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She needs 24/7 supervision. She thinks she will get better and go home. Slight dementia, cannot live with any relatives... her home is too much to keep up. We are in process of spending down/ applying to Medicaid.

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You should not make a point of telling her you are going to sell her home. It will serve no purpose other than to upset her. If she has dementia, she will most likely not understand what you are saying or remember what you’ve told her. She won’t understand the Medicaid spend-down either.

If she asks about going home, tell her when the doctor says she can go home you will talk about it. Tell her you’re having the house cleaned and “fixed up” for her. Don’t upset her by telling her she is in the facility “forever”. We call it the “therapeutic fib”. It’s the kindest way to handle this.
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shad250 Aug 2018
Poor lady
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Does someone have POA already? Would she need to sign paperwork? If not, why do you think she needs to know the house is being sold? I don’t tell mom anything that would upset her or make her sad. Ahmijoy has given you a great comeback when she asks...she can go when the doctor says it’s ok. I throw Moms doctor under the bus daily. The doctor says you need to gain 5 pounds. The doctor says you need to drink this juice. The doctor says ......
You’ll find you’re roles are reversing. You are now becoming the parent, the responsible one, for her benefit, just like you would shelter a young child from harm and give her hope.
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Every family is different. Although I knew that my mother would never return to her home because she was not ambulatory and because of her démentia, I never told her that we were préparing to sell the home. The procèeds of the sale were going to be needed to pay for her nursing home care. I knew that as long as we were "private-pay" we would have more care options. I never told her. I knew it would break her heart. There was absolutely no reason to tell her. I have never regretted that décision. My mother and father loved their home and were very proud of it. Whenever she asked about the house, I always told her it was fine. I felt terrible about lying to her all the time, but I thought it was best to do that then and I still feel the same way today. It would have been much better if she had been willing to sell the home while she was still reasonably well. But, it just didn't happen that way. There is a message in this for all of us. There comes a time when it's important to downsize and maybe even to move into a smaller home where there is less to manage. When things become too much, that is the time to make those changes. So, my answer to your question is, no, do not tell her. Just do what you have to do if you have power of attorney. Help to maintain her peace of mind as much as possible. Use her liquidated assets to finance her care. Hope this is helpful.
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Could you provide more details as to your situation and other alternatives
that participanrs might suggest?
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Nanna231 Sep 2018
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Hang on.

What do you mean by "slight dementia"? Does your mother, legally speaking now, have mental capacity or not? On whose authority is her home being sold?
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Nanna231 Sep 2018
Cuurently Diagnosed w/ moderate to severe dementia. History of Psychosis controlled with MEDS. UTI triggered this episode. She lived alone and cared for herself, even drove locally to grocery store. 5 mos ago admitted to Getiatric Mental facility suffering from Hallucinations and Delusions. After 3 mos in Geriatric Center and upon their severevDementia Diagnosis, admitted to Nursing home requiring 24/7 care. Has gotten much better, only suffering with slight delusions.
Cannot go back home - too much for her, cannot live w/ any children -all work, etc. Not enough $$$ for assisted living. Nursing home cares for her, but she is much more functioning than the other residents.
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I agree with Countrymouse. All of the answers you got are good if and only if you have financial POA. Also, you say your mom has slight dementia... my mom with that diagnoses was sharp enough to comprehend selling the house and still made some decision regarding her own well being. She did not need to be in a nursing home, just independent, and later assisted living. Does your mom have physically issues that require a nursing home?
To get more accurate answers, more information is needed.
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I agree wholeheartedly with Cinderella5001!
Therapeutic fibs really cue into the new reality of the person with dementia. I’ve learned this with both my dad and my aunt.
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Nana231, nursing homes area much more expensive than assisted living. Does she have long term care insurance that pays for NH? We still do not know if you have POA for fiancial decisions. If you do not, you really need to contact an elder care attorney as your mom may not be able to sign documents giving you POA at this point and without that, she ia going to have to sign paperwork to sell the house!
Another lesson for all of us...get your estate in order early and revisit frequently. When we updated my parents' trust, we made changes to reflect my mom's declining mental status...the attorney kept stressing that to do the changes, my mom needed to have the capacity to understand those changes!
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I've just gone through this. Emphasize the upkeep, how it's a burden for you to look after the place. Ask something like, "can you imagine doing all that yourself now?" Hopefully, she'll recall how much work it is, and be sorry that burden now falls on you. My Mom didn't want to sell when she first moved to assisted living 2 years ago, still emotionally attached and thinking she might move back, have "someplace to go", if AL didn't work out. She is aware of her limitations, knows she couldn't move back and handle it all. But I didn't want to approach it by emphasizing her short-comings, rather that it's just too much for me to handle the house.
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Slightly dementia? Like being a little pregnant.
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Gerip1092 Sep 2018
So true!!!
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What's with all the questions. If there is no one to care for LO within her home, it needs to be sold. I myself shall give Nanna the benefit of being intelligent enough to not be doing this unless it was necessary, she's not asking whether or not it should be done, the decision is made, how to tell Mom? Better to spend your time answering the question instead of rethinking the issue.
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Nanna231, kudos to you for helping your mom, but like Countrymouse advised, "Hang on." Your mom was apparently doing alright when living alone until a UTI triggered an episode from which it's taken quite a while for her symptoms to significantly improve and from which she might further improve. Yes, it's good for her, you and your siblings to start discussing possible changes to her permanent living arrangements, but it's probably premature for her children to completely take away her independence, even if there exists a DPOA that might be interpreted to allow such. Everyone should be allowed as much independence and self-direction as they reasonably can maintain for themselves. While it's often easier and less time-consuming for adult children to usurp their ailing parent's free-will before it's really necessary, doing so could worsen a parent's physical and mental well-being and might possibly even be viewed as elder-abuse. 

Has 24-7 care been determined to be absolutely necessary for the rest of your mom's life? If not, then there's the possibility that her condition will improve to where part-time, in-home assistance might suffice for a while. Has this been considered? As others have said, we don't have enough information about your mom's history and prognosis to give solid advice for your particular situation. Watching the decline of our parents is hard and it's even harder to figure out how to best assist them and then make more changes as they continue to decline. But, there are lots of good resources to help become better educated and contacting your state's office on aging could be a good start. Best wishes in your endeavors to help your mom.
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Unfortunately, just seeing that a plan is necessary it does not give you the legal authority to carry it out.

You may think it's safe to assume that Nanna has dealt with the competence point; but then again she or he wouldn't be the first not to realise how limited powers of attorney are until the person for whom they are held is incapacitated.

How and what and indeed whether to tell the Mom in this situation depends quite a lot on who exactly is making the decisions and what exactly Mom needs to know. Best not to take anything for granted, is my view.
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We have just gone through this. We told her the truth and that we could not afford the house payment since her SS was paying for her care. Yes, it hurt and still does. All is well.
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Be up front about it.

I told my father that it was obvious that he could no longer do any of the upkeep on the house, such as lawn mowing, repairs, painting, shoveling, etc. due to his health conditions. Also, he had no relatives in the same city who could help him with any of it.

After a brief rehab stint in a nursing home after yet another stroke, it was obvious when he returned home that he was unable to manage AT ALL. (He even admitted that he thought "all would be well" once he was back in his own house - but realized that it was a booby trap for him and unsafe for him to live alone.) He was unable even to manage his bills after that point.

So, I just started making the necessary plans to put the house on the market - and never looked back. I did what needed to be done - which is what we all need to do.
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Going through it now, why tell her? Just going to cause tears.. My mom asks occasionally, but I try to change the subject. Too much care needed for her to be at home and a broken brain will not comprehend anyway .. Do what you need to do, even though it is not easy. Good luck.
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After I was made DPOA for two friends of mine, I started looking for a place they could live with help. I went to 8 or 9 assisted living places and checked out their memory care facilities. The wife had frontal temporal dementia, the husband short term memory issues which prevented him from understanding how his wife was changing. I found 1 place with memory care apartments large enough for a married couple with a choice of a two-bedroom, one bedroom or efficiency apartment. It took over two years for the wife's condition to get bad enough to need 24 hour care in a locked facility. I got them to move after about a month of this. I did get the husband's agreement, but he kept forgetting. We had 4 conversations, including the day of the move and he ended up agreeing again each time. The day of the move, another friend took them out to breakfast in a nearby town, then to have their nails done while a moving agency and I got the furniture moved and set up in their new apartment. We arranged everything just like my friends had them in their townhouse. When they arrived, the husband saw his favorite recliner and the familiar furniture arranged the same way and sat down with a sigh of relief and never once talked about going home.
The wife passed on 5 1-2 months later, receiving the best of care every step of the way. I had the responsibility of taking care of all their personal belongings and furniture and then selling their townhouse. That took over 2 years. I never asked the husband for advice or told him what I was doing and it was a peaceful process, just very time consuming. Their most personal belongings--old family photos, etc. I have at my house in order to get them to distant relatives. They had no children or close relatives to be part of this process. The sale of their townhouse proceeds went right to the husbands bank account and helps pay for his care now. This facility agrees to take public financing if they pay regular rates for 18 months and we are way past this now. He will be eligible for veteran's benefits once he becomes poor enough. This couple were smart, had good jobs, invested money for the future, all of which made my job in their care a lot easier. I am also the executor of their estate and know what their wishes are if any estate is left over. The husband is 92 and in good physical health, so we are likely to use up all his money in about two more years.
Not involving him in the decisions I was making on his behalf made my job a lot easier, since he wouldn't remember anything I told him or asked him about anyway. He is content where he lives and thinks everything is just fine. Since we made his apartment just like his old town house, he may not even remember he ever moved. I am thankful I found a place that provided and continues to provide good care to my friend. I visit at least once a week and always keep my eyes and ears open. The staff is so supportive.
Best of luck on this journey. If you have DPOA, you already have the authority to make these types of decisions and don't need to tell her about them.
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Blueransom Sep 2018
Wow! What a wonderful friend you are! Bless you!
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There is no easy way to tell your mom that her life is about to change. Do it in the kindest way possible. Generally most elders think or believe (their minds are broken) they will get better.
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Talk with the social worker in the facility where your mom is. It sounds as though she still has the capacity to make decisions, so she needs to agree with you and the other siblings. If you have POA to manage her finances, good, you are ahead. The social worker could set up a meeting with all family involved to discuss the issue of where to go now. If at all possible, have your mom there as well. You want to include her as much as possible in making any changes. Your mother is blessed to have you there for her.

My mom had short-term dementia from a stroke and she would ask over and over, "when can we ... go home." Heart-breaking. There were financial resources to keep her and my father in the home until dad became too ill, we then found a private home with very loving staff who were AL with a hospice waiver. I had to keep reminding mom that they had moved into the AL because dad needed more help. They were in a nice large suite with a private bath, and thankfully never had to go to a skilled care facility.

It isn't easy to go through end of life issues with parents. Luckily, my dad had time before he became too ill to make me trustee for their estate and give me POA for health and finances and also put me on all bank accounts, etc.

Mom only lived in the AL for about 9 months before passing from cancer, and dad only lived not quite 90 days after mom passed. Mom was 92 and dad 93. I'm grateful they both had forethought to have the living trust set up and we had time to talk over what they wanted.
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To others who are questioning the "slight dementia" - Please read Nanna231's reply to Countrymouse on 9/1/18. It is not slight from what that paragraph says!

To Nanna231:

I agree with Ahmijoy and rocketjcat's suggestions. It serves NO purpose to tell mom that her house is being sold OR that she will be living where she is forever. Best case is that she *might* understand, for a bit. Worst case is that either of these revelations will upset/anger her. Even worse than worst case is that she might forget what you told her and you would have to upset her all over again, and again, every time she remembers and asks about her home or going home. Fibs and redirection/refocus are your best tools... Hard as it is to make up stuff, it is not done to hurt her, but rather to avoid hurting or upsetting her. If SHE doesn't bring it up, don't discuss it at all.

Our mother begged and begged my brother to take her back to her condo the few times he visited. She never asked me, thankfully! After about 9 months, that focus changed to her previous home or her mother's. The previous home was sold about 24 years ago and her mother has been gone about 40 years. She has not asked about the condo in almost a year now. So again, what purpose would it serve for us to tell our mother we are selling something she doesn't even remember now? The hard part will be to come up with some plausible excuse for what she will have to sign (the deed - we had a living estate set up. Only the deed needs her signature, everything else I was told by EC atty could be done via our DPOA.)

If someone is not suffering from any kind of dementia, these topics could be discussed. Neither would probably be well received by anyone, but at least at some point the person might become resigned to the fact(s). With dementia, it is much easier and less distasteful to the person to make up some excuse or just avoid the topic altogether.

Although mom's place was smaller than a house, it still required payments (utilities, condo fees, water, RE taxes) and upkeep.  Just the condo fees and taxes alone were sucking up about 14k/year! Then there are the repairs - heating system died (5k) and many of the double paned glass windows were losing their seal and showing moisture (another 5k!) Those were the big repairs, but there were many other issues, all of which adds up! The biggest (aka longest delay) was getting all her stuff out (over 1.5 years!!) so we could fix and clean!

We just signed the P&S and will be RID of this in a few weeks! A major headache (several) taken away for me, as I pay all the bills, and coordinate everything, plus it is 1.5 hour drive EACH WAY (yes, I am one of those who has 2 siblings, but guess who gets all the work?!?!?!?!!)

Even if mom was still thinking of the condo, I would NOT tell her. If she asked and avoiding it or redirection did not work, then some plausible excuse would be used, such as those suggested by others (painting, repairs, etc) or lay the blame on the doctor - cannot go back until s/he gives the okay and change the subject/focus.

Also, you can apply for Medicaid, but the proceeds from the sale of the house will have to be used to pay for her care until it is gone, THEN Medicaid will kick in, if they approve the application. Since it can take time, it is likely best to apply, with the understanding that while she may be approved, she won't get anything until all monies/assets are spent.
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This is not addressing your original question, but like some others I do question the statements about NH costing more than AL. NH is 24/7 care, with MUCH more focus on medical needs outside of memory issues, requiring nurses vs CNAs. Even MC should cost less.

My understanding is that Medicare does cover X days after hospitalization, then more and more of that cost will be offloaded to the patient, eventually (100 days is the max I believe - sooner rather than later!) ALL of it. How long has she been there? If it has not been long, then you may be in that initial coverage period. If so, you may be VERY surprised when you start receiving bills!

You should, for her sake and your mom's assets, verify how much this NH is going to cost AND check into memory care places. You even say she "is much more functioning than the other residents". I do not know a lot about Medicaid, but is it possible they would refuse to pay for NH because mom doesn't really NEED to be in a NH?

From your descriptions, more than likely your mom does not belong in a NH. SOME MC facilities do accept Medicaid (ours is private pay only) and some NHs have MC units, but again a NH is usually more for someone who has myriad medical needs that cannot be handled in AL or MC.

Quick lookup for the Medicare coverage of NHs:

"For each spell of illness, Medicare will cover only a total of 100 days of inpatient care in a skilled nursing facility, and then only if your doctor continues to prescribe skilled nursing care or therapy."

"Medicare helps to pay for your recovery in a skilled nursing care facility after a three-day hospital stay. Medicare will cover the total cost of skilled nursing care for the first 20 days, after which you'll pay $164.50 coinsurance per day (in 2017). After 100 days, Medicare will stop paying."

"Medicare covers inpatient hospital care and some of the doctors' fees and other medical items for people with Alzheimer's or dementia who are age 65 or older. ... Medicare will pay for up to 100 days of skilled nursing home care under limited circumstances. However, custodial long-term nursing home care is not covered."

Another concern is if they are not billing you (in full or partial) because you are applying for Medicaid - beware because if you are denied, the WHOLE bill will be yours!

Please see:
https://www.payingforseniorcare.com/assisted-living-vs-nursing-homes.html

This page has a brief comparison of costs and care - this document shows about $1,700 more/month for the NH (those monthly costs vary widely depending on where in the country you live, AND the quality of the places, with some in the south being less expensive, those in/around NY City or parts of CA can be quite expensive, HOWEVER, NH costs will vary as well, keeping in line with the "going" rates. We are currently paying over 7K/month for a private pay MC facility (the other one we considered was already 8k a year ago January, more than what our initial rate was at this place - our rate was increased in January, but it is STILL less, and I am sure the other place would raise their rates as well, so it will extend our funds! ...and it is a much nicer view....)
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I would skirt the topic for a bit. If she is really there in that facility for the longterm, I think it can cause too much anxiety and in tern it will cause you undue stresses. Just like taking a car away, make excuses.
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If you weren’t spending down to apply for Medicaid, I’d advise keeping her home as long as she’s able. I said she, because it’s her house, right? She worked her whole life for it and it’s her link to life, much like you are. Would it be possible to make selling the home “her idea”. I know she hopes to move back, but if she owns a house, she also understands finances. Give her a chance to worry about her money, her health, and her home. Don’t necessarily boldly say, “Mom, we have to sell your house”! Perhaps try explaining about dwindling funds and and how you worry about going into debt with her care. If she’s able to understand with mild dementia ( my dad is), she will feel empowered being able to help you with problem resolution. I think you should give her a chance.
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