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My father was recently admitted to a nursing home/rehab facility after a week in the hospital. He was diagnosed with vascular dementia, cerebral atrophy (chronic small vessel disease) after a couple MRIs, liver disease, and is physically impaired (has trouble walking, balance problems, can't write, and is very weak). He is also addicted to opioids and is diabetic.


He has fell 4-5 times at least in the last couple of months, and three of these episodes have landed him in the hospital. During the last visit, for two days he couldn't remember his own name, but then recovered some of his faculties and is somewhat lucid. He does not want to be in the rehab facility and has been uncooperative and combative. When I go to see him and try to explain that he needs to work with the staff to get his strength back, he is abusive and threatening (says he disowns me, will disinherit, sue, etc. --he is paranoid)


When he was at the hospital, a doctor and neurologist deemed him incompetent and said he needs 24/7 skilled nursing care. They did not think he could go home with a nurse (he lives with a girlfriend who is 20 years younger and simply wants his money --she has forged checks, among other things). So my sister took medical and financial power-of-attorney and worked to get him into the facility where he is now.


But here is where it gets confusing. The nursing home has a different criteria of what constitutes "non-decisional" or incompetent. Apparently, they can't base their decision on the hospital doctor's evaluation alone, and my sister might need guardianship (he has a trust which outlined POA criteria for medical and financial--that has been satisfied). We have asked for a neuropsych evaluation, but that takes time. Meanwhile, he is hell-bent in getting out of the facility, and I am worried he is going to somehow get out of there, and go back to the girlfriend who will simply rob him blind, help him disinherit his family, and then keep everyone from seeing him, while he sharply declines and then dies (she can't take care of him--he has been in and out of the hospital since moving into her condo).


Any advice would be great--not sure where to go from here.

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What you probably need to do is find an attorney who specialzes in eldercare and possibly go to court to seek guardianship. Absent that, a person has a right to revoke a POA he or she created. If the facility decides to discharge there is not a lot you can do-hence the recommendation to find a lawyer. Usually 2 doctors need to state that the person is incompetent, but each state has its own requirements.
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AT1234:

I don't think the AL facility can simply let her go without your permission as PoA.

Has she been formally diagnosed with dementia? Were MRI and similar tests conducted? If that is the case, you have strong reason to keep her in AL.

Our problem is that once dementia set in with my father, he became paranoid, abusive, and combative. He demands to be discharged from the nursing home and has told me and my sister he will disown/disinherit us immediately. These kinds of threats are very unusual coming from him, and I think a lot of it is due to the dementia. Meanwhile, the girlfriend is waiting for him to be released so she can immediately marry him and get him to sign his estate over to her (it is quite a bit of money). So it is a really bad situation.

My father can sound perfectly reasonable one day, and the next he is wandering the halls naked, falling down, or can't remember his name.

I told my wife that once I reach my late 60s, I will make my trust irrevocable, so that no one, including myself, can change it. We forget that the biggest danger to our estates can be ourselves --how many stories have we heard of 80 year old, somewhat senile men, marrying some bimbo after their wives die, and she gets everything (disinheriting the kids).
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AT1234 Nov 1, 2018
Yes, to diagnosis and ct scans. Plus, the threats to disown and uninherit, there is no one else. She’s also been termed by rehab as combative. I’m trying to get along with her to keep her calm but that will only last so long. I don’t have a boyfriend waiting in the wings but I do have an family member out of state that has all the answers. It’s tough. My heart goes out to you.
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Thanks for posting this. I do not understand this either we are going through same issue with my mom. Today is her Second day in a AL she was in a month ago. She got mad wanted to go home and 19 days later she fell broke hip had to had replacement and then rehab and bc cognitive issues we were told she can not go home alone. She of course disagrees and has started her campaign to rally support.
This is her second surgery after falls in 3 months. The director said they would not release her without 24/7 care. Which she didn’t want or could afford so she decided again to come back to AL. And two days later she’s ready to leave. I don’t know what legal rights I have if any.

I’m wondering if I could enlist a neuropsychologist to get a better idea of what’s mentally going on. She is diagnosed dementia, but is very cagey and manipulative so she may be able to convince them to let her go! She’s still in wheelchair. Yes, I’m her POA.
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I’m not sure what you mean when you say your sister took POA for the dad. POA is something he voluntarily assigns to someone he trusts. You can’t get or take it.

If the POA knows that a DNR disrespects the patients personal wishes, he/she can have it changed, after all, you represent dad, he’s the boss.

If dad voluntarily assigned POA of finance to his child, there are options to protect finances. Even if he has a lady friend.

The law states that nursing homes must clear medical decisions with the POA before making a move. I’m not sure how your facility tried to get around this. I tried to make sure my dad had the option to make as many personal choices as possible (while making sure he received the care he needed. ) That’s what makes him a man.
And a good POA eliminates the need for guardianship.Are you sure you understand the issues with the nursing home? They do have to honor his wishes unless he is declared incompetent, but they can’t just let him walk away without considering his health needs, informing somebody, or asking doctors permission, without risking litigation. Ok, so I see you changed care providers so that’s a moot point.

Guardianship may may be contested but the final say rests with the patient and the judge. Most judges will respect a patients wishes about who is or is not the guardian. My fathers wife sued for guardianship of my dad because he didn’t want her as his DPOA. The judge ruled that if he were happy with her as his wife, she’d automatically fulfill her care duties without suing for guardianship. The judge disallowed her. Yes, it cost a bunch to go through that whole mess. But it was dad’s choice. Good luck with this. Who knew parents could create such issues?
VK
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That is all good news.

Not having that to deal with on top of what your dad is going through is a blessing.

I hope things go well for all of you.
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Thx for the update. It looks like you have everything in order, My error - I am glad he did not marry his girlfriend Your sis needs to take control of his money and all his affairs and it looks like she has. Your dad is pretty ill. I agree with your comments on guardianship. I think you have all you need now to properly care for him. Hope he settles in to his new place well. Let us know how it goes.
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OK, here is an update

My father had a "change of mental state" at the nursing home and was sent back to the hospital he was originally at. I assume they were worried he was having a stroke. He didn't want to go and was combative and paranoid, even going so far as to throw a punch at a female nurse from his wheelchair.

He never married the girlfriend, and I don't see that happening now

He is now back with the doctor who originally diagnosed him with vascular dementia, chronic small vessel ischemic disease, cerebral atrophy, etc. (he also has diabetes, liver disease, and a bunch of other problems). The doctor worked with my sister to get him transferred to another nursing home that will better suit my father's needs. The doctor can continue seeing him there.

In accordance with my father's living trust, my sister has durable PoA for health, personal, and financial. We even got a letter from the attorney who created the trust and had it signed by the doctor. In addition to that, we had formal competency letters signed and sent to my father's financial advisor (where his accounts are), the bank, etc. My sister has his checkbook and credit cards.

I am not sure seeking emergency guardianship is necessary, since she seems to have all the authority she needs. What worries me about guardianship is that it can be legally challenged, requires court appearances, and my father can be represented by an attorney --it will cost a lot of money. Seems like there are some serious risks involved with doing that.
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If your sis has POA she should be able to transfer his funds or tie them up in some way until the neuropsych eval goes through, so that the new wife can't rob him blind. He won't like it but it is in his best interests since this gal has shown her colours. You need to protect his funds for his care.

Some of his emotional/behavioural problems might be addressed by meds. Can you review this with his doctor?

The whole issue of competency is a difficult one. When mother was in a geripsych hospital early in her dementia, the psych deemed her incompetent in terms of her medical care, so I had to make those decisions, (she was refusing meds) but for not anything else like where she was to be placed. They skillfully involved her in her own placement choice which was good, The choices they gave her were, of course all suitable for her. I questioned him on it but he stuck to his position. It wasn't that I wanted to "take control of her life" but it didn't make sense to me I think they are reluctant to take all decision making power away from anyone if they still have any marbles left. Good luck.
ETA
Emergency guardianship sounds like a good idea.
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Silas1066,

As a facility they may have their own criteria for competency because they are protecting themselves against liability. If there is doubt, get proper legal authority to act whether a POA or guardianship. The Guardianship May have a bit more authority for ensuring against the flight risk or uncooperative nature of your father. You should seek an Elder law Atty who can help you determine the fastest most efficient route.

Emergency guardianship may be done within a few days and doesn’t require out of pocket expense, depending on the State.
Scott C.
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If you can afford it, get an attorney fast. We couldn't afford one when my Dad's gold-digging wife put him in a nursing home (after he received a settlement from the VA) which was his personal property, not community property. She was using an invalid and forged POA and finally a hospital realized it and rescinded the POA. But under TX surrogacy laws, the wife is the first person to be designated as a surrogate healthcare decision maker. She made all information regarding Dad's health unavailable to his children and only she and her daughter (not Dad's) had rights. She denied him treatments until he wasted away and signed a DNR which he would never have wanted. I pointed out to the NH that the DNR was not his wishes and advised them of the multiple reports of neglect & abuse filed against his wife regarding her treatment of Dad. The legal counsel responded to me stating I needed to go to court to remove the DNR. I think since his children were restricted from getting any health information about Dad, the NH had a duty to properly review the medical POA to determine that it was invalid before adhering to it. Adult Protective Services decided more than five cases of abuse and neglect without talking to Dad's family at all. Instead they decided to side with the wife because she had two "really good witnesses", her friends who signed the forged and invalid POA. Also TX is the only state that allows food and liquids to be withdrawn during end of life situations. My sister and I watched my Dad die after six days of no food or water. She basically scheduled the death of our Dad, tried to ban us from the funeral and has hidden his will. She got what she wanted and her daughter said so after the funeral ... she said "You all are the real losers, we got everything." San Antonio Police Department won't do anything because his autopsy report said "natural causes." I don't think there is anything natural about starving someone to death who is already physically compromised (Parkinson's) and elderly (89). If I had my way, I would kick her out of the house she had Dad purchase for her, make her sign a DNR and go without food and water in her last days. More likely, nothing is going to happen to her until she gets to that special place in hell God has reserved for her. However, I am writing our senator about these stupid laws and advise of the ineffectiveness of APS. I'm also writing the police department about their failure to properly investigate the homicide and forged document and their APS-like incompetent investigations. You need to get all the rights you can, medical and financial, because these women are ruthless, greedy, selfish, narcissistic, underhanded breed that is barely human. The depths they will sink to will amaze you and horrify you. Best of luck to you. We need to stop this elder abuse, neglect and financial exploitation crime spree from going on.
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Isthisrealyreal Oct 29, 2018
My dads wife got away with everything except killing my dad, God's grace allowed him out before it was over but it was close, days actually, all because they were married and by law she is next of kin and gets everything unless there is a will.

They (police) pointed out that regardless of how I felt, he married her and gave her all these rights. Gee you think I didn't know that, I just thought that when someone does things so horrific that there was some repercussions. Not in this life apparently.

I am so sorry that you are having to go through this.
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If a doctor and a neurologist in the hospital deemed him incompetent then there is NO reason the nursing home should not accept this! Most poa's require two doctors to deem the individual incompetent, from what you said this has been done. I would really want to know what the home's criteria is.
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Start the process for his geriatric psychiatric assessment today. It will CONTINUE to be useful as a baseline for future changes.
My LO was a “difficult” resident, and periodically continues to be, and the concise assessment has been a useful tool for managing her care.
Be pleasant and persistent about the timely administration of his evaluation.
Has anyone mentioned a trial of medication to improve his ability to accept needed help from others?
If medical personnel have recommended NH care have you “shopped” for another placement that might be more willing to accept his attitude and symptoms?
Have you considered taking legal action to protect him from his predatory companion?
Considering his numerous symptoms, is it possible for you to objectify his behavior towards you as “symptomatic” and not take it personally. Most likely it is. My poor LO makes all sorts of negative comments to me when she wants to “go home, but I am able to ignore them because I consider them to be part of her condition. I love her, and I know that her “real” self loves me too, but her damaged brain causes her to say things she doesn’t mean.
Ask his present nursing home to notify you immediately if he attempts to take steps to leave. The medical POA can hopefully request this.
I totally agree with Countrymouse-your father needs protection, and your family needs support and sympathy in your ongoing efforts to protect and care for him.
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I don't know, but I wonder if your sister might do well to go for an emergency guardianship order while everything else is being organised. That should stymie the NH when it comes to who's the decision-maker, and as I understand it you can get it done pretty d--- quick.

Hmm. It would suit the NH fine if this extremely difficult patient were able to discharge himself, wouldn't it? I hate to be cynical but I suspect they wouldn't be half so keen on your father's autonomy if he were a sweetie-pie.

Is this NH actually equal to the task of caring for him? Might you need to look for somewhere a bit more heavy-duty?

Competence can indeed be a movable feast, they're not making it up or anything. But never mind the philosophy, what about protecting your father? I hope your sister will be able to take steps to do that fast.
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I went through the same situation except my Mom has no other relationship other than us her family. Her aids were stealing from her and I had to finally commit her to a geriatric psych ward for my second evaluation. She was taking her medication like candy. She had a UTI but still heavy with dementia.
I had hired a lawyer who represented me in court and Mom had to be served due to her legal rights. She is now in a nursing home and wants to go home. The guilt is riding me all the time but she wouldn’t take help from me and I had to leave a new good job due to taking off for all this before I got laid of.
Get legal counsel with someone who can advise you on what to do and save him from the heartless people out there. It’s hard but at least you have a POA for now.
Good Luck! God Bless!
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So, how does the NH determine incompetency? What criteria do they use? Did he agree to the initial admission, or did they accept him at the time over his objections because they deemed him "non-decisional" then?

I would think that if they allowed him to check himself out over his legally appointed and qualified POA's objections--especially when she has medical diagnoses supporting her decisions--they'd be open to a liable suit from the POA on his behalf. You might want to point this out to the NH and stress to them that the POA wants to make sure he doesn't act on such a foolish idea.

On the other hand, he may threaten to sue them to make them discharge him. Of course, he's not competent to accomplish that job; and if he enlists the help of his gold-digger girlfriend, that's not going to get far, either. At least not with a reputable attorney, and certainly not in court. You might need to tell the NH this, too; although it should be evident.

Good luck!
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Reply to Agingmyself
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Based on your other postings, your Father's situation sounds really, really complicated.  Maybe someone else can give you better assistance than I can.  Good Luck.
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