The phone call came to Dad’s daughter (FD) at 6 AM. Again. This time, it was the night caregiver reporting that her father had fallen while trying to get out of bed. She had jumped up and tried to stop him but she could only get to him in time to break his fall. Fortunately, he wasn’t hurt this time. She had a hard time getting him off the floor by herself and had called out to Dad’s wife in the next room to help get him back into bed. His wife, (SW) had slept through the entire thing. The caregiver was exasperated. She needed more help and SW did not provide it. It was the third incident in two weeks, and FD knew something had to change.
Trying To Supervise From A Distance
For months, FD had watched her father’s condition deteriorate from 300 miles away, visiting as often as she could. Advanced dementia had robbed Dad of his independence, and multiple physical ailments had left him requiring round-the-clock care. He was on hospice care, meaning he was expected to be at end of life within six months. He could no longer climb stairs. Even with workers there 24/7, he was not receiving the quality attention he needed in the two-story condo he shared with his wife of fifteen years. The bathroom was on the second floor and he couldn’t even have a shower. Sponge baths were just not what FD believed were good enough.
SW was extremely stubborn and totally resistant to change. She refused to participate in any discussions about FD moving Dad to a memory care senior home even when invited to do so. At 78 herself, she lacked the physical strength and emotional willingness to provide the extent of help her husband required. She was also rejecting the recommendations of both his primary care physician and the hospice team, countermanding their orders and putting Dad at greater risk every day. FD felt compelled to make a decision about moving Dad.
The Daughter’s Legal Authority
Years earlier, when her father was still lucid, he had designated FD as his agent with power of attorney for financial decisions. He had also placed her as his agent to make healthcare decisions if he could no longer do so. He intentionally did not give any such authority to his wife. Perhaps he understood that he could not really count on her if he ever became impaired. FD had already taken charge of Dad’s finances and was paying all the bills, including the rent on the condo. She knew she had to preserve his assets to pay for care to the end of his life, and she wanted the best for him. He was just not getting it with paid caregivers working one at a time on their shifts. More reinforcement was needed.
She did her research. She found an excellent care home a few minutes from where she lived and worked. She could stop by every day and check in on Dad, something she could not do from hundreds of miles away. Adding up the cost, it would turn out to be less expensive than the current arrangement, with the caregivers and rent on a condo that was not a workable environment for him. He would have to move and SW would have to also. That was going to be tricky to navigate.
Navigating Family Conflict
FD’s efforts to involve her stepmother in planning better care arrangements over the full prior year had been met with hostility and non-cooperation. Despite repeated invitations from FD to SW to discuss the issues about Dad with the beloved family doctor, and make a plan for moving Dad, SW seemed to cling to denial. She would not plan, nor discuss the matter.
The conflict created additional stress for everyone involved, including her father, who could sense the tension even in his diminished cognitive state. FD realized that waiting for agreements would only put her father at continued safety risks in an unacceptable quality of life situation. He kept begging FD to take him with her every time she visited.
Hospice Care-Could It Continue?
The new facility was willing to work with a local hospice organization that could continue the medical oversight her father had been receiving. This meant his medication management and comfort care would remain consistent while significantly improving his daily quality of life. They also recommended a new hospice physician who was treating other residents at the home and FD asked for him to accept her Dad for care. He did so. FD signed the documents to get Dad into his new home, and furnished his room. A date was set.
The Strategy Of How To Time the Move
FD sought advice from us at AgingParents.com, a nurse-lawyer/psychologist team about the move. Did she have the legal right to do this? Yes. Should she tell SW well in advance? No, that would create an opportunity for SW to undermine and sabotage the plan. We suggested that FD get copies of the legal documents together and create a letter to give to SW at the time of the move. She and another sibling who lived out of state were able to coordinate the plan for taking Dad by car to his new home. The sibling would be there. A faithful caregiver would accompany them on the drive of several hours. They informed Adult Protective Services and the local police department in writing that this was a legally authorized move and why it was necessary. They did this in anticipation that SW might call the police and accuse them of kidnapping Dad when they took him out. The preparation was in place. The move happened, much to FD’s relief.
SW was given a choice. She could move to a smaller condo in the same complex, suitable for one person if she chose, and FD would pay the rent there. Or, FD would help her find an appropriate place to live near Dad if she chose to do that, and FD would pay for the move and pay the rent from Dad’s assets. At the moment of the move, SW did not make a choice and her next steps were not clear yet. Whatever she decided, she would also be safe with enough of an allowance to live comfortably.
The Takeaways
- If you as an adult child or other family face these hard situations, trust your legal documents. FD knew that she had legal authority to make decisions for her Dad who was no longer competent to make them, and those decisions were necessary for his safety and well-being. She had to act courageously as SW resisted everything she offered prior to the decision. Most important, Dad had begged FD to take him with her when she visited, a sure sign that he was not happy in the condo with less than he needed and no privacy.
- Focus on your legal and moral obligation to protect the person who gave you authority to act when that person is no longer capable of making such decisions. They come first. Resistance from others must not stop you.
- Before any difficult decision like moving out of the home takes place, offer others involved the opportunity to give their input. In this case, multiple attempts to give SW the chance to weigh in were met with stonewalling or hostility. She then was told how it was going to be, as she failed to express any interest in decision-making. The consequences of refusing to plan with the person in authority had its impact.
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