Elderly Aunt, Substance Abuse, and COVID-19
March 26, 2020 9:12 PM Subscribe
I live in a large US city that has issued a shelter in place for two weeks, subject to be extended. My parents live 1.5 hours outside this city, to the east, and are in their 70s. They are on a farm, they are isolating, I am very lucky that they are behaving this way considering the way a lot of my friends' parents are reacting.
My elderly aunt, however, is another story.
My aunt lives about an hour outside the city, but on the opposite side from my parents. My parents are younger than her by about 5 years and my mother is her POA at this time. Last year my aunt was committed (for lack of a better word), basically for substance abuse. She appeared to be spiraling into dementia at the time, but once they got her off the insane amount of prescription substances, she stabilized and was able to go back to living independently after bridging some time living with my parents.
She is a med hoarder and a doctor shopper and even though my parents tried to get rid of all her meds while she was in the pokey, they apparently didn't get them all. These include muscle relaxers and pain medication along with a slate of standard old-person meds. She takes them "as directed" but when you have three docs and a pain clinic "directing" things get out of control fast.
She's stubborn and a control freak. You know where this is going.
She checks in with my parents every day, and they are becoming concerned that her behaviors and communications are getting erratic again. My mom specifically told me she thinks that my aunt is "using" again. My dad has a heart condition and they neither of them should be leaving home for any reason, much less to drive the 2-3 hours from their place, across town, and out of town again to my aunt's to check up on her.
Furthermore I don't want my aunt to bring the virus to my parents - no one knows how well she has been isolating. She is not fit to drive the distance between her house and my parents'. I am under shelter-in-place and I guess I could leave since this is a medical situation, or it's about to be, but I don't want to bring the virus to HER. I am not her POA and my mom can't just transfer that to me, of course.
I have absolutely no idea what to do when this all goes pear-shaped. She lives relatively in the middle of nowhere and is not close to any other family (and is also not on speaking terms with them, anyway). She has always loved me but in her old age she is both pretty fragile and pretty volatile.
What should we do? What should I plan for? Should I plan to have to leave my house and just -- have my mom on the phone if necessary? I don't want my aunt to be re-committed but she almost killed herself the last time we went through this, I don't think she will survive another time.
My aunt lives about an hour outside the city, but on the opposite side from my parents. My parents are younger than her by about 5 years and my mother is her POA at this time. Last year my aunt was committed (for lack of a better word), basically for substance abuse. She appeared to be spiraling into dementia at the time, but once they got her off the insane amount of prescription substances, she stabilized and was able to go back to living independently after bridging some time living with my parents.
She is a med hoarder and a doctor shopper and even though my parents tried to get rid of all her meds while she was in the pokey, they apparently didn't get them all. These include muscle relaxers and pain medication along with a slate of standard old-person meds. She takes them "as directed" but when you have three docs and a pain clinic "directing" things get out of control fast.
She's stubborn and a control freak. You know where this is going.
She checks in with my parents every day, and they are becoming concerned that her behaviors and communications are getting erratic again. My mom specifically told me she thinks that my aunt is "using" again. My dad has a heart condition and they neither of them should be leaving home for any reason, much less to drive the 2-3 hours from their place, across town, and out of town again to my aunt's to check up on her.
Furthermore I don't want my aunt to bring the virus to my parents - no one knows how well she has been isolating. She is not fit to drive the distance between her house and my parents'. I am under shelter-in-place and I guess I could leave since this is a medical situation, or it's about to be, but I don't want to bring the virus to HER. I am not her POA and my mom can't just transfer that to me, of course.
I have absolutely no idea what to do when this all goes pear-shaped. She lives relatively in the middle of nowhere and is not close to any other family (and is also not on speaking terms with them, anyway). She has always loved me but in her old age she is both pretty fragile and pretty volatile.
What should we do? What should I plan for? Should I plan to have to leave my house and just -- have my mom on the phone if necessary? I don't want my aunt to be re-committed but she almost killed herself the last time we went through this, I don't think she will survive another time.
Honestly if she's talking to someone everyday, that's a great sign. It's not a super happy sign, but it means 1)she had access to a phone 2) she is remembering phone numbers 3) contact with family is important to her 4) she's walking and talking and alive.
It is okay to do just phone check ins and not visit her in person. Right now, unless she is in total crisis getting a bed in a communal environment like a substance abuse center or inpatient unit for behavioral health issues may cause more harm than good depending on her risk factors, and many places are only accepting support serious cases for that reason.
Is there a way to look into county resourses for things like delivered meals? It would increase the people checking in on her and get some basic needs met at the same time.
I suggest asking questions on the phone about her routine as a part of natural conversation. When's the last time you went grociery shopping? Are you showering everyday? I ran out of soap, can you believe it? Just ways to get her talking about what she is doing. Also, it's a way to indirectly educate her about shelter in place. For example, saying things like, I'm really disappointed because the first Sunday of every month my friends get together for lunch and we can't do that right now. Is there anything you've had to cancel? It models appropriate behavior, builds a relationship, gives you an idea of her daily activities and is non judgemental .
posted by AlexiaSky at 9:31 PM on March 26, 2020 [14 favorites]
It is okay to do just phone check ins and not visit her in person. Right now, unless she is in total crisis getting a bed in a communal environment like a substance abuse center or inpatient unit for behavioral health issues may cause more harm than good depending on her risk factors, and many places are only accepting support serious cases for that reason.
Is there a way to look into county resourses for things like delivered meals? It would increase the people checking in on her and get some basic needs met at the same time.
I suggest asking questions on the phone about her routine as a part of natural conversation. When's the last time you went grociery shopping? Are you showering everyday? I ran out of soap, can you believe it? Just ways to get her talking about what she is doing. Also, it's a way to indirectly educate her about shelter in place. For example, saying things like, I'm really disappointed because the first Sunday of every month my friends get together for lunch and we can't do that right now. Is there anything you've had to cancel? It models appropriate behavior, builds a relationship, gives you an idea of her daily activities and is non judgemental .
posted by AlexiaSky at 9:31 PM on March 26, 2020 [14 favorites]
In terms of crisis, yes you should try and go if you need to. You could call local police/non emergency services for a wellness check if you cannot get out there, though YMMV drastically on the usefulness of that encounter, and the safety of doing such a thing .
If hospitalization is warrented, it is warranted. You may want to reach out to the facility she was seen at last time or facility of preference (this also depends on how long ago she went there) and speak to intake about the possibility of her returning just to get an idea of if the current situation is impacting the services they are providing.
Ideally there is some outpatient service she could be connected to that would assist her.
posted by AlexiaSky at 9:43 PM on March 26, 2020 [2 favorites]
If hospitalization is warrented, it is warranted. You may want to reach out to the facility she was seen at last time or facility of preference (this also depends on how long ago she went there) and speak to intake about the possibility of her returning just to get an idea of if the current situation is impacting the services they are providing.
Ideally there is some outpatient service she could be connected to that would assist her.
posted by AlexiaSky at 9:43 PM on March 26, 2020 [2 favorites]
Any chance your aunt could obtain or would accept the services of a nurse case manager (some insurance plans offer this for people with complicated medical needs, seems like Medicare may cover it) or a visiting nurse or something? Does your mom have medical POA? Could she call one of your aunt’s more responsible doctors and ask her to prescribe/recommend such services?
posted by mskyle at 3:55 AM on March 27, 2020
posted by mskyle at 3:55 AM on March 27, 2020
I think you need to offer more support to your mom - obviously she is feeling responsible for her adult sister's life and she shouldn't. Are there any online Al-Anon or other groups you can direct her to? Your situation isn't unique - a lot of "hidden" addictions are coming out in this crisis situation. You may have to accept that these are the choices your adult aunt is making and you have no control over those choices. That you, and your parents, are witnessing this is absolutely heartbreaking, I get that, but there really isn't anything you can do as your last, relatively recent, intervention did not have any lasting effects (it sounds like she had, at best, a few months of sober independent living?). I am so sorry you are going through this. Please seek care for yourself and your parents, you celarly have very generous and open hearts.
posted by saucysault at 7:41 AM on March 27, 2020 [5 favorites]
posted by saucysault at 7:41 AM on March 27, 2020 [5 favorites]
I agree with saucysault. Check in with your aunt but you can only be someone's support system if they let you support them. Do your best to support your parents. (And keep your oxygen mask on when you do - you may have picked up some self-sacrificing habits too.)
posted by headnsouth at 12:04 PM on March 27, 2020 [1 favorite]
posted by headnsouth at 12:04 PM on March 27, 2020 [1 favorite]
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posted by mwhybark at 9:29 PM on March 26, 2020