Dear Readers – A family’s fears regarding a husband’s inadequate caregiving for his wife with dementia, brought many responses regarding vulnerable seniors - a topic that also affects younger relatives as decision-makers (April 18):

Reader #1 – “It’s possible that the husband (age 80) may be experiencing cognitive impairments of his own, or physical issues, that may affect his ability to care for his wife.

“Their sons should encourage him to see a physician regarding his own health.
“He may be simply overwhelmed by the caregiving demands. He may believe that he’s solely responsible for his wife’s care, though there may be other avenues open to him.
“In Ontario, Community Care Access Centres (CCAC’s ) can offer access to additional supports at little or no charge. (Ellie – Similar agencies can be sought in other locales).

“These include help with bathing, laundry, adaptations to the physical environment, etc.

“So the woman’s concerned sisters may contact the local CCAC.
“The husband may find it more acceptable to have a third party involved rather than having immediate family tell him that his care is inadequate.

“If he’s concerned that his wife may be taken away, but with current waiting lists for Long Term Care, a situation would have to be extremely critical, plus there would have to be agreement with the decision-maker.”
- From a Registered Nurse who’s been involved with both sides of similar situations.

Reader #2 – “The husband's abilities and judgement should also be assessed by a doctor.

“It’s highly unlikely that the wife is fed,  given regular exercise, mental and physical, and have all hygiene needs attended to.

“Re-using diapers will eventually cause skin breakdown sooner or later.

“The Public Health Department in the area might be able to help also.

“The Alzheimer’s Society does provide visitor or respite care to families caring for a loved one, in some areas.

“It’s possible that this man will be unable to continue, so contingency plans should be made.”

Reader #3 – “Besides CCAC’s there is also, in Ontario, an Office of the Public Guardian and Trustee (OPGT) regarding situations like these.

“They may be called upon to assess the wife, and the husband’s capacity to help her, or initiate other actions to assist her.

“If the husband’s found to be incapable as a substitute decision maker, then her sons may become her decision-makers and can begin to legally act in her best interest.

“Even without an assessment of the husband, since the sons have Power of Attorney, they’re her substitute decision makers for personal care, not her husband.”

Reader #4 – “The Alzheimer's Society has terrific programs for dementia patients.  The concerned sisters should attend one of the information sessions to get advice and maybe convince the husband to go to a session.

“They were a godsend for our family!”

Reader #5 – “As a lawyer, a significant portion of my practice is now known as “Elderlaw.”
“The husband’s refusal to involve outside care for his wife isn’t unusual.

“It arises from a variety of causes, such as, as Ellie noted: Concern about cost, inability to accept the ageing process in one’s self or spouse, inability to recognize the poor quality of care and fear that the spouse will end up in a care facility, leaving the other spouse “home alone.”  Or a combination of those.
“Advance care planning is very helpful before cognitive functions decline to the point that fears take over. This family should’ve had discussions years ago.”

Reader #6 – “Recently, a condo resident drowned herself in her bathtub.

“She’d moved here several years ago as a young senior, with her husband.

“Suddenly, he died and she became disruptive to anyone she tried to befriend.

“Obviously, the husband had managed her medications for her bi-polar disorder. She probably didn't take them since. As a result, everyone shunned her.

“She spent stints in the local hospital’s psychiatric ward, but there was no follow-up.

“Apparently, her family could do nothing with her, and she refused to move into a care facility.

“Once gone from the hospital, no one followed up on her state of mind. There has to be a way to help someone like this poor woman.”

Ellie – This last response takes the case of the wife with dementia to a further issue: When there’s no family involvement, communities have to find acceptable legal means to care for seniors who can’t be on their own.