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My 83 -year-old mother has been living in her home (dad died 2 years ago) and has moderate dementia (she cannot remember recent events and doesn't remember that my niece has been staying at her house every night for her safety and my sister has been going over daily to prepare and give her meals). I live out of state but go to stay with her for a week every 3 months to give my sister and niece a break. She has told us that she will not go to an assisted living facility and would rather die than do that. My sister has POA and medical POA. When you talk to her, she seems very reasonable but anything you get her to agree to ahead of time, she forgets then gets mad because you didn't ask her. She also says she doesn't need help, she can make her own meals and make a grocery list, etc., but when we test this, she just doesn't eat or drink enough liquids (got a bladder infection) and for grocery list, we get excuses like she doesn't know what she has.


If we get to a point that she needs to move to AL against her will, what documentation should we have to show that this is necessary for her safety.


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We were in a similar situation .
We could not physically get Mom to leave her home at all anymore. I had picked out an assisted living facility . Mom refused , and would not leave her home any longer even to go to the doctor because she was afraid we were going to “ dump “ her “in a home”. Mom insisted she was ok alone .

We called the County Area of Aging . A social worker came and interviewed Mom and determined she was not safe living alone and they were willing to come back 2 weeks later to physically remove her from her home . She ended up in the hospital before that happened . Told the hospital social worker what was going on . The hospital social worker called and spoke with the social worker from the County area of Aging . When Mom was discharged from the hospital she went straight to assisted living .


You will not be able to reason with Mom due to her dementia . Call the County Area of Aging to see if they will help you . Tell them family can not stay with her or care for her anymore . Have a couple of facilities chosen already . Or if Mom ends up in the hospital tell them no one can care for Mom at home anymore and she needs to be placed .
Good Luck .
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LauraAT Dec 10, 2023
I appreciate your advice. I will definitely call the County Area of Aging so I at least understand how they can help. Thank you.
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My friend told her mom that there was a termite or rat issue and that mom needed to stay in a board and care in the meantime. The documentation was that the hospital has released mom with the understanding that she couldn’t live alone, not that it was ever challenged.
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LauraAT Dec 10, 2023
It does feel like there is no way she will agree to move and even thru some miracle, I got her to agree, she would forget by the next day. We may definitely have to use something like what you suggested. Thank you for your advice.
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You've all been doing yeoman's work on your Mom's behalf but it's not sustainable and her PoA doesn't need to wait for "cooperation" or her memory to magically be fixed to move her.

I would have her Medical PoA get her on some anti-anxiety meds before attempting to move her. The PoA and family can create a therapeutic fib the day of moving: there's a gas leak; the furnace is leaking CO2; theres a bedbug infestation; whatever works. The facility will be happy to participate in the attempt to get her in an settled. Tell her it's a temporary apartment until the house problem is fixed. She will not be happy to be there no matter what -- no senior ever is -- so be prepared for this.

The PoA needs to read the document to see when the authority is activated. Sometimes it take more than 1 medical diagnosis of cognitive/memory impairment. Once this is met, the PoA takes the docs to her bank, her doctor's clinic, and the facility to put on record.

I wish you success... if you have time please give us an update.
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anonymous1732518 Dec 9, 2023
Tell her she will have people to wait on her almost every need like she is a queen
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A lot of them say they would rather die than move to a facility . That’s a guilt trip to keep you and your sister in servitude .

Right now my mother in law is a big disaster waiting for a place to happen . She’s been telling us for many years she is never going to a facility . The last few times she looked right into my eyes and said she wouldn’t want to live if she had to go to a facility. I looked right back in them the last time and said .” It’s out of our control . Your body will dictate where you live”. She is competent, still living in her home with no safety in place . Refuses walker etc . Falls a lot . I’m not banging my head against the wall anymore . We just wait for the phone call that some disaster happened and since she refused to get POA in place……. She will become a ward of the state .
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againx100 Dec 9, 2023
It is so sad that so many elders are so damn stubborn and short sighted. They make their lives and the ones that are trying in vain to help them, MISERABLE.
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House of cards. It stands for now, but it's looking shakey. When sister pulls her support base out, Mom staying at home will probably crumble.

She'll join the others saying I'd rather die etc. Maybe some do.. (stop eating for long enough will do it) but many adjust, start socialising, eat better, enjoy the activities. Some even blame you for making them stay alone when they could have moved earlier to a 'hotel'!

Pathways to AL include POA taking over IF the person has been delcared unable to make lifestyle decisions. Temporary stay in AL for respite, that becomes permanent. Often it is directly after a hospital stay, rehab then AL.
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LauraAT Dec 10, 2023
Thank you for your thoughtful reply. I am so glad I found this forum. It has helped me sort thru my thoughts and realizing that unfortunately, we just may need to just wait for a crisis to occur, I just need to try to support my sister as best I can.
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If your sister is POA she is the one that makes the decision to place mom.
With dementia she should be in Memory Care not AL.
If your sister thinks mom is safe remaining at home and your niece is satisfied with the living arrangement, and your sister is not complaining about the tasks that she has taken on and you are alright continuing to go care for her every 3 months then there is no reason to change what is being done.
IF YOU decide that you can no longer make the trip 4 times a year will your sister and niece be able to get Respite caregivers in for a week?

With the diagnosis of dementia it is your sister that decides when mom is moved into Memory Care. She is POA and she is the one that makes that decision NOT your mom.
Legally your sister has to do what is in mom's best interest to keep her safe.
And I hate to break it to you, or your mom, but she WILL die but not because she is in a Memory Care facility.
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againx100 Dec 9, 2023
I do not think that a dementia diagnosis means it is time for memory care. My mom was diagnosed 2 years ago and has been in AL for 1 year. At some point she will need MC or SNF but that day is not here yet.
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It depends on how the POA reads whether u need a doctor or not. Mine was immediate, no doctor needed. The other type is Springing which needs a signature of a doctor or more.

My Mom was about stage 5 or 6 when I placed her in an AL. We told her she was going to a new apt and would make friends. She adjusted well. Yes, I was lucky.

Its no more what Mom wants. Its what she needs and what is good for everyone who is caring for you. Sis is ready to quit. So Sis goes and researches ALs near her. If Mom is in early stages of Dementia they may except her. Sis picks the one she feels is best. Then she tells Mom a fib. "I and niece need some uninterrupted time to ourselves. So I am having you spend some time in an AL." And do not tell her this until the day of. After that, when she asks to go home, you say, still trying to get caught up and things done that did not get done when at ur house all the time.
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LauraAT Dec 10, 2023
Thank you for your thoughtful advice. I need to re-read the POA and MPOA to make sure I understand them completely to advise my sister.
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Laura, that is nothing but manipulation on her part.

Personally, I would say, "Geez mom, sure would hate to see you die because of an address change but, you are an adult and can make your own choices. Just as your offspring are adults, with lives, jobs, families of their own and are as equally free to make their choices. If you don't want to become the States problem, we really need to make this work for ALL involved, so, when would you like to tour facilities or are we gonna play the whole crisis, hospital, no choices game?"

The one needing the help does NOT get to drive the situation, PERIOD!

Give her a definite date that in home help, to prop up her charade of independence, stops and then stop on that date. Otherwise, she doesn't need to change anything, she will NOT make a different decision until you ALL stop letting her manipulate you.

Best of luck in a truly stinking situation.
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BurntCaregiver Dec 10, 2023
Best advice of the day right here from Isthisrealyreal. I hope the OP follows your comment to the letter.
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You will need documentation from two doctors to use a POA if sister has POA. However, mom may STILL say no if she isn't deemed incompetent before a court. She can still refuse placement, even if an MD feels she is not safe without it. Only incompetence in her own decisions can insure someone else can act for her.

You say that your mom says she would rather die than go into care. This is quite common, in fact. And many do wish they could die. It is not an option at present, however, so it must be honestly explained to her by ALL involved that they can no longer be responsible for her being alone at home unsafely and that she cannot live with any of the children she may be holding out as an option (if this is the truth). Therefore, there is little choice than to choose, with your help, the best place available.

Family should get together first to discuss. Then an HONEST discussion with mother as to being home alone not being an option is next. If she digs in her feet you may not get her to an exam and may not get MD letter to present in court regarding incompetence.

In that case something WILL happen and intervention, when there's a hospitalization, will get the exams, the letters that she requires conservatorship and placement can be done.

We have seen seniors who refuse placement in the past, and we have even seen members here who lost a parent because they fell at home and no one saw it until it was too late. In all honesty sometimes that IS the option the senior does/would rather make.
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NorcalAE Dec 9, 2023
It's clear that there cannot be any 'honest discussions' here. Your intentions are in the right place, but this family is dealing with someone with anosognosia - she will never ever be convinced she can't do it all herself.
Not all POAs require conservatorship. As long as she has been deemed incompetent by a doctor (it only required one in my case), I was able to make all decisions for Dad.
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