My mother and stepdad are both in moderate to severe dementia and their doctor has recommended placement in LTC. I think my stepdad will agree without much resistance, but I am expecting my mother who thinks she's perfectly capable of caring for them (but doesn't even try -- can't remember to take her meds or help him take his; refuses PT, -- I could go on) to pitch a fit.

I'm in Texas. I am in the process of getting them approved for Medicaid and hope to have that in place by Oct 1. I have read many stories online of older folks refusing care or going to a nursing home and us caregivers and the elder care industry are powerless to force them or keep them there. Further, since as a child of my mother anyway since I have taken on the role of caregiver it seems that I can be charged with elder abandonment if I just walk away. They have all the cards and power, but they're incapable of making sound decisions for themselves or each other.

Any suggestions on how to navigate this nightmare?

I should mention that I have POA and med POA in place for both of them.

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Could you focus on your stepfather? If he will agree to go, or not resist if the doctor says he must, your mother might go to be with him.
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I had medical DPOA, my Dad was evaluated in his last hospital stay to not have the capacity to make his own decisions. I was able to get him transferred to a skilled nursing facility. However, the nursing home said they could not physically touch someone if they got outside. That they would have to call the sheriff and have him admitted to the ER, then to a geriatric behavioral facility.
While we were getting guardianship through probate court, he wore an alarm.
Staff shadowed him everywhere and “steered” him away from the exits. They also gave him a shot of haldol when he started swinging a fire extinguisher.
The staff was wonderful due to the efforts of the social worker who kept delaying nursing requests to remove him. She just felt he would adjust if given time, appropriate medications and nutrition. He is now doing great.
If you are not living with someone, or have charge of their finances and not giving them money, you cannot be forced take them in.
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Tell your mom that it is for your step-dad's sake & that the dr recommended it - she is going too because you need her to make sure he is taken care off properly & so they are not separated - in other words make her think she is going only to assist him - even that the dr wants her with him so he made out paperwork to make it easier for her to go too & isn't the dr great for seeing how important they are for each other to be together

Lay it on with a light trowel but basically work on getting her to think she is a helper for him - also say that all meals & laundry included so it will be like being at a spa - theraputic fibs & 'thank you for helping me making this easy for him' will go a long way -

With theraputic fibs it is best to stay as close to the truth as possible so that you don't get tripped up too much if you forget them - just tweek the actual facts & stay as close to them as you can - good luck
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Others here have great ideas about planning and preparation. I'd also offer that you might look to see if there is a state form that your state has that Medicaid may require that the doctor completes that states the applicant's needs, health status, abilities, etc. As well as whether they need skilled nursing care. Some people report that that is an issue for them getting into a nursing home. I'd explore nursing homes, assisted living and assisted living Memory Care, to see the differences.

I'd explore what type of facility your parents will actually need and if Memory Care is appropriate and available. An assessment to determine the level of care they need would be a good idea. Make sure you are present, so you can provide a candid picture of their abilities. They may not report it accurately.

Will your mother physically stay in an AL or NH if she's opposed to it? If not, she may require a secure facility. Usually, the doctor prescribes that. And, as you report, that they have moderate to severe dementia. I'd discuss how the LTC facility that you are exploring handles that. When they are past the point of reminders, complete supervision and assistance with all ADLs will be needed.

I'd also make sure that your POA is a Durable POA, before the doctor says they are not able to make decisions.
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You sound like you do have your ducks in a row as far as the paperwork goes. It’s very difficult if not impossible, to reason with a person who has dementia. In your mother’s mind, she is taking care of Dad. Most of the time, reality has not much to do with their lives. And, at this point you need to do whatever it takes to place them. Reassure Mom that she can still “take care” of Dad, but now she will have people to help her. Are you thinking Assisted Living? They will be together?

Are you considering walking away? Things are that bad? Call your local Area Agency on Aging and ask if you can be assigned a social worker. This is someone you can talk to and who can talk to your parents. Sometimes they will listen to a relative stranger before their own child.

Good luck. Keep us updated.
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Since you have POA, I suggest approaching Mom's doctor and see if he will provide a statement of incompetence so that Mom could not override your decisions. As HCPOA, you would then have the legal right to determine where Mom lives. That doesn't mean she would stay but the LTC would be more cooperative about keeping up with her or placing her in a locked area.

I have found that sometimes it is much easier to get an elder to agree to some type of assistance if you can frame it as helping someone he/she cares about instead of as something he/she personally needs. Is there some PT or social aspect (card club, golf outing, etc) that would appeal to or be beneficial for your step-dad at LTC?

Is there some chore Mom doesn't like that LTC would provide - cooking or some aspect of housekeeping (dusting, vacuuming)? Would she enjoy group shopping trips (if she's still able to participate)?

I would also suggest touring and getting brochures on various LTC facilities to show your parents they can take some of their furniture, photos, wall hangings and other stuff to make their room more like home. Depending on the dementia state, you might want to consider having their home telephone line/number installed in their room so friends can still reach them. When you have an actual facility engaged, start planning what your parents will take with them. If funds allow, you might suggest shopping for some new things that would fit the room or their needs better (maybe a lift assist recliner).

Most of us fear the unknown, and your parents are facing two unknowns - what's going to happen as their bodies age and decline and what this new living arrangement is going to be. By seeing the facility and talking about practical aspects of their lives there you can remove some of the unknown and some of the fear. Don't forget to emphasize that whatever happens there will always be someone at the LTC to help and that you will continue to visit often.

My dad with vascular dementia didn't want to go to MC and even to this day complains about me "forcing" him there; however, after he toured the facility and found out he could eat when he wanted to, have his own snacks, phone and computer in his room, he became much less move resistant. He actually got in the car with my brother and went to MC on his own.

Good Luck!
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