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When a guy won't take care of himself?

FinishingGrace
Posts: 83
Joined: Apr 2017

Thanks to everyone who has helped with advice regarding my neighbors stage 4 metastatic prostate cancer. It's been so helpful and I need advice from other guys about helping him.

He is not taking care of himself in many areas. He is an adult, I know I'm not his mom (acknowledging he is responsible for himself), he is very ill, and chemo is hitting him hard. He is also making many poor choices.

He is skipping meds that I clearly label for him, even when he gets a reminder text to go take them. He is eating fast food exclusively. His restaurants of choice are popeyes chicken and long john silvers. He refused to take advantage of the great advice here about gearing up for chemo when I shared some of the strategies with him. He isn't drinking enough water or any other liquid. That choice landed him in the ER this afternoon dehydrated and with extreme constipation. 

Any suggestions on how to encourage him to 'man up' or would it be better to keep my mouth shut (my current strategy) and let the consequences of his choices speak for themselves?

I will continue helping him with meds and oncology appointments regardless of his choices. I welcome any suggestions or insights. Thank you.

VascodaGama's picture
VascodaGama
Posts: 2933
Joined: Nov 2010

Depending on the regulations in the place you live, by assisting your neighbor you might be committing a crime. What you describe above is opposite of what you commented in your earlier thread. It seams that your neighbor is looking for Euthanasia and probably trying to get you as his assistant. This is punitive by law in most of the counties. I would recommend you of informing the local authorities before you proceed with anything.

FinishingGrace
Posts: 83
Joined: Apr 2017

Thank you.

I'm not quite sure I understand your comments. But I haven't gone back and reread my original thread. I made two committments in my own mind to establish boundaries for my own good. One is to help my neighbor to take his meds at the proper times. I can't force him to do so but I remind him. The other is that every third Wednesday I take him to chemo. These are the two things I've done for him from the begining. I'm not sure how those actions could lead to assisted suicide but I'm curious to understand your thinking. Thanks!

Old Salt
Posts: 720
Joined: Aug 2014

I also do not understand Vasco's response. The neighbor is just continuing to make poor choices, notwithstanding better (in our eyes) advice. It's his life and he is allowed to make his own choices. And, in all honesty, even if he were to take all our advice, his outlook would still be dire.

hewhositsoncushions
Posts: 253
Joined: Mar 2017

Grace

A very complex and difficult situation here.

I'm speaking here as a trainee therapist not a newbie PCa victim so bear with me.

May I suggest the first thing you do is start to think of is yourself first. I know this sounds harsh but you need to protect yourself mentally, emotionally and legally. If you expend all your emotional energy on someone and take ownership of someone else in a situation like this, you will be less able to help in the long term because you will be stressed. You may also as Vasco says be seen to be abetting. Finally, whatever their current sitiuation, this is their life for them to own (with help).

You need to seek help for him, not take all the burden. The establishment should be the one bearing the burden for someone with diminished responsibility and no kin to help. Not sure where you are in the world (US?) but try contacting his doctor, a local cancer / mental health / people with no families charity or something. Get advice on how to flag his situation up to the establishment and get official help.

In terms of his behaviour, he may or may not be trying to end his life. People's motives are often complex and it not be (or just be) a desire to end it. I'm rapidly starting to realise feeling a lack of control is part of this process. It could be thats he is acting out by missing his meds and bad eating as a control mechanism. Deep down, where he is not aware of it, he may find comfort in the control he feels he has by choosing a burger over greens. This is similar to why people cut themselves if their life situation is bad. There may be other reasons and motivations too, such as simply being in denial. This is why he needs mental health help, not just medical because you probably can't and arguably shouldn't unpick his motives from where you are and certainly will face an uphill battle getting him to change.

I'm UK based and the level of MH support I got when I was sat down and told (however kindly they did it) was "here's a folder with a load of advice and contacts, now bugger off until we MRI you." MH support generally lags behind everything else around most of the world which is why we need to own it as individuals.

Hopefully others can share ideas as well.

Good luck!

C

FinishingGrace
Posts: 83
Joined: Apr 2017

I appreciate that insight. I've wondered if he isn't eating what he wants, etc. because he feels like he's going to die anyways, so why not?

The oncologists, nurses, and social workers are fully informed of his living conditions (deplorable), the fact that he has zero income, his depression, and the other behaviors because I report in regularly. I am protecting myself and putting myself first by allowing them to fully manage those issues for my neighbor. I give him his meds and take him to chemo. That is a good balance for me. It may not be for everyone.

I haven't seen clearly, until your post, that he needs to be getting mental health care. He is terrified and is completely denying everything. I cannot help him in this area nor am I going too. I will place a call to his somewhat worthless social worker today and ask her to get that set up.

Thank you.

hewhositsoncushions
Posts: 253
Joined: Mar 2017

Grace

It's people like you and the others on this forum that give me hope for humanity. It's the paper pushers in the estalishment that make me despair. It all evens out :)

It may be that. As I suggested, it may well be more complex. It may even be a cry for help. Only somene sitting down with this person will tell.

You are right not to own this. This is a difficult situation as the kind of help this person needs is very specialised. Do you have the equivalent of https://www.macmillan.org.uk/ where you are? They provide a huge level of support including I suspect for situations like this.

Keep us posted!

C

hopeful and opt...
Posts: 2218
Joined: Apr 2009

We are all different. You and your friend significant ly differ on what needs to be done to abate the progression of his cancer. He obviously is not, and will not in the futurecomply with his doctors medical directions.

As you realize, you will not be able to change him. Time to stop beating yourself up, trying to change him, and take care of yourself.

FinishingGrace
Posts: 83
Joined: Apr 2017

Yes. Absolutely. It seems clear that he is not going to comply with the doctors. That is his decision. 

I was hoping that perhaps there was some way I could help him see the need for self care and that you guys might have had some experience personally with feeling the way my neighbor feels. Guys and gals tend to approach health and self care differently and I wanted some insight to help me know what might resonate with him. Sometime people need a small or large smack in the face to help them see the truth. Sometimes nothing is going to work.

I am at complete peace. It doesn't bother me to watch him eat fried chicken every day because I simply cannot care so much that I am bothered by it. Meds and chemo is all I'm in for.

I will ask about my liability regarding the meds and will step away from that if necessary. I don't think I'm beating myself up. Yesterday, when he needed a ride to the emergency room, he asked me to take him. The answer? No. What do I do? I take care of meds and chemo. I do not take care of getting you to the ER because you won't take care of yourself. 

No trouble sleeping last night. :)

Swingshiftworker
Posts: 1013
Joined: Mar 2010

If your neighbor needs a "ride" to the ER and you don't want to be the one to take him there, call 911.  That's what the medics and emergency medical services are for. 

As for your dilemma, it's only such if you take responsibility for it, which is something that you absolutely do NOT have to do in this case. I'm not sure that you are "aiding and abetting" in his demise if you "help" him to take his medications on time and take him to chemo BUT it's NOT something that you have to do.

If he is of "sound" mind, he is doing what he wants to do for his own reasons.  It may be to speed up his death or it may just to be to enjoy what life he has left in the way he prefers.  

If you cater to his whims at the sacrifice of your own well being, you are fostering a co-dependent relationship (the dependency obviously is on his side but you would be enabling it) that will eventually harm and deplete you emotionally and otherwise.

If he is NOT of "sound" mind and there are social service personnel involved, they should be the ones to decide to commit him or not and to force him to receive the care that he needs regardless if he wants it or not. 

In California (and most other states), there is a law (Welfare & Institutions Code section 5150 in CA) which permits a law enforcement officer or clinican to authorize the taking of a person into custody involuntarily for 72 hours for "observation" if the officer believes that the person is a "danger to himself or others." 

Generally, this law is used when a person is acting erractically but it can also be used to hospitalize a person if he is not taking care of himself.   Committment beyond the 72 hour period for 14 or 30 additional days is also available at the initiative of the supervising clinician. 

See: http://www.disabilityrightsca.org/pubs/502401.pdf

If 911 is called, the medics should know to call the police for this purpose and any attending physician would know about the availability of this legal action as well.

That these kinds of things need to be discussed indicate how messy a situation this is and I personally I would "wash my hands" of it.  I know you would rather not do such a thing but there is no reason for you to be involved if he is not a relative, spouse or significant other.  

We'd all like to be good neighbors but there is a limit and that limit generally begins and ends at the front door.  Entering the door changes the relationship and not necessarily for the better as you have already discovered. 

Again, good luck!

 

 

Clevelandguy
Posts: 393
Joined: Jun 2015

Hi,

If he has no famly to consult with I would call 911 and tell then the sitiuation of him being very ill.  Hopefully they will send over the right people and get him the help he needs.  As a friend you can only do so much, but then again you don't want him to die.  There should be some kind of social agency that can help him fight through his illness.  Eating fried chicken I think is the least of his worries at this point in time.

Dave 3+4

Old Salt
Posts: 720
Joined: Aug 2014

I agree that calling in 'mental' services/help is appropriate. Where I live, mental support is available, but this may not be true everywhere in the USA. And I predict  that, even if available, they may not be able to do much.

hewhositsoncushions
Posts: 253
Joined: Mar 2017

Grace

Swingshift is right (we call it sectioning in the UK) that it might be possible to get him committed as a precursor to better care.

The main thing is that this gets done sensitively because having a "One flew over the cuckoo nest" moment would not be helpful.

Just remember that you've done your best whatever the outcome.

C

bassoneman's picture
bassoneman
Posts: 58
Joined: Apr 2017

I can only speak from my experince, And believe me I should not eat fast food.. But as I was doing radiation treatments ( not chemo) I was very fatigued..  My wife bless her heart knowing I was not feeling well always makes a nice meal for me..  However around the 25 treatment she went to Florida for 10 days on a vacation that was planned  with some of her friends. Well I am a grown man I can take care of myself and yup I can cook too. But.. I felt so crappy I didn't have the energy and I would wait until I was so hungry that I would head to the local pizza place and grab a slice ofpizza, a sub, or a quick burger.. Why? .. It was fast..   As mentioned I didn't have chemo but I have heard that really knocks the crap out of you.. I imagine food doesnt look too promissing specailly when you have to cook it.. I would most likey do the same thing he does..  (And I have 7 heart stents with carotid issues so my  PC is icing on the cake) So  a suggestion, is meals on wheels still around? I know the new administration was cutting some of the funding for that.. But that may solve the problem of him eating fast food. He is eating the fast food because he doesn't want to cook and mostlikely doesn't feel well enough or have the money to sit in a restaurant. And I think you mentioned he didn't have very much monetary resouces.. Fast food is cheap...  Also in our area we have a town nurse which can be a resource if there is one in your area or the council on aging may also help..  I would try that route before having him sectioned..  But that is me..

 

FinishingGrace
Posts: 83
Joined: Apr 2017

That makes a lot of sense. 

Meals on Wheels is still around but the service starts at 60. He is 59.

bassoneman's picture
bassoneman
Posts: 58
Joined: Apr 2017

I don't know if he has gone this route.. But if he hasn't this may help.  If someone has metastasized prostate cancer they qualify automatically for disability benefits.. This is just for your info... Just passing it along... 

SSI Disability Benefits for Prostate Cancer

The following types of prostate cancer qualify automatically for disability benefits:

  • Prostate cancer that progresses despite hormonal treatment. 
  • Prostate cancer that recurs despite hormonal treatment. 
  • Prostate cancer that has metastasized to other internal organs.

To qualify under the third option, you'll need a CT scan, MRI, or biopsy of the metastatic tumors. 

If your prostate cancer doesn't fall into one of the three categories above, but it significantly limits your ability to work a full-time job, you still may be able to get benefits. The SSA will give you a “residual functional capacity,” or RFC, to determine what you are still capable of doing. The RFC will include any limits you have on how long you can walk, stand, and sit, how much weight you can lift, and whether you need any accomodations like frequent rest or bathroom breaks. Prostate cancer patients who have the need to urinate frequently or have pain and stiffness in their hips and lower back should have these limitations in their RFC. 

If the SSA finds that, given your RFC limitations, age, education level, and job skills, there are no jobs you can do, you can be granted disability benefits via a “medical-vocational allowance.”

Grinder
Posts: 433
Joined: Mar 2017

Just my opinion, but the behavior of your friend sounds typical of adult autism or possibly Asperger's Syndrome. His refusal to take responsibility for himself, his denial of his condition, his indulging in comfort food, etc. Let me ask you this question... do you feel like you have taken the role of his parent? Does he regard you as a parent? This usually goes undiagnosed because of our expectations of adult behavior from older persons. When they display juvenile or child-like behavior, we write it off as immature or antisocial behavior, when in fact the person is biologically fixated at a juvenile stage of maturity. Does he act and behave as a ten year old? A fifteen year old? etc.

One way to know for sure... was he indulgent and irresponsible before his cancer diagnosis, or is this behavior solely caused by the shock of the cancer diagnosis. Judging from the complete void of friends and family, I am betting he has always been this way, and his family misinterpreted his behavior as antisocial and irresponsible, when it may have been behavior consistent with autism. 

If it is autism or Asperger's, that needs to be considered in his cancer treatment by a professional familiar with adult autism. If he is eligible for Medicare, he can have a hospice worker visit to manage his meds. That would also relieve you of some of the liability VDG mentioned, of which I am also concerned about. Upon his demise you may be subjected to unfair implications since you are not a family member nor a professional health care worker. But don't let that sway you if you feel like you are his only contact with compassion. It takes a lot of character to do the right thing when someone doesn't show their appreciation for it, or even resents your compassionate involvement.

This is all my opinion and my experience with autism and its associated behaviors.

FinishingGrace
Posts: 83
Joined: Apr 2017

I really didn't know him all that well before his illness. We spoke occasionally and he did odd jobs in our neighborhood like washing cars and taking care of yardwork. He did stuff like that for me occasionally.

He always struck me as an intelligent and articulate man who was simply down on his luck after a life threatening motorcycle accident. My elderly neighbor attended church with him and took him in when he and his daughter were going to be homeless. He was just starting to recover financially (had started a new business and was seeing some real success) when this cancer reared it's ugly head. 

FinishingGrace
Posts: 83
Joined: Apr 2017

I went over tonight and gave him his meds for the evening. We had a good talk and he mentioned that he believed he needed to see a therapist because of the struggle he is having handling all of this appropriately. Huge step for him. He is super emotional and I see the effects of the hormone shot they gave him last week. He can't do anything but cry.

He sees the doctor on Wednesday and I've communicated the challenges to the office so the doctor can address these things with him. I'm also going to call his (still worthless) social worker and see about counseling for him. I'm tempted to call her every hour on the hour until she returns my calls.... -_-

The American Cancer Society is providing him with rides to all of his appointments except for when I take him to chemo. Got that set up today, such an incredible help for him.

There is a balance here for me and I'm not certain I've found it but I have certainly been helped by everyone's insight and advice. Thanks guys!

hewhositsoncushions
Posts: 253
Joined: Mar 2017

@Grinder - you may be right but there is probably not enough information here. It could be Aspergers, it could be co-dependency, it could be severe depression, it could be early onset dementia, it could be diabetes, it could be Bipolar. And so on.... The experts will review and make an assessent and he will (if lucky) be triaged to a counsellor, therapist or clinical pshychologist as needed.

@Grace - great news. When you mentioned the hormones, that made me twig. They will definitely be playing a huge part - he needs to be aware that it is not his fault but the hormones, and leanr to accept and process the feelings. If his social worker still draags, perhaps you can sic the ACS on him? Sounds like you are reaching the right balance.

 

C

Grinder
Posts: 433
Joined: Mar 2017

I checked his age in the earlier posts after Hewho suggested age related disorders. The beginning stages of early onset Alzheimer's could be possible, like Hewho is suggesting. In that case, unlike autism and Aspergers, the deterioration in behavior will get worse. A lot of times people think of adults exhibiting "child like" behavior, its the happy trusting kind. But no, often its the rebellious, indulgent, and antisocial behavior like an angry adolescent. Parents of difficult teenagers know what that behavior is like and how monumentally difficult it is to deal with it. I think, just my opinion too, that the case worker is in way over their head in this, because those behaviors will only stir frustration and resentment in anyone not trained to handle those persons and their particular behaviors. The problem now, these syndromes are relatively newly recognized so there may not be a lot of resources available. He is not eligible for Medicare so that is a sticky wicket. I know from experience with similar situations that Medicaid will be unable to provide the proper diagnosis and treatment for any of these conditions, and the health insurance companies including the ACA exchanges will not prioritize the mental health treatment of someone with a terminal illness. 

I am still shocked and amazed that you continue to go to bat for him. I have been very disappointed in the attitude of Americans for some time, and feared for the future of this country. But when I think of the time and energy you have spent helping someone that society just kicked to the curb, and that someone is not capable of appreciating it, it restores some of my confidence. Let us do what your friend is incapable of doing because of his peculiar mental condition... We thank you from the bottom of our hearts for him.

Grinder
Posts: 433
Joined: Mar 2017

My daughter in law is a supervisor as well as case worker in social services. I am going to ask her if she has any recommendations for available resources for your friend, as well as your liability in this. Am still greatly concerned about that. It may take a few days though.

FinishingGrace
Posts: 83
Joined: Apr 2017

Thanks.

I'm interested in the liability as well but not overly concerned.

FinishingGrace
Posts: 83
Joined: Apr 2017

Last night when he mentioned the need for counseling I gave him back some paperwork regarding SSI. He hasn't filled it out for me to be able to help him with it so I was unable to talk to the SSI people. I gave it back to him and let him know he would have to handle it. Huge blessing in disguise! He got up this morning, got dressed, took his trash out AND made some calls to SSI and got things straightened out. He told me on the phone that he wasn't going to sit around and feel sorry for himself any longer and he was going to do what he could to improve his situation.  

It's easy to help someone with such an attitude. He sees the doctor and a counslor tomorrow and his social worker is meeting with him to get him signed up for food stamps. (Someone lit a fire under that social worker and I'm not saying it was me but it wasn't anyone else!) Cool 

I'm not going to any of this and I'm certain he can handle it. 

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Glad to hear that your neighbor has taken a turn for the better.  Sounds like the hormone treatment may have had something to do with it but it was probably mainly a depressed mental state which caused the "funk" he was in that he has now "decided" to dispense with.

Hope things continue to improve for both him and you. 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3188
Joined: May 2012

Grace,

Like everyone else, I'm glad to learn of your friend's change in attitude.

But I would caution that a change of that magnatude is odd, and may well be either feigned or very short-lived

But it is excellent that others are now legally and ethically obliged to assist him now. 

I am not intending to speak as a killjoy here, but it is also worth understanding that many cases in both oncology and various forms of rehab are simply terminal and irreversable.  It is good that others are now in the loop, for I found Vasco's post near the top very reasonable, given what I have seen happen in hospice-situations in the past,

max

FinishingGrace
Posts: 83
Joined: Apr 2017

I don't think you are a killjoy. He may revert but I'm hoping not. He went to all of his appointments alone today and arranged for his own transportation and gathered the needed paperwork for a visit to the Social Security office tomorrow.

And God help me, I took him to Walmart today (still trying to work out out that relates directly to meds or chemo). Someone gave him some money to pay his electric bill and a little extra. He got a couple of things he needed and I picked up two inexpensive things I needed. He insisted on paying for my stuff. He told me he wanted to and it was nothing compared to what I have done for him. He thanked me more than once. I'm not doing this for the thanks, but it is nice to be appreciated.

So cross your fingers for him or say a prayer that this will last and he can be productive and happy in whatever time God gives him. I'm optimistic. :)

Grinder
Posts: 433
Joined: Mar 2017

It sounds like he may have turned the corner. Its like you rescued a drowning man, and now that he is in more shallow water you can let him get back to shore himself... hoping so anyway.

Old Salt
Posts: 720
Joined: Aug 2014

with the latest (May 9) development.

A good neighbor is better than a distant relative. In this case MUCH better!

hewhositsoncushions
Posts: 253
Joined: Mar 2017

Great news!

Have a virtual beer on me :)

Getting him to realise that he can have control by taking ownership of his health and treatment rather than control by self harm would be a good next step.

VascodaGama's picture
VascodaGama
Posts: 2933
Joined: Nov 2010

Grace,

I am glad for knowing about the developments. There are two faces in a flipping coin and fortunately he chose to live. You doing it well in restricting the help you provide. Now there is a whole team around him. He just needs guidance and someone for counseling.
I admire your wish for being at his side in spite of the uphill such help could bring up to you. He surely is grateful for what you have done. Your past experiences in your family and your Christian believes has succeeded.

Congratulations.

VG

FinishingGrace
Posts: 83
Joined: Apr 2017

Thank you. I'm praying it will continue. His attitude change has transformed everything and I hope for his sake he can keep it up!

GeneRose1's picture
GeneRose1
Posts: 64
Joined: Aug 2016

Grace, I've been following these posts & just want to say that you've done a wonderful thing helping your neighbor. I was just approved for Social Security Disability & was able to submit everything online via the Social Security website. They have a compassionate allowance program that expedites approval for folks with advanced PCa. I submitted my test results (CT Scan, Whole Body Bone Scan, & Bone Biopsy) along with my treatment records and was approved in record time. Is your friend a Veteran by any chance? The VA has an excellent disability compensation program and many hospitals and local clinics staffed by very dedicated doctors, nurses, and specialists. They're also able to tap into some clinical trials that might extend your neighbors life and improve his Quality of Life. For the meals on wheels program, I believe he can get a waiver on his age because of his illness. His social worker just needs to make a phone call or two and work it out with the local providers of that service (county or city government). Hopefully you'll be able to keep him & his social worker energized and on this. The thing I've learned about cancer is that knowledge is power and these discussion boards and the internet are precisely the source of some of best information available. Good luck to you. You inspire us all.

FinishingGrace
Posts: 83
Joined: Apr 2017

Thanks Gene. I'm happy to report that he also experience the expidited approval process for SSI. He was miscategorized but that has been fixed and will get his first check soon. He isn't a veteran but that is good info to know.

I haven't asked again about meals on wheels because I was told he had to be 60. I will ask again about it and see if there is an exception. 'Energizing' the social worker is a great way to put it cause this particular social worker needs a new set of batteries!  Wink

hewhositsoncushions
Posts: 253
Joined: Mar 2017

Sounds like good progress. We can only hope that more people in trouble get help from good people like you!

Grinder
Posts: 433
Joined: Mar 2017

I talked to my daughter in Law the social worker, and she suggested that at any time you feel your neighbor is failing to take meds or needs rides or becomes despondent from depression or whatever, that you should put in writing (like an email) a detailed log of his activity as written proof of his need for further professional help, and send it to his doctors and counselors and social workers. That way, if he fails again the ball is in their court. If they respond with resources to help him, that saves you from expense of time and money, and you can just participate in non-health care activities with him. If they do NOT respond with further resources to aid him, then you have reason to assist him because they failed to assist him and it covers a lot of your liability because you will have established that the professionals that should have assisted him failed to give the proper care for him.

It sounds like he may have turned the corner now, I think we all are hoping. But in case he has a relapse, you probably should protect yourself. The problem is that you are performing health care and mental health care for him that is reserved for professionals. By giving him that care, you are taking responsibility for his failure to respond to your attempts at his health care and mental health care. I know this sounds patently unfair, and it is, but in our litigious society, you are risking liability when you provide health care that is the purview of a professional. It is like coming on a car wreck, and seeing someone in serious condition, and saving his life, but if he is injured in some way by your attempt to save him, you can be sued since you are not a doctor. This has actually happened.

But as long as you have written proof that your neighbor required further assistance, and you notified the particular professional responsible, and they failed to respond, then you have limited your liability because the professional will then be responsible for any failure on your part to provide professional level care.

I hope I explained this as well as she did. Unfortunately, I am probably not representing her in the convincing detail she gave me... I am just trying to remember everything. Also I think she said he may be eligible for hospice care if he is a terminal patient, possibly through Medicare even though he is not 65. Still not sure I have the details right, but he could look into free hospice care from some government agency. Or his counselor should be able to say something about it, or just google it if they don't come through.

Good luck and God bless.

FinishingGrace
Posts: 83
Joined: Apr 2017

Thank you Grinder. Very helpful. I have considered keeping a journal of sorts but just haven't wanted to bother (to be perfectly honest). It is clearly needed and I will begin at once, keeping in mind your daughter's specific suggestions.

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