My 93 yr old aunt (no children or spouse)lived alone in NYC. She fell several months ago and suffered a broken hip, brain bleed and concussion. She was not discovered until at least 12 hours after her injury. Had she not been expected in Chicago that day for a visit no one would have found her. My cousin called the doorman after she didn't show up on the airplane and had him break into the apartment where he found her on the floor. My cousin flew in for her surgery and then I came into town from Virginia to get her moved from the hospital to a rehab. After her rehab my brother moved in with her (temporarily) to help her until she was back on her feet. She has home health aides 8 hours a day. Her mental health has continued to deteriorate and we now realize that she will never recover to the point of being able to live alone. My brother needs to go back to his life in Washington State. He is completely burnt out. My cousin and I found a care facility for her near my cousin in Chicago (I live in VA) but she says she would rather die than leave her apartment.
Her closest relatives are her sister's children and the widow of one of her nephews. (My cousin and brother and I are more distantly related although emotionally closer with her). The widow holds POA and Health Proxy but doesn't want to actually be involved with her care. The other 2 argue that we can't force her into care and need to accept her wishes.My cousin and I argue that she is mentally incapable of making decisions regarding her care and that we'd rather she be in a home than suffering a gruesome death at home alone.My aunt is physically incapable of living alone. She requires help using the toilet, dressing, etc. let alone paying her bills and managing her healthcare. She has recently not only had memory loss but full blown hallucinations where she thinks distant relatives have visited her.My brother is on the verge of a nervous breakdown, he is averaging about 4 hours of broken sleep per night because she gets up and forgets to use her walker or starts yelling that there's someone at the door when she hears noise from the street. She insists she doesn't need help but when he left her alone for 1 hour last week (she was angry at him telling her what to do and told him to get out) he came back to find that she had tried to get the mail, wearing only underwear and her robe and a neighbor had found her and helped her get back to the apartment. She was in the hallway, unable to figure out how to unlock the door.My cousin and I are unable to leave our families and obligations to just fly to NYC and take care of her. My brother has lost his job and his apartment back in WA and has blown through his savings caring for her.At this point we don't know what to do.He cannot continue to care for her.We cannot afford for private in home care and even if we could get her approved for 24 hr care through Medicaid, we've been told the aides cannot dispense medication.We've also seen evidence that some of the part time aides have stolen jewelry, cash and clothing from the apartment even with my brother there. We are concerned about what would happen to her without a family member there to watch out for her.The family member with POA and Healthcare Proxy will not take action to be declared guardian.None of us with the willingness to do so can spend that much time in the city (for court) or have the money to pay the court fees.Is there any option to keep her safe other than reporting to APS and getting her made a ward of the state?
Editing to add: The facility we found near my cousin in IL has a MC wing that she would qualify for with her Medicaid. (No private rooms unfortunately, she'd have a roommate) She currently lives off her Social Security and her apartment is both rent controlled and partially paid for through a local Elder Care group.
Please give suggestions. We are out of ideas.
The niece who is PoA does not have to be involved in her care but if the Aunt doesn't ever have a formal diagnosis of cognitive incapacity, then the PoA authority is not actually active.
Your Aunt will eventually be assigned a court-appointed guardian who will manage her affairs and make decisions on her behalf. Although this is probably disappointing, it is a still a solution -- and probably the only solution.
1. Brother needs to write the POA for Aunt that he is leaving, and present the date he will leave. This should have been done on day one, but that's neither here nor there, as it wasn't. Now it must be. I would give at least one week notice.
2. Brother informs agency help caring for Aunt of his leaving, and that POA was notified to assume care. The numbers for the POA are presented to all caregivers/agency.
3. Brother calls APS and informs them he is basically slave labor who allowed Aunt to be delivered home, discharges unsafely from rehab without any legal proxy to act for her, and that the legal proxy REFUSES TO ACT. He tells APS of his date of exit.
4. APS either will step in or will not. Agency should be informed to call EMS to have Aunt sent to a hospital if the Proxy does not assume care. She will then likely be placed in guardianship of the state.
The health care proxy should be informed of all of this. She can then assume her Fiduciary duties or resign them, giving care of Aunt into the state as would happen were there no family whatsoever.
I am very sorry that your family stepped in here. You cannot act for someone without the authority to do so. Aunt now has dementia and cannot appoint a new POA I am assuming. Brother has already forfeited his job, which is extremely sad, and very poor decision making, as he has placed himself in a limbo that cannot continue.
I am so very sorry. Your message to us, I hope, will serve as a warning to any who are thinking that any of this could possibly work out well.
My thought here is that the health care proxy has no intention of doing this difficult work. She will almost certainly not assume any POA duties. Aunt will likely have to be sent back to hospitalization from which she will be placed, but this will likely to handled only through state authorities via APS.
He refused. He also made promises he could not keep (which I and my cousin told him not to do- namely promising her that she wouldn't have to go into a care home). I know that his choices were not the best. Unfortunately he refuses to just leave her. Hopefully the advice I'm getting here will help persuade him that this is our best choice left out of the lousy options remaining.
If aunt has enough money to pay for 8 hrs in-home care per day, does she have enough to pay for 24 hrs of care? If so, tell him to hire more help. He would be there to oversee the goings on, but others would be doing the care. He can handle the meds since home health folks won't do it.
Once she's getting close to spending up the last bit of savings, he can call ambulance to come for her during an episode of hallucination. When hospital gets ready to release, you get her released to a NH in area near hospital: tell staff she's not safe and has spent all her money to provide 24hr care and not enough relatives to cover 24 hr care for her. Her memory has reached a point of needing facility care.
After you get her in a facility, you can make arrangements to get her moved to the other facility that is closer to relatives.
He has repeatedly attempted to get her additional hours of care. He is currently working with an elder care organization that is helping him appeal after being denied the extra hours that the doctors recommended. Unfortunately they are telling him that he may have to initiate a lawsuit against the insurance for denying her the hours of care. We're not sure how that will progress but he has attempted to submit a new request for additional hours after her most recent hospital stay.
They don't need to do anything legal to be declared her guardian.
All the POA/Medical POA needs to do is to find a place and get her accepted. She might not know what the financial situation of your aunt is, that would be daunting. Find out if the POA/Medical POA will allow the move to Chicago. If not, then ask the POA/Medical POA how you can help. If she wants her to stay in her house, without extra help, then let it be and call adult protective services and walk away (it will be rough, however, sometimes, that is the only way you can get some people to recognize the dire consequences of the situation.)
Yes, all dementia patients don't want to move. That is normal. However, you have to do what is right for people who do have all their facilities.
Moving to Chicago might not be a good thing. Medicare will change assuming that you change her address. In addition, since she has assets in another state, when the time comes to divide up the estate, it will cost the executor even more to settle her estate because of rules in 2 states, versus only 1.
I would:
1) Remove all the emotion out of this decision and agree to do the best is what you can do, given the circumstances.
2) Formulate a plan and alternatives in your head about what you want to do if you were making the decision. What to do if she were to stay in NY, what to do if she were to move, how would you move her, what would you have to bring, how is she going to pay? What happens with her current home? Decide what you are willing to do and not willing to do.
3) Go to the person holding POA/Medical POA to see what they want to do.
4) If you and the person holding POA/Medical POA cannot come to an agreement on a plan, you and your brother have to walk away.
5) Help the POA/Medical POA, if you can, to deliver on their ideas. However, if they don't want your help, then walk away, but keep the offer to help open.
Even if you aunt's mind becomes unfuddled, she will never be completely independent like she used to....and no one wants to think about all the responsibility that was just heaped on them.
I'm sorry you are going through this, however, this is only the beginning.
One last word of caution: No matter what happens, do not feel guilty. Try your best, yet respect the decisions of others....then when stuff happens (and it will), try your best again. Do not become a nagger or I told you so....just keep on accepting the present and try to make a better future. This part of the journey will test your patience, negotiation skills and all your preconceived ideas of the life of the elderly.
You will and can be a better person out of this.
For Medicare (not Medicaid), moving to another state is not particularly complicated. If she has a Medicare Advantage plan, she probably would need to change it, but change outside of open enrollment is allowed when somebody moves. Medicaid IS quite complicated to change, if you move to a different state, because you must apply for and be accepted by the new state's Medicaid. Also, if she now has Medicaid while living independently, she will need to apply for institutional Medicaid (I am not using the correct term, which I don't recall) even in the same state.
In my hubby's case, the doctors realized his kidneys had failed and he only had about 10 days to live. We got hospice and brought him home to die which he did about 5 days later.
You could see what arrangement the facility you pick can make, and perhaps paraphrase your call to 911.
We would need to send her by plane with a family member as escort. The big fear there is that she might agree to the flight to see everyone but then refuse to go into care once she's there and there is no where for her to safely stay outside of care once she's arrived.
If after ‘oats’ for a week or so, she still wants to stay and die at home, just let her. It’s not an unreasonable choice, just hard to live with as an observer.
I can’t say it would work for your aunt but I’d tell her there’s a wedding or a new baby to see in Chicago and then check her into the memory care telling her it is a hotel or tell her it’s rehab. It’s not like she will be able to walk out and go to the airport by herself.