Moving Mom with dementia from one nursing home to another. She does not have POA, what should I do?

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I'm trying to get my mother moved to a nursing home closer to me. The one she's in now is 300 miles away and there's no one near her to look after her. The nursing home she's in now isn't providing the paperwork the new nursing home needs to evaluate her. She is a medicare patient with only SS as income and I am her HCA but she does not have a POA. What should I do?

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They won't send the paperwork unless SHE signs the release, and they won't be in a hurry to do that. They don't want to lose a paying resident. If she is happy there, she may not want to move and it is all up to her. Moving carries risks of aggravating the dementia. As far as looking after her, I would make daily calls to her nurse for updates. You are only as far away as a phone call.
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Lyn - I moved my mom from one NH to another and here's my experience. Mom was @ NH # 1 for maybe 9 months. Care was ok but management had many problems (multiple administrators, clueless business office, Stark issues). The NH I toured initially when looking for a facility was not at all the NH it has morphed into. Staff was bailing so the writing was on the wall. NH#1 was less than helpful in mom's move too

I live out of state and the NH were in the same city. I don't think your mom's move can be done without your being "boots on ground" to get some of these issues done.The fact that your are not DPOA for your mom is totally working against you as your long-distance request(s) has no effect. They can go to mom & ask "Mrs Smith do you want to go away" and she can say "No" and case closed. Without you're having DPOA, you kinda have to be there and get mom to the point of her wanting to go back with you and stay till either this can be worked out and then you physically drive her to the new NH or hire a transit ambulance to do this. You have to be a pretty definite (firm, nice but not too nice) personality too.

For my mom, I, like you, found a new NH. But unlike you it was in the same city, as DPOA I signed a form @ the new NH to request a on-site evaluation by the care team @ the new NH to be done. I would think as your mom's HCA you can sign off for this to happen. The new NH has to do this to ensure that they can provide the level of care that my mom needed. I also filed a request with my mom's gerontologist for all her medical records to be made available to the new NH - as your mom's HCA you should be able to do this (they could charge a fee for this and for copying the file). If you haven't done this yet, I would fax over to her MD a request for this to be done and records sent to you. I'm assuming her MD is the medical director of the NH, I would fax it over to his/her private practice office #. Before this happened I met with admissions and the social worker @ NH # 2 to get all mom's paperwork into their system so that we were all kum-ba-ya on payment. My mom is on Medicaid and has Medicare. (Now you mention mom has Medicare, so how is her NH currently being paid?…Medicare pays for short term - 100 days max - NH stays usually as a "rehab" placement @ the NH, Medicare doesn't pay for the long term costs of their room & board, so how is that being paid??…..settling this will be an issue for the old NH and also needs to be done for the new NH too..if the new NH is waiting for the records to accept her, I'd suggest you talk clearly with them on how mom's bill is to be paid).

The care team went to old NH and called me from there as the floor nurses were less than hospitable. I had to put a call to the DON (Director of Nursing and they are usually the goddess & rule the NH) that I requested the evaluation and that if need be I would be at the NH tout suite. DON told the floor nurses to behave. The care team called me from my mom's bedside to tell me that mom was totally OK for them. I then faxed over a letter to NH#1 that my mom would be moving from the NH and that this was their notice (faxes are legal while phone calls aren't). Now under Medicaid rules, the NH is paid a day reimbursement rate set by the state and they can move from NH to NH with no penalty. So I planned the actual day to move her to a few days later and right after the beginning of the month. Mom had done her Medicaid required co-pay to NH #1 for the current month (and there was no way the clueless billing office would ever send mom a check for the unused days). So on the 3rd of the new month when mom got her SS and her annuity, I divided her co-pay by the # of days she would be at old NH and then @ new NH and paid them the exact amount required. Moved her on the 5th of the month to NH # 2. Old NH sent bills for the next 3 months along with care plan meetings as if she was still a resident too…. just amazingly incompetent.

Now since the new NH is not in the same city, this is going to be a hurdle. Perchance is the new NH part of a group that also has a "sister" facility in the old town? If so, then maybe they can do an on-site evaluation needed? Would new NH accept an evaluation by a gerontologist or other MD? If that route can happen, then schedule mom for a visit and go over and spend the days needed to have her seen by the MD. If push came to shove, you could private pay for a concierge type of MD to go to the NH to see & evaluate her and sign off the paperwork. Just because they are in a NH doesn't mean they can't see other MD's. I took my mom to her old eye doctor for the first couple of years she was in a NH.

One thing you need to do is to get all of your mom's medications @ old NH when she moves. Medicare & Medicaid are pretty strict on med's and will pay only once for them. If mom is on a lot of meds's this could be very expensive to do again. Most of their meds @ the NH are done in either 30 day or 90 day blister packs or big dispensers. All this at the nurses station in hanging bag with mom's name or locked medication closet. Again, YOU HAVE TO GET ALL HER Rx's. Take ziploc's and a sharpie marker to ID the meds too. When I moved mom, the floor nurse said they had no containers and literally threw pills on the desk in a pile. Got my pint Zippies out and no worries. Her look was priceless.

Guardianship is a pretty costly & involved legal process. Just because you are her daughter, it is not assured that you will be named guardian either. If the NH for whatever reason challenges this, the court could grant temporary guardianship to one of the numerous attorneys or other state approved temporary guardians. I would try to work the HCA along with your boots on ground presence to try to make this happen first. Good luck.
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If you mother has dementia it is nearly impossible for her to assign anyone POA without a Courts Supervision which is somewhat counterproductive. You need to file for guardianship of your mother-either Limited Guardian if she is capable of doing some things on her own or Plenary if she is completely dependent on someone to take care of all of her estate. In some cases a Guardian Ad Litem is assigned on your mothers behalf to make sure all of her legal necessities are being met.
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You may be well-served to contact an elder law attorney. If your mother has dementia then at some point she will not be deemed competent to make her own decisions. If no one has POA then you might have to go through a process to obtain guardianship. Having a POA is a much easier process.
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Call the Ombudsman in your state, and explain that the nursing home is not providing the paperwork your mom needs. That should help expedite things.

Best wishes with the move. I hope this reduces the caregiving stress and pleases your mother!
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