I cannot count the number of times I have heard some version of this story: “My Mom is losing it. She’s lost $20,000 to various scammers who call her pretending to be collecting for charities. She’s not paying her bills. She’s always been tidy, but her house is a disaster now. She forgets doctors’ appointments. When I try to help, she accuses me of trying to control her. She tells me she doesn’t need help. She tells me to go away. What do I do?”

Alas, all too many families face challenges like these. They’re all struggling with what’s called “capacity,” that is, the “capacity,” or ability, to perform tasks necessary to managing an adult life: scheduling, planning, weighing pros and cons, being able to tell if someone is trying to take advantage.

As elders begin to have cognitive decline, these various capacities may be damaged or destroyed. The result? Piles of unopened mail, chaotic homes, missed meetings, and so on. It’s also incredibly common for elders to deny that any of these problems exist.

What do you do?

  • Take a deep breath.
    These situations are always complicated. It may take months, even years, to resolve. You will need a team of family, caregivers, medical professionals, and probably an attorney and an accountant. Just take it step by step.
  • Then talk things out.
    Call a family meeting. Make sure to involve everyone who has an active role in the elder’s life. Ask your elder what should be done in case of a medical emergency. If they can’t make medical decisions, who should do so? Who should take over managing the finances if the elder cannot? If you can’t resolve everything at that first meeting, it’s essential to start the dialog.

If your elder resists this conversation, make the point that you’re trying to make sure that their wishes are respected. Seek professional advice if necessary.

  • Consider hiring someone to help with finances.
    Many accountants or care managers will also act as a “fiduciary,” paying bills and balancing accounts with input from the elder. Often, a person who feels their grip slipping will become paranoid about family members. Sometimes it helps to have a third-party professional step into that role.
  • Get some legal advice.
    Now is the time to draft advance directives for medical care and choose the person who will have a durable power of attorney should the elder become unable to make decisions. It is also the time to discuss who will have the power to make financial decisions. Do this before it’s too late and before some unscrupulous person swoops in to take advantage of your loved one.
  • Get input from your loved one.
    Before cognitive function becomes too impaired, ask your loved one what their priorities are. Do they want to have every medical treatment done, or do they care more about quality of life? What do they enjoy doing? What hobbies bring them the most joy? Would they prefer to live alone or in a group setting? The answers to these questions should guide the care of your loved one.

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