My uncle does not want anyone to know about his finances and will not complete a health care proxy.

Q: My uncle lives in low income housing. He is 94 years old and keeps to himself. He has no children to help. My uncle was very involved in my life as a child and I would like to be of assistance to him. My uncle does not want anyone to know about his finances and will not complete a health care proxy. He only provides me with limited information about his health. He told a cousin that he would like me involved in decision-making if he can not make decisions for himself. Is there anything I can do prevent a crisis?


A: Unfortunately, unless there is a document such as a health care proxy there is nothing you can do to avoid a crisis. Without your uncle completing a power of attorney or a health care proxy the physicians are not legally bound to discuss with you any medical problems about your uncle. If your uncle chooses not to complete a health care proxy and presents with dementia, then a guardianship will need to be obtained through the courts. If your uncle trusts his physician or a friend, maybe they can talk with him to explain the importance of these documents before a crisis occurs. As long as your uncle is competent to make his own decisions, then he is able to choose not to complete these important documents. If there is a medical crisis, remind yourself that you tried to avoid this situation.


Q: My mother lives in an assisted living facility. I am wondering when it might be time to move to her a nursing home. My mother is now requiring more help with personal care and her dementia is worsening. She loves her apartment and her friends. Moving my mother is emotionally difficult for me but I know I need to do what is best for my mother?


A: Seniors move from assisted living to a nursing home for many reasons. One of the top reasons for a move is because of a medical need. Assisted living facilities are social models and nursing homes are medical models. First talk with the assisted living personnel to discuss with them what they can and can not provide. Some assisted living arrangements may have a memory care unit where more care is provided. The memory care unit within the assisted living offers more hands-on care and activities geared for the senior with dementia. Another option is to increase services for your mother however this will cost an additional charge. If you feel that the cost is just too high or your mother's savings are limited then it is time to think about a move to a medical model. Most assisted living facilities are not able to provide two people for care or transfers and that is the time to consider a move to a nursing home. Some assisted living homes can provide transfers with a Hoya lift, allowing a senior to stay longer. If your mother needs monitoring during the night (i.e., wandering through the night or help getting out of bed for toileting), if she has a diagnosis of dementia and the disease is progressing, if she needs 24/7 supervision and assistance, if she is unsafe in her current environment, if her finances do not allow additional services to be put in place, and if she now needs a nurse for medical care, then it is the time to move your mother to a nursing home.


ElderCare Resource Services is a partnership of geriatric nurses and social workers that helps families to investigate, assess and recommend medical and non-medical care and resources for seniors.


Send questions to SeniorSavvy@ElderCareResourceServices.com or ElderCare Resources Inc., 29 Gano Road, Marlborough, MA 01752, or call them at 508-879-7008.