Mental Competence and When to Step in for Mom and Dad

There’s no doubt about it–helping your loved ones can be difficult. You observe little things at first, such as forgetfulness.You let it go for a while, but soon you find yourself trying to evaluate a host of “little things” that collectively are adding up to the big question, “Is Mom or Dad mentally competent?” We have some answers and also some tough questions to help you evaluate your situation. Read on for more in-depth answers, and see our 3 Quick Questions to Ask (at the end) when you’re not sure what to do. 

What is mental competence?

According to the Public Legal Education and Information Service of New Brunswick, “Mental competence is the key to rational decision making. Unfortunately, disease or injury can affect the mind making it hard for a person of any age to make sound decisions. Sometimes it may be impossible for the person to look after themselves or their affairs.”

When do you need to step in to make decisions for Mom and Dad?

There’s no easily, identifiable time and there is no easy formula as to when you should step in. But you and any other caretakers need to have a conversation with your parents focused on SAFETY. Ideally, their physician would partake in this conversation as well.

• For instance, you don’t want to take away their license, but they are forgetful so they go the wrong way or neglect to stop at the lights sometimes. That’s unsafe. 

• Or one morning when you visit Mom you realize the oven is on, from dinner the previous evening. That’s unsafe. 

Be mindful that you distinguish between a true safety issue and a “matter of opinion.” If a physician or other professional deems your concerns as your opinion, they will not be willing to take the reins from Mom or Dad just yet. Simply disagreeing on what is best doesn’t mean your loved one isn’t capable of making his/her own decisions.

If it IS a safety issue, then it may  be an issue of mental competence and it is time to step in.

When you know they need help, do you make all decisions or just some? 

If they’ll let you help make decisions, keep it simple and do it without getting involved in legalities. ALWAYS let them make as many decisions as possible, whether or not they are mentally competent. You can step in when necessary. No one likes to lose their freedom to choose, so even if they can’t drive anymore, be creative in the way you maintain their ability to have a say. “Do you want to go to the grocery store or the post office first?” “Would you like to stop for lunch before or after we pick up your prescription?” Choices like these can go a long way in helping them to feel valued and heard, at a time when they may otherwise be feeling a sense of loss.

Start small–unless it’s a safety issue–and always give choices.

What if Mom and Dad don’t want help? 

Difficult behaviors. That’s what they’re typically called in the medical world. And refusing help usually falls into this category. Reading and learning as much as you can about how to deal with difficult behaviors will be of great value to you as you navigate this chapter of your parents’ care. Even training for dementia and Alzheimer’s can be extremely helpful (whether or not your loved one has these diagnoses) because it helps you understand more about the aging process, signs to look out for, and helpful things you can do. 

If Mom and Dad don’t want help, you have a few options:

1. If they are competent (they can make decisions for themselves mentally), you can continue to be a support, provide guidance and resources as they need it, and be alert for any changes in condition that indicate they may be unable to safely make decisions. And while there is nothing you can do to make your loved ones accept help, you can be prepared by understanding future options for care:
   1. Ensure there is a Living WIll (Advanced Directive) and Power of Attorney items filled out (General, Medical, Financial are all types of Power of Attorney).
   2. Read our handout “How to Prepare for Your Golden Years”
2. If they are NOT competent (they can’t make decisions for themself) and you have a Power Of Attorney (POA), you can ensure the physician has them officially declared incompetent and then you can assume decision making for them. 
3. If they are NOT competent (they can’t make decisions for themself) and you do NOT have a POA, you can ensure the physician has them officially declared incompetent and consult an elder law attorney to ensure appropriate and legal documentation is created and implemented. 

3 Quick Questions to Ask When You’re Not Sure What To Do:

1. Is Mom or Dad mentally competent?
2. Do I have our team ready?
   1. Find a good Elder Law Attorney (or Estate Planning attorney)
   2. Know the contact information for anyone else that needs to be involved with a decision for your parents (i.e., their siblings, their caretakers, additional family)
   3. Know the people involved in your loved ones medical care (doctors, social workers, case managers). 
3. Do I know what to do if Mom or Dad can’t help themselves anymore? See our Golden Years handout for good questions to consider.

If your Mom or Dad doesn’t have the ability to make decisions but continues to do so, safety, quality of life, family relationships, and health can suffer quickly. The bottom line: Understand your options and make the best informed decision you can with the resources you have.

Need some help going through the process? Find all our contact information at our website: silverlininghealthcare.com. 

Additional Resources:

• “Mental Competence” published by Public Legal Education and Information Service of New Brunswick
• The Grey Zone”: How to Handle Partially Incompetent Aging Parents
• How to Legally Declare Someone as Mentally Incompetent? 
• How to Get Guardianship of a Senior 
• Safe Seniors: Ageless Advice for Older Drivers
• 6 easy ways to make a dementia-safe kitchen 

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