PCPs Need to Get Smarter About Invoking Healthcare Proxy

I am working with a family who is desperately trying to get the PCP to invoke the healthcare proxy for their elderly mother.  The PCP is unwilling to invoke it because she doesn’t want to take away the parent’s independence.  It is very frustrating.  The family knows their mother is  making poor health decisions and putting herself at risk.

I have been working with the family for two years and have watched my client steadily decline.  She is unsteady on her feet with poor balance, has difficulty making meals, taking her pills, cannot pay her bills and is confabulating.  She is very forgetful and their are many cognitive changes.  Recently, she forgot her son’s birthday.  Her personality has begun to change and a person who used to be gentle and kind at times will be anger and mean.  She is prime for a fall.  Several of her other doctors, have commented to me about obvious changes and inquired, is some one going to do anything.

When a healthcare proxy is not invoked, then the individual has the right to make all their decisions. What do you do when it is obvious, the decisions make no sense, are creating an unsafe environment and putting the individual at risk?  How do you get the PCP to be an advocate for the safety and well being of a person?

Several months ago, one of the son’s and myself went on a visit with the mother to the PCP.  I had informed the PCP ahead time of the issues.  What I find with many older clients is they have ready pat answers for the PCP.  For instance, PCP: Do you take your medication? Patient: I have system that I take it out of the bubble pack at the times I need to take it.  The reality is, when she is on her own she takes the medication when she remembers.  She also forgets for stretches and then decides to double up.  When she asked about it,  an typical answer is, The pharmacist didn’t do the packs correctly.

The problem is that a 15-30 minnute visit is a mere snapshot into a person’s changes.  I watched my mother-in-law’s doctor allow her to be her own healthcare proxy, even when at visits, she obviously wasn’t bathing, the family reported she was drinking her meals, she had stopped paying bills and was confused.  The result  was my mother-in-law  hit her head on the second floor of her home and laid ,semi conscious and bleeding for 2 days.  Repeated calls from family and a call to the police resolved the issue.  She is now in assisted living.

The situation that my current family is faced with, is the mother who has assistance in the home 7/12, is stating she is going to stop it.   The family is frantic because they know she is not able to preform most of her activities of daily living.  They are trying to negotiate with her but it is a slippery slope.  The family is not trying to control her life or take away her freedom, but rather keep her safe and her allow her to have the best possible quality of life.

It is my belief, the PCP is putting my client at risk.  In the past, the PCP has said she is just uncomfortable about invoking the healthcare proxy.  She feels it is a family issue.  That really makes no sense to me when the family is begging her to help them keep their loved one safe.

Healthcare professionals need to come up with a more realistic approach to supporting families when elderly loved ones are at risk in the home.  They have to stop turning a deaf ear to the pleas from the family and have a more thorough assessment not just a snapshot, 10 minute office visit to support their decision.  They have to stop the archaic thinking that they are taking away someone’s independence when they are actually creating a dangerous situation.

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