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Elderly Mother and her husband are the guardians of my neice and nephew. The kids are 9 and 13. Mom was diagnosed with dementia last week. Her husband has a history of heart disease, has had some stents, has back pain, smokes a pack a day and has type 2 diabetes. He does not walk much and sometimes falls back into his chair when getting up. Both Mom and her husband are very private. I am worried about their safety and the kids. Any thoughts?

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It sounds as though even if things are OK for now there is a very high probability that you will need to do something before the kids reach an age to be on their own. I think you really need to start by visiting a lawyer well versed in family law and guardianship of minors that can tell you the process involved and how to finesse your way through it with the least amount of trauma for all involved.
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Excellent idea. Is your mother the one driving the kids around? Does your father drive them around, too?

If you think they should no longer be taking care of your niece and nephew, is there someone else willing to step in and raise them?
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Also, her husband does not go into the grocery store with her or any store. He is unable to walk around. He still drives, not sure how he does that. I am going to spend the day on Sunday to try and assess the situation more.
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How are the kids feeling about this?
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So we assessed the situation over the weekend. The kids are very good and well behaved. Mom's dementia was not obvious. She did well. Her husband did not come out of his man cave to visit. We were told his back hurts and he doesn't walk much. He is still driving. He drives the 12 year old to the grocery store and sends him in with a list. Mom is barely leaving the house now. So right now we are just going to keep making frequent visits.
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May I ask how old are your parents?
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70 and 71
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Mom does not drive. Her husband sits in his chair, watches TV all day and smokes. My relationship with Mom has not been the best over the years, not fighting, she is just sorta odd and now with the dementia, ugh. I am concerned. She read me the list of her medications (2 of them) and then repeated the second one and spelled it a second time. She had no idea she had just read it to me. The kids are legally their kids, the mother gave them up completely and legally. My husband and I would be the ones to take the kids, as we are their only family now. I will update this after I visit on Sunday. They will not release the kids willingly. Any thoughts regarding what I should look for regarding safety? I want to discuss with Mom about her wishes.
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