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my step-father refuses to send my mother to day care or have any services in home. My mother has Alzheimer's and he keeps claiming he can take better care of her, than the professionals. She is getting injured, and is at risk for harming herself or him.

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GuvnaBruce:

You will not find a Medicare agency to provide personal care/attendant services for your mother unless a physician first orders skilled services.

Medicare only pays for intermittent skilled home care (physical therapy, occupational therapy, etc.) and while skilled services are being delivered some intermittent personal care may be provided (e.g., bathing twice per week). Physician orders typically do not run more than 30 or 60 days so this is not a solution.

If your parents do not have funds to pay for care, contact their local Area Agency on Aging (search this phrase followed by the name of your county) and ask them to do an intake. They will help them apply for any pubic benefits they may be entitled to and help identify appropriate services.

Be careful contacting Protective Services. The result (mom being removed from the home) may not be what you anticipated or desire. Better to let a professional social worker (from the above mentioned agency) have a go with dad first.
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poa is for finances, do you have medical poa? if you do then you would have the choice as to what happens with her care whether he likes it or not
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If she is getting injured with frequent falls, day care may not be an option. In home services can be ordered by her MD and covered by Medicare, so there is no cost to Dad. His instinct of course, is to protect her, but if the doctor recommends a visiting nurse once a week, I think he would respect the MD's opinion.
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Make a call to Adult Protective Services or a welfare check by police and see what the conditions really are. You don't give much more information. Who has this POA? How do you know she is harming herself or will harm him? I need more information and I am a professional.
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You need to have an ACTIVATED POA for medical and if possible financial as well. If the POA document hasn't been activated with a letter from her doctor then your dad is in charge. I agree with ferris1 I would call social services and voice your concerns. You just don't know exactly what is going on unless you are there 24/7 and You know that the care he is providing isn't the best she could be receiving as much as he wants to provide care. Just keep in mind no matter what choice you make if you are going to have the authority of your dad removed and take over her care he probably won't be happy at first and your relationship with him may suffer too.
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Captain, you sure are a handy person to have around. You give such practical advice.
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DugPam, the one with POA is only responsible with what's on the paper. If it's only financial, then it's only the financial matters. If it's medical POA, then the POA can exercise their authority based on the medical reason - backed up by the doctor.

Being a spouse does not automatically gives you a right over your spouse. When my mom was still alive, she was bedridden and completely in a vegetative state. She could not move at all, nor blink at you, etc... Several times when we took her to the clinic and the ER, my father (who had legal guardianship but never presented his papers) was forced to sit in the waiting room while the medical staff attended my mom...sometimes without even anyone asking us why she was brought in. They treated mom for something else and not the severe bedsores on her back and butt. That's when I realized that being a spouse is nothing if you don't have POA/medical POA. With our hospital, they prefer the POA and not the Guardianship paper. I read the Guardianship paper. And it does give my father authority over my mom's medical issues.

Guvna, it's like what Ralph Robbins said. Medicare will only cover Temporary any home care issues but it must meet certain criterias. Whenever one of my parents left the hospital after an extended stay, they would get the home health nurse visits for up to a certain time period (6 weeks???) They will come for an hour, do any sponge bathing, vital checks, physical therapy, etc.... It's really only temporary - a couple of weeks.
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When she falls and gets injured, make sure that 911 is called and that she gets taken to the hospital. Someone other that spouse should be on hand politely but firmly insist that they check out not only injuries, but reasons for the fall (and the previous falls). This will give you access to social work/discharge planning, possible temporary rehab and a longer term plan for her care, whether at home or in a facility.
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All medical professionals should accept a guardianship if it is for medical decisions and include the guardian in the treatment options. If there is no guardianship then medical power of attorney or health care agent is acceptable to make medical decisions. A guardianship and a power of attorney can include financial. I think approaching the husband first by stating we need to do what's best for mom; he may be afraid that she will be taken away and placed in a facility. You will need a doctor's order for in home care, start out once or twice per week, then increase if needed. Contact your local Area Agency on Aging or senior center, they will be able to answer questions regarding in home care and are a valuable resource.
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Ralph:
Thank you for the detailed answer! I've heard that some life insurances can be used to pay for part-time attendants also.
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