Holidays are emotional times. When multiple generations of a family unite to joyously celebrate, the moments are magical and memories are special.  Paradise is good health.

If absence makes the heart grow fonder, it also makes changes in aging parents and other family members more noticeable. Since the last family reunion, maybe your nephew sprouted several inches and his voice has deepened.  Perhaps your niece became a fashion-conscious young lady.   You noticed that your sibling added a few pounds and his hair thinned and became grayer.

Even though all of these changes are to be expected, they are surprising.   Some family members comment about the changes over a holiday meal, as others cringe or blush.  Usually, by the time dessert is served, the family has adjusted to a new normal.

Alzheimer’s disease and other causes of dementia can introduce shocking changes, which are harder to talk about and cause concern which can take away the appetite for dessert. In the early stage of the disease, change can be dramatically noticeable to out-of-town family members.  Sometimes the caregiving spouse, fearful of losing independence, compensates or covers up for the cognitive decline of a spouse.  However, when visiting children notice that their father no longer dresses appropriately, or that their mother’s cooking no longer tastes the same as it once did, concern can trigger a call to action.

As attorneys who focus our practice on helping clients in this condition, questions we hear from their concerned children are, to a certain extent, predictable, even though dementia leads to unique circumstances in most cases.   Family members worry about safety and family liability of a cognitively impaired parent who continues to drive.   Adult children wonder when and how to intervene to help a cognitively impaired parent to relocate to a safe environment.

A search of resources at www.keystoneelderlaw.com will reveal several articles which address the issue of how to deal with a parent who should no longer be driving.  Although Pennsylvania law requires the treating physician of a patient with dementia to use a Penn DOT DL-13 form to report a patient within ten days of diagnosing a medical impairment, a significant number of physicians refuse to file this report.

There is no civil or criminal liability for a physician or other person who reports a person prematurely or wrongly for being an impaired driver. In theory, failure of a physician to report could result in a small fine or vicarious liability in a tort action brought against an impaired driver, but we have never heard of any such fines or lawsuits.  Family members may also file a report.  Sometime it is possible to solve the problem by hiding keys or disabling a car.

It is also difficult to know when to relocate a person who is living with Alzheimer’s disease to a safer environment. Whether a person is living alone or with a spouse or other caregiver makes a difference.  When cognitively impaired people live alone, their inappropriate behavior can cause them to be a threat to themselves or others.  Emergency personnel who frequently must help a disoriented person find his or her home are distracted from opportunities to help others.  Auto accidents or house fires become more probable.

Unfortunately, some of the best dementia-care facilities are not able to accept Medicaid to help to pay for the secure care of a person with dementia.   Because of monthly costs of $5,000 to $8,000 per month for dementia care, some families do not have the resources to consider these facilities. With proper guidance, such families can locate a skilled nursing facility which accepts Medicaid and provides secure and compassionate dementia care.

A business which uses a retired television journalist to encourage adult children to make a free call for help to find a place for their parent is unregulated. This is unfortunate. On numerous occasions, people who work in an admissions department of a long-term care facility have shared the frustration that this “expert” referral source has never visited their facility and will not make a referral without receiving a commission. This free “expert” help is not in the best interests of a person with dementia.   Keystone’s own care coordinator has visited every local facility and made a large number of referrals; and we have never received a commission for doing so.

When a cognitively impaired person is living with a spouse or other family member, there are a number of home care agencies which can supplement the care that the family provides. Our website has a wealth of information about how family caregiving agreements and life estate deeds can provide financial tools for adult children to minimize economic sacrifices if they are willing to become emotionally invested as a caregiver.  Eventually, even the most loving families can reach a point where home care is no longer possible when a person with Alzheimer’s disease is physically able to walk out of the home, but too disoriented to return safely without assistance.

When we receive calls about such issues, as often occurs, we consider a checklist of basic preemptive issues: Has the loved one seen a neurologist?  Are all medical providers aware of all prescriptions that are being taken?  If a behavior change has been recent, has the possibility of a urinary tract infection (UTI) been considered?   How current and thorough are legal documents such as the power of attorney and advanced directive for health care?

When your family first experiences dementia with a loved one, it can be very frightening. Tension or conflict can occur among family members when the severity of the disease is perceived differently.  As time goes on, caregiving can become exhausting.

It is possible to create a safer environment for the one suffering from dementia as well as a support system for the increasingly exhausted caregivers. Hope is a necessity of a healthy and happy life.  With proper guidance, hope does not need to be completely lost when dementia disrupts the family peace.

By Dave Nesbit, Attorney