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My father is 86 years old, he will be 87 years old in 4 months. His wife died 2 years ago, and I, as well as, my husband, sister and brother started to help him. His wife was a hoarder and we removed 60 tons of stuff, we sold 5 of his propeties, they had not prepared for retirement, we dealt with 12 renters, and cleaning up the 5 properties. When we found him he weighed 128 lbs, and had no food in the house. We removed over 200 mice and rats. We got his BP under control, had his cancer in his nose removed, had his Parkinson's dianosed. He got up to 151 lbs, and was doing wonderful. My brother moved into his home, but he could only be a companion and 1st responder because he is disabled, blind and double aputee. My sister is 70 years old, and she cleans his 2800 sq ft house, and my father has a cather she has been trained to flush, we have a visiting nurse come to the home to change the cather. His drivers license was suspended by the DMV, and we sold his cars. He has fallen and had a brain bleed, so we replaced the carpet with hardwood floors, and we have made a lot of changes to the house, for safety, handrails, etc. Back in January we started the conversations about going into a assistant living home, he just said NO. I live out of state and I handle all his bills, bookkeeping, accounting, insurance, and keep the books for the one rental he has left. We now have a standing medical order from his doctor that he can not live alone or take care of himself. That he also needs skilled help, and we are unable to provide him that care. He can not afford for someone to live in his home as a caregiver. We have found a wonderful Assisted Living Facility, and even though he is still sharp in the mind, he can not take care of himself, and continues to fall as his Parkinson gets worse. He will not even consider going to see the facility let alone move in. We are lost, my sister and I do have Power of Attorney, both medical and durable, what can we do? We would love it if he could see the whole picture, but he will not.

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Thank you so much for your kind words. Who knew the answer was letting your parent see for himself. Who knew stepping back was the answer. I am grateful for my new friends on this website, thank you all so much.
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Sometimes it is hard being the adult and making the right decisions. "lostfamily" you and your siblings handled it beautifully. We should be so fortunate!
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Wow - looks like you handled it just right! So happy that you and your siblings working together were able to work out a plan, stick to it and help your dad see the truth of caring for himself. All while ensuring his safety and care. Way to go!
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I am back, and was glad that some people found my last post helpful. I wanted to give you all a update. My father moved into a ALF two weeks ago. We talked to him after he visited the ALF and he did not change his mind about moving, but we did something that we had never done before (it was the answer) we gave him food that he could fix himself, and my brother did not fix his meals, he just showed my dad how to fix meals, and my sister did not come but every other week to clean and do his laundry. We made sure his needs were being taken care of, but kept a distance, so that he was alone quite a bit, and then after 3 weeks had another family meeting, guess what, my dad told us that he could not do it by himself. We moved him into the ALF the next week, and he went willingly. Now that he has been in the ALF for two weeks, he loves the meals, the attention, and that there is staff there 24/7.
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After my brother, my sister and myself talked, talked and talked some more, we all decided that we could not keep giving everything to our dad, we realized that why should our father want to move into the ALF when everything, I mean everything was being done for him. He does not care about our health, or well being, as long as he is being taken care of and can stay in his home. So, we are making a few more changes to his home, for safety. My brother is going to move out of my dad's house, and we thought about moving in a caregiver, but so many walls come up. 1-background check, 2.- possible abuse 3.- They would have dad's ear on a 24/7 basis, and could take advantage. So I hope this can be helpful to others who might be struggling with this same issue. We decided to let him have his choice to stay in his home, but we could not continue to abandon our lives to keep spending every moment taking care of someone who does not care about anything but staying in his house. We realized that he is putting his house before himself, before us, and before cost. So we are closing up half of his house, we given him a way to reach the outside world "Lifeline and cell phone and Internet" we are having someone bring food and meals, and someone to come clean his home and do laundry, visiting nurse will still come to change his catheter, I will continue to pay his bills, etc. my sister will visit one day a week, take care of his medications and medical supplies, take him to his doctor's appointments, my brother will visit one day a week and keep up his repairs on his mobility scooter, and handle any personal needs, and we will hire outside services, yard work, pest control etc. Bottom line is that he will have to do for himself, and that is the only way he will ever see how much has to be done, or that there is to much to do. We cannot fight him, we are not walking away, but instead, trying to open his eyes.
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I am back home now, and I wanted to share with everyone that I had some success, I hope that this might help others. One of our biggest goals was that my father at least visit the ALF, since he is in good mind, that way he could understand that this facility was not a "Old School" nursing home. My sister and I visited her Pastor, and he gave us both spiritual and actual advice, we then saw an Elder Care Lawyer, and he gave us some financial, as well as, some hands-on advice that we could use to put things in motion. We had a family meeting, and my dad was interacting with us, I told him straight up, you have an standing doctor's order that you can not live alone, and that we are all burned out, he has to visit this ALF, we have to get him signed in, so that we have documentation that he has visited this facility. That we could not go any farther without him "proving" that he was sound in mind, and did not have dementia. I told him that if he wants to stay in his home, he has to prove to outside sources that he has seen all the options and that he was able to make a well informed decision. He protested some, but agreed to go sign in, and visit the facility. It was wonderful, he actually was surprised, he even asked to see all of the apartments. He talked to the people that lived in the facility, and interacted with the staff. We took him home and let him think about everything for a few days before bringing up the big question. Sooooooooooooo here is what happened after that. We once again sat down in a family meeting and asked my dad what he thought. He told us that he did not want to leave his home, that the ALF was to social for him. All that hopefulness we were feeling went away.
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I agree, that is why I am flying (I live out of the state) down to were my father, sister and brother live, so that the three of us can get a plan. I am the one that does not see my dad on a daily basis, so I have to be the bad guy. NancyH, do not be sorry, I needed to hear it, and you have just given me the energy to do what has to be done.
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Lost, maybe it's time for an intervention with your dad. If you can get your sister and brother on board, then it's probably time to get in his face over him HAVING to move, whether he likes it or not. Unfortunately someone is going to have to be the bad guy, so that's why all 3 of you need to join forces. Tell him it's out of your hands now, so it's going to happen. He's gonna scream and holler most likely, but that's to be expected. Gotta do what you gotta do. Sorry.♥
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We are in agreement. (((((((hugs))))))) .
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I agree with you 100%. I may have said it incorrectly, I was only trying to let sunflo2 know that point exactly, you did state it with more clarity. It does not make her a bad daughter because she is trying to take care of her mom, or that she wants to put her mom in a ALF instead of moving her mom into her home.
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No one wants to "wait till something happens". However, if all avenues have been explored, and the legalities are such that you cannot force a competent person to act against their will, what choice do you have? lostfamily, I would like to see every caregiver, who is concerned for their charge's safety, be able to find the solution you are seeking. I truly hope that you are successful in your attempts to convince you dad to move to assisted living. However, I am sure at times, reading various posts on this site, that even the most caring people have not been successful in doing that. It does not mean that they don't care, but that their hands are tied in their present circumstances. The ideal is that every senior, with the support of their loved ones, should make the decisions that woud keep them safe. The sad reality is that that does not happen all the time, and indeed, sometimes something has to happen which forces them to make to move.
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sunflo2, I forgot to mention in the last post. People that are telling you that you are a bad daughter, they may not have had your problem with elderly parent(s). So loving your mom, and getting her help, proves to me that you are a caring and loving daughter, if you were not trying to help her, that would make you a bad daughter. You did not mention if you have any family members that could help you. I read the same post about how you cannot make your parent move if they do not want. I also do not want to wait until something happens, I think that is uncaring, We are going to have our Pastor talk to my dad, does your mom belong to a church? If your able to afford a Elder Care Manager, they might be able to help you if you do not have other family members.
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sunflo2, The difference is my dad would lose in court. The visiting nurse has reported to my dad's doctor that he can not take care of himself. They have been in my father's home and have done an assessment. My father's doctor has written a standing order that my father can not live alone, and that he has to have skilled help. I take care of all his financial business, and we also have a medical POA. We could go to court and still may have to, but we are trying to have him see that he has to move. If I am understanding you, is that you do not have anything in place to help you if you have to go to court. I think you need to talk to your mom about these things first. POA, both medical and durable. Executor on her trust, have someone do an assessment of her living arrangements, talk to someone about the dangers in her safety, make a appointment for her to get a assessment from the doctor, etc.
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I'm in a similar boat. My mom refuses help and would be considered competent if she had to go to court. Her drs have examined her within the last 3 mo and will not force her into anything. i worry about her because she doesn't eat or prepare meals as she should; she has no regard for spoiled food; undercooking; clean prep area, etc. She is able to keep herself clean and toilet herself. She has long periods where she is not lucid and living in fantasy world. She no longer answers the phone. I've been told similar, that you can't force even with POA or DPOA at this point and have to wait for an "event". It is hard. I don't have any answers either. I have friends who think I'm a bad daughter to not just force her into care or make her have in-home care, take away her license, etc. based on her current condition. They haven't had that struggle with their parent; and parent listened to reason and accepted help offered. My mom refuses all help and any offer for financial mgt. We worry constantly about unpaid bills, taxes, etc. but she has only missed a couple bill payments and then caught them up before they turned off the service. She has money to afford any care needed but refuses the help. I'm fortunate as she doesn't ask me or expect help from me -- but it still leaves me feeling neglectful. I think the only help she is willing to accept is for me to move and take care of her -- which I can't/won't do. I live with the guilt and come here for the support and understanding. One post here said we can't force them and as long as they are competent they can make bad decision for their living arrangements even if we don't agree. That is where my mom is. She says she is not unhappy and wants others to stop telling her how she "should live". I'm trying to honor her wishes even if doing otherwise would be easier for me.
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Yes, please do keep us updated. We learn from each other here.
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Bless your heart, you hit the nail on the nail on the head. He knows that he is doing these things, he does not care, he knows they will be taken care of. But, we can not just walk away, after all, he is our father. The visiting home nurse has asked him many times what he can and can not do. They have to report (not sure to who) that he is not able to take care of himself. That report was also given to his doctor, so that is why the doctor's order was written. Everyone has explained this to him, and he said that they can not make him move. We have given him our concerns for his safety and that we can no longer do or continue to work like this. Now we are back to the original question. How can we help my father see that he can not live alone any more. My sister and I can not give up, we will talk to her pastor and hopefully he will be able to help. If not we are going to hire a Elder Care
Manager, they may be able to help us. If that does not work, we may have to go to court so that we can protect him from himself. I will keep everyone updated, and hopefully how we handle this may help others.
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Ah. I misunderstood. I thought the major obstacle is how much it would cost to remodel for a live-in caregiver suite.

Yes, 24/7 care in a private home is prohibitively expensive for most middle class elders. Did you say he is not cognitively impaired? He was in on the cost discussions, he doesn't want to pay what skilled care would cost at home, and yet he refused to consider the more economical alternative. Hmmm ... What does he propose?

Wait ... I can guess. That his 70 year old daughter cleans a 2800 sq foot house for free (and continues cleaning it when she is 75, 80, etc). That family members empty his cath bag. That family members do his laundry. And change his sheets. And make his meals. And drive him around. All for free. Hmmm ... again.

What if you stop trying to convince him what he should do, but instead you tell him what you are/are not going to do? I have no idea if you could pull this off, or what the outcome would be, but what if you tell him your sister is retiring from cleaning any home but her own, that he is going to have to figure out how to get his meals, that if he spills his cath bag while emptying it he'll have to live with the urine smell, etc. etc. And if he can't do a decent job of taking care of himself, you will get authorities involved to assess his living conditions and they will determine where he needs to be.

Because when I really think about it, why should he want to change anything? He is comfortable right where he is, and the price of all the care he gets is certainly affordable. Going to ALF would be an improvement for all of you, but not necessarily for him, right? Now that the mice have been evicted and there is food in the house, he's got it better than he's had it for years! Why on earth would be agree to change?

But of course, you can't keep it up. I understand that. Your enormous efforts can't go on forever. But have you made that aspect of the situation perfectly clear to this man who is "still sharp in the mind"?

You've spoiled him. Totally understandable and probably appropriate at the time. I'm not blaming you or criticizing you. But seeing it in that light may help set the tone for what has to happen next.

My heart goes out to you and to your sister, and to your father, too. I hope this can be resolved soon.
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What? I do appreciate your help but Caregivers in the home whether live-in or in shifts, cost more money than he has. If he stays in his home, he still has to pay a mortgage payment, property tax, insurance, utilities, repairs, expensive upgrades to comply with caregiver standards, plus the cost of salaries, is a cost of over $60,000 a year versus $25,000 a year that covers all expenses, except medical supplies. Again, my father needs 24/7 care. The Assistant Living Facility has a skilled 24/7 staff. This is a man that will not empty his catheter bag in the toilet, he sometimes empty's it in a pee bucket in his carpeted bedroom, or he removes the bag and lets the pee go all over everything. We have been doing all of the work, at no cost to him, we can not continue, and the doctor's order also states that he needs skilled help. We have really discussed the option of a caregiver(s) in the home, and if he stays in his home he will not have the money to live comfortable for any length of time. He was in these discussions, and he did not want to pay that kind of money. He refused the nurse to change his Cather because it was a man not a women, That was a 9pm, after hours because he was in pain, so my brother and his son had to drive him to the ER at 4 am in the morning. On top of that he has told us that he does not want stranger in his house.
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Why are you only considering a live-in caregiver? What about caregivers in shifts?
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Thank you, emjo is right, you can lead a horse to water but you can not make them drink. We have made so many changes to his home in the last 2 years, so we could honor his wishes to stay in his home. The house is huge, and for 30 years it did not have repairs or maintenance, so even though we have made improvements, the cost of repairs and upgrade to get it ready for a live in home care would be thousands and thousands of dollars. We can not continue to handle his needs, and remember, he can not do simple things like fix a meal, empty trash, or even wipe down the kitchen counter. He has enough money so that he does not need assistance with aid, that is not the issue. Living in his home is double the cost of a ALF. If we can sell his home, it would give him the additional funds to cover his costs to be able to have a comfortable life. Living in his home, he has his mortgage, property taxes, insurance, utilities, repairs, cost of food, and more. The ALF covers all of that. We are guilty, we have done everything for him. Money is not the issue, he is comfortable with his funds, he can not afford, because of the cost to do improvements to his home, for home live in care, we can not continue all the work, we are all over 60 years and we all have disabilities. We do not know how to physically remove him from his home. I am flying back for a short stay, and my sister and I are going to talk to her pastor, we are hoping that he can talk to our father. I was hoping that someone had to physically take a competent parent to a ALF and how they did it.
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jeanne -good suggestion! The voice of experience speaks!

palebluedot ((((((((((((((((((hugs)))))))))))))) I am sorry. Your situation, like lostfamily's, is not easy. However the Elder Waiver that jeanne mentions may be worth looking into.
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Our authority and responsibilities as DPOA are different if the loved one is not legally competent to make their own decisions than if that is not the case. Emjo is right. It is apples and oranges. POA gives us authority to act on the loved one's behalf in financial matters. That may include contracting with an ALF, arranging the payments, etc. But if the person is still considered by law competent in other matters, it may not be as easy as dropping them off and saying "this is your new home." (Not that that would be easy, either, but it is at least possible.)

Therefore lostfamily's question is very valid. How can we convince someone to do what is clearly in their own best interests? (In the orange case, we don't have to convince them, in the apple case we can't act without their cooperation.)

I don't know the answer. :( I think it often is some kind of crisis that finally convinces the loved one that he or she must accept help. Or in the case of dementia, the person clearly becomes incompetent.

Lostfamily, if Dad can afford ALF, could he afford some in-home care instead? Or would he have to sell the house to move to ALF, and use the proceeds to pay for his stay? Does he have assets in addition to his house? I wonder if he would qualify for Medicaid (or could use his assets other than the house for his in-home care until he did qualify.) Mediciad isn't going to cover in-home care that winds up being more expensive than a care facility, but the Elderly Waiver portion of Medicaid may cover significant help to keep him in his home instead of a nursing home. It might be worth looking into. That is how my 92-year-old mother is managing to stay in her apartment. My sisters are keeping a close eye on her, and it may be necessary to move her to a nursing home before long. But as long as what she needs is "assisted" living, she can get that assistance right where she has spent the last three decades. It's a thought ...
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You are so right that some of us have been advised to wait until they have a fall or "something happens." That's all we can do. Very sad.
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Well done, rhody. I think some of us are dealing with people who would have to be physically forced to move to the next level of care, should that be required. I suspect that is what lostfamily is looking at. How do you get someone, who is mentally competent and adamantly refuses to move, into a facility. It may not be a question of buy-in, which would solve the problem if it could be accomplished, but of the physical transportation of someone against their wishes to another abode.
lostfamily's dad is refusing to move. His mind is still sharp. I don't think you can legally force someone to follow doctors orders if they are still competent. This general issue has arisen before here regarding mentally competent seniors refusing to comply with treatments their doctor has ordered. You can lead a horse to water but you can't make him drink.
I have read of others who simply take their parent for a drive and stop at the home and, as you did, explain this is their new home. My mother would not buy that nor would lostfamily's dad, from the sounds of it. In my mother's case I suspect she would, like lostfamily's dad simply refuse to move. What then? For now she is well enough off, and has been given "home care" in her ALF for life, but, one day that may not be enough. I totally agree as DPOA you have to act in your parent's best interests. So far my mother is considered competent. She would pick up on any subterfuge (she is a bit paranoid anyway) and resist it.
In some instances here, people have been advised to wait until "something" happens to convince the person that they need better care. No caregiver is comfortable with that, but, at times, it seems to be the only alternative, as seniors -even seniors with illnesses, but who are deemed competent, have the right to make decisions for themselves, even bad ones.
You are fortunate that your mum made the transition so easily. My mother has walked out of hospitals before being discharged, and would likely walk out of a facility if she didn't want to stay there, contact a lawyer, and rage about being kidnapped. She has done that already to a hospital who simply put her in a geriatric ward, after she took herself to the ER with electrolyte imbalance, when she was in her nineties, and got an apology. I think we are comparing apples and oranges.
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As the DPOA you make the arrangements, you pack your loved ones things and you take them to the ALF or whereever you have selected. As DPOA you have the authority and as the doctor has ordered the care - it is your obligation in the best interest of the loved one that you carry this out without delay.

The ALF should be well able to handle the arrival. In my moms case (dementia) she was happy to go with me and I stayed to visit, showed her her new room etc. The staff made her welcome. I hugged her before leaving and told her I would be back again later.

I came back that evening and again each day. Everytime she asked when she would be going home, i explained that this is now her home. That I work and my husband works and we can not be with her during the day or give her the help she needs. This is now her home and because they care for her, we are able to come enjoy visits with her.

My sister and I selected a place that is an Adult Family Home for dementia and all the way through to hospice. She should not have to ever move. However, if she does we will do what is in her best interest as lovingly as possible. As the DPOA I do what is best for mom, no matter how much easier it would be not to have to - as I feel it is my duty as her legal decision maker. There is a reason for the POA. It is in place because Mom can not make her own decisions. In view of that, I don't need Mom's 'buy in' and if someone is waiting for a 'buy in' after the doctor says they need full time care, then they need to recognize that not acting is doing potential harm. If they can not act, they need to have someone else that can named as the POA. It really that simple.

Just as you would not allow a small child to live in an unsafe situation, as POA you cannot let your loved one either.

My neighbor handled the situation much the same way. They took the Mom to a new ALF and while she is still unhappy about it - she will adjust.

I love my Mom very much. Enough to make the tough decisions I have to for her safety. That is who she raised me to be.
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I have wondered about this as my mother, who is in an ALF, would most likely resist strongly going to the next levek of care (an NH, or multicare facility), yet the time may come when she needs to. She is receiving all the help she can get at the ALF, and is very stubborn.

rhodygarden, could you share more specifics with us as to how you, and your neighbours, managed this transition with your mums? I think it would be helpful to several people.
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While it is understandable that you and your family really want himyour father to be involved in the decision and want him to happily go to the new facility - that is just not going to happen. As his POA you and your sister have to do what is in his best interest and that means following the doctor's orders.

I had to do the same with my Mom and my neighbors recently also had to with their Mom.

Doing what you know is best does not make carrying it out easy.

Be storng and make the arrangements. You don't have other options.
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Yes, The doctor told him that he could not live alone, the reasons why he could not live alone, then he wrote the standing order. My dad still will not visit the Assistant Living Facility, I have heard from many people that when they put there parent(s) in a facility, they just took them there one day and told them that was there new home. My dad is still sharp in mind, and we really want him to be involved in this next step in his life. I just need some idea's or suggestions on what to say to him, we have told him all the great things about this facility.
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Has the doctor told him directly that he cannot live alone, and why?
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