Newsletter June 2009

It’s Carolyn here with your June edition of the Aging Parents
newsletter. I hope you found last month’s edition helpful on the
frightening thing about having a loved one in “the grey area”. If
you missed it, be sure to send me an email letting me know, and I
will happy to forward it to you.

This month were discussing “frustrations with the healthcare directive” (a document that enables you to act on another person’s behalf for healthcare decisions), sometimes its also called a “healthcare power of attorney”, or a “living will”.

Let me start by saying this, if you think everything is fine once
an elderly parent signs that healthcare directive, think again.
Not everyone understands how it should be used, or even what it
means. The law is clear–but people aren’t.

The following is a situation that really took place in an assisted living facility involving a caregiver daughter who is the lawful agent for her
mom’s healthcare directive. Mom has dementia. The treating doctor
decided to try her on a medication to treat the symptoms of
dementia. And now, he’s out of town…

The daughter, herself a nurse, noticed that her mom has diarrhea
and it started exactly when she began the new medication. Nothing
else in mom’s diet or other medicines has changed.

Daughter asked the administrator to stop giving the new medication until the diarrhea problem is discussed with the doctor. The administrator refused to stop the medication.

The administrator is wrong in doing so. The mom is no longer
competent to maker her own healthcare decisions. The purpose of a healthcare directive is to appoint a competent person to make
healthcare decisions when an elder is no longer able to do this.

The administrator insisted that mom had to “refuse” the medication
or it had to be given. Regardless of diarrhea. Of course, this is
dangerous.

Continued diarrhea can lead to dehydration and that can cause other, serious health complications. Mom has no idea what medication she takes and won’t remember if her daughter suggests that she refuse the medication.

What should the daughter do?

She had contacted us for a consultation before this incident, so we were familiar with the general circumstances of her mom’s health. We know that every assisted living facility in the state has a liaison, called the “ombudsman”, whose job it is to serve as a go-between when there are resident or family complaints about a facility. We advised the daughter to contact the ombudsman immediately. We suggested how she approach the subject and what to say.

The ombudsman has the obligation to investigate the problem. It’s
possible that a conversation among the administrator, ombudsman and daughter will lead to the desired result. But ombudsmen are often volunteers, and are generally not medically trained. There is a
chance the ombudsman won’t act or act fast enough.

If asking the ombudsman for help did not work, daughter would have
several other alternatives…

She could contact Mom’s doctor’s office and find out who covers his
calls when he is out of town. She could contact the substitute,
explain the situation, and ask that that MD stop the medication
until the treating doctor gets back in town.

She could have an attorney contact the facility on her behalf and
assert her right to act as her mom’s agent on the healthcare
directive. The administrator doesn’t seem to understand the
meaning of this document. This could work, though it could make
the administrator defensive and hostile.

Another approach is to stand by mom’s side when the medication is
about to be given to her (along with the medications she needs and
will take), and direct her mom to refuse the new medicine.

Finally, she could put her request in writing for the medication to
be stopped on the basis of her right to make this decision as mom’s
agent for healthcare. In the letter, she could mention that as a
nurse, she has a reasonable belief that the medication is causing
diarrhea and that she thinks several more days of diarrhea would be
dangerous to her mother’s health.

It is amazing how making a written request creates a record and has a way of getting the attention of administration.

That’s it for now. If you have any further questions, comments, or
feedback, I would like to hear from you. Just hit reply and send me
an email.

Thanks for reading,
Carolyn L. Rosenblatt, R.N, B.S.N, Attorney at Law
AgingParents.com

To learn more about how to advocate for aging loved ones, see The Boomer’s Guide to Aging Parents, Vol. 9: How to Stand Up For Your Elder in the Healthcare System –> HERE <–