How best to help someone who thinks you're out to get them?

September 1, 2009 5:23 PM

Seeking some advice on how to best help my father in law. You are not my lawyer; you are not his doctor.

My father in law has just been discharged from a psychiatric facility after he stopped taking his Haldol a couple of months ago and spiraled into paranoid delusions and ended up in the emergency room (he has also suffered from epilepsy his whole life & ended up in the ER after a seizure, but that's not the issue at hand).

Short version: he cannot continue to be held at the psychiatric facility, and a course of Resperdol has gotten him aimed back at lucidity, but he isn't there yet. My wife is the only child in the local area, and her parents are divorced, so the onus falls on her. In speaking with the psychiatrist and doing some research on my own, here's where I am in trying to help address his health and well-being over the medium and long term:

1. A durable medical power of attorney (and possibly a bundled advanced directive) would be a proximal step; because this was not in place, getting cooperation from the hospital staff was right out of One Flew Over the Cuckoo's Nest. There are freebie legal forms for this.

2. Home health care agency services. He needs medical supervision because prescription blood thinners are a medical necessity. Ideally, I'd like to ensure as much as possible that he stays on the Resperdol as well. I realize this may be in vain, but I have to try.

3. Conservatorship, Or

4. Guardianship, with the help of a probate attorney. I'll freely admit that my grasp of these last two are profoundly shaky, but I'm a quick study.

Add the fact that his paranoia is still very manifest makes these options fraught with potential drama (suspecting my wife and I of being complicit in the conspiracy). For that reason, and because I'm concerned about continuity of care should we relocate away from the area, my instinct is to look into naming an agency as guardian/conservator of record.

Obviously, he may not consent to any of this. What I need from the hivemind is advice on the above options, please. Insights, pitfalls, the like. Also: if he does not consent to any or all, how do I seek assistance (not where; I'm okay finding local resources - I need to know what questions to ask).

I have the name of a probate attorney as an initial contact; his psychiatrist has also begun the process of contacting a home health agency to get at least that ball rolling. Thanks in advance.

posted by Emperor SnooKloze to law & government (3 answers total)

Since nobody seems to be biting on this, let me just say that it seems you have the situation pretty well thought out, and nobody on here will be able to give you any better advice than a good lawyer.
posted by number9dream at 8:57 PM on September 1, 2009 [1 favorite]

if he does not consent to any or all, how do I seek assistance

Have you come across this estate planning guide from the National Alliance on Mental Illness?
posted by Monsters at 9:54 PM on September 1, 2009

I am not a doctor or a lawyer, but I am the primary caregiver for an adult schizophrenic man, my brother, who lives with me. Risperdal is a potent atypical anti-psychotic medication, typically prescribed for schizophrenia, some schizo-affective disorder conditions, and some kinds of adult dementia. You also state that your father-in-law has additional, long term, serious medical co-conditions including epilepsy, and is taking blood thinners. Moreover, he is still evidencing paranoid thinking, at least to you and your wife's actions on his behalf. Clearly, his case is medically complicated.

As a layman, I've got to say that it doesn't seem likely that your father is a good candidate for independent living, even with temporary home health care agency services. The likelihood that he will remain medication compliant, even with supervision, is fairly low, over the length of time for which his conditions are likely to persist, even if he has top quality home health care support, and the independent financial means or insurance coverage to assure this. But the likely severity of his medical situation, and his recent hospitalizations may make it easier for you to gain guardianship of his assets, and participate with the court in crafting a care plan for him, based on nursing home support, or other long term assisted living situations, supposing he is of independent financial means, and has the insurance coverage to support such options over the long term (years or decades, depending on his age).

You're going to need the services of a competent legal firm, who are completely familiar with your state's laws, and Federal tax law, regarding guardianship/conservatorship, and also able to set up and administer beneficial trusts, if such are recognized in your state. It really is important to shop around for legal expertise in dealing with mental disability cases - this is very much a specialist area of law, and not every general practice probate attorney is going to be versed in the matters that will ultimately be most important to your family. You should be looking for firms with demonstrated expertise in this area, and one way of finding these people is to ask families of other such patients for their recommendations, if you know any such families. If not, you need to find area support groups like your local NAMI chapter, and begin doing some networking, including attending meetings. You should also be actively seeking the advice of medical social workers at the hospital that has been treating your father-in-law. They can recommend local resources, and might refer you to legal and medical specialists best able to help your family establish care plans (but be aware that in many states, medical social workers are prohibited from making specific referrals).

I'm also going to make the point, based on your question being framed as if you intend that your father-in-law go back to independent living, that your interests, and his, may well be opposed in the immediate future. If he hasn't been declared incompetent by a court, he retains the right, if not the capacity, to act on his own behalf, even if that means his actions are not in his best interest. So, you need to be prepared to retain counsel on your own dime, to guide your actions, until such time as you have determined what the best course of action for your father-in-law is. You may also need to see that he has independent counsel, up until you take over his affairs, through appropriate means. This is particularly important if your wife has other siblings, and the estate issues are not clear cut, and well known in advance to all, as it seems from your question, they are not. You cannot expect to save a little money by working with a single attorney, until it has been established that you are empowered to act on behalf of your father-in-law's best interests.

"... For that reason, and because I'm concerned about continuity of care should we relocate away from the area, my instinct is to look into naming an agency as guardian/conservator of record. ..."

I'm not surprised that this is your first thought. Many, if not most families faced with the prospect of caring for a family member with severe medical problems and mental illness want to hand over the case to professionals. For the very wealthy, it is possible to do so, but for the majority of the rest of us, there rarely any "agency" willing to accept that burden, particularly for patients who are argumentative, ambulatory, and prone to paranoia, and who have limited financial means and insurance coverage. You also say "My wife is the only child in the local area, and her parents are divorced, so the onus falls on her." which indicates to me that you and your wife are struggling with this, as a new family responsibility that you'd rather not have, but can't avoid, under family expectation.

What is unclear from your post, and perhaps generally unclear to you, is whether, beyond geographic proximity, you and your wife are, in fact, the best overall qualified family members to head the effort to care for your father-in-law. So, I'm going to suggest that you get the other family members on some regularly schedule conference calls, in the days ahead, to discuss all this, as you get more information, and that you all try to jointly decide what is best to be done, and who should be doing it. It may take the coordinated support of your entire family to get your father-in-law through everything he will face in coming months, and you'd be best served now, by inventorying and marshaling your family's total resources, rather than stepping immediately into the fore, on the basis of geographic proximity, before everyone else has had their chance to comment and contribute. You may find that family dynamics, probate laws, or other situations favor pursuing care alternatives for your father in a state or place other than the one in which you are currently living, and that making any necessary physical moves for him, before starting legal proceedings, is vital to your father-in-law's, and your family's, long term best interests.

Finally, I'm going to point you to a Metafilter thread from August 26, which discussed the difficult case of six year old January Schofield, diagnosed as a severely disturbed schizophrenic child, as reported in the LA Times. Late in that thread, I joined to comment regarding issues that schizophrenic patients and their families must often face in dealing with mental illness, that may be of help to you, at least in the sense of knowing that families do cope with these situations, and that your reactions and problems are not unique.

Sometimes, just that knowledge, is enough in the early days of dealing with such situations, to be pivotal in pushing through. Good luck to you, your family, and your father-in-law in coming days.
posted by paulsc at 1:00 AM on September 2, 2009 [4 favorites]