Can a Person With Dementia Refuse Medical Treatment?

Hi everybody, today we're here to answer the question, can a person with dementia refuse medical treatment? Care refusals can relate to the approach of the caregivers in the home and in the care professional medical setting. As dementia advances, if you're a caregiver, you probably know that the physical assistance by family members usually increases with daily activities. So hands-on care, things like bathing, dressing, using the toilet, changing protective underwear, brushing hair, brushing teeth, taking medications and so on. And so these interactions can also increase if a loved one is hospitalized or goes into a nursing home or lives in a care community and there are staff there doing things, because they're there to help people who need the help. So refusals can happen in two ways. So in the home setting, maybe a family caregiver is having a bad day and they're rushed, they're trying to rush the person, or maybe they're speaking to the person as if they were a two-year-old child. That person with dementia may not react positively to that. They may have other stuff going on. Maybe they're hungry or thirsty and they can't get those words out. Maybe they have some other need that is preventing them from participating on what the caregiver is trying to get them to do. Bathe, dress, take medications, eat. Refusals from people with dementia can look like moving away from the caregiver, saying no, verbally refusing, no, I'm not gonna do that. Physically refusing, becoming upset or angry or animated or pushing or pulling somebody's hair. A lot of these refusals can be circumstantial due to the interaction with the caregiver and how the caregiver is approaching the person. But specific to medical treatment, this can relate to a lot of issues. So maybe a person with dementia is sent to the hospital emergency room alone and there's no caregiver to advocate for them. There's all these strange people. People are saying things, they have no idea what they're saying, and the staff in the hospital isn't trained in dementia care. Of course, there's gonna be a reaction, probably a refusal. That can be way different from a person with dementia who goes to their regular doctor that they've known for years and a family caregiver's there. And the person's agreeable to everything, right? Because it's a calm environment. Care refusals can also happen when people with dementia live in a nursing home or a care community and people are trying to push them to do things and they're just not wanting to do it. So to answer the question, can a person with dementia refuse medical treatment? For this video, we're gonna contrast medical care refusals for a person with dementia who doesn't have a legal advocate versus people with dementia who have the support of a family caregiver who is that person's medical power of attorney or guardian. Because there is a difference between agreeing to care when you understand what you're being asked or agreeing when other people know that it's something that you would have wanted and they're advocating for you. So I'm gonna share examples of a couple of situations to help explain this a little better, so stay with me. If this is your first time here, I'm Pamela D. Wilson, I'm a caregiving expert, advocate, and speaker, almost 25 years of professional experience. Information about me, my bio, ways to schedule a one-on-one consultation are all below with links to my website, PamelaDWilson.com. If you are a return visitor here, I thank you so much, welcome back. Thanks for continuing to support my channel. Please do like this video, click the link below to follow my channel, share these and other videos with other people. Also, please do comment. One little thank you or comment makes a big difference, helps other people find their way here and it helps my channel grow. So let's talk about the care refusal of refusing to take medications. What options are there? There's actually a lot of options that you may not have considered. Some medications can be put in liquid form or a patch. If you get approval from a doctor and it's okay, you can crush those medications, put them in a little scoop of pudding or applesauce or something else to like mask the favor and just get somebody to take it. Refusing to shower or bathe can be another big one. Refusing to change protective underwear. People can get physically agitated when you try to make them do things they don't wanna do. And then there's the idea of refusing to do things that a person has always done and what that change means. So refusing to eat or maybe refusing to continue with cancer treatments or kidney dialysis. So these are the three examples that I'm gonna share here. But let's start with the medications. So typically, you've seen this, hospital and nursing home staff comes and they bring a cup and they bring a glass of water. It's like, here it is, right? Well, if you're the family caregiver and you get your loved ones to take medications at home, may take you a while to do this. You may have to sit with them at the kitchen table for five or 10 or 20 minutes. Keep putting them in front of them until they take it. Well, the people in the hospital, so the care communities, they don't have five or 10 or 20 minutes to spend with your loved one who is looking at those medications, saying, I'm not taking those. So that's where I mentioned before other options. Can it be put in a liquid or a patch so that it's just, you drink it or it's on a patch. You don't have to like swallow these pills. Or can you get an order from the doctor if it's okay to crush the pills and put them in something else. So there's ways to get around these care refusals of medical treatment. But to do that, you have to make a little effort, right? You gotta talk to the care staff. If somebody is in a nursing home or a care community or if they go to the hospital, you may need to tell the hospital staff, hey, they're not gonna swallow pills, but if you crush them, they'll take them. Beyond this, obviously a person with dementia can still refuse medications. And if the person doesn't have a legal advocate, like a medical power of attorney or a guardian who can bring up these alternatives, there may not be a lot that can be done with the exception of the care staff trying to figure out how to get this person to take medications. Now some people taking medications may have been like a lifelong pattern or maybe not. If a person with dementia never took medications during their lifetime, and all of a sudden you're trying to get them to take pills, they may not wanna do that. So this is why if you have a loved one diagnosed with dementia or you're diagnosed with dementia, you wanna put your wishes in writing into a document, a medical power of attorney document. And you wanna say things like, you know, I've never taken medications, I don't believe in it, I don't wanna take medications, don't do that to me. Or I'm okay taking medications if I'm in pain or suffering because I don't wanna be in pain or suffering, I'd be okay with that. But if I start tearing out the IV in my arm because you're giving me IV medications, then that means no for me. So there's ways to understand when and under what circumstances it's okay for a person with dementia to refuse medical care. Let's look at number two, which is that refusal to take a shower or change protective underwear. This can be a hard one regardless of whether you're the caregiver or the medical power of attorney because it's hard to force people to do these things. Options that I've seen in my almost 25 years working with my clients, for whom I was legally responsible and not legally responsible, starting with trying to find a caregiver that the person with dementia was comfortable with, family member paid caregiver. Then maybe scheduling the shower on a certain day or time the person used to shower. So if somebody is used to like showering before they go to bed, trying to get them to take a shower in the morning may not be possible, right? Other things like playing some soft music, having warm towels, make it like a spa experience. Sometimes none of that works and you gotta do body parts. Maybe you're bathing the left arm today and tomorrow it's the right arm and the left leg and the right leg and the back and the feet and then you're doing hair. Sometimes you gotta do what you can do. Now, separately I've had clients who would become really, really agitated when it was time to shower or bathe or change depends. In those cases where I was the medical power of attorney or the medical guardian, I had to work with the medical staff or the staff at the care community to see what we could do. Again, could we change shower times? Could we do showers and body parts? Sometimes we had to resort to giving a person medication 60 minutes before they were gonna take a shower to help manage their agitation and aggression. And the reason we did this is because I was afraid that my person was gonna hurt the caregiver in the community. You never wanna be in a position where, as the caregiver you're getting injured by the person that you're trying to get to do something. So while you may be a family member who is concerned about medicating your loved one, one, you wanna make sure the medications don't cause them to be more of a fall risk or anything like that, but in some cases that might be the only way to make sure that you're safe and the person that you're trying to bathe or change is safe. What happens if they go out to strike you and they slip in the tub and they fall and they pull you down and then you both fall? So there's a lot of balances between looking at approaches to change the environment and interactions and considering sometimes medications to preserve safety and wellbeing of the caregiver and the person with Alzheimer's. Because for people with dementia, not bathing, not changing protective underwear, that can result in a whole lot of other issues. Serious skin breakdown, bed sores. I have seen people die from bed sores. So if you're the caregiver or the medical power of attorney or the court-appointed guardian, you really have to look at these situations on a one-by-one issue, do a lot of problem solving, try some things, see what works, and work with sometimes doctors and care staff to look at other options. Because in the case of bathing and hygiene and incontinence, refusing really isn't an option. It's your duty to make sure that that person is clean and safe and not getting skin wounds. The third one here, refusing to do things a person has always done. And I'm gonna relate this to two clients that I had, refusing to eat and then refusing to continue to participate in a treatment. So this one goes back to, again, if you have the information, what would this person wanted for their care before dementia? In a perfect world, all this stuff is, it's clear and it's in writing in a power of attorney document. Now, it can be challenging if people don't think of circumstances that might happen, right? Whoever thinks you're gonna have dementia and need to plan for that, or that you're gonna have cancer and need chemotherapy, or your kidneys are gonna go on and you're gonna need dialysis, or even you're in a tragic accident and you have a brain injury and you have a feeding tube. Do you want that? It's hard to think of these disastrous and unexpected scenarios that can happen and plan for them, which is part of what I do when I help family members and people with dementia care plan. Because I have 25 years of experience and I've seen all kinds of things happen. I'm able to say, well, if this happened, what would you want? Write that down, put it in a document so that if it happens, you're covered, you're good. You're not gonna have to worry about that. Some families for people with dementia would consider a feeding tube if somebody can't eat, right? Without choking or aspirating or getting pneumonia. But the question is, would your loved one would have wanted that feeding tube if that's the only thing extending their life? These are hard topics to discuss, but they're easier to discuss when somebody's healthy and they're clear about what they might want or might not want. And I can tell you, if this information is not spelled out in written documents, family caregivers can get into huge disagreements between children, between children and the healthy parent. And some family caregivers become emotionally attached to keeping a spouse or a parent alive. And they put them through a lot of treatments that extend life, but don't make life better. I had one client with dementia who all of a sudden just refused to eat. And really that meant she was done, she had enough. She wasn't happy living in a nursing home. She didn't want to extend her life. And her desire to stop eating ended her life. Another client of mine went to dialysis for three days a week, probably 10, 15 years. All of a sudden decided he was done. So while we may think that people with advanced dementia don't know what they want, there are times when they very much know what they want. And those wishes should be honored. We should not prolong lives that have no quality. So again, to answer the question of whether a person with dementia can refuse medical treatment, the answer is yes. And it depends. It depends on if the person understands the medical treatment and can make an informed decision. Depends on what the person would have wanted for their care before this care issue happened. And it depends on whether they have a power of attorney or a guardian who understands what they want. Now there were some situations where I was appointed guardian and I didn't know the person. But I relied on communication with their family members and their friends saying, do you know what they would have wanted? What was their life like before this? What choices would they have made? There were also other situations where I knew the person and we were able to sit down and have these in-depth conversations about if A happens, do you want B? If B happens, do you want C? So it's important to have these discussions because if you are that agent, that legal agent, it's your job to do the right thing. If you're in this situation and you don't know what to do and you need help, you can always schedule a one-on-one consultation with me. I can take you through choices and options so that you can make the right decision that you're comfortable with. If you want to schedule a one-on-one, there's a link below this video. There's also links to my website, courses on my website, information on my website. Caring for a loved one with dementia is probably one of the most challenging things anyone will have to do. And making decisions, especially medical decisions for a loved one with dementia is another hard thing to do, especially if you did not have discussions before and you do not know what they would have wanted. It can be emotionally challenging. But there are ways to figure this out. There are ways to do a little bit of trial and error, to figure out what works, to work with staffing care communities and to make all of this work so that you can answer the question yourself. Can a person with dementia refuse medical care or treatment? I thank you all so much for being here. I will see you again soon in another video.