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By Carolyn L. Rosenblatt, RN, BSN, Attorney

Mom has dementia and her daughter, Jennie, is worried.  Mom clearly should not be driving anymore. 
Jennie finally just took the keys away.  Have they talked about it? No. Argued some, maybe. But talking starts out with anger and ends up worse than ever.

Jennie saw the dents in Mom’s car and asked about what happened.  Mom refused to discuss it. First of all, she doesn’t exactly remember.  But she’s embarrassed. She had a perfect driving record.  Not even a parking ticket. Now this. Something is happening to her memory and keeping track of things.  She doesn’t want anyone to find out.  It feels horrible to Mom.  What if they put her away?

Jennie threatens to stop Mom from doing something stupid.  Mom wants Jennie to butt out.  How dare she tell her own Mother what to do?  Can this be solved?

This scenario is real.  It’s also not uncommon.  The problem of how to approach a person who may have a vague idea of something wrong with their memory but won’t admit it is affecting thousands of families every day.  Driving is one area where memory problems can affect lives and can put the public, as well as an aging parent in danger.

Consider the concept of mediation of a family dispute about an aging parent’s driving.

Mediation is a way of resolving disputes of all kinds. We’re quick to say “use mediation” for a labor dispute, or between warring countries to bring about peace. But, we usually don’t think of it for situations like Jennie and her Mom.  However, it can bring hope when conversations and arguing end up in a standoff and anger is destroying family relationships.  There is a way to resolve even the stickiest family issues.

Think of mediation as a way to get an outside, skilled person trained in resolving conflicts to come to your aid.  Think of it as a way to end the fighting, and to work out solutions with help and guidance.  Sometimes a few simple suggestions you’ve never thought about can turn the tide of a family conflict.  People who do this are called “elder mediators” or even “family mediators”.  The process is elder mediation.  People come to their own resolution with the help of a mediator.

You can find one by doing a search in your area for mediators who work with elders and their families.  There is normally a fee, though some community mediation services provide mediation at low cost or free.  If your family is suffering over a driving issue, or any other elder-related issue, think of mediation.  It may be the way out you’re looking for.

To learn more about adult children and dangerous older drivers, see my article in Forbes.com.
To download a short book with step-by-step guidance on how to deal with your aging parent’s driving, try How to Handle a Dangerous Older Driver .

Can an Elder With Dementia Participate in Mediation?

Carolyn L. Rosenblatt, R. N., B.S.N., Attorney
© 2009, AgingParents.com

Can an elder with dementia participate in mediation? The short answer is, it depends on the progress of the dementia.

Dementia is one of several kinds, the most common being Alzheimer’s Disease. It causes progressive damage to brain cells, initially affecting short term memory, and gradually affecting all “executive” functions of the brain, including judgment, analysis, thinking, and others. The affected person eventually loses the ability to recognize familiar objects, and even loved ones.

In the early stages, this kind of dementia affects short term memory, but other parts of one’s thinking can seem to be all right. One can carry on a conversation, express one’s self, and make decisions. An elder with early Alzheimer’s Disease (AD) may be able to live alone, drive, and manage affairs. However, even at the early stages, one must be aware that this condition is progressive. It affects everyone differently, and is therefore, unpredictable.

What we know is that a person’s decline with AD is steady and that it will certainly get worse until a cure or better treatment is found. We don’t have that yet. In the meantime, what if there is a family conflict, mediation seems to be the way to deal with it, and the elder has dementia? Do we invite the elder to come?

Our experience at AgingParents.com with elders who have dementia is that they are invited to come to mediation if they are willing and want to be there. They may not stay for the entire discussion. We may want to provide for a caregiver to accompany them elsewhere after a part of the talking is done. We do want an elder to be able to express his or her wishes. We do want him or her to feel respected and a part of the process. However, we don’t want to expect too much from someone with limited capacity to remember and participate.

As mediators, we offer the opportunity for the elder to participate when we have a pre-mediation conference with the family or others who will be present at mediation. At that time, we try to assess the level of function of which the elder is capable. We ask the elder about coming if the elder is available to us by phone.

Sometimes, things will be talked about at mediation which could upset the elder, or cause unnecessary stress. We make every effort to be sensitive to this, and to arrange with the family members to spare the elder from extra stress.

In our experience so far, some elders stay for the entire session, and some leave early. In some cases, the elder is too disabled to be there at all. So, the question of whether to ask or permit an elder with AD to come to mediation must be decided on a case-by-case basis. Even if their participation is only symbolic, and they are likely to forget what happened by the next hour or day, it can be a respectful gesture to ask the elder to be at mediation, at least for awhile. The family’s wishes about this are also considered.

The final point is that settling an issue at mediation requires the ability to make a reasoned decision and to keep commitments made at mediation. Where there is conflict, those participants who have decision-making authority should have the final word about any outcome of mediation.
©AgingParents.com
Learn more about dealing with elders with dementia at http://www.agingparents.com

I shudder when I see these situations. The parent thought, somehow, she was doing the right thing. Or dad wanted his kids to “work together”, even though they’d never done so in their lives before.

The parent appoints two children as “co”- powers of attorney for finances. Mistake!

When the aging parent gets too incompetent to make decisions because of dementia, or some other condition, the two siblings begin to argue and hassle each other about money. One wants to spend it on mom’s care. One wants to move property and money around (all to be done legally), make the parent poor enough to qualify for Medicaid, and not spend the money so that he/she can inherit it.

These are difficult situations to mediate. The sibling who wants to impoverish the parent so he or she can qualify for a Medicaid bed in a nursing home is looking for that inheritance, and not for what is best for the parent.

It’s not that every nursing home is bad. Some do a good job. But, many are unsafe and neglect is quite common. I know this because I’ve personally sued nursing homes for neglected clients. Three beds to a room are often the situation when Medicaid is paying. Private pay beds are expensive, but usually, a lot better. Some nursing homes do not accept Medicaid.

How do we help families negotiate these situations? We encourage them to research the nursing homes in the area, to visit them personally, to spend time there observing.

We help them explore all the options available. We encourage them to choose one of them to be the decision-maker and the other to be the back-up. That’s a lot cleaner way for the parent to set things up to begin with, but it doesn’t always happen that way.

Greed can drive a dispute pretty far. If your parent has set up his or her power of attorney for finances with two, instead of one decision-maker, and the parent is still competent to change this, talk about it now! It can get very messy later, if the two who are supposed to decide such important things as spending money on a parent’s care are unable to agree.

To learn more about sibling conflicts, visit AgingParents.com, for articles, and our free newsletter.

Family conflict brewing. It’s already rearing its head in the form of aggressive emails. One sister wants control of mom’s money and property. But she wasn’t the one mom appointed to be the durable power of attorney when the time came.

Now mom has dementia, and the time is here for someone to take over the finances. In fact, the daughter mom appointed (we’ll call her Phoebe) has been handling the money for two years now. What’s wrong?

Another daughter (we’ll call her Linda) looks as if she just wants to make mom’s care cost as little as possible so she can inherit more when mom dies. Shocking? No. We see it, unfortunately, fairly often. Linda wants to control that checkbook badly. She’s demanding to “help” Phoebe manage things.

Here’s the heart of the conflict: Phoebe is the properly appointed power of attorney, and mom chose her for mom’s own reasons. This was 15 years ago, and mom was completely competent at that time. Linda doesn’t like the idea, because Linda wants Phoebe to sell a house mom owns and keep the rental house mom also owns. The rental is worth a lot more than the other house. Several hundred thousand dollars more, even in today’s market.

Phoebe wants to sell the rental house, and keep mom’s home. Why? Because yet another sister is living in mom’s home and goes to see mom daily, and attends to her needs in assisted living, takes her out, and goes to the doctor with her. Mom needs that kind of care, as she has dementia. That sister, we’ll call Teresa.

What can Phoebe do? We suggested a family meeting with neutral mediators (ourselves), to see what Linda is willing to work out, and to see what Teresa can offer in the way of solutions.

Phoebe asked if Linda could “take her to court” if she disagreed with the way she was handling the funds mom has and the property. Answer: unless Phoebe is abusing her role as the agent for finances for mom, there is no way Linda would have a winning case against Phoebe. Disagreement with the agent is not enough.

Mediation could give the family the best chance of working out a solution which everyone could accept. Why can’t they do it without a mediator? Complicated situation, lots of issues no one talks about, and mom is going downhill fast lately. The sisters don’t get along. A mediator could help them get the matter settled among them.
Carolyn L. Rosenblatt, R.N., Attorney at Law, Mediator,
AgingParents.com.

To learn more about how to resolve disagreements like this one, see The Boomer’s Guide to Aging Parents, How to Handle Family Conflicts About Elders, available at http:/www.AgingParents.com/familyconflict, in print, ebook, or audiobook.