Mom is refusing to eat and take her meds. If she dies can I be held liable for her death from starvation?

Jimmy,
This is a very hard situation, in so many ways! SO hard to watch someone you love, dwindling in front of you!
More information/evaluation is needed.

She can't do her own activities of daily living [ADL's]--or she wouldn't need a caregiver.
Refusing food is unhealthy, generally; losing significant weight in fairly short time [[??]], MIGHT indicate she's NOT thinking clearly…OR, she might be trying to act on her diagnoses, to prevent a long-drawn-out slow death.
Elders refusing to see a Doc, may be hiding something, or fear something.

---How long since she was seen by a Doc?
---What's her actual diagnosis?
---Might she be "show-timing", fooling people about her level of mental clarity?
---Might she have an infection or other conditions which could cause her to not want to eat, or to not want to live? [[infections, ills, zinc deficiency-very common in anorexia…etc.]]
---Age?
---Existing depression?
---Used many antibiotics [[which kill off the gut Flora, and THAT can cause loss of appetite-- those good Flora help stimulate appetites, provide nutrients that decrease depression, and help with digestion…]]

Caregivers exist --because someone needs help-- including maybe, with some decision-making---particularly when ill in ways that can cause poor decisions / choices.
---You can "entice", "offer", etc. nice ways of inducing her to eat something.
---You can try offering things that have nutritional content, that might be easier for her to consume--like that Juice Ensure.
---Ask/Observe if eating is too difficult / hard for her? Maybe a feeding tube could help.
---Mashed Meds in applesauce are still nasty [[eeww!]]--those might even be delivered via that tube--meaning she no longer needs to taste that nasty stuff.
===BUT ...if there's an infection she can't tell exists [[this happens a lot!]] --it's common to refuse medical help, & act-out in various ways, including starvation.

You can call your local Area Agency on Aging, to start the ball rolling--ask them how to get in-home evaluations done for an elder who refuses to see a Doc, and is starving herself.
Social Workers can come to the house to do an evaluation.
Their evaluation appointments usually takes about 2 hours.
You tell them her age, conditions, & that she refuses to eat anything [& for how long], that she has lost [how much pounds from her previous stated weight?], and that you are very concerned that she is deliberately starving herself to death, and you need advice & help with this issue.
They will ask you questions, ask her questions, evaluate situation.
When they ask -her- if she wants to move to her own apartment, or if she wants to go into some sort of assisted living, elders generally say 'no'.
BUT, you can say then, how much help she needs w/ her ADL's.
Make sure the Social Workers understand how much care is needed---how costly it might be to Medicaid if the elder lived on their own, or in a facility--sometimes, even Social Workers can have some faulty reasoning….they need hard facts.

They document things….so be specific…what, how often, when, how much, etc.--you can write up a page of what you have done, to give a copy to them. .
They create a file.
This helps protect YOU, --and-- the elder you care for.
How good their evaluation is, depends on how specific/factual your input is, and how much they can observe for themselves.
IF she is really good at "Show-timers", let them know that when you call them, so they can assess that too.

Sometimes, just going thru this evaluation, can convince an elder who is acting out [[IF that's what they are doing]], to start eating again--just to keep officials from coming to the house again.
BUT…if there is something warranting deeper evaluation, they can usually help get this done…Like:
If Hospice in home is needed, they can help get that set up.
IF she needs to be in a facility, they can get that ball rolling.
If in-home help is needed, even a few visits, they can help get that going.

Please keep us posted how things are going!

I just realized that I have another blessing to count. My husband, just starting the dementia process, is a hypochondriac and loves to have people take care of him. I will probably never have to try to force him to seek medical attention, or force him to allow home health care. My father was more like your mother.

It's horrible when you want to help them and they won't let you.

Sorry that you're going thru this. I went thru it with father in May. He absolutely refused to go see the doc even though he was coughing so hard and coughing up phlegm that was changing color until it was greenish brown and very thick. I knew he had pneumonia just from these signs and spent weeks trying to get him to the clinic. I also knew that because he was bedridden, if he died, I would be held responsible. Our current Attorney General's pet project is elderly abuse. I did not want to be one of his pet project..... Then, he got very confused and couldn't tell anymore if it was day, night, morning (it's always morning to him) and wanting to eat breakfast (even if he had his nutrient drink an hour ago), saw invisible people and didn't recognize me at all.

I did what you did. I had to beg 911 to come (they weren't going to come because he said that he will not let them in the house). And they did. They asked questions - he answered it correctly - and amidst of him telling them that he knows that they're trying to make him look crazy - they left without even touching him NOR did they write anything down on the chart they were carrying. NO Paper trail from that one.

I called APS - they heard out my story by phone - and then referred me to the elder care lawyer. I called them up and was told to come in for interview. I did. After that, the office manager told me that father has a right to decide if he wants to die. (mom just recently died a month ago - in April). She said that he needed grief counseling. So, I then went to the medical insurance to see if they provide home visits from the doctor. I was told very firmly that their doctors do not do home visits nor do they give diagnosis via phone. I have to bring my father to the clinic. They then proceeded to give me a phone number - to the APS! I was back where I started.

I had NO paper trails in all this. Everyone just kept passing me around. I think it's a great idea that you have these paper trails - even if it's your own. As for my father, because it was pneumonia, he finally told me to call 911 because he's tired of the pain and he can't breathe. His left lung was almost filled with fluid. At the hospital, his UTI got worse. He thought he was at home. I mentioned to the attending physician about his UTI and the doc was very abrupt with me - saying that he has more urgent situation to deal with (pneumonia). Father was released from the hospital without his UTI being treated. sigh.... Fortunately, Medicare provides options of home health care after hospitalization. I was able to convince the attending home nurse on his visit that dad had UTI. Father STILL refuses to go to the doc for anything. So, I'm hoping to learn from here what others input is on this situation. I have feeling I will be going thru it again....

I hope you find a way to encourage your mom to eat something.

Jimmy, I'm so sorry about this. It does sound like she's going.

It might be easier if, at 4 AM, you moved into her room to sleep - on pillows on the floor, or in a lounge chair. It wouldn't be quality sleep, but you could just lie there and reassure her without having to get up. If she's in a big enough bed, it might even comfort her if you lie next to her. I think it would not be "improper," if you were both comfortable about it.

Try and see if that lets you sleep more. If not, try to nap during the day. God bless you.

Jimmy I absolutely agree this is a time for action not wait and see. it is good that she ate something however little. Have you tried giving her Boost. It is a high protein drink and comes in strawberry, vanilla or chocolate. The chocolate tastes just like chocolate milk although it does not contain milk and is very easy to drink.

Jimmy they will always say no to a question of do you want to go to the hospital. The real question is, "Should she be in the hospital?" If the answer is "YES" then you need to get her there.

When they are calling out for their "Momma" they can be dreaming but they are most likely hallucinating. My mother did this in September when she was hospitalized..... her medications were wrong and she was dehydrated. If you Mom does this when you leave the room, she may also be afraid to be alone. My father began sleeping in the living room because he was afraid to be in his bedroom, my mother now will sometimes make that comment as well.

I think you need to either take her in to see her doctor, call her doctor and explain everything that is going on or call a social worker or hospice to come and check on her. Do not just leave her in this condition.

Thanks again for the comments and advice. Mom is allergic to Citris acid so NO kind of juice i can give her. The ensure i gave her was like a milk, and I even tried making a Milk shake out of it with some Ice cream. Didn't like it. Today has been rough since about 4 am she has been calling out for her mother and saying hurry. I can here this on the baby monitor. I go check on her and ask why she is callin out for Mama and she says she didnt know she was. But as long as I'm in there she mostly quite about the time I would go lay back down she would start again. I got her to eat a little of corn, peas, sweet potatoes, and potato salad but only a bit of each.She is saying ok Mama I ate now please come get me. Her Mom has been gone for over 40yrs.Trying my best to remain strong and be there. I asked her again if she would got to the Hospital and she refused. again Thank you all

Maybe the pharmacist, the "tech" or hospice will have some ideas that you haven't yet tried. One thing I wanted to mention was that you said you tried to give her Ensure. Was that the milkshake type of Ensure? Did you know that they have a juice blend Ensure now that is thinner like a juice and yet it contains protein? Have you tried that? If you haven't, do you your mom would sip that if she just thought it was a liquid juice? It might give her some nourishment if she's willing to try it thinking it's only fruit juice.

Now that her sisters have been there to see her, and stayed such a short time for such a long trip, don't be surprised if they take some kind of action to obtain control of the situation legally and without informing you until you get notified by the court that there is a hearing scheduled. Long distance non-caregivers who gain guardianship for conservatorship will often make an arbitrary decision that patients are not being well cared for, take them out of their home and place them in a facility. It may be right or wrong, needed or not, but it often leaves the caregiver out in the cold with no place to live. I hope you have some plans in place for yourself about what you will do in this eventuality. I don't want to be negative or a wet blanket, I just don't want you to be in shock and unprepared should that come to pass.

Oh jimmy, we all know how hard this is on you as the person who provides the 24/7 maintenance. Watching a human being, especially a relative and more especially a child or parent, decline before your very eyes when you are helpless to change the outcome, is just one of the most stressful and horrific things that can happen. You have done the best you can and other than continuing to provide access to anything your mom WILL accept, you are pretty much powerless. Just I know that you can be proud of your behavior and that those of us who know what you're going through really appreciate you!

Jimmy, if you want to you can call an ambulance regardless of your mother's wishes. She's 64 (i.e. young), diabetic, has been refusing medications and sustenance and is now hallucinating. I'd be surprised if she didn't have some raging infections as well.

Now, this is not a simple call for you, I do understand that.

1. If you're convinced that your mother set out on this route knowing it would lead to her death and intending it to do so, you can document document document as described, and you're in the clear.

2. But it might always be at the back of your mind that maybe something else started her off and she wasn't really making a rational decision - in which case you will always be sorry you did nothing.

I think if I were in your position I would call an ambulance. She will still have an opportunity to refuse help, and if she can convince the paramedics that she is of sound mind and making an active decision to refuse their help they will leave her be. The worst that can happen is that she's taken to ER, dragged back to life, gets sent home, blames you, and has to start it all again - in which case you get her to make an advance directive and sign it in front of witnesses.

Really hard for you, either way. But make your decision and act on it now.

Thanks, Her Sisters did come Visit one sunday a couple weeks ago stayed maybe 30 mins after driving about an 1 hr and 1/2, They had to get back. After that is when they decided this. I have gotton letters from a Pharmist and a Tech which states me asking question on how to get her to eat and suggestions on what to eat. Trying to get Hospice to come in now cause she is seeing things and People that are not there.Thanks for the Hugs and Prayers.

Have you asked her if she wants to starve to death? I actually asked my husband that once when he decided he didn't want to eat and drink anything after his stroke. It turned out he didn't want to die and just didn't realize how little he was eating and drinking and wasn't hungry or thirsty anyway.

If she does want to die and she doesn't live with you, you're probably not legally responsible but who knows how much trouble could be stirred up by grieving sisters. If she lives with you or she is otherwise in your care, document everything and get her doctor to make sure she's competent.

I have some personal experience with this. Having to force a person to eat is a fairly drastic step. If she won't eat, the options are limited. If she gets a feeding tube, you might have to restrain her (tie her down) to keep her from pulling it out. Are you willing to do that? You have to know that she might improve from it. Otherwise, how is it different from torture?

Also, let me be bitchy for a second here. If her sisters are so worried, why haven't they done something other than berate you? If they think you're starving their sister but sit idly by, what kind of people are they? If you feel charitable, chalk it up to their grief and let it go. If you don't feel charitable, ignore them or tell them to put up or shut up, whichever fits you best.

Here's a ((hug)) for you.

I would call her doctor and explain the situation to him and let him know that you have tried to get her to come in for a visit and she is refusing. It sounds to me as though she has chosen to die and this is the path she is taking. When my mother stopped eating or was eating so little that it would not keep a bird alive, I called and asked her doctor for Megace to increase her appetite which worked. If your mother however wishes to end her life verses just not eating that is something different.

At this point you basically need to protect yourself from accusations of elder abuse or neglect, therefore I would call Adult Protective Services, get a social worker to come in, call Hospice, call her doctor and explain the situation, do whatever you have to do to protect yourself. If you want her to get better and not allow her to die then you need to seek psychiatric or medical help for her.

I had an Aunt that chose to end her life by refusing to eat and she was probably in her 60's, she literally starved herself to death. It is my understanding that she had refused food at other times in her life although she never looked anorexic but possibly that may have been an issue.

In my Mom's case the Megace worked but we had also told her that we did not care what she said, she was going to the doctor even if we had to drag her there and we meant it. It is a difficult line that you walk with a parent in this situation, when you are old and ill your body does begin to slow down and shut down and the intake of food dwindles, but you need a doctor to make this call for you so you will never be accused of neglect.

Best Wishes to you both!

I'd call public health nurse to come out and make a report, they have a great way of getting things stirred up. You must be on record, cover your self.

I would think you could--something like negligent homicide. You need to call a social worker right away and take active steps to address this. If simply trying to feed her doesn't work, then it is your responsibility to try to further address the issue. I realize you probably feel like you are at your wit's end, but you need to address this in a way that is documented by other people.

Caught up with your posts....Diabetes and Uti can make for one out of control person. She needs medical help whether she wants it or not. Is she obese?
Letting the person have their own way is not always the most kind thing to do. with the blood sugar issue and uti she is incapable of rational decision making.
In addition is she depressed? Sounds like she could be. On meds for such?
She needs to stay hydrated? Does she drink?
You can always video her for documentation. When my daughter got sick it was the video that convinced the dr's something was really wrong. Smart phones are great. You can send it directly to her doctor. You can even use a "spy cam" for 24 hour surveillance or just to keep on eye on her when you are in another room.

How's it going? Can you update?
Does your Mom have a good PCP?
Has she seen him/her lately?
Does she been suffering acute or chronic health issues?
Could she be "actively dying?"
Have you Investigated hospice?
I think if you have her assessed by her physician that would rule out neglect.
Maybe her physician would like her in hospital for a couple of days to
hydrate her and get a psych eval?

What a difficult time for you! Personally I believe everyone has the right to eat/not eat/drink/or not/sleep or not. When someone has been through operations, long difficult illness, and-or is just plain tired of it all she/he knows "what to do" to slide away peacefully.
In the past,My own mother, step-father, brother and sister, in their own time, all over the age of 80 were able to stay in their own home with some pain relief and ice chips for dry mouth. Each of them glided into restful sleep…forever.They had been checked by docs and hospice nurses.We were letting them take control at the last. Keeping a detail log is a great idea as is staying in contact with her doc by phone.Does she respond to you at all? Sometimes a lift of an eyebrow, a lop-sided grin, a tiny nod of the head is all the response you may get. Did she used to like music? Does an on-going radio ( try the NPR station) soothe or irritate her?
Best wishes to you, gather around you (in person or by phone) supportive friends,minister? And be sure to keep your own self nourished.

jimmy - whatever you do, don't forget to email, fax or snail mail a brief but thorough description of what's going on to your mother's doctor, who needs to be on board with what is currently happening, even though s/he was aware of what happened at the hospital. It's truly unfortunate that you cannot put all your effort toward your mom's care and have to CYA, but it IS a reality that you MUST protect yourself when you have opposing forces working against you.

My Mom is 64, She is Bed Riden now cant get up so peeing in a diaper or pad is what she has been doing so constantly changin Diapers and Mattress pad and Cover is an everyday thing. I have started a log (Documentation) Of everything from the start. also Have My Aunt that lives here doing the same. also Have other people that I have went to for suggestion on what to get her to eat and how. to right out a statement also. A pharamist, a Tech, and an Exc from my Job that witness when she first had an episode at my job so Im CYA. Its a shame though All my concentration should be on her not liablility, But I know I half too. I told my Aunt that lives here in town that she can tell the others to stop calling me or my house I was not going to talk to anybody that talks behind my back and is trying to conspire to get me in trouble.

And it would be excellent to convince her to sign her medical and financial POA's do you know when she is competent. Make her understand that you want to do this so that you have the authority to follow her wishes. You must explain to her that if she doesn't have those documents in place when she is of sound mind, you will have to do it anyway, later, and it will either cost a ridiculous amount of money or, if you can't afford the money to do this, the state will take over and they will no longer allow you to care for her. Tell her that is the last thing you want to happen, then ask her if she wants some stranger making decisions about her health, her medical care and her last days.

If she is in sound mind- get her to create & sign & have witnessed (objective 3rd party notary?) a healthcare directive and living will (have her state her wishes/ prove her sound-mindedness on video?) - and follow those to insure her wishes and that no one suffers false claims/accusations, and she is not forced to suffer unwanted treatment.

Living at any cost is not living... I prefer to live and die naturally.. with minimum drama for myself & others, minimum cost to me and others, while reducing profits of the billion dollar, out of control, medical-marketing industry... i just say no, thank you.

I have seen far too many elders linger in pain, suffering and regretting their choices for years, thanks to having chosen the "benefits" of the miracle of modern "medicine".. when - if they had not taken the meds, or had pacemaker installed, heart transplant, etc.. they would have died as they lived, vibrant and still contributing and caring for themselves.

Yes, jimmy, Veronica (as always) has a good suggestion. Does mom pee in the toilet? You can go to her customary lab and get a sterile sample cup. You can also pick up something called a "hat" which is a clear insert that you put across a porcelain part of the toilet but under the toilet seat. It can't really be seen but the urine will go into the Hat rather than in the water of the toilet. To avoid contamination of the specimen, you should sanitize the inside of the hat with rubbing alcohol and let it dry completely before use. Then after mom makes a trip to the bathroom, you carefully poor some of the urine into the sample cup. Refrigerate immediately and get it to the lab as soon as possible. This could not only demonstrate an infection, but might show sugar in the urine and other problems, any of which could lead to a subclinical type of confusion for your mom that would cause her to make inappropriate decisions.

With the way you've described her recent hospital stay, that may be enough documentation to show her intent, especially if the medical professionals did nothing about it but sent her home. As you have no posted this more specific information, I would say a nanny cam and journaling may not be necessary - may just be more work, too much work, for you. And goodness knows, I would never suggest unnecessary work when you're overwhelmed with what you're doing already.

But I would still recommend the fax or email sent directly to the doctor about her current behavior and her current choices, as well as remind the doctor at the same time, in writing, about her behavior and refusals in the hospital before they discharged her. The more you put in writing that they don't respond to, the less you are responsible, IMO.

You still haven't said her age or if there's anything else wrong with her, like something major medical, other than the diabetes. I want to ask you, jimmy, are YOU prepared for her to pass away. Her sisters may not be prepared because it's too close to mortality for them. But perhaps it's time for you to prepare yourself for her to depart in case that is truly what she wants. It is it possible to keep everyone alive, especially if their soul or spirit is heck bent on leaving. I just want you, if it's inevitable, and if the decision is it made out of impairment, to be able to except letting her go and know that you did everything in your power that she was willing to let you do.

Please keep posting.

When we got her to go to the urgent care last month she had a UTI and since she had stated that she could not take her med. cause she could not swallow. The Doctor there suggested she be put in the Hospital to get the meds in her.this was a thursday on that Friday they Hospital did a procedure to see if anything was blocking her from swallow there was anything.After that she refused to let thme connect her back up to I VS. and she refused everthing threw the night from Blood Presusre check to, Sugar Checks and refuse to take her meds mouth. On Sat they came in and said she can go home , But need to follow up with a swallowing Test and with Her Primary care Doctor, She is refusing to go anywhere cause she dosent want to go back in the Hospital.

Oh and yes if anyone else has POA then they can be done for neglect but i take it from your post that she may not have any POA?

Yes get as many people involved as witnesses but report her to her doc and get a nurse in, here the law is different if she is a threat to herself then she can be taken into hospital by force a diabetic not eating is serious she could go into a coma I am having serious problems with mum she has bedsores,a urine infection and her bloods are off the wall she refuses to see a Doc and keeps saying shes not well enough to go?? I am trying to track down our useless district nurse who shouldve called 3wks ago as bedsores are serious my useless bro as per usual just says well we cant make her go YES WE CAN.
Here we have district nurses who call to sick patients at least once a week they assess the situation and report everything dont you have this system in the US?
Let us know what happens as this is important to know and what a stressful time for you. I know my friends mum is not recovering well after her op and is of sound mind the nurse says if she dosnt put on more weight soon she will be readmitted to hospital until shes a normal weight! Hugs to you this is very stressful and such a worry and like another post says tell her sister to get her ass there and feed her! Everyone has an opinion but is not there to help?

You say the urine smalls awful. Can you get a specemin and take it to the Drs office so they can check for an infection

jimmy - document, document, document. How old is your mom and is anything else wrong with her besides the diabetes? Do you believe she is at the end of her life and wants to pass or do you think she maybe depressed and suicidal and making an inappropriate decision to not want to live anymore? You most likely know her better than anyone else and should be able to have a feel for these answers.

I am a big believer in nanny cams for video evidence of how a person is behaving and whether their decisions seem to be of sound mind or not. You can usually tell but a picture is worth a thousand words and a video is worth a thousand pictures. You can get a miniature clock with a concealed camera that is motion activated, has a USB connection so you can download the video to your computer and burn a disc to show others. All available for under $100. That, and document, document, document + fax or email hey very succinct yet complete letter to her doctor. S/he may put your mom into a 72 hour psych evaluation to determine whether this is truly hurt and of life choice or is a temporary mental illness. She could have out of control blood sugar, a B-12 deficiency, a thyroid problem or a number of other issues that could lead her to confused decision making. Be cautious of her sisters and their judgments. They are obviously sitting back and letting you run the show, but then forming conclusions that you're not doing it the way they would do it. Be sure you include their concerns in your written communication with the doctor.

Yeah she is still passing Urine its like a dark amber color and smells allful.Thanks for the Idea of keeping a log will start today.

There is no POA. I tried to check into it and was told that she would half to give the consent for me to be it. I'm alone except for Aunt that lives here others live a couple of hours away and there the ones saying this.Nobody for me to talk to and its driving me crazy.

Is Mom still passing urine? What color is it? Is she a secret drinker as in does she get a drink of water while she is in the bathroom? If you call 911 she will again refuse to go and I don't believe you can make her. Have hospice come in and evaluate her, she may be nearing the end of her life and this is common though upsetting behavior. Will she let you weigh her?