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FullCircle Asked March 2020

End of life decisions for estranged aunt in ER. I’m feeling totally lost :(

backstory ......I’m on this site because my mother is 85 with end stage copd and lives in assisted living but I’m the one taking care of all her affairs, am her poa and trustee to her trusts. While I don’t care for her ‘day to day’ I’ve been managing her life for the past 6 years while trying to be a mom to my own 3 kids and work full time. I’m burnt out.


my mother has one sister who is 89 and lives about 5 hours away. I’ve met her only 6 or 7 times in my life and the Last time I saw her was my wedding 18 years ago. She was married but her husband died 10 years ago and has been in a steady decline for the past 4 years. She is in a nursing home and was recently moved to another facility that could give more care. She really has no one overseeing her care :(.


She has severe dementia, is not able to walk and recently lost the ability to speak and write. She is not really aware of where she is.


My mom is her POA- I think? I’m not sure exactly that the paperwork says since I’m not sure who has it at this point but my mom is not able to really make decisions on aunts behalf so facility has changed to calling me for info, asked me to sign an update acd (that they now can’t seem to find) and sign off in some Medicare treatment changes. The facility felt that working with my mom was hard and while I’m certainly not looking to take care of yet another human, I’m the only person who really can do this.


now this makes my mom very angry because she thinks she can manage decisions for aunt so while I try to keep her in the loop, it usually ends up with her screaming at me that she should be doing this. So, While I am the key emergency contact, I don’t thing I have any legal authority.


this morning I got an urgent call from facility saying aunt was on the way to the ER and likely is septic. While I recently made specific instructions on the acd to not transport to hospital, forgo any medical interventions and only do comfort care they don’t have that so sent her to the hospital.


I've talked to hospital ER nurse and 2 doctors assessing her and they seem to understand my wishes (and can tell they both strongly agree this is the best way to proceed and let nature take its course) but I’m all of a sudden wondering what the hell im supposed to do. Last dr I talked to told me this is the beginning of the dying process for sure:(


Do I really need to be poa to manage her death? I’m not even sure where her legal documents that explain the care plans she has are located (I KNOw this was done but I don’t know specifics other than she’s to be cremated and buried with her late husband)


im thinking I need to make arrangements with my kids so I can make the 6 hour drive to manage this right? Do I wait until she passes?? I was the executor of my uncles estate and took care of his affairs but he was local and I was very close to him so it was not difficult. There is no will or money or anything- I’m just trying to understand how to process this and eventually get aunt to her final resting place.


god this is so long and jumbled and likely hard to follow but I just kind of lost here and not sure what do so. I did call our friend who is also our lawyer but haven’t talked to him yet.

499HopeFloats Mar 2020
Cwillie is right. In the absence of explicit wishes and/or POA, doctors will talk to whatever family are around, but they have the authority to make treatment decisions on their own. If you are sharing what aunt would want and, in their professional opinions, that want lines up with their treatment plan, then they just move forward.

Problems come about when there is a conflict... between the doctor and the family (doctor can override family if they believe it is in their patient’s best interest) or between family members (luckily, I didn’t have this happen when I had to make end of life decisions for my mother (who was young and had an ICH stroke out of the blue while I was caring for my elderly in-laws), but I was prepared for it and had a terrific neuro who explained how the system works in the absence of a POA or written wishes.)

You don’t have to actually go there. It sounds like they are talking to you. Try not to take more of this on unless you really want to. Elder care of any kind throws people into emergency-mode. It is hard to work from that place. Keep asking the physicians what they recommend or what they have seen in similar cases and let them know that you are, at best, kind of distant back up support. You don’t want to drive the bus:) It sounds like they are making a good plan.

Wishing you well...

AlvaDeer Mar 2020
First of all, you are not poa for your aunt. For health care nor for financial. Nor likely listed as executor. Your Mom may well be, but clearly seems not competent to do so. If you are listed as ANYTHING you can resign that duty easily enough. This would make Aunt a ward of the state to make decisions. It sounds as though she is dying. If that is the case, when she is dead you will see who is listed as executor. If it is your mother you can say that she is no longer able mentally or physically to do this duty and that you are happy with the court appoint a fiduciary to do so. DO NOT TAKE THIS ON. Go to an elder law attorney to see how to go about putting someone else in charge of this.

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JoAnn29 Mar 2020
Who placed her in the NH? Who do they call when there is a problem? Is the State her guardian? If not Mom, someone has been involved with Aunt. Maybe it would be better if Mom was involved. Its just yes or no. Best the Aunt is just allowed to go. Maybe back to the NH on Hospice. I think Medicaid pays for cremation.

cwillie Mar 2020
I don't think you have to "do" anything, it sounds as though the doctors agree she is end of life and given her age and terminal diagnosis (dementia IS a terminal disease) I doubt anyone is going to attempt anything heroic. I hate to think of anyone dying alone in an acute care hospital, if you can it would be a blessing for you to be with her but given the distance it is understandable if you can not.

Once she is gone there will be a legislated process for people who die intestate, you can let it play out - you don't have to step in.

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