How can we move someone with dementia if she does not want to go to a facility?

Yes. I am too young to go to a care facility, but I am already on a waiting list for my favorite place -- a Quaker run place with gardens, libraries, art galleries, connections to a kid's school so that the older folk mix with young ones, and close to both the countryside and a big city and lots of universities. I begged my parents to move there, and, of course they wanted to stay at home and have my partner and I take care of them! I hope when I'm ready to go I do it cheerfully and graciously.

Ha! Love it. And I agree... One thing I have learned from all of this is to plan ahead. I am going to make my plans and desires known well in advance and accept that I may reach a point where I need this level of care. If so, I want my children to do the best they can for me but to do what is necessary and NOT struggle with this decision as I have. I think that is probably the best gift you can give your loved ones.

On the lighter side, all this is one giant note to self, I will not put anyone through this. I hope when I am old & demented I go to an adult family home that has speakers in every room playing my favorite music, gardens with bird feeders out side, and that I can know when its time to go.

Thank you cfant55,
I have thought of that....and I can understand how it may cause more problems by bringing her home. I brought her home for thanksgiving and it was fine (difficult to take care of her but emotionally fine)... But the next day she told me she should have had us drop her off at her apt. I tried to explain to her that we couldn't/wouldn't do that and if we did, we would have to live with extreme guilt when she fell and hurt or killed herself....but I don't know that she really understands that, she just wants to be home. I am just hoping for the best, but I see the situation getting farther out of my controll. Her body/mind is determining the way things will go now. Very difficult. Thanks for your thoughts on this and for sharing your experiences. It helps me and hopefully others reading.

Cindyy - Just a note about bringing your Mom home as much as possible. I had thoughts of doing this with my Mom, however, after lengthy discussion with professionals (including ALZ.org help line) - I followed their advice. Dementia patients need to adjust to being in a AL or NH - changing settings (even for a short period of time) is not good for them. I was also advised to keep my visits and phone calls to bare minimum for the first 2 weeks. That was a bit too much for me, so I went every other day instead of every day (we still need to insure the facility is suitable and meeting needs). I made visits short - and hour or two at most. I did take my Mom out of the facility about one month after admission which proved to me how bad Mom actually was as she had a panic attack when we arrived at a favorite park. Taking her to your home may confuse her even more and you may have a heck of time getting her to go back to the facility, keep that in mind - if that happened it would be painful situation for both of you. I never was able to bring my Mom home, which breaks my heart, but I did what was best for her.

Thank you Stephan and CarolLyn,

I have found all of the responses and other peoples stories helpful and is hope that the responses to me did nit take away from you Stephan. Our situations were similar so I hope you benefited from all of the stories too. CarolLyn is so right...each circumstance is very different and each family dynamic is different. Re: convincing to go to AL or NH...I am in the middle of that now so I do not know how to do it but I have no ability to provide 24 hour care in my home unless it can be provided through insurance which I am quite sure is not...my thought now is to find a place in my town or very close by so that I can bring her to my house as much as possible, but still have somewhere for her to be taken care of when I can't do it....not sure if I can get her to go along with this...she just wants to go home...and who can blame her. re: will insurance pay? It will for some I think..but if she doesn't have tons of money..you need to file for Medicaid for her..this requires a lot of paperwork so good to start early. It requires lots of digging through paperwork in her home and trips to her banks...etc. you need the POA to get the info from the banks and they need to bring that documentation with them to the bank. Good luck

Stephen, I am so glad you posted and that you found some help in the responses given here. I was concerned that we had hijacked your query in trying to help cindyy.

But I'm going to take issue with one response in particular:

"Simple answer, your Aunt, unless she raised you.... is NOT your responsibility...................period."

My aunt, my mother's sister, was widowed at the age of 56 due to an egregious hospital error perpetrated upon her husband, also 56, and with no ability for resolution through malpractice. They had no children. Due in full to my aunt and her husband, she and my mother were estranged from 1952 (when l was 7 years old) until 1982, when my great aunt died. Mom & aunt just never spoke of the past and what on as if nothing had happened.

My birthday was the day before my aunt's and she always felt a special connection to me because of that. With my mother's personality, one did not have a relationship with someone she was angry at, so I was also estranged from my aunt during those 30 years. But when it was " acceptable" for me to have a relationship with her, we bonded over love for my great aunt and over our animals, of which both of us had many. In short order, she asked me, if anything happened to her, would I take care of her animals, to which I agreed.

Unbeknownst to me, she went to her attorney and set me up as medical and financial POA as well as her heir. She lived in No. CA while the rest of us lived in So. CA so we didn't realize that, over time, she had become a cranky, reclusive alcoholic. She "retired" early but I found paperwork later that she had been fired. She was an accounting manager and she was treating her employees very badly. They give her time to clean up her act so to speak but she couldn't seem to do it. Of course, it was the alcohol talking, which eventually lead to the dementia.

At the time, my mom and I were dealing with my dads Alzheimer's so we were unable to take trips up north. Over the phone, for short conversations, let's just say she hid it well. It wasn't until she fell and the paramedics reported the squalor in her home, cat and dog feces everywhere and the hardwood floor under the carpet completely warped from urine soaking through. Smell-o-vision anyone?

Without rehashing the timeline, I stepped in and basically saved her. She was near death; the doctors didn't think she would survive very long. But I took care of her for 6-1/2 years and she was probably more well then she had been in the last 30.

Every circumstances different and there are no blanket rules. My and didn't raise me and, due to no fault of my own, I didn't even know her for more than half of my life. But this was my decision to take care of her and not turn her over to a public guardian. I took care of her because I could and because in my case it was the right thing to do. That doesn't mean it's right or not for someone else to take on that responsibility..................period.

I appreciated beachlover's response -- unvarnished, but true. So many of us caregivers will bend over backwards to help everyone and anyone -- it's good to be reminded about maintaining boundaries. However, my aunt called and asked me to be her advocate, so I did have a reason to be involved. And I did my best to communicate her concerns with her daughters, and they listened, and we discussed all the options, and came up with an equitable sloution that for now suits all parties. We'll see. But for now, that you all for your feedback. It helped.

Thank you for your comment ...it's so difficult and I appreciate any and all feedback to help me wrap my brain around this.

Cindyy,
From your last comment, I can tell you that it would be wisest and easier on everyone, including your aunt, if you put her in assisted living or whatever is appropriate for her. Your situation just screams no. Been there, done that, don't kill yourself trying to do the impossible. JMHO.

Thank you...and I do appreciate it. While the other persons comment was quite direct...I have some understanding of that too as I am not a fan of drugs and or nursing homes etc. however....I don't think it's that simple...some drugs are necessary at this late point in life due to mistakes made over 90 years of living...and I am just not sure how I can take my aunt home with me...I have a very small house with an extra bedroom that is now a play room...but it's upstairs and she can not get up and down stairs. She can get around a little bit with a walker...needs help with ADLs but can do some of it. I would have to move...which I am willing, but it takes time, effort, and money...I have two boys ages 8 and 10 who are very active and loud...and a little dog with sharp claws....both my husband and I work full time and the kids are always having sports so we are out most evenings at practices and games...not saying I'm not willing to try...I just can't figure it out....maybe if we had lots of in home help...but not sure if that is affordable ...we do not have extra income...neither does she...it's just a tough situation...but she has always been there for me and I don't think I could live with myself if I let her go into a NH now...she is too with it still...I just don't know....life stinks...I'm never going to get old..... :(

First, look at the insurance, many have complicated rules, need extensive paperwork from the MD's who must be willing to provide certain required tests. Second, the daughters should petition for guardianship, because if the court determines she is incapacitated, the insurance companies probably won't fight the judge.

Wow Beachlover. What is the point in voicing your heartless answer to this thread. I just can never understand people who go to the effort of writing hurtful words where there were none.
Cindyy, I agree the MPOA is important for any older person to have in place. Even if your Aunt doesn't go into AL, she should designate at least that so that someone can make her final wishes known. I would speak to the dr for sure like we talked about. I don't look at a nursing home like most people do. My father had a great many years where he completely took care of himself and managed his diabetes injections just fine. He ate horribly and junked out on sweets albeit ones with artificial sweetners. He right where he needs to be at this point because every time it tears at my heart to bring him home, I go to Nursing home to visit and help him try to just go to the toilet and with me helping him, He cannot even lift himself and he has even dropped a LOT of the weight that he had put on. So, I am not naive enough to think I can take care of him. If I were to suddenly become rich, I could insource it but at this point I am far from being well off.
In your case, maybe your aunt is still mobile and functional. If that is the case then maybe you can take her into your home. Some people do this for a while until it gets to the point that they can no longer handle their loved one.
My father has fallen 4 times this week because his obsession is to walk and who can blame him, his brain wants to get up. He wants to do what he has always done but his body can no longer do that. They are working on strengthening his legs in PT and I have hope that he will get more mobile at least. He still does not know where he is- he cannot remember that his wife passed away. He often thinks she is still alive. It is very sad, and I guess I get mildly offended when ppl propose to take an elder off of all drugs and that the simple solution is to bring them home and remove them from toxins etc. It sounds great on paper and perhaps that person is able to do that. Perhaps she has the bandwidth and the capital to pull it off. Perhaps that person is married and has a spouse that can help life the person to the bathroom and out of bed, into bed, get meals, wash their clothes and maybe theyhave children around that can watch the elder while they shop for groceries or port children to school.
I for one, don't have those resources. I also don't think you can speak to a person's condition when you don't know their history and you haven't watched their digression. That's just what I think. Srry for this mean person being short with you. Most people are nice on here. xoxo BG

Yes, my aunt raised me and she is my responsibility....even more so than a "real" mom....she didn't have to raise me....

Simple answer, your Aunt, unless she raised you.... is NOT your responsibility...................period.

Why does she have dementia in the first place? is it caused by the prescribed drugs and vaccines that her doctor is pushing on her? is she taking a statin? If so, then FYI, statins do cause dementia, along with congestive heart failure, muscle wasting, cancer, kidney and liver damage, etc. Instead of forcing her into a nursing home, you should consider advocating on her behalf AND questioning the doctor on the drugs she is taking. You should even consider weaning her OFF of all of her drugs and switching her over to a more healthy regimen of supplements and non processed foods. You might be surprised at how much your aunt will improve in her abilities to care for herself once those toxic/deadly drugs are flushed out of her system. A lot of people on this list are pro the medical system but according to the famous Starfield Study, JAMA, 2000, the US medical system is the THIRD leading cause of death and over 100,000 people are killed each year due to taking properly prescribed drugs. The nursing home IS NOT the answer for your aunt. In fact, the nursing home could be very dangerous for her. Best to keep her at home and keep her away from any drug and vaccinating pushing doctors. I provide this advice based on the very bad experiences we had with drug pushing doctors, a nursing home and hospital. Our mother is home now and doing much better. Aloha and good luck.

Cindy - while it might seem like the compassionate decision for you to move your aunt into your home, you have to consider the effect it would have on your life. Whstever you see right now in terms of her behavior and medical conditions will soon not be the case. Unless she develop some kind of disease or illness it kills her before the dementia progresses, you are looking at a future of homecare taking which includes confusion, disagreement, obstinance, incontinence, hygiene problems (refusing showers, insisting on NOT changing their depends), sundowning (up all night _ how will YOU get any sleep?), exit seeking and attempts to wander (get out, get away, "go home" when they're already home), depression, and on and on. Unless you have a huge support system at home (which will quickly become damaging to your family life) or lots and lots of money to hire in home help that you still need to supervise and evaluate and sometimes replace, you can't afford psychologically to have her in your home. It may seem like a good idea right now but at some point in the near future you will be wishing you hadn't done it.

Stephan, my sister and I are in the same boat as you. Our mother has mild dementia and is living alone but shouldn't be. She has always told us she NEVER wants to move out of her house. She has told us that if we move her to AL, she will cry and cry, and then she will die within two days. She refuses to even go on a tour of an AL to see what it is like. Until she gets to the point of getting her POA activated by two doctors, there is nothing we can do about it. More than one professional and friends have told us that we are just going to have to "wait until something happens to her" and then we can get her moved. It's very frustrating. I understand what you are going through. Good luck.

There are groups around that have Gerontology Case Managers and there are Gerontologists and Neurologists that can help you have your Aunt evaluated and assist you with have her put into an Assisted Living Facility or Nursing Home. My mother was hospitalized and I had to tell everyone and their dog that she "has dementia." They would come in an begin asking her questions and she gave wrong answers and I would have to jump in and explain, "My mother has dementia and you have to understand the answers she gives you will most likely be wrong!" When she began sundowning in the evening we asked for medication to calm her and it reacted the reverse on her and she went wild! Then everyone realized they had a person with a problem on their hands....up to that point she seemed absolutely fine and could carry on a conversation and even joke a bit with the nurses, so I looked like I was an idiot and Mom was fine! When this happened day after day, one doctor took me to the side and said, "You need to put this woman in a nursing home, you cannot take care of her alone, you will fail, you will hate yourself and you will make yourself sick....put her in a home!"

If this happened or happens to you, this is exactly where you jump in and say, "Okay I need someone to assist me with having her admitted!" You are doing it on the advice of a doctor!

It does not sound like your aunt ever had a Trust or a Power of Attorney, if she did the POA could have her admitted, without that you have to seek to be her guardian and she will have to have testing done to provide the evidence that she is legally incompetent and needs someone to make these decisions for her.

I doubt that there are very many people at all who will willingly say, "sure I will agree to move from my home into assisted living or a nursing home, and that is especially true if they have dementia or Alzheimer's.

I would speak to my aunts doctor and lay out the situation to him and see if he can offer any assistance. Perhaps getting a social worker in place or finding a gerontologist who specializes in dementia or Alz to help would work as well. Do not stop asking everyone you know for help. You really will need to have her tested for competency, this is a must. I think when you tell them, she can no longer stay in her home, her daughters can no longer care for her and she is financially broke so hiring a caregiver is no longer an option, I think some doctor will listen and help you.

In my mother's case, she was brought home, we got her to a good doctor who prescribed the correct medications for her and she is doing very well at home with me caring for her. The correct medications in my mother instance where a game changer!!! She sleeps and we no longer have angry outbursts, she is calm and easy to handle. Thank God!!!

I understand where your dilemma comes in because no one wants their loved one in a place like a nursing home if they can manage at home. I guess you have to figure out what will fit into your own life and what you feel comfortable with. I have and still have a lot of guilt feelings about my dad even though he was not that great of a father. Since I was the MPOA, I am responsible for him being there and he of course doesn't like it. If I had more backup from family it might be different but I don't. I do know this: My father needs 3 meals a day, plus snacks, bloodsugar checks and medicine adjustments, He also has hi bp, is agitated beyond belief. He gets up at night and falls. When he could walk he spent all of his time trying to leave. I knew that unless I could clone myself 3 times I would quickly burn out. The dr visits alone for someone with my father's kidney disease, diabetes, gout, dementia, and now stroke, I knew that I cannot keep up with all of these things. I am thankful that he is overseen by professionals. He has meals that he can take in his room. He can do pretty much the same as he was doing at home which is to sit and watch TV in his chair. If I was ultra rich and had the money I would set that up at home but I'm not. Plus he gets the social aspect of it too. I can focus on enjoying the remaining time he has and he gets fresh aides and nurses around the clock who bathe him, feed him, minister to him where I cant. My father needs that but perhaps your Aunt isn't at that place.

Butterflygrl is right. The other way to get incompetency declared is to take the "emergency" route. However, it doesn't sound like your aunt is in the state you'd need to be in to do it that way.
So, again, if I or my loved one had LONG TERM CARE INSURANCE (I assume that's what you're talking about when you say "insurance"), I'd be beating a path to the door of the most luxurious AL in town!
Read her policy carefully – many of them cover AL (doesn't need to be SNF) and most have set limits (per day or lifetime). If you're confused by the language, take it to the AL you're considering, they've seen plenty of them. Even if her policy covers a set daily limit, she'd only have to make up the difference and it surely would be less expensive (and BETTER for her and her family in every way) than paying for private aids at her children's expense.

p.s. - A visit to the elder law attorney is advisable, too.

Butterfly girl,

Thank you for the response...sooo helpful...my one question...how did you deal with the decision , or, nit, to take your dad into your own home vs. A nursing home or Al? My aunt raised me and I feel I can't put her in a NZh or naybe even AL...but....I don't know if I can care for her at my home....so hard.....

Oh and BTW, all the POA stuff we printed out and he signed with witnesses. The DPOA I did at the nursing home who had a notary. End of story. So whoever is going to be the designee doesn't need a lawyer for that either. Every place I take him they ask for copies and I have had no problems. Even SS office and the HMO he was on took the copies and I have had no problems. NO lawyers. thank god cause I can't afferd it. :P

This subject is near and dear to my heart as well. I can't tell you how many people told me that I could not move my father into a nursing home "against his will". I personally think there is a great deal of confusion about this subject and people make it harder than it has to be. My father had been driving erratically even before his wife passed and once she passed it was even worse. He could not find his way home. God knows what a danger he was to other drivers. He lived in my hometown 4 hours away. We had already had him sign a MPOA in case of emergency with me as the designee. My father lasted 9 months after his wife passed falling down, driving around erratically, having delusional episodes where he had left his house and was stumbling around in the dark with no shoes on and terrified that ppl were in his house that meant him harm. Even still with him in this condition, I went to several dr visits with him and his GP finally did a short memory test and determined that he had dementia. he then ordered a bunch of diagnostic testing like MRI and such. Well, I had to call upon family members to take him to these tests but he would get there and assert his will that he didn't want to do it etc. etc. These are the same folks who think that told me repeatedly that they didn't think you can make someone go into a nursing home if they protest. Finally my father started falling all the time and he told me on the phone that he thought this must be the end- that he was dying. He couldn't stand up without feeling dizzy etc. My Aunt and cousin kept asking him if he wanted to go to the ER, Dr etc. Of course he said :NO.
I would be on the phone and so exasperated because I couldn't get my family to override this man who could not make decisions for himself! arggggh. Eventually I talked to him and he couldn't even make one decision so since I was MPOA, I told them to take him to the ER. My aunt is a devout christian had trouble telling him a white lie that she was taking him to the ER because I told him he had a dr visit. :( Once he got to the hospital, his blood sugar was 700+. It was so high that it didn't register on the machine. Of course he's feeling messed up. He was very agitated cursing so they moved him to a behavioral unit. By this time the dr had told me he can no longer live alone. Up to this point I had agonized over how to get him into a safer environment because we had been through this with my aunt and she kept falling and laying on her floor for hours or days and my fahter and I were upset about that happening and I was determined that that would not be the case for him.
Even AFTER the dr told me he could not live alone, a nurse at the behavioral unit told me the same thing. She almost scolded me that I could not just drive up and deposit my father at a nursing home and that it was a misconception blahblahblah. I was very distressed by this because I was on this forum and people would say, oh it's very costly to get guardianship, you have to get a lawyer $$ go to the court and the person has to go before a judge and the judge has to determine him to be incompetent. I was mortified that this was the system because I didn't want my father to stand there and be humiliated in this fashion after living his whole life. I was so frustrated that they could let someone who couldn't make decisions decide about his care.
Well, I'm here to tell you: someone contacted adult protective services anonymously. I suspect it was the dr's office. That too sounds scary to me but it turned out to be the best thing that could have happened. The drs at the behavioral unit were the ones to do the evaluation and declare my father incompetent. There was no lawyer, no judge. The woman at adult protective services told me that my father HAD to go into full time care or else I would be liable for elder abuse. She followed up with me after I moved him into a nursing home near where I live and finally he is safer than he was at home by himself. The nurse who preached at me was the one to get his paperwork ready to go and she didn't utter a peep to me. I was really angry about this because it was so unnecessary. The whole situation is emotionally charged anyway and it really isn't up to family members to make these calls. If your aunt is unsafe or you feel that she needs AL, then this needs to be brought to her Drs attention and then she be evaluated. No matter even if she can talk pleasantly, these drs have tests to determine their competency and they will tell the family if she is at the point where she needs this care. If so, they can declare her incompetent for the purpose of making big decisions and once it gets in motion, it has a momentum. They didn't go to my dad and announce " you are incompetent!" or anything like that. They treated it like a drs order. I was so relieved. In this region, Texas, louisiana, it is considered elder abuse if they determine they cannot be alone. You can be charged with it so you are forced to resolve the situation. In our case, I could not manage my father from 4 hours away and the family was so wishy washy on it I am happy that he is near me. I would not go paying a bunch of lawyers and getting all of these papers drawn up because of course they will initiate it for you, it lines their pockets. I would talk to her drs. If she is at the point where she cannot be alone, then it isn't up to her anymore.
One thing they told me is that it is much easier on them if they go straight from a hospital to the NH rather than home and then decide. I personally think you have to proceed as if they are like toddlers ONLY in that they can't really make proper decisions because their brain doesn't have the capacity to. Sometimes, you have to trick toddlers into eating or bathing/going to bed. Personally, I didn't sit around asking my father what he thought about it. After the authorities got involved, it was done and I am so glad. If your Aunt has dementia, it will progress so it's not a matter of if, it's a matter of when. It is so much easier without all of this upheaval and I can't tell you how much heartache it caused for people to tell me that he could do what he wanted. I wish the best of luck and PM me if I can help sort it out. hugs BG

Yes, gladimhere , you may be right...except that she gets very upset when we suggest that she is having difficulties...she is great at making excuses for forgetting to pay bills etc. even when I straight out tell her of an error she has made...she brushes it off (or gets upset). There is no one close...I am really the only one...I am 45 min away...there is a neighbor upstairs in her apt that has been "helping" her for the past few years but through all of this I have discovered she has taken a fair amount of money from my aunt..in the form of loans...which she has not and can not pay back...so I feel she is using my aunt for her financial needs. The neighbor is also very controlling and gave my sister and I a VERY difficult time when we began getting more involved after the fall. She has been quite verbally abusive to us. I have to report her to elder services to protect my aunt....my aunt, thinks she "needs" her because she has been thoroughly brain washed by her. It's all so complicated. I don't want her to go back home and be unsafe, but I can not put her in a NH ....maybe ALL, if she will go...but I know she won't....I am sure she would come live with me but I am unsure I could handle that...full time job, two young boys, dog, upstairs bedrooms...we would have to move and still get lots and lots of in home help.....just not sure what to do....

You can't make her go anywhere as long as she is still in her right mind. Assisted living is probably NOT covered, read the insurance policy.
Her MD would have to recommend aides covered by Medicaid if she is eligible.

Cindy-
in some ways you are fortunate. Perhaps the dementia has progressed to the point that she doesn't think she has a memory problem. Imagine early in the disease how difficult it must be for them, knowing something is wrong but not knowing what. My moms disease has progressed to the point that she really believes there is nothing wrong with her which is much better than where she was a few years ago, terribly depressed.

Often times people with dementia are very successful in covering up what is occurring. Is there a friend or family member that spends a significant of time with her. I do not mean a few hours each week, a few hours a day would be required at a minimum.

This is so difficult...and near and dear to my heart...my aunt, who is like a mother to me, is in a rehab after breaking her hip. We are not sure where she will go from here..she fully expects to go back home, with help, but I think the rehab feels a NH or AL is the appropriate place. My aunt has not been declared incompetent because she can have a nice little talk with you for a short time and can answer basic questions like what year it is.....however, she has almost NO short term memory and makes really bad decisions, like paying someone over and over again to clean a clean, empty apartment....to the tune of 650.00$ in 4 months time. She doesn't pay her bills, etc. etc. tells me the same thing multiple times in a short conversation, etc. I don't know what to do either, it's a tough situation. She doesn't even think she has a problem with her memory. How do you tell a 90 year old person that they are so impaired? I am trying to keep her from getting depressed....not make her more depressed. I think I am in that waiting it out phase that someone mentioned earlier...

I am in a similiar situation. My father is 90 has good days/bad days. recently moved my mothers diabetic medicine (which I had to find), and other things that mysteriously disappear but yet "he claims he didn't have them". I am going to check with our office of aging for some guidance, but not "all" older people think doctors are "gospel in their words". My father HATES all doctors so its hard for me to get him to go to one for just a regular checkup, only if he has an issue will he go anywhere. So I can't answer your question other than I guess get some guidance from someone (doctor, elder attorney, ?) to help you make your decision easier.

As a professional caretaker I've seen many elderly who did not want to enter a facility till after a medical disaster {falls, etc.} They would give many reasons to stay home, except one:: The FEAR of change. To some degree they are aware of their memory loss, hence are afraid of having to get used to, and MEMORIZE , a different life situation...That is DEEP DOWN absolutely scary to them.... but they can't put it into words....often don't fully realize that this is the core-fear. .....Reassurance, stating in a loving way that they will not have to remember a thing, that the personnel at the home will remind + help. DELAYING present visits - to make them realize how much more help they now need - is another way to convince...!!! Explaining the need for PoA to keep them safe should something happen,+ the often not realized fact, that without PoA, Doctors + Hospitals cannot talk to family about the elderly's heath condition at any point in the future also emphasizes that Families should discuss end of life possibilities very EARLY, while reasoning is no problem yet... and explain that secrecy toward Family can only lead to disaster ...Get the elderly + family to understand their financially possible choices + keep suggesting that memory status, not only physical disability, is a big reason for timely change.... keep stating how Family will have LESS WORRY about their safety, would have more time for pleasant visits, instead of chores + expense to keep the old house running. Emphasize the fact of no longer having to get oilchanges and pay car insurance, Emphasize the much safer travel choices the AL-Home provides, that would reduce FAMILY WORRY !!! Emphasize fun weekend vacations spent with family... and how important those easy visits are to the whole family Unit... Convincing them of all those facts, makes the eventual change easier for them...and spares them the HUMILIATION of HAVING to APPEAR BEFORE A DOCTOR/psychologist TO BE CHECKED FOR MEMORY ABILITY AND REASONING prior to a PUBLIC competency hearing..not to speak of the initial expense and the constant reports +expense that the courts require there-after. Wishing best outcome to all !