’s very hard to set that kind of limit, especially if he is frail, or otherwise is unlikely to be able to live on his own.
Good luck!
Natalie says
There is no shortage of documents for family members and caregivers but I have yet to find a document that I can provide my 75 year old mother, recently diagnosed with vascular dementia, who for years refused opportunities for assessment (until January and April this year, indirectly, long story) refuses to accept the doctor’s diagnosis, refuses treatment and medications and additional testing and assessment. The rest of the story is long and complicated. For now, I need something in writing that I can give her to read over and over and over again that will help her to understand what she is experiencing (because although she says there is nothing wrong with her brain and she’d know if there was, there is and she may but she is denying it) what he doctor and I are trying to accomplish, which is to help her, slow the disease as best we can and ensure she is safe and can continue to live independently.
Leslie Kernisan, MD MPH says
Explanations can work for some people with dementia but often do not work. I think any written document would have to really be tailored to the individual person, and would have to be based on something short that had been reasonably helpful when told orally to the person. The only way to know what — if any — explanation will work is to experiment and try. For some people, explaining that they have dementia (or a “brain problem”; there are many ways to try to frame this) and hence need to let you do XYZ works; for most, it doesn’t.
I would recommend you work with her usual doctor to try to figure out what you can say, to help her feel better and/or cooperate with what you are trying to do for her. If the doctor doesn’t have experience communicating with people with dementia, you may want to look for a dementia behavior specialist to help you with this.
I would also recommend you find a support group for dementia families, as you’ll get lots of ideas and support re communication with your mom.
Good luck!