Is This Abandonment?

Per our local social workers - if we assume care in any form for my father's wife while he is admitted to a hospital for any treatment that requires overnight stay - we have assumed caregiver status of her and could be sued for abandonment if we leave at any point to go to work and do not take care of her for the time he is in the hospital, even if that stays results in days or weeks. She has Alzheimer's and is NOT OUR MOTHER. HELP!!!

As a social worker by training, and as a professional who has had more than one person's share of contact with the Adult Protective people, I have to say that this is correct. I'm regularly infuriated that people who call themselves social workers are so quick to point this out, but so slow to offer possible solutions. It's less than helpful to threaten people who are caught up in this situation through no fault of their own.

As a result of a lot of bad press about babies being injured and seniors being abandoned or exploited, some of our protective services agencies seem to be moving into a pre-emptive mode. They are usually chronically short on money and staff, so they would prefer to frighten you into assuming responsibility. Many of their workers will not hesitate to make charges of abandonment. Whether abandonment charges are valid or not, you will be placed in the position of having to defend yourself.

This is why it is so very, very important to make care plans in advance.

Having laid that groundwork, there may be several options for your family.

It sounds like your father is your step-mother's primary caregiver. If he is not presently ill and in the hospital it is critically important that you sit down with him immediately and discuss how he plans to provide for her care if he is unable. I would venture a guess that he has no plan other than you.

If he is in the hospital now, then you will have to create an emergency plan.

Assuming that your mother-in-law's dementia is advanced to the point where she needs supervision at all times, here are some options:

Option One: If the money is available you can hire a private caregiver to come into the house to provide care and supervision. If a family member is able to stay with her at night, or if she will stay at your home, you would possibly be contemplating 10 hours or so of private care every day. Costs generally range between $12 and $20 per hour depending on location. This option is only reasonable if your father could pay for this from his own funds.

Option Two: If someone from the family will be supervising at night, an adult day care during the day may be an option. Because you have to work, getting your mother-in-law back and forth might present a problem. She would have to be accepted into a program, so this is not a solution for the very last minute. Adult day care is also a private pay matter, but much less costly than in-home care.

Option Three: You can try to place her in an assisted living facility for "respite care." Many assisted living residences offer short stays for just this kind of emergency. She will need to present a list of her medications signed by her physician (so they can safely and legally give her whatever she is taking). She might also have to have had a recent negative TB test. So, respite care can be complicated to arrange at a moment's notice. This, too, is private pay. You might check with your local Alzheimer's Association to see if they have any respite funds if finances are a problem.

Option Four: You can try to place your mother-in-law in a nursing home for care. Nursing home care would be less expensive than 24-hour care at home. This, too, would be a private pay matter unless her assets and income are very low. If they don't have the funds to pay for care, look for a nursing home that accepts patients who will be applying for Medicaid assistance. If you go this route, she would probably have to remain in the nursing home for an extended period to qualify for Medicaid (at least 30 days, possibly more depending on your State regulations). You will need cooperation from her physician to have her admitted to a nursing home and there will be considerable paperwork to apply for Medicaid.

I do not recommend that you tap into your own funds to pay for care. So, for all of the above options you will need legal access to your father's assets. This means, at the very least, that someone is a signer on his checking account. Someone really should have a Durable Power of Attorney. Your mother-in-law may be unable to sign legal documents if her dementia is moderate to advanced.

If the necessary legal documents are not in place I recommend that you get your father to an attorney as soon as possible to have these drawn up. You can find elder law attorneys at the National Association of Elder Law Attorneys website. You also need legal advice about your own obligations, so I recommend that you meet with an attorney even if your father won't attend.

Option Five: If your father is unable, or refuses, to do any advance planning, and if he/they don't have the money to pay for private care, you may have to do something very unpleasant. Should he have to leave the home overnight for any reason you can immediately call your local Adult Protective organization. Their number should be in the Blue Pages of the phone book. Inform them that a senior with dementia is alone and unsupervised and at great risk. Then stand back and wait for extreme pressure to be applied for you to assume responsibility. If you truly are unable to provide care for her, then say so.

If you are in a situation where she is in your care...meaning she is either with you, or you are at her home...you must stay with her until someone else assumes responsibility. This could be several days if the Agency deems that she is presently safe and not at risk (because you are there). Family members may have to take turns taking time off from work.

Adult protective agencies generally have few alternatives other than placing her in a nursing home for a short period. It would quickly come back to your father to either pay for ongoing care or to apply for Medicaid on her behalf.

So Option Five is not a good choice for many reasons.

This has been a long response, and not as helpful as I'm sure you would like. If no one has done long-term care planning, an emergency eliminates a lot of options. It is so important to plan ahead for just these kinds of situations because a crisis never comes by appointment.

Follow-Up:

Another reader asks: With the available monitoring technology, could there be an option six? What is your take on elder care monitoring for such situations?

Answer: Excellent question, and I sure wish I thought the answer was "yes." But I'm afraid that the human services agencies responsible for elder safety would probably not be impressed by technology that left a confused and vulnerable elder alone and without human supervision for any length of time. While these technologies can report a fall or other similar occurrence, they won't prevent a senior from going out the door and becoming lost. They won't prevent a confused senior from doing something that could lead to injury (putting a hand into the disposer, etc.). Technology is advancing, but it's not yet a perfect substitute for having a human being on hand.