Mom now lives in another state with one of my siblings. What changes must be made?

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My 94 year old Mom went to visit with my sibling and while she was there she got very sick and had emergency surgery. She's 94 and has dementia. She had been living with me, and we had a personal care agreement in place whereby she contributed $3000 per month for room, board, and care. I'm her POA, and now my sibling should be compensated. But because she is much more helpless now and needs more care, he wants a Personal Care Agreement that specifies at least $6000 per month paid to him. I realize this is likely the amount she would have to pay if she were in a nursing home, and maybe that amount is warranted. As her POA, I want to know what my responsibility is in getting a fair deal for Mom with regard to payments for her care. Must I go to the other state, hire a lawyer, and oversee this new contract?

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I assume that your sister is handling the multitude of things that will need to be done.
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Probate can happen where her bank account is, where her property is, or where she has been living for the last two years. $6000 seems high as my mother was cared for out of state by a sister in her home for expenses only.
Not familiar with the PCA, as it sounds like something your parent signed for their care.
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Garden Artist make several great points. I would definitely get a professional involved; a geriatric care manager, a social worker - someone that can assess the situation. I do not know your mom's condition but $6,000 seems very high. My mom is in memory care and her expenses are around $4,600.

I hope this isn't all about the money. How are your mom's resources. Will $6,000 a month drain her account quickly. Would she be better off in a memory care facility? Will she have to eventually be moved into an care facility and will she has enough funds for this? A lot to consider

I would contact a professional - have her assessed - get a few opinions on all your options and have the care plan drawn
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Your responsibility is to exercise your POA in your mother's best interests, and to act as she would have done were she still operating independently.

So the question to ask is: as of now, what are mother's options? And unless you can come up with a better one than that proposed by your brother, and unless you think the budget he is suggesting is unreasonable, there is no reason not to go ahead and transfer the PCA to your brother. The only snag is the vastly increased (albeit justified) care cost element, because naturally it isn't now possible to ask your mother to revise the PCA and I'm not sure that you have the authority to authorise this additional payment to a family member: how ironic that if he were a Nursing Home there'd be no issue.

Tricky. Maybe the lawyer who assisted with the original POA and PCA can advise how you get round this? It's a technical issue, not a substantial one; and I congratulate you and your brother on your evident cooperation in challenging circumstances.
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Lots of issues here.

First, I assume you trust your brother and have confidence in his ability to provide care?

Second, I'm wondering if the higher level of care can be provided solely by your brother or if there will be a need for additional home medical care, and if that's 24/7 whether in fact a facility with staffed nurses might not be more appropriate.

Third, if #2 is correct and your brother would need to hire private duty nursing as well as other home care help, would he pay that from the monthly $6K, or would it be an additional cost? If the latter, the cost could easily spiral upward.

Fourth, as your mother's proxy under the POA, your rights and duties are spelled out, but you're wise to look beyond the terms and conditions and consider the implications of the options.

It wouldn't hurt to research facility care options, home care agencies costs and options, and discuss them thoroughly with your brother. I think it's important for the two of you to be in agreement on what might trigger a change to a care facility, or when he might reach a breaking point.

I'm assuming your brother is retired and isn't working out of the home? If that's an erroneous assumption, you'll have a whole other list of care issues for when he's gone.

Fifth, I would also seriously consider involving an attorney to draft the care agreement to cover everything that could possibly arise, including the eventual need for escalation of level of services.

Sixth, are you going to request an itemized breakdown of his time and activities? For $6K a month, I think you're entitled. Even if this is a challenging job, that's a lot of money, more than I made even when working at good jobs.

Seventh, I think I would make a trip to your brother's home initially and periodically thereafter, unless you trust him implicitly. Even if you do, if he's never had home caregiving experience, he may shortly find it overwhelming, and you'll need to monitor him and his own health and reactions to ensure that he continues to be capable of caring for your mother.

Eighth, does your brother have the facilities in home, including all retrofits needed, to care for her now, or will retrofitting for assistive devices be required? Has he made plans for other issues, such as transportation via paratransit to medical appointments, relief for when he needs to get out of the house to do shopping, etc.?

Ninth, summarize, I would spend some serious time creating your own plan of care, thinking of every conceivable option, and discuss this thoroughly with your brother to make sure you're in agreement. You should also be in agreement on issues that would dictate a need for change in the care he'll be providing.

Better to do all this now than later. You will have a lot to handle once he starts his caregiver role.
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