Wednesday, June 22, 2011

What happens when a spouse is in denial about losing capacity?

Here was a question an attorney called with. Let's call this couple Mr. and Mrs. Smith. Mrs. Smith contacted the attorney because she was concerned about all of the couple's money being lost through the husband's bad business deals. The husband had started a small business, funded out of the couple's joint account. For a couple of years, the husband had been forgetting more, and making very bad decisions, and the business was bleeding money. The husband denied that the business was losing money, but the wife could see the books, and knew what the facts were. Wanting to protect their financial assets for the rest of their retirement, she went to the attorney, who suggested that the husband needed a medical or psychological evaluation to determine his decision-making capacity. Since the husband became very angry whenever the wife suggested there were problems, the wife did not believe her husband would consent to having an evaluation. The attorney called me to ask if I had any recommendations in this situation.

First of all, some facts about Alzheimer's: the very circuits in the brain that allow us to be self-aware are often affected by the disease. Denial of problems isn't just the person being stubborn, it's a real symptom of ALzheimer's. On top of that, the individual with Alzheimer's is often frightened by the changes taking place, and the anger that comes out in response to family members' saying something is wrong sometimes comes from this fear. Imagine that you couldn't remember things, and didn't realize that you couldn't remember - the world would suddenly seem like a bewildering and frightening place. It's easy to understand someone being edgy and defensive in such a situation.

It is also possible the husband doesn't have Alzheimer's, but some other condition. One much less common type of dementia* is called "frontotemporal dementia," because the frontal lobes and temporal lobes begin to atrophy in this disease. Memory is generally fine until very late in the disease, but the person has problems with social judgment, motivation, empathy, and self-awareness. So frontotemporal dementia also means the person will be in denial, not out of stubbornness, but because the brain circuitry for self-awareness has been damaged by the disease. Since poor judgment in interpersonal situations is a key symptom of frontotemporal dementia, making bad decisions about finances is not uncommon with this disease.

As to what to recommend in this case, it's a very difficult situation. One possibility would be for the wife to initiate guardianship or conservatorship proceedings, and request the court to intervene. In this case, the wife was not willing to do that -- it was too adversarial, and she thought it might ruin what there was of their marriage. My suggestion in terms of getting the husband for an evaluation was this: Perhaps the wife could go to the husband and be an ally to him, saying, "Look, how about going to get an evaluation to prove once and for all that everything's fine with you. So when creditors for the business start asking questions, or anyone asks about your ability to be independent, we can say, no, look, we've had it tested, and it's all fine." I'll be honest, I didn't think this had a high chance of success, but it was clear that the more confrontational approach of telling the husband he was having problems and asking him to go get an evaluation had a 0% chance of success.

An elder law attorney I talked to in general terms about the case also suggested that the wife could move some money from their joint account to her own personal account to protect some of their nest egg.

I wish that there were easy answers in situations like this, but unfortunately, there are not.

* dementia = any progressive neurological disorder that has been present for more than 6 months, and has caused a gradual loss of functioning from a previously higher level. Listen to the podcast on "Those Grey Areas" at www.AboutCompetency.com for more detailed information.

No comments:

Post a Comment