Mentally competent elderly woman in very bad health. Refuses to go into nursing home.

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She is afraid that if she is honest with doctor he will insist on hospitalization and then a nursing home. She lives alone but does receive help from friends, but they don't live with her. Can she refuse doctor's advice? If she does, can anyone be charged with neglect? How does this work if a competent person can choose to refuse medical care - can they then be forced to accept it? Can they be deemed incompetent if they choose to refuse care and put their lives at risk? Some people might say that is crazy behavior, but every person should be able to decide if refusal of medical treatment is actually irrational as they view it. They might well decide that death is acceptable in comparison with their current state of health. They might just decide that they are tired of living as they are and whatever happens, so what!
Can anyone else be held liable for neglect? Seems there is an inherent contradiction here. Supposedly you have freedom to decide, but actually you don't.
What are the laws in California about this kind of thing?

11 Comments

Rovana: Could you explain your personal situation. You talk about this like it is happening to someone else, but I think it's happening to you. Is this your mom or dad? Do they live close to you? I'm assuming you are in Ca which is why you want to understand the neglect laws of the state.

Off the top of my head, I think a "competent person" can make the decision to stay in their home. Reason being that you can't force them to move if they are competent. I think you know this and appreciate that a competent person might prefer to stay home until an injury occurs that forces them to leave. I kind of think you appreciate this desire of an older person to live the way they want to live.

On the other hand, you know this person is not safe and your conscience and concern regarding liability makes you wonder if you should push to have the elder taken into the system of hospitalization and nursing home care; a life they do not want; to eliminate the possibility that you will be held liable for neglect.

These are just my guesses, based on what you posted. Are you able to talk to the doctor? Do you feel doing so is a violation of your elders trust? Is in-home care available for the elder or is that against their wishes? You could call Adult Protective Services and ask them what they think the laws are. You could call your local Area on Aging and see if services are available to keep the elder at home as long as possible.

Could you share more from a personal perspective. I think it would help you and those who read your thread.

Wishing you the best outcome. Hugs, Cattails
Cattails - I really appreciate hearing from you - you are generally right on target. Actually this concerns a ninety year old woman who is a very long time friend of one of my sisters. For some months, I've said "they are adults and making their own choices and none of my business." However, this morning my sister called her friend - she calls everyday - and her friend said she was feeling bad (she has congestive heart failure) - my sister told her that she would come up to Mammoth Lakes where her friend lives - my sister lives about 40 miles away - and take her to the doctor. Her friend said that she was afraid to go to the doctor because he would hospitalize her and then she would have to go to a nursing home. My sister told her she would come up and visit and see how things were. This elderly woman lives alone, is on oxygen, increasingly frail and has some outside help. Also neighbors watch out for her and help. But she is alone most of the day and at night. Frankly, I don't think it is safe and my sister, I'm pretty sure, agrees. Her family wants her to come and live with one of them, but she is a VERY stubborn woman and simply wants to live out her life in her own home. I think, from comments she has made over the years, that she associates going into any kind of facility with dying - "you never get out of those places alive" and she holds onto life tenaciously. She is more mentally competent than most "normal" adults and can certainly consider her options rationally. But, as my sister asked me this morning, can she be forced into a facility against her will? To put it bluntly, if a person wants to die in their home can they tell the authorities to just "get lost, it's none of your business"? I guess it could be considered suicide, but is it legal? I have a feeling that this is getting to the point where I cannot just stand back, but I don't know what to do. My sister is a very wonderful person and very compassionate, but I don't want to see her hurt. The children know that their mom's health is very bad, so they are not ignorant of the situation. But my sister wants to honor her friend's wishes not to "go behind her back and talk to the children." They live in the eastern US and we are out here in California so her kids can't visit often. I'm hoping for any legal advice and guidance - I'm going to check with our commission on aging - but am nervous about contact with Adult Protective Services. I guess what I'm trying to ask (among other things) is: if a competent person wants to live and die at home, can they be forced out?
This woman is 90. She has congestive heart failure. Chances are extremely high that she is going to die within the decade, whether she remains in her home, goes to a care facility, moves in with a child .. any option you can name, she has limited years left to her.

I would be less worried about dying in her home than about suffering. It would be awful if she falls and is in agony alone for several days, for example.

If it were my friend, I would try to come up with ways to minimize the risk of suffering, and let the timetable for death take care of itself.

We have a scale hooked up to our phone life. Hubby weighs each day. He also punches in a series of answers on the little screen. If the nurse monitoring the readings and answers sees potential congestive heart failure problems she phones here and also reports the situation to his doctor. That kind of remote monitoring might make sense for your sister's friend.

A medical alert system allows someone to call for help even if they can't get to a phone. We have one, but I'm not at all sure that my husband with dementia would remember to use it. My mother wears one, and though she is often confused (92, livng alone) I got a call for the monitoring company last week telling me that she pressed her button and could tell them she fallen, wasn't hurt, but needed help getting up. Perfect! If Friend doesn't have such a device, I think that would be an excellent first step. You say that she is competent so the chances of it being used appropriately are pretty high!

I don't know what other things you are worried about. In what way does staying in her home seem "suicidal" to you (or your sister)? Are there ways to minimize those risks?

You and your sister seem like very compassionate people. I hope I have friends like you when I hit 90.

I hope you can get your question about liability answered with a simple phone call to an aging help line, without giving any names. I can't imagine that if anyone is liable for a charge of "neglect" it would be a friend. But, hey. laws can be weird. Call and get an answer and put your mind at ease. In my book, your sister has no moral obligation to force her friend to do things against her wishes.
Jeanne, thanks for your reply. Some of that has been covered - the manager of her condo checks in with her several times a day and so do various other friends. I'll suggest the life alert. She always carries a cellphone on her and friends make sure it is charged and operable. So, I don't think there is much risk of her lying alone undiscovered. There is a good informal support network. She is very frightened of nursing homes and I think she is best off not going into one. However, she is worried that her doctor (or someone else) could haul her off against her will. I really don't know if that is possible in California. The general problem is this: a competent person has the right to refuse medical care, but if their refusal would endanger their lives, could they be declared incompetent, a danger to themselves? There seems to be a contradiction here - you can refuse care, but can you choose to "endanger" yourself? I'm thinking here of some well-meaning bureaucrat who thinks that anyone who does not get medical care is crazy and/or suicidal. I think there is a crucial difference between someone who shoots themselves or takes sleeping pill overdose and someone who decides to let nature take its course and not do anything to prolong life, but there are many people who would consider both suicide and might insist a person prolong life. To put it very crudely, how do the cops feel about the person who says "I'm not leaving my home, let me rot in peace and when my corpse gets too smelly, a neighbor will call sanitation and haul it away." (Yes, I actually knew a man who insisted on just that. Fortunately his body was discovered rather quickly.) Will the powers that be say "ok, it that is what you want we will not interfere." I've read posts on this site, but have not found any covering this type of situation as it would play out if followed to the end.
rovana, why don't you pose your question to the Aging helpline in your state? If you (or your sister) could convince the Friend that a doctor could not force her into an NH against her will (assuming that is true, and it certainly should be!) that might encourage her to get medical help and prolong her ability to stay independent.

My mother sees a wonderful geriatrician. Mother was in a transitional care unit and had some tests. A growth was discovered in her pelvis. This was unrelated to the reason she was in TCU. When she was discharged and saw her doctor, the doctor said, "I see that you have been advised to have further tests done on a growth that was discovered. Would you like me to arrange that for you?" My mother (aged 90 at the time) said, "No. I don't think it is anything. It doesn't both me. And if it is something, I don't want to know." Doc said, "I will respect your wishes. You certainly can make up your own mind. But I need to tell you that if you do have cancer there are treatments for it and that could give you a longer life." My mother said, "I have lived a good long life. If I have cancer, I will not take any treatments for it. So I would rather not know. What will be will be." The doctor asked me how I felt about this, and I said I respected my mother's right to make that decision. She then assured my mother that she would respect her wishes, and that if she changed her mind at any time further tests could be done then.

So at least in this state doctors may be required to spell out options for their elderly patients but nobody hauls the patients off to a nursing home if they select the "wrong" option. I sincerely hope that is how it works where you are!
Jeanne, thanks so much. I'm going to check about the legal situation - should be able to do that anonymously so no repercussions. Daughter and son are getting LifeAlert and we willl impress on their mother the importance of using it as a tool to make continuing life at home possible. Her doctor is really great - even willing to make housecalls - so he should be able to convince her that he respects her fears and she can be honest with him about her medical problems. Thanks so much all - I think I went off the deep end unnecessarily.
Please check with your local HOSPICE FOR NON PROFIT. I am using them now with my father. Pleas know that there are two differnt types of HOSPICE, for PROFIT and NON PROFIT. You want the NON PROFIT. They do not turn anyoine down. They will come to her home and acess her condition. Will give you your options. Each Hospice also has their own caregiver treatment center where they care for the sick if they make the diagnosis she should not be alone. It is death with dignity and painfree, in a loving enviroment as aposed to NH. I cannot say enough for these folks. They are Angels amoung us.
I went thru this with my 93 yr old Dad for the last 2 yrs. I was told that unless he was a danger to himself or to others there was nothing that could be done.
His situation finally escalated to the point where he needed immediate medical help and was hospitalized. He was found to be "incompetent " of making decisions so he is now in a facility. The DR. told me that had my Dad been mentally competent (understood the consequences of his decison) then he could have gone home.
I live in California. I was told by an Attorney that our elders have the right to make what you and I consider STUPID & SELFISH decisions.
You are liable for this person IF YOU take over being their care-taker and somethings happens to them because of something you do or don't do and they get hurt or worse. This is what was explained to me anyways by MIL's attorney.
Hope this helps.

Rovana: It sounds like this elderly woman has the support of many friends and neighbors. The fact that those living in you building check on her several times per day and help with various things is all any of us could wish for an elder that wants to be at home. I love that she has a doc that makes house calls, but she will probably need some tests to determine how she is doing. I would support her any way I could. That's just my opinion. I hope she will get with her doc and see what, if anything, can be done to make her better and keep her home. That would be the best of both worlds. Hope your sister and others can help her feel safe in getting medical treatment. Don't worry about the liability. Hugs, Cat
Thanks so much everybody. Good advice and it sure helps!

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