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Hi,



My mother-in-law has been living with a partner for several years in an isolated rural area. She had her thyroid removed two years ago and last fall arbitrarily decided to stop taking medication. During the last six months, she as rapidly decline to a point of total self-neglect, with her partner doing his best to try and care for her. However, they are not married, and the state she lives in does not recognize common-law marriage, so he pretty much as no rights to make decisions for her.



My husband is her only child. He is with her right now and it's an untenable situation -- she is incontinent, is having severe cognitive issues (seeing things, sometimes doesn't know who he is), not bathing, etc. But we don't know how much of this is caused by her not taking thyroid and other medication or what her true baseline is.



She needs round-the-clock care right now, but he's not sure how to proceed, because there is some hope she may improve to a higher baseline level that she could live with less assistance than is required now.



Anyone with advice? He is pursuing conservatorship/guardianship to be able to make decisions on healthcare and finances. But even if he is awarded that, we're not sure if it's better to try and find someplace near us in another state, or somewhere close to where her partner is, and he could visit her regularly. He is really the most familiar face to her.



Any thoughts or advice is welcome.

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She doesn't so much need rount the clock care now as she needs immediate admission to an emergency room. Have your husband take his Mom to the ER right now. She is not taking medication without have a thyroid could be the ENTIRE answer to what is going on, if not a partial answer.

While she is admitted you husband needs to contact the Social Workers at once. This will take more than asking a nurse or a doctor. This might take pounding on the desk if they don't get you one quick.

Then husband needs to tell the Social Worker what you have told us as well as all the doctors and nurses. There is going to have to be neuro evaluation here to find out if Mom has the ability to understand the danger of being without this medication. There may be need for emergency guardianship here as well; again the social worker helps with that.

I am so sorry, but this has been delayed too long already. This is an emergency situation. Call EMS. Do not let Mom refuse transport; report her as confused and incompetent in her own decision and EMS will transport her to the ER.
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Your profile says your Dad is 89 years old, so I'm wondering if your Mom-in-law and her partner are close to that age as well? I'm asking because the person who has guardianship should be someone younger than her, preferably by a generation. Also, an alternative guardian should be named, should the partner predecease your MIL. Ideally your MIL should live in proximity to the guardian. That's what I would want if I were in your situation.

Does her partner have adult children from a prior relationship? I'm asking this because often when partners in later-life blended marriages age, there is confusion as to who the "point person" is when they reach a stage of needing outside care.

Another issue is the thyroid thing. She needs to go back to her doctor to get rechecked and her prescription renewed. if she's gained or lost weight her prescripition would need to be changed or else it could cause a problem. She could also have a UTI, a vitamin deficiency or other issues that present like dementia and these are all things that can be diagnosed and treated. An accurate assessment of her health is first and foremost before any bigger decisions or changes are made, IMO.
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Nedgirl Mar 2023
my husband is younger than me and his parents had him at 20 while my parents had me later in life. All this is to say my mother-in-law is only 73. My husband is 52, and the only child so he really needs to be her guardian.

Social services has been contacted and did visit the home. She has been seen by medical staff and is back on her thyroid medication, but they think it may take awhile to full take effect.

Hope that helps.
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Nedgirl, one thing your Mom-in-law needs to do is to have a test for an Urinary Tract Infection [UTI]. Such an infection can mimic cognitive issues, seeing things, strange behavior, etc. The infection can be cleared up with antibiotics. Her primary doctor or even an Urgent Care can run the test [peeing into a cup, she may need a nurse to help her].

Not bathing is common as we age. Showering/bathing can be very exhausting the older we get, so we put it off. Plus there is that fear of falling, even if the shower/tub has a mat. Also, some people start to get claustrophobic of showers/tubs.

If it turn out that Mom-in-law is dealing with dementia, it is much better for her to stay in her current community or nearby, but in a Memory Care facility if she can budget for the cost. That way she can still see her sig-other.
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