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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.

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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Reply to Geaton777
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Thank you for your advice.
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You should visit her now if at all able to do so. It sounds as though there are many reasons she is unable to now live alone if that is what you are being advised. As POA you will need to have an assessment done of her mental ability. It doesn't mean that she may not improve later, but it DOES mean they will assess her now, and if she is incapable of making good decisions for her own safety you will be asked to make them for her. It seems quite clear they believe she is not able to go home alone now; so the answer may be that for now, yes, she does require care facilitiy, whether that is nursing home, in home care, ALF, SNF or Rehab. Wishing you good luck. This will be very difficult to do long distance.
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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 13, 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 13, 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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So the hospital says that your mom cannot make decisions for herself. What decisions can't she make? She may be able to make some but not others. She may not be able to decide some health care issues but can decide to have soup for lunch.

The American Bar Assn. Puts it this way: “Advance directives are legally RECOGNIZED documents and doctors must respect your known wishes, but doctors can always refuse to comply with your wishes if they have an objection of conscience or consider your wishes medically inappropriate. Then, they have an obligation to help transfer you to another health care provider who will comply.

So the hospital must honor your role as the POA except as stated above. You can make the decisions that your mom would make for herself. Your POA gives YOU the authority to decide for your mom, not them!
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SAnn55 Feb 13, 2021
It is my oldest sister - 73 - who lives in another state. Thank you for your informed reply.
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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 13, 2021
Thanks so much! You offered some really good advice and things to consider.
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Thank you for your reply.
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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 13, 2021
Thank you.
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Her doctor can also request a home assessment and see if home health is available for her - the insurance company sends a team to evaluate and they recommend if they can assist at the home.
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Aging in place is fine as long as the senior has the capacity to care for themselves or the money to hire help, or family/friends that are willing to make it possible. Is this the situation in this case?
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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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Reply to thingsarecrazy8
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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 16, 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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Reply to Taarna
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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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I would trust your judgement as you know her much much better than they do— it’s a easy “fix” on their part to activate poa. This is a I suppose you could say unfortunately not that uncommon medical institutions want the easy cop out. I don’t know the legal avenues available, could you afford to get an attorney consult? Also document- document all the dates and times she’s cognizant and document your concern they are perhaps doing this a easy “fix” and that your years and all your daily conversations don’t mesh with their opinion.
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Reply to Sarah3
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I would let that hospital know that YOU are POA and that you will be getting in touch with your attorney. Maybe if you can afford, make a trip to see her for yourself. Yes some people do have a way of hiding but eventually they will slip up and you can tell for yourself. Get in touch with previous doctor and have him write something up so you can show the attorney and then approach this other place. If she is eating, moving around, it could just be a little confusion due to the virus but she could be fine otherwise. I wish you luck and hope she gets better.
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Reply to wolflover451
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Being dehydrated alone can cause confusion. I have worked with many people in home health and in nursing homes. Please look into this further before you accept the statement that she could be "hiding" this. I would NEVER accept that blanket statement especially when you say that she is making sense when the 2 of you are speaking. Many time the Dr. or the facility use that to over medicate and not spend time with someone. I have even been in instances where we have had to change where the person is because the place just would do anything to keep a person bedridden and for them to keep the money coming in. I don't want to be alarmist and I have seldom seen it BUT I have been there when it happened a few times.
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Sorry you are going through this long distance. While tiring, it is always a bit easier to be on site and see what is happening. Hard to consider travel even just to a different state in a pandemic.

Being in a hospital alone is enough to cause confusion. It's been my experience as a caregiving daughter, a certified assisted living administrator and a Director of Admissions for a LTC that some people can definitely "hide" their confusion with some people and in certain environments. The hospital may feel that your Sis really need rehab before she can address returning to living alone; if she is refusing rehab when it is in her own best interest, they may be recognizing your PoA status in the hope that this is the way to get her to rehab. She may be able to get some rehab at home (social worker can tell you if she is eligible) but they may feel that it is slightly better in a STR facility (they have more equipment if that is what she needs). PoA and medical proxy are not forever but are to be used when necessary. See if you can talk to both the current attending and the hospital social worker to see if your Sis can even remember how/why she fell. Don't be alarmed if she doesn't remember - that is common if she lost consciousness. Also see if you can get in touch with her primary care physical to see what her/his findings were the last time he saw/spoke with her.

Wishing you luck, health and stamina on this journey. Please keep us updated on your progress. Hope your sister is soon well and back home.
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Reply to geddyupgo
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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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Reply to Chickie1
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If you have the ability to travel to your sister and spend a few days with her, spending as much time as you can with her to determine what you think. I never fully understood my Aunt's dementia as she would have these wonderful conversations on the telephone but in the end, a roommate stole all her assets right under my nose. My Aunt had dementia and when you visit and spend time, you can see the cognitive issues that could result in the ability to care for oneself and make them vulnerable. We remember most and longest, what we have done our whole life, so having a conversation on the telephone is one of the things we remember how to do but given the decisions that one must make every day, the logic that must be used to understand complex projects and the ability to complete tasks which is nothing more than a bunch of little steps but those steps all require memory to get to the end result. Please visit your sister if possible so you can see in person whether she is in need of help. Do not trust the system to help her...they will not.
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Reply to LauraJeanette
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The only way to know is to spend a week or so with her in the house, and observe. Can she cook her own meals? How is her driving? How forgetful is she?
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Taarna answers sound great.
I am dealing with a family member with dementia. My family member was able to “ mostly” mask her dementia for the past several years. It’s only upon being with her for more than a couple of days did I really see it.
the MD had no clue. Healthcare professionals who have worked with her had no clue- she’s that smart and that quick to deflect, not answer, or change the subject. Now it’s very obvious.
As your sisters HCPOA- you can make informed decisions because temporarily she really should not and it appears she cannot because she’s (been) that I’ll.
You can let her know what is going on. If you truly don’t trust them, do you have a friend who can answer your questions about her? If so, get the person to ask your sister targeted questions - the SW can give some questions to guide you.
Bless you as you navigate these waters.
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Reply to JoyfulOne
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Unless it's medical POA, the POA is for finances only. Sister maintains her own rights. Hospital staff are very lacking when it comes to POA and Medical POA. Stay strong and don't let them activate it. She is entitled to an advocate, find one who will help her,
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Reply to Becareful21
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Imho, you need to see your sister in person, if possible.
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