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I hear you, Llamalover. And I strongly agree that the MIL is clearly not competent if she is having a bowel movement- of any consistency- on a public sidewalk, or "in the grocery store as she's walking around" and "thinks nothing of it" as the OP has stated to have had occur. The sticking point is "declared", which implies legally declared. As others have implied - when push comes to shove, no one can force the MIL to do anything. UNLESS the family can get MIL into a facility under an involuntary hold so her mental state can be determined. In my opinion this woman is a danger to herself and others and if going Baker Act is what it takes -so be it.
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Continued - sorry, Veronica, I paraphrased that).



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This truly is a sad state of affairs. I understand that her family is on another continent. It seems as though this woman is more ill than anyone presumably thought. Like anyone, i wish for a successful conclusion, knowing that she needs a mental assessment or as Veronica said "at least there is one thing that she can control-her bodily functions (
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Churchmouse: Okay, let her refuse the colonoscopy; any woman who loves to poop all over the place and likes to smell is not competent (declared or not). I never inferred easy at all.
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Babalou: White she may be deemed "competent," any woman who loves to poop, stink, et al IS NOT IN THEIR RIGHT MIND!
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She probably doesn't, since the doctor didn't say anything about the fecal sample. If it was a public threat, I think he would have to let vulnerable people know. Still, anytime I see runny poop, I think about c-diff. Survival instinct, I guess. My mother had a case of it two days ago and I still feel diseased having to deal with it.
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But JessieBelle she was only in the hospital because her bowel had become impacted, notwithstanding the diarrhoea, and this was after her GI man had recommended the colonoscopy. Doesn't mean she couldn't also have picked up Cdiff, of course. Like she needs more trouble, poor lady.
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A huge concern I would have is c-diff if there is bad diarrhea. This would be particularly a concern to me after she had been in the hospital. There is no better place to pick up c-diff. If she does have it, she is a threat to herself and the community around her. I wouldn't allow anyone to clean her apartment without finding out if she's infectious.

Some older folks are mentally ill and rather mean. Your MIL seems to be very out front with it. In your shoes, I would let the county HRS know about the problem, then see if the State can assume guardianship of your MIL. I wouldn't want to try to wrestle with a mentally ill, ill-tempered person if given the choice, even if they were related to me.

How does your spouse feel about all this?
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While MIL is still deemed competent she can refuse anything. She has already had a bowel obstruction for which she had surgery. i would guess while they were in there they had a good look round so someone knows if she has colon cancer or anything else. Chronic diarrhea can affect anyone and often no cause can be found so a colonoscopy or other tests may be a moot point.
There is clearly a mental problem by her behaviour. I am just guessing but think the dementia is probably further advanced than anyone knows and the recent surgery for the impaction may have advanced it considerably. If she appeared rational the surgeon probably told her what he found and of course she does not have to share the information and the surgeon is unable to if she refused. As her life spins out of control ( the family moved her and sorted through her things) One thing she can still control are her bodily functions. It would appear to me to be a final act of defiance. Pressure should be put on the POA to act or hand over to someone who will. This is not a sustainable situation. The diarrhea has probably persisted for many years if she was over using Imodium. arbitrarily taking them away did not help anyone. Of course it was the right and rational thing to do but to her it felt as though it was another thing she could not control. Not an easy situation for the family to deal with but this poor sick old woman needs comfort and compassion and placed in a safe environment.
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Llama, the MIL has already refused a colonoscopy.
It has yet to be established that the MIL is incompetent.
Therefore there are important things that have to be done before anyone can charge ahead on the investigations, even assuming that it is decided that the investigations are worthwhile, and those things will prove extremely challenging to accomplish from 4,500 miles away with a six or seven hour time difference and without POA which is held by someone else.

Don't tell the poor lady it's simple and easy. It isn't.
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Yes, LL, but she can't force her MIL to get treatment or tests. The woman is still deemed competent.
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Churchmouse: #1 The OP CAN do something..."all the way over in Norway" has no bearing on it and here's why-the OP can research my teenage (yes, true, that) nephew, Jack Andraka.com-his work on cancer prevention invention.
#2 Get a colonoscopy.
#3 Or go with the mindset "ignorance is bliss."
#4 The woman who loves pooping all over the place is acutely mentally ill.
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Llama... I not only wonder that, or something like it, I wonder if MIL herself has already half-wondered that and is exceptionally determined to pretend all those symptoms aren't happening. I'm not sure what the poor OP can do about it from Norway, though. There are other hurdles to be got over first.
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Worse case scenario is that she has colon cancer. Get her to a doc STAT!
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Who has POA should the original POA be unable to fulfill his duties? It should be stated in the original POA document. Get a copy of it from your brother-in-law. I was my Mom's POA and my husband (bless his heart) was my alternate should I not be able to fulfill those duties. I feel for you being so far away (out of the country). It's got to be maddening for your son and his family.

You MIL CLEARLY has some sort of mental issue if she doesn't care where and when she has diarrhea. You may just have to petition the court for guardianship (which is an expensive process) if she clearly is a danger to herself. Unfortunately, this process will take more than the month you have in August.

You don't mention how old MIL is but a geriatric psychiatric evaluation would not be out of the question. As others stated, should she slip and fall again and can't get up, have the EMTs take her to the hospital "to get checked over" and then discuss her situation with the doctor and discharge planner. Under no circumstances would I (or should any of your family) have her discharged back into her home (apartment). Tell the discharge planner that she is a danger to herself and there is no one at home to properly take care of her. The planner will have to find her a proper place for her needs. Good luck and come back and let us know how YOU'RE doing.
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Yikes! Poor MIL! Poor You! Poor Husband! This is a miserable situation.

My first thought upon reading your post was "Call APS." After also reading responses I've revised that slightly.

1) Give BIL the facts of life regarding POA. Give him 24 hours to formally resign the role, in writing, if that is what he wants to do. This is just a courtesy to minimize his accountability for neglect. He can take it or leave it. Not your worry.
2) Call APS from Norway. Don't wait until you are actually here. Yes, that involves time differences and call-backs and expense. But this has gone on far too long and needs to be addressed NOW.

One possibility is to invoke the Baker Act, and place MIL under 72 hour observation in a hospital, against her wishes, to determine how best to address her self-neglect.

I hope the month you are here is enough to get things started on the right track, but I wouldn't wait for that.

I doubt that you could obtain guardianship while you are abroad. Frankly, I don't think I'd sign on for that responsibility.
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With respect to your BIL, whether he wants to be or not he IS involved. And will be so until he takes active steps to uninvolve himself. It's not enough for him to imagine that her whereabouts make any difference. He has Power of Attorney for a lady who is manifestly away with the fairies: that makes him responsible for protecting her best interests. Do it or resign his POA are his options.

You (actually your husband) might also usefully remind him that he has been responsible for her from the time when she became incompetent to manage whatever aspects of life the POA covers. If anyone is in the firing line for failing to protect a vulnerable elder it's him. I hope this notion might make him a little more inclined to co-operate/get his finger out.
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Wow. If everything is as you describe I'd say you have a very serious issue on your hands - and no pun intended but "on your hands" is a literal discription - and on your shoes, tracked back into your car, your home etc. Cleaning up poo - getting rid of the bacteria and the health risk is a serious matter. Anyone who is accepting of this type of situation- thinking it's okay to poo any and everywhere - to refuse to deal with it medically or even wear a diaper is seriously mentally ill - whether it be dementia or some sort of psychosis. I can promise you there is poo EVERYWHERE in her apartment and you're gonna need professionals in hazmat gear to make her place safe again. If I were you I'd be doing some on-line research now and when you arrive here be prepared to take some drastic action. Your MIL needs to be evaluated in a facility for both physical and mental
illness - even if it is against her will. Forget about whoever has POA responsibility now - obviously they're no help. Find out now what steps you need to take to get emergency guardianship and when you get here - do it.
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Call Adult Protective Services in your county NOW. Report her as a serious case of "Self Neglect" Anyone in her state can't stay by themselves. Even of there is someone right there. If she won't let anyone in and she won't wear lifeline button, and is living in filth is a danger to themselves. Call now. She will be admitted for an evaluation and don't take her back. She needs 24/7 supervision.
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Then, as CM indicates, he should resign the PoA. Although she may not be competent enough to sign a new one.

I'm not sure what state you all reside in, but it feels to me as though PoA might be held in some way responsible for not reporting her self neglect.

It also seems like someone should rattle the doctor's cage a bit. Does he consider her competent to make her own medical decisions?
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His dad asked him years ago if he would do it and he said yes. Now his dad has died and the family just doesn't want to get involved. They are quite happy that she now lives in our house so it's our problem. :(
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Your brother in law has Power of Attorney but "doesn't want to get involved"?

?!?!?!?

What did he think he was agreeing to???

He must resign it, then. What a [blank]!

I sympathise with how infuriating you must find your position. All that time, effort and - not that it's the point, but still - cost. But. Your MIL is old and by the sound of it pretty ill. Be pissed off, I don't blame you one bit, but not with her if you can possibly help it.

E.g. nobody loves having diarrhoea. I hear what you say about her relishing her weight loss, but you know better than I do that she's grasping at straws. She must be lost, scared, in despair, in crazy denial, God knows what; but you can forgive her for not wanting to acknowledge what's going on. It is scary stuff. Pity her if you can.
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My mother-in-law [late 80's] was having major issues with diarrhea but she was very careful about keeping her home and herself clean. She took the gambit of medicines to try to stop the problem. Doctors weren't sure what was going on. Eventually she found that eating 2 tablespoons of cooked rice [not instant rice] before eating helped.
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I'm in agreement with CM, that this doesn't sound like OTC med abuse, since it continued in Hospital and NH.

She doesn't sound like someone I'd want guardianship of, since she is uncooperative. I'm curious why hospital didn't address the issue.

If she's ever hospitalized again ( and if she fell on my watch, id call 911 to get the ball rolling), someone needs to step up and refuse to sign for discharge until her medical and mental issues are addressed.
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It sounds like your MIL needs psychiatric evaluation and (hopefully) that will give a family member guardianship. Her behavior is not normal and you need a medical proxy or whatever to take over her decisions. As you said, to allow her to defecate wherever she is, you will never find someone to care for her until that is under control. Caregivers or AL do not have the legal right to force care on her, so you definitely need guardianship of some sort to get her under control.
She sounds a bit like my mother, who went through a stage where she abused milk of magnesia and lost control of her bowels. (She was obsessed with constipation, which is pretty typical but it drove us nuts for about 5 years)
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So very sad. I'd call APS from Norway. Or ask your son to do so.
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She doesn't have a computer so she can't order off of Amazon. The diarrhea was discussed in the hospital and they saw it there and in the nursing home. My BIL has POA but he's not really interested in getting involved.

The family has assumed NO responsibility for her. That is why we have to do everything from Norway ourselves. My son (from a previous marriage so he's not her grandchild) and his family moved in to help as they can. We spent all of our saved up leave time and went into future leave time to go back, pack her out, move her into the house and we spend all our time going back trying to fix things. I'm beyond pissed off that one lives "71 seconds away" yet her husband said "she's not my blood" when I asked for help.

We go back on August 21st so I'll call someone then. We're there for almost a month so hopefully that will be time to get the ball moving on things.
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So, here's the thing. She's clearly incompetent to care for her own health. Her home sounds like a biohazard. This is where getting the "authorities" involved comes in handy. You guys shrug and say "you won't let us help you, mom. So the state is going to step in and help".

You might present this to her as a choice ( not a threat), but I'd be on the phone to APS before a neighbor is.
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If the GI internist wanted to do a colonoscopy, and she suffered an impaction, and there's chronic diarrhoea, and she's lost 75lbs, she still could be abusing laxatives but that wouldn't be my first thought.

Royneberg, your son might also want to get back to the GI man, update him, and get advice on what to do now.
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If you are in Norway, you can't deal with this. You say your MIL had to be moved, that her keys were taken away last year and so on: so I gather that the family has assumed responsibility for her, would that be fair to say? In which case, whoever has been left i/c MIL needs to get on top of the job. It sounds like that would be your son. He had better get in touch with the local social services for older adults and seek their advice. Your MIL is at real risk of sickness and injury, and since it's proven beyond you - I don't blame you, this is not simple or easy to solve - it's time to call in professional support from elder care specialists.

Your MIL won't have it, of course. But this level of self-neglect is not wilfulness: it's nuts, and it's dangerous. If she carries on like this she'll be deemed incompetent so fast it'll make her head swim, and after that it won't be up to her who gets in to her apartment.
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