For an elder in slow mental decline, how do you know 'when' to step in and fully take over decision-making?

This is a difficult question to answer because it depends largely on the relationship you have and the best interest of the senior. Certainly, if the senior is making decisions that are harmful to himself, it is in his best interest to have someone else helping make those decisions. In my experience, most seniors have a very difficult time relinquishing control and it can add to their stress and agitation. I think there is a balance you should strive for in stepping in when it becomes necessary to protect the senior, but trying to also show respect for their desire for independence by explaining to them what you're doing and why (assuming they have the mental capacity to understand). You can always have a doctor evaluate the senior to get a full assessment of their medical and mental status, which can help inform this decision as well.

I found it very difficult to take that step. It became more of a realization on my part of the things that my mother could not do that she had always done in the past. I found food items in her fridge that were long past their expiry date. My mother was unable to find the words to describe certain things or even what she had eaten that day. She had lost track of time and called myself and family in the middle of the night. Specifically with money, I noticed that she would dish out the money to a cashier, expecting them to give her the appropriate change as she couldn't calculate the amount required and know if she had given enough money. Too many of those types of incidences in a short time frame (keep track of them) make it very clear that they cannot make decisions on their own. It is so heartbreaking to have to step in and take that independence and control away from a loved one. As mentioned above, I discussed the DNR with my mom when I realized that she was mentally sliding so I have to be confident that I am complying with her wishes when she is now unable to make those decisions now.

Eyerishlass: be sure to get your POA on file with the bank, doctor, hospital and creditors. You probably have done that, but if you haven't, send them copies ASAP. That's how I was able to take over finances and be involved in all discussions with the doctor. Not trying to tell o what to do, just know if I didn't have a POA ie re my Mom, I wouldn't have been able to be involved in her medical appts and SHE LIES to them all the time (or just forgets -- she has Alzheime's). Good luck everyone. Caregiving my mom has taken such a toll on my health. And now my brother has accused me of Elder Abuse! He never helps our Mom, just sponges off her. He's being retaliatory bc he assaulted me, and I filed a Temporary Restraining Order. Nothing like creating problems. But he, like our mother, can be very hateful & vindictive.

I just recently (last week) had to figure out how capable my dad was of making healthcare decisions because as his healthcare POA I needed to make some decisions but I didn't want to whip out my POA unless I was convinced he couldn't make decisions on his own. So I devised a test for him.

My dad willingly and gladly signed a DNR many years ago. In this DNR it covers the basics, no paddles shocking him back, no breathing tube, no extraordinary measures of any kind. It was pretty standard. Plus, both my parents made me and my brother aware of what they wanted and didn't want so there was no confusion.

So I sat down with my dad and asked him, in effect, if he was still on board with the DNR. I asked him, "Dad, if you go into cardiac arrest and your heart stops, do you want the Dr. to shock you with those paddles?"

"Yes", he answered. I told him that in the event his heart stops the Dr. will have to put a breathing tube down his throat so a ventilator can breathe for him. Again I asked him, "Is this what you want?"

"Yes", he said.

I knew then that he was incapable of making any kind of decisions on his own and would be horrified if we did any of that to him. Based on this conversation my dad officially became incompetent. It's in his chart now.

So I would suggest you devise a test for your elderly loved one. Something brief and uncomplicated and to which you know the answers and see what he/she says. It may not be a medical test but it told me exactly what I needed to know so that I could act accordingly.

Eyerishlass -- I agree I should "test" him, and I do. 99% of the time he is fine. He just gets confused if a call goes over an hour, or gets into too deep of legal / law discussions. He's in his 90s and many days he keeps up with people half his age. Then last week he started (4 events) doing / saying things that didn't make sense, but otherwise seemed fine. It's just a gradual decline, but the "executive planning and function" and "discernment of right from wrong" seems to be starting to slide a bit.

Re - your situation - - your father may just have changed his mind. I would suggest asking a few more questions. At 92, my relative still makes "rational" changes in his decision-making. My friend's father is 93, and fairly recently changed from a DNR to deciding he wanted to have all measures taken to save his life if the need arises short of a coma. Sometimes when people get closer to the time to cross-over, they aren't so sure they are ready to be released from the family "this life". I'd just ask more questions. Are you 100% sure when he answered the questions the first time that he was a) not depressed, b) thinking he didn't want to be a burden on his kids?

It's hard to tell - the only thing I'm kind of thinking, maybe we "connect the dots" - - and between a certain time window, the "most common answers" are the ones that control the decision? I.e. if most of the time over a year he says "save my life" - then that is what he really wants to do. May also depend on financial / insurance issues. Maybe "ask" what is he basing his decision upon?

Thanks (((LEP)))

I've got everything I need. I keep copies of the DPOA and my dad's advanced care directive in my home, car and purse and they're on file with the hospital, his Dr., and the NH. I know my dad didn't change his mind, lol, and suddenly want to be flogged over and over in an ER if he's in cardiac arrest. He and my mom not only put it all down on paper but they drilled it into us for years. His answering 'yes' to all of my questions demonstrates that he is incapable of making his own decisions. But if that wasn't enough he didn't happen to ask me, "Where am I?" My lovely father would be horrified if he could have seen into the future and seen himself like he is now. He's barely conscious.

I'm thinking of you, LEP. I've read your post several times and am so sorry that you have to go through all of that with your brother. And I think I mentioned this before but I think everything will turn out ok. I know it's hard and scary but you haven't done anything wrong and maybe I'm naïve but I have to believe that if you didn't do anything then APS will figure that out too. Just put one foot in front of the other and keep going.

(((Hugs)))