Can a doctor tell the family that their loved one should be in a nursing home for long term care?

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I am, like many of us, at times overwhelmed with caring for Mom. Recently, I have felt that it is time for Mom to be in a NH (as from my previous post).


I am the youngest of 5, and am the main care giver. Three of my siblings can see how hard it can be, and are in agreement with me. My older brother (who lives with Mom and has the most health issues —heart disease, pulmonary fibrosis, and leukemia...) is not in agreement and wants to give me money to hire a caregiver so that Mom can stay home. (He is in denial that he may need the money for his own care....) What do we do when we run out of money??


I did tell him that if he passes before Mom, she will have to go to a NH. While, he has said that he didn’t expect to live until September that past two years, he now says that he “thinks he is going to be okay.” Of course he cannot walk 20 feet w/o oxygen, and he certainly cannot handle Mom...


Mom does not have a medical POA. So, as I understand it (as it was with the hospice care), we all have to agree before we can put Mom in a home. Or should it be he oldest who makes the decision??


Yesterday, my SIL told ME that I should go to Mom’s doctor because he can tell us that Mom needs to be in a NH (thinking that my oldest brother would listen to him).


I recently had Mom to that doctor to have paperwork filled out for the VA. At that time, he said that the person is better off in their own home, but they worry about caregiver burnout.


I understand the doctor can certify a patient’s incompetence, but it seems to me, that unless the person is a ward of the state, the family (collectively) would be the ones to determine if the loved one should be in a NH for long term care, not a GP. Am I right?




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I know, different states. If Mom is not capable of making informed decisions, then she can't assign a POA. The nxt step would be guardianship. It was mentioned on another post thst the NH helped to get POA. With me, Mom went to a lawyer, talked to him about what she wanted, signed the papers assigning me. The papers were witnessed and notarized.

As POA, though, you wouldn't need anyones OK to place Mom.

Is brother afraid that he will lose his place to live? With his health history and if he is on SSD, with Medicaid he maybe allowed to live in the house as long as he pays the utilities, taxes and upkeep. At time of Moms death, a lean will be put on the house that will need to be satisfied at time of sale. He maybe able to continue to live there. My cousin is doing this now and my Aunts been gone 19 yrs.
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Mapotter Aug 27, 2018
Hi, JoAnn. According to what the nursing home told me is that they would initiate the assignment of a medical POA after she is admitted. Guardianship is a costly adventure.

The rest of the siblings agree that we want our brother to continue living in the house when Mom passes (if she does before he does). I know that Medicaid would not force the sale of the house if he is living there since he is receiving SSD and because of his health issues. I have wondered if Medicaid would put a lien on the house until it is sold.

I think my brother is in denial or thinks he can keep Mom alive forever. When Mom has a good day and she eats well, he says, "She did good!", like that is going to change the outcome. She is 94, and has not taken any medication in months now.

From Tuesday thru Thursday, she was pretty alert and out of bed. On Tuesday, the hospice nurse came and after the team had their meeting, it sounds like they didn't recommend re-certification in the program. If that is the case, I will appeal. Mom has been mostly in bed and not eating much since Friday. It changes frequently. I pray for a peaceful passing. :-(
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I posted my question late last night because I couldn't sleep, with the hope that my mind would be eased.

This morning, I contacted the nursing home and wanted to share my findings here in case it helps others. This may be different per state, I don't know. This is in the state of MD.

The nursing home told me that having a doctor evaluate Mom to see if she should be in a nursing home has no bearing on whether or not she is admitted for long term care. They do their own assessment. Having my brother not be on board "makes it difficult." But, as financial POA, I can complete the application, get the financial information together (since the process takes a while), and hopefully my brother "will come around." After Mom is admitted, they would work on certifying her unable to make decisions and decide who should have medical POA.

So, it is all good to know.
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Collectively? No. Facilities would not be as numerous if all in a family had to agree to placement. That is the reason that POA's are usually assigned to one person with a successor.

A doctor has to order nursing home. You may be misinterpreting doc's comment about better off at home. Most docs would agree that people, generally, are better off in their homes. That statement has a big BUT that comes with it. Only if they can get the necessary level of care in their home. The large majority cannot afford that option.
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You cannot simply check your mother into a nursing home. She needs to be medically in need of a nursing home, and that has to be put in writing by a doctor. I think that's what your SIL is referring to.

How will the nursing home be paid for?

Will your mother agree to NH care? If she has no POA, it's HER wishes that matter here.

Unless your brother is going to take over your mom's care, I don't see how he has any say in the matter.
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Mapotter Aug 27, 2018
hi, Barb. Mom has aphasia and she is not able to understand or verbalize what she wants.

The nursing home would have to be private pay until her assets are down to $2500, then Medicaid would kick in. Because her assets are limited, I would have to submit everything for Medicaid at the same time as the NH application.

As I learned today, the nursing home will make the determination if she qualifies for care. Her doctor’s opinion has no bearing. But, I did submit an application in May for an advisory level of care and she did qualify for NH care at that time.

Thr NH told me that having my brother not on board will make it difficult. But, as financial POA, I can still submit the application for Mom because it takes a while to process. Maybe by then, my brother will change his mind. Mom has not been doing well the past few days, so maybe I won’t have to fret over it....
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The family cannot just place them in a nursing home for such a placement must have a doctor's order with it.
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