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She hit the corner of the coffee table and has a goose egg bump on her head. She should be checked over by a doctor, but has already refused medical care when I took her to the emergency room after an even worse fall some time ago, and refused medical care when I called 911 after a fall last week. It's been explained to me that no one can force medical care on her. I believe she has dementia, but we haven't a diagnosis because she refuses to see a doctor or have medical care. Help.

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Hi No recess:

The others that pointed out that you need to have her diagnosed as lacking capacity such as severe dementia or Alzheimers and procure guardianship.

If she is not diagnosed with the above, you can not force ongoing treatment on her.
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You did the right thing. It sounds like things might improve for you since I read your last comment.

My mom says stuff similar to yours but she also has dementia. I finally got her to the doctor by telling her I had something wrong with ME and they couldn't figure it out unless they compared us. The doctor agreed to the scenario and got the staff on board with it. I needed her to see the doctor for the checkup, diagnosis, etc., similar to you. She couldn't get other services without being seen first and having a diagnosis.

She never liked going to the doctor before she had dementia, but I based my choices for that plan on her actions in the past. Even though she didn't necessarily LIKE to go to the doctor, she DID choose to go to the doctor even on her own (Pre-dementia) when something was wrong, and she did make efforts and changes in her life to be healthier. Because of those things I decided that my plan was in line with her previous ways. Her current refusals were based on not being able to remember she had reasons to be seen by the doctor, etc.

Good luck sweetheart, this is hell for all involved.
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You’ll need a diagnosis of dementia before she’s judged not capable of making her own decisions. A geriatric psychiatrist or general practitioner can give her simple tests. I went the Geri Psych unit in a psychiatric hospital way. Then along with the diagnosis the psychiatrist started her on a medication to calm her and facilitate her thinking.
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Much thanks and love for all of your kind, thoughtful, and wise comments. I cherish the experience and love shared in our group.

Mother's right-side chronic hematoma (brain bleed) in addition to the right-side acute hematoma are stabilized so she will be released from hospital today, and fingers-crossed, she will agree to go to a few days of physical therapy to help strengthen her. Since she is bed-bound, we need her to at least maintain what strength she has which helps keep her out of the nursing home, which is what she wants. I do strength training three times a week so that I am better able to manage the physical aspects of her caregiving, so i believe it's only fair that she put forth as much effort as she is able.

The decisions made to call 911, the wonderful emergency personnel, the good doctors, the fantastic hospital and staff, and all of you have made it possible to finally have help at home: a hospital bed, physical therapy, nurse visits, Hospice, and all of the products and services she is entitled with her excellent health care insurance. Prior to this hospital visit, we were not eligible for any help whatsoever because she absolutely refused to see a doctor and doctors orders were required for medical help and services in the home.

For the last three years, I've gone it alone and it was frightening and the worst experience of my life. It looks like those days of loneliness, fear, and no support are behind me thanks to caring and brave people who reached out and helped me during my time of need.

My mother is very fortunate and as sick as she is, things could not have worked out better. My only wish is that we could all have good care during our dying days.
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Whatever happens don't burden your spirit with guilt - as they used to say 'you can take a horse to water but you can't make it drink - you can only help her so much & if she refuses then you then that is her call -

NEVER FEEL GUILTY ABOUT SOMEONE ELSE'S ACTIONS ONLY YOUR OWN - you can't be responsible for her refusal for treatment as many do because it was her call in the end - some people just get to point that they are finished with life because THEIR spirit is tired & want to quit - nothing you can do to help & it really only stretches out their pain [physically & mentally] so that you may need to back off so that she can go in peace rather than struggling with life

This is not all people but there are those who want to go on their own terms - there used to be a saying 'she/he turn her/his face to the wall' which meant they were ready to go on their terms & without interventions
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My mom developed vascular dementia from years of falling. The fact is you can't stop falls. She fell a few times even with a walker.
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There should be a law that protects caregivers. Yes LOs can refuse care and be granted it. If this happens, get a report that medical care was refused. TG my POA was in place when Mom started to decline.

Why is Mom having these falls. Won't use a cane or walker? If she is in the hospital long enough rehab will be suggested. If she won't go to rehab, try home therapy. Both will evaluate Mom and may recommend she use a walker. Maybe even a wheelchair. If she ever breaks a hip, thats a few weeks of rehab.

If Mom can still make informed decisions I would talk to her about financial and medical POAs. If she fights it, ask her if she wants strangers making decisions for her. Once she can no longer make informed decisions, you will be able to make them for her. My Moms MPOA read like a living will. Here in NJ all healthcare facilities have DNR form that can be filled out wit Moms wishes. Will need her doctors signature. Since she already has in her head she wants no interference concerning her care, then it should be easy for her to go along with. Keep a copy for the EMTs. One at her primaries and one on your person. Be aware though, once a feeding tube is inserted, its very hard to get removed. My daughter told me with Mom having Dementia, don't allow it at all.

It is so hard dealing with our aging parents. I was one of the lucky ones. Mom just went along with it. She knew early on she was having problems and always asked for help. It is so hard to know what to do. Good Luck.
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NoRecess, as so many have said here, you did the right thing. Such a dilemma and I relate to your comment about not being able to forgive yourself. I so much would have liked to prevent all suffering for my Mom but I couldn’t. Luckily her short term memory loss helped. How much would we all love to have our precious parents die peacefully in our arms with a smile on their faces during a nap in their own home. Rarely does it go that way. We are not to blame that they are old, ill, confused, immobile, etc. The reality is that our parents WILL die and we are left wondering if we did the right thing. You did.
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Oh my gosh.....so much to say on this subject but will try to keep it short (I said I would try:) As I'm typing sitting here waiting on a CT scan for my 95 year old father. He fell Friday morning around 3am. Usually he calls to tell me (yes, at 3am) but he didn't this time. When I went over in the morning to take him somewhere I saw his head, face and arm. I checked him over and made sure nothing was broken and he felt fine so I made the hard decision not to take him to ER. We just happened to have a drs appt yesterday where the dr thought it was best for him to have an ct scan. In the elderly it takes a few days sometimes for symptoms to show up, headaches, dizziness, nausea, confusion etc. So here we are. He got out of hospital and 6 weeks of rehab in Feb. for a fall. We discussed assisted living then. I gave in when he said he would like to give living on his own (in retirement facility) until he couldn't anymore. Well, this time there is no debating. He and I are both sad about it but it's aging. Just how life is. He's very frail and declining. My mom passed 2 years ago from a 12 year journey of dem/alz. Please know that you have done NOTHING wrong. Yes, you feel bad about doing it this way but IF she does have dementia/alz. then she is not in her right mind and can't make the correct and safe choices. Wouldn't it be great if we could all just sit in our favorite chair and pass peacefully like my husband's grandmother did? That's not the norm unfortunately. Guilt means you've done something wrong on purpose. You havent. You are trying to do the best and the right thing for your mom. Good Luck to you on this journey and remember we are all with you. God Bless
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I had the same situation this past winter with my 94 yr old mom. She fell and fractured her arm. After much coaxing, EMTs took her to local ER where she got a temporary cast with instructions to go to follow-up visit with Orthopedic doctor. This she refused to go to on the day of her appointment, she was also acting very strange. Such hearing noises that weren’t there, etc. I called police to come, explained the situation, EMS were on hand as well. They coaxed her over an hour and she kept refusing. Up to this point she had not been tested for dementia because she refused to get evaluated. Long story short, police officer took her into custody so to speak and she was taken to nearby hospital. I was then advised that my mom could still refuse medical care. I had to agree to having the police officer write up that she is incompetent to make decisions. She then got the necessary evaluations that diagnosed with Alzheimer’s. I had to go to court to gain Guardianship if Hwalth and Finances. It was a rough two months and I’m sure there are easier ways with the aid of a lawyer if your loved one is in agreement. My mom never wanted to update her will. All those who were designated to be her POAs for finances passed away. I had POA for health if she was diagnosed incompetent. So guardianship is an option but not easy.
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NoRecess… Hang in there. You did the right thing. I know what you did was so hard for you. Please do not feel guilty. From reading you post and responses you love your Mom and want the best for her. How old is your Mom (may have missed that)?

I agree with rocketjcat. When your Mom is home and feeling better sit down and talk to her about what her wishes are and see about a DNR (medical directive) and a Medical Power of Attorney. My honey and I both have advanced directives, medical power of attorneys and full POA. We had ours done just prior to my honey’s strokes in 2005. As was mentioned in rocketj’s post she needs to understand that you love her and want what is best for her, but in the case of end of life you want her to be comfortable if she is set on being at home. None of us know what kind of condition we will be in when we reach end of life. My directive advises that if I cannot return to a semblance of the quality of life that I have had, I do not want my life prolonged artificially. I would want hospice to keep me comfortable though (maybe I am a coward but this is fact).

Even with what my honey is going through right now, and as much as it will break my heart, if he decides he does not want to be on an IV for the rest of his life, have a heart pump implanted and/or if he is not able to have a heart transplant I will abide by his wishes even though I have the POA. He has been through so much for the last 27 years that I can understand. The main bone of contention between us right now is that he wants to come home and I am not physically able to care for him or afford 24 hour care.

Hang in there NoR… I know it is hard, but hopefully your Mom’s anger will be short lived and she will realize that when you took her to ER for the fall you did it because you care. It will all work out.
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I live in Massachusetts where we have the MOLST form. On it, one can indicate whether they desire temporary or long-term artificial feeding, intubation, and dialysis. One also states (by checking off a box) if they want CPR, and most importantly, whether one wants to be transported to the hospital. This form then is signed by the patient and her doctor. This can be done at the hospital she is in right now (that's what I'd do!) or a doctor's office. This form should be be posted on the fridge, kept in her handbag (and yours!), and given to all of her doctors. Then, you as caregiver abide by her decisions. She can update/change her decisions as her medical situation changes. It isn't permanent, in other words.
Without that document or something like it in place, you did the right thing. Now is the time to clarify by identifying her health status, setting up an advance directive document, and eventually marrying the two together by securing hospice services.
Hang in there, and assure her you are working as a team; she needs to feel heard and validated and you're doing your best to help her live on her terms safely, comfortably, and with dignity.
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I was going to ask if you had explored why she is refusing medical care. I see you posted again that she wants to be left alone to die of natural causes. I know it is sad for you. We often aren’t quite ready to face that the end is coming. But watching my parents fade with dementia, and having provided care for a number of friends who slowly died of cancer, I need to tell you that none of them, my folks included, enjoyed the extension of their lives that resulted from medical care. I have come to believe these are things done for the loved ones and for the pride of the medical community. I have already told my husband that if I get dementia before there is a true cure, I want none of the meds that stave off the progression. I want to go straight to oblivion and death.
I think going forward if you document your attempts to get care, you cannot be accused of neglect. Keep the lines of communication open with your mother, even if there may be some dementia. And know that her desire to refuse care may ultimately be a blessing to you both. I wish for you strength, clarity and peace as you walk this difficult road.
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No Recess, If/when she gets home, how about having someone from a hospice agency stop over with you to see her? They have social workers who can assess her thinking ability without her knowing, (in the course of a conversation) and then you can see a lawyer and have yourself named her guardian. If she wants to die at home, then Hospice is your answer. They can come in and help her around the house and do so many things for her, while giving you peace of mind that someone is helping you keep an eye on her. Plus, they can give you the emotional support you need during this time in your life. They are really amazing.
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It is very tough! I go through this exact same problem, but with two parents. They gang up on me — mom particularly angry at me. I represent everything she is losing as she ages: I can see clearly, drive, go to work, and to really frost the cake, the dog likes me better than he likes her. She is angry at me all the time. I suspect that that a lot of the anger your mom expresses isn’t about you as a person, it’s about her frustration with getting old.
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call 911
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I think you absolutely did the right thing to get her checked out. Now you'll both know what you're dealing with and can go forward with that information. I agree with Rocketjcat to discuss possible scenarios with your mom so you know how she wants things handled. As my mom got into her 90s, she was always adamant that she wanted no interventions or treatments. But whenever she has an issue, she'd immediately say, "I think you'd better call the doctor". Or, "We should go to the hospital" But she was clear enough about her overall wishes that when she started to fade, I brought in hospice and she was able to die in her bed. I'm happy that I was able to give her that final wish. Good luck with your mom. I think you'll be able to bring her home and help her honor her wishes while taking care of yourself and your own emotional health. {{{Hugs}}}
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NoRecess, good job on getting her to urgent care. Please share what tactics you used to accomplish it!
When she’s feeling better and back home, it might be helpful to really define what she means by dying at home. Mom has a DNR order, and I have reviewed different scenarios with the staff at her NH. If she falls and breaks something I do want her to get it set. But invasive procedures like surgeries etc, no. Maybe you can review different “what-ifs” with her. It’s not all about “dying at home”...it’s important to get an understanding on other less serious medical emergencies as well, so when the time comes she can die in the most comfortable way possible at home.  When she thinks of dying at home, she may have this vision of peacefully passing in her sleep. Wouldn’t that be wonderful. But the reality is without a thought out plan it might be a lot more painful than peaceful. And I don’t think either of you would want that. 
Good job. This is tough stuff.
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"Who dares wins," NoRecess.

Good call on your part, you did well to risk your mother's wrath and get her seen; and the outcome will, God willing, be exactly what she herself chose for her latter years.

She might even reflect that she has you to thank for bringing her there safely. Only, I wouldn't necessarily expect that... ;)
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NoRecess, you did the right thing. If you did not take her to the hospital and she died at home, they would have done an autopsy. Then you will be required to explain why there was a blunt force trauma on her head, bleeding internally. Depending on the autopsy report, you may or may not be arrested for elderly abuse, involuntary manslaughter, etc...

My dad was like your mom. He refused medical intervention. He refused to go to the clinic despite the urgings of the home care nurses. When I knew he had pneumonia, I called 911. I begged them to visit and atleast try. They came. My dad refused them to do any vital signs. He refused to go to the ER. The medics told me that he has a right to refuse medical help. Then left.... If your mom truly wanted to die, then at the hospital, she could have told the doctor straight out: I was forced by my daughter to come here. I don't want to be treated. I want to go home... . If your mom was persistent, they are obligated to release her. But, if those doctors/nurses are like here, they would be able to sweet talk your mom to stay. Like with my dad.

You did the right thing... before they release her, make sure that hospice services have been approved. Hate for you to go home and then try to get it done. Your mom would resist you 100%. Take care.
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NoRecess,
That sounds like a good plan.
Hoping your Mom agrees to hospice after awhile.
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My mom was moved to ICU in a bigger hospital nearby. I will know more tomorrow when the neurologists' report is received. They're monitoring her condition, subdural hematoma on top of a hematoma from a previous fall, and barring any more bleeding, will be released in two or three days. I'm really hopeful that she and I can get some help, support, and when necessary, Hospice, at home during her final years now that she has seen doctors and been evaluated.
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PolarBear
I agree with your comments and I know you did not mean to be unkind to NoRecess. You said as much.
It seems very difficult to die at home of natural causes these days, especially if one has insurance. But it IS very difficult not to take whatever action we know to take when someone, really anyone, is hurt.
Plus we never know when an event, such as this fall, can render one incapacitated in a way that could cause years of misery vs a desired outcome of death if medical help isn’t sought.
In other words it just isn’t that easy, is it, to know what to do?
NoRecess if or when your mom is mentally able perhaps you could press for clearer instructions in writing on her wishes to not only protect you from negligence but to draw comfort and strength from that you are doing as instructed.
We know that not every problem can be anticipated or orchestrated for optimum outcome. You are doing the best you can NoRecess.
And Ahmijoy is right that we want to support you in this difficult time.
Please keep us updated.
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NoR you did the right thing. As mentioned earlier without the trip to the ER something may have happened that could have had you in legal trouble. Hope all is well, very soon.
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I'm feeling hopeful and trust that everything is as it should be.
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Bless you all for your support in our time of need. I hope I am able to pass along such kindness and love in someone else's time of need.
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Polarbear, we are all entitled to our opinions on this site, but there is a time and place for sharing them. Your comment to Norecess was uncalled for. The poor woman is in a world of hurt right now. She needs our support, not our judgment. She did the right thing for her mom and herself. Please choose your words more carefully. We are here to offer kindness and support. All of us.
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That is why it is so important to have a Medical Directive so that family will have in writing what the person wants done in their final months.

I was so glad that both my parents had such documents, it was like a blueprint to follow so I wouldn't worry that I wasn't following their wishes. Once Hospice was on board then no more hospital or urgent care runs.
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Norecess- I don't mean to make you feel worse. However, If I want to die by refusing medical care, it's my right and I would be furious if other people force their will on me. They might think they are doing it for me, but no, they are doing it for themselves.
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NoRecess, no you didn't take away her final wish to die at home because your Mom can eventually go home if the brain bleed isn't that serious. You did the right thing.

I remember when my Dad fell and had a major goose egg on his head. Of course my parents didn't tell me until many hours later. I was going to take Dad to urgent care, but he was too wobbly to walk. So I called 911. Rather be safe then sorry.

My own Mom had a brain bleed from a fall. Mom stayed in the hospital a couple of days then was sent home. Mom was back to her old self, stubborn as ever. Doctor requested she have caregivers watch over her, but my Mom wasn't going to have any part of that.

So let's think positive that your Mom will be back at home.
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