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I am helping my friend with her healthcare (Medical POA) and have a dilemma. She was recently hospitalized after collapsing and I found an assisted living facility for her and got her transferred there upon hospital discharge as she was still recuperating. My problem is this; she is doing well at the facility - eating all of her meals, taking her meds and allowing people to help her bathe - at home alone in her apartment she stopped eating well, said she lost her appetite, didn’t take her meds properly, wouldn’t let people assist fully with bathing, etc. - it was her lack of proper nutrition and her not taking her iron that contributed to her collapse; she was so weakened that she got double pneumonia and needed a transfusion because of the lack of iron.
Now that she’s feeling better she wants to go back to her apartment where she lives alone (with part time assistance from myself and two other people). I am so afraid that she will backslide again if she leaves the facility and will eventually collapse again. This her second collapse in two years. The first time (before I became involved) she only weighed 66 pounds when she collapsed that time. She has osteoporosis as well and can’t afford another fall. I know that she would like to maintain her independence as long as possible but she is very frail.
Is it wrong of me to push her toward staying in assisted living when she wants to return home? She can afford self pay for a while and then we can apply for long term care Medicaid but she wants to save that money to leave to family members. I say take care of yourself with that money but she is stubborn!
I have checked into home care agencies as well and having someone come in for 8 hours, 7 days a week; to fix homemade meals, give meds, light housework, bathing, etc., will cost $5,000.00 a month. That is currently what she is paying for AL, and that facility has someone there 24/7, not just 8 hours a day. I don’t even know if she would spend the money on home healthcare.
Any suggestions?

If she has not been declared "incompetent" she has the right to ask to be discharged to her home.
If it is not "safe" for her to do so she would have to be declared "incompetent" someone, most likely a relative, the state or a friend could petition to become her Guardian. Then the decisions will be out of her hands.

As a friend you can encourage her to remain where she is.
If she is aware of costs you could discuss with her the "Pro's and Con's" of living at home VS in Assisted living.
Is she paying a mortgage, insurance, property taxes, gas, light, garbage service, food bills. Assisted Living most of that is not an issue and would go to pay for AL.
She has people around her now, activities, possibilities of outings where as at home she has none of that.
At home she has more independence That is a biggie for a lot of people.
As a friend you should also do your best to support the decision she makes.
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Reply to Grandma1954
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Of course its not wrong to push for her to stay in Assisted Living where she's thriving! It's only common sense, really. Stubbornness creates emergency situations where decisions will ultimately be taken away from her anyway. Why not make the decision now and save a whole lot of headache and heartache down the line?
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Stilltired Sep 23, 2019
Thank you. This is my take on it as well but when she expressed her wish to return home to her apartment, her PCP answered, “I don’t see why not. Let’s see how things go after your tests.” This leads me to believe that going home to get apartment is what will happen.
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You are such a good, good friend to this woman that it may be time to practice a bit of tough love. You can clearly see that she flourishes in the assisted living situation. She's already collapsed twice while at home and you know that it will only happen again, and when at home she needs constant assistance from friends, who can't/won't always be able to provide it. BUT, she is mentally competent to make her own decisions, even bad ones.

You can't make her stay in the assisted living (even though you know it is far better for her), but you don't have to facilitate her move back home. If she has to take on all of the responsibility of getting moved back home, arranging for caregiving (not the kindness of friends), etc she probably won't be able to do it and will stay at the assisted living facility by default. If she does somehow manage to get herself moved back home then you need step back in your assistance - still be a friend but not a caretaker. At that point she will either have another collapse and start the cycle again, or better she will see that assisted living was a far better choice and return to the assisted living facility.

The level of care that you and her other friend are providing means that she isn't living independently no matter what she thinks. Pulling back on my help was the only way I finally got my father to agree, begrudgingly, to move to assisted living. As long as I made it possible to stay in his home (even though it was a terrible situation) he was going to do it. As a friend mine who is a hospital case worker told me "People are allowed to make their own decisions, even bad ones, but you don't have to help." It's hard to take that step back but it may be necessary.
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Stilltired Sep 23, 2019
Thank you for thoughtful reply.
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Medicare pays for rehab for a short period of time.

Sounds like self pay for assisted living is an option. If she is competent she has the right to decide where she lives. That may not be what you consider the best v decision.

But, once her cash runs out what will happen? Check with Medicaid, many states Medicaid program will only pay for nursing home, not assisted living.
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Stilltired Sep 23, 2019
Thank you. I have been checking into long term care Medicaid for her.
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" ...she wants to go back to her apartment where she lives alone (with part time assistance from myself and two other people)."

How much is the rent for the apartment? That plus utilities plus food plus $5K/month for home care would seem to cost more than the AL.

" She can afford self pay for a while and then we can apply for long term care Medicaid but she wants to save that money to leave to family members. I say take care of yourself with that money but she is stubborn!"

and

" I don’t even know if she would spend the money on home healthcare."

How much time are you (and the other 2 part-timers) spending to help her? Are you being paid? (I suspect not.)

So she is relying on this free help and doesn't want anything to change so that she can leave money to family? I bet she will balk at paying for home help.

Who is her POA? Do you ever talk to any of her family?
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Stilltired Sep 19, 2019
She never married or had children. Her closest relatives are her cousins. I do talk to them. They are all in their 80’s or late 70’s and have their own families and health issues to tend to.
I am her POA in all matters but she & I work together to get things done like bill paying. I make no decisions against her. Yes, she is mentally competent.
I visit with her about five times a week, bring food, shop, have a meal together, chat, pay bills, etc. I take her to appointments and for drives around town. I am not paid.
One other lady who is not paid heats up her evening meals and the other is paid to come in twice a week to do light housecleaning, laundry, errands and cooks her brunch on those days.
My main concern is keeping her as healthy as possible and when she’s living alone it doesn’t always go well.
You’re correct that her expenses would be more at home than at AL if she had someone coming in from an agency to help out.
She has a mindset that she must leave something to her cousins, which in itself is not bad, but it is an almost obsessive goal and she lets her health fail instead of spending on herself.
I do realize that in the end it is her choice. I voice my concerns though.
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Who has her durable POA?
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Stilltired Sep 19, 2019
I do. Haven’t used it to override her on anything.
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