I have now moved from being a companion for my 83 year old mother to a caregiver as her memory and dementia worsens for the last three years. At times, we can still have serious conversations about her worries and her losses of recall. I want to discuss with her and have her reiterate to me her wishes for long term care. What are some gentle questions I can probe of her?

I have told my own daughter, I want to have her establish a stepping away point ahead of time for caring for me, if my future repeats like my mother. I tell myself that when she becomes incontinent or begins to have safety issues living in my home or her home, beyond my abilities to care for her, I will need to get help. Right now, I just sadly deal with her worsening ability to engage in anything productive, her moodiness, her restlessness and long hours of wakeful nights, appetite and eating and of course repetitious conversations. I am a widow and other sib are all about 600 miles away in different states. Mom is in good health otherwise - still cares for cat and dog which are happily fed often. Loves to be outside and has always been an introvert. Others are questioning this path I choose as it is a sacrifice for my own married daughter to be so far away for long period of time. I tell her, I do not feel like my life is "on hold", I am doing what is kind and necessary, I love and enjoy her company. My brother has power of attorney, but I help mom keep up with mail and bills. Maybe she is now beyond asking any questions. She just seems to want to talk about the important things right now -- as she scrambles to hang onto her life-long sense of responsibility. She has a little resources for assisted care, but family argues about the need for this and what it would do to her if it was forced on her. This is so sad... but not having a plan may be worse.

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P.O.L.S.T. This stands for Physicians Order for Life Sustaining Treatment.
This document contains the following information...
Section "A" and you check one.. Attempt CPR or Do not Attempt CPR
Section "B" Medical Interventions Full Treatment:, Primary goal is sustaining life by medically induced means or
Selective Treatment: Primary Goal of treating medical conditions with selected medical measures. or
Comfort Focused: Primary Goal of maximizing comfort.
Section "C" Medically Administered Nutrition:
Long term,
Trial period
No medically administered nutrition
Section "D" Document of Discussion :who detailed the information provided
Then the rest is various signatures
Each one of the sections goes into a bit more detail than I have indicated here but this is the basic information on the POLST . As you can see it is a bit more detailed than a DNR.
And a few things to remember with a POLST or a DNR if you do not have them with you when the person is taken to the hospital, if it is not available when Paramedics respond the document for all intent and purpose does not exist it has to be present or the paramedics or hospital staff will resuscitate. That is their job. So always keep a copy with you, make sure that the hospital is given a copy.
And this document CAN be changed if circumstances change.
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Reply to Grandma1954

Good for you as being proactive is far better than being reactive. One thing that I did experience and I'll pass along to you is that basically everything we tried when I had to move in with my late mother from out of state fell by the wayside---oftentimes at the virtual eleventh hour and we had to start from scratch.
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Reply to Llamalover47

Making a plan is always better than not having any. If your mom is capable of telling you her desires, or if she's already put this in writing somewhere (with her lawyer who did her Will, Trust, POA, etc.), then looking at this can be extremely helpful.

You sound like a loving and caring daughter. I'm sorry you are a widow trying to go through this with little help. This is one of the hardest jobs on earth, being a mom is difficult, but being the caregiver of your own mom or dad at times is overwhelming. Thankfully, there are people who can help. It might take some time to find those who will be supportive of you and your mom, but they are out there. Hospice is a huge god-send for so many people and I always tell people that you don't have to wait for your loved one to be completely bed-ridden or actively dying before calling in hospice. While there may be various diagnoses that can place a loved one in hospice care, typically if there is a serious illness (cancer, Parkinson's, failure to thrive, etc.) and a medical doctor has stated that the patient has 6 months or less (by what they can tell), then hospice can be called to evaluate and determine whether a patient is "hospice worthy." Your mom may not be at that point yet, but it's nice to know that this is available when the time does come.

I trust you will get the help both you and your mom need now and will need in the future.
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Reply to busymom

This is an excellent question. I had these discussions with mom and dad and thought I was prepared. However, sometimes their medical conditions become something that neither the parent or adult child anticipated. Sometimes, the condition isn't "cut and dry" so to speak. When that time comes, your parent may not be able to express their wishes and your earlier decisions might not apply very well. Do your best to touch base as you go through this. Also, ask your parent's doctor relevant questions. And after all of that, trust your heart.
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Reply to lynina2

I would and am going with the last cognitive wishes my father had expressed to me three years ago. This makes it simple at least on the funeral arrangements. He wants to be home, at this point in his disease it’s very difficult, he can no longer support himself so falls when he tries to walk. We have now brought in Hospice for him. I bless them with everything I have. An aide comes three times a week for bathing him as I cannot do it myself. They provide all meds, underwear, bed pads, soaps and lotions for bathing at no cost to dad. In my area they also have overnight respite for five nights maximum for emergencies or if I want to take s few days off that can be arranged also, I just have to be flexible on when as it’s if a bed is available for those occasions. They also have a companion person that will come if I need to go out for errands, they just aren’t allowed to do more than make sure he stays safe. You see why I bless them!
This would enable you to be with her if her desire is to stay at home, but it would be a longer commitment from you. Also because Alzheimer’s is such an up and down disease there are criteria that the patient must meet to be eligible. Dad being in the bed meets it. They reevaluate the need every 90 days and should he suddenly exhibit the ability to get out of bed and walk and care better for himself services are withdrawn until another decline. I don’t think that I have to worry about that at this point.
Anyway if she wants to stay home I highly recommend that you get her primary care doctor to evaluate her and recommend hospice if she is ready.
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Reply to Glendaj2

You mention you want her to reiterate her wishes so it seems you have discussed this in the past, are you sure you want to have this conversation? What if she has changed her mind? What if she says don't ever put me in a nursing home, or that she wants to be full code, are you prepared to reconcile that with the wishes she has expressed in the past?
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Reply to cwillie

The Five Wishes booklet is a great way to start.
A P.O.L.S.T. should be one of the documents that you get. It is much more detailed than a DNR and it will cover many of the things that you would want to bring up with her.
Please also discuss Hospice and the advantages to Hospice when "conventional" measures no longer are a viable option.
The POLST, and Hospice can be discussed at home and with her Doctor at the next appointment.
As you get into discussions bring up her wishes for the type of service she wants, music, cremation, burial or donating her body. And all the other "Stuff" no one wants to talk about.
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Reply to Grandma1954
busymom Dec 3, 2018
Grandma 1954, I have never heard of a POLST. Can you explain it a bit? We had DNR in place for both of my parents and we used hospice for them, too. I am now dealing with elderly aunt and uncle who made no plans for future care and have become "wards of DSS." Both my husband and I have learned so much as we cared for my parents (who had plans in place, thank the Lord!) Because of what we've seen with my folks and my aunt and uncle, we want to make sure we have thought-out and planned as much as we can for our future care needs. I guess I could Goggle the POLST, but I'm sure others would also benefit from your explanation of this. Thanks so much.
You will want to try to have this conversation at a time that is good for both of you. Usually that would mean morning for your mother, maybe at a relaxed breakfast. Or, if you are not ready to think clearly at that time, over a mid-morning coffee or tea.
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Reply to Joanies

The Five Wishes booklet is quite helpful. Available online.
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Reply to jjmummert

I’ve read Countrymouse’s UK site, and it’s really good, particularly on ‘business’ type issues, well worth a look. There are also healthcare issues for your mother, and things that relate to people in her life.

The healthcare issues are things like ‘do not resuscitate’, ‘no tube feeding other than short term’, ‘no supplementary feeding if I do not wish to eat’ etc. Perhaps Hospice could give you a list. I’d say ‘these are things some people don’t like and get upset about’ rather than ‘do you want this or not’. Make it a general discussion, rather than a rather frightening plan for her. Try to avoid ‘I don’t want to go into care’. It may have to happen, and her comments would make it worse for you and for her. Perhaps you could focus on ‘what would make you think that going into care was the best thing to do’ - and bring into the discussion the impact on you as carer and other people involved.

The ‘people’ issues might be quite enjoyable to talk about. Ask her how she would like to think things will work out for grandchildren, nieces and nephews, yourself etc. Are there any of her special things that she would like them to have eventually? Would she like to leave them with a letter, a family history, or even just a message with her best wishes and hopes?

I hope that you can find a way to make these conversations happy and rewarding for you both.
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Reply to MargaretMcKen

Begrateful, the link below takes you to a UK government website for people who want to create Lasting Powers of Attorney.

Obviously, this is not for you to use as intended; the reason I'm suggesting you have a look at it is that it discusses the decisions involved.

You can skip all the bits about Financial LPA because your brother is already handling that. But in the UK there is also the Health & Welfare LPA, and the notes about that are, I think anyway, pretty well done.

In particular in Section 7 it suggests the *kind* of thing that might be important to people trying to plan their future care; and it explains another key point, which is the difference between giving instructions, and expressing preferences.

Anyway, I hope it might be helpful.

When it comes to considering options for her care, if her needs develop beyond what can be managed at home, what is available? Have you had an opportunity to visit any facilities, do you know the reputation of those near you?
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Reply to Countrymouse

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