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Saturday, July 11, 2009

Does your aging parent need a guardian?

In this post, I am discussing guardianship of an ageing parent as opposed to trusteeship. The difference is that guardianship deals with personal and health issues and trusteeship deals with finances. In a future post I will talk more about how to tell if your parent needs a trustee.

The terms "guardianship" and "trusteeship" here refer to legal roles appointed by the court. If your parent has a valid Personal Directive and Enduring Power of Attorney in place, there is usually no need for anyone to be appointed by the court. However, if your parent hasn't prepared those papers, you may find that your parent needs protection and assistance and that you or someone else must be appointed by the court to provide that protection and assistance.

Your ageing parent might need a guardian to assist with personal and health care decisions if he or she:
- is unable to safely prepare meals for himself or herself, leaves pots and pans on the stove to boil dry, repeatedly scalds himself or herself with hot water, starts kitchen fires, or has problems remembering how to carry out other daily tasks that used to be familiar;
- becomes disoriented when he or she leaves home, forgets his or her address or forgets how to get home;
- fails to recognize people he or she has known for a long time;
- is unable to maintain personal hygiene on his or her own (e.g. bathing, toileting, dental care, grooming) or is unaware that hygiene is a problem;
- is unable to manage a condition or illness on his or her own, forgets to take essential medication or treatment, or because of memory loss, takes too much medication;
- is unable to safely transfer from a wheelchair to bed, toilet etc on his or her own;
- neglects medical or dental appointments, does not know how to make appointements, or is unable to get to appointments on his or her own;
- forgets to shop for food, toiletries, and other essentials or is physically unable to shop for essentials on his or her own;
- is unable to maintain his or her home in a safe, hygienic manner, neglects to repair broken windows or appliances, hoards items (e.g. newspapers) to the point that they become a hazard, fails to take out garbage regularly, or neglects to clean up after pets;
- often puts things in the wrong place, such as putting the telephone in the refrigerator;
- is experiencing more and more memory loss;
- has undergone noticeable personality changes or has become unpredictable; and/or
- would not be able to get out of the house quickly on his or her own in the event of fire.

These behaviours can be seen in many elderly people who are beginning to lose their mental competence. However, unless you are a doctor, it's not easy to understand what these behaviours mean or why they are occurring. By consulting with your ageing relative's doctor, you may be able to understand what is happening, and predict the kind of care your relative will need now and in the future. Keep in mind that the level of assistance needed may well change over time.

As a cautionary note, try not to jump to conclusions about an elderly relative's capacity. There could be medical explanations other than lack of capacity for isolated symptoms. For example, sometimes a person giving inappropriate answers to questions is confused and forgetful and this might be a symptom of incapacity. However, it is also possible that the person is perfectly in control of his or her faculties but is giving inappropriate answers because he or she is hard of hearing and doesn't have his or her hearing aid.

This is exactly what happened to a client of mine in his nineties who was taken to the hospital by ambulance and had no chance to grab his hearing aid on the way out. He couldn't hear the questions properly and his answers didn't match the questions he was being asked. It was taken as a sign that he was losing his mental abilities, though it was later shown in court that he was not.

The issue of identifying mental incapacity for the purposes of court-appointed guardianship (and what to do about it once it's identified) is discussed in much more detail in my book "Protect Your Elderly Parents".

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