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Barbelo Asked August 2022

Is there a service that can assist in planning future AL care, that would be binding in court, for my mother with dementia?

My mother has lived with me for about 12 years. Within these Covid years, my mother's drivers license was taken away and these things have made her dementia worsen, although she can still make decisions. My sister (who lives more than an hour away) and I have a very difficult relationship. We rarely agree on anything and she is angry that I have POA for our mother and am the emergency contact for her medical care. I would like for my mother to meet someone who can discuss AL care options for the future when I can no longer able care for her so she is comfortable with the decisions. I would also like to have some kind of binding document that would enforce these wishes that would stand up in court if it came to that. Does such a unicorn exist? Thanks for your help and support!

Grandma1954 Aug 2022
Your mom does not need AL but Memory Care.
If you have POA and the POA is active you can place her in Memory Care when you feel that you need to. And you do not have to have a "reason". Nor do you "need" your sister's input or approval.
Your mom meeting with someone is going to have little effect, with dementia she will not retain information nor can she enter into a contract.
If you are unsure of your abilities now would be the time to place her.
If you are talking "the future" what is that? 6 months? 12 months? 2 years? At what point will you no longer be able to care for her?

Frebrowser Aug 2022
I’m not clear on who the intended audience for this document would be.

Your mother, as the dementia worsens, won’t be able to comprehend legal documents or logical arguments. The POA is the correct document to handle her financial affairs, perhaps a living trust if there are a lot of assets including real estate. An advanced directive can let her describe specifics on medical care and living conditions and who is responsible for carrying out her wishes.

Or are you more focused on your sister? Are you concerned that she is the successor POA or there is no successor, and that she won’t follow your mother’s wishes? If so, a consult with an elder law attorney is in order.

There is an increasing awareness of solo agers, who lack immediate family to designate as their decision makers. If there is money available, professionals can be found to monitor care as specified. If there isn’t money, then Medicaid limits the options (Assisted Living often not included depending on state).

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JoAnn29 Aug 2022
My Moms decision making was giving her 3 selections when we went out to dinner and her picking one. Which went to 2, which went to me picking out what she would have.

I doubt in sitting with her now she will be able to retain what is being said. Short-term memory, reasoning and comprehention are the first things to go. And depending how far her Dementia has progressed, she cannot sign a binding contract. She has to fully understand what it means.

I would say an Elder Lawyer. They are versed in Medicaid. He can determine Moms competency. He can explain what AL, MC and LTC means in the future. ALs and MCs are self-pay unless ur State has some kind of waiver. NJs is self-pay for at least 2 years and then apply for Medicaid. Understanding how Medicaid will be the most important thing.

You have POA. It should be in effect if Mom has been formally diagnosed by a doctor or two. That gives you the ability to place her. A paper saying she agreed to it now is not going to mean anything when the time comes and she has no memory of the meeting and signing a document. It should have been understood at the time she assigned you POA that you would be making decisions in her best interest when she is incompetent to do so.

If you need the paper because of your sister, same thing, you are the one assigned to make decisions for Mom. If sister does not agree with that decision, she can take on the care of Mom.

Fawnby Aug 2022
I’m pretty sure that salespeople from the AL you’re interested in would come to the house to discuss with you and mom. I wouldn’t present her with more than one choice, which means you’ll have to narrow it down. Too many choices just confuse dementia patients. The visitor can leave some brochures showing beautiful gray-haired people living it up at their facility. Mom could visit some morning. By that time you’ll have figured out how to close the deal.

MJ1929 Aug 2022
If for some reason you can't care for her and handle her affairs, then you're done being POA. Did Mom assign a back-up POA? Everyone should have at least a couple of back-ups.

Why do you think you won't able to care for her any longer? If it's coming to that, and it's just the physical work of care you're talking about, then place her now, and continue handling her financial and medical for her.

igloo572 Aug 2022
The only way to have full control over decision making is for you to file for guardianship over your mom. It’s a legal process done in probate court. Mom would have to be seen by MDs, have testing and documentation to show that she is NOT at all competent or cognitive. It’s not a DIY but need an attorney with expertise. The costs (maybe 7-12K) to do this are on you too but should you be successful then you can seek reimbursement from her financials.

if your mom still is able to do for herself and fairly lucid, it’s going to be hard to ever get guardianship done imo.

sis could challenge your being appointed guardian, but if she lives in a other state or even another city, the judge isn’t likely going to appoint her. They want it to be someone who lives in their jurisdiction.

I’m guessing going guardian route isn’t feasible…. so I’d suggest that you get mom into 3-4 times a week full day programs, or a PACE center, or lunch & activity couple of days a week programs asap. Ignore any “I hate it” stuff. Sign her up and take her; even if you end up hanging in the parking lot for 3 hours for first few times. Often IL & ALs do these & it can help get them adjusted to moving into this facility as a future resident. Removes some of the fear factor. Also your Area on Aging will have info on programs. Get her into something now even if she carps and then after the start of 2023 find an AL for her to move into.

AL run 3-4K and by & large AL is always private pay. ((Medicaid via its LTC program will cover a NH / SNF if she is “at need” but most states Medicaid do not cover AL)) Please pls be realistic as to mom being able to afford AL entirely from her own money. If she flat does not have the $, then you’ll need to look at income based housing which tend to have waiting lists. So ya got to get on signing her up early. The Area on Aging should have info on theses as well.

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