To those that believe the elderly should always make their own decisions

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I was one of those social workers who investigate people for elder abuse. What I did in reality wasn’t anything like that sounds. Someone would call us worried about an elder, and I’d go figure out what was going on, and do everything I could to help. I did lots of listening, hand holding, phone calling insurance plans, finding Medicaid beds in assisted living, lining up care givers, and finding mental health providers. Oh, and lots of cleaning for people with hoarding disorders. My clients were almost always mentally ill or had some level of dementia. It was truly, truly rare to have a situation where some one was abusing an elder for malicious reasons. It was almost always a situation where physical health and mental health decline simply made the family system collapse. Unless there was violence or outright theft of assets no one was ever “brought up on charges” or “charged with elder abuse.” We were just social workers, not police, and the only tools we had were help.

OP, I know this is hard. I hope you find some peace and some enjoyment this holiday season.

Haven't you encountered the elder who is able to present as absolutely logical, or who at least is able to present as legally competent but exercises rights to his/her own decision making? And perhaps a spouse who is totally on board, or presents as being totally onboard? I'm thinking of 2 situations. One where an elder relative wanted help from adult services but due to problems with decision making let others make the call, and when investigated still wanted the help but was deemed too capable (his physician, nurse, and the social worker they worked with knew better, but adult services gave a thumbs down). And one involving hoarding, some long standing MH diagnosis where treatment is refused but where the mental situation is not dire enough to warrant hospitalization, even though the hoarding has long reached the point where it is life and health threatening.

Yes, for sure I’ve encountered those situations. Unless a person has significant dementia or is truly psychotic they generally retain the right to make terrible decisions. It’s a tricky balance and I don’t envy the doctors and judges who together make these calls. In the few times in my work where an elder did have a guardian appointed and that guardian forced something like a nursing home or a move the elder often did not thrive in the new setting. It makes kids feel like they have done the right thing to have a parent miserable, angry, and depressed (but safe) in a nursing home rather than somewhat content (and at high risk of death) while home alone. I don’t entirely understand. I’ve spent plenty of time in nursing homes, and personally I’d rather take my chances with a fall and lingering death on the floor alone. So I give my own parents (and gave my clients, where they were legally competent) the same respect for their preferences.

I can't with this. So the parent has the 'sads' but is safe, warm and fed. EVIL KIDS, clearly. I guess I should let my parents live in a home they can't afford, have it sold out from under them to pay for debt they incur. Maybe they can lose their last asset that can pay for their care, but hey, they are happy so why not, right?

This is why I can't stand social workers. You are all about 'the feels' and not the practicality of the situation. Did you NOT read the earlier post about the poster who said her grandfather starved her grandmother to death? Do you let toddlers wander outside in snowstorms in a diaper because they might tantrum in warm clothing?

I’m the psychologist PP above: you’re either not understanding or choosing not to consider adults’ agency in these scenarios. Once someone turns 18 and is a legal adult, the standards for obtaining legal guardianship are very, very high. You can debate whether they should be so stringent, but hating on social workers is unfair and misplaced anger. They don’t make the laws.

The grandfather starving the grandmother is similar to intimate partner violence scenarios, in which the abused partner chooses to stay. There’s almost nothing another adult can do, legally, to force that person to leave. Someone upthread suggested the grandchild in that case should have reported her grandfather to adult protective services, only to be told by someone else (you?) that would have meant more problems. These situations are rarely as straightforward as they may seem to be from the outside.

No, not me. Go look up Valerie Smelzer and tell me not to hate on social workers after reading how they failed that child, after call after call reporting abuse came through to them, from the school to neighbors, etc. NOTHING was done for that poor child. They dropped the ball.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I was one of those social workers who investigate people for elder abuse. What I did in reality wasn’t anything like that sounds. Someone would call us worried about an elder, and I’d go figure out what was going on, and do everything I could to help. I did lots of listening, hand holding, phone calling insurance plans, finding Medicaid beds in assisted living, lining up care givers, and finding mental health providers. Oh, and lots of cleaning for people with hoarding disorders. My clients were almost always mentally ill or had some level of dementia. It was truly, truly rare to have a situation where some one was abusing an elder for malicious reasons. It was almost always a situation where physical health and mental health decline simply made the family system collapse. Unless there was violence or outright theft of assets no one was ever “brought up on charges” or “charged with elder abuse.” We were just social workers, not police, and the only tools we had were help.

OP, I know this is hard. I hope you find some peace and some enjoyment this holiday season.

Haven't you encountered the elder who is able to present as absolutely logical, or who at least is able to present as legally competent but exercises rights to his/her own decision making? And perhaps a spouse who is totally on board, or presents as being totally onboard? I'm thinking of 2 situations. One where an elder relative wanted help from adult services but due to problems with decision making let others make the call, and when investigated still wanted the help but was deemed too capable (his physician, nurse, and the social worker they worked with knew better, but adult services gave a thumbs down). And one involving hoarding, some long standing MH diagnosis where treatment is refused but where the mental situation is not dire enough to warrant hospitalization, even though the hoarding has long reached the point where it is life and health threatening.

Yes, for sure I’ve encountered those situations. Unless a person has significant dementia or is truly psychotic they generally retain the right to make terrible decisions. It’s a tricky balance and I don’t envy the doctors and judges who together make these calls. In the few times in my work where an elder did have a guardian appointed and that guardian forced something like a nursing home or a move the elder often did not thrive in the new setting. It makes kids feel like they have done the right thing to have a parent miserable, angry, and depressed (but safe) in a nursing home rather than somewhat content (and at high risk of death) while home alone. I don’t entirely understand. I’ve spent plenty of time in nursing homes, and personally I’d rather take my chances with a fall and lingering death on the floor alone. So I give my own parents (and gave my clients, where they were legally competent) the same respect for their preferences.

I can't with this. So the parent has the 'sads' but is safe, warm and fed. EVIL KIDS, clearly. I guess I should let my parents live in a home they can't afford, have it sold out from under them to pay for debt they incur. Maybe they can lose their last asset that can pay for their care, but hey, they are happy so why not, right?

This is why I can't stand social workers. You are all about 'the feels' and not the practicality of the situation. Did you NOT read the earlier post about the poster who said her grandfather starved her grandmother to death? Do you let toddlers wander outside in snowstorms in a diaper because they might tantrum in warm clothing?

I’m the psychologist PP above: you’re either not understanding or choosing not to consider adults’ agency in these scenarios. Once someone turns 18 and is a legal adult, the standards for obtaining legal guardianship are very, very high. You can debate whether they should be so stringent, but hating on social workers is unfair and misplaced anger. They don’t make the laws.

The grandfather starving the grandmother is similar to intimate partner violence scenarios, in which the abused partner chooses to stay. There’s almost nothing another adult can do, legally, to force that person to leave. Someone upthread suggested the grandchild in that case should have reported her grandfather to adult protective services, only to be told by someone else (you?) that would have meant more problems. These situations are rarely as straightforward as they may seem to be from the outside.

No, not me. Go look up Valerie Smelzer and tell me not to hate on social workers after reading how they failed that child, after call after call reporting abuse came through to them, from the school to neighbors, etc. NOTHING was done for that poor child. They dropped the ball.

Do you always generalize a single case to an entire profession?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I was one of those social workers who investigate people for elder abuse. What I did in reality wasn’t anything like that sounds. Someone would call us worried about an elder, and I’d go figure out what was going on, and do everything I could to help. I did lots of listening, hand holding, phone calling insurance plans, finding Medicaid beds in assisted living, lining up care givers, and finding mental health providers. Oh, and lots of cleaning for people with hoarding disorders. My clients were almost always mentally ill or had some level of dementia. It was truly, truly rare to have a situation where some one was abusing an elder for malicious reasons. It was almost always a situation where physical health and mental health decline simply made the family system collapse. Unless there was violence or outright theft of assets no one was ever “brought up on charges” or “charged with elder abuse.” We were just social workers, not police, and the only tools we had were help.

OP, I know this is hard. I hope you find some peace and some enjoyment this holiday season.

Haven't you encountered the elder who is able to present as absolutely logical, or who at least is able to present as legally competent but exercises rights to his/her own decision making? And perhaps a spouse who is totally on board, or presents as being totally onboard? I'm thinking of 2 situations. One where an elder relative wanted help from adult services but due to problems with decision making let others make the call, and when investigated still wanted the help but was deemed too capable (his physician, nurse, and the social worker they worked with knew better, but adult services gave a thumbs down). And one involving hoarding, some long standing MH diagnosis where treatment is refused but where the mental situation is not dire enough to warrant hospitalization, even though the hoarding has long reached the point where it is life and health threatening.

Yes, for sure I’ve encountered those situations. Unless a person has significant dementia or is truly psychotic they generally retain the right to make terrible decisions. It’s a tricky balance and I don’t envy the doctors and judges who together make these calls. In the few times in my work where an elder did have a guardian appointed and that guardian forced something like a nursing home or a move the elder often did not thrive in the new setting. It makes kids feel like they have done the right thing to have a parent miserable, angry, and depressed (but safe) in a nursing home rather than somewhat content (and at high risk of death) while home alone. I don’t entirely understand. I’ve spent plenty of time in nursing homes, and personally I’d rather take my chances with a fall and lingering death on the floor alone. So I give my own parents (and gave my clients, where they were legally competent) the same respect for their preferences.

Do you understand that sometimes the person living on their own in a dangerous situation isn't just a hazard to themselves, but everyone around? If they light their own kitchen on fire it can affect the neighborhing homes? A firefighter can be severely injured or even killed try to put it out/rescue the people inside?
So what if a 30 year old firefighter that's a spouse and parent of 3 young kids die--as long as 90 year old grandpa doesn't need to do a single thing he doesn't want to do?

[Anonymous]

This whole discussion underlines the fact that we have to have a reckoning about the aging process and how to manage it as individuals, families, and as a society. People are living so long now (I would argue perhaps TOO long) that the final stages of aging are lasting longer and causing more problems for everybody involved. I don't know what the answer is, but I know we have to have the conversation and that policy changes have to follow at some point.

[Anonymous]

I watched my inlaws literally die from being allowed to make their own decisions. "They deserve to live and die how they want."

No, they were in denial that they would die, period, refused treatment, got thrown out of rehab for not cooperating, went home with poor and absent care and died in a horrible nursing home due to systemwide septic shock and stroke. Horrible to watch. The other died at home, refusing help. They actually would have not only lived, but thrived for several more years, even possibly a decade. One sibling did her best to let them do what they wanted. There's always one sibling who does this because they don't want to help.

[Anonymous]

Nursing homes are where the elderly go to die. At least the ones where the person is confined to a room with one bed. I've never seen anyone willingly move into a nursing home.

[Anonymous]

Anonymous wrote:Nursing homes are where the elderly go to die. At least the ones where the person is confined to a room with one bed. I've never seen anyone willingly move into a nursing home.

there are steps between four bedroom house with a yard in the burbs and a nursing home. trying to convince my parents to downsize to something more manageable at their age--no yard, one floor, less square footage so easier to maintain--but they refuse. they don't want to deal with the hassle of downsizing, but how is that going to get better or easier when they're older?

[Anonymous]

Anonymous wrote:Nursing homes are where the elderly go to die. At least the ones where the person is confined to a room with one bed. I've never seen anyone willingly move into a nursing home.

Not true. Especially for stroke victims. Due to the incredible amount of physical assistance the paralyzed may need (usually requiring two able-bodied people) it is nearly impossible to care for them in any home-based scenario.

You may also be surprised to learn that not all residents of "nursing homes" are elderly. There are usually a good percentage of younger residents, too. Like car accident victims.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Nursing homes are where the elderly go to die. At least the ones where the person is confined to a room with one bed. I've never seen anyone willingly move into a nursing home.

Not true. Especially for stroke victims. Due to the incredible amount of physical assistance the paralyzed may need (usually requiring two able-bodied people) it is nearly impossible to care for them in any home-based scenario.

You may also be surprised to learn that not all residents of "nursing homes" are elderly. There are usually a good percentage of younger residents, too. Like car accident victims.

^Meant to add that stroke victims can live for MANY years after their stroke.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Nursing homes are where the elderly go to die. At least the ones where the person is confined to a room with one bed. I've never seen anyone willingly move into a nursing home.

there are steps between four bedroom house with a yard in the burbs and a nursing home. trying to convince my parents to downsize to something more manageable at their age--no yard, one floor, less square footage so easier to maintain--but they refuse. they don't want to deal with the hassle of downsizing, but how is that going to get better or easier when they're older?

It won’t. They will rely on relatives to help with all the chores involved in caring for their home or for continuing to live in their home. This will give them the illusion of independence. That’s what has happened with my in-laws and with the parents of several friends and neighbors. Their children or nephews/nieces are the ones cutting the grass, shoveling snow, doing the grocery shopping, managing medical appointments, etc etc. In several cases, daughters (or sons, but to a lesser degree) have had to move in with their parents to care for them in their own home, to the detriment of their careers and marriages. My SIL has been doing this for over 10 years. It cost her her marriage and she can’t work FT, but she wouldn’t have it any other way. It’s not about an inheritance—she is in a lucrative profession. It is what it is. I vow every time I think of it to never do this to my own child.

[Anonymous]

I am seeing a little of this dynamic from afar with my MIL. She is in advanced stage of Parkinson's, and needs day time care, and night-time supervision. One of my BIL lives with her, and there is a cast of rotating aides.

We're overseas and can only help by managing the long-term portfolio, to ensure that she has money until the end. However I feel for my BIL who lives with her. I'm not sure if this could continue just with the aides, who are willing and kind enough, but uneducated and who might not know what to do in case of emergency - and there have been emergencies. So it all comes down to my BIL. He has two houses, but chooses to live with his mother. He could go on vacation, but prefers to work and then sleep the night over at her house so he can be there in case of falls or pain crises.

He's a saint. I am forever grateful that such people exist, but I worry that he's too hard on himself. At the same time, he's probably thinking that all the other possible options, such as hiring an aide for the night too, aren't good enough for his mother and too expensive for the service he's going to get. He's the type to prefer doing things himself.

[Anonymous]

Anonymous wrote:Drop the rope, Drop the rope, Drop the rope.

If you sister won't let you sleep in a bed in a bedroom in the house let your sister manage all of the affairs.

This. Drop the rope. If sister is in town let her deal with it. If you cannot sleep in a bedroom in the house turn everything over to the sister.

[Anonymous]

Anonymous wrote:Nursing homes are where the elderly go to die. At least the ones where the person is confined to a room with one bed. I've never seen anyone willingly move into a nursing home.

No. Rehab nursing homes get the person back to wherever they could be. Stop generalizing. Without care, elderly patients die from a lack of oversight in diabetes, stroke, septic shock, pill misuse, nutrition, oxygen levels.

[Anonymous]

Anonymous wrote:I watched my inlaws literally die from being allowed to make their own decisions. "They deserve to live and die how they want."

No, they were in denial that they would die, period, refused treatment, got thrown out of rehab for not cooperating, went home with poor and absent care and died in a horrible nursing home due to systemwide septic shock and stroke. Horrible to watch. The other died at home, refusing help. They actually would have not only lived, but thrived for several more years, even possibly a decade. One sibling did her best to let them do what they wanted. There's always one sibling who does this because they don't want to help.

Exactly right. Do people let toddlers make their own decisions because ‘it’s easier’ or ‘it’s what they want to do’? Because that’s essentially the age-range you deal with as elderly fail

[Anonymous]

Anonymous wrote:

Anonymous wrote:I watched my inlaws literally die from being allowed to make their own decisions. "They deserve to live and die how they want."

No, they were in denial that they would die, period, refused treatment, got thrown out of rehab for not cooperating, went home with poor and absent care and died in a horrible nursing home due to systemwide septic shock and stroke. Horrible to watch. The other died at home, refusing help. They actually would have not only lived, but thrived for several more years, even possibly a decade. One sibling did her best to let them do what they wanted. There's always one sibling who does this because they don't want to help.

Exactly right. Do people let toddlers make their own decisions because ‘it’s easier’ or ‘it’s what they want to do’? Because that’s essentially the age-range you deal with as elderly fail

In many ways the "classic" forms of dementia like Alzheimer's or Parkinson's are easier because there's a clear trajectory and a list of defined options. Moderate dementia without a diagnosis or mental illness are so so hard, especially if the person presents as normal long enough to get through a short interview. There aren't legal mechanisms to intervene. There often isn't universal family support to intervene. Yet the person can do a lot of harm to themselves and others. It's really hard.

For examples, recall all the examples of elderly people driving through farmer's markets or the wrong way down streets, killing and injuring people. In those cases I bet all should have had their license taken away sooner, but there wasn't the family will or a legal means to do so.