A recent Guardian article offers excellent advice to caregivers for individuals with dementia. The author, Cynthia Dearborn, shared her experiences about caring for a father with vascular dementia. Cynthia described how her father’s short-term memory became severely impaired, along with his judgment and reasoning skills. I am having a similar experience with a Transition Plans’ client, who for the purposes of this post I will refer to as Mary.
I first met Mary thirty years ago when I prepared her first set of estate planning documents. We kept in contact over the years, and Mary came back into my offices shortly before Covid to review her power of attorney forms. Some relationships had changed in Mary’s life, and so we put new Transition Plans documents into place for her. This past December, four years after execution of the most recent powers of attorney, Mary emailed to indicate she would need a new set of power of attorney forms. When I questioned whether her relationships had changed again, Mary hesitated. I then forwarded copies of her most recent forms and suggested we get together to discuss whether Mary actually needed new forms. Mary did come in and we revised her health care power of attorney, but left her financial power of attorney in place. Two months later, Mary fell down some stairs at a church and broke her arm and leg. Mary’s attorney in fact then called me for help. Mary had to be hospitalized and it was discovered that Mary had vascular dementia. Mary has no family and was completely dependent upon her attorney-in-fact. The attorney-in-fact was overwhelmed by all of the decisions that had to be made for Mary’s financial affairs and long term care.
As the Guardian article describes, Mary has serious short term memory issues. She would raise an issue which we would discuss, and then after a few minutes, raise the same issue again. Mary often became belligerent about changes required for her physical therapy. The doctors concluded that Mary’s injuries would require months of therapy and would preclude Mary from returning to her home. Mary aggravated the situation by refusing to follow the doctors’ orders about walking. Certain issues triggered a foul mood for Mary, and we would have to change the subject when that mood threatened to shut down the discussion. We quickly concluded that care decisions had to be made without Mary’s input. As the article suggests, we had to alter our way of communicating with Mary.
Dementia patients cannot often grasp the issues they face, and consequently, all responsibilities for finances and health care may be thrust upon the caregiver. In Mary’s case, there were POA forms in force that allowed her attorney-in-fact to make critical decisions about the move to assisted living and the sale of Mary’s house in a timely manner. Without powers of attorney, a caregiver must go to court for both a conservatorship and guardianship for the authority to make such decisions.