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Per the hospital social worker, I anticipate a Virginia state attorney will contact me within 4-6 weeks to initiate the process. I'm her next of kin (oldest child/son) and the sole immediate family member who has maintained contact with her in the past six years. I have one sister, but unfortunately they haven't communicated in six years. Although my mother is suffering from late stage cancer, congestive heart failure, memory issues and in my opinion, some undiagnosed personality disorders, she refuses to sign advanced directives, POAs and cancels ALL appointments for medical treatment. My mother believes she can handle her affairs; however, two separate hospitals declared her "unable to make medical decisions" and have reached out to me for consent, as next of kin, prior to performing medical procedures. My mother is a self-proclaimed "private person." Recently, she has been requesting complete privacy and a social worker told me she now has a "do not announce" code associated with her hospital visits. For example, if anyone were to call the current hospital where she has been admitted, the operator would say something like: "no sir, she is not in our system" or "I don't have her in our directory", even though she is really there. Two hospitals have informed me she needs 24/7 care or live with a family. Unfortunately, I don't have the resources for her to live with me (I live 15 minutes away). However, I've reached out to her siblings and one of my aunts volunteered to let my mother live with her. My aunt is 10+ years younger than my mother, retired, financially secure, has a loving heart, and has cared for two other siblings with late stage cancer. My aunt has also volunteered to be the guardian and asked me to research the process. My mother has made it clear to hospital staff she doesn't want to move and/or live with her sister and told staff she doesn't want me to be her POA (or advanced directive). My mom doesn't have enough resources for 24/7 care and in my opinion her home is unsafe (she won't let ANYONE in her house, for 10+ years). My mom signed herself out of a hospital last Thursday, without medical consent, then called an ambulance last Friday and is currently hospitalized (confirmed through reliable 3rd party sources). So bottom line: my mom is not well, it is unsafe for her to live by herself, she is not making good decisions, I expect her current hospital to call me soon and tell me she is "unable to make medical decisions" and I'll be able to talk to her doctors and case workers. After not knowing where she was since last Friday, I'm thankful to know today she is currently in a safe environment (hospital). I'm okay with not being the guardian, but prefer a family member to assume this position ANY DAY, as opposed to the state of Virginia. Any recommendations? Thank you in advance.

Well.

Given that your mother has arrived at the juncture as a member of her family, what makes you think that any member of that same family is equal to the task of directing her care now, when she has so effectively seen them off in all the preceding years?

I would say this is a job for professionals in any case. And while it is very sweet of your aunt to extend a welcoming hand to your mother even at this late and extreme stage, for one thing I seriously doubt that your aunt has the faintest idea of what she might have been letting herself in for and for another your mother has already bitten that hand. Has she not.

What do you believe the advantage would be of keeping this in the family?
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Reply to Countrymouse
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You mother has made it crystal clear, on many occasions, that she doesn’t want anything to do with anyone, most specifically, it seems, her family. Why were you so determined to cast about, finally finding an aunt who agreed to take her in after everyone else refused? Just because your aunt has done this before doesn’t necessarily mean it’s now her calling. Especially for such a difficult patient. I think from what you’ve written about Mom, you’d be sacrificing your aunt for her. I would not be so certain this arrangement would work and you ay be delaying the inevitable. Having her become a ward of the State may not be as bad as you think.
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Reply to Ahmijoy
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She needs a NH and Hospice. She could pass by the time this gets thru the courts. At this point, I don't know why u don't go for guardianship. If Mom has money, Medicaid allows you to use her money, in case you may need Medicaid. It seems that Mom will pass sooner than later. As guardian you will be able to put a DNR in effect. You also will be able to place her into a NH with Hospice. All her needs will be met in the home. You can enjoy visiting. I think its nice of ur Aunt but like you said she has cared for other people. She may be a person who can't say no. Caregiving is not easy especially for an older person.
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Reply to JoAnn29
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Savitaa, that is exactly the point - why? would you not want the state to take over your loved one's care?

You have to bear in mind that in the OP's case we are talking about a loved one who *has consistently been* adamant that she does not want her family involved. So why go against those wishes when her needs can be met outside the family? What, at this point, could HelpingSon do for his mother that cannot be done much less painfully and just as effectively by the state's own officials? These people are paid, they are experienced and trained, and above all they are not emotionally vulnerable in this situation.

State guardians must act in the best interests of their ward. They will not prevent the OP's mother from seeing any of her children or other family members if she wishes to; and they will not ignore reasonable input from the family.

I cannot see what either HelpingSon or his mother stands to gain from fighting this battle.
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Reply to Countrymouse
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First, did the hospital rep indicate they're filing for guardianship b/c your mother needs care as well as a greater level of supervision, and is not cooperating with them? Or is there another reason?

Has anyone at the hospital discussed with you your position on this, or that there is a relative who can act?

I'm a bit confused about the 4 - 6 period before a state attorney contacts you. Where will your mother be in the interim? Did anyone mention an emergency guardianship?

I think you need to have a good discussion with whoever the hospital appointed to contact you to delve deeper into their intentions and purpose. It may be that they're leaving the choice of guardian up to the court, so make sure they know there's a family member available.

HOWEVER, even then, there's still the issue of placement. With late stage cancer and CHF, she's going to need a lot of support. Is she getting chemo? Radiation? Taking care of a late stage cancer patient is demanding, and emotionally draining, and from your description, will be a challenge as she won't cooperate.
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Reply to GardenArtist
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Helpingson, you mean the wider family would consider it shameful for your mother to be a ward of the state?

I understand that; but when you think it through this then becomes a matter of putting family pride or honour above your mother's own wishes, which she has made consistently clear, and possibly her best interests too.

She may have mental health issues, but she can be as nutty as a fruitcake and still have a genuine aversion to her business being discussed within the family.

As you say, and I'm sure you're right, there are issues at play here which are quite different from what you have all managed (great credit to you) to deal with before.

With your mother's being as ill as she is, perhaps you could persuade everyone that going with the flow for the sake of peace and quiet, and your mother's peace of mind as far as possible, would be for the best. The idea of the state's stepping in might still go against the grain, but these people are experienced professionals and the job will be done right. Nor will you be excluded from all discussion about her care, particularly not if you demonstrate that you want to co-operate.

I wish you the best of luck dealing with this very difficult situation.
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Reply to Countrymouse
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Countrymouse, thank you again for sharing. My mother will soon find that after her pending discharge, going home may not be a simple task due to the increased awareness by county/state agencies and hospital assessments of her physical and mental health. So my immediate short-term priority is to assess and recommend options. I will meet with her hospital Dr and staff today per their request (finally) ... they do not believe they can make a safe discharge, even though my mother wants to leave now. I'm searching for an elder care attorney, but that is to discuss long-term plans.
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Helpingson, I went to court to get guardianship over my mother in the state of Virginia. She fought it and the court appointed her a lawyer to represent her, and a guardian ad litem to make an independent assessment about what would be in her best interest. I had my attorney. It was not cheap: cost $18,000 for the three attorneys. (Fortunately, this came out of her assets per the law in Virginia.) As guardian/conservator, I can make all decisions about her health and welfare. I immediately moved her out of her condo and into assisted living (she has dementia).
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Reply to middledaughter
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HelpingSon, Guardianship is not necessarily care giving. The Guardian is the decision maker, much like a parent is for a child. You could make all medical, living, and financial decisions. For example, you could choose to place your mother with your aunt or in a SNF; whether your mother gets a certain treatment, when a DNR is applied, etc. The Guardian either appears before the court or at least files paperwork at least annually providing a status and accounting for expenditures - different states have slightly different procedures for obtaining guardianship and the guardian's responsibilities. I am most familiar with the process in TN, but have also researched laws in neighboring states where extended family live.

In most states, when the state/judge appoints a guardian it is often an attorney if the person has any money and a state social worker if private funds are not available. A judge is likely to appoint a family member over a social worker unless your mother can convince the judge she has a good reason not to accept a family member; although some judges will appoint the social worker if your mother states any objection at all.
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Reply to TNtechie
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Helpingson, if your mother has, God forbid, developed brain metastases and is no longer capable of mental functioning, then an application for guardianship will need to be made for purely practical reasons. But the family does not have to do that.

She could not have made it much clearer that she does not want her family directly involved in her decision-making. That is her right. The deep-rooted reasons for her strong feelings may not be known to you, may indeed have no basis in rationality, may be terribly unfair in their reflection on her relatives; but if you wish her to enjoy peace of mind might it not be better, as well as easier, just to respect them? Then you would be free to focus on offering her comfort and reassurance, as far as she will allow, instead of spending time on administration.

After all, the outcome in terms of her care plan won't be affected, just the personnel making the arrangements.
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