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First of all, I have found this forum very beneficial and informative. Everyone's situation is different but I have learned alot from this site that I hope will help my case. I am an only child who has a 91 year old mother who has been living independently in her home by herself since my father died 4 years ago. I live 4 hours away from her home and can only checkup and help her maybe twice a month. She has a sister and niece who help her with medications, grocery shopping, and doctor's appointments. Her only physical problems include some vision loss, some hearing loss, and some fraility from being 91. She walks with a cane or walker. She was doing wonderful until about 2 months ago when she came down with pneumonia. She has been in a rehab facility for about 5 weeks. The social worker there is telling me that at this point in time it doesn't look like they can recommend her for a safe discharge back to independent living. The only options for us is for her to remain in skilled nursing or go to assisted living (which she should physicallly qualify for). My mother has all her mental capabilities and a sound mind. She just wants to go home and not pay any money towards assisted living or in-home care. I am at my wits end trying to determine what to do. Her discharge date is about 2 weeks away. I'm afraid she won't qualify for a safe discharge to independent living. I have legal power of attorney, but can I "force" her to go into assisted living if she doesn't want to? I also get the impression that the Skilled Nursing Facility is steering us towards their Assisted Living because it will be self-pay. My mother could only pay for Assisted Living for about 6-8 months until her savings runs out. Does this sound familiar to anyone???

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Thank you everyone for your feedback. Mother has passed her PT and OT tests and is heading home on July 4th. We are planning to have some personal care aids come in a few days a week for a couple hours and help with odd and ends. And she has some family members in the area who will check in on her throughout the week. I feel for everyone who is in this situation. I can remember my mother telling me when I was child - "just put me in a home when I get old". But when we all get to that age, we change our minds. I guess I will be the same some day. Fortunately for her, she still has some time to enjoy her home and independent living. But I will continue to talk to her about what may be in store down the road.
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Whozee, VW9729 made some very good points. POA and HCP don't really kick in until your Mom is not mentally competent to make her own decisions. From your description, other than being a little wobbly, she can manage her ADL's adequately - eating, dressing, washing, transferring, walking, toileting, and does not need help with these in her own home? The risk of falling seems to be the main concern here, and the Life Alert necklace (or bracelet) seems like a 'must do'. Is she able to take her medications reliably (not forgetful)? It sounds like you are at a turning point in her ability to live independently, but as long as she is reliably and consisently using her walker and cane, and handling herself well within the home, I don't think you can steer her to give it up. If you can convince her to try an ALF for two months, primarily for her physical safety, and she can afford it, maybe that is the way to go. But again, you can't force her. If she insists on living at home, you may need to comply with her wishes. Once the doctor writes the script for skilled nursing care at home, the Home Care agency comes in and does an eval, and then coordinates with Medicare who may also do their own eval. Generally she must have a need for skilled nursing care once a week in order to qualify for the custodial care provided by aides. Let's say the doctor wants her to have physical therapy (I'm pretty sure Medicare gives up to 6 weeks) and writes the script for it. During that time, a PT would come into the home 2 or 3 times a week (the skilled care part), and during the same period she would qualify for an aide to come in a couple of hours a day to help with custodial tasks - maybe meal prep or cooking, light housekeeping or assistance with bathing. You and you Mom can decide what she really needs help with and assign those duties to the aides for each day they visit. When I arranged this for my Mom, I had one aide help her bathe in the tub once a week, and the other aide helped her with household chores. I took care of her laundry, but I had the aide do a little ironing every visit. I also had them call me every day to give me a report before they left the apt. So I think a reasonable solution can be worked out to satisfy both you and your mother.
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In my state, a dr has to certify that AL is necessary. This would imply that they were no longer competent, right? Our estate attorney says no, that as long as the elder knows who they are, who you are, where and when, they are competent to make a POA. Essentially, the only time you are safe is when they forget you have a POA!
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The ALF is part of her rehab facility??? Well then, I'm very leery then that they are pushing your mom into their ALF so they can have even more money. There is DEFINITELY a conflict of interest here if you ask me. If your mom is getting around still even with a cane, I personally don't see what the problem is as long as she is able to get up and down from a chair, bed or stool. But I would strongly recommend she wear an "alert" necklace in case she falls since she lives by herself. I would also check into senior apartments or other senior living arrangements that could be more affordable. My mother-in-law was in an ALF, and they cost an arm and a leg. I don't know too much about your mom's health, but it sounds like she's still doing well and doesn't require all their services. And yes, if your mom is still of sound mind, she can overturn your decision of what is best for her or revoke your POA if she wants to. Good luck!!
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Yes, I do have POA and her Health Directive. But since she is of sound mind can she over turn my decision on what is best for her? We can sell her house and that would be the plan for the long term. We have approached her about touring Assisted Living Facilities, but she wants no part of it. At best, we may be able to convince her to try (for a month or two) the ALF which is part of her current Rehab Facility. That would be the easiest transition. Thank you!
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Do you have POA and her Health Directive?

I would have a meeting with the nurse/doctor at the skilled facility and your Mom and have them explain to her what the options are. You are not ASKING your mom to move into ALF, you are telling her.

Look into options in her town and in your area. Take tours with your Mom, if possible, and have her be part of the decision making process. ALFs are expensive and costs accrue quickly based upon level of need - and needs increase in time.

Can you sell your Mom's home to pay for her care?
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