My Mother Is Forgetting Things. When Is It Time to Step In?

Dear Mr. Miller:

My mother is 82 and still lives alone. Over the last year, she has become noticeably more forgetful. She repeats stories, sometimes forgets appointments, and recently paid the same bill twice. Last week she couldn’t remember where she had parked her car at the grocery store.

My brother says this is just normal aging and that we should leave her alone. I am worried that if we wait until something really bad happens, we will have waited too long.

How do I know when ordinary forgetfulness has crossed the line and it is time for the children to step in?

Worried Daughter

Forgetfulness or Something More?

What Should I Be Watching For?

Stepping In Doesn’t Necessarily Mean Taking Over

This Is Also the Time to Look at the Legal Documents

What If Mom Refuses Help?

Don’t Wait for the Crisis

Dear Worried Daughter:

Forgetfulness or Something More?: There isn’t a particular birthday, diagnosis, or number of forgotten appointments that tells a family, “Now you must take over.”

In fact, forgetting things occasionally is a normal part of aging. The more important question is whether your mother’s memory problems are beginning to interfere with her ability to manage her everyday life safely.

For example, forgetting where she put her glasses is one thing. Regularly forgetting to take important medications is another. Missing a bill once may happen to anybody. But getting lost in familiar places, repeatedly asking the same questions, becoming unable to keep track of finances, repeatedly paying bills twice, or falling prey to scams may indicate that ordinary forgetfulness is beginning to interfere with everyday life.

What Should I Be Watching For?: I would pay less attention to isolated memory lapses and more attention to patterns.

For example, my mother-in-law once stopped by the house. As we spoke, she mentioned almost as an aside that she had hit another car while parking hers. I asked whether she had left a note or what she had done. She said, “Nothing. I just drove over here.”

That concerned me. It wasn’t the fender bender itself. After all, most of us have had one sometime during our driving careers. What bothered me was that she seemed to attach no importance to what had happened and apparently had not considered what she should do next. That suggested a possible change in judgment and reasoning. We decided it was time to keep a more careful eye on things.

Is Mom still eating properly? Is she taking her medications correctly? Is the house reasonably maintained? Is she driving safely? Is she keeping up with bills and taxes? Is she making financial decisions that seem completely out of character? Has she become unusually vulnerable to telephone calls, mail solicitations, or people asking her for money?

You also want to notice whether she can correct herself. An older person may forget what day it is and then figure it out a few minutes later. That is quite different from consistently being confused about time and place.

And don’t assume dementia simply because memory has changed. Medication problems, depression, sleep problems, infections, nutritional deficiencies, and other medical conditions can sometimes affect memory and thinking. A medical evaluation should therefore be one of the early steps when the changes become noticeable.

Stepping In Doesn’t Necessarily Mean Taking Over: This is where families sometimes make a mistake. They think there are only two choices: leave Mom completely alone or take control of her life.

There is a very large area in between.

Maybe you start by going through the bills with her once a month. Perhaps someone accompanies her to important medical appointments. You could arrange automatic payment of routine expenses, help her organize medications, or simply check in more often.

California law recognizes this idea of using the least restrictive form of assistance that will do the job. Supported decision-making, powers of attorney, advance health-care directives, and other arrangements may allow a person to receive help without surrendering control over every decision. A court conservatorship is generally something to consider only when lesser alternatives are inadequate.

The goal should be to preserve as much of your mother’s independence as is safely possible.

This Is Also the Time to Look at the Legal Documents: Families often wait until a parent has clearly lost the ability to handle things before asking whether the estate plan is in order. Unfortunately, when a person loses mental capacity, some estate planning options are no longer available and some become more difficult or expensive.

While your mother is still capable of understanding what she is doing, find out whether she has a current Living Trust, Durable Power of Attorney for financial matters, and Advance Health Care Directive.

Then look beyond whether the documents simply exist.

Who is named to act if she can no longer act for herself? Does her Trust explain when a Successor Trustee can take over?    Is the financial Power of Attorney immediately effective or does something have to happen before the agent can act? Are the people named still alive, available, and appropriate?

These documents are much more useful when the family understands them before the emergency.

What If Mom Refuses Help?: That is often the hardest part.

An older person does not lose the right to make her own decisions merely because her children disagree with them. Nor does an occasional poor decision automatically mean she lacks legal capacity.

If your mother is still capable of making her own decisions, persuasion usually works better than confrontation. Telling her, “You can’t handle things anymore,” practically invites a fight.

You may have better luck saying, “Mom, I’d like to make things easier for you. Why don’t we go through these bills together?” That lets her remain in charge while accepting some assistance.

This is also where a care manager can be very helpful from several different perspectives. First, a care manager can help you assess the situation and your mother’s living environment. Are there dangers in the physical setup, such as throw rugs that should be removed, extension cords that create a trip hazard, or other conditions that could make it more difficult for her to remain safely at home?

Second, having a care manager perform an initial assessment can be very useful later if your mother’s physical or mental abilities deteriorate. The care manager already knows your mother, understands her living situation, and has a baseline from which to judge changes. That may allow the manager to step in much more quickly without first having to start from scratch.

Perhaps just as important, you and your mother will already have a relationship with someone who can help advise both of you as circumstances change.

Hiring a professional trustee to help manage your mother’s financial assets can also be very useful, particularly if she has been the target of scam artists or has come close to being scammed.

For one thing, it places someone between your mother and her money. If she suddenly asks for a large, out-of-the-ordinary amount, the trustee can ask what it is for. Sometimes that little bit of “friction” is all it takes to get Mom to slow down, explain what is happening, and think the transaction through before the money goes out the door.

The trustee can also take care of routine financial matters, including recurring monthly bills—the cell phone bill, the garbage pickup, the gardener, and similar expenses. That can help considerably when financial forgetfulness is beginning to become a problem.

And there are intermediate steps here as well. A Daily Money Manager may be able to handle routine bill paying. A professional fiduciary who also serves as a trustee may be willing to act simply as Mom’s agent for financial management rather than assuming the full role of Trustee. That can provide another layer of protection and assistance at a lower cost, while still allowing the arrangement to be tailored to the amount of help Mom actually needs.

If, however, she eventually becomes unable to protect herself or manage her finances and the voluntary arrangements are no longer sufficient, court involvement through a conservatorship may become necessary. A conservatorship is a court proceeding in which a judge appoints someone to make decisions for an adult who can no longer adequately care for herself or manage her finances. Less restrictive alternatives should ordinarily be considered first.

Don’t Wait for the Crisis: From what you have described, I would not conclude that your mother is incapable of managing her affairs. But I also would not ignore what you are seeing.

This sounds like the time to begin paying closer attention, encourage a medical evaluation, offer some practical assistance, and make certain her estate-planning documents will actually work if greater help becomes necessary.

The best time for families to discuss these things is usually before Mom leaves the stove on, sends $20,000 to a stranger, gets hopelessly lost while driving, or reaches the point that she can no longer participate intelligently in the planning.

Stepping in does not have to mean taking your mother’s independence away.

Done properly, it may be exactly what allows her to keep as much independence as possible for as long as possible.

If you are trying to figure out when it is time to step in—or you simply want to discuss the issues your family is facing—call us at 760-436-8832. We would be pleased to discuss this with you.