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I've been POA for my father for almost 4 years and care manage his entire life. This includes taking care of his old house, paying all bills, managing his health care, dealing with issues with his tenants and caregivers (and finding these people/hiring/firing etc) I live in a different state. I have full time work that I can't effectively do. I have developed intense debilitating anxiety and depression dealing with all of this. I've kept him in his house all this time (he's 91 with dementia) but at great cost to myself. He is currently in a temp rehab place and absolutely miserable saying he wants to go home. I need to step down but don't see what other options I have. He has children in another country but they don't help, only tell me what to do. I am going nuts. What do I do...

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Hire all of this out with dads money.

Get a property management company for the rental, they earn their money dealing with everything with the house and tenants.

A care manager will help dad with his in home help and report to you. They can also deal with all of his medical appointments and transportation to and from.

This will cost him and he will probably not like having to pay for all of the services that you now do for free.

Get all of his bills online and then you just have to go online monthly and send a bank check. Most bills can be rescheduled and then you have one due date for everything.

Being POA doesn't obligate you to kill yourself to prop up his charade of independence. You matter as much in this situation as he does.
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Reply to Isthisrealyreal
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Thank you isthisreallyreal, the problem is he is also running out of money! So what do I do in that case...
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M209M209 Apr 6, 2021
My heart is breaking for you. You are at wits end and overwhelmed with responsibilities. I was there once. Sole responsibility for my mentally ill mother most of my life. Three thousand miles apart and working full time. I became a mess. Obese, excessive alcohol, increased depression and anxiety. It has been five years since she passed away. I lost 80 pounds, stopped drinking and still working on depression and anxiety but it is manageable. It is a burden that most of us can not bear. Write down everything you have questions about. Write down what you believe your options are. Chip away at your list as best you can. Above all talk to someone to get help for him and for you. Doctor, social worker, A Place for Mom, attorney... whoever you can find. You will get through this. Small steps at a time. Come here often for solace, advice or a shoulder to cry on. Hugs from me to you ❤️
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Then he will have to sell the rental property, use that money up and then apply for Medicaid.

Is he safer in the facility?

He may have to do what is best for him and not what he wants.

None of us gets everything we want, especially at someone else's expense.

I am so sorry that you are dealing with this.

Edit: if nobody takes care of him, the state will intervene and take control of him. This may be the only way to save yourself. He doesn't get to kill you because he doesn't want to change anything. It sucks that we have to go there with our parents but, they created the situation.
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How much property does he have that's rented out, and how many tenants?    You might consider hiring a property manager for these functions, although I doubt that it will be cheap.
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Being POA does not mean you have to do everything yourself.
It now is not what Dad wants its what he needs. He needs a AL. Does your POA give you the right to sell, then I would do it. Sell his home, his rentals. Or use the rentals to pay for his care in an AL.
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Frebrowser Apr 3, 2021
I agree. You definitely need to find ways to decrease the amount of work required and delegate much of what is left if in order to maximize your ability to continue to act as POA at all.

I would suggest getting expert tax advice before selling the rentals. The depreciation that gives rentals a cash flow advantage, is recaptured on sale. I'm not saying not to sell, but don't let the resulting tax bill be a surprise. Installment sale might stretch out the tax bill or 1031 exchange into something with better income might help, but an an expert can tell you the advantages and disadvantages.

If it all feels too expensive, remember the likely alternative is likely state guardianship, which will not minimize expenses.
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Please leave him there long term. ...short term will be paid by Medicare for at least a month...then the secondary will be a copayment....you can’t take him home. It’s not safe. Also, see Elder Care Atty for help in Medicaid application ...after the short term rehab ends..Hugs 🤗
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sunbrooke, you have way too much on your plate. No wonder you are stressed out, I know, been there, done that, haven't have time to wash the t-shirt.

Tell your Dad either you step down, he returns to his home, and have his other children take over..... or he moves to Senior Living and you will continue overseeing his bills, and managing his health.... but the rentals need to go and so does his house.

If he bulks at these two choices, tell him up to 40% of grown children who are caregivers die leaving behind the love one they were caring, what would he do if you passed on?

Don't give up your life so that your Dad can continue his lifestyle with a lot of help.
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sunbrooke Apr 3, 2021
thank you so much for understanding.
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What took him to the short-term rehab place this time?

What sort of dementia, and how advanced?

How far apart and how different (I mean in terms of climate, local culture etc.) are your respective states?
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sunbrooke Apr 3, 2021
Hi countrymouse, he was in the hospital for a UTI and dehydration, then the PT at the hospital determined he needed full time PT and so he was taken to the rehab for that.

Alzheimers, he always knows who I am and can have coherent conversations but has little short term memory and can't do much for himself.

I'm on the east cost, he's in the midwest.
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Please keep in mind EVERYONE “wants to go home”, and very VERY rarely are able at some point to appreciate the obligations and consequences of cari g for themselves.

Your work load already demonstrates that your father is unaware of his lack of ability to manage his own affairs.

Consider also that you DO have options. It is your FATHER whose options are diminishing.

If your POA was drawn up by a lawyer, you can contact that person and have the Bill sent to your father, and indicate at the same time that you are doing all that you are doing, and can no longer manage.

Dad’s SAFETY is critical and YOUR SAFETY IS TOO. Start today to ignore anyone and everyone who chooses from afar to tell you what do.
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If he was dehydrated and had a UTI, he wasn't getting very good, or enough, or effective homecare. He neds full time supervision.

It sounds like he has assets (as in a home and realty) that can be sold, or put under management to fund his care.

"Dad, the doctor says this is where you need to be right now. I can no longer handle managing your properties, so either you hire a realty company or sell the rentals. You need the funds to pay for your care".
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sunbrooke Apr 4, 2021
He only has the house he's been living in which he still owes a lot on, possibly no real equity there.
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I would have him evaluated while he is in rehab for 24/7 care. If its found he needs 24/7 care then you need to determine how much care he needs. An AL will be cheaper but is restricted in the care they give. So LTC maybe a better choice. For now, this will need to be private pay because your Dad owns rentals. His house will be an exempt asset under Medicaid but I don't think his rentals will be. To receive Medicaid, they may have to be sold at Market Value and the proceeds used for his care.

I don't know how you are doing all of this from a distance. You may want to talk to a lawyer in Dads area that is well versed in Medicaid and can give you advice on his rentals. Maybe you can hire a firm to handle Dads rentals. Being a POA does not mean you have to do all the work. You can distribute it. You may want to check into Family Leave where u work. It has been mentioned here it can be taken in increments.
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sunbrooke Apr 4, 2021
He doesn't own rentals, just his own house which he still owes a lot on.
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Hi! I feel your pain and concern. I just completed a 7 year volunteer overseer for a former neighbor with Parkinson’s/ Lewy Body Dementia. As her symptoms worsened, I became her POA. As such, I became responsible for the many tasks you outlined, Arranging 24 he care and monitoring Care Givers, Medication Management, Medical and Physician interface, paying bills as well as Home and Property Issues. A window, she had one son who lived on the east coast, she on the west coast! He chose no personal or family involvement. He visited annually but he vacationed so to speak.
She got Covid from a Caregiver (please do not hire if not tested or vaccinated).
Het Covid symptoms passed but did not help her Parkinson’s and she passed away.
So all of this is to tell you that the first person you must take care of is YOU.
i would talk to the Social Worker at the Rehab and advise all details of his situation. She should be able to help you file for SSI through Medicare and most assuredly he will receive Medicaid, which would help pay for care at a facility that has Dementia safe facilities.
I also found an Elder Care Lawyer a great aid in guiding me as a POA. They can better advise on steps to manage the house and other assets.
I would recommend that you ask for some remuneration in the form of a contract. I know this work is time consuming and takes away from all of your personal responsibilities. You have given so much of yourself that you are feeling depleted. Money is a source of energy and it should be received as well.
Just some thoughts...
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I urge you to see a Medicaid Attorney (not and Elder Law Attorney) right away. The Medicaid Attorney will help you understand how to navigate the upcoming decisions you will have to make. But you need to make these decisions and not feel guilty about them because they won't be easy. But once you see the situation for what it is legally and financially, you can start to breathe again. Also, please see a counselor to help you with anxiety and depression. Elder care is too much for one person, and it's a long, sometimes rocky, road. But knowing options and having a plan is the best solution for you. My best to you.
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Caregiver1955 Apr 6, 2021
Agree with talking to Attorney. Try to get one with a good rating. There is a lot of paperwork including 5 years of banking records. If he was a veteran there are also benefits to help pay for care. I had the same situation with my mother over a year ago. Ended up moving her to a AL with memory care near us, after being in the hospital for dehydration. Moved her directly to AL from rehab, rather than 4 hours away. The AL has skilled nursing if need and has some Medicaid beds with about a 4 month wait. The attorney commended 3 facilities. I knew he was good when we visited the places, they knew the attorney and had no issues that mom would be accepted in Medicaid when needed. We sold house since it was out of state using POA, all went fine. That will give us a couple of years in the AL. She still thinks she is going home when doctors say she is OK. We tell her the house is fine and everything is being maintained. When I looked at the cost of caregivers and maintaining the house it was more than the cost of the AL. Lot of stress off me and we can see her every week. Some AL take a Medicaid waiver, it may very by state and can have a longer waiting list than regular Medicaid. Found a useful book "How to protect your family's assets from devastating nursing home costs by K. Gabriel Heiser with an Indiana verson. I liked the case studies near the end of the book and the VA benefit requirements. Found an attorney from my financial advisor who gave me a good list of items needed for Medicaid application.
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If it were me, I would be telling the social worker at the rehab that discharge to home is no longer an option. It has been my experience that the job of the social worker at rehabs (depending upon the state) is to effectively discharge the patient. And if you are POA they will lean on you, so you need to be firm about it being unsafe for him to go home and that you live out of state, and that you can’t care for him at home because you work. I would be consolidating all his assets for a spend down. Your goal might be getting him into a facility where you pay one bill a month, the facility coordinates all the care, until he runs out of money, and then apply for Medicaid. If you can find a decent elder care attorney for advice I would consult with one about your various options, including selling his home. I don’t know what resigning a POA, entails but believe me I have wanted to resign my POA many many times. If you do resign and no one steps up, he will be assigned a state guardian that will manage his affairs. But if you had things under control, you wouldn’t feel this great of a burden, And use your fathers money for the attorney. Do not make the mistake of using your own money to supplement his care or bills. The lawyer can advise you on what expenses for which you can reimburse yourself.

You cannot go on trying to figure out how to make what he wants happen. It will kill you! Your health and personal life will suffer, if it’s not already. You need a different plan and you need to tell your father his plan is not feasible. At 91 and with dementia, your father has no business owing a ton of money on a home that he cannot manage or seem to pay for, on his own. It is not easy. He will be angry with you. But his situation is not going to get better. Having POA means YOU make the decisions- you are in charge - you are not following your fathers impractical plan. I would also advise counseling. I had to go to counseling (via Zoom) and start medication for the anxiety and depression brought on by stepping in to care for my mother. It really helped. Good luck!
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Reply to Mepowers
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You have 5 choices.

Keep doing it.

Step down and not do it any more.

Hire someone to handle it for you.

Let someone take his home over to use as a Care place that includes him living there.

Bring him to live with you.
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Jean1808 Apr 6, 2021
Question . how can someone take over a seniors residence to use as a care place with them in it? I am wanting to find my mom a new roommate (I move out) who would pay rent and watch over mom.
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Taking care of someone with dementia is overwhelming and depressing at times.  The key is while making good decisions for him, you have to make it manageable for you.  The fact that he is not currently in his home is the perfect time for you to find a facility for him to go to permanently.  If you let him go back home, it will be twice as hard to get him back out.  If you get him into a memory care facility and sell his house, you will have much less to manage.  At my mothers place, the doctor comes to her, the podiatrist comes to her, the meds are administered there, ect….everything is streamlined so that I am not managing the logistics of all of that.  Sell his things and move him to a great facility where they can provide the care he needs 24/7.  Then you are paying one or two bills and filing his taxes for him.  Much less stress.
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What do you mean they "tell you what to do"?
Do they instruct you on each of the aspects then you carry out the wishes of his other children?
Tell them that you are no longer going to be POA. Is the Attorney that drew up the papers still a family lawyer? If so send them a certified letter that effective (and give a date) you will no longer act as POA. Make sure the date is enough in advance so that the others can be informed and another POA chosen.
You can tell them that this is your plan so that they can begin the process of choosing another.
You do know you will be "roped" into doing all the same stuff you are doing now just because you are here and they are not in the country.

Your other option would be to discuss with the Social Worker where he is now the fact that you can not effectively care for him, manage caregivers and care for his house so it would be best to find permanent placement in Memory Care.
Then you can begin the process of selling property that will pay for his care.

I do hope you have been getting paid to do all that you have done. Geriatric Care Managers get paid quite well. (range is $50.00 to 200.00 per hour.)
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Most people with dementia do not like change. They tend to thrive on a consistent routine. So living at home has been the one thing consistent in his life. However, it appears that trying to provide this consistency at home is coming at great personal cost to yourself. So, it is time for a change - and he will not like this change until it becomes his new routine.

Talk to the social worker at the rehab facility. Let them know that you care not able to continue managing your father's care as you are currently doing. You have choices

1 - It may be time for your father to enter a memory care unit. Then, you could sell his place (you'll have to do it after he passes) and put the money into an account to cover his expenses.

2 - Ask for the courts to appoint a legal guardian. This person will do the job you did as POA. This person may or may not be able to keep your father in his home. Most likely he will be placed into a memory care unit, his home will be sold along with all assets, and his assets will be placed into an account for his care. Not sure what will happen to any assets after he passes. You might wish to talk to a lawyer before going this route.
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KaleyBug Apr 6, 2021
If she has a POA she can sell the house if he is in memory care.
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Whi ok e your health is important and taking care of someone with dementia is a very daunting experience. The one thing I do know is if you step down and no other family member is willing to take charge, he will become the ward of someone that has no vested interest and possibly a ward of the state. While the decision of putting him in a care facility that deals with people who are diagnosed with dementia may be a decision that is hard to make and you probably will get backlash from your dad and other family members it will drastically reduce your tasks for his care. He will be fed, bathed. clothes washed and a whole lot more. There are doctors right there and while I do suggest you take a FMLA to check places out near where he lives. The home will call you if there is a problem. Many will allow auto withdrawal for the rent, reducing much stress. I had to make that choice for my dad, as he had dementia and to be honest it was the best thing I ever did. It is about providing the best possible care for your father meanwhile preserving your own health. The perception of what a home for the aged is now to what the elder preceive is quite different. Your dad will most likely continue to want to go home, but the staff is trained how to deal with this situation.
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I was tested and wound up being autistic +dd a few yrs ago which answered a few questions.My wife who is several yrs younger is like a care giver not poa have also became incontinent which adds something else.
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If your health or your livehood is affected you must step down -- Contact Elder Services - tell them you are no longer capable of taking care of your father. Give them the names and telephone number of your sibling. Tell them by expressed signed notification that you are stepping down effective "x" date and that one of them need to step forward otherwise, The state will appoint a legal guardian.
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Dear sunbrooke- you have some excellent answers here. Mepowers really sound like like they know and have researched this issue. Prayers and virtual hugs
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My heart goes out to you, you have been amazing managing your Dad from afar for so long. Of course he wants to come home, who wouldn't? However, with dementia it's obvious he should have 24 hour supervision. It's time to make a change.
Talk to the Social worker. Do not have him released home, the hospital cannot release him if he doesn't have someone to care for him - but if you do - it will just be a matter of time before he has another hospital event. If you can hire a Geriatric Care Mgr this will take some of the load off of you in regard to coordinating his health care.
Another option would be to take him in with you until you can find a nice facility near you that can give him the care and safety he needs. You say he is running out of money and still owes on his house. Please contact a well regarded elder care lawyer who can help you navigate real options for your specific situation, rather than just getting family opinions. This is probably the most important thing for you to do without further delay. Keep us posted on your decision and progress, we really do care!
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The rehab place has a social worker. That is the person you need to be talking to. Laws vary in each state. DO IT NOW!

It sounds like he's got money, so there is no reason why you cannot use his money to pay for an eldercare attorney to sort things out, including a court appointed legal guardian.

If he has dementia you are not doing him any favors letting him live by himself. One day he will wander off and get injured or killed. My sister-in-law let her mom live by herself, and I have been warning her for years to not allow that. She refused to listen. Her excuse is that her mom did not want to go to assisted living, and totally with it. She was in her 90's. She fell, broke her hip, and was on the ground for DAYS before someone found out. She ended up dying from the complications of being in the hospital from a hospital-acquired infection.
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If he will not accept placement you likely need to resign or hire a financial fiduciary or allow state guardianship. Time to discuss with family. This may be able to be done from outside the country, or he may need to be moved or have placement. Start with discussing with his children out of the country. Tell them you cannot go on and that State guardianship with appointment of Fiduciary to manage and place will be next if they don't wish to participate.
All of this assuming he will not move near you and be placed in assisted living with the sale of assets there where he is now.
So you will start with speaking with Dad and other relatives that you will be resigning you POA, or hiring a Fiduciary if assets allow. As POA you can do this.
The cost in California for a Fiduciary runs about 90.00 an hour more or less two years ago. Costs more while setting up the system, less once set up dependent on the amount of personal care the person requires.
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Take a vacation!!!! If I was you I would leave him in the nursing home . All dementia patients want to go home. They don't know where they are but do know things are not familiar. I have been in rehab, nursing home and assisted living. And most of the patients want to go home and many that isn't realistic. He wi get used to the place and be will complain and still want to go home. This kid all part of his illness.
Bow you do all you do from another state and still work full-time is beyond me since your siblings are not helping you have the POA SO SE THE OLD HOUSE AS IS. Sell all you can and use the money to take care of your father you can take his favorite chair,his tv, pictures or art work . Make his room as much like his home this will help his anxiety and feel he is at home. Good luck to you. Take care of yourself. Keep the POA .
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Did you contact an attorney? If he has tenants, he may be able to have a legal guardian take over if his children won't. You may need an attorney to contact his children if you do not. I certainly understand. Taking on these responsibilities is huge. Often we do not know what we are getting into until we are smack in it and then wait and wait and wait until our own health is seriously affected.

YOU NEED TO MAKE OTHER ARRANGEMENTS NOW.
For your own well-being and health.

Yes, he will continue to say he wants to go / come home. Expect this. Do not allow yourself to feel guilty - you'd want to go home too. However, there comes a time when changes need to be made. And that time is NOW. He will adjust to 'what is' as best he can. As you have adjusted. We do what we do for as long as we can do it.

And if his children and he do not thank you, I am thanking you for the four years you've been doing this. It is a huge service. I know, I'm in a similar situation. gg
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I want to echo what TouchMatters said: TAKE CARE OF THIS NOW. He gave you power of attorney for a reason: so that you can make decisions, tough decisions, that have to be made (which is why IT IS SO IMPORTANT TO HAVE P OF A IN PLACE BEFORE IT IS NEEDED!)

Tell him he must go to assisted living and sell his assets to pay for it. and do not feel guilty; everyone facing this must make these hard decisions; it is part of life.

That said, if you just feel you can't anymore, go to court and get a court appointed guardian; they will make the tough decisions for you; they deal with this all the time. Caveat: once you have done this, stay out of it and let them do their jobs! `
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No advice. Sharing tears and hugs.
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Is there a secondary agent listed on his POA? If so, they could take over. If not, is he able to appoint a new POA? If so, have him do that; if not, you are looking at hiring an attorney (elder law) and getting a guardian/conservator appointed by the court.
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disgustedtoo Apr 7, 2021
"...you are looking at hiring an attorney (elder law) and getting a guardian/conservator appointed by the court."

Question - why? OP has POA. I do know that POA doesn't allow you to force someone to move or give up their homes, but with dementia, we can work around some of these issues.

We had POAs, wills, etc all done. When it wasn't safe for mom to remain in her place and she refused to move elsewhere, the EC atty told me we couldn't force her to move and suggested guardianship. I highly doubt she would have been approved at that time. She was still able to do ADLs and could seem very normal, but it wasn't safe for her to remain in her place alone (she refused to let aides in.) We managed to make the move happen without taking her kicking and screaming to the facility AND without guardianship. The facility staff had told me 1) they don't accept committals and 2) just get her here, we'll take it from there. So, we were able to move mom WITHOUT guardianship. That is expensive and time consuming, even after it is approved.

I don't understand why you say OP needs to do this. If at all possible, I'd see about keeping him in the rehab, even if it means self-pay, until a place in a MC facility can be secured and then move him directly into that. POA WILL allow one to sell the home too - no need to involve the courts.
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