I am POA (general, durable and health care) for a family friend. He has vascular dementia and landed in AL over a year ago after a hospitalization related to the dementia. He wasn’t one who took to the AL. After a year, he was becoming more and more unhappy there, was not engaged in activities and had enough cognition that it was clear he was planning an escape to the home he purchased to grow old in. He was gathering a team around him to get himself home. His POA was aging and wanted to get him home but didn’t have the executive function to make it happen so he signed over to me and I was able to get him home with 24 hr home attendents, 1/2 paid by long term care insurance.

Initially we thought he had money for 6-8 yrs at home, but we also thought he’d graduate to 12 hr or live-in care. His dementia has progressed a little and the agency has felt he continues to need 24 hr care. He sleeps or at least stays in his room at night. The caregivers note when they hear him up going to the bathroom or occasionally coming downstairs for water.

He has lost strength and some mobility but overall he’s pretty healthy so we believe he could live quite a few years unless he has a stroke or fatal fall. He still feeds, toilets and bathes independently and he helps the caregivers sometimes with cooking and cleanup.

Options seem to be:

1) Wait until money gone then back to a facility, wherever will match his long-term care as close as possible

2) Hire overnight or live-in caregiver outside of agency for less $ but then have to deal with employment and management at a distance (we’re 4 hrs away - no family close by to check-in)

3) Privately hire someone from the agency - I know people who’ve done this. Seems like it wouldn’t be allowed and we might burn bridges

4) Try to convince him now to go back to a facility. With his house and investments he could choose one of the nicer places that takes your home as the investment. I don’t see him cooperating with this and if they decide he needs memory care, I’m not clear on whether a more expensive place actually gives different care than one where long term insurance covers the full bill.

5) Implement technology - wearable, bed and door monitors (I’m sure there’s more that I’m not aware of) for nighttime safety and switch to 12 hour care. I’m on the fence about this option because of the history of hospitalization related to dementia

Can you please help me think through this? I’m also a bit concerned about whether I could have legal liability for any of the above decisions of his child decides to get litigious related to any outcomes in the above scenarios. The child is very interested in the inheritance and believes the senior to need 24 hr care to prevent another hospitalization.

In a similar situation - LO has 3 years LTC insurance (1/3 behind us) and find it covers 85% or so by having 1 person for 24h live-in Care through a
staffing agency that we found through this website. (It was a bit circular as I was misrouted to nursing home at first but found the right person after a few transfers)
The way it works in our state (NY)- as long as the live in aide can get 6-8 hours sleep a night, and meal periods - paid for 14h a day- 5 days a week.
we find this works for mom who has similar presentation as your LO…

We also have private pay person working daily rate that aligns with insurance for weekends that is covered 95% by LTC insurance and includes extra chore services which are limited through the agency.
8 months in it work most of the time.
Have the live in and not 2 people makes this manageable.
of course this works as LO sleeps through the night and we have a security system with wide angle cameras inside and out with sensors that chime when doors open / close through Vivient - chime extender allows aid to hear if LO gets out of the room. The system can also be viewed / monitored by cell. This acts as a backup plan in case aide is sound asleep and LO gets up.
Others have posted about bed sensors as well.
Mostly Working for now.
Once LTC runs out we’ll be applying for Medicaid spend down with look back. I get to do the paperwork for my LO after doing it for so many others as my day job… (it’s much easier when it’s not your LO. ) Local dept
for aging Caseworkers /
Catholic Charities, the home care reps on this site and elder care attorney can all offer guidance based on your state.
Hope this helps.
Helpful Answer (0)
Reply to AliOJ58

A poa cannot reassign their duties. Are you sure you’re legally poa?
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Reply to PeggySue2020

He needs to be in a facility where he can be cared for 24/7.

Your idea about technology is kind of pie-in-the-sky. It doesn't provide "nighttime safety" at all because by the time you know he's wandering, he could be in a ditch half a mile away, and then what? It doesn't do one bit of good to know if he gets out of bed in the middle of the night if someone isn't there to chase him, and even that has predictably bad outcomes sometimes. Also, he may not have (now or eventually) enough mind left to understand why he needs to wear devices or how to use them. Alarms going off scare dementia patients and everyone else around. A person who doesn't even recognize words like "shoe" or "morning" isn't going to retain "alarm" or know what it is when it goes off.

His money being used to pay for a nicer memory care facility is a good idea because they may have a better ratio of caregiver to resident. Caregiver retention may be higher and training may be more thorough. Also they generally have more activities to keep them occupied. I emphasize "generally."

I wish you luck in finding the perfect care solution for your friend!
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Reply to Fawnby

Does he need the overnight care? Is he capable of calling 911 if there is a problem?
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Reply to brandee

redmustardseed: Locate a facility that accepts Medicaid NOW.
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Reply to Llamalover47

First of all, you'll save a fortune on his care if you cut out the agency-hired caregivers.

I own a homecare agency and am saying this. Hire private people from a caregiver website like then lay out a flat wage that you're paying. Your best bet is to hire two who split the week so no one can make his home their official, legal residence. If I were you, I'd leave the agency out of it altogether. Every homecare agency is going to say a client needs 24 hour, live-in care. Time is money, my friend.
I don't so this because I do not offer live-in caregivers. Hourly only.

You can check references and interview people yourself.

You could also hire a 'Sleep Aide'. This is a person who for a low wage (not even minimum) comes when the caregivers shifts end and literally just sleeps there. This way you're covered on someone being there 24/7 if he really needs it.

Check out a caregiver website though. Talk to a few people. If you poach an agency caregiver, so what. Just don't broadcast about it and you'll do fine.

You have choices. Of course you could get him placed now in a good facility while he still has some money. When a person enters a care facility and they've already spend down their money and are on Medicaid, it is not going to be a nice place.
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Reply to BurntCaregiver
MiaMoor Jul 9, 2024
Does Medicaid cover the costs of the care home once the resident's money runs out? And is there a cap on how much they'll pay out? (I'm just asking out of interest, as it makes a difference to the decisions carers make.)
His child needs to understand that he doesn't have enough money to pay for all of his care and there will be no inheritance. Him getting an inheritance is not a factor in this equation. The sad and hard part of all of this is that your friend is still with it to know what is happening and that he doesn't want to be in a facility with elderly people he would not normally be around. I think most people with mild or early stage dementia feel this way. I would wait until the money is gone and hopefully in 2.5 yrs when that happens, he will be far enough along cognitively that placing him in memory care will not be so traumatic for him.
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Reply to Jamesj

I am actually concerned that the care agency has stated that your friend needs 24 hour care when, from what you have said, he is quite capable.

I don't understand why live in care would not have been sufficient, unless he has more complex needs than you have said.

Nevertheless, at some point he will need more help than he can get, or afford to pay for, at home.

Is your friend still able to make decisions? I wonder if he had a say in where he would go rather than others swooping in and making the decision for him because there's been an emergency, it would help him adjust.
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Reply to MiaMoor
BurntCaregiver Jul 9, 2024

Every homecare agency is going to say a client needs more hours even if they don't because time is money.

The people who see this guy every day know if he needs thos much care and they should trust themselves to decide.
You need to move him sooner rather than later to a memory care situation. He's not going to like it or agree to it, but someone needs to be the take charge person to make it happen. It's like sending a kid to kindergarten. They want to stay home and you know that they have to go, so you drop them off, wish them the best and know you've done the right thing Not to say you don't go home and cry. It's the same situation. If you move him now he will have some time to acclimate before he loses more abilities. If you wait to move him until the very last minute he'll not be able to understand and it will be like you just delivered him to Mars. Take the advice of MACinCT and get him in an appropriate facility as soon as you can.
Helpful Answer (1)
Reply to jkm999

Where can u find a senior advocate? I see it being recommended all the time.
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Reply to Dcoyne22
MACinCT Jul 3, 2024
National Resources for finding Advocates
It depends on your location
Medical Advocate locator:
Find an advocate:!directory/map

Aging Life Care
See a geriatric advocate asap to do this right. They help you find a good facility that takes Medicaid. The good ones can have wait lists of a few to many months. You begin private pay and when it is time for Medicaid he goes to the top of the facility wait list. If you wait till the end, he goes to the first facility with an open bed which may be crappy. You need to plan about a year ahead of money depletion.
BTW ALs are not Medicaid eligible. He is getting weak and once he is a 2 person lift or cannot get into a chair without help, then that means LTC. Hope that within the next 18 months he will require LTC. You might want to talk to him about his savings if he can understand but he may be past that. You asked about several scenarios and 3 and 4 are reasonable. But do seek an advocate. Best of luck. You still have some time on your side
Helpful Answer (4)
Reply to MACinCT

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