Planning for Alzheimer’s Disease with Mental Health Advance Directives
72 Pages Posted: 26 Aug 2009 Last revised: 8 May 2010
Date Written: 2010
In this article, I propose a new way of planning for a future with Alzheimer’s Disease using Mental Health Advance Directives (MHADs). Typically, MHADs have been used by clients with mental disabilities like bi-polar disorder, schizophrenia, and severe depression. Clients with these illnesses tend to have periods of relative stability followed by de-compensation. During less active periods of the illness, clients can draft MHADs to make predictions about what kind of care they are likely to need at a future time and to decide on options. However, people with dementia tend to get increasingly worse rather than cycling up and down. The article explores how this difference affects planning and future decision making about Alzheimer’s care. It also explores when planning should be done, what care needs are predictable early on, and what are the legal and ethical pitfalls to MHAD planning for Alzheimer’s Disease. There are currently few planning tools available for those diagnosed with this illness to use in retaining decisional control and independence, and in anticipating future needs. Other than Living Wills, which typically involve planning for end of life and the refusal of treatment that prolongs the dying process, people with Alzheimer’s Disease have had almost no ability to plan for or decide in advance on their care. I propose that the MHAD is one planning tool that has great potential to meet the decisional needs of both Alzheimer’s Disease patients and their caregivers/family members. I outline the predictable and most difficult decision points that people with Alzheimer’s Disease are likely to face during the course of this disease. Possibilities for deciding in advance how to deal with issues like planning for in-home and nursing home care, dealing with anger control, wandering, involuntary commitment, consent to participation in drug trials, caregiver choices, financing the high cost of care with Medicaid planning (including Medicaid Divorce consent), and consent to involvement in other intimate relationships are considered. Legal, ethical, and emotional issues that are likely to arise are explored.
Keywords: Alzheimer disease, mental health advance directives
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