My 83 year-old mother has intermittent episodes of confusion, crying, and agitation. She does not want to go to a nursing home.

My own opinion is that attempting to be POA or Guardian (yes, about $10,000 and you can't get it without proving person incompetent legally) is that it is an impossible task. Given that you end responsible for everything, bill paying, meticulous records, dealing with entities hard to deal with and you have an uncooperative person it is almost impossible to do.

I would tell the rehab social workers that you cannot act for your mother legally, that you haven't the knowledge nor the time and cannot control her, and that you are requesting that APS examine her for competency and diagnosis. I would tell them that you want state guardianship and that sending her home is an "unsafe discharge". It is important that you use that exact wording--unsafe discharge--and repeat it to nursing, discharge planning, social workers, doctors.

I would allow the state to take guardianship. You do not tell us here that your mother even has a diagnosis. It isn't clear whether she is suffering from dementia or from mental illness. She doesn't seem to have a diagnosis. She needs help you really aren't qualified to give her.

If she does go home call APS for wellness checks. Do not enable her staying in an unsafe environment on her own.

I am so sorry you and your mom are going through all this.

Use these words “unsafe discharge” and keep repeating them.

Yes, there is no diagnosis. I believe it's an underlying mental health issue that is now more pronounced. We've always suspected bipolar or something, but she refuses to take anything other than the depression meds she's been on for over a decade. Now complicated with age, it could be dementia as well. For the last two years, she's had UTI, and when she gets those, she hallucinates and is completely confused, but once in the hospital, she's come back to normal. This last infection was c-diff and the same thing happened; she was in the hospital utterly confused and not okay one bit, received treatment after that, she was 'normal' and was sent to the rehab center to get stronger, but now it's more and more apparent that she's not stable mentally.

Try to keep her out of the facility as long as possible.

I would contact her primary physician and appeal to her/him to work with you to give her a cognitive/memory exam. Your Mom's PoA will need this to activate the authority. Then the PoA will be able to prevent her from leaving.

In my personal experience with getting PoA activated, the doctors are very sympathetic and willing to get this done. I'm PoA for my 105-yr old Aunt in FL (I'm in MN). She has been amazingly cogent up until these past few months. She is barely mobile, living in her home with a paid family caregiver. Because I had accompanied her to past medical exams and met with her primary doc, I was able (over the phone) to get her this doctor to do a house call (yesterday) because I made the case that I can't do anything for her until she has a diagnosis in her records, signed by her doctor. I told the doc she is running out of money and without active PoA I had no way to pay for her future care.

I've also done similar with my MIL and my own Mom.

If you are her PoA then see what you can get done by carefully and diplomatically explaining to a primary doctor that you can't help her until she has a diagnosis of cogntive impairment that requires help by her PoA. At 83, it is highly likely that her prior undiagnosed mental illness is now blended with age-related decline that she would have had anyway, mental illness or not.

I wish you success in getting this done instead of guardianship.

Have her evaluated for 24/7 care while in Rehab. Explain to the SW she is an "unsafe" discharge because there is no one to care for her at home and she cannot afford 24/7 care. Where I live the Rehab and LTC are in the same complex. Because of this, if Mom is found she needs 24/7 care she can be easily transferred. Do mot take her home. Once u walk through that door, she is your responsibility. Don't let them tell you there is help. They will not help once your through that door.

She needs to take her meds and the nursing staff has ways of getting that done.

It’s ok to educate yourself about guardianship since, in the end, you may have to go that route. But, you asked about alternatives. First - who has POA? Hopefully she has named one. Regardless, make an appointment with a neurologist to get a professional medical evaluation of her ability to manage important decisions. Just because she is social or can carry on a conversation doesn’t mean she has the cognitive ability and insight to make sound decisions. If she has named anyone as her financial and health care POA then that person can use the neurologist opinion as a basis to assume that role. Get the neurologist to refer you for a second assessment if you can. Most courts want more than one opinion. You may not need to become her guardian if you have POA and two medical opinions.

So sorry for what you are experiencing! Call an Elder Care Attorney. Check with department of aging. Your mom needs medication for her anxiety. She may be a danger to herself while alone. If you can get your mom to a Neurologist, they can recommend future care. Your mom may have to go into a psychiatric care or memory care facility.
I managed to get my mom out of her house when she fell. I had her hospitalized and the social worker petitioned the court for me to have guardianship.

Use the words “unsafe discharge” when they start talking about moving her out. Do not take her home.

No one wants to go to a nursing home. You do what is necessary for their safety and well-being (as best as can be provided - a nursing home).

It isn't a matter if 'she looks lucid.' Dementia is a medically diagnosed condition. Some MDs will say that a person is not capable of caring for themselves (their own welfare). However it is documented, it is necessary for you to acquire this medical determination. You do not 'talk' logic as it doesn't register. You are talking to 'fear, confusion and perhaps anger - at the unknowns. The best you can do is talk to her in a way that will keep her as calm as possible. "I am doing my best ... (if she says she wants to go home). You do not argue; it just causes more emotional upset / turmoil.

She 'should' be watched to ensure she is taking her medication. How do you know she isn't taking them?

If you cannot afford an attorney, which you need, see if you can find a pro bono attorney. Research low income attorney services. Contact your city hall, Senior Service Dept.

Gena / Touch Matters

Tell her its a hospital -- yes lie! tell her that the doctor has not released her from the hospital and that she needs to be in this place until she is ready to do things by herself. You can also use the "Doctor has prescribed the nurse to come to the house to take care of you or you will need to go back to the hospital" line. I used this with my daddy and it worked. It may or may not work for you but you can always try. Remember to tell the social worker at the hospital that she has no place that is safe for her and the SW will get help you get a place for her.

Rt, it is very important that you tell the rehab facility that she lives with you and your family and her care needs have far exceeded your ability to safely care for her in your home.

That way she can say whatever she wants but, she will be considered an unsafe discharge, use that term frequently in your conversations with the facility. She can not legally obligate you to take her back into your home if she has care needs that you can not meet.

You must stay firm in your lack of ability to safely care for her, no matter how emotional or abusive she becomes.

Best of luck, these situations just stink.

Absolutely under no circumstances think about “guardianship “!! It’s a horrifying, corrupt system that ends up causing a tremendous amount of trauma, costing more money, taking all power away from the family in most cases, and putting everything in the hands of strangers that don’t give a crap about anything but taking your mother‘s money. Believe me, I’ve been through this, and I had to go to court and fight to get back “custody” of my own mother. They didn’t care if she broke her wrist, had a head injury, etc. we were not allowed to make medical decisions for a number of months and it was a nightmare. Don’t do it.

Also, “memory care” is a misnomer. I have not seen a facility that actually provides any memory care. They just dump everyone with memory problems, in a specific unit.

I have a friend that deals with a lot of these issues in Arizona, if you would like to give me your email address, I’m happy to pass your info along and see what kind of suggestion she has. I’m in Pennsylvania so all I can say is that the facilities here are horrible horrible horrible. Nursing Home neglect is a long-term problem and “guardianship” adds another layer of issues, with more uninvolved uncaring people to be paid.

You can email me if you’d like:
I created that email when we were trying to get our mother out of the clutches of strangers. Do not buy into the myth that “guardianship” is a helpful thing.

rtmontoya2: Inform the social worker that she is an unsafe discharge to home.

You say that POA does no good if the person is lucid, and that guardianship is costly. Do you, or does anyone, have POA?
This is something you could work on having her sign now. If she will.

You have applied to the state - for what? Medicaid assistance? In AZ, that would be AHCCCS LTC. I live in AZ too. That might give you some options to get home health care. But I've got to be honest, caregivers are in short supply. I am my husband's caregiver, for which I am paid through his AHCCCS benefits. That is what works for us.

The very harsh reality is, unless you move her in with you and become her caregiver, if she can't be placed in a nursing home - Everyone says they don't want that - then, she may live on her own, not take her meds properly, not eat properly, and not take care of herself to the standards you would like to see.
And, her improper care could be life threatening. That is the reality of growing old with disease. You can accept that she will die on her terms or intervene and get her into a nursing home or care for her at home.
Sit down with her in one of her lucid moments, and see if she will assign POA to you. And discuss with her what her options are and what you plan to do. Be open and honest.
You can download the POA forms online, and she would have to sign with a notary.

Echoing what Ohwow said - tell her she's moving to a new rehab until the doctor says she has improved enough to be on her own, set concrete goals for her to achieve if that would be helpful.

This is all very interesting - unfortunately, it differs here a bit in the UK, although we still have LPA for both finance and for health. I currently have POA for just the finance part. My mother started with psychosis 18 months ago; she is now 95. She does not have dementia - in fact, she is very on the ball. She was eventually sectioned under the UK Mental Health Act to get her into a mental health hospital and then switched to being a “voluntary” patient, which she accepted and stayed for seven months whilst they gradually titrated up her antipsychotic.
she was considered safe for discharge - recovered, basically - and moved out into a care home temporarily whilst we waited for the purchase of her new apartment very near me to complete (for the purchase) - I had had to sell her house as she felt neighbours were evil and could see through the walls at her and accused her of murdering her husband etc etc etc (she didn’t btw!!). She then refused to take her antipsychotic in the temporary care home and regressed completely into another psychotic episode. It was a nightmare but I moved her into her flat anyway. Then she miraculously seemed to recover, still refusing to take the antipsychotics. This was three months’ ago. She is now back in a general hospital after taking an overdose of paracetamol and relapsing with another psychotic episode.
They have called me today about discharge - I am finding it a struggle to go in as she is desperate to come home but the hospital staff said they will slap on a DOL order if she tries to leave (deprivation of liberty).
it gets a little complicated in the UK as healthcare is free of charge here. HOWEVER they do try and get you out of the system as soon as they can unless they are found to be responsible for ongoing healthcare. They were taking about a residential care facility (like your mother, mine will not entertain the idea of going in one) but in fact, many care homes will take seniors with dementia, but not a schizophrenia type illness like psychosis…. I am literally becoming ill with this actually.

rtmontoya2,

My mom was very similar. I lived across the country and my only sibling lived in another state as well. My mom was convinced that my sister and I were stealing from her. She hid everything and was constantly angry. She refused anyone coming into their home (my dad was blind and they lived in a two story house alone). We did hire in house help but my mom was pretty horrible to both of the aides. My sister and I had POA. It does not help in terms of making her do anything she did not want to do.

I set up an appointment with a neurologist and flew to NY to take my mom to be diagnosed. When I arrived at their house, I found a note on their front door stating that my dad was in the hospital and this neighbor (who did not know either of my parents) had taken my mom down to the emergency room to see my dad. My mom was wandering the streets of their neighborhood looking for help.

In the end, the hospital knew my dad needed rehab and that my mom could not be responsible for him. He went into a nursing home, and she followed because she could not live alone and did not want to be away from my dad.

She hated it but he was fine. She passed in June and he knows this but still pretends that she is still here but in a different ward from him and that she does not really know who he is. I let him believe that. No sense making him sad.

My point is that decisions had to be made to make sure they were safe. My mom was wandering, sad, scared, seeing people in their house, believing that cars were following her. She was suffering. Did she like the nursing home? No. Would I do the same thing again? Yes.

Was it easy? No, but they were safe. I could not take them across the country to my home, my sister could not take them in either.

Look at your options:
Hiring help in is great but expensive and they have to agree to the help. It is also hard to find help, especially if you want full time help and if your mom wanders, you need night time help.

Set up an appointment with an elder attorney. One hour can give you what you need - knowledge. I disagree that guardianship is awful, but it is REALLY expensive and you have to pay ($10,000 - $15,000) and it requires court dates so you have to be local.

Call the Alzheimer's Association and request an in home visit so they can assess your mom.

Call A Place for Mom or another business that helps you find nearby senior facilities that fit your mom's needs. These companies are free to you and they break down all the costs and then go and visit the ones that fit your mom's needs.

Call Adult Protective Services and have them come and assess her. This did not help me but it was another question asked and more knowledge learned.

Basically do what you are doing here, ask questions and learn what your options are. My mom was miserable in her home and she was miserable in the nursing home. But she was safe and medicated in the nursing home.

I so hope you find some answers. It is a hard road but there are lots of people who care. Ask all the questions you can. What I did worked for me but it was hard. I wish you luck and send positive vibes.