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Hi all,
Your forum has been a wonderful resource for me in helping take care of my grandpa. My issue in short is this:
Granddad (83) has dementia, and a giant cutaneous melanoma tumor on his thigh the size of the palm of my hand. He hid this from us until we noticed a terrible smell and finally caught him with his pants down, it's a large, actively bleeding, crusty growth, about an inch tall and circular with a horrendous rotting smell that permeates the entire house. I cannot enter his bedroom without gagging.
He refuses to go to the doctor, has no health insurance, no doctor, and no money. I have engaged with multiple elder law attorneys, but it has been months of getting the run-around to begin the process of guardianship, I haven't even been given a consult despite waiting multiple months. I asked the fire department, and they said they can't take him to the ER if he refuses, which he will. He no longer has the ability to understand how serious this tumor is.
We are not just worried for his health, but also for what may happen to us were he to pass away with this tumor while not being under the care of a doctor. There is a risk that we may face charges for neglect despite his steadfast refusal to get this treated. When my grandma passed last year, because she was not under the care of a doctor, law enforcement responded to the house including a homicide detective. I cannot imagine what the cops would think if they smelled his bedroom. I am so tired of holding my nose in the house and asking him if he'll go to the doctor. Every time it's a "I just got up" or "Maybe tomorrow", then tomorrow comes and he doesn't remember saying it. I have asked him over 200 times.
We are in desperate need of help. My original plan was to obtain guardianship, have the paramedics come and take him to the ER, then file bankruptcy on his behalf after the treatment, if he survives that long. Since the attorneys are dragging their feet for months now, I don't know what to do. I feel trapped in a house that stinks of death with no way out.
What are our options? How can we force him to get treatment? What do you guys recommend?

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Call APS(Adult Protective Services)and explain everything you said to us and let them come out and do an assessment which of course when they do they will see and smell how bad things are.
And it might just be best now to allow the state to take over your grandfathers care since he won't listen to any family members.
He desperately needs help and APS can get him the help he needs. So call them first thing in the morning.
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DCHelp Dec 8, 2024
My only concern with that is his house is reverse mortgaged, and we may lose the house if he is placed into state care. The mortgage requires an occupancy certification every year. I also feel terrible for him because he won't understand why he's not at home, he definitely does not want to leave. But, we're between a rock and a hard place, and what you suggest is most likely the best thing to do. This situation cannot go on any longer.
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How do you know this is melanoma grandpa is dealing with? I ask because a tumor of that size and the condition it's in would have metastasized throughout his body by now, either ending his life or ending it in very short order. Melanoma is VERY aggressive, one of THE most aggressive cancers there is. By the time mine metastasized, I was given 2 months to live. Immunotherapy saved my life however, miraculously. Is grandpa feeling serious pain elsewhere in his body? Mets to the brain can cause dementia symptoms and stubborn behavior as your seeing.

The lesion on his thigh needs to be surgically removed, obviously. I'd take
Geaton's advice in this situation.

As far as reverse mortgages go, the loan becomes payable to the lender upon grandpa's death, when he sells the home or when he moves out permanently.

The loan and interest are repaid when the home is sold, and the lender recovers the money advanced plus interest. If the home sells for more than the loan balance, the remaining equity goes to grandpa's estate or heirs.

Good luck to you.


 
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DCHelp Dec 9, 2024
Given the size and presentation of the tumor, there's only two possibilities, squamous cell carcinoma and giant cutaneous melanoma. Unfortunately, the pictures of the melanomas are closest to what he's got. I'm almost certain it's metastasized, as he coughed up what appeared to be a bloody discharge into a wine glass this week. When asking him "Did you cough up blood?", he couldn't remember but said "It's a possibility". He has also lost weight over the last few months.
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Does he want to die from this? Does he have the idea that this will kill him fairly soon, and he prefers that to treatment or a care facility? Are you prepared to let him do this? Is he sufficiently aware to be ‘allowed’ to make this decision?

My suggestion would be to get APS in to go through those questions with him, and give you advice about what to do. If they say ‘let him do it’, and you can cope with it and that decision, get it documented to protect yourselves.
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DCHelp Dec 9, 2024
He certainly seems at peace with the situation, it's no big deal to him. He has said "If I go to the doctor, they'll tell me I'm dying", which makes no sense to me as a young man. Getting the giant necrotizing smelly, bleeding tumor off my leg would be my first priority if I were him, but it just doesn't matter to him. He wants to sit and watch game shows on TV and ignore the problem. Our next step will be to bring APS in and see exactly what their plan is for him. I have already lined up hospice care for him in the event he declines rapidly, we may end up just going that route if the APS caseworker agrees with it.
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I'm sorry for all your Grandpa and family are going through.

I would call 911 and tell them he has an infected wound and that he may be septic and having cognitive impact and not making decisions to get it treated. You don't tell them anything about dementia because this is not considered a medical emergency. But he actually may have sepsis, so make this call and go with him to the hospital. Once there, tell them he is an unsafe discharge. Then ask to talk to a social worker about options for transitioning him directly into a facility.

If for some reason 911 won't come or won't try to make him to to the ER then I'd find some therapeutic fib to tell him to take him to the ER yourself.

If none of that works you should report him to APS as a vulnerable adult. If they determine he is not able to make decisions in his own best interests, they will recommend his case to a judge who will assign him a 3rd party guardian and will make all his medical decisions going forward and manage all his affairs.

I would not get your hopes up for cancer treatment, yet. And if he does have sepsis and his cognition improves once it's treated, then consider asking him to assign a PoA, THEN take him in for a cognitive/memory test.

Pursuing guardianship can be very expensive and time-consuming and you may find it's no easier to get a demented LO to cooperate with a very rigorous and challenging cancer treatment than before having that authority.

Another outcome could be that the county decides he needs a court-assign guardian. Then you won't have to worry about making decisions for him or getting him to do anything against his will. His guardian will take care of that.

I wish you wisdom and peace in your heart on this journey with him.
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Wow.
The LEAST of your problems is that gpa's house is reverse mortgaged.

He will not accept any kind of medical help for something that sounds is going to take his life. Once a tumor begins to look like what you've described--my guess (and it's just an educated guess) is that he hasn't long to live.

You are going to have to decide if you want to leave him be and suffer whatever fallout comes.

Or--you notify APS and whatever other agencies might get involved. He has dementia, so he really can no longer make his own decisions. It's sad, but it's often what happens in life.

Your plan is a sound one and at least it's something. Plan that it will be awful, and you won't be shocked when it is.

But he deserves a clean bed and care for this tumor & other health issues.

Sadly, we often cannot give our LO's what we want to give them. We have to make do, and if this angers them--well--it was done out of love.

(And, BTW, I know that 'smell'. Just thinking about it is gagging me as I type.) He is literally rotting from the inside out--poor man. I hope you can get him help.

As far as health insurance--minimally, he should have Medicaid--why hasn't anyone checked that out? Is he not a citizen? Something you need to find out.
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Geaton777 Dec 9, 2024
Did you mean Medicare? Not Medicaid...yet.
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Call APS. If necessary tell them you are moving out as you can physically no longer tolerate this.
This will get state guardianship started. I caution you NOT to take guardianship for an elder who is non cooperative because at the point you get it you have a Fiduciary duty not to abandon and no court and judge will allow you to resign your guardianship. I am RELIEVED the attorney hasn't got you guardianship at this point and hope you stop asking for it. You cannot help someone who is undiagnosed and refusing help.

Truth here is that you may need to LEAVE and report granddad as a senior at risk. IF this is a cancer it is almost certainly metastasized at this point, and granddad is dying. You are not qualified to take this on alone without medical care and he is not your responsibility.
Where this man's own children are in all this I can't know, but if they exist you should leave the premises and report you have done so, allow THEM to call APS and proceed with care.
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DCHelp Dec 9, 2024
The adult children (with the exception of my mother) have universally taken advantage of granddad for years. Each child received a free home from granddad except my mom. All but one either sold or lost their homes to foreclosure. Grandpa's youngest son (as mentioned above) withdrew money from the reverse mortgage to live on for a period of 10 years until we caught him and revoked his privileges when we moved in, but the money was already all gone. No one said a word while this was going on. Now that youngest son has cancer himself, and so does grandpa, so it's really a rotten situation. Somehow, I have to navigate through this to get grandpa the help he needs, minimize the financial damage to his estate and ensure my mom has a place to live once this is all over. All before I'm 30 years old. In a way I'm glad that it's me and not someone else, I am confident I can steer the ship.
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I would recommend what Geaton says, but have him made hospice (get a hospice consult).
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Your grandfather doesn't have Medicare because he never paid into it. He may be eligible for Medicaid if his income is low enough.

He owns a property and if he pulled the equity out of it through a reverse mortgage yet never gave getting health care coverage for himself a thought, then too bad for him. The taxpayer (aka the 'state') will pay for him and he'll get Medicaid if he needs to be in residential care. The state (Medicaid) is not going to pay for him so you and the other family can remain living in his house. That's not going to happen.

If he goes into care the facility takes whatever equity the house still has then it will have to be sold at market value, not what's owed on the reverse mortgage.
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DCHelp, you say you are concerned about the consequences if your grandfather dies while not under a doctor's care. The fact that you are delaying getting him medical care because you don't want to lose the house for yourselves is unconscionable and makes those concerns justified. "As grim as it sounds, we have to plan for ourselves in this situation as well." Plan to avoid being charged with neglect by getting him assistance immediately. You are young and competent and although I'm sorry your situation is difficult, you can find a way to take care of yourselves. Your grandpa can't wait.
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DCHelp Dec 9, 2024
Frankly, the situation in its entirety is unconscionable, and if we're being unconscionable by not immediately making a decision as to his care without considering how it will affect us, then it's a drop in the bucket as far as I'm concerned. We were kept in the dark about grandpa's health and financial situation by his youngest son, who was in charge of caring for the grandparents before we took over. He set up the reverse mortgage for granddad and only gave granddad a pittance ($200/month) while withdrawing whatever he wanted and spending it. We put a stop to this as soon as we found out, but it was too late. Grandpa failed to plan his estate, no one said a word, and we're stuck picking up the pieces. Every time we asked, we'd hear "Everything's fine, don't worry about it", now we're in this mess. We will start the process with APS and sell the house. It really angers me that we have to let it go, but as you said, we can take care of ourselves. He can't.
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Forget about what the fire department told you. Call 911, tell them it's an emergency and that you need an ambulance. The paramedics can evaluate his condition (insist that they look at the growth) and if they believe that your grandfather is not competent and/or that he's in danger, they can take him to the ER even if he objects. All the rest involving the house can be sorted out after that while he gets treatment. Ask to see a social worker at the hospital and tell him or her that he has dementia and has shown an inability to care for himself, so they can help you make a plan for him going forward. Don't wait around for the lawyers and guardianship. Call 911 now. (And if he somehow persuades them not to take him to the hospital, there will be an official record that you did try to help him, which will help protect you and your family.)
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