How do we get my mother into assisted living with ensured around the clock care?

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Father, very elderly with many health problems is ready to move and just relax the remaining days of his life. He does not want to have to worry about pipes, bills, cars, driving etc. anymore. He just wants peace.
Mother has increasing dementia, COPD (no tank yet), diabetes, battle of breast cancer and we think sciatica but not sure as she won't go to doctor and have it checked out. She takes a break to lie down a good part of the day because she says she has back pain.
Have a 50ish aged brother with his 18 year old son living in the basement who are supposed to be looking after them and helping keep up the house. This has not been done.
Mother refuses to leave home as son does not have the means to have a place to live and she wants to remain in her home like her mother did. (Her mother did not have these type of health issues). Son has lived totally free for 15 years yet has NO savings whatsoever to speak of. Works an hourly job so if he does not work he does not get paid. Grandson never has had a job and only takes out garbage when reminded.
My parents can remain in their current house but with great health cost to them (especially my father) and great concern to other children or sell the house and go into assisted living. My father won't 'abandon' my mother and they can't afford 2 places. House continues to get run down every day as nothing has been updated in 40 years.

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Having been through similar situations with my two parents....who both desired to be home, but exceedingly could not do it without fighting with each other due to dementias....I say most of the others have good ideas that I was able to institute at one point or another. BUT...to get helpers in the home, or get them to move out of the home.....the VERY easiest way to do it, is with a doctor's order or as a result of a hospitalization. It would help if you already have POA....as this is the only way that you can use their money to pay for things. No WAY should you go into this without that....and start to pay for anything yourself! If you do not have that....and they have a family lawyer...I suggest a quiet little visit to that person to let them know what is happening in the home. Perhaps he could call them in for an 'annual review' of their affairs, and then suggest, that based on their ages, it is time to get all that stuff in order...POA, health care paperwork, DNR paperwork etc..... that's what I did when I found my Dad was no longer paying his bills and Mom did not know how. A POA allows you to have control of what your parents are not able to handle....yet give them the decisions they are able to handle properly. My Dad ended up in Memory Care. My Mom was then home with caregivers part time, and a monitoring system in her house, with cameras so I could keep tabs on her when she was alone. NOW, Mom is in AL, Dad died last August and Mom;s house has been emptied and sold to pay for her AL apt. AL is NOT 24/7 care. But it IS 24/7 supervised care. My Mom is on oxygen constantly, so the staff must make rounds and check on her every two hours. They stand by for showers, and remind her about meals and other activities. They bring meds to her and assure they take them properly. But, in between, yes, she is alone in her 1 BR apt, that is furnished with her own furniture.. Two could live there, with a lesser rate for the other, so Dad and Mom could be together, and Dad would NOT have it all on his shoulders. My Mom gets weekly laundry and housekeeping including in her charges. She has Alzheimer's so she's on the waiting list for a Memory Care female bed. Her facility also has independent living....where two could be together, without the hassles of home ownership, IF Dad did not actually have to care for mom...assure she took her meds on time and was compliant with what the doctors wanted her to do. And as for the 'moochers' in the basement, YEP....IF they are named to inherit the house, then they need to be given notice that things are going to change, and there's no need for a great deal of sympathy.
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If your mother does not want to move, and your father does, there is nothing you can do, except leave them be. Yes, it is hard to sit and watch and know that there is something better for your parents, but there is nothing you can do. For yourself, stop worrying about the future and look after yourself. All the best, Arlene Hutcheon
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This post is not really about 24 hour one on one care, it is about the person with early dementia being the one who's calling the shots, making major life decisions on the basis of their own comfort zone and desires, which is unfortunately not necessarily the same as deciding rationally or with any real consideration for the needs of others, or even for the practical realities of the situation for that matter.

It will take a major shift in family dynamics for you to see what you want to happen - brother and nephew living as independent adults, Dad with some peace and security, and mom not able to keep those things from happening because she thinks she can just stay in her familiar home while maintenance type things just magically take care of themselves and her medical condition just stays stable without any medical care. These are unwelcome changes, I'd grant you (and her) that, but someone with a functional adult mindset and a POA should be the one to manage them if at all possible.
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Someone should have power of attorney for their finances and health care to be able to step in and make decisions on their behalf. Getting mom to agree to anything is the big issue. Find out if there is a will and if not, arrange to have one made. The power of attorney forms have a list of things to check showing which areas the power if being given and there can be more than one person receiving this authority. The health care POA forms also get into end of life care issues that should be addressed, too. Your parents are soon facing them. You do not need an elder care attorney for this, but they are still a good resource to use to help explain your options and good ways to get things set up.
I have found a good AL facility with memory care floor for my friend and they will provide whatever level of care is needed, up through hospice at the end. Of course, I pay for this with my friend's money and it can vary month to month as the level of care varies. At this point with minimal care needed--meds and eye drops , laundry once a week, house cleaning, and reminders for meals--it is running about $7,000 a month. Between his monthly income, IRAs, savings, long-term care insurance and the sale of his condo, we can manage this for 3-4 years and then public financing will take over. The AL facility agrees to use public financing as an alternative after 18 months. There would be VA benefits then, too, once his assets become low enough to qualify. I am in frequent contact with the registered nurse in charge of the health care there as issues arise and she is so helpful explaining what needs to be thought of and what they are doing. Best of luck. The toughest part is dealing with the family dynamics. I was spared that for my friend--no children, no close relatives, just 3 POAs willing to see to things until the end. At that point, I am also the executor of his estate.
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AL'S are not the place for 24/7 care. Look into an NH.
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I would not make a single move without consulting professionals. If money is a problem, ask your potential consultants what they recommend in terms of getting your parents to pay for this 'essential' planning for the future.

Adult children do not decide what level of care their parents need.This is done by any facilities you may be exploring, but you also can do it beforehand 1 of 2 ways, I think: Ask your local elder service agency what they recommend for an in-home needs assessment for your mother, and/or ask her doc to order an eval by the VNA. They do care evaluations that carry much weight & can be very helpful with next steps. They could even recommend a social worker come out and assess the family situation as it impacts your Mom (that is how you get them in the door).

Simultaneously, find an elder law attorney. You do not need any family cooperation to get a consultation. You can expect to pay a fee, up-front, and you will be able to ask- and get answers to- all the questions you can fit into the hour+ you have with them. Some firms apply the consultation fee to future costs if you hire them. Obviously, it's a good idea to get recommendations about the best elder care law practices are in your area. All the decisions ahead have so many practical, legal & financial implications, that making uninformed choices now can have very expensive, even ruinous consequences.

Are there any board- certified Geriatric Physicians who could take your parents on as patients? She/you ought to be getting more help from her doc than is the case now. Really good Geriatric practices can be very helpful managing the issues you discuss. Certified Senior Care Managers can also be the salvation of many families, but they are expensive, and it is likely you would meet much resistance from the family to the level of involvement they need to do their jobs effectively.

Your father may be an ally in any of the above actions. Sounds like he is fed up, but feels powerless to effect any change. Feel him out, privately, about his thoughts/wishes. Finally, consider getting a social worker or other therapist with experience in these issues for *yourself.* You will need a lot of support for the long haul...nice to have an informed & objective ally.

Keep breathing. We get through these stages in the lives of our families of origin, somehow...
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I think you might have to buy out your brother for his share of the house, is what I have heard. He could argue he could stay there and 'take care of the place" (and father, if father stays there). Don't fall for that! I would call an eldercare lawyer, definitely, this is more complicated situation that can't be easily answered here.
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Can your brother and his son come live with you?

hahahaa, just kidding. Yes, find out if parents have a will (I hope) and who the house goes to. If it is to all the offspring, you can't evict them, I don't think.
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Some ALF have levels of care which might accommodate your mom and dad together as roommates (less expensive for 2nd person sharing room). You would probably have to sell their home to pay for it which means son would have to vacate. You will likely need a lawyer (elder) as they deal with these things all of the time. Your brother may be difficult to remove due to something to do with squatters rights. Good luck.
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As far as your brother and his son living in the basement. Does you mother own the house? Maybe you should find out who her house is willed to. Since he doesn't have a place to go, she may leave it to him. Then they would have legal right to live there. Stranger things have happened.
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