What to do when relative refuses to leave home and is danger to herself?

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My Aunt is 80 and afflicted with severe Parkinsons. She sits in her wheelchair and urinates and defecates on herself, and cannot move or eat without help. She has about 20K a year income and owns her own home, but is just about out of money for homecare (which may not matter because her providers are fed up with her poor treatment).

The family wants her to sell her home and move into a nursing home - she refuses. At some point in the next few months she will be out of money, and will demand that her relations get on an airplane and come and take care of her. What to do? If someone helps her for a few weeks, she will still refuse to sell, continually call 911 for her routine needs, and make life miserable for everyone.

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I think some elders are afraid of nursing homes for a variety of reasons. Maybe someone they knew from 40 years ago had a parent in a nursing home that didn't go well, thus today that elder believe that is the same today.

News magazine shows such as 20/20, or 60 Minutes or Dateline may have had a show where they presented a nursing home in not so shining light. Again, that show will be remembered, thus the elder will say *no*.

And today on TV, I see advertisements for *elders to live at home instead of in a home* where everyone is smiling. Thus, elders who need 24 hour help think they should have the same, not realizing the elder in that ad is healthy, active, and very mobile.
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With no assets and that low of an income, chances are she will qualify for Medicaid, if that helps any. Of course she does not want to go into a nursing home, but no one should really expect they can just demand to be taken total care of by family, and totally on their own terms. She might not have to sell the house - typically, it is an exempt asset as long as her stated intention is to return, but there would be estate recovery later and maintenance expenses continuing as well.

One possible option would be to see if a rehab facility would accept her for a trial - I think a diagnosis of Parkinson's will get you in - and then get her a neurology consult to see if tuning up meds, etc will help any, and work with their discharge planners on anything that is feasible given the results of what would be a more extended evaluation. You would then have the information you would need for activation of a POA or for guardianship.
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Countrymouse, BINGO !! Hopefully this is a learning experience for all of us. I know I am doing a 5-year plan, and 10-year plan, and moving to a retirement community is on my plan. Some of these communities are like living in a 5-star resort, I am ready to sign up now..... Now I just hope I remember to do that :P
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Thanks for all your posts...I need to digest all the advice.
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I think there's a lot of truth in that, FF, and I'd add to it that it's human nature to imagine that 'everything will be okay, we'll manage somehow, we don't need anybody' and then for panic to set in when we actually get to the point that, no, we really can't cope on our own any more. It's not sensible to suppose that if we make a particular plan, everything will pan out the way we expect; but on the other hand it's really dim to make no plan at all and find yourself up sh*t creek without a paddle at 80, when you're too old and tired to do much about it except cry for help. Lesson to us all: if you don't want to wind up somewhere you don't like, make alternative arrangements well in advance.
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I think many of today's elders don't know what to do as families aren't always all in one city to personally take care of them..... not like generations ago when the grown children's siblings lived around the corner, so did the aunts/uncles, it was a small village caring for the elders who back then were in their 60's and 70's.... and the grown children were in their 30's and 40's with a lot of energy. Today we have seniors caring for their parents.
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Who is POA? I would tell Aunt, "I love ya, but can't come, call your POA". If she doesn't have one, then tell her, Aunt Joan, you have to call lawyer and draw up a POA, if it's me, then send me a copy." Eyerlish gives the best advice here.

Frankly, I'm fed up with elders demanding family come in and helping, especially when they live far away. If the elder needs help, then they need to understand and be open to their options, including options they don't like such as moving to a care facility.
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She can demand that one of her relatives gets on a plane and rescues her. What I'm not so clear about is why any of you has to comply. For a start, why don't you all agree not to get on the plane?

This lady is your aunt; but who else is included among the relatives? Does she have any children of her own?

I think Pam S has taken from your comments that this lady is already in the habit of calling 911 for trivial reasons - is that so? If it is, it would certainly help your case in court (nothing gets the authorities more excited than an expensive nuisance being caused to fellow authorities); but other than that I don't see any comments in your thread related to your aunt's mental capacity. And everything, surely, hangs on that. Severe PD does not *necessarily* mean dementia sufficiently severe for your aunt to be recognised as incompetent. So, big question, does she or doesn't she have capacity?

Meanwhile, build a united front among the family. No plane rides. No "few week" stays. Link your arms and harden your hearts, or you'll all be playing pass the (ticking) parcel.
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Yes, guardianship takes some time to establish and if you are out of town you will have to go back and forth to your aunt's as needed

You do NOT need a Dr.'s OK to place your aunt in a nursing home.

Someone needs to do some homework. Find a couple of nursing homes, tour them, decide which one you think will suit your aunt best. Decide which one you think she'd like best. You can do this on your own time without consulting your aunt. But how to get her there, right?

If she refuses to agree you can always try to have her admitted to the hospital on one of her frequent calls to 911. Gang up on her with the paramedics and get her to the ER. Then you tell the ER that she can't be left alone and that there's no one at home to care for her. Hospitals offer social services so request a social worker and get the ball rolling. The hospital won't put her out on the street unless she has somewhere to go and social workers are magicians when it comes to finding a bed in a nursing home. Hopefully one that you've seen already and approve of.

Your aunt can demand that people come and care for her all she wants but if she needs 24 hr care, and it sounds like she does, she needs to be in a facility.

As for how to pay for the facility, since she's going to be out of money in a few months her next of kin or POA (please tell me she has a POA) needs to apply for Medicaid on her behalf. The house will need to be sold. Medicaid and a social worker can walk you through the application process and your aunt can stay in a nursing home as long as she's going through the Medicaid process (her monthly income will go to the nursing home as well).

I don't know how many people are involved with your aunts care or who is responsible for her but things like that need to get figured out. If she hasn't assigned POA to someone she needs to do that ASAP. Someone in the family is going to need to be responsible for the house and dealing with that, someone needs to be responsible for the Medicaid process, someone needs to be responsible for holding your aunt's hand because this is all going to be very tough on her, and someone needs to be responsible for being the family spokesperson with the hospital and social worker.

Get organized. Who can do what?

It would be a lot easier to go for guardianship, that's for sure.
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maxparrish, that's a tough case. Get the family together and have someone fly in to talk to your Aunt, don't bring up the fact that she needs to go into a nursing home, instead have her come up with a solution AFTER telling her that she is running out of money to pay for home help care. If she says she will call other relatives, tell her you already asked and the other relatives cannot fly in to help her, they wish they could but they just can't. If the idea comes from her to sell the house and go into a nursing home the easier it will be.

If she digs in her heels tell her she has to cut corners.... no more cable if she has it... more meals of oatmeal and cereal... cut cost on other things she uses.

Sounds like your Aunt has 24 hour care.... thus she is use to having someone around all the time to help her. She doesn't know what it would be like to be all alone in the house. Talk to the caregivers and ask them what would they recommend, maybe they have ideas they have used in the past that work.
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