Who initiates the paperwork for NH placement etc.?

I cared for a lady at her home and was absolutely at the end of my rope trying to help her. She needed 24/7 nursing home care, but I had no way to demand that she go and she would not go voluntarily because she felt she was "fine" and would give me a certain look like I was the stupidest, craziest person on the planet for thinking she wasn't fine. It was one of the lowest points in my life and I still am not the same.

Anyway, I agree that you need to have someone come out to assess her. However, I tried this and it did not work due to show timing (which I learned about here on the forum). My elder looked and sounded VERY normal while the woman was there assessing her - even though elder initially could not answer the question "what is the important (3 digit) number to call in an emergency?" Yes, my elder got it wrong - but got it right on the 2nd try and the woman doing the assessment thought this was just precious. I'm sorry, but if it's a true emergency.... one needs to immediately know that we call "911" for help. There's no time to get it wrong on the first try. There were other things that I noticed, but the evaluator did not. Elder giggled/laughed and got through the interview pretty well. She was charming as heck. The woman looked right at my elder and told her "NO ONE can force you into a nursing home." And then she left. So goes one of my many cries for help. And now elder had an attitude with me because she felt I had been put in my place and she had come out on top. Shortly after this, elder went right back to her perfectly "normal" behaviors: letting in strangers, throwing the mail in the trash, hiding important things, falling, leaving the phone off the hook so we could not reach her, failing to take meds, taking meds wrong, believing there were people in the house when there weren't, waking/sleeping at weird times (including wandering at night "I'm just getting dressed"). And plenty of other things. Plenty of bad things - and she denied all of them because she was "fine." My cry for help went unanswered and I was still stuck in this endless nightmare with her. Long, difficult story (too long to write here) but she's now in a nursing home permanently as she ultimately *did* meet all criteria for it and continues to meet criteria - no thanks to the woman who assessed her. Just be cautious that your loved one may be able to really turn on the charm for someone coming to assess them and they may very well pass that assessment. I did not know that could happen and I was dumbfounded as to how to handle things after that.

There is no way she could function in Assisted Living as she can barely get herself dressed in the AM let alone try and live in an AL environment. I guess we are just surprised how quickly she got to this point.....

Thanks JoAnn for your input.....I guess I really am stupid when it comes to this stuff and I believe she has reached the point that assigning POA may not work for us as we do not have it and not sure she would even agree to sign any papers to do at this point. The last few weeks she has been really bad, she can't remember what happened 10 minutes ago and yesterday we caught her standing in the kitchen looking at a ketchup bottle and trying to figure out how it worked. Its sad really that she has gotten to this point so quickly or really maybe it's been there all along we just never noticed not sure there.

You, the family, initiate the process. If you're going to look into a memory care home, they'll send someone out to assess your mother to see if she's a candidate.
Her doctor can be involved or not, but he doesn't make the call as to whether she goes into a nursing home or not.

The person who has the authority to do this is your mother's power of attorney (POA) for medical care. I hope she already set up this paperwork before getting to the point where she is now, but if she didn't, she isn't likely competent to do it now. You may have to get legal guardianship for her in order to take over the decision-making for her.

You can also contact the the local senior services department where your MIL lives, and they can give you assistance on how to proceed. You should also
contact a trust and estate or elder care attorney for more information on guardianship.

IMO, Mom needs to be accessed for Dementia by a neurologist. She should have labs done to rule out anything physical causing problems. Once she is declared needing 24/7 care by a doctor you can begin to try and place her.

LTC facilities have a criteria that has to be met. Also, the easiest way to get her placed is private pay until her money runs out and then apply for medicaid. Assisted living is a cheaper choice but that depends where u live. They are private pay. In my State, some will take Medicaid but u must private pay for at least 2 yrs.

I agree that POA is needed. If she refuses, then explain that if she does not assign someone, the State may take over her care and money. If she is declared incompetent to handle her affairs, then with a POA you have a tool to help get her placed. To apply for Medicaid. It helps to make life easier.

If she cannot start working toward placement then a POA must do it. If she is unable to appoint a POA to act for her due to already having dementia, no one can act for her.
No, the doctor will no do anything about nursing home, and apparently her doctor isn't even getting her assessed for her mentation. You can't do that either without a POA. So basically POA is the first step if she will give it to a family member to make decisions for her if she cannot. If it is too late for POA it is the more difficult process of being appointed as her conservator or guardian. Both require a diagnosis in which she is unable to act for herself.

Your loved one would need to be assessed by the NH as being in need of NH-level care, as opposed to say, Assisted Living. Each NH in my area does its own assessment; you call them and they generally send a nurse and/or social worker (sometimes both) to visit with the patient.

You could also contact your local Area Agency on Aging and ask for a "needs assessment" which will give you an objective view of what her medical and ADL needs are currently.