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Dad has moderate dementia, OCC. So Mom is in charge. Both are almost 90. Mom refuses to sign the papers to allow one or more of the adult children to make medical decisions for her or Dad in case she is unable to do so. She thinks we would just then have the power to not consider their wisher and just "kill" her or him.Both have also had falls at home. Thankfully no serious injuries. But perhpas Mom and Dad should have a Medical Alert system in case of other future emergencies. Dad has always been in charge of everythng, Mom is leery of making decision. How do we approach her gently on these ideas?

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Who is making the health care decisions for your father? You can tell her that your dad can no longer make decisions for her because of his dementia. Then tell her she has two choices, either the state will appoint a guardian (usually a lawyer wet behind the ears) or she can actually choose someone in the family who loves and knows her.

Your mother is in the 'very old' stage. Her mind/body can go in the blink of an eye which is what happened to my mother. She wouldn't sign a health care proxy. It was a mess. The state appointed a lawyer who was wet behind the ears. Judges set up court in hospitals on a regular basis, complete with court officers, stenographers, the whole nine yards. My mother was in a reputable hospital in Boston. They don't play around. This is serious stuff.

Or perhaps you can hire a good, reputable, elder law attorney to talk with her. Has her doctor or your dad's doctor spoken to her? I know I'm always throwing my hands up in the air I'm so exhausted at times dealing with everyone.

I've learned one very large lesson throughout the past ten years in dealing with my elderly parents...everything is changing rapidly. People need to keep up or they will be lost. I love my children. I never want them to be placed in this situation.
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My mom's mom would never sign over her house into a trust, or any POA, or even make a simple handwritten (holographic) will.....I know because I accompanied my mom many times as she tried politely to explain these were all good ideas, and would preserve the family home for the family (instead of being used for nursing home bills). Well you guessed it. Grandma got more & more frail and eventually HAD to be placed in nursing home. Her lovely farmhouse sold for her huge bills.....somebody else lives there now. And my mom & I were at the mercy of the State as far as grandma's burial costs, well even before that the nursing home choice was dictated by the Medicaid availabilities. But even the sale of her home was dictated by state, multiple repairs had to be done, it could not be sold "as is" because of lien placed by DHS. I don't like scare tactics, but you might have to explain to your mom what could happen if she doesn't have a DPOA, health directive, Will, (Trust) and Executor picked out well in advance. She can always make changes down the road, but at her age anything can (& will) happen.
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Our parents had nothing signed....they were going to live forever! Dad died suddenly of a heart attack many years ago. Mom lived 20+ years after that (much too our amazement, she grieved every day). She always said "I don't want to be a vegetable" but in the hospital each time she would not sign a DNR. We never left her alone in a hospital or rehab or at home, one of us was there 24/7 and every doctor visit. When the time came and she was unconscious, the doctor came by and the nurse was there. They ask what did we want to do, Mother was slipping away. I looked at my sister and she repeated what Mother had always said. They both nodded and left the room. She was gone within the hour. Mother was 89.

Families have to be very familiar with the doctors and present at whatever facility. The staff gets to know you and sees how much you care for and love your loved one. It makes all the difference when decisions need to be made.
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Rather than encouraging her to sign power over, she can sign an advanced directive, which documents her wishes for herself. Dad may be able to do the same IF he can understand it.
I would not stress about this too much. Typically the hospital does revert back to the next of kin - spouse, then children - as long as there is no obvious difference of opinion on "choices" from the children, they move on. At their age and under their medical conditions, God often makes the choices for us.
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I could have killed one of mom's docs a couple of years ago. We had a living will and everything in place. Doc asked mom if she wanted all means exhausted to save her. What in the world did she expect her to say?!
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Mother refused to sign too. She was 89 and far from having demential...as her son said about Miss Daisy (Driving Miss Daisy)..she was TOO MUCH there. :) She said of "course I want to be revived...should I just lie here and wait to die? When the Good Lord calls I will go and that's that." So...one evening at dinner, with a fork still in her hand, He called and she answered. I guess it all worked out the way she planned.
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I went through all of that with my parents. They put each other as everything (AMD, POA, executor), even though they were in their 80s and 90s. The lawyer let them do it. Finally I convinced them to allow me to be successor trustee and AMD/POA but it took another more responsible lawyer to convince them. You can always have a provision that you are second, if the first choice is incapacitated.
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I'd bring in a 3rd party, someone that your mother trusts, for instance a pastor, old friend or a sibling. I'm suggesting someone that your mother knows has nothing to gain from her death; possibly someone your mother knows has their own money and does not need hers. I had a similar problem trying to convince my mother that she was going to lose her house and money because her grandchildren had deceived her. For some reason, she has never listened to me. I explained the situation to an elder in her church and showed him documentation about the situation-- a man my mother has known for many years. He visited my mother with another elder and they persuaded her that I was right. After that intervention, I was able to get my mother to sign a POA and a healthcare proxy. Even if you do have a good personal relationship with the 3rd party, if they care about your mother, in all likelihood, they will help you because they want to help your mother. The 3rd Party even went with me and my mother to get the documents notarized. Your objective is to get the job done. Ask for help. Wishing you God's speed.
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GOGURLZ, I am having a similar problem with my Mom... recently my parents got their *draft* copies of their Will, POA, etc. and Dad was ok with everything... but Mom [who now can barely see or hear] saw the Power of Attorney and assumed that it meant that the Attorney took over the power of everything related to her and Dad. With her hearing issue we had a difficult time trying to explain what a POA was all about, and even though Mom is still sharp as a tack at 97, she still didn't understand how a POA worked.

Why on earth didn't my parents have this all updated years ago is still a mystery. Must be in denial about their ages.
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Your mom can complete advance directives, this way her health care wishes will be in writing. Should she become unable to speak, her doctor and family will know what care she would want. Dad can do the same if he is able to and understands the questions. A power of attorney can be completed and the effective date can be when she becomes incapable/unable to communicate; this way whoever she names is unable to make decisions until the time comes she is not able to. Planning ahead is so important. Surely she wouldn't want a stranger to make decisions for her; a stranger won't know her values or thoughts about treatments. Who ever she names must make the choices she would make herself if she were able, if it's something you haven't discussed, then her agent would make a decision based on what's in her best interest. Contact your local area agency on aging, they have staff there can assist and answer questions regarding planning ahead.
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I am the caregiver for my father who has Alzheimer's. He refuses to sign anything because he is paranoid and thinks every document is to "take him away." My mother has dementia and she is sometimes capable of comprehending and willing to sign, only recently becoming paranoid about documents. I needed my dad to sign VA forms this week and he would not. I waited until his healthcare nurse came for her weekly visit and she told him the paperwork was legitimate and it was okay for him to sign. It's sad that they will listen to a third party instead of their children, but that is the reality with these diseases. Luckily, my sisters and I took both of them to an attorney a year ago and they signed the POA forms. You need to do this right away. Once they lose their rational thinking it only gets worse and the paranoia is part of irrational logic.
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Mom cannot sign papers assigning someone to act and make decisions for Dad. Dad has to sign them. He can do that, even with dementia, if he clearly understands the meaning of the papers. But he cannot, of course, be forced to sign papers.
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I don't think you can really do anything until you determine whether Mom has sufficient capacity to sign any legal documents. If she is, having her discuss with a lawyer the importance of having these choices in place might be helpful. If understands the consequences if she were to have a stroke with no in place to care for either of them legally, then sometimes its the state or county who makes those decisions. If she doesn't have capacity, then you may have to seek guardianship/conservatorship (depends on state), over both of them. Being 90 doesn't mean she doesn't have capacity. My mother-in-law is also 90 and she still has her mental faculties although she has difficulty with some things like remembering computer passwords (yes, she's even on Facebook). So you really are not going to know which way to go until you know where Mom stands with capacity. That's your first step.
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Get an impartial third party involved such as a Geriatric Case Manager, many times a social worker. They would do an assessment of your folks needs and also be able to explain why it is important to have POA's, DNR, Living Will in place. It is to protect them and to insure their wishes are followed. Sounds like they are afraid to die?

If these documents are not in place then there would be a delay with appropriate desired treatment that could possibly "kill" them until someone on the State's payroll is put in place as a guardian. Would they rather have a child making decisions, or someone else of their choosing, or an employee of State Social Services?
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Visit with your mother and ask her what she wants for herself and your father. Let her see you making the list. If you can take her to a lawyer, let the lawyer explain the importance of getting their affairs in order. While at the lawyer's office, do not offer any advice or coerce in any way. Let the lawyer do the talking. Sometimes, a third party can help your parents make logical decisions and ensure they get what they want. A DPOA does not invoke until the parent is incapacitated. Also, if the parent does not allow anyone to be their DPOA, a guardian will be appointed by the court. This is a costly, and some states do not even allow a family member or relative be the appointed guardian. My father would not do anything until I took him to the lawyer and he made all of the decisions, which is empowering. If your parents cannot afford an attorney, contact Elder Affairs and a legal forms, such as DPOA and living wills can be implemented for free. Good luck!
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Your mother may also have some dementia and is unable to see the reason in your need to help. Check out other areas on this site about "guardianship". You need to start this process now.
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