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My brother is a doctor. He lost his license for 3 yrs. due to unethical actions while my Dad was dying. He is now a danger to my mom. What options do I have to help her? She has dementia and worships my brother. He and she hid my father's very legally drawn up Advanced Directive. My father suffered horribly for over 8 months and had requested no intubation. He had a DNR. My brother intubated him behind my back. I would have stopped it. My brother broke AMA Ethic 8.19 which forbids a doctor making decisions for or treating a family member except in an emergency. As I watched the poor decisions being made by my brother, was asked to stop him by his hospital, and was told an ethics committee was being formed, I understood why such an ethics violation is a felony in Georgia. In the end, the hospital located Dad's advanced directive. My father was mentally capable and assigned the health POA role to me. I was alone when he died. Now my mother is still struggling with a TBI that resulted when an umbrella pierced her neck and almost ripped off her head while she was on a windy beach 7 years ago. She is not taking care of herself, her house is dirty, she will not allow me to help because "i allowed my father to die" , and she is being treated by my brother for medical issues. The treatment is not appropriate. She fell recently, hit her head, appeared to have a broken arm, had sore ribs, and started with dizziness. He and she refused to obtain medical help. I would have. She has rages that are dangerous. My brother hates me because he blames me for the loss of his license. I am a retired special needs teacher after 35 years of working with students of normal intelligence who were very sick children. I could and did take care of many of my father's more simple medical needs. My mother does not like illness and would barely touch him after 63 years of marriage. My older sister died of an alcohol related illness three years ago.. Our small town is supportive of me, mother has gone against everything my father requested regarding family property and houses. I now have COPD due to constant pneumonia, I never smoked , and I have an immune disorder.I am disabled by the standards of the Social Security Office. I miss teaching. I was planning to teach until I was 65. I am 60. Each day is worse. Should I just give up, should I report this to elder care abuse, or does someone have a kinder suggestion? My father warned me it might be like this but asked me to take care of my mother. My mother's rages frighten me. She has a gun.

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Vstefans, I actually love my brother and would have stopped the train wreck. However, he was not able to understand that we were a group of adults now, and my mother ignored the rest of us and made him king. My sister has passed away since Dad died. She was a true High Functioning Alcoholic, couldn't make herself touch Dad very much, and finally couldn't withstand pneumonia. My other brother was a career true black ops and has finally retired even as contractor. He does not communicate unless he has to now, and is over an hour away from my mother. I understand PTSD., and he deserves to have it. He saved many people.He found a contract job as my father became very ill, and he left the country. My older sister lived 8 hours away and was "too fragile" according to my mother to handle this. I would have helped my brother and tried, but my mother threw it in his lap and enjoyed freedom after 63 years of marriage. My problem is that I realize I am still the strongest one to help Mom, now. Also, all of the unkindness from my siblings that I kept stuffed inside like a well-behaved Southern woman, came out like gremlins. I am in counseling, and what you are saying echos what my very kind psychiatrist has said. I think I will sit down with a few long time friends who know about this and will look for help outside of the county. The nearest large city can provide help. My friends keep a sharp eye on mother. Her driving is still okay in a county with 8,000 people, but the car is in my name. I will stop her when necessary in the kindest way possible. She is tired, I am tired, and I hope treating her as the mother I need will help her. I tried this last night, and the results were wonderful. I think kindness without boarding their train is the key here. Bless you for answering and understanding my brother.
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My heart goes out to your brother as well as to you - I would sense that he could not see a life beyond practicing medicine for himself and could not begin to see his way clear to giving it up when his mind began to fail him. It could be a chicken or the egg thing, where he started to have problems and then started using the controlled substances rather than the other way around, but there's no telling. It sounds like a lot of people thought the world of him and wanted to stop the train wreck they saw coming but your brother had already become unable to reach for his own better judgement and listen. You absolutely do have to keep up with paperwork - it is at least as serious as the 8.19 thing as your billing becomes fraudulent without documentation. I watched a good colleague recently forced to give up her career and retire early because of this; the stress of trying to do something she could no longer do was not helping her brain function either, and she is a bit better now but still diagnosed. StillTrying, you can't un-wreck this train and the crash was not your fault; if they could not stop him, how did they think you could?? - but there you are, still cleaning up at the scene, doing the best you can. Bless you!
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This is for vstefans: My brother and mother hid my father's legally created advanced directive when he was entered into 8 facilities. Dad told me he had created one and what was in it. I didn't have a copy until Dad and I were leaving the ICU for the second time and the staff came out to say farewell; the chief of staff handed me a copy. They had found it in an old file. My brother has been having severe difficulties for years. His medical colleagues and ex-wives called me to see if I could help him. He was not functioning, answering texts, hiding from phone calls, and was 5 years behind in Medicare paperwork. He had created a wonderful medical center with a group of friends during the seventies. They voted unanimously to fire him ( with one friend refusing to vote) two years before Dad became ill. He seemed to be not sleeping and using medications meant for ADD. Our state takes the AMA's 8.19 ethic very seriously. It is a felony if pursued by a patient or medical hearing panel. My brother was warned repeatedly to stop over-riding the decisions made by specialists - he is an excellent family practitioner but is not a specialist in all areas. I was approached by hospitals to stop him. He had rarely been around my father for about 40 years. My father was treated by his cardiologist at a well known teaching hospital in another city when he had a heart attack 15 years ago. Everything went well. Basically, my brother was used to be held in great esteem and wanted to be in charge. My father removed all power from my brother and my mother about a month before he died. He gave it to me in front of medical professionals and told them I was the only one of his children who was strong enough to allow him to die. My son and I saw him almost everyday. My mother did not want to see him over once a week. My brother's decisions were very harmful to my father on at least four occasions. I have spent 35 years of my life teaching and working with emotionally disturbed or neurologically impaired people. My brother scares me.
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That is a good clarification. 90 year olds should not have to take care of 70 year olds. It sounds like your brother lost his medical judgement and should not be going back to work as a doctor in any event - I can understand wanting to practice even if practice is restricted to your own mom, but he needs to give it up permanently. You can love him but not want him going back to active medical practice. I sure would not want him as a primary or ER doc for any of my patients.
From your desciption, I am not sure his judgement is even good enough to be her caregiver or to manage his own affairs. Yes, I'm hinting that maybe he has at least mild cognitive impairment himself...he won't be jalied then.

That said, he and your mom can both be fully expected to have a really hard time with giving up control even though they are clearly making a muck of things. You probably need to have Mom get a serious, comprehensive, eldercare legal evaluation. YOU didn't fail your father. Your brother, when you and he both thought he could and was functioning as a physician, made bad medical decisions, maybe in good faith, and I don't see how you could have overridden them other than exactly as you did, making sure your father's health care directive was found and followed. Just my $0.02. And, I'm glad you have friends.
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Still Trying. you are currently in a no win situation and not doing anything to help your own health. Your brother is clearly a very disturbed man and probably should not be practicing medicine at all but that is beside the point. He is clearly just using the house as a convenience when he works nearby. Is he married? Have a family?He is making no attempt to actually care for your mother mainly because he is incapable. You are no match for these two so you have two choices. Involve authorities in getting help for Mother which may not work if she is not declared incompetent. Is she properly diagnosed with dementia or is this just what everyone thinks? Who is taking care of mother's financial affairs and paying the bills etc.?
The other thing is to walk away and let the chips fall where they may. Do not put your name on anything that may make you responsible for anything financial.
Have you received any councliing for these issues or at least have a trusted friend or relative you can confide in. Do you think your brother is exploiting your mother financially? Is that why he is keeping such firm control. As vstefans suggested go to Dad's lawyer and seek his advice. At the moment you are just tying yourself to a runaway horse. Jump off.
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I am answering several questions at once. My brother will never be allowed to make ANY medical decisions for me. I have already dealt with that. I live twenty minutes away from my mother, and use a totally separate set of physicians. I don't know that Mom is truly incompetent. She needs knowledgeable medical assistance, medication she took for two years for anxiety and anger, and was much better when my father was alive because she was taken to the appropriate doctors. She is my main issue here. The small town she lives near is full of my friends. They did not know my brother or sister well. We had a house in a nearby large city and used the farm for weekends and summers. I taught in the county, and most people believe I was born there and are shocked when I explain. I go to the same church as my mother. It was my church until I married. I could cause a huge amount of chaos, but that is exactly what I want to avoid. I don't want my brother to lose his license on a permanent basis, and he would. It is a 3rd class felony in our state for him to be my mother's (or any family member's) regular medical caretaker. He could have served up to ten years due to my father and was warned from the first day Dad was admitted to the hospital by his peers. His friends prevented a felony for him. I don't like my brother and never really have. He admits he is a bully and his two ex-wives call him that. He almost appears to have have entered a mental illness that distorts reality. BUT, I love him and feel a great deal of empathy for him. I feel the same way for my mother. The people in the small town she "works in " called me about her arm. They helped me by insisting she have it x-rayed. The arm looked infected and she could not move it in some places. My brother read her x -ray and did not send it on to a radiologist. ( Protocol for any doctor) I am going to let the county help me with this, I think. I will not get involved. I am worn out and I feel like I have failed my father. One of my best friends is a state judge and cattle farmer. He cannot stand my brother anymore due to my brother's arrogance. Ray and Mom need help. He is close to reaching seventy. Mom is almost ninety. I have just turned sixty. Most women in our family live independently until they die. Mom wants to do that. I hear all of your suggestions and you have been kind. However, they both need help. I can take care of Mom unless my brother fights me. I still volunteer when I am well enough to do so. Mom has enough money for a caretaker, and I have a list of people who want to help her. With that help, I could clean up the house, rent a pod for her papers so she could go through them at her leisure, and try to bring joy
back into Mother's life. She has told me she resents taking care of my brother. It is just sad. Thank you !
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I agree with rainmom. A middle road will be a lot of ongoing difficulty and stress and probalby will not lead anywhere good. Unless you can tiptoe around and be allowed to make things better to the point where you can live with them, you probably should do one of two things:

1. Let your mom and your brother have each other. That's what they want. They made stupid headstrong decisions that cost your father his life, ruining the last few months of it, and they blame you and don't want you involved.

2. It is not about kindness any more. If you see your mom as a true victim, OR you see yourself as being blamed for her deterioration, then a report to Adult Protective Services should be made. I don't know what you would lose by reporting. If they realize that you called in the report, they will go on hating you irrationally. If APS sees the situation as dangerous, they may take steps to change things, or supervise them being cleaned up. And if they then shut you out even more thoroughly than they have, at least you have tried and are not responsible for whatever happens next.

Whatever does happen next, focus on taking care of yourself and your own pulmonary condition and get the best treatment possible. Don't be exposed to filth, fumes, etc.

And - would you be at liberty to explain exactly what your brother actualy did? Did he prescribe narcotics and appropriate them for himself or to sell? What is he doing for an income without his license - you know, most of us docs simply are not good for anything else besides practicing medicine. If he is a criminal and ends up in jail or prison or more optimistically in rehab, and your mom then needs guardianship and facilitly care, that's a better outcome than you are looking at with things as they are.
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Has your Mom been declared incompetent? If not and she is choosing to have your brother be her caregiver then I agree with pamstegma about letting go.

Unless a home is declared a public health hazard the law is not going to step in. Rages are scary but they don't automatically translate into violence. You believe your Mom broke her arm when she fell but do you know that or are you speculating? Is it possible you are feeling powerless and things are becoming exaggerated in your mind? I ask because I struggle with that.

Each person in a family is going to have a different idea of how to do things for their elders. Your brother obviously wanted to keep your Dad alive despite the DNR. He went against your Dads wishes and broke the law. That was a desperate and emotional choice on his part and he paid dearly for making it.

The situation with your Mom is different. She supports your brother as her caregiver. I know how hard it is to have a sibling swoop in and take over the handling of elderly parents. And I know how doubly hard it is when you don't agree with the choices they are making. When that happened to me it was suggested by a few people here that I let go and focus on how I might be of service to my parents, on my own terms. This advice has allowed me to see through my emotions and better accept the situation. Someone else asked me if proving I was right was worth what I might be destroying. I'm not saying you are doing that but it is worth thinking about.

I wish you the very best in this difficult time.
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Stilltrying: I want to acknowledge that your looking for a 'kinder solution' between family members in a difficult situation is to be admired.
Maybe an attorney who specialized in settling an issue amicably can be of assistance to you.
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Go see your father's attorney, get a copy of his will. Discuss with him how you can protect. 1) Yourself, and 2) Your mom.
You seem to be next in line (with your disability) for brother's medical care. First Dad, now Mom, then you? Does that scare you?
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Sheez. On the first post it should read walk away OR reporting - not walk away OF reporting. Makes a difference in my point.
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Huh? The first part of my post got eaten! Well - basically I was saying that unless your mom is likely to be declared legally incompetent your hands may be tied and you'll be forced to just let it play out. If incompetent you could fight for guardianship but if you won you'd probably be dealing with an angry mom who could make things unbearable for you.
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Sorry - hit the send button by accident. So to continue - based on the three options you feel you have, it looks like it comes down to walking away of reporting - which could still lead to a family war but one you have a better chance of winning if you had agency support. A lot depends on how far you are willing to go. If you report your brother and succeed in getting him removed from your mothers care decisions, all of that could end up in your lap. If mom is going to get angry over you doing that she could fight you tooth and nail on every decision and every attempt at assistance. It's tough enough trying to look after an elderly loved one even when they are compliant. The walk away option would only work if you could truely do it - without continually looking into how your mother and brother are doing. This seems unlikely based on your current level of concern and it sounds like you live near by - and would always have a glimps of how mom is coping. Perhaps setting a meeting with someone at APS could give you a start at better accessing your legal options. Keeping in mind, of course - that if you mention anything illegal/ abusive regarding your brother APS will be obligated to act. No easy answers here - but you know that.
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Obtain a second opinion from a doctor-neurologist-certified geriatric specialist-at the nearest or best teaching hospital FOR your Mom.

Can your Mom stay alone? Four days a week brother visits? Where are you? This is more about the house than you know. Escape with your sanity, visit if you can.
Because these two people lie, your involvement in any of this will cause you great harm.
Do what Garden Artist suggested, call APS, but on your way out the door.
If you stay, you will need a witness, so rent out a room or two. You will need to be very strong, are you up for this?
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Please excuse the mistakes. I cannot always see the type on this computer. :)
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Thank you for your suggestions ! The gun she uses is just one of many on what was once a working farm. There are coyotes, packs of wild dogs, snakes ( she could never hit one), and possibly dangerous people that might come up. The house is just a very large farm house built in 1859. The original plan created by my father and uncle was to create a very large apartment for her within the house and have my husband and me move in and use the money from the sale of our house to clean up the house and redo it. My father wanted me to have the house because I had helped them through financial hard times and he could not pay for my college like he did for the others. My mother changed Dad's plans after he died. The house has been given to my older brother (the doctor). I can live without the house. It is what it is.It gives me the creeps now. However, the plan everyone had was excellent and would have benefited mother. We would still have four bedrooms left and many other rooms;Mom would have as much or as little care as she needed. The house is very unsanitary now and packed with boxes and bits of this and that. My brother spends the four nights he is there in one of the sections of the house that can be closed off. It will take one spark and the house could burn down before the volunteer fire dept. could arrive. My father and I once put out a chimney fire before they reached us, but every healthy person in our section of the county was part of the fire dept.What I am trying to get across, badly I think, (sorry everyone) is that nothing is going to change unless someone outside of the "good old boy" structure comes in and takes charge. I am the wicked witch in my mother and brother's eyes. I have three choices: walk away and pretend it isn't what it is, call in outside agencies, or start a war that will split all of us up even more. You see, my brother wants the role of the oldest son, and when he left home in the sixties I was just a quiet little girl who read books, rode horses, and played with the dogs. He really never came back home for more that a very rare overnight visit.I became a specialist in working with students who were neurologically impaired. Now he needs my mother and wants to be "the man" without taking into account everything that changed while he was gone. The is a mess. What do you suggest ? I'm open to suggestions.
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Guns and dementia do not mix.

I live in a suburb. Cars are a tool. We all need them. But that didn't mean my husband with dementia should be allowed to drive.

That is just common sense.
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I have nothing against guns - own several myself. But you don't have to be a tree hugging passivist to know guns and dementia do not mix. Call me an ignorant city girl, but I can't make an argument for living
on a farm reason enough to let that combination continue - unless that is, you're afraid mom is going to be assaulted by a cow. If it's the rural isolation that's justifying the gun - mom must be in her 80's, right? What are the odds mom will be able to effectively aim and shoot an intruder? More likely the electric company meter man is gonna end up shot one day. Go to the local sherif and explain your mothers mental instability and having a gun in her possession. The sherif may or may not be able to get mom to turn over the gun - but most likely they'll pay mom a visit and at a minimum you'll have another set of eyes on her living conditions, should you need to gain guardianship.
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Thank you for understanding and giving me the courage to do what I feel I should do. You have been a blessing !
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Trying to sum up the situation, I see a brother who doesn't have either the practice specific experience or emotional distance to handle care of his mother, who has been disciplined (presumably by the medical profession) in the past, and a mother who is deteriorating and not getting proper health care or medical treatment by someone who should not be treating her as his patient it to her in the first place.

It would be an easy decision to put Mom's welfare over that of the brother's. If you don't, you'll regret it. I get the impression from your posts that brother has more problems than are mentioned.

I'd call APS; at least see what they can do. But do it anonymously, although your brother will probably suspect you of it. That may in fact bring out unacceptable behavior on his part that convinces APS to act.
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I appreciate the fact you took the time to answer, but I may not have been clear about the situation.This situation could become heartbreaking. Dad wanted to die on God's time. My father was not on hospice when he died like you assumed. My mother thought he would get well. He was dying. Dad was in the one nursing home my mother and I had promised him he would never go to. She sent him anyway. Three months earlier and about halfway during Dad's recuperation process, my brother and mother moved him out of the palliative hospice Dad loved and sent him to a facility that was more socially acceptable in my mother's eyes instead of the vent care center where he could finally learn to eat again. This was Dad's goal. They acted against the directives of the pulmonologists. My brother is a family practitioner and was fantastic for several decades. Mother thought we could have picnics and social events at the famous facility Dad was sent to, but she just couldn't understand the facility was not able to provide the vent care he needed. He lasted 4 days before he coded, was resuscitated for the 7th time and was placed back on the vent. Dad suffered horribly for over 8 months even after he had taken the time to go to an attorney, construct a clear and legal plan for not being intubated, and had a clear DNR. Mother and my brother were in this together, and there really didn't seem to be a reason other than power over Dad. Mom lied at each of the 8 places Dad was sent to and told the registration desks he did not have an Advanced Directive. She had it in her pocket book the entire time. She is angry with me because I used to be a compliant person , and she blames me for my brother's consequences.I never accused him of anything. He created his own mess. I finally confronted the two of them right before Dad died because Dad had removed POA from Mom and had given it to me. Actually, Dad was declared mentally competent 6 months prior to his death. I did not have a copy of Dad's advanced directive. The last hospital Dad was in was where my brother had just started another job. He had been fired from the large medical group he helped to start 40 years ago. I love my older brother, but he has not been a stable person for over 15 years. The hospitals protected me, my son, and my husband because one of us came daily, and we had gone through a training program so he could be brought home or to my house. I found the palliative hospice instead because Dad was afraid no one else would help me. The last hospital where my brother worked found a copy in the computers of Dad"s advance directive and handed it to me. My father was a kind WW2 vet who gave us a wonderful childhood with many advantages. He adored my mother,but my mother has always been volatile. Yes, guns are a part of a farm. I have two and learned to shoot before I was 8 yrs. old. However, Mother has irrational rages now and threatens to shoot family members. I am seriously concerned. She might be able to function normally with medication and a neurologist's help . My brother is not a neurologist but will not send her to one. He should not be acting as her physician and has been warned so many times. My last graduate degree was in abnormal behaviors and neurological disorders. 35 years of experience tell me Mom needs help we cannot provide. She was once a beautiful and immaculate person. She just isn't maintaining personal hygiene despite the fact she is still a broker and goes into the office and banks every day. This situation has the potential to become a tragedy. You are correct when you say that my health does not need this. However, the farm was my home for many years after my much older siblings left to go college and moved out. I have helped take care of dogs, the lake , the boats, the 2,000 ft. well, horses, taxes and her car. I think she could have a wonderful quality of life with specialized medical help, and she has the means to pay for it or I would pay for it. This situation is like being Alice in hell instead of Wonderland. It doesn't have to be this way. The division of land, etc is not an issue here. My father took care of some of that. I just feel responsible as my mother's only living daughter, I love her but do not like her due to her snobbery, and I am in counseling after being diagnosed with PTSD. Mom deserves so much better, but I am helpless in this situation.
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Getting further embroiled in family controversy will badly affect your health. Step back, let go, let God. Focus on getting better and let them hash things out on their own. Even the gun thing; guns are tools in rural areas.
Your father was on Hospice; no one is to blame for his death.
Your brother does not deserve further punishment. He is probably also taking a beating from your mother. Let that go, too.
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Yes, I took care of her and my father for years. My older sister always provided respite care despite her illness. My brother became involved when his world fell apart. I wanted my mother to attend counseling with me to help her let go of her part in Dad's situation. I believe that torments her and makes her more hostile toward the world. I can handle the gun situation. This is a very rural county. Mother does not have neighbors she can see. Thank you for answering. Your concern over the gun validates what I am feeling. I can file a complaint with elder care services and have spoken with them briefly. I don't want to cause my brother to lose his license again. I just want my mother to be clean and have the medical care she needs to be improve her life. She and I have a wonderful time together when she is not angry. Her quality of life was better before my brother started staying with her during the week. My father was on the board of a group that created clinics for rural counties. My brother received his current job through that connection but still has a house in another large city. He could be a blessing but seems unable to be one at this time. I will contact elder care services today.
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Get the gun out of the house. Call the police department and ask them what you should do with it.

Since your brother is not caring for your mother the way you think he should be call and file a complaint with elder care services. Will you be able to take over your mother's care?
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