Does anyone have a sibling they may one day be responsible for?

[Anonymous]

Just looking for advice on what kind of planning we should do. SIL has significant mental illness. She currently lives with MIL largely unmedicated (she is in her mid 40s and has one 12 year old daughter). She has really been decompensating but refuses to get help. MIL is not able to take the steps necessary to get a guardianship/conservatorship or have her committed. They live 2K miles away from us. When MIL passes (she has a current heart condition with deteriorating health) she plans on leaving everything to us (but she is low income so not much). SIL can not live alone . Hopefully her daughter will be 18 and off to college when MIL passes, but if not she will hopefully go live with her dad as her mother is not capable of taking care of her. SIL can 100% not live with us (I don't believe it is safe) and she can't live alone. So I don't really know what the options are aside from us getting conservatorship over her and committing her (which sounds like a very long expensive road) or essentially let her be homeless. Is there some option I am missing?

I have zero problem with just getting her a small apartment if I thought she could live by herself, but I don't think she can. She experiences extreme paranoia (constantly calling the cops to report people harassing her). I suppose there is the option to get her in home care, but she lives in rural TX so there aren't many options and only has disability. I don't think we can afford anything beyond state care.

Basically it is a mess and I was just wondering if anyone has any advice because I am kind of stressing out thinking about it.

[Anonymous]

Eek I'm so sorry OP. This is a very very tough situation. I don't have any great ideas because sadly the options are.. almost nil for severe mental illness like this but I will share that the idea you have about "committing" her is not something that really occurs anymore. Most laws have pretty strict laws about how long someone can be kept in a hospital or care setting involuntarily and the criteria to even be kept for 72 hours (literally) is HIGH. You have to be an ACTIVE threat to others or yourself. Clear and present threat. Not like, well she COULD do xyz, no it has to be that she actively said if she walks out of this building she is going to significantly harm someone AND she has the means to do it. That criteria will get you a 72 hour hold. After that the court becomes involved and at every step it has to be shown there is a threat.

So I would generally move away from in your mind that you will be able to somehow commit her. I would start trying to learn about mental health law a little and how all of this works. THere were major changes and they were done to protect those who are mentally ill, AND they can be very hard on families.

When you say she can't live alone, why? I don't mean that facetiously, but her overall functioning is important here. Calling the cops due to paranoia doesn't actually tell us about her ADLs or activities of daily living - could she feed herself? dress, shower? What kind of activities of daily living does she need help with? Medicaid will probably be the best route to get her care either through assisted living and/or eventually a nursing home setting but it's hard to know without really understanding what her level of functioning is.

[Anonymous]

most states* not laws

[Anonymous]

My point is, having paranoia or calling the cops doesn't actually preclude someone from living alone. I'm not saying it's an ideal circumstance, of course it's not. but without knowing more about someone's level of functioning in actually taking care of themselves it's hard to know. And basically there aren't many long term facilities for someone with persistent mental illness. Those that exist are very expensive. Most live with family, or if not live somehow subsidized on their own ideally with some wraparound services. This is why we have such a problem with homelessness with folks suffering from persistent mental illness. There just aren't adequate supports.

[Anonymous]

Know a woman with some sort of mental disorder. For years I witnessed her sister distancing herself from her. The woman lived with her mother who was advancing in age. The mother died and the sister let her stay with her for a short while. Over the past winter the woman started living in her car and the sister offered her a blanket.

[Anonymous]

Anonymous wrote:My point is, having paranoia or calling the cops doesn't actually preclude someone from living alone. I'm not saying it's an ideal circumstance, of course it's not. but without knowing more about someone's level of functioning in actually taking care of themselves it's hard to know. And basically there aren't many long term facilities for someone with persistent mental illness. Those that exist are very expensive. Most live with family, or if not live somehow subsidized on their own ideally with some wraparound services. This is why we have such a problem with homelessness with folks suffering from persistent mental illness. There just aren't adequate supports.

+1. No matter what path, it’s going to be a hard life. But many people in her shoes live alone. I think the Britney Spears situation has given people the wrong idea about when people are truly too impaired to be independent (and as a result need a conservatorship or other intervention). It takes much much MUCH more profound impairment than you describe OP.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My point is, having paranoia or calling the cops doesn't actually preclude someone from living alone. I'm not saying it's an ideal circumstance, of course it's not. but without knowing more about someone's level of functioning in actually taking care of themselves it's hard to know. And basically there aren't many long term facilities for someone with persistent mental illness. Those that exist are very expensive. Most live with family, or if not live somehow subsidized on their own ideally with some wraparound services. This is why we have such a problem with homelessness with folks suffering from persistent mental illness. There just aren't adequate supports.

+1. No matter what path, it’s going to be a hard life. But many people in her shoes live alone. I think the Britney Spears situation has given people the wrong idea about when people are truly too impaired to be independent (and as a result need a conservatorship or other intervention). It takes much much MUCH more profound impairment than you describe OP.

I forgot to add: if MIL owns the property I would just give the sister the right to stay in the home until she passes, either as a formal or informal life estate.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My point is, having paranoia or calling the cops doesn't actually preclude someone from living alone. I'm not saying it's an ideal circumstance, of course it's not. but without knowing more about someone's level of functioning in actually taking care of themselves it's hard to know. And basically there aren't many long term facilities for someone with persistent mental illness. Those that exist are very expensive. Most live with family, or if not live somehow subsidized on their own ideally with some wraparound services. This is why we have such a problem with homelessness with folks suffering from persistent mental illness. There just aren't adequate supports.

+1. No matter what path, it’s going to be a hard life. But many people in her shoes live alone. I think the Britney Spears situation has given people the wrong idea about when people are truly too impaired to be independent (and as a result need a conservatorship or other intervention). It takes much much MUCH more profound impairment than you describe OP.

a

Agreed pp, the britney situation is truly bizarre - it usually takes a pretty extreme circumstance to get conservatorship and even if you do it still doesn't mean they can just be "committed." The idea of this comes from old movies and times before the 70s when our approach to mental health radically changed (for better or worse, some better - some worse)

[Anonymous]

pp that originally posted here and thought of one practical thing that could be helpful for her mom to do or you can help with when the time comes - does she receive disability? it often takes years and multiple attempts even for someone with profound issues who really cannot work, so starting the process early so that she has some form of income stream is very helpful. This will also help in terms of Medicaid and accessing assisted living/nursing homes if that time comes.

[Anonymous]

I was hopping on to say the same thing - commitments are not a thing. Unless the state or county offers some sort of adult services, there really nothing and it’s been that way for decades.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My point is, having paranoia or calling the cops doesn't actually preclude someone from living alone. I'm not saying it's an ideal circumstance, of course it's not. but without knowing more about someone's level of functioning in actually taking care of themselves it's hard to know. And basically there aren't many long term facilities for someone with persistent mental illness. Those that exist are very expensive. Most live with family, or if not live somehow subsidized on their own ideally with some wraparound services. This is why we have such a problem with homelessness with folks suffering from persistent mental illness. There just aren't adequate supports.

+1. No matter what path, it’s going to be a hard life. But many people in her shoes live alone. I think the Britney Spears situation has given people the wrong idea about when people are truly too impaired to be independent (and as a result need a conservatorship or other intervention). It takes much much MUCH more profound impairment than you describe OP.

a

Agreed pp, the britney situation is truly bizarre - it usually takes a pretty extreme circumstance to get conservatorship and even if you do it still doesn't mean they can just be "committed." The idea of this comes from old movies and times before the 70s when our approach to mental health radically changed (for better or worse, some better - some worse)

As an attorney, I’ve had several people come to me proceeding with an assumption they can get a conservatorship over their relatives. The Britney Effect I guess.

[Anonymous]

I was a case worker for mentally I’ll older people, and things are much more stable for people who own their home. People who rent or live in governement housing can be evicted, and landlords will work to evict mentally ill people who are disruptive, don’t pay the rent, frighten others, hoard, etc. You can’t take away someone’s housing for those things if they own it!

Could you buy her a tiny house so she’ll have a place to live? That would reduce substantially her risk of homelessness.

As a PP said, I institutionalization isn’t a thing anymore for the mentally ill. It is for the developmentally delayed or those with physical impairments that prevent self care (like eating and toileting). She should already be on disability - if not, work on that.

[Anonymous]

Thank you everyone. I can provide a bit more detail. I think she is unable to care for herself, but don't know what the legal definition requires. She can not leave the house and is unable to attend doctor appointments or shop for food. She doesn't shower or brush her teeth (she actually doesn't have any teeth anymore. She got dentures but she did not take care of them and then got infections and wound up in the ER). She is unwilling to take medication.

She will eat if someone supplies her with food but she can not cook her own meals. She rarely eats meals even with food supplied and largely lives off little bite muffins (which are one of the only things she will eat). This is partially due to her lack of teeth, but again she refuses to seek help for her teeth.

If MIL leaves her alone for even small period of time she starts to decompensate and will not get out of bed (she even has difficulty leaving to go to the bathroom). She lives in MIL house but doesn't come out to the rest of the house and her room is essentially a hoarding situation.

She would be unable to pay or manage any bills. She is on disability, food stamps and welfare. She has been on disability probably for close to 20 years.

[Anonymous]

MIL doesn't own the property she mortgages it. We would sell it for money for SIL. I think maybe an apartment might work but I would need someone to come in to provide her with cleaning services and drop off food and encourage her to bathe and take care of her mouth (I assume there is some care even with no teeth).

[Anonymous]

Anonymous wrote:I was a case worker for mentally I’ll older people, and things are much more stable for people who own their home. People who rent or live in governement housing can be evicted, and landlords will work to evict mentally ill people who are disruptive, don’t pay the rent, frighten others, hoard, etc. You can’t take away someone’s housing for those things if they own it!

Could you buy her a tiny house so she’ll have a place to live? That would reduce substantially her risk of homelessness.

As a PP said, I institutionalization isn’t a thing anymore for the mentally ill. It is for the developmentally delayed or those with physical impairments that prevent self care (like eating and toileting). She should already be on disability - if not, work on that.

We may be able to buy her a place when the time comes. At least rural TX is cheap. I just worry about her living in squalor. I also really worry about her daughter, but just pray to God her dad will step up.