When the Time Comes

April 30, 2011

A story for all of us who have been accumulating the years.

What to do when we can’t care for ourselves.

A couple of weeks ago a Thai friend called saying that she had a serious problem and maybe we could help. It seems that she has been helping out an 80 year old American man who is suffering from dementia. He has no family and doesn’t seem to have any close friends here and when he began having memory problems, and was becoming increasingly feeble and unable to care for himself, there was no one to help care for him.

He was visited by the U.S. Consulate staff who were more than willing to help out, but this man in his confused state refused any help. By law, the consulate cannot force their help on anyone and even though they are very concerned, without a person’s consent, the consulate can’t do anything, even if the person, as in this case, cannot really make informed decisions on his own. They still have to ask for help, which he is either unwilling or unable to do right now.

Also, there are no involuntary commitment laws here in Thailand. In the States, if a person is a danger to himself or others then they can be committed to the hospital for observation and later a judge will determine whether the person needs further hospitalization (with or without their consent). In Thailand, the family is relied upon to make those decisions. Since this man has no family here, and is unable to give any information about his family back home, we don’t have that option. Even though he is obviously a danger to himself, and without assistances would most likely die in his room, he is currently stuck in limbo.

So, my Thai friend, a former English tutorial student of his, not really a personal friend, saw that no one was helping him. She felt that she could not just let him starve to death in his room. She has been bringing him food and looking in on him. But she has a business to run and a 98 year old mother to care for so she has been unable to visit every day. Since he is so out of it he doesn’t realize that the food she buys him needs to be paid for (he only will eat western foods) she has been footing the very expensive food bill. At the end of her rope, she finally decided to ask us for help.

When we visited the man it seemed that he hadn’t had anything to eat or drink for a few days. He was completely incoherent and could not answer any questions, even his own name. We found out from the residence’s staff that he often walks the halls naked and confused. He recently had a serious fall in the bathroom but fought like crazy when they tried to take him to the hospital. At the private hospital he was taken to he got violent with the nurses and doctors. They treated him for broken ribs and a punctured lung but said that if he needed any more help that he would have to go to the government hospital. They were not equipped to handle his problems.

Currently his food is being paid for and someone visits him daily (out of kindness not being paid). For him to pay for a caregiver he would have to sign a power of attorney so that they can access his money (he has more than enough). But he is much too confused to understand this. So we wait, maybe for an accident, for him to take another fall, or for him to walk the halls naked again, so that the police (probably the Tourist Police) will be called to take him by force to the hospital (They won’t come just for a senile old man, he has to do something disturbing.) Then he can be evaluated and then the U.S. consulate can possibly arrange for his care. Other than that we wait and he sits in his apartment awaiting his daily visit.

The moral of this story.

Most of us when we retire overseas are still in pretty good health. We are strong enough to travel the long distances to Thailand and to set up house and begin a new life. But we retirees are usually past the midway point in our sojourn on this planet. And the things that are happening to this old man can and maybe will happen to us. He was not always a senile old man. He has a PhD., was a university professor, and a military officer. But he did not prepare for this time in his life which is why he is in the situation he is currently faced with. Although I don’t know him personally, I feel he deserves more than to die in his room alone. All of us do.

Maybe we should do a little planning ahead.

In trying to find help for this man I contacted the U.S. Consulate, the local chapter of the American Veterans of Foreign Wars (VFW), a local group of concerned Expats, and a local assisted living program. I was amazed at the warm and caring response from all, and the feeling of impotence we all shared that no one could help this man. And at each step of the way I was told to spread the news that we all need to prepare for this time so this won’t happen to us.

I talked with the director of a local assisted living program. She felt just as frustrated as we all did and said that she had encountered similar problems as the one we were facing and suggested that we all take the steps to prepare for our getting older because, as so often happens, when the time comes we just might not be able to make any decisions for ourselves.

Here are a few things that we can do – before “the time comes”.

  • Make sure someone here knows how to get in touch with your family.
  • Let your plans for care be known – by telling your friends and in writing.
  • Sign a living will.
  • Sign a statement of what to do should you not be able to make decisions for yourself.
  • Sign a power of attorney so that your care can be paid for even if you are unable to make that decision.
  • Check out assisted living programs and local care givers here before the need arises. In case taking care of yourself alone becomes impossible, you can have the option of getting help.

In working on this problem I discovered the Dok Kaew Gardens Assisted Living program here in Chiang Mai. I found it to be the cleanest, most cheerful, hospital, in a beautiful tropical, riverside setting. The cost for ambulatory residents is 24,000 baht per month, food included. For those who are completely dependent on care givers, 35,000 baht per month. That’s a lot cheaper than a five star hotel, something the “Gardens” resembles. Check them out.

For home care givers in Chiang Mai I have heard good things about Centa Care.

You should check these out for yourselves, for your own future needs or for elderly loved ones.

For those living in other parts of Thailand and who know of other programs like these please add a comment and let us know about them. We’d all be grateful.

It is probably best not to wait.

Post Script

This is an update on the condition of the 80 year old American suffering from dementia that I mentioned above.  It is taken from an email I sent to the Chiang Mai U.S. Consulate.

Earlier this evening xxx was taken to xxx Hospital by ambulance and a Tourist Police escort. The crisis we had been waiting for occurred when he refused to eat anything for the last 5 days. He was fairly calm, but confused. Accompanying him was a manager from the xxx Bank, xxx the Thai person who has been bringing him food, the manager of The xxx Apartments, xxx his American neighbor, and my wife and me. Note that none of these people were relatives or personal friends. He is alone which is one reason he is having these current problems.

We stayed with him when he was brought into the ICU. They attempted to do a number of tests on him, blood, X-rays, EKG, and started an IV. He was quite weak when he entered the hospital since he had not eaten and was dehydrated.  He got stronger and stronger as the IV took effect. So much so that he began to complain about wanting to go home, and kept trying to pull out his IV. They were not able to do most of the tests they needed.  I stayed with him throughout all this to try to let him know what was going on, keep him calm as he was becoming quite confused,  and to advise the hospital staff that it didn’t matter what language they tried to talk to him with that he would be unable to give normal responses.

The doctor could see immediately that many of his symptoms, especially his swollen limbs, were due to malnutrition. He also has a severe bed sore at the base of his spine from sitting in his chair for months at a time, and it looks like he may have fluid in his lungs.

The doctor said that it would take at least 4 – 5 days for him to recover from the malnutrition.

Since they were unable to X-Ray him, and he kept trying to pull his IV out, and he kept saying “Take me home.” over and over again, the only thing he could say, it was decided to sedate him. Once he was sedated they began working on him and it was time for us to leave.

This all took between 5pm and 8:30pm.

The manager of the xxx Bank brought along a withdrawal form thinking that we would need to get a thumb print so that they could access his money. It turned out that we were able to get him to sign the form. That is all we needed to be able get the money to pay for his treatment.

The Tourist Police were very helpful and had to spend two hours of overtime to remain with him. They were given an overtime fee of 1,000 baht which we paid for using his money.

The manager of The xxx Apartments will not allow xxx back into his apartment. This sounds quite harsh but we all agreed that if he had the choice to return then he would most likely die there. This also forces the hands of those making decisions on what will happen to him. They will not have the option of returning him to live alone in his apartment as before.

At this point I believe that we have done all that we can do. We are going to pass on the responsibly now to the Thai government and to you and the Consulate.

After he was taken from his apartment we did find some emails that were sent by his sister and I have emailed her. We just received an answer, they had lost contact with him for over a year, and she was going to meet with family members there and get back with us.

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