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I am 61 and my mother is 83. I presume that most people in this forum are at least middle-aged to be dealing with aging parents with health/cognition issues. My dad died four years ago. My mom has diabetes, congestive heart failure, and stage 4 renal failure. Another 5 point decline in GFR and she will need dialysis. She falls a lot and in the past year, has spent more time in hospitals and rehab centers than at home. After harping at her for the past two years, I finally “stole” her car a couple months ago. Two days later, she passed out in the car while my sister was driving her home from a doctor appointment. Had I not taken her car and she been driving at that time, who knows if she would have killed herself and perhaps someone else on the freeway. Four weeks ago, I put her into a group home against her will. That decision was hard enough, let alone the paperwork and drama that followed.


Mom does not have serious dementia and is fully aware of what is happening around her. Yet she refuses to admit her declining health and the fact that she cannot safely live on her own anymore. Our conversations have been reduced to: “Why are you doing this to me?” “I want to go home.” “Why can’t I go home?” Why are you so mean to me?” “Why do I have to stay here?” After multiple “come to Jesus” discussions, she finally signed a medical and durable POA yesterday, allowing me to access her bank accounts so I can pay her bills and group home costs as well as file paperwork for state and VA benefits. This whole thing is very complicated, time-consuming and emotionally draining – especially since this whole thing has been a fight from day one.


I am not writing this to complain, but to add a perspective to the conversation here. I have become acutely aware of the importance of having one’s affairs in order BEFORE it becomes acutely necessary.


PLEASE… While you are healthy and clear-headed, make arrangements to save your children from being forced into an untenable position. We all think about having a will and advance directives for health issues and final disposition. We don’t think about preparing for many of the other details. For example:


Driving – Do you have a document assigning someone to make the decision about when you become unsafe to drive, and agreeing that their decision will be final?


Guns – Many people are passionate about their weapons. I heard a story on NPR a year ago about an elderly father in the early throws of Alzheimer’s who locked himself in his bedroom with all his guns. The family was terrified. Do you have a document giving someone the authority to take your guns away from you when they feel you are no longer safe with them?


Medical POA – More than a simple DNR form, a medical POA gives someone the authority to make medical decisions for you when you cannot make them for yourself. Who decides when that time comes? Give them that authority now.


Independent living – Perhaps the most important document is a Springing Durable Power of Attorney which gives someone the authority to take over your affairs and make decisions on your behalf when certain conditions are met – usually physical or mental incapacitation. The most important part of this document should be how the determination as to your incapacity should be reached. Perhaps a consensus of doctors and family members would be good. If you do not articulate this detail, it will fall to the courts to determine competence. This process is VERY arduous, expensive, and pits you against your loved ones as enemies. Why would you do that to your kids?


Most of us believe that as we age, we will be reasonable in making decisions. Even though a person may not have serious dementia, sound reasoning tends to wane with advanced age. You do not have to be wealthy or have a complicated estate. These are simple issues to deal with now but will become more complicated when you start getting up there in age.

Please remember too, that if a house is in an elderly parent’s name, the deed to the house is just in the elderly Parent’s name, it WILL go through probate.

I went through this with my Mother. Two weeks before she died she was adamant about not having her will go through probate. The house was in her name ONLY. She never put my name on the deed so the house went through probate.
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Tressie, what a hard the of it you had! Thank you for sharing - it will help others.

In fact I fear your past is my future 🙁.
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GaryinMesa: You are so right - be prepared. Prayers sent.
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One thing I would add--and this is simply a 'cautionary tale' as it were:

My mother always wanted me to read her will. IDK why, because she has literally nothing but junk to leave us and nothing of value....but one day, I was waiting for her to come home from someplace and I decided to peruse the will.

Pretty straightforward and boring--UNTIL, I find a looseleaf paper with this written on it: "B" owes estate $1500. "R" owes estate $6000. Not notarized, just stuck in there. No explanation whatsoever.

Well, I am "B" and I cannot for the life of me figure out HOW I can owe her trust money! And "R" is the son who added on to his house and took mother and dad in. And he OWES money to her trust?? 24 years of CG and he owes money.

I talked to lawyer son and he said this is NOT legal and whoever is her POA should destroy the paper before R can see it. This has a technical name, but son referred to it as a posthumous "FU" and is nothing but hurtful.

DON'T leave your heirs any anger, emotionally damaging words---mom doesn't know I read this, altho she obviously wanted me to see it.
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Having been through all of this with my father I keep urging my husband to talk to his 83 year old brother who lives alone 2 hours from us. We are his next of kin. My husband has no idea how much a mess this can turn into. I keep begging him to have the 'talk' with his brother and he refuses...they don't talk about stuff like that. I will be damned if I am going to have to go through all of this with my brother in law. My husband did help minimally with my father and I am willing to help some with his brother but I know he rely on me more than I am comfortable with doing. He just has no idea. At least I was put in charge of my father's finances early on and he was only 30 minutes away. I had POA and made sure he had a will. If something happens to his brother we know nothing about his wishes. I know it is a difficult discussion to have but it needs to be done when the person is of sound mind.
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This is an absolute necessity, as you have outlined. My mother and father, when they were in their late 50s and early 60s set out to make my life as easy as possible when they became elderly. I am an only child and have run 2 small businesses for the better part of 40 years. At the time they drew up POAs, a pour over will, and a trust, they were both in perfect health. Fast forward 30+ years. My mother started exhibiting signs of dementia in her 80s. My father first noticed it. She had (has) long term health care insurance. My father was ineligible as he had received a liver transplant when he was 70 years old. I was their appointed POA, trustee, durable POA, on and on. My father then at age 92 developed lung cancer, he had been taking care of my, by this time, severely demented mother, with the help of visiting nurses. Even with radiation therapy he became disabled quickly. I had taken it upon myself to start visiting assisted living and memory care facilities, he protested and wouldn't visit them with me. I wanted my parents to stay together and found a facility where his AL apartment was close to her memory care, in the same building. Then it started with my father. He wanted to stay at home, to the tune of $600+ a day nursing care for the both of them. Their house was becoming disheveled, even with my husband and myself cleaning it twice a week. An hour after it was clean, my mother would go through things looking for something familiar and turn the house upside down. My father was getting more and more debilitated and didn't have the energy to deal with her "episodes." Then he tried to reverse all the decisions they had made, by now, almost 40 years before. The pain of his cancer and a little bit of dementia on his part were taking over. "You like to see me suffer," "why can't you help me stay in my home." "You're the woman, you're supposed to take care of us." "I never believed you would do this to us." On and on. When I wasn't at the house he would call me every 20 to 30 minutes, one day I counted, it was 23 times, as he would call in the middle of the night too. When I knew they had nursing care there, I would unplug my phone. If he knew I had a business meeting he would deliberately call in the middle of it and make demands. If he couldn't get hold of me, he would call 911 while the nurses were out of the room and an ambulance or fire truck would show up at the house, to the surprise of the visiting nurse. I got them both into assisted living, Mom willingly, Daddy not so much, but by this time he was under hospice care. He passed away 16 days later. My mother has embraced he new living situation. Had my parents not taken care of things while they were of sound mind, my battles would have been a nightmare. They were, as it was, unpleasant, but it could have been so much worse. Please, please, get your affairs in order, and I think a video of your wishes is a great idea! We didn't do that, just had things in writing, in a safe deposit box. Even with all of their attention to detail, getting things settled was sometimes an all day ordeal with what seemed like endless phone calls. Thank goodness we all used the same banks, investment firm, and CPA, so everyone was on board when my father passed and I was allowed access to assets fairly quickly. What they did for me was nothing short of a blessing! All of their funeral arrangements were even made and pre-paid.
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Very good advice- thank you!! It's good to have documents in place whatever the age (we've had too many taken from us at early ages due to cancer and other reasons). As a rule of thumb, my SILs and I had documents drawn up when our kids were small to include who would get guardianship in the case something happened to both parents.

I'd also like to add to ensure you have a trust as simply having a loved one's name on your personal assets will NOT protect those assets- I believe an irrevocable trust is better, but an estate attorney could advise on that and any rules of your state.

About the guns, one thing to think about if you are in a state that has tough gun laws (we do in MD) or even if you don't reside in a state like that. I have a friend whose dad has an extensive gun collection from hunting. She has advised him to leave instructions on the value of the guns since if she was to take them to a gun shop she would have no idea on how much they were worth. She also asked him to instruct her on how to go about parceling them out to loved ones or how to go about selling them here. If he had any that he wanted to get rid of in the meantime she asked him to do so now.
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SwampOphelia, recording wishes is a great idea.  It's personal, but it also allows someone who might have difficult reading to convey his or her wishes w/o reading all the legalese that's typical of end of life documents.   And it's probably a lot cheaper.
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Taarna, where did you get that "statistic"that 75% of people over age 75 have some form of dementia?I am a person who has spent over 40 years in eldercare and have never seen any such documented evidence of that range of dementia. I also have a graduate degree with a concentration in geriatric studies. There are many mentally competent people over age 75. You do a disservice suggesting that a mere 25% of older people have capacity!
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With today's technology, I'd think it would be a good idea to also make a video stating your wishes in addition to your written and signed documents.

You could state what you want done if you become incompetent, uncooperative and argumentative and/or don't realise you need help.

You could basically give your loved ones a video pep talk and encourage them to follow through with the plan you had made when you were of sound mind.

In my video, I would say something like this to my loved ones, "When I'm wetting my pants and "more" every day and refusing to change or shower, it's definitely time to place me in assisted living. No matter how much I argue, this is what I want. I don't want you to have to change my pants or argue with me about showering. Thank you for doing this for me. I love you!"
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After many years of heartache my caregiver days are over now.

I think it is fantastic that you have written a wonderful guide for caregivers to follow.

I would add only one thing. When my mother was in rehab and I was filling out all of the paperwork I was asked if I had medical POA, to which I replied that I did.

The social worker advised me to fill out a POLST form which apparently is the most effective way to communicate what is desired to be done in medical situations.

I am curious as to how you were able to have your mom agree to living at her facility. So many people have major issues with placing their parents if they choose not to live in a facility.

I am very glad that you were able to make your situation as best as it can be for your mom and yourself.
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The problem with dementia (and 75% of seniors 75 years old and older have it) is that you don't realize you need the help.

Basically, have those hard discussions early (50s-60s) and find a good family lawyer to write our those legal documents.
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Great advice!
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Lother of elderly people have come to realize that their children will do what's best and easiest for them, like making them move from the comforts of their home into a facility where they will be miserable, lonely, feel unloved and sad until they have lost the will to live.
If Chikdren took care of their parents like parents took care of their children and like how it was in the old days when children wijld take care of their parents when the time came instead of unloading them at what and where they think best.

I promised my Dad that he wouldn't go to a home and now at 96 yes old and Dementia, he is still living in his home with 24 7 Caregivers. Yes, he is using up all his money for his care instead of leaving the money to his children which is exactly what should happen.

He wouldn't last a month in a home.

Praters for all the Aging that they have chikdren tgat will do what is really in the best interest for the Senior parent and not what is easiest for them.

Old people deserve to live out their remaining life how they want.
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Thanks for your comments. I agree completely! Having become both my Mom's and MIL's caretaker, both my husband and I are acutely aware of the need to prepare.
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I agree! Everyone needs to find an estate lawyer and get prepared. A lawyer is important because state laws vary and everyone has a different situation.
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Very good advice. My husband is soon to be 55 and his mother soon to be 90. She has a history of undiagnosed mental illness. She gets worse with age. She is suspicious and hostile most of the time to her only son. When telemarketers call to try and sell car maintenance insurance she believes that we are buying cars in her name. She will not sign POA. I believe she would benefit from some type of assisted living but she thinks she is fine and believes there is nothing wrong with her and occasionally believes she should live with us.
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Gary, excellent advice. I know I didn't pay much attention to legal documents until I noticed my elderly parents' Will was older than dirt. That was my light bulb moment for myself.
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Dear "GaryinMesa,"

Very informative and thought provoking comments. Thank you for taking the time to lay it all out in detail for everyone.

Living near Mesa, I have never heard of a "Springing Durable Power of Attorney." I had received all the necessary forms to take care of my mom when (at the time) Governor Jan Brewer held a speaking engagement regarding elder issues. They had a table set up of all types of information and forms. Since that was in 2005 after my dad died maybe it's something new or replaces the form I received.
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Good post, but I'd add that the gun and driving documents you suggest have no legal power and can't be enforced.
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Wonderful post. Thank you.
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Great message.

Also, people should invest in long term care insurance to help pay for care when older.
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Your post is certainly very thorough and hopefully helpful to many. The only point I choose to differ with you is advising for a springing POA rather than a durable one. In many cases and for many necessary institutions it won't hold up and if it does it may not last. It may be easier for the person granting this but it will be difficult for the person trying to advocate for the one they are trying to help.
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Gary, thanks for the time and advice and willing to share your insights.  They're very helpful, and a good outline and guideline.
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Great advice Gary. You're right, many if not most people wait until their choices are few to create the documents you mentioned if they can create them at all. The one issue I would take exception with is the creation of a “springing” POA. As you know, a springing POA requires a trigger such as incapacity of the grantor. It is not actionable by the atty-in-fact until then. A standard HCPOA becomes effective and actionable by the atty-in-fact the day it is signed. It does not, however, give that person carte blanche freedom to act any way he wishes. The POA must still act in the best interest of the grantor. So with a springing POA what does incapacity mean? It has to be defined. Is every possibility stated? Will the doctor agree that the term is met? What if you need help before you're incapacitated? What if the doctor and atty disagree? What if the grantor has some good days and bad? All of this is just to much to consider and allows for indecision and delay. I much prefer the std healthcare POA.
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Good advice--

We always had a 'holistic will' for when the kids were younger and we wanted whomever 'inherited them' should something have happened to us, to know what we wanted and where the money was.

A few years ago, I talked DH into doing a 'real' will. Trust, actually, but same end result.

I did ALL the legwork and research-all our atty did was have it cleaned up, legalized and notarized. Gave us some advice on things we hadn't thought of.

I also had a dear friend who does gorgeous woodworking make our columbariums, where our ashes will repose. This year I intend to reserve our 'spots' in the cemetery where DH's family all is.

My kids are SO GRATEFUL that our wishes are spelled out and there should be no fuss.

I've seen the hot mess left behind by people who think that they'll either never die, or figure the 'kids' will work it out. My FIL had a very unfinished will--and it was kind of a mess for a solid year, as we navigated our way through his stuff.

My MIL refused to make a will, and then I told her that total strangers would sort through her stuff (kind of true) and she said "even my underwear drawer???" That alone pushed her to make a will. Funny, DH is her executor but she has written him out of the will.

SMH. Life is funny. A will/trust is the last gift you can give your family.
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GaryinMesa, very sensible advice. My mother has some of these in place and that is just as well for me because she too is in denial about her general age related decline. But I see so many of my friends trying to set these things up when there is a crisis. By then, everything is urgent, but the legal process takes time - and longer than ever due to court delays because of covid. In my view it is better to deal with these things when everyone is fit and well, and the dicsussion is more palatable because it seems a hypothetical one. The same could be said of writing a Will. I do not want my son to be bereaved AND have to sort out the mess if there is no Will nor any provisions in place for his future. Some of my friends thought we were control freaks for having Wills when we were in our forties, but then one of them died suddenly due to an aggressive brain tumour. The rest suddenly saw first hand the difficulties facing her family, some of which could have been avoided if a Will had been in place.
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This is excellent advice.
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One thing the past year has shown me is that people are not very good at planning for the future or calculating risk, far too many of us can clearly see what the other guy is doing wrong without noticing our own mistakes and vulnerabilities. I do have a long term plan and I've got my legal ducks in a row.
One thing I'd like to add to your very good advice - while I can sort of understand why "springing" POAs are popular in families that are contentious or dysfunctional in my opinion they add a layer of difficulty at an already difficult time. My mom's POA and the one I have for myself was/is in force the moment it was signed and witnessed. Because of this I was able to gradually take over mom's financial affairs, from at first doing simple banking for convenience to arranging the sale of her home and property years later when that was necessary.
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