Do I tell my dad with early dementia that he is now paying my sister to care for him when he is very paranoid about finances?

A side note of unsolicited advice. If you haven't already, you might want to make sure there is a caregiver/shared expense contract in place for the money your sister is being paid. Down the road when your dads money is gone, should the cost of his care become more than you and your siblings can shoulder you may need to apply for Medicaid. You don't want your sisters compensation to be viewed as a gift as that will mess up and ultimately disqualify your father.

If your dad is living with your sister it's reasonable for him to contribute to the household expenses. He should be paying his own way, your sister can't shoulder the extra expense on her own. Since your dad is lucid 90% of the time hopefully he'll be able to understand this if you decide to tell him.

Otherwise, it might be a good idea to wait on making the decision on whether to tell your dad this or not. Feel him out when you get there. See how the conversation goes and then decide. Don't make any decisions until you see him for yourself.

I would not tell him. I handle the finances for my folks due to my Dads dementia. He thinks Mom does it all and that's fine. We are to the point of having to do what has to be done. It gets me nowhere to try and get Dads approval for anything. We let him believe whatever he wants. There's no dishonesty or guilt in this. At some point you can't let the dementia control the situation and make things unmanageable.

$1,000 a month is being paid for caregiver services; $2,000 per month to the OP's sister to include - yes? - all living expenses including a fair share of utilities, groceries and so forth. I'm sure going rates are highly variable according to where and how one is used to living; but certainly this sounds reasonable to me, is it not?

The thing is, in his 90% frame of mind, your father surely understands that he's not living on fresh air; and he isn't paying - or at least it doesn't sound as if he's paying - anything out of normal bounds. If you were to break down for him his costs in terms of rent, property taxes, utilities bills, groceries and so on, would that make sense to him? And if that goes smoothly, you could then think about adding 'domestic and personal assistance' to explain where the other $1K is going.

Trickier would be explaining to him what happens next. But ideally you and sister plus any other family members will be able to work out a plan, including a budget, and go through it with him if only to reassure him that there is one.

I'm not sure paranoid is the right word for your sister to use! - seeing as you say your father is right to be concerned. And pretending everything is fine and there are no problems to resolve when it isn't and there are... well, if he's lucid most of the time you're not going to fool him for a moment. Wouldn't it be easier to set his mind at rest by being straightforward about what is going on and how you are - my applause, btw - working together to handle it?

Here is another perspective. Since you are the POA, do you feel that this is the best arrangement for your Dad? What does the $3000/month cover? Presumably Room and board. Does your sister provide caregiving as well? If finances are tight and he is in reasonably good health, what is the plan for when his finances are depleted? Most places that accept Medicaid expect/need the resident to do private pay for a specified period of time. One AL near me required 18 months of private pay before they would take that person on Medicaid. Will the proceeds from the sale of his house give him a better financial outlook?

All great advice. Our plan is that when the money runs out, the kids pitch in. Staying with my sister is still cheaper than a home and he sees his family everyday. Thank you all for your responses.

My mother's big concern was not about her money, but about being a burden. So we reminded her often that she was paying her own way while she lived at my sister's.

Do what makes Dad most comfortable. Don't worry so much about "the truth" -- when dementia is in the picture that becomes a flexible concept.

pamstegma, i am not challenging the money which she is owed, I am questioning how to discuss money with my dad. But all other posters, thank you very much.

I always said I'd keep my husband home for his "assisted living" needs. When he exceeded that we'd be looking at skilled nursing. (He never needed that.) My sister hosted our mother through here "assisted living" needs. Then she went to a nursing home.

I just mention this for thinking about what comes next. While geewiz is right that many assisted living places only accept Medicaid after a period of private pay, that is far less true for nursing homes. If Dad runs out of funds while still in a state that your sister can handle, the family pitching in makes sense. If Dad runs out of funds and also declines and needs more intense care, Medicaid may need to be considered for a nursing home. (This will cost much more than $3,000/month.)

Just in case, having a written agreement now for Dad's room and board and care will be handy if you need to apply for Medicaid down the road.

"Our plan is that when the money runs out, the kids pitch in. Staying with my sister is still cheaper than a home and he sees his family everyday." The kids pitch in to continue the $3000/month payment to your sister? Or...what, exactly? Say he needs more and more help...are all the kids going to help bathe, feed, toilet him if it comes to that?