Comments on: Everything you need to know about dementia & legal issues

By: Dr. Nathan Herrmann

Dr. Nathan Herrmann — Fri, 16 Nov 2018 16:53:00 +0000

Hi. People with moderate dementia living on their own are my professional nightmare! The scenarios you describe are unfortunately not uncommon, and current medicolegal regulations in most western countries have made it increasingly difficult for families to intervene until danger is “imminent”. That is the price of ensuring personal liberties and limiting professional paternalism. I spend a lot of time empathizing with families in this situation, and telling them that sometimes, people need to get much worse cognitively or functionally before the family is able to intervene. As you note, it sometimes does require a crisis or an emergency room visit to finally enact an appropriate care plan.
Having said all that, caregivers should be aware that there are resources in many communities that might be helpful. Some communities have mobile crisis teams,and/or home visiting psychogeriatric services. In certain locales presenting before a Justice of the Peace, or utilizing the Public Guardian may allow intervention. Finally, in many communities, Community Relations Officers from the Police Department, can be very helpful.

By: Liz

Liz — Thu, 15 Nov 2018 22:11:00 +0000

Hi Dr. Herrmann,
I work in private retirement communities. What I often find is that those with more moderate stages of dementia that develop behaviours while living in their own home are very difficult for the family to manage. For example, residents refuse to take medication, refuse to use a walker, refuse to bathe, send home care help away, stop eating, devlop infections etc. No one can “force” these individuals to do these activities. Families often watch their parent decline not knowing how to help. What are families to do when doctors are unwilling to declare an elderly person incapability of making there own medical decisions? Even if they are declared incompetent, can they really force someone to bathe or take medications. Do they have to wait for an emergency room visit before they can act? These seniors are often at medical and financial risk due to ‘stubbornness’. They experience personality changes and start lashing out at their family who is only trying to help.

By: Dr. Nathan Herrmann

Dr. Nathan Herrmann — Fri, 24 Aug 2018 14:28:00 +0000

Hi. The answer depends on the province/country in which your dad resides, as all these issues differ from province to province, and country to country.
In general, as POA for property, it should be your responsibility to protect your Dad’s estate, based on his previously expressed wishes. If, in your opinion, your father is making inappropriate financial decisions based on the impairment from his dementia, it would be best to speak with his MD and then a lawyer about how best to proceed from a medicolegal perspective. While he may need to be declared incapable to manage his affairs, the process differs based on the exact wording of the POA document, and the local legislation. Best of luck!

By: D Mercer

D Mercer — Thu, 23 Aug 2018 18:48:00 +0000

Hi Dr. Hermann. I am a Canadian resident with an elderly father with vascular dementia and 2 previous strokes, in residential care (nursing care). My question is medico-legal regarding declaring incompetency of handling his own affairs as he is starting to request thousands of dollars on hand, purchasing a car he would be unable to drive (no license, would not be qualified), etc. I am the only active caregiver and do hold all of the usual medico-legal paperwork that my father put in order a few years ago so I could manage his affairs. My question is, with his new requests which are not in his best interests, is it adviseable or necessary to get him legally declared incompetent?

By: Dr. Nathan Herrmann

Dr. Nathan Herrmann — Wed, 27 Jun 2018 19:39:00 +0000

In reply to BrandStrategyGuru. In Ontario and most jurisdictions, the personal health information and privacy legislation that governs health care practitioners would not allow the physician to provide any health information to you or your aunt’s husband, without your aunt’s permission. However, there is absolutely nothing that bars you or her husband from contacting that MD either by phone, email, or even in person, to provide the doctor with information about her health or express concerns about how she is doing. It would then be up to the doctor to decide what should be done next, but at the very least, he/she should assess her with those concerns in mind. If your aunt’s cognition, function, or behaviour will result in imminent harm to her or someone else, the Mental Health Act allows for a variety of responses including calling the police, appearing before a Justice of the Peace, and/or having the family MD complete a mental health act form which would compel her to undergo a psychiatric assessment in hospital.

By: BrandStrategyGuru

BrandStrategyGuru — Wed, 13 Jun 2018 13:01:00 +0000

Hi Dr. Herrmann. I am a US resident, and my aunt lives in Ontario. She has been showing severe signs of dementia but her husband feels helpless because he says he is not allowed to speak to my aunt’s doctor and that since my aunt does not trust him, he is unable to do anything to help her. (she thinks he is trying to poison her, that he brings other women to the house, and other fantasies). I’m trying to understand what can be done so I can help my uncle who is having a very rough time. How can dementia be diagnosed so that my uncle is actually able to care for my aunt?

By: Dr. Nathan Herrmann

Dr. Nathan Herrmann — Mon, 27 Mar 2017 11:50:00 +0000

The POA document will indicate how the instrument is activated, and this should be reviewed with a lawyer. Some POAs become activated immediately on signing, and some will be activated under certain circumstances. The standardized POA documents available in Ontario for instance, are activated only when the person is declared incapable to manage their property (i.e. their finances) under the Substitute Decisions Act. In this case, an Assessor from the Public Guardian and Trustees Office will have had to be engaged, to assess the person (with their permission) and determine their capacity. Obviously, this might become problematic if the person lacks insight as you describe in your comment. That is why it is preferable to have a more specific POA written by a lawyer, which might include the instructions that the POA can be activated whenever the POA deems necessary, when the Family MD feels the person lacks capacity, or under more specific and detailed circumstances.

By: Andrew Hunt

Andrew Hunt — Fri, 24 Mar 2017 22:21:00 +0000

About a POA, you say that it may, “be triggered by specific circumstances, such as the person being declared incapable of managing their affairs.” Some people with dementia don’t think they have any impairment.

I wonder how is the declaration arrived at? Who makes it? Who decides when a POA can be exercised?