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I am his POA. Can I discharge him w/o issues (like them stopping me)? I feel like we haven’t really been given a choice in his rehab so I’m worried. My dad has lived an independent life. Prior to last week taking care of himself, driving, cooking etc. with only mild dementia symptoms. He fell down his steps, had a stroke and is unable to use his right hand/arm. Everyday his arm seems to get more feeling/movement but they are concerned with his dementia and living by himself. A lot of the things they seem to be concerned about have been happening when he is in a new place. He does also have confusion but we feel if we take away his car and make some modifications with his house he can still live by himself with daily checks and it be okay. In his environment he doesn’t forget direction/rooms etc. but in his current environment he is struggling. He also just wants to go home and I want him to have a quality of life as long as he can and being in a nursing home is not what he wants. I also think staying with me or another family member would also create more frustration & confusion because he isn’t familiar with his surroundings & staying with him permanently isn’t an option for me. I would rather him do in home therapy once we have his house modified but I’m worried someone will step in and say he’s not fit to go home and send him to an adult care center/rehab center.

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There is a good chance due to his stroke that his cognitive status will not go back as well as you may be assuming it will , even being in familiar surroundings again . Some people have their parent living next door with cameras to check on them . But for Dad to live literally alone , does not sound safe especially if rehab is saying that . Rehab is going to discharge if they think the living arrangement is safe . A stroke is life changing , no matter how well he was doing before . You need to focus on what Dad NEEDS not what he wants or what you want for him . Your father is no longer independent .
He also can not drive with dementia .
Your choices seem to be Dad lives with someone or he moves to long term care facility .
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Reply to waytomisery
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Please read your PoA document to see what activates your authority. It is usually 1 medical diagnosis of sufficient impairment. Have you ever presented your PoA documents to his primary doctor, or the rehab facility? Your authority should be active if you get the diagnosis on the clinic letterhead with the doctor's diagnosis and signature. But you need to bring them the PoA paperwork. Then no one can override your decisions on your Father's behalf.
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Reply to Geaton777
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lealonnie1 Aug 14, 2024
Sounds to me as though her POA authority SHOULD be overridden!
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“We feel if we take away his car and make some modifications with his house he can still live by himself with daily checks and it be okay.”

No. This is what you WANT to happen, but he is not likely to be anywhere close to who he was and his abilities prior to this. And it is not likely ever will be again. He is no longer able to do what he did before. In some ways he is not the same dad you know anymore.

There’s so many everyday dangers in a home that we forget about. I have a friend whose MIL was in the same position. Family thought with daily checks she’d be fine. Until one day they checked in and she had put a pot of water on the stove, turned it on high, walked away, and forgot about it. Pot was boiled dry and there were several hand towels next to the burner. Had there been a fire, she might not have had the ability call 911 or get out of the house.

“I want him to have a quality of life as long as he can and being in a nursing home is not what he wants.” You need to reconsider what is SAFEST, not just what he wants. Living alone in his house doesn’t guarantee a good quality of life. He will still be struggling most of the time.
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Reply to LoopyLoo
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You say D has “mild dementia symptoms”. Then that the rehab people “are concerned with his dementia”. You say “we feel if we take away his car and make some modifications with his house” he will be OK – which means that with dementia he has still been driving, and you have been OK with that (and the risks entailed for him and other road users). It also means that you haven’t made any mods to his house so far – and the houses of most elders with dementia need at least some mods. You think he will be OK alone “with daily checks”, while most people with dementia need more than that.

It sounds that the medicos feel that you aren’t taking the dementia and other health problems seriously enough. You are POA, but what do other family members think about this? Are you the one doing the caregiving (such as it is), and if not what are the views of the person who is most in touch with him throughout the day? It is quite common for a POA to be a trusted male who is not involved enough in the details of intimate personal care to see through 'showtiming' and realise quite how bad things have become.

To an outsider, it does seem that you may not be realistic about all this. Talk to some more of the people involved, without starting from the point of believing that they are wrong and you are right.
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Reply to MargaretMcKen
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I hate to say it, but you obviously are in denial about your dad and his condition, which isn't all that unusual with family members of a demented person.
Of course he shouldn't be living by himself anymore. That ship has now long sailed.
And since you say that you nor any other family member can take him in, then you should instead be focused on getting your dad placed in the best facility he can afford,
Sadly life doesn't always go the way we would like it to, but we all have the choice to make the very best out of what life does give us.
I wish you well in finding the right and best facility for your dad.
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Reply to funkygrandma59
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This fall and stroke have changed things for Dad. They are OK till they aren't. Strokes cause brain damage and Dad already has Dementia. Not saying he would not do better in familiar surroundings but is not an option now. The professionals are telling you he can not live on his own. By law, they cannot release him if its thought sending him home is an "unsafe" discharge. You will need to prove that there will be 24/7 care in his home or your home.
He either pays for aides to care for him in his home or he will go to Memory care or Long-term care. It all depends on his finances. Not sure if an Assisted Living would take him depends on how much care he needs.

Its no longer what Dad wants, its what Dad needs and as POA your job now is to make sure he is safe and cared for. Read your POA, if immediate there is no need for a doctors letter for financial. Usually for Medical there is. Some Financial POAs stipulate a doctor or doctors are needed to declare incompetence before the POA is invoked.

Your Dad losing his independence was inevitable. His Dementia would have worsened and he would have needed 24/7 care. Time to take away the keys and sell his car. If you bring him home, the car should not be there. Its also time for some white lies. You took it for a check up.

So, to answer your question, yes the Rehab center can have Dad placed in LTC if they feel that Dad will not be cared for 24/7.
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Reply to JoAnn29
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Do you mean to say that if dad can live alone and there is a fire in his home that he can safely get out?
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Reply to MACinCT
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As a loving family member, you want the best chance for a full recovery, right?

Recovery sometimes is the wrong term. Recovery can conjur ideas of returning to *before*.

Stroke recover varies. Recovery can be more like *adjustment*. Through a crises stage & into the *new normal* level of health & functioning.

By all means, have HOPE & engage with rehab & set goals. But also be realistic.

"My dad has lived an independent life. Prior to last week taking care of himself, driving, cooking etc. with only mild dementia symptoms."

"He fell down his steps, had a stroke and is unable to use his right hand/arm".

Your Dad is now a stroke survivor.

Hopefully 1: he may make more gains in his mobility over the next months
Hopefully 2: any delerium could lift (often caused by fall, stroke, hospital/rehab environment, pain, new meds)
Realistic 1: delerium can stay for weeks or months
Realistic 2: dementia is progressive
Realistic 3: stroke recovery varies

Think carefully on WHY you want Dad to go home, alone.
What thconsequences would be?
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Reply to Beatty
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Being given POA means that you were considered to be a responsible person who would make decisions that are in your dad's best interests. Not accede to his wishes, which could put him at risk.

I don't know the law, but I would be very surprised if it would be ethical for health professionals to knowingly allow you to leave your dad home alone. Also, I don't think that you would be fulfilling the terms of the POA if you made the decision to leave your vulnerable father in a house, however modified, on his own - knowing that he has dementia and has had a stroke.

Act in your father's best interests and keep him safe. That means 24 hour care.
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Reply to MiaMoor
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Why on earth would you want to send a stroke victim with Alzheimer's back home to live alone????? I guess you don't understand how dementia works and why, if dad is not fit to go home, that he SHOULD go home! Or at least go home with 24/7 caregivers in spite of your inability to care for him. Why would you question the guidance you're getting from the rehab pros?

Please use your authority appropriately and make sure dad has full time care. Either at home or in managed care. Whether he "wants" it or not is irrelevant, he needs it.
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Reply to lealonnie1
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Rather than berate you for your sad introduction to senior issues, I sympathize with you for your denial to reality. All it takes is 1 fall..1 stroke..1 incident..and an elder life changes forever.
If you REALLY believe your dad can live alone or with you, then take him in and let us know when your mind changes.
Otherwise as others have written, you have a duty and responsibility as POA that can be very heavy on your heart...but you must do what is best for your father, regardless of your personal wishes and pain.
The coming days will be very hard. I hope you make the right decision- if you can't -then resign the POA ...IF you can get someone else legally assigned by your father, which may not be possible given his alzheimers and stroke conditions.
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Reply to ML4444
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Igloocar Aug 16, 2024
Only the OP's father can assign a different POA, and then only if he is judged competent to make the decision.
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There's a part of this story that I don't understand. OP says, "Prior to last week taking care of himself, driving, cooking etc. with only mild dementia symptoms." If this is literally true, then I agree that he isn't being given a fair chance at rehab. Shouldn't he be eligible for three weeks at full reimbursement plus more time at half reimbursement, as long as he's making progress? (I am assuming this is in the U.S.)

I do agree with other commenters that with a dementia diagnosis he shouldn't be driving or living by himself any longer. The medical professionals who are caring for him now obviously are seeing deficits that OP is missing. You can't assume he will continue to improve to his former level, and if he is confused by his surroundings and can't use one arm, it isn't safe for him to be alone.

The last sentence is a little confusing to me also. If he's currently in the HOSPITAL and they are wanting to send him to REHAB, in most cases that would be the appropriate thing to do and I don't understand why OP would oppose that. In any case, more physical therapy, with the goal of him having full use of both arms and being able to ambulate steadily, seems like it would be most helpful and might eventually allow him a much better life in an assisted living environment.

OP - In the end I suppose they can do whatever they want if they feel strongly enough that you are not acting in his best interest. Why not discuss further and keep an open mind as to what they are seeing that you may not be?
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Reply to iameli
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MiaMoor Aug 16, 2024
I think the problem is that a person with dementia cannot improve. The stroke will have been a further assault on his brain - due to the dementia, he won't be capable of improving to his former condition as a person who had a healthy brain prior to the stroke would have the potential to do.
After a stroke, a previously healthy person would work towards repairing the damaged neuro-pathways, so that they can be themselves again (if possible - it wasn't for my mum).
A person with dementia is already losing those pathways, even before the stroke. Their condition will have inevitably deteriorated. Rehab can only do so much - it can't fix something that is unfixable.
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Walmah123: As your father is a stroke victim suffering from Alzheimer's, he requires residence in a memory care facility no doubt.
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Reply to Llamalover47
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You need to deal with the "stair issue" since that is a major concern. Talk to the case manager or social worker to find out what are the legal ramifications of taking him back home. If he is deemed "unable to be alone," you will have to make arrangements to have somebody with him all the time.
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Reply to Taarna
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My understanding is that rehab and the hospital can’t ‘put’ him anywhere, but they can’t do an ‘unsafe discharge’. That gives them a very difficult situation, if no-one is agreeing and paying for any alternative care. Your option is perhaps to accept a discharge to you and your house, even if you don’t want it. Once he is there, it is up to you – and him.

Having said that, be aware about his needs, and the risks to him if you move him from your house to his without adequate care. It is possible that you might be blamed if he has a bad accident while he is still ‘on the radar’ for the medical system. However once you have him in your house and are caring for him, you may be less likely to underestimate his needs. Remember that an accident (or an 'incident') can lead to a rapid decrease in his ability to meet his own needs.
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Reply to MargaretMcKen
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QOLSAZ Aug 15, 2024
I definitely agree, well stated.
The hospital and or the rehab center would be held responsible if they discharged him and it's "not safe" per their professional opinion. But there are options for your dad to live at home.
In home non medical care would be a great option, or live with family in their home. But being alone may be challenging and very risky for him and you.
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The stroke may have accelerated the decline of not just Alzheimer's but he may also have Vascular Dementia that may have gone undiagnosed if his doctor did a simple exam and proclaimed it "Alzheimer's".
I am one that believes that when a person does get the diagnosis of dementia they should not be living alone. I say that mainly because by the time family, friends notice there might be a problem often the person has been "hiding" symptoms for sometimes up to 10 years and it has reached a point where the person can no longer hide the fact that there is a cognitive decline.
All it takes is for a person to get in the car, go to the grocery store that they have gone to for 40 years, get turned around and become lost. Going the wrong way down a freeway....running into a crowd of people...driving into a retention pond....

Making the coffee that they have made for 40 years and leaving the potholder on the burner....Putting the mail in the oven then turning the oven on to make dinner.....
Answering the door for the "meter reader" and allowing him/her into the house and getting robbed....
leaving the water running .....
Trying to light the furnace.....

there are just so many things that can go wrong.

While your dad is in the care of the facility it is their responsibility that he is safe and he has a safe place to return to.
If you say he will go home and will live on his own and they feel that it is unsafe to discharge him with that plan in place they can refuse to discharge him to your care. If necessary they will get the courts involved and a Guardian will be appointed in order to ensure he is safe.
If you present a plan that will account for his current cognition and have caregivers in place they my feel that that would be a safe discharge. That plan should include caregivers, modification that need to be done to make sure he is safe.
If he does improve once he gets home and is more comfortable then maybe he will not need 24/7 caregivers.
But he should not be driving until he is evaluated.
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Reply to Grandma1954
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MiaMoor Aug 16, 2024
My mum has been in hospital 3 times this year. Each time, they would not discharge her until it was confirmed that "home" was a suitable place to be, and that a care plan was in place.
I was really glad of this because the first visit, this year, forced her husband to move to a retirement flat in a building with a lift and carers on site (I had been pushing for this since Mum had her stroke 13 years ago). He also had to up the care calls from once to 4 times a day - again, something I had previously suggested and was told I'm too fussy.

This last hospital visit, my stepdad told me he was reducing the care calls once Mum had been discharged, but the hospital put Mum onto end of life care and have arranged carers and daily district nurse visits, so it was taken out of his hands.

He just keeps underestimating the care Mum needs and the help that he needs.

My current issue is that he's insisting on giving Mum her epilepsy tablets, even though she only takes tiny sips of water, and she's not fully sitting up, not aware, and not opening her eyes when he does this. He's so worried about her having a seizure, but if she does, she won't be aware, but she'll be very aware if she aspirates a tablet. I want her death to be peaceful, without distress, as much as possible.
I'm also concerned for him - he would be devastated if Mum was choking and gasping for breath. A peaceful death would make it easier for him to accept losing her.

It's natural to be in denial, but accepting the reality of the situation makes us better carers, or advocates, for our loved ones.
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At the very least dad should move to a single floor home with no stairs.
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Reply to cover9339
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Been over a week and OP has not responded.
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Reply to JoAnn29
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MiaMoor Aug 16, 2024
Let's hope that OP comes back and reads these messages when it doesn't feel quite so emotional or stressful. It can take a while for us to get our heads around the reality of our loved ones condition and their care needs.
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NO MEANS NO PEOPLE. A facility can not force anyone to stay. They would need a court order and facilities will absolutely not do that. Facility can call APS but they won't get involved as he's in a facility now. If he is in a rehab facility the rehab facility would have to move him to their longterm side if he wants to go. Don't let them tell you they have no beds. All facilities that have medi-cal have beds even the bed he is in. Depending on dad's income he may qualify for IHSS that could possibly help with care. My question is why can't dad live with you? You could also qualify as his care giver and be paid by state. The sad news is dad has the right to make all the wrong decisions and go home. But if you want him safe DO NOT take him home and DONOT let the facility state he can't stay. My point to that is once you take him out you can't go back as that's another huge issue getting him back into a facility.
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Reply to LoniG1
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Lori, thats not so. If a Rehab deems someone 24/7 care and there is no one to care for them 24/7 they cannot release the person. Its call an "unsafe discharge". The family must prove that 24/7 carecwill be given by family, aides hired ir the person will be placed in a facility. If this can't be done, the facility places the person in LTC, requests the persons SS and any pension to offset their care and if no money starts the Medicaid application. This happened to a friend of mine. No family to do the 24/7 care.
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