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Recently a friend who is 90, has early stage dementia, and is currently living alone (her companion had to leave unexpectedly to take care of her own daughter) called to say she was looking for someone to live with her. She doesn't feel the need for nursing care, just a companion so she's not alone in the house. Another friend was looking for a new housekeeper position so we thought 'perfect! problem solved on two fronts'. The two talked and were ready to work with each other.

Having known her for 40 years as an independent, business-minded individual and seeing her moving around her own home comfortably (if a little slowly) and knowing no one was there with her regularly - well honestly it never occurred to us to ask whether someone else needed to be in on the decision. And you know our parents never think they need to defer a decision to anyone. : - \ But there turned out to be two - a nephew and a family friend - who felt the decision should have been theirs. So the hopes of both friends are dashed as the family feels she needs 24/7 care (even though they've left her 'home alone' for two weeks, having someone pop in once or twice a day and no one there at night. At least the proposed arrangement would've had someone there during more hours of the day and all night. But that's another story...)

I'm wondering how others have handled this; at what point and how do you ask a friend whether they're still capable of making decisions?

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Thanks for the pushback all. IsntEasy, you're spot on about knowing the true extent of the dementia. Our friend says she makes notes to self and she has no problem deciding what to eat and getting it, dressing, toileting, etc.

And as for the nephew, I do believe he is devoted to his aunt but it seems he's in an awkward position. Lady 90's only child contentedly lives out of state and from there is dictating the preference for 24/7 care (even though she had no problem wrapping up a visit and leaving her mom in the house alone a few weeks ago!) She's a nut job and Nephew is trying to support his aunt while limiting interaction with NutCousin. I certain hope he has POA!

I know things will work out - Lady 90 has a wide circle of friends that keep tabs on her. With all that I've experienced of dementia in a parent, I don't know why this caught me offguard, the idea that a friend would need her decisions vetted. Probably because she's still relatively independent though she doesn't drive. I mean, if a person shouldn't be making their own decisions, why on earth would they be left in a 3-story house alone except for occasional drop-ins for nearly a month??

Anyways, I tried looking at it from the Nephew's perspective too. How would one encourage their independent-minded elder to tell people that decisions are made after consulting with a POA? How DOES one tell a parent/elder 'don't make any decisions without me'??
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raven, I would want to know the reason the nephews are saying 24/7 care. Maybe they know something everyone else doesn't.
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Do the nephew and/or family friend have POA? Do they have the legal authority to make decisions for your friend? Is your friend (as far as you can tell) competent to make decisions like this?

I guess the very first thing I'd want to establish is WHY these people should be consulted. I'd try very hard not to drive any wedges between you and the nephew and not to alienate others who also care for this friend. Best if everyone can work together. But I'd be a little cautious about taking everything he says at face value.

Maybe nephew is genuinely concerned about his dear aunt. Maybe he has POA or some other legal responsibility that he is trying hard to discharge well. Maybe his main concern is conserving the estate he will inherit. I think I would dig into this a little further before I'd just give up on your plan. When I'm 90, I sure hope I have some friends who will look out for my best interests and not just take other people's word for it that I can't make up my own mind how I want to live!

Bless you for caring.
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A companion is often a wonderful solution if it works for all parties. However, I've seen how dementia works in all its forms and you have no real way of knowing the severity of your friend's dementia. I'm often astounded by how well some elderly can 'perform' for short periods of time and for certain people, even into the advanced stages of dementia. Maybe the nephew and family friend have a clearer picture of whether or not it's dangerous for her to stay in the house. They may have been in the process of coaxing her into a safer living situation. That's often a very delicate process.
Also, I have a couple of friends who are charged with looking after a childless aunt or uncle. Those arrangements (sometimes documented and legally binding and sometimes informal) have often been made years in advance and reflect the closeness of the relationship between the person and their niece or nephew. If your friend had a son, you likely would have consulted him, right. This nephew should be considered your friend's surrogate son.
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I am going through this now. But with your question how do you ask about a friends mental status? I am not sure there is an answer for that one, except the fact, if you are close to this person, then you can usually can make that judgement on your own by just being a regular visitor there.
My mom is 89 and living alone since my dad passed 7 yrs ago. After a fall last year, that landed her in a nursing home for awhile, she came back home. Her doctor had suggested full time care. And I believe we should listen to the doctor as he is the best one who evaluates. But how would you know what the doctor wants if you are not family, or a close relative? You cannot ask those personal questions either. But I can, because I am a daughter. I still am struggling with a difficult situation. I am the closest living sibling and my mom depends on me for everything. I take her shopping, do some of the household chores and handle all the medications. At her worst times, I have had to bring her to my home, or I have had to spend the night over there. I have seen things regularly that I know my mom needs a roommate, or assisted living. She refuses assisted living because of giving up her home and things, and hates the cost of it. She used to become very angry if we even mention it. I work 5 days a week and have both houses to take care of. I am there usually everyday, Sometimes, stop in the morning on my way to work, have lunch there in the afternoon, and stop at night on my way home for dinner. She loves to cook for me because I feel it gives her purpose. But at times I feel I have no life because of this. I have even given up my dog because she is now waking in the middle of the night quite often hearing a knocking sound. I ask if the dog barks at this sound, and she says no. I said if the dog doesn't bark, then no one is there. So I am not sure what to think of it. I set up a box of pills for the week, and it never fails that the box gets screwed up and she tells me that its me screwing it up. I have told her that if that continues, that then we will have to hire a professional nurse to come in to do the pills. My mom has left things on the stove numerous times and food has burned. She starts cooking and then lays down for a nap. As far as the bills go, I noticed a long time ago that she was over paying bills and they keep returning her money because of the over payment. While in the nursing home, we talked her into letting my sister become the POA. I am the POM, (power of medical). But I often tell my sister and my brother, that mom does this or that, that scares me to death. But none of us, want to make her move into assisted living if she doesn't want to. I think as time goes on and the more that happens there, that we will ultimately have to make that decision. I want my mom to have more of a social life, like she craves, but she also does not go out of her way to meet friends. I have made many suggestions, and recently I got her signed up to go to Adult Day Care Services. I drive the Public Transit, and therefore, I am the one who sometimes gets to pick her up to go there. This has helped as an outing and we also taught her the use of the computer. Though she regularly forgets how to sign in and get to where she wants to go, it has been an entertainment for her, and keeps her connected with family. If you are a constant observer, I feel you should be able make that determination on your own, whether a person is capable of living alone. I feel that over time that elderly, do get more needy and the only way to meet those needs is to have someone coming in to check on them, live with them, or make sure that somebody has been notified of their needs. If they tell you a story of burning food on the stove, leaving the water on, or telling you a story of how they forgot to lock their door all night, that these are signs that they are not able to be alone. My mom has all those things going on right now, but again, nobody wants to make her so what she doesn't want to do. I know that ultimately we are going to have to make a decision to get in some more care, or she is going to have to go to assisted living. With age, and time as it progresses, nothing gets any easier for them, and they do need help with all aspects of their daily living. There are many programs available for outside help to come in. I am now starting to use a lot of these free programs to check in and help my mom. That has helped me a lot. I lost one job already because of my dedication to my mom when she was ill, but I know I cannot give up my life totally to fulfill her needs. It has in the long run, made me bitter, angry, and unable to be the one to do everything for her, but I do what I can. Call the local Human Services to discuss your concerns, if you are not close to this person. As far as you mentioning that there is just a nephew and a close friend, I feel that is not enough and nobody knows what is going on there, unless you are there everyday and very often. Just listening to the elderly person describe their day, or an event that may have happened in the home, should be enough for you to make a judgement as to whether they can handle it or not. I feel that no elderly person should be alone, for over time, they do forget a lot of things, that in reality can bring danger to them. So the answer to your question, from me, should just be your own observation. And if you have concerns, contact the closest family member, or call the closest Human Services to voice your concerns.
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I would tell the nephew and the family friend that it is none of their business. The two ladies live independently and do not need others meddling when they are capable of doing so and of watching out for each other. Keep watch over them but only take action if action is needed. Perhaps you could discuss with your friend the possibility of giving you a medical power of attorney, etc so that you could officially help make these decisions without input from those two others. They should go ahead with their plans. The nephew and family friend have no right to dictate to them.
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Anyone can make a judgement carefully. Has the person's behavior changed? Is hygiene adequate? Paying bills. Is there food, clothing, and shelter? I've been around seniors who slowly declined. Unable to manage finances, not telling anyone until the neighbors called a niece, her aunt almost lost the family 20 acre farm due to not paying property taxes.
Each case, person, situation is individual. Over come your fears of butting in. Use common sense. Take time and get involved. You'll feel better about yourself and tthem. And be prepared to make mistakes! No easy answer, except warching is the biggest mistake!
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