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She wants to stay in her home but resists care coming in. Looking for suggestions on how to deal with the fluctuating competence. I am trying to act in her best interests, but her best interests would be for her to be in assisted living.

You are correct that her best interests lie in being in care all of the time; it would be impossible to otherwise "guess at" her need to be in care. It may be, however, if her mentation fluctuates to this extent, very difficult, without letters of incompetency from two examining doctors, to get sister into placement against her will.

I would start with going with your Sis to visit places where she might stay. I did this with my brother when he made me POA when first diagnosed with "probable early Lewy's Dementia". He came over time to understand that without a support system, and with his very poor balance, he was no longer safe in his small home; he also knew, with me living other end of the state, he wasn't safe depending upon neighbors. He can to accept and choose the place he liked best. We were lucky it went so well. It is a place for you to start, and see how it works out.
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