With severe short term memory loss who decides to move to assisted living: Me or my mother?

Hi, can you give us more details? Who has power of attorney, who has financial power of attorney? Have you checked out the cost of memory care units in your area?

Making major decisions for people who are not in agreement can be complicated. If you have a DPOA or HCPOA, I'd have it reviewed by an Elder Law attorney to see what your options are. And, if you don't have documents, I'd consult anyway, to see what the law says in your jurisdiction and what your options are.

Short term memory loss can really create safety risk in the home. The person may forget and leave the stove on. They may forget that they the already took medication and take it again. Doing this repeatedly could be very dangerous. If shopping, she could walk out of store, forgetting to pay.

I would look at whether her condition is documented in her medical record and if there have been complaints from others or close calls. Keep notes with days and details.

Your mother’s funds should be used to pay for her care, not monies from you and your sibling

We would be using my mother’s funds not ours but my sibling doesn’t want to spend such a large monthly cost from her funds while I am concerned about her physical and emotional well-being being alone so much with such a poor short term memory.

My sibling believes that my mother is the one to decide whether she should go into assisted living while I think she is not capable at this point of knowing what is best for her.

MWR1985, this is a hard intersection. In my case, we discovered my MIL was not remembering to eat. Not just that she was forgetting there was fresh food supplied by us in her fridge. Not just how to work the stove or microwave. She thought she had eaten. She only lived 6 miles from us but when I'd call her to "check" what she'd eaten that day she would tell me what she was convinced she ate. But in going to her home I found food rotting in her fridge, no dirty dishes in her sink, no food packaging or waste in her trash. On a family outing with us she nearly passed out because she hadn't eaten.

Sunnygirl and Tothill have posted good insights. The caregiving arrangement needs to work for both your mom and who ever will be providing the hands-on care. Neither of you is obligated to provide it yourselves. Neither of you should be paying for any of her care as this won't be sustainable for long.

Your profile says your mom is 91. If she's anything like the elders in my family, she could live another 10 years. It is completely common for seniors to be utterly resistant to such a life-altering transition into AL...who can blame them? At some point you don't need to put too much effort and emotional stress into convincing her, you will simple need to do it if that's the best solution. If she has "severe" memory loss she will most likely be recommended to go into Memory Care, not AL.

I recommend that before she gets a medical diagnosis of dementia or memory loss, you help her get DPoA in place or you won't be able to legally help her. You'd need to pursue guardianship through the courts.

Find a reputable, local facility. Make sure they accept Medicaid residents. Have her enter on private pay. When she runs out of resources/assets then you apply for Medicaid for her. The only difference in her care will be having a shared room but she gets to stay in that facility (not all facilities and shared Medicaid rooms). In the meantime, make sure she is not gifting you or your sister any money, since Medicaid can have a 5-year "look-back" and gifting may cause her to not qualify. If there's been gifting you should spend a little money to consult with an elder law attorney who has experience with estate planning and Medicaid applications.

Tell your sister that at some point your mom's in-home care will overwhelm both of you, especially if she has any mobility, incontinence or medical needs. I wish you all the best in finding the best solution for everyone, and may you have peace in your heart no matter what that is.

1) Is anyone assigned as POA?
2) Has mom been assessed?
3) Just to confirm, mom lives alone?
4) "Cost is an issue to my sibling." Does this mean someone wants to preserve assets so someone can inherit more?

1) If there aren't POAs in place, you can try getting this done NOW. A good EC atty can interview your mother and determine if she is capable of signing legal documents (mom's assets should pay - check naela.org for local attys, many offer initial free consult, so have your questions ready!) If EC atty determines mom isn't capable, someone will have to be her guardian (EC atty can assist with that too.)
NOTE: POAs allow you to sign paperwork and make some decisions for the person that they would have made if they didn't have cognitive issues. It does not give you the power to force her to move.

2) A GOOD assessment will help you to put mom's abilities on a scale, determine how much she can do, and decide whether she should be living alone, in AL or MC. It would also give your assessment of your mother more support. Getting some good information about dementia to your sibling, assuming s/he will actually read it, could be helpful. This can help you as well (I knew little about dementia before mom's early signs. Knowing more about it enabled me to make decisions for her and know when it was time to intervene.) Too often those who are not around the LO as much don't see the big picture and/or are in denial, so if sibling doesn't interact much with mom, s/he won't get it. Also, sometimes in the early stages the LOs can "show time" - they can pull it together for short visits (such as with docs) and appear relatively normal. It is only when they can't keep those walls up, can't support them, that it all falls apart. Sibling needs to spend a day or more with mom, to get a better picture (you go & stay in the background and let sibling SEE.)

3) If mom is living alone, relying on you to take her to appts, shopping, or whatever, she could be in danger. As others noted, she could forget the stove in on and start a fire, she could get hurt and be unable to call for help, she could start wandering - any number of dangers lurk for those with cognitive issues! The problem is there's no definitive timeline to work with, so she could start doing these at any time, even though 'we have never seen her do this before!' If she has to take medication, this can also be a danger as she can forget to take them, think she already took them or think she hasn't taken them when in fact she has. Any of these scenarios could be hazardous to her health! A locked timed dispenser can help, but she would need someone checking (our mom would sometimes miss the alert or just not take them.)

#4 is a HUGE issue for many families!! IF this is sibling's thinking, sibling is dead wrong. The assets your mom has are HERS and should be used to care for her, whether it's bringing help in or finding a nice place for her. While it's nice if one can leave a legacy to their children, it's NOT a right and should NEVER be considered if the person has needs to be met!

As to your initial question, who decides:

IF you can get mom to agree to move and stick with that decision, run with it (best to have POA in place.) More than likely she will either not agree OR will forget that she agreed. Once a certain level is reached, a person with dementia can't be counted on to make any kind of decisions or manage their own affairs (this is why we have POAs.) We had POAs in place yrs before dementia, and despite her plans to move to AL when she felt it was time, ANY kind of move was off the table for her. Nope. Adamant that she was fine and independent. The EC atty told me we couldn't force her to move and suggested guardianship. Facility said no. So we had to "trick" her into going.

There is no guarantee your mother will ever be able to decide and sibling is clueless about this. You don't give major important decisions to a child, and this is similar.

"Cost is an issue" raises a big red flag about your siblings motives imo.

Are you making your mother appear to be independent by propping her up? Providing food, laundry, cleaning, appointments, bill paying, entertainment? So many people do, and as a result neither the parent nor the other family members can understand that they can no longer cope on their own.

Make a list of everything you do. Make another record of anything that goes wrong – where mother’s short term memory problems are potentially or actually unsafe. When you have done that, have another talk to sister, with detail about the problems. If you still can’t come to an agreement, then stop the ‘dependent/ independence’ charade. Stop propping her up. Then when things go bad, call APS.

This is a ‘softer’ version of ‘wait for the fall and the hospital visit’, which is what many people have to do if the person being cared for is obstinate but convincingly mentally competent. Think it through. There is a lot of expertise about this on the site, so perhaps come back with more information about how things go. Yours, Margaret

Thank you everyone for your input as I’m finding it very useful. And for taking the time to respond! She has a POA in place that is shared if possible or if not it names my brother (who is an attorney). I will take everyone’s comments to heart. We do have a doctor appointment with my Mom, my brother, his daughter and me for next Friday, June 29th. I feel like his wife and daughter “get it” but also want to avoid being the ones to say it to him. His heart is in the right place and split 5 ways there is no real money to inherit, especially as we are all financially fit. It’s his relationship with money that is getting in the way. Or possibly out of guilt for not preparing her estate to protect part of her money when it was possible. I want to do what’s best for our Mother but I don’t want it to create a lasting rift between us. I agree it’s HER money and it should go for her care. I’ve also involved another brother who lives out of state.

Any way brother could visit and stay with her for several days? It would probably open his eyes much wider....

Have you considered a part or full time caregiver so mom can stay in her home?
Use the caregiver for day hours to help with meals, meds, bathing and light housekeeping. I have been very satisfied with this for both my parents and an elderly aunt. No one uses a night time sitter.

Have your mother evaluated by a doctor for mental competency as well as health and safety concerns. If she passes, then your mom can decide. If she doesn't pass, then somebody else will need to be her advocate. This is when a power of attorney is really necessary.

Cost is an issue? Does that mean the cost of care will come out of mom's money that some view as potential inheritance? Or does it mean all the kids would have to pay for mom to be in assisted living? If it's her money, that's what she saved all these years for - her old age and her care. If it's going to be out of pocket for the kids, each one has the right to say what they can afford or willing/not willing to pay for her care. Then decision made as to what is available to mom based on what kids can pay.

Tell sibling to stay with her a week to see if her memory issues put her in danger. Leaving pots on the stove, forgetting to eat, maybe only eating very simple things because she forgot how to do proper meals or doesn't want to take the time. Maybe seeing first hand will indicate the need for in home care, moving her to siblings house, or moving her to facility.

Talk to her doctor to get the best advice. Doctors routinely evaluate for memory issues and will recommend what they see as the healthiest and safest living arrangement. You and your sister can consult the doctor together and discuss your questions and concerns. Also reach out to your state’s Office for the Aged or senior issues resources for more information about making this big decision. It is also important to have the power of attorney in place before your mother’s ability to make decisions is impaired. An attorney can discuss how this will benefit your family and ensure that Mom is protected as her memory slowly fades. I just spent the last year learning all of this after my Dad died. You have some hard decisions to make with your family. Work to include your Mom and sister in the process with you. It works better when the family supports Mom together. Good luck!

Bottom line is if she’s safe at home. Does she wander? Does she turn on oven or burners,and forget? Can she remember to take her medicine? Can she get food? What would she do in emergency? If she has dementia, she will get worse. As the illness progresses, your decision will become clearer and clearer.

Imho, as you asked if you or your mother decides if she should move to an AL - the answer is SHE will not decide as most likely the elder will NOT decide. I have seen that happen time and again where the elder has waited too long for any amendment to their aged living housing status. YOU would be the one to decide.

And btw, the adult children of elder parent do not foot the financials of their parent's care.

Getting my mom to move into Assisted Living was the best thing we ever did for her. Our family was never close and I was becoming resentful being the one who was doing all the day-to-day caring.

After several doctors advised Mom she should consider AL
( god forbid she should listen to her children!) she made the decision herself. We toured several facilities and she picked the one she liked. We went through her house and she picked out the furniture and things she wanted in her new home. I rented a storage locker for off season clothes and decorations.

I felt it was very important that she be allowed to make as many decisions as possible to fell that she was in control and no being coerced into moving. It was her money, her stuff, her choice. As far as her kids are concerned all her assets will be used for her care, we don’t expect anything.

It took her a few months to settle into the new routine. But the consistent nutrition, supervised medication, and social opportunities were wonderful for her.

Your mother ultimately decides if she wants to move into Assisted Living. Otherwise, she won't go unless you have guardianship over her after she's deemed incompetent and only then can you place her whether she wants to go or not.

I feel that my mother's money is HERS, not mine, so it's being used to fund her care in Memory Care Assisted Living since 2014. When she runs out of money in 2021, I'll apply for Medicaid to fund her care in Skilled Nursing.

Your sibling needs to put her mother's safety and comfort first; not HER inheritance potential! Of course your sibling will insist your mother can live alone, even when she can no longer do so, if the cost of AL will affect her inheritance. SMH.

Good luck!

With Short Term Memory Loss Assisted Living might not be the best option. Memory Care might be more appropriate.
Assisted Living she can walk out the door with out a problem. If she does that does she know where she is? Where to go? How to get back?
Memory Care usually locked units to prevent people from leaving for these reasons.
If she continues to live alone the same problems may arise. If she leaves the house to get the mail, walk around the block or even sit in the yard...will she know where she is, how to get back into the house? Granted she may not be at this level yet but all it takes is 1 time, 1 catastrophic event to change her life, your life and your sisters.