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I'm the HC and Durable POA for a friend with no living relatives. Her dementia (diagnosed at least 3 years ago) has progressed to the point that her violent outbursts make it unsafe for her to live alone in her home. Attempts at getting her live-in help have failed (she's mean, belligerent and doesn't admit she has problems), and she still has access to a car! It's just a matter of time before she harms herself or others. Just last week, we had to call the Sheriff to get EMS to pick her up because she was having one of her tantrums against the caregiver and no one could calm her down. She spent 5 days at the behavioral unit at our local hospital, with everyone in agreement (social workers at the hospital, the head of our county DMH who knows the history, DSS, etc.) that this would be the perfect opportunity to finally place her somewhere. But the young doctor assigned for the final assessment, didn't agree, because she has an uncanny ability to become "perfect" for those she knows will benefit her most. So he released her! Was about to send her home in a cab last Friday, to no one to even check on her, because I was out of town and so was her other caregiver (unexpected funeral). I had to beg them to keep her until I got back and could make sure she was safe.


I picked her up on Monday, and she's had a series of violent, destructive outbursts since, and even though I have a HC POA that gives me the right to choose where she lives, I'm being told that I can't exercise it (because she won't go willingly for sure), without a doctor's letter stating her incompetence to make such decisions. Her doctor wrote us a note years ago indicating she did not possess the capacity to deal with her financial and legal affairs, but now even with pages and pages of photographs and written documentation of the various meltdowns and their aftermath, including an accidentally obtained video when she attacked her security monitor and set it to record on baby monitor mode, showing her as literally a wild animal, beating on the TV with her fists and head, stomping on the cable box, shattering a TV remote, and just in general going wild, the doctor is telling me she won't write the letter that's required for me to have a facility do an evaluation and take her in involuntarily if they agree. I've honestly never experienced such CYA in my life, and am so disgusted with the medical industry! It's no wonder so many people are killed by the mentally ill. My friend's problems may be exacerbated by her dementia, but it's my opinion, she's been mentally ill (and an alcoholic) for years prior, and now we have a triple whammy.


So the advice of "if you have a valid HC POA" is BS. Even that can't get you the help you need to protect them from themselves.


Any ideas? I'm in SC, by the way.

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Call legal aid and speak with elder attorney. From the research I did now that you have her listed as having dementia. U can pursue placement for her with a durable POA as long as it states you can make decisions if she becomes incapacitated. Dementia by law fits that. U do not need guardianship in SC.
I have guardianship of my father, the law is clear had he had a valid durable POA correctly done he did not need a guardian.
U can move her money, decide where she lives a of that without going to court. U can also research durable POA and guardianship in SC
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So, as a followup, I took her to her regular dental appointment yesterday, where she got very agitated and pissy because she had to wait 10 minutes between the cleaning and the dentist arriving.  She was already in a foul mood, because the assistant had handed her chart to me to check for accuracy, instead of her, and she still thinks she's Superwoman, and still keeps up with all her affairs (it's been 3+ years since that was the case).

We spent the better part of the day together, where I went and got a new TV to replace the last one she shattered (it didn't last a week), and tried to coax one of her cable boxes back to life (unsuccessfully).  She was, of course, her usually self, waffling between, "I'm so lucky to have you," and "Why won't God take me and end my suffering?"  (Did I mention she's a drama queen too?)

So, this morning, I got a phone call from her and she was literally wailing and crying into the phone that "Everything in the house is messed up, and I don't want to live!" or some version of that.  When I tried to find out what had gotten her so upset, she couldn't tell me.  I asked her if she agreed she needed to see a doctor, and she said "Maybe," so I let her get about 11 minutes of the wailing off her chest and called 911 and sent the EMS folks to get her again.  This time, having been educated a bit more by my friend who used to work for the Dept. of Mental Health, I had them take her to a different hospital, where they still have a psychiatrist on staff.

About an hour after she arrived, I received a call that they were discharging her.  She had turned into "Perfect Barbara" and demonstrated none of the craziness I witnessed on the phone.  I went over to her house and documented what she had destroyed, and found several notes reminding her to call her lawyer and remove me as her POA -- no doubt triggered by the dentist asking me the questions "she's perfectly capable of handling herself."  I did tell the counselor at the hospital that I would not come to pick her up, and did not support their sending her home again, and that I wanted it documented that I felt this was an "unsafe discharge." (thanks to Alvadeer for that advice)  Those words seemed to set them back a bit, but they still argued that the only deficiency they were witnessing was dementia, not a mental illness.  I later learned she was quite combative, and would not allow a blood test (which tells me she had been drinking this morning too).  They kept her all afternoon, and the social worker called and we talked for an hour, but still the only thing they would do was arrange medical transport to take her home because I still would not agree to go get her.  So, barring any ability to get someone else to witness her "in the act" of her mental breakdowns and violent tantrums, we seem to still be at an impasse.
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Samsung137 Feb 2020
Time to film her on your phone if you havent already. I would film and document several episodes.
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She needs a guardian and conservator appointed. Together, the conservator and guardian are stronger than a POA, but requires a lawyer and two doctors affidavits. The prior POA strengthens your case. Cost will probably be several thousand, which you may have to front, tho you might be able to recover if all goes well.
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Get another doctor? Get a lawyer? Her record of incompetence has to be seriously considered.
calling a lawyer does wonders.
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Even if you have a POA, I have found that every entity requires you complete their own form. But I think you can do that on her behalf with the POA you have. Consult legal aid or an attorney. If she's on Medicaid, it requires a doctor to certify the need for long term care by a doctor who has been seeing her for at least six months. Good luck.
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Disable the auto. Call Adult Protective Services.
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Time to stop being her friend and protect her from the demons-- call Adult Protective Services after having her admitted via the emergency room at your local hospital-- Do it now ! No talking to her-- do it now ! You cannot be a friend and a caregiver--- choose the wrong one and watch her get no help and die pitifully and painfully. DO NOT depend on the medicos to make the right decisions-- demand she be moved to a facility when she can be sedated and treated properly. Use all your social resources. Go to the police, get an objective doctor to evaluate. Do not be stymied or think you cannot achieve your goal. Good luck. God BLESS you-- oh-- get a Pastor involved as well or even a Police Chaplain.
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DugganB Feb 2020
PS-- call 211 and find out how to revoke a driver's license and don't just unhook the battery cables-- remove the battery entirely -- and get all her personals-- ID cards, bank cards-- close her bank accounts. Get her soc sec card. The whole 9 yards. You will be thankful you did later.
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In Pennsylvania, an involuntary mental health commitment requires a person to be the petitioner and complete a form known as a 302. This form certified that a person is a danger to themselves or others. If the examining physician concurs said person is held for five days. After five days, the case is presented to a mental health judge who may or may not commit the person for a longer time. This is known as a 303. As durable power of attorney, the document should be able to give you the ability to make decisions. Have you contacted the attorney who drafted the documents? Has the physician regarding the decision not to facilitate the commitment?
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Clanier,
Start with the car! Disconnect the battery cables so she can't start the car. You're right, she is not only a danger to herself, but she is a danger to anyone she may encounter on the road.
If the state of her home is less than satisfactory, maybe try calling Adult Protective services.
You can only eat an elephant one bite at a time.
Do what you can on your own first. Seek help from others for the tough stuff.
Senior Legal Services was a great help to me.
God bless you for caring for your friend!!
You're an angel!
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If anything involves money you need 2 (TWO) POA. One for medical, and one for financial things. Medical POA is limited in receiving information and in making end of life decisions for them if they are unable. If you need to have them admitted to someplace for full time care, you need both POA in place. Hope this helps. Too bad the person who set up the medical POA did not do both at the same time. Good luck.
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Peanuts56 Feb 2020
Not sure where you received your information but according to an elder lawyer, it is not necessary to have two separate Power of Attorneys for an adult. You may be thinking of a situation where the person is a minor. In that case you need a person overseeing the money and another person overseeing the other matters affecting the minor.
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Maybe if she acts this way in front of you again call 911, and just say she is having a huge panic attack, and is not acting right. If you get into the ER, they may run a multiple amount of tests. They may check her for UTI, brain scan. etc.
This time ask for social services, say you have POA.. ask social services with doctor there is she a fall risk? Do you think it is safe for her to live alone? can you evaluate her the 30 day trial in the nursing care, until we can figure out the next step... Bring all her medications so they can see them, and see if she is taking the correct amount at the right time. This was huge for my neighbor, His mom took too much at one time. Got confused so she took more. Probably should have paid the board n care the extra $300.00 a month to regulate the meds...
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I don’t know the laws in SC, but in Florida I was a geriatric care manager, and also performed competency assessments for the court which was used to determine if the court would adjudicate the person incompetent. If incompetent, then a guardian was appointed. Here there are two components of the guardianship, one for financial affairs and the other for “the person.” It certainly sounds like this friend would meet criteria for both. If a doctor will not complete paperwork to initiate an evaluation for competency, again here in Florida, two people can sign a form, obtained from the Clerk of the Circuit Court. Once signed, documenting observations warranting guardianship, the judge appoints a committee of three to evaluate the individual. Based on the evaluations the decides whether or not to deem the person incompetent and appoint a guardian. In my experience, if there is a friend who is willing to step forward as guardian, this typically happens. Given that you are her POA I would think this will strengthen the likelihood that you would be appointed.

If you want local SC information, I would contact the Clerk of the Circuit Court’s office. Another option would be to contact a local geriatric care manager - search geriatric care manager on the web. When I was a geriatric care manager I was a member of the National Assoc of Geriatric Care Manager. Since my retirement they have changed the name of the organization, but a search of the assoc above will get you the info.

Hope this is helpful
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Don’t know the laws where you live, but here in California there is specific legal forms that require a psychiatrist to fill out to carry real weight, and would also be considered and more then likely accepted by a judge if needed to have the person placed in a LTC or locked facility. Without that “lack of capacity” paperwork the patient still retains their freedom.
My LO with Dementia, and underlying mental issues was somewhat like your friend, and I jumped through so many hoops to find out what paperwork was required to deem them incompetent and have lack of capacity to make their own healthcare decisions. Prescriptions etc. My LO’s neurologist wouldn’t complete the paperwork, and he informed me that it’s done by the psychiatrist.
The law is written to protect the individuals rights, and for good reason but sometimes it’s just crazy the steps that need to be taken to protect the person from themselves.
Does your friend see a psychiatrist ?
In the end it was a mental health court counselor who led me to the correct process. Even the psychiatrist never mentioned it to me but when I asked him to complete paperwork he looked at me and said yes this is what needs to be done!! Go figure 🤔
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Switch Doctors.
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DSS by law are responsible for securing her safety, the hospitals cannot legally discharge someone without a safe discharge plan.
Call dss and make a report about her being a vulnerable adult who is unable to care for herself, if they do not get her the help she needs call the state dss number to report them for failing to do their duties.
The hospital by law have to have a safe discharge plan before releasing someone. I will come back after I get my dad up for the day and post the numbers to call to report both places.
I am in SC also, retired social worker from the dss system in NC and from personal knowledge and experience, sometimes dss will not act if they are not forced
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The only status that lets you decide where this person lives is Legal Guardianship, petitioned through Probate Court.
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Find another Doctor and/or call the State authorities that deal with self neglect of the Elderly.
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Time for another doctor. Show the video. Get testimonials from caregivers, hospital personnel... Then, you may able to have her "admitted involuntarily" to a geriatric psychiatric facility.

Sorry you are in this position.
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The reason may be dependent on what choices she allowed at the time the POA for HC was written, and if indeed she was considered capable at the time. No way to tell from given info. Was a Financial POA also granted?

If she is placed under a guardian ship, she virtually will have no rights, As much as you may care, for your friend, a court appointed guardian should protect you from accusations of elder abuse, and you would be essential relieved. I'm assuming there are no family members involved?
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jacobsonbob Feb 2020
Situations like this must be extremely frustrating for caregivers and for family members. They have to worry about being accused of elder abuse, but it's an uphill battle when they themselves are trying to deal with a potentially dangerous person. Too often we have to "wait for something to happen" before we can get appropriate help. I know there are many laws guarding people's rights, but does anyone else get the feeling that somewhere along the line common sense got legislated out of the equation?
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All great suggestions above. I would definitely call APS so they can assess her. You are a true friend and she is lucky to have you but this seems to be an impossible situation and very dangerous for the both of you. She needs more help than you can provide for her. Hugs and prayers for a safe quick resolution.
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Resign your DPOAs and formally hand your friend over to APS sending them all of the documentation you have accumulated. I honestly can't see any other way forward.

It isn't that you don't want to help your friend, or don't care what becomes of her. It is that you are powerless to intervene. So give the task to people who aren't.
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I'm really sorry you have to go through all of this, and I'm also sorry for your friend who is probably very lonely. Ask a social worker (perhaps next time in hospital or Department of Social Services), you want to relinquish your DPOA and get a court-appointed legal guardian instead. Especially since she is violent you want to remove yourself from this; refuse to pick her up. Sad situation for the both of you, and admirable you are willing to help a friend, but not to the point it completely disrupts your life. Sounds like she needs to be in a group home or nursing facility. At least in those places she will not feel lonely anymore.
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Will her primary care or neurologist write the letter to trigger the POA? I know my husbands pcp was reluctant but the neurologist had no hesitation. Best wishes.
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Call Adult Protective Services. Once you do, the ball will start rolling very fast. She will likely be removed from her home, if that's what they believe to be the only solution.
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It sounds as if you may be dealing with the damage of long-term alcoholism, causing irreversible alcohol dementia, that is also overlaid by some other form of dementia (Alzheimer's, vascular, etc).

You are her Durable POA & have a physician's letter that she is financially incompetent - - use her funds to see a lawyer to file an emergency ex-parte motion for "conservatorship of finances AND person". Generally, a hearing is rapidly set, and the patient is advised to appear. If they don't, that's already an indication of a problem.

Once you get to court with the documentation you have, the judge may make a temporary order or, if there is "competent" disagreement (that is, the behavior in court doesn't speak for itself) they will likely appoint their own trusted doctors or other individuals to do an assessment evaluation.

Even if her funds are limited and she would be on Medicaid now or later, her intentions, when she was "of sound mind", were for you to act as her advocate. You won't be able to do that if you turn her care over to the State.

I have seen folks do that to family and friends and it wouldn't be my personal choice unless it's a last resort.

Unlike a POA, the conservatorship gives you to complete authority over decision making. Once you'd probably obtain that and install her in a facility, the institution doctors will likely find cause to medicate her which, in the long run, will help with her anxiety and make her more comfortable.
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gladimhere Feb 2020
States have different laws. In my state it is called a guardianship.
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She will end up in the hospital again. You need then to refuse any participating in taking her anywhere at all, and to let them know if they discharge her they are doing an "unsafe discharge" (use those words) and will be held responsible to that. You need then to put that in writing, keep a copy for yourself and ask a copy be inserted into the chart. You need to start keeping a complete diary. IF she is adjudged incompetent in her own care and that document is no longer good, this must be done again. I myself would not be capable of handling this and would give up POA on a friend you cannot possibly handle, ask for APS to begin the work of State Guardianship. This is about the only way to get thing done. There is little you personally can do in all this.
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Clanier, you're certainly a devoted and caring friend, and I applaud you for that.

Has your friend displayed these behaviors before showing signs of dementia?   I'm not a medical person, but I think her past mental illness as well as the alcoholism may be either contributing or the foundation for her violence.   And from your description, she clearly can become out of control.   

Do the doctors make any suggestions as to alcoholic withdrawal, in an appropriately monitored setting?    Has she been forced into a detox situation?  I'm wondering if that triggers the violent episodes?  What about medication?   Has that helped?

I'm wondering if at some point the local county might need to take over her control.   Decades ago I was a court reporter and primarily covered juvenile cases but we also substituted in Probate court for mental incompetency hearings.   

I recall that judges would when warranted issue 30 (+/-) day mandatory commitments in a psych hospital for evaluation.    That might be a consideration; the local police or Sheriff's office could probably offer more insight into how the local courts might handle this, if it's an appropriate alternative, and how to implement it.

I feel badly for you; it's so sad when a friend's path leads him or her down an even worse road to violence and addiction.

I really don't have any insightful observations to offer, but perhaps after others do my mind will be stimulated to think of something.

I just wanted to extend support for your concern and the dilemmas and challenges both of you are facing.    This must be so frustrating.


ETA:  LoopyLoo's reference to relinquishing control (or ceding it to the local governmental or other appropriate agency) might be an option through the Court's involvement as I mentioned above.   

One concern I do have is not only for your physical safety but your responsibility as well to step in.    I'm not knowledgeable in the area of whether or not proxies do have obligations or responsibility for someone who's out of control; this is a legal issue on which I'm not qualified to opine.   Local police or the Sheriff's office might provide insight on this.
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You're a wonderful friend for sure! Bless you for that.

But, sadly, it looks like there isn't much you can do for her. Like you said, she is mentally ill and longtime alcoholic. I'd be worried about her attacking you, if she is this much out of control.

I don't know the steps to take with relinquishing POA or what the state does afterward, but many on here do. I'd think once state had custody, she could be placed somewhere for good. Likely won't be an ideal place, but at least she'd be somewhere.
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