No healthcare proxy or medical POA established. My sister and I are fighting over his next step. Who decides?

Rehab in a facility is far superior than home care rehab. The former not only has more equipment, but it has full time therapists, who are accustomed to working with the elderly. Some home care therapists are; some are not. The activities are limited and minute for minute, hour for hour, do not yield the results that rehab can. Personally, from what I've seen, I don't think that home care can in any way even approximate the value in in-facility rehab.

The other aspect of rehab is that it can be a respite for someone living alone, especially if the facility is outstanding (as are a couple I've found). Meals are hot and freshly prepared, nursing and aide staff are available, lots of rest is available, and there's no responsibility to care for a house or apartment.

The bad part is that rooms are generally shared, and often the roommate is someone who has the tv on all day long. That can make the situation miserable.

There's another issue and that is how long your father has been in the hospital. Three days hospitalization (of admittance, not observation) is necessary before Medicare will pay for a rehab stay.

There is an option that addresses both of your concerns. Ask the treating physician if your father is ready for home care, or if in-facility rehab would be more beneficial. If your father's getting minor rehab in the hospital, ask the therapists the same question.

Your father can always get rehab in a facility and continue with home care after discharge - that's how we've worked it. The "heavy" rehab takes place in a facility; the follow-up lighter and less intensive rehab takes place at home.

I agree with FF about the advisability of having the full range of equipment available in rehab. And the professionals can generally get the patient involved more readily. Getting dad to do exercises between PT visits might be hard.

On the other hand, the rehab environment can be very confusing for someone with dementia. If the plan is to bring him home after the rehab (that is, he is not going to be living in a care center) then this interruption in his environment is going to be a set back in his dementia. Expect it to take a few months to recover cognitively from the rehab experience.

I would personally lean toward the rehab, but I can see value in both points of view. Here is what I suggest. And I'm serious.

Decide by flipping a coin.

The whole legal process of guardianship to decide between two valid and supportable opinion seems way out of proportion to the need.

If you and your sister are both truly trying to act in Dad's best interest and if you can usually disagree without long-term drastic alienation, then work together to make decisions on a case-by-case basis. It is too bad Dad didn't assign a medical proxy, but he didn't. With good will the two of you can handle this.

To answer the question about going into rehab or bringing Dad home for rehab, I would vote going into rehab.... one reason is that there are many more machines that Dad can use at a rehab facility.

The machines would be more interesting to use. Not saying therapy at home isn't good, but there is only so much a therapist can bring into a home. You want the patient to be interested in what he/she is doing.

You'll have to go to court for guardianship..

thanks for the responses. unfortunately dad has dementia and doesn't really understand what is going on (should have included in my synopsis)

Yup, up to dad. It would be helpful to dad if the two of you would make an effort to get along for the sake of your dad. There are many more things that are going to come up as you move down this path. It is important that Dad have his poa's in place as well as other legal documents. It is time, but perhaps dad is putting it off because of the relationship that his daughters have with each other and he does not want to cause a rift. Rehab situation is the least of your concerns.

With no POA the decision will be up to Dad..