How can we make decisions for our aunt with dementia when she never designated a POA?

Let me correct my error and thank you jeannegibbs for catching it. Her sister SHOULD NOT have responsibility over her.

Just as a point of information, MsNancy, DigitalBanker has never cared for someone with dementia. I can absolutely guarantee you that lots of milk and vegetables will not cure your dear aunt of dementia. It is not the replaced hip that is going to be the issue, it is the dementia. Many people on this site have cared for one or more people with dementia. They know what they are talking about.

If your mother, you, and your sibs can visit your aunt regularly in a care center that will go a long way toward improving the quality of her life, right where she is. My 3 sisters and I each visited our demented mother in the nursing home once a week. That enabled us to observe the quality of her care and to be her advocate. One of us always attended the quarterly care conference. We did various activities with Mom, wheeled her around the neighborhood on nice days, and generally let her know that she was loved. After a rough adjustment period, she blossomed in the nh in ways we never expected.

Please don't think of this as all or nothing. Even if she can't afford the care she would need at home, that doesn't mean there is nothing you can do to contribute to the quality of her last years.

Llamalover47, why would this woman's sister have responsibility for her?

If you bring her home, it will only be temporary as she will absolutely get worse and worse and will need care around the clock.  At age 87, it is a certainty.  Moderate dementia can change quickly, never for the better, after a trauma like a broken hip or moving to a different place.  Who is going to look after her 24/7 and how will it be paid for?

If she has "moderate" dementia, she may very well be able to assign financial and medical POA at this time. Can she understand the concept of allowing someone else to make decisions for her when she cannot?

The attorney who came to our house early in my husband's dementia journey showed him the papers and summarized them paragraph by paragraph. Then she asked if he understood what they meant. He said, "If I can't make decisions, Jeanne can make them for me." That was enough. She had him sign the papers.

So the very first thing I would do in your situation is determine if Aunt is able to name POAs and if she wants to. The healthcare POA would be the one who could decide where she should live.

Whether she is able to name POAs or not, finances are a big part of the decision of where she should live. If not yet, she will eventually need 24/7 care. How would she pay for that?

The center that she is at will ask her who is going to care for her when she gets better. Detached or not her care is your mother's responsibility, not your own.

Being able to sign such documents only means that the person was able to comprehend AT THE TIME of signing.

I had a similar issue with my Dad. The lawyer and notary together interviewed my Dad. They determined that he did understand the document he was presented with and what it meant. This was not to say he could function normally....that is not the legal requirement. He signed the POA, the family lawyer witnessed and attested to his assessment of Dads mental state...the notary signed and sealed it. And it was filed with the county clerk
Done

It sounds like she's actually doing a very good job at managing her own affairs and making sure her bills are paid on time in full each month. Good for her! Your aunt doesn't necessarily have to go into a home, her hip will heal and she can resume life as it once was. What she needs right now if this hip is a fresh break is lots of whole milk which will speed up the healing process along with a very healthy plant-based diet. Of course throwing in a little meat and poultry will also help but when I broke my ankle, I ate mostly veggies when I got to come home from my friend's house after about a week or so of him caring for me. Coming home may actually speed her recovery, she'll be surrounded by the comforts of home. She's independent anyway and she deserves a reward. What you can do is actually get her a wheelchair so she can get around the house for starters. You can usually get them cheap at Rite Aid, they're on the bottom shelf and come in a box. You don't necessarily have to go to a medical supply store to get a simple wheelchair if she comes home, and I hope she does because no one should have to live in a facility like a prisoner (which is what those facilities really are).

Avoiding (financial) POA through online auto bill pay

Another thing you can consider if she hasn't already done so is have her sign up for online auto bill pay but set up each of her bills from her and only and don't let no one come in and get the money, this is how people get ripped off. If anyone is coming in to get her money, see if she'll go to the bank with you and have that company cut off from access to her bank account. This will trigger whoever the company is to send out a bill. The billing department will send out the bill to her and she can set up online auto bill pay from her end and have all of her bills including that one come out automatically on the first or third of the month whenever she gets paid.

* When I broke my ankle July 4 of 2017, online auto bill pay came in handy for me and so did a pair of crutches and a wheelchair. Everything I needed was at accessible level for the short time I would be in the healing process. When you live alone, sometimes you have to make slight changes to your lifestyle and what I did to survive was I kept plenty of water by the bedside because I was in bed pretty much all the time. I also kept canned goods and other nonperishables handy.

You never know when auto bill pay will come in handy until you face such a crisis as your aunt is facing now with her broken hip. Anyone who's ever had a serious injury will go from taking online auto bill pay for granted to actually appreciating it during times just like you're describing. Of course online auto bill pay comes in handy when you have no car and the weather is bad but you have no ride anywhere and you end up staying home. That's also when online auto bill pay is handy. With the right strategy, you should never ever need a (financial) POA. I saw what happened when someone got a hold of my bio dad's money and he had Alzheimer's, I'm currently dealing with the aftermath of it and I wish he would have better protected himself then he actually did, his preparations left him sitting duck and someone who became his POA and actually lived with him and ended up taking dvantage of him. It's stuff like this is exactly why I tell people about online auto bill pay set up from only your end because too many people are getting ripped off when someone else steps into the picture and start handling their money. Good for your aunt for never assigning financial POA and it sounds to me like she probably wants to live and doesn't want anyone making medical decisions either that could be detrimental to her. That's why i'm very proud of people who can make their own decisions and prevent others from overturning those decisions and doing something they wouldn't i'm very proud of people who can make their own decisions and prevent others from overturning those decisions and doing something they wouldn't want, good for your aunt!

I know the feeling of wanting her to get to go back home. My mother, with vascular dementia, went through a situation with the same outcome when she had congestive heart failure, gained 13 pounds from fluid, and could not walk on her own: After going into the hospital & rehab for removing the fluid and placing a pacemaker, should she go home, or should she go into some sort of 24/7 care?

With dementia, as stated above, your aunt will not know her home when she IS home. My mom thought we moved her into a brand new house every night along with all of her clothes and furniture. Every night Sundowners, a very usual part of dementia, would cause her to not know where her bedroom was, or who my dad or I were. Within just 3 months of first showing signs of dementia, she would wake up around midnight and get dressed for the day and then start wandering. My dad would be awake most of the night helping her find the bathroom, her bed, her clothes, etc. This was only going to get much worse.

I know this is hard to even fathom when you have never seen this before. But please trust us. We have been there and know the anguish, stress, and hurt that this causes. A protected 24/7 care environment will be so much better for your aunt - and your whole family - than going alone through the constant changes as the dementia progresses.

Also there is a group you can find online called A Place for Mom that will offer advice/referrals for free. Each county also has an Area Agency on Aging that can give you resources/info for free. Praying for you, your siblings, and her siblings as you make these decisions. It's not easy, but please know you are not walking this journey alone.

Something to consider here. People with Dementia, Alzheimer's, etc generally get much worse after experiencing trauma, like breaking a hip. Moving from place to place also affects their minds. Home to hospital, hospital to rehab, rehab back home. Many times they may not even recognize "home" any longer. My advice is to put her where she gets the most help.

Why sign the house over to one of you? If she had done that she would have encountered major problems qualifying for Medicaid.

There are some good comments here, financial is very important,depending on your state laws they have community based hone assisted living funds that nay be helpful. You can still be her poa and take care of her in an assisted-living if she qualifies, because she will still need someone who can help her. Talk to the social worker where she is because she has to stay in rehab a certain amt of time to become qualified for some funding. Just don't abandoned her and Pray it will work out

You may have to become her Guardian. Or the court would appoint a Guardian if there is not a family member that will do it.
I know that you would want her home but that is a HUGE undertaking. Just read some of the posts and comments and place yourself in the Caregiver role.
What might be better is to have a discussion with the Social worker where she is and begin the process of application to medicaid. They will help you with this process.
If you have family yourself and a job I would strongly urge you not to bring her into your home. I guess I should say unless she has the financial resources to pay for caregivers so that all does not fall on you and your family.

Who intends to pick her up and sign documents that they will take care of her and be responsible for her? It's an around the clock job. You can't just have a person with dementia living alone. Eventually, they need everything done for them, bathing, feeding, changing, etc. I'd explore how she would pay for this.

I would hope the family could figure this out and help her make arrangements. I would likely see an attorney to get advice on the matter, options, etc. It may be necessary to have a guardian appointed if no one has Durable POA or Healthcare POA.

If she goes back to her home, who will care for her?

What is the professional assessment (by the rehab discharge planners) of what level of care she needs?

Can family members provide that care? Does she have the financial resources to pay for that care privately? Have you looked into her eligibility for Medicaid?

What level of home care will Medicaid cover in your state?

The bottom line is, not what anyone "wants" rather what she needs and how to get that put in place.