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  1. Salladay, Susan A. RN, PhD

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I'm a nurse facing an ethical dilemma in my family. My widowed mother, 87, has heart failure and has been hospitalized repeatedly for complications related to diet and medication regimen nonadherence. Although she can be forgetful at times, she refuses to move from her home into an assisted-living facility because she values her independence.


Her physician and nurses are pushing me to have her declared legally incompetent so I can be appointed her guardian and have her placed in a care facility. I'd prefer to let her stay in her home with daily home healthcare assistance. This dilemma's so hard because I can see both sides of the issue. What's your view?-B.L., GA.


Actually, I see three sides to this issue. It's not just you versus the healthcare team; your mom has her own side too. If she isn't involved in all care decisions, she needs to be.


To help defuse emotions and avoid polarization on treatment decisions and competency issues, turn to an objective expert. Have a geriatric nurse practitioner, psychiatrist, or psychologist evaluate your mother to give you, her, and the healthcare team a clear and accurate assessment of her ability to make competent decisions about her treatment and living arrangements. That evaluation should also include an assessment for depression and anxiety.

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Then work with your mother and caregivers to draw up a "contract." It might say, for example, that your mother agrees to stay in her home as long as she can make safe decisions. (This could be evaluated by her home healthcare nurses.) Although not legally binding, such a contract can provide a framework for future decisions that everyone is prepared to accept.