Dignity of Risk—What is Your Plan?

A family in crisis came to see me recently. There were multiple children. Mom was there. She is in her eighties and recently had a series of crises, resulting in a couple of hospitalizations. The family reported signs of dementia, but in our meeting, mom was articulate and engaged. A couple of the children live in the area and are trying to help mom. One child from out of state has come home to get mom through this crisis but needs to go back to her own home out of state. Some of the children want mom to move to assisted living; others are supportive of mom’s goal to stay at home. Both sides had very compelling arguments. For me, the biggest tipping point was what mom wanted: staying at home.

I started my elder law journey with my 86-year-old grandmother. I took over her care at a time of minor crisis. While strongly urging her to move in with me, or into assisted living, she was adamant about staying in her own home in Texas. Along our journey we had multiple crises: falls, poor nutrition, hospice care, and a poor health care system. But when I would confront her again about moving, she would always say to me, “Honey, I know one day I will have to go to a nursing home. I just do not want to know about it.”  She meant as long as she was cognitive, she was willing to take the risk of staying at home.

Over time I evolved to the position of “dignity of risk.”  What I mean is that my clients with capacity ought to have the dignity to decide the risks that they would tolerate.

I wish the decision was black and white.

Back to the family in crisis. I thought about our meeting for several days, and then wrote a letter. My position from our meeting until I wrote that letter evolved. I let my client know that while I strongly support her desire to stay home, there must be a plan. It cannot be throwing all the burden on the children, as they have their own families and their own jobs. Over half the family is out of state. While supportive of her desire to stay at home, there needs to be some type of plan to oversee her care.

I do not know what the family is going to decide to do. As I said, they had compelling arguments, but the mom’s proposition to stay at home with no plan other than relying on the children is not going to work. Of that I am certain.

It is interesting that right before I drafted this article, I worked on a presentation about Alzheimer’s. While it is great to say, “I want to stay at home,” be sure that you are open to having some type of mechanism or plan to make that happen. It is worth taking time to think about.