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My sister - 73- was recently admitted to the hospital after falling. She was dehydrated and they later found she tested positive for Covid. She has fallen before. She was moved from one hospital to another for "therapy". Now after assessments, although she has not been feeling well, they have deemed her unable to make decisions. I live in another state. She is single - no children. I speak with her most every day, and even in the hospital, I do not agree that she can make decisions, that she is not alert, etc . I have asked that the hospital not make her take "speech" or cognitive tests as long as she is not feeling well and focused. They have told me that they are activating POA. I was named in her POA many years ago. The doctor in the previous hospital did not see the need to activate the power of attorney. I have asked - She IS eating and drinking and moving about. Does she HAVE to go to a nursing home? Again, when I speak with her, she seems fine. Her memory seems fine. When I commented on this, the case worker at the hospital said "some people have a way of hiding it??" I don't know what to do for her. Help! I would think they would want to allow seniors to age in place. I am a younger sister - 66. I'm not quite sure what subject to select. Advice will be much appreciated.

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"Activating" a POA? Either you are the POA and have the legal right to make decisions for your sister, or you aren't the POA and don't have the legal right to make decisions. There is nothing to activate. You simply have the legal right to act on your sister's behalf, or not.

The "doctor at the previous hospital" probably conversed with your sister and got the answers he/she needed, no need for you to make decisions at that time.

Having a POA doesn't take away your sister's ability to make her own decisions, if she has that ability. A POA, in this case, merely allows you to make decisions for your sister should she become unable to. That's it. Not a big drama, just a safety net.
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Invisible Feb 2021
And no, she doesn't have to go into a nursing home just because you step in to make temporary decisions for her. This just makes you the first point of contact in those decisions.
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POA's are for whenever a person is unable to manage their affairs - short term and/or long term. If your sister has COVID and isn't feeling well, she probably has enough to deal with just trying to get better. She is most likely tired, weak, and feels like everything is like lifting weights. Don't resist the social worker, but talk to your sister to keep her in the loop about her financial matters and her health concerns. She needs you to pay for things from her accounts while she focuses on healing. Be her advocate and help her while she heals . When she is over this infection, she will resume taking care of her own affairs.
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Are they using the term long term care facility aka nursing home in place of rehabilitation facility?

Thats what they social worker was telling my dad and he absolutely refused going for rehabilitation because of the way it was presented.

Ask about her prognosis and care plan, this could just be to get her strong enough to safely go home.

Be cautious with covid. I was told that a mild case in the elderly can come back around days 8 thru 12 and that is the dangerous time. It was for my dad and for many others from my research. Encourage her to be patient and accept the rehabilitation and other care she is entitled to with Medicare, all was not well prior or she would not have been hospitalized.
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SAnn55 Feb 2021
Thanks so much! You offered some really good advice and things to consider.
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Agoing in place is an option, if the person is able to care for themselves, including meal prep., bathing, hygiene, dressing and so on. Since your sister has had fall issues, she may not be a candidate for living alone. Assessments for necessary adjustments for the home in which she currently resides is highly recommended. This will provide a good baseline for what she needs. If she has the finances to hire care workers, that is great, but if not, the best option maybe a residential community that provides proper care for your sister. I can say from experience the comment "some people are able to hide" is very true. My dad was able to hide his issues for years and while I would talk to him daily, I had no idea he was not eating on a regular basis. When I visited I was appalled by what I found. He had empty boxes of cereal in his cupboards, green butter on the fridge, empty ice cream container in his freezer, yet, he kept his home meticulously cleaned. He was also always well groomed. He sounded great on the phone. Maybe he went to a restaurant to eat, but his breakfast description didn't fit what I saw. He would say he had made scrambled eggs, toast, bacon or sausage, but there was no sign this was what he made, all items were non existent in his fridge or cupboards. While it was possible he finished all of those items, it was doubtful as this was the same answer each time we spoke. He would say a tin of soup for lunch but no tins in cupboard. Please, do not let your feeling of not wanting to have your sister placed in a senior facility over ride what maybe in her best interest. It is very hard to see or accept decline, but, this maybe something you have to accept and follow through for her best interests. My dad was placed in a senior living facility and it was the best thing I ever did, it was against his wishes and I have no regrets for doing what I did, he survived another 8 years. He would not have done as well in the situation he was in. I wish you and your sister the best in whatever decisions are made.
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I would believe your sister.

When the Dr says she is well of Covid, let her go back to her own home if that's what she wants to do.

If the Hospital won't allow her to check out on her own, go there yourself, check her out and let her go back to her own home and you should be able to see how she is the first 24 hrs.

You should have a couple Nest Cameras installed in her home and she should be wearing a Fall Alert bracelet or necklace..

Nest Camerasate not hard to install and you'll be able to check on your sister 24 7 on your computer or cell phone..

if she can afford it she might have a Caregiver come by for a couple hrs every day or a couple times a week whatever.

Prayers.
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SAnn55 Feb 2021
Thank you.
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You will need to check the wording in the PoA paperwork to see when and how it's authority is triggered. Also, you will need to consider that she maybe didn't have good judgment in caring for herself and that's how she ended up falling. You may talk briefly with her on the phone but unless you actually live with her there are many things about her behavior and cognition that you would not be aware of. My MIL lived only 6 miles from us. I talked to her on the phone everyday. Nothing seemed terribly amiss until at a family gathering she nearly fainted. Upon closer inspection of her home, we realized she wasn't remembering that she hadn't eaten. There was rotting food in her fridge, no dirty dishes in the sink, no food packaging in her garbage. She had short-term memory loss. Because of this, she needed to have care 24/7.

Did they test your sister for a UTI or thyroid problems? Is she on any other medications that she could accidentally overdose on? I'd make sure of some of these other possibilities if you are able.
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My cherished LO has suffered TWO separate cases of Covid and survived both at age 91-92.

I myself (her POA) have just survived a 3 week case of Covid at age 76.

While I am fully aware that some people are able to present themselves as cognitively intact even as they are beginning to experience the symptoms of dementia, I will tell you from my own personal experience with Covid that it may be difficult to achieve a valid assessment of what her skill levels actually are.

As you read your POA document you may FIND that there is some descriptive language that can help you determine what role you need to be performing now concerning both her immediate future and appropriate long range planning.

The effects of even mild cases of Covid can be VERY difficult to deal with. Can you contact someone who can actually see her and talk to her? I can’t imagine that
you’d be able to actually see her whether you were able to travel to her present site or not, but it may be VERY helpful for you to understand her current situation if you have the input of a second witness present at her bedside so that you three can chat.

Hoping that you’re able to get the input you need to make the best decision for both you AND your sister.
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SAnn55 Feb 2021
Thank you, Ann, for the very helpful advice.
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Activating her POA isn't necessarily a permanent thing. I'm not understanding why you don't want to ensure your sister receives the proper care. As POA, you're free to consult with her all you want as to her care.

Once she fully recovers from her hospital stay and illness, she can take over her own care decisions independently, but at the moment, even you say she feels unwell and is unfocused. Why do you want her to be vulnerable to bad decisions when she's in that state?
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SAnn55 Feb 2021
I feel that this reply is shaming me. Of course, I want her to have proper care and I, of course, do not want her to be vulnerable. Life is stressful enough without shaming someone. I'll talk with my friend who understands.
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Be glad that they are asking you to speak for your sister. This doesn’t mean “forever.” Some conditions can render a person temporarily unable to think clearly. They are asking you to step in for her to insure that her wishes are met. As her HCPOA, you should have been made aware of her needs and wishes before taking on the responsibility of speaking for her in these times. She is fortunate to have you.
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Is there a reliable friend or neighbor that could go to visit her in the hospital and give his/her assessment of the situation?
Is there a rehabilitation center in the hospital?
I think the hospital needs to release her to a safe environment. It may not necessarily be in patient rehabilitation. However, as far as I know, Medicare will pay if transferred directly to in patient rehabilitation. Please, check the logistics. You need to act quickly.
Best wishes.
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