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I am in the middle of trying to make a difficult decision. My mother is in a nursing home in GA, but I live in NC and want to have her moved to a facility closer to me. She is 82 and showing early signs of dementia. The problem is that she does not want to leave GA. She was living with my niece who has proven to be unreliable. We have never been very close, but I can't see leaving her their as a good idea. Everyone I talk to says I'm doing the right thing. Anyone else been through this? Open to ideas...

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Your mother is 82 or 83?

It's not that it makes an enormous difference, and maybe it was her birthday yesterday or something, but this is a basic detail that one would normally expect a primary caregiver to have straight.

It's just that I have an overall impression that - not unreasonably, because you do explain that you and she have never been very close - you're perhaps not as fully briefed as you might want to be before you make any major decisions.

If you and your mother have been happily leading completely separate lives for many years, and now all of a sudden she is frail and ill and in need of support, and it has fallen to you to see that she gets it, nobody here would blame you for feeling, as you say, totally confused. You didn't ask for this, and there is no shame whatever in having no clue where to begin.

So. Where I would begin is with getting to grips with the history in order to have a complete overview of her current medical and financial and living situation, leading to a care plan that is both manageable and designed to maximise her quality of life.

So. Medical matters. Your mother has heart disease: but what sort, and for how long, and what is the prognosis, and what are the co-morbidities? - note, vascular dementia is very common in later stages of CHF, for example. I suggest you liaise closely with the NH and with the primary attending physician until you have a good grasp of what is going on and what you can expect. Are you running into problems with HIPAA? - if so, see 'Guardianship' below; and meanwhile get your mother to give her consent to her healthcare team for you to be fully informed.

Leading on from that, you need some kind of assessment of your mother's mental state to establish whether or not she can be considered competent to make decisions for herself. If not, and assuming neither you nor anyone else has power of attorney?, you will need to make an application for guardianship in order to manage her affairs. If she is competent, then you will need to ask her to give you power of attorney, to manage her money, and to appoint you as her health proxy (there are various terms for the latter); but do note that you can only ask her, you can't force her, she is free to refuse.

If hard questions have been asked, let alone if accusations have been levelled, then it is safe to assume that the niece won't want to touch the situation with a stick and you will have to do without her input; that's probably best for all concerned, at least until there is a lot more clarity about what has been going on with your mother's assets. But where are your niece's parents? - Are they too on hand? Is there anyone locally you can ask for reliable help?

What financial information have you been able to get together? How long was your mother living in your niece's home, and what was the understanding between them? What happened to your mother's property when she moved in to her niece's home? Are we talking credit card debt, or what?

Or, would it be possible for you to travel to your mother's home town and devote a week or two to getting things under control? It might be a lot easier to get sensible answers from people if you can sit down in the same room with them.
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Is your mom seeing this as staying in GA is a chance she will get out of the NH and go back home? Or a comparison between NH in GA vs NH in NC?

Is anyone visiting your mother in the GA NH? Minister? Friends? Other family? Were people visiting her at home before?

Will your mother need to stay in a NH or would AL or MC be adequate at this point? My dad has some heart issues too and while he would medically qualify for NH he's doing well in a MC. Your mother may be more open to AL/MC too.

If the financial resources are available and your mother doesn't have a strong social network in GA, then I would probably try to relocate her to NC, looking for AL/MC instead of NH. Sounds like she's early to mid in any mental decline, so she will still enjoy people and a space of her own. Remember your mother will be in the AL/NH most of the time and friends only visit occasionally - so make sure there's some activities and socialization opportunities.
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Why's your mother in a nursing home? It's not because there are early signs of dementia - what other medical conditions or physical difficulties does she need help with?

When you say your niece, who was your mother's full time caregiver, has proven to be unreliable... You'll have to forgive a fellow-caregiver's cynicism here, but what do you mean by unreliable? You see, it could be anything from financially abusive through neglectful of her emotional needs to overwhelmed and burned out. How long was your niece responsible for your mother before her "unreliability" came to light?

It is not unreasonable, if you are assuming responsibilities as your mother's primary caregiver, to locate her within reach of your home. However, be clear: you would be doing this primarily for your benefit and convenience. As long as the move has no negative impact on your mother, that's not a problem; but if it does have a negative impact - and while she remains competent it remains her decision in any case - then you will have to think again.

Try weighing up the pros and cons of a) her current NH versus b) the place you wish to move her to; but do it as objectively as you can, and give due weight to small things such as her seeing people - other family, friends, neighbours, PCP and dentist, for example - she knows and having access, perhaps, to familiar sights and places (shopping trips, the view out of the window even). Small things can add up to quite a lot when you're calculating quality of life.

Finally, who is the 'everyone' you're talking to? If they include people in GA who know and care about your mother, fair enough; but be careful you're not consulting only people you know will agree with you.
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Richards Sep 24, 2018
Mom was put in a skilled nursing facility for rehab after having issues with her heart, she went there after a hospital stay. While in the hospital she started acting very iratic which is not at all in her character. When she got to the NH where she is now, she calmed down a great deal. I could tell her memory was slipping before all this happened, but it really went downhill after the heart episode. I also forgot to mention that she had to go back to the hospital twice for UTI issues which I am told can affect the elderly mentally (she is 83). As for my neice, I have now found out that my mom has gone into a large amount of debt that I know is things for my neice. The last time I was home the house was filthy which means my mom was doing all the cleaning; she definitely will not be going back there. For basic things my mom has needed at the NH, I have had to send long distance although my neice is right there in town! I do honestly have to say that my mom ABSOLUTELY does not want to come here to NC, but I just dont know how good I feel about leaving her there. I am totally confused on the best thing to do.
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If Mom is on Medicaid it doesn't go over state lines. You may not be able to apply for it in NC because she is not a resident. I would find out what NCs time period is. Can Mom pay privately for a yr or more?
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