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Originally published July 30, 2007 at 12:00 AM | Page modified July 30, 2007 at 2:01 AM

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Aging Deliberately

What to do when those with dementia don't want help

My e-mail inbox has filled up in recent weeks with one repeated theme ... older person with dementia isn't taking care of herself...

Special to The Seattle Times

Whom to call

When someone with dementia has no Durable Power of Attorney, contact:

For a care manager, The National Association of Professional Geriatric Care Managers at www.caremanager.org

My e-mail inbox has filled up in recent weeks with one repeated theme — an older person with dementia isn't taking care of herself.

She needs help paying bills, preparing meals, bathing and other important tasks, but she refuses to allow anyone to help. She hasn't named a person she trusts to make decisions for her, or she's named someone who's doing a poor job. What should the people who care about her do? Today I'll address the first issue: What to do if no one has the authority to make decisions on behalf of someone who's become demented. Next week I'll tackle the second: How to undo the decision-making power if it's in the wrong hands.

Here are two situations that have recently crossed my desk:

"Our elderly aunt broke her pelvis this summer and stayed for a few weeks in a nursing home to rehab, where the doctor diagnosed her as having dementia.

"Recently my brother and I brought her home because she insisted, even though we know she can't take care of herself. She thinks people are coming into her condo and stealing things, so she hides them, then forgets where they are — proving, she says, that she has thieves!

"She's easily confused, and I'm sure she can't pay her bills. Her condo is a mess. She hides food in the oven. We've contacted various social services agencies and have been told there's nothing we can do short of taking her to court and having her declared incompetent.

"She refuses to give my brother or me power of attorney, and she has no other living relatives. We live miles away and can't check on her daily like she needs. What can we do?"

And this ...

"My neighbor, a retiree in his late 70s, lives alone. His wife died years ago, and they had no children. He's a lovely man and quite capable physically, but he's now having trouble paying his bills. I'm convinced he has the money, but he's confused. The landlord is about to evict him."

Multiply these examples by, oh, a million older adults, and you can see what a common problem this has become. People over 85 are the fastest growing segment of the population, and almost half of everyone who reaches 85 has Alzheimer's (as well as many who are younger).

Dementia is something we must all prepare for, yet most don't. The consequences — often long, drawn-out horror stories — fall not only on the older person but on their families, friends and neighbors.

Documents known as "Durable Powers of Attorney" (DPOAs) allow us to name someone we trust, an "agent," to carry out our wishes when we're no longer able, and avoid these problems. One governs our health care; the second our money. We need both, but today's spotlight is on the financial tool.

The key to all DPOAs is to prepare and sign them while we're mentally capable. If you don't and you become demented — or if you're hit by a truck and left unconscious — your family has virtually no legal grounds for taking care of you the way you'd want. In most cases, their only option is to go to court and have a guardian appointed, which is an expensive and time-consuming process that requires ongoing oversight by a judge.

The good news is that there's still a little wiggle room for those who default.

"Getting a diagnosis of dementia before a DPOA is signed doesn't necessarily mean it's too late," says Janet L. Smith, an attorney in Seattle who focuses on guardianship and protecting vulnerable adults. "An experienced attorney can help families determine if the person has enough mental capacity to understand the document she's signing — in which case, she still can name someone to make decisions for her. This is why we encourage families with loved ones in the early stages of dementia to see an attorney."

Even when someone is confused and refuses to sign a DPOA, Smith says, there's still a chance. By getting past family dynamics, a neutral professional in the field — a fiduciary (someone who's paid to handle their financial accounts) or a geriatric care manager (a nurse or social worker trained in the needs of older adults) — may be able to develop trust and persuade them of the benefit of signing a DPOA.

When a guardianship is the only choice, says Smith, the process itself may cause the demented person to settle for a DPOA. In the case of the retiree, for example, the neighbor called Adult Protective Services, which contacted the attorney general's office to start guardianship proceedings, and a family member was found who became his decision-maker as part of a DPOA.

The first step is to get professional help, says Smith. A care manager can be invaluable, helping locate other resources, such as an attorney, guardian or fiduciary with the experience to know what they're doing. Adult Protective Services may also be helpful, especially if there's no family.

Next week: what to do if the designated decision-maker does a poor job.

Liz Taylor's column runs Mondays in the Northwest Life section. With 30 years experience in the field, she writes and lectures on a host of aging topics. E-mail her at or write to P.O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at www.seattletimes.com/growingolder.

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For an attorney, National Academy of Elder Law Attorneys at: www.NAELA.org.

For Adult Protective Services in Washington state, call 866-363-4276.

For a fiduciary or a guardianship service, contact the Senior Information & Assistance office in your area by going first to the nationwide Eldercare Locator at 800-677-1116 or www.eldercare.gov.

Copyright © 2007 The Seattle Times Company

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