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Can a doctor force a person have a companion and meals on wheels or threaten he will have her put into a nursing home? My aunt lives in Delaware. She is 90 years old and lives alone. Her doctor has worked with her daughter and told my aunt that she either must have a companion for 3 hours a day plus meals on wheels or he will go to court to have her put into a home. She is scared to death that she will be put into a home. We all agree that at 90 she probably shouldn't be by herself but she is healthy and knows what she wants. She repeats herself but she pays her own bills and keeps herself and the house clean. Does the doctor and her daughter have the right to threaten her or can she say NO to the aids? She did have a companion 2 days a week for 2 hours at a time to go to the doctor etc. She was very happy eating cold sandwiches or microwave dinners. She does have a security device that she wears and has used it on occasion to call for help. In November she slipped on a rug and fell and called for help. She went to the hospital and was checked and released as not injured. I feel bad for my aunt as she has lived alone for 40 years and made all her own decisions and now she is a nervous wreck because of the threats from her daughter and doctor. Her daughter lives an hour away and visits about once a year (due to health issues of her own). She has a son close by but he is not involved in her care. Who can my aunt work with who will stand up for her opinions and rights?



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No, the doctor can't 'force' a patient to do anything. S/he can call Adult Protective Services who, after evaluation, can force a person to go into a facility. But it seems very reasonable to me that the doctor should have a home care team including an occupational therapist come out to Auntie's house. The nurse and OT can have Auntie demonstrate how she takes care of herself and give a report to the doctor, as well as instruct Auntie on how to remain independent longer and to have fewer falls. How is Auntie getting essential supplies now? Food, toilet paper, etc? Has Auntie visited any 'homes' recently? Some are designed for more active people with lots of trips and adventures. Most are no longer the dismal, dark, stinky places she may recall from 60 years ago.
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To add to my post on the previous page, I use to be in the exam room with my parents whenever they both saw the same doctor, had back-to-back appointments.

Driving my parents home from the appointment, they sat in the back seat and I could hear them talk about their appointment.... good grief, I felt like I was in a Twilight Zone episode, as what my parents were talking about was not what the doctor was saying.
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Topper, I'm so glad you are being open to all of the many suggestions being given to you regarding your Aunties care. So many times on here, we see people who reach out for supposed help, but only want to be justified in their own manner of thinking. This site is so full of experienced caregivers who have been there, and done that and have learned, that listening to great advice, can really help you to explore the very best options for your Loved Ones! I have learned So much from all of you, and really appreciate everyone's opinions and suggestions! Always keep an open mind and much will be revealed as we all travel the road of caregiving together! Good luck in your endeavors!
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You all brought up very good points and gave me a lot to think about. Thank you so much for your insight.
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God save us all from stubborn 90 year olds! My mom lived on her own too and I spent almost every weekend with her, but I failed to see what was right in front of me. Sometimes people get an idea in their heads and won't listen to reason, you aunt probably feels that she has made it to 90 and may as well die in her own home. But is it really the best decision for her?
"She likes sandwiches and microwave meals" probably means they are easy and affordable, not that she wouldn't enjoy eating real food for a change! Instead of welcoming aides to come in and help with difficult tasks like laundry and bed making and to help with bathing she is screaming foul... I discovered my mom hadn't been in the bath for years because she hated showers and couldn't get up from the tub. Yes, she washed, but it wasn't quite the same as actually cleaning her whole body! Perhaps your aunt is worried someone may discover a similar secret?
Leaving those issues aside, I imagine a 90 year old on her own might be pretty isolated, even with visits and phone calls living alone is a lonely existence. I know this for myself, as now that my mom lives with me I can't leave her alone for long and often the only human contact I have in a day is with the good people on this we site, even an old introvert like me knows we are not meant to live that way. Instead of going to war on your aunt's behalf you might consider ways to alleviate her fear of accepting more help, after all I think anyone who makes it to 90 deserves all the help that is available!
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I''m going to approach this from another perspective...If neither you or your mom have ever gone with Auntie to prior appointments, then quite possibly, her MD does not know you even exist or are there on a weekly or regular basis with Auntie at all. What doc sees is a 90 yr old non-compliant patient who has been to ER for a fall recentky and whose DPOA lives far away & is nonparticipating and has her own health issues & has stated she wants mom in a facility or with day to day at home care& meals in some way.

You need to go with Auntie & stay with her at her next appointment & take notes. I would suggest you have at the ready a MPOA done before the visit so you can go into the room with her. Your Area on Aging should have some sort of advanced directives packet legal for your state & there will be a mpoa form in there with the other AD stuff. Get her to sign it. Its just meducal so no alarms bells should go off fir Auntie or her daughter the dpoa. You could say something like, I would like to start picking up your medications auntie, and having MPOA will make this easier. Make copies. The doc office may have their own HIPPA firms for her to sign off on as well.

If auntie has appt scheduled, great & plan on doing the MPOA beforehand and you drive her to the appt. If none is scheduled, then call her doc & make one. If asked what for....well I'd suggest saying she has a rash that isn't responding to OTC creams or ointments or something else very vanilla that won't trigger the office telling you to take her to the ER. Understand?

Also go through her place and write down all the medications in the house. Both RX & OTC. With detail as to date, size, expiration date, etc. type it up & print copies. What you want to do at the visit is go over the list with her doc & auntie. That you want to go over her "medication management". Everbody - you, doc, auntie - has their own print out. Auntie needs to feel & see she is included in all this.

Give it a few days after the appointment and reevaluate aunties situation.
My late mom was very independent as dad died mid 1980's and lived on her own in her home with a big yard till she moved into IL in her 90's. I'd say 1/2of her playback of what anyone told her was accurate; 1/2 was what she wanted to hear then mid 90's it deceased to 1/3, 1/3 & 1/3 was thoughts from another solar system and she went into a NH for her own safety. Since you are involved in her life, you can figure out when she's gone beyond her ability to be on her own. Good luck, there's hard choices to be made by all.
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Topper, I think this is one of those situations when if you'd been a fly on the wall you might have a different recollection of what exactly was said by whom to whom.

Now, it may well be that, in support of her daughter, your aunt's doctor strongly advised or recommended that she either accept more help at home or should move into a residential care setting.

Or it could be that he was being rather heavy-handed in the way that he phrased his advice.

Or it could be that he gave his advice in the ordinary way, such as you and I might expect to hear; only your aunt perceived what he said, in combination with comments your cousin made perhaps, as being threatening.

Who knows? In the ideal world, you or your mother would call your cousin and ask if what you've heard is quite accurate: is pressure in fact being applied to your aunt in a way that she might find coercive. But it's very hard to open that kind of conversation without sounding accusatory, I know. Are you on generally good terms with your cousin?

In terms of your aunt's rights, assuming she is of sound mind, then no one can force her to move against her will. If she wishes to appoint an advocate then, again assuming that she is of sound mind, she can do so by giving your mother or yourself - or anyone she chooses - power of attorney, which can be restricted to decisions about health and welfare or whatever concerns she has. But if she wants to do this, and you are happy to take it on, then you will need to be very careful to focus on her best interests. You may not like the way that the daughter and the doctor are going about things, but are you sure they're wrong? Is your aunt beginning to need more support than she is used to having?

And to answer your direct question, it would of course be unethical for a doctor to make threats of any sort - but so obviously unethical that it seems very unlikely that he would exactly do that.
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I'm also curious - why accompanies your aunt when she visits this doctor? Since her daughter doesn't visit more often than annually, do you take Aunt to her doctors, does she drive, or take public transportation?
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I'm wondering if your aunt misinterpreted the situation; it's easy, especially for older ears, to not hear the entire conversation. Was it her daughter who told you about the alleged threats? That might make all the difference.

And it could be that the daughter has her own agenda and/or is feeling overwhelmed given that she visits rarely and has her own health issues.

However, it doesn't make sense that the doctor would threaten litigation because all he/she has to do is document your aunt's chart, send her a letter, and he's literally documented his obligations. And sometimes CYA is at the basis of the issue.

And why just 3 hours? Why not 4 hours? And what specific time of the day? A demand of a 3 hour companion doesn't in my mind make sense unless it's for specific issues, such as assistance in the morning or at night.

There is a way you might bring out his/her true intentions, and that's by writing to him/her, with a letter countersigned by your aunt authorizing him/her to respond (or download a standard HIPAA authorization, have your aunt sign it, and include it with your letter) to your specific questions.

In the letter you can question the specific issues of demand, ask him/her to clarify his/her position, and ask for the reasons behind these demands. What you do is turn the situation back to action from him/her.

You can also ask for specific recommendations for a 3 hour visit from a specific care agency; if it turns out badly, you can always blame the doctor! My guess is any doctor would be careful about recommending anyone specific.

But I honestly don't think any doctor can demand that someone have MOW, especially since he/she's not paying for it.

I think I'd also have a conversation with your aunt about creating medical and financial powers of attorney, preferably with you and your mother since you're close and already visit regularly.
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You are right that I'm only hearing one side of the issue and I'll try to get more info. Thanks everyone
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This IS America, land of the free and all that. However, I can't imagine her doctor would be going to that extream if he did thing it necessary. I imagine it wouldn't actually make it to court - if it did Auntie should try to get in touch with the ALCU. They'd probably love a case like this - probably generate a lot of publicity. But again that would only happen if in fact, auntie is truely able to take care of herself.
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Topper, I guess what we're saying is, have you heard this from the doctor? Can you accompany your aunt to a doctor's visit?
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All I can say is that my mother and I visit my aunt every other week so I see her more than her own daughter. I just don't think anyone should be threatening an her - do what I say or else.
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I agree with Babalou, there must be something else going on.... otherwise why would a doctor make these suggestions out the blue.

I thought my parents were doing well being in their mid-to-late 90's living on their own, the first floor of the house was neat and clean, and I though my parents were paying their bills.

It wasn't until my Mom passed that I was finally able to nose around the house. Dust was almost an inch thick in the bedrooms upstairs, the upstairs baths were gross looking, and I was finding over-due bills hidden around the house. So you never known until you start looking behind the scenes.
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Is this the story that you are being told by your aunt? Have you heard the other ( her daughter's) side of the story? Aunt's impairments might be more than she is letting on to you. Not saying that is true, just pointing out that there might be another side worth looking into...
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I would think the only way he could force her to do anything is if she is declared incompetent. From your description it sounds like she is very competent.
Sounds like it is time to find a new doctor!
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