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Another attempt to get a plan in place.


Made a Doctor's appointment today with my sister's new General Practice Doctor. I realise the Doc can't talk to me but explained to the receptionist my sister has special needs & I had big concerns about her. I wanted to get advise re POA / Guardianship & fill Doctor in * ie ME talk TO the Doc. Doc just takes notes & can verify/ask my sister as she wishes *


Receptionist now called to cancel appointment. Doctor will not see me alone. Can see only me if I come with my sister. Can't bring sister as #1 she won't go. Even when she does go (eg when scripts are due) #2 I won't take her due to her new spasmodic fecal incontinence problem. Already urinary incontinent, falls risk & too hard to get in/out of my car. A support worker takes her now. I suppose I could meet her there (if I was advised when next apt is)?


All advice comes to this: Have to let it go. Let the chips fall. Float on by. Ride off into the sunset.


I am struggling with this... Already wrote to Doctor. Maybe I should write another letter? - send to Sister, Dad, Doctor, Psychiatrist & Care Coordinator.


Then just wait for *the fall*. Let the Social Worker make a plan. Learn to float & ride until then? Then get capacity tested & guardianship if required.


Is there any other option left????

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My Doctor said I could try Social Worker - BUT they will not see true picture - depends on time of visit (if Aide is there, Sister & home ok). Said Guardianship could be grated to Dad, not me. Only an option if Dad not in picture.

I will indeed think very carefully about Guardianship if that day comes. If she is in AL or NH & I can *manage* her care needs from afar but NOT if it is supporting her in her current way. She has mild intellectual disability, schzophrenia, depression (both well controlled) & major stroke deficits. Eats poorly, obese, hardly any exercise so the big chronic lifestyle diseases are coming too (more strokes, heart disease, diabetes). Memory a bit *off* so chance of dementia probably in the mix too. Her newest symptom (black tarry BMs) may just be iron tabs but also internal bleeding - needs a medical opinion. Hence my attempt at seeing her Doctor.

I think this is *self-neglect* (unless proved incapable), then it's *neglect* by my parents (Mum has a Doctor's letter stating she us competent to make decisions for HERSELF). Dad IS competent (just stubborn? naive?) This is where I think I need an Elder-care lawyer or Social Worker to explain this to Dad.
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If the doctor takes notes on your questions then asks sister her permission or opinion, then that is a statement in itself that the MD thinks she still has some capacity to make own choices. In that case, will she agree to you being POA at this point? or does she refuse you? If she has a teeny weeny bit of capacity left, now is the last opportunity to get that done. If no capacity, and you do want to pursue guardianship, but the cost is prohibitive, you may be able to find pro bono services at your county legal aid program, we have that here in California. Here, the court does require MD to sign a capacity declaration. Good luck, it's a hard one. Sometimes you have to wait for a disaster before anyone can intervene. My thoughts are with you and your sister.
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Beatty Sep 2019
I don't know if she understands what POA is. She hasn't refused me as such... but anything 'yucky' to talk about gets a screwed up face & ignored. You see it - face screwed, look of discomfort, thought tossed aside, pick up phone to play distracting game.

When asked by a nurse if she had any plans for herself in case she got sick she said "but I'm not sick now".

When asked "who would make desicions for you if you couldn't?" Got "I don't know". Asked "would it be a good idea to do that?" Answer "I suppose". Here is a form. The screwed up face. Form ignored.

She blamed me for the awful dental xray I made her have because the machine was yucky & the day was too hot. I have explained I merely drove her & the Dentist requested it. But that's her level of understanding.
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Hi Beatty, just read your profile and the bus analogy. IMO they are not keeping you a hostage on the bus. You are refusing to get off the bus because you think/know what may happen if you get off. But they aren't letting you take the wheel. So let them stay on the bus and now you get off. Not sure how old your sister is or what her health/mental issues are but you taking guardianship will be like a part (or full) time job so make sure it's what you and your spouse can agree upon as a time/financial/emotional commitment. Bless you for having such a heart for the vulnerable. Wishing you objective wisdom and peace in your heart.
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Beatty avatar
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Beatty Sep 2019
Geaton, thankyou for your kind words and for your clarity.

Yes, you are SO right. I need to Stand Up & Get Off The Bus. Hmm, standing up for myself... maybe that has been the problem all along.
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Is your sister still living alone? If so, a Social Worker can get temporary guardianship for her and get her into a LTC facility. She will at least have a doctor associated with the facility, aides and nurses. You can call APS and say sister is at risk and there is no family to care for her and she isn't compliant.

Guardianship is the only way to go at this point if sister can't assign POA. Its expensive. I doubt if sister has the money. Guardianship carries a lot of responsibility. You answer to the state. Once gotten, very hard to revolk. Me personally, I would allow the state to take over her care. If you are still caring for ur parents, you have enough on your plate. The State can move faster in getting sister into LTC and other resources she may need. In the case of my Nephew (who I have POAs for) I have told my daughters if something happens to me, let the state take over.
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If she can not give consent for you to be her POA or even complete the instructions on the HIPAA form at the office the only way you can obtain information would be for you to seek guardianship. At this point you need to be talking to an Eldercare Attorney.
Technically even if you got a doctor to come to her they can not give you any information without her consent to do so.
I think if you contacted a lawyer and he or she came to the house they would not have a problem starting Guardianship procedure. It does not necessarily take a doctors letter to confirm incapacity.
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When my husband, also with many health issues, became incapacitated to the point he couldn’t get to his doctors without expensive medical transport, I researched home visit physicians. They are not as common as you would think, but I found a company called Visiting Physicians. They are not perfect, but they have provided my husband with the carehe needs. Obviously, they come to our home. They have the capacity to do chest x-rays, blood tests and other testing. Maybe this would help you to get your sister the care she needs.
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