What do you do when Mom isn't able to care for herself?

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My mother is 78 years old - which doesn't seem so old, but she is. She's been in bad health for several years. My dad died a little more than 2 years ago and I've watched her go downhill. She has COPD, has had 6 bypass surgery seven years ago. Recently she was diagnosed with stage 2 lung cancer. After chemo and radiation, she seems to have won that battle...no signs in the lymph nodes, etc. Her short term memory began getting bad and I wrote it off as "chemo-brain", but it's been 5 months and the memory is getting worse. She seems easily confused and agitated. She recently was back in the hospital with pneumonia and due to her overall health, she was sent to rehab. She signed herself in and said she'd do what she was told. She's been there 2 weeks and she won't cooperate. She'll do arm exercises, but refuses to walk or do any kind of leg exercises. If she won't participate or improve, Medicare will stop paying and they will release her. She lives in Assisted Living, but she doesn't take care of herself. Her apartment is always littered with papers and Kleenex on the floor, the cat box full (and she always says she cleaned it the day before). I try to get over 2 - 3 times per week and spend the time cleaning (often she refuses to allow housekeeping to come in). I was thinking she was lazy and taking advantage of me. Now I think she can't take care of even the little things anymore. Although I have medical POA, until I can have her declared incompetent, I'm limited on what I can do. I'm torn between leaving her in AL with some additional care for quality of life, but I feel she'd be safer in a long term facility for her safety. I have an appointment for an geriatric evaluation in April, but won't have the results until May - and that's IF I can get her in the car and to these appointments. How do I choose the right course, how do I qualify her for Medicaid to help pay the costs of long term care (she private pays for AL) and how do I declare her incompetent without humiliating her? I'm her only caregiver. My sibling is estranged from the family - and in my opinion, just waiting for my mother to die to see if there's any money left. She stole from my mother's house the day after my dad died. She is not someone I can turn to for help. Feeling really stuck. Thanks for suggestions and advice.

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You call in APS for help. Let them declare her incompetent. The you are free to move her to a Memory Care Facility, she is no longer capable for ALF. Have the staff at ALF document her deficits, that will help you.
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The ALF's I have had my mother in usually will take care of everything for the elder, from med management to meals and laundry, now, the challenge is to find the right one, some are clean and well run from the food to the treatment they give the elder, others are practically dumps, there is also the issue of the elder liking it and getting used to it. My mother being the harsh, stubborn selfish woman that she has always been was never able to adjust to any of them and I feeling sorry and guilty brought her home over a year ago to find myself worse off than before. I'm trying to place her in a new one with her own little private room and bring her home to stay with us some weekends and holidays when I'm off from work, right now she goes as a daycare patient. Right one she doesn't have medicaid so a NH is not the option. These tend to be very expensive if paid out of pocket. Medicaid laws vary from state to state. You should go to one of their local offices, find out if your mother meets elegibillity and if so apply, in my state she could only have a small sum of money in the bank but no more, if she gave property away to anyone or sold it they have a 5 year look back period so she would be punished for selling or transferring, the divide the market value amount into what they consider it takes to maintain a person monthly, and that would be the amount of time she would not gave medicaid, these amounts vary per state, in other words my mother's property was supposed to just sit there and rot or allow someone to live in without charging rent because that would have brought her bank account up making her not eligible for medicaid, and then the amount of social and if she receives pension also determines her being able to qualify. In other words the less she has the better. Still find out your options, there are trust funds that can be established through an attorney and that Medicaid cannot hold accountable when qualifying an elder. Find out Medicare laws in your state and if your mom qualifies and then just apply. Also if she pays the ALF out of her own money, or if you have to help her financially because she doesn't have enough to meet her expenses, will probably more than qualify, also a lot of places that are not 100% privately paid will apply on her behalf for all sorts of benefits, sadly my mother doesn't qualify for medicaid living with me but as soon as she begins living in the ALF there is a huge probability she will meet the criteria to have medicaid, I know it sounds complicated, believe me I have been through it all, just find out as much as you can from your state agencies. Next challenge is working with your mom to convince her what she needs, or document everything so you can go to court and be appointed your mother's guardian, sorry to say it doesn't get any easier, as time goes by they only deteriorate. Good luck to you.
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exhaustedmomma, you mention you have the medical POA. Can you go to your mom with DPOA papers and have her sign those too? If not then you'll have to wait for her incompetency declaration. You can't do anything "for" her unless she signs away her rights to make her own decisions, and you'll need not only DPOA but also the incompetency declaration.
If she won't sign the DPOA papers, you can still attempt to get incompetency declared, but be sure to document (like, videotape or audio tape what you are saying, and describe what you are doing as in her best interests) and that way you can go before a court and show the judge, you are trying to do the best for your mom and not just trying to twist her arm.
You could also have the AL facility schedule a family meeting with your mom, you, and the staff, and perhaps they have a social worker who could describe the need for her to have a DPOA.
For your estranged sibling, you do need to be extra careful that your mom's will is as your mom would like it, too, because with no will, your sister will receive 50% of anything that is left.
You may need an attorney to help organize all this, but it is not necessary and it definitely is expensive. Lots of information is out there, check your state's attorney general website--they'll have all the DPOA forms right there for you to download, plus loads of information to help guide you.
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I would try to keep her in the rehab and tell her she needs to try to exercise her legs so she can gain strength and return to her AL. If she can move back to the AL I would see why the housekeeping can't clean the small apartment. I think you mother needs to rid herself of the cat if she isn't able to care for it. Perhaps a relative or friend adopts it and if it is allowed let it visit her at the AL when she improves. Basically, if you can't care for yourself you are not able to have a pet.

I would see what the evaluation uncovers about her abilities or future health needs. She is a bit young for a nursing home, nursing homes were usually for the last 18 months to 3 yrs of life. She isn't 80 yet.

I suspect she may be a bit depressed with the loss of husband, mounting health issues which could be reflective of the memory/confusion. Some of her meds may be part of the problem also.

Good luck.
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exhaustedmomma --- i can relate to some of your issues with your mother. I am the only sibling living here near my 95-yr-old mom, so i'm it! She lives alone since my stepdad died 6 yrs ago, just a couple of blocks from me. Her good health is both a blessing and a curse --- she is too "able" to get any in-home assistance, but it has totally exhausted my energy. My husband passed away suddenly last year, and i am struggling to cope with that tremendous loss (we were married 40 years & he had just retired) , plus the fact that i have some surgeries coming up in the near future, and i am simply tired! I am 74, and have been in good health, but the stress is really beginning to wear me down. Of course, my brother & sister - who both live away from here -- want to keep mom in her home, but it is becoming increasingly harder for me to keep up with everything. I wish i had some suggestions for you --- sounds like you're feeling like me --- totally stuck in a bad situation! However, i would think that with all your mother's health problems, she would be a good candidate for Hospice care. Have you checked on that? You may have to just do as i have learned to do --- trying to respect my mom's independence, i was allowing her to make most of the decisions about herself, but have realized recently that if i am going to be able to cope with this much longer, i have to make some tough decisions that will be more beneficial to MY wellbeing. I finally told her that if she wants to stay in her home, she is going to have to realize that things cannot be her way all the time, & that i need to take care of myself as well as her. IT'S A SUCKY JOB, AT BEST!
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Going through this same thing with an elderly relative for whom I have POA. I have been working closely with her doctor, but "Mabel" refused to move to AL last fall when there was an opening. She is currently in Independent Living with nurse visits twice a week when she remembers she/he is coming, and minimal housekeeping assistance. I write the doctor a note about what I have observed and go to the doctors visit with Mabel and hand the note off to the nurse. That way we haven't talked about the issues in front of Mabel, which helps avoid the confrontation. Issues have been not taking meds; pills laying all over the apartment; food hoarded, but not eaten; feces on bed, chair, everywhere in bathroom, etc.; mental decline such as not taking care of paying her bills, not going to scheduled meals (optional), etc. It has taken two visits to the doctor. Mabel had not been eating correctly and ended up in the hospital with an unidentified infection, possibly pneumonia. She is currently in the hospital and under treatment for at least 3 days. This is one route to get to the assistance needed. She will be evaluated before release from the hospital and they will make the call that she needs to be either in AL if her strength and abilities improve, or in health care. Just another approach.
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Agree with JessieBelle, also consider looking at other AL and personal care facilities. What you've described sure doesn't sound like the ALs that I'm familiar with. There's a wide range among ALs with some nearly like nursing homes and others more like independent living (sounds like your mom's is in this category).
For the most part, they are all more affordable than SNFs, so depending upon your Mom's finances, she may be able to live comfortably in an AL without exhausting her funds.
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"OUCH" Personally I had to come to the point where I had to make the painful decision for Mom regardless of what she wanted (to stay in her own home). I worked closely with her Doctor and he agreed to have the talk with her. That took a lot of the sting away from me being the awful child trying to get rid of her and run her life.
I can't stress enough how important it is to establish that relationship with her medical team. As far as medicaid, spend the money for a good elder law attorney and cover all your bases. Step back and look at this as what can I do today. As long as the big picture is blocking your view you'll drive your self crazy and it will paralyze you from even making the first move. It doesn't all have to be done right now. You'll make mistakes and that's OK just share them with the rest of us along with your triumphs. I find it no different from raising kids "tough love" I'm doing this cause I love you and want what is best for you! (cause their not able to do it for their-self). As far as Chemo brain I'm convinced it messes with your memory and thought process and not sure you can put a time limit on it. They are so busy trying to cure what is trying to kill you that they have no idea what the long term affects are. It's been almost 3 years and I still struggle wondering if there is permeant damage done with my ability to multi task and recall even the smallest stuff. As far as your sibling, You may be right but it's out of your control. You have to live with your decisions and actions. My first step if asked..... Give Hospice a call and ask if they would evaluate your Mom. Their not just end of life and an amazing resource. Second step call her insurance and say this is the problem what can you do to help us, what is available to us?
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exhaustedmomma, sometimes it feels like we're painted into a corner with no way out that doesn't make a mess. A big question here is what your mother's doctor and the rehab people feel would be best for her. Given her limitations, do you think they would recommend to discharge her into a skilled nursing facility? Perhaps you can look around and find one that is nicer. Modern SNFs are not like the NH of days gone by. Many will accept Medicaid after private pay money runs out and will help you apply for it. Look around and see what is available and what you feel is right for her. Knowing what is available may help give you some direction of what to do.
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