By Dr. Sheila Wijayasinghe, Globe and Mail Update, Published
From Globe Life, Health & Fitness, Ask a Health Expert, Ask the Doctor
The question
My 79-year-old mother lives alone, five hours away from me. She refuses to move closer – she’s stubborn and determined to live independently – but I’m afraid her health (and mind) are going. She hasn’t seen a family doctor in decades, and refuses to do so. What can I do?
The answer
This is a challenging situation that requires a great deal of sensitivity. The answer to this question will depend upon your mother’s capacity to make decisions. It is fair that you are concerned for her mental and physical well-being. But if she is able to make safe decisions for herself, there is little you can do to influence where she lives or whether she sees a doctor as it is her right to make these decisions.
This being said, if your mother is not caring for herself and not making safe decisions in terms of her health, you can consider requesting a formal capacity assessment.
Capacity is a legal term relating to a person’s ability to understand information that is relevant to a decision and to appreciate the consequences of that decision. It is not a clinical condition or a diagnosis. It is based upon a legal assessment and there are offices located in every province that can let you know where to seek help and how to find a qualified assessor (most are physicians specifically trained to make such a judgment).
Capacity is complex because it can vary based on the area of concern and it is possible to be capable in one area and not another. For example, someone might struggle to understand complex medical decisions, but still be capable of making informed choices about their financial or social activities. If someone is deemed incapable, a substitute decision maker can be put in place to make decisions in the area that the person has been judged unable to do so for him or herself.
It sounds like you care about the well-being of your mother and you have valid concerns. My suggestion would be to discuss your concerns about your mother’s well-being and safety in a non-threatening manner because it can lead to a great deal of tension between family members. From your mother’s perspective, she has likely established a home for herself and does not want to lose her independence. It is important to honour and respect her wishes but also address your concerns honestly.
By bringing up this concern in a non-confrontational manner and framing it around her safety, your mother may be open to discussion.
While having this discussion, you may also want to see if your mother has taken steps toward ensuring her decisions are respected further down the road by assigning a power of attorney or a substitute decision maker. Stress that it’s important to you that she choose someone who can represent and respect her wishes if a time were to come where she could no longer do so for herself. She could also include her choices in a will or personal directive so everything is clear and legally documented.
Hopefully this is something that can be worked out in a respectful manner. If you do need support, however, in finding someone to assess capacity, check in with your local provincial authority or her family doctor.
