[mrscrofts]

My 71-year-old mother-in-law is a chronic alcoholic and smoker for over 50 years. Over the last several months she has lost a dramatic amount of weight, appears jaundiced, her fingers and toes are purple, and she can barely walk. Two weeks ago we got a call from her neighbor because she suddenly was no longer able to walk. When my husband went by her house, she initially didn't seem lucid and didn't recognize him for several minutes. Her house was a mess and it was obvious she was unable to care for herself very well. But she refused to go to the hospital and told him the same thing had happened the month before and she recovered in a few days. The next day my husband went back and she was shuffling around with difficulty. He convinced her to sign advanced directives and she designated him as her power of attorney. Nevertheless she doesn't want to go to a doctor and insists she can take care of herself. She is on medicaid and got a reverse mortgage on her house with $20k left in the account. I talked to a friend of mine who is an ER doc of over 20 years and she told us to take her to the ER to get a battery of tests, scans, x-rays etc. to get some answers. Once we get a diagnosis we could do hospice. What do you suggest?

[medic-dan]

Hi MrsCrofts,

You're in a difficult situation.

As long as your mother-in-law is capable of making her own informed decisions she can refuse any and all medical care. It's her right.

If you ever find her in such a condition, shuffling and not recognizing people/places, that's when you seek emergency medical attention - CALL AN AMBULANCE. She can't refuse treatment if she's not competent. Your husband did everyone a disservice.

You don't know if she needs "hospice care" yet. You are not in a position, and neither is the "ER doc" without an exam. It may be an easily treatable condition.

Did she actually see a lawyer about the advanced directives/power of attorney? Or was it prepared and brought for her to sign?

There are many things about this post that I, from someone in the healthcare field, find disgusting. You both seem to be more concerned with finances than you do her health and well-being.

[joypulv]

medic-dan, there is NOTHING in what was said that is disgusting or overly concerned with finances.
The husband did all the right things in my opinion, from the POA (not sure what kind or kinds) to advance directives, to worrying about how much she has left before her house is sold out from under her by the reverse mortgage lender!

Bottom line is that your MIL can refuse health care, refuse to get into an ambulance, and revoke POAs.
If you find her in a state where she is unable to walk or be coherent, by all means call an ambulance.
I would sign up for visiting nurses in her area. She will need to have a regular MD first, who will have to order the VNA.
Hospice nurses are defined as '6 months to live' but can keep being renewed, so are a good thing, because Medicare pays for more hours per week for hospice (in the home).
Why not let her stay home as long as she wants, if possible?

[medic-dan]

I respectfully disagree Joy.

If you find someone having difficulty walking and not recognizing family member you call an ambulance - RIGHT THEN. You don't wait. What if it was a stroke? You get MEDICAL help before you get LEGAL help.

The reverse mortgage is irrelevant to her health or care at the moment. That's what needs to be addressed before ANY decisions are made.

[joypulv]

He is to be forgiven for not calling an ambulance in the first minute. It's normal to try to connect with your mother when she's being vague and not lucid! Then (2, 3 minutes later, not clear, the OP is the DIL) she recovered enough to refuse to go. He had no choice at that point.

Speaking as a person who has cared for both parents before they died, I assure you that finances are intertwined every step of the way, even at the most critical moments, and being prepared with answers is better than not. I had to provide financial information when one parent was one the way from one place to the next. As soon as the term is up, she is evicted.

OH - and both my parents 'refused to go' too. Happens every day, and it's a tough situation. I understand your position, but the words you used were too condemning.

[medic-dan]

I understand your position as well.

Perhaps I was too harsh, for that I apologize to Mrs. Crofts.

I've seen it all, many times.. You're trying to administer care and the family is already discussing who gets what - in front of the patient.

The mother-in-law needs medical attention, clearly. There was an opportunity to do that if she is not lucid. Let the professionals evaluate her, it's their job. They can explain why she should see a doctor much better than her family.

At this point, if she won't see her doctor there is nothing else that can be done for any sort of care, including hospice. That's where to start.

[dontknownuthin]

The OP is asking for advice and harsh as it may sound, these symptoms are almost certainly not going to be easily treated. Common sense suggests a high possibility that a lifelong alcoholic in the described state is in liver failure... dead giveaway being the jaundice. No guarantee without a professional medical evaluation, but she is probably dying.

I do not know that taking her out of her house against her will is the best thing to do. From the standpoint of her comfort, she would have to stop smoking and drinking, and the detox would be very hard if she is hospitalized. It might be more humane to give in to her wishes to stay home.

It sounds neglectful, but anyone who has dealt long term with an alcoholic understands that they do not think like sober people, and the road out is a long and painful one. If she's in her last days, it's a little late for rehab.

Perhaps the son can try to get her to get checked out, but respect her wishes if she learns she is dying and wants to go home.