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My Mom fell and now I'm in a panic. I've tried and tried to get her to start making plans but she always made the excuse that she was too tired etc. Now I don't want her to go back to her apartment because even before the fall I knew she needed more care than I could give. There are no plans made....No POA no funeral arrangements nothing. I don't know where to start. I know I sound like a complete idiot but I am disabled also and work I can't sort my brain out right now. I'm worried about her savings for funeral costs and her bills.

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They will try to pressure you to take her home, make your stand and hold it - absolutely not.

Also, never, ever sign anything that makes you responsible for any charges or bills of your mothers - the facilities might try that too.

Stay calm, deep breaths, and keep thinking “I’m stronger than you know”. You’ll get through this.
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Start by talking to social services and case management at the hospital. They can help you understand the types of services your mother qualifies for. They can also help with applications for any services your mother needs.
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Laura22: Prayers sent. You are not PoA and also are in no way financially responsible for her.
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Have discussion with doctor who is overseeing her medical care (in hospital, primary care or specialist) Caseworker is in hospital for assistance, too. Communication is key. Just experienced what you are currently facing with exceptional to your Mom having dementia. After my mom was discharged a home healthcare nurse visited and she made recommendations and contacted pulmonologist for palliative care. Once that process began, a domino effect began, there were a few bumps in the road but communicating was key.
Remember resources are available, it seemingly is overwhelming and rightly so. But use your time wisely, worrying is unproductive (and it took me fifty years to realize this). Do not be afraid to ask medical professionals questions and know they are there to help. Be open, honest and patient. Keep a notebook of who you talk to, date, what you are told. Even write the questions you want to ask. Calm down, take time to process and start
1. Communication
-ask questions (prepared)
-listen carefully
-take notes
2. Patience
3. Persistent
4. Pray (a lot)
Many families are facing this. Remember you are not alone.
Rely on the professionals.
Reminder: Take care of yourself!
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When you go to the elder care attorney, specify that you want both medical power of attorney and Durable Power of Attorney—not “springing” power of attorney. You want powers that go into effect as soon as the POA is signed. If you get the “springing” kind instead, your mom will have to be declared legally incompetent before you can act on her behalf. Also, once you get the POAs started, take your mom to her bank(s) and have her add you to all of her accounts so that you can help manage all of her finances. (DO NOT EVER COMINGLE YOUR FUNDS WITH HERS.) I’m going through this process with my mom right now, and it’s a royal pain because the banks require their own POA documents, separate from the POA Mom did through her attorney. In our case, my Mom had to go to the bank with me to agree and sign off to add me as POA to her accounts. We are almost done with it, thank goodness. It’s a process you need to complete before your mom’s cognitive abilities decline too far. The bank has to believe she is competent enough to give you POA. She can do that even with early dementia in my state (Texas), as long as she can answer their questions when they ask about her wishes to take this action. I’m not sure how exactly it works where you live. The attorney will advise you.
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First - my empathies for the issues in front of you. They can seem like Mt. Everest.
Second - don't hide or hesitate to act on this! Not just for your parent, but for yourself. Get the POA to include bank accounts-real estate-personal property-medical decisions-etc, Living Will, DNA if you want that - whatever you don't have - in place immediately. Enlist your siblings if you have some. Then make those plans for her as she obviously cannot do it for herself.
Third - enlist the help of the hospital patient advocate to find and finance the appropriate post-hospital care for her.
Fourth - Talk to your chosen funeral home. Learn about costs, options, payment plans. Shop around if you have the time but, again, don't procrastinate.

Make a list of thigs that need to be done - keep remaking it with priority in mind. Cancel services at her apartment that are no longer necessary. Decide what (and how) to do with her apartment and the items in it (some may be able to go to her new living situation). Make arrangements for her pet. Keep records or a journal of everything.

My very best wishes to you!
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I got my mom's POA online (Seattle I think), had a notary come to the house, done. I used it in California, no witnesses were required. Some banks have their own I have learned, some states as well. But something is better than nothing. I got both a Financial and Medical completed, I have had no issues with the Doctor or Bank...except her trying to take me off because she was "ready to take her independence back". Not that knowing the amount of Rent or how it is paid is important, but since the POA says I have to be legally notified and the Bank says she has to come in person, she'll never get it done on her own. Dementia sucks.
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There are actually 2 Powers of Attorney - one for health and one for finances/assets. They need to be written to take effect as soon as they are signed. Different states have different names for these forms, and getting the right form for each of these powers is crucial.
Facilities often have the forms on hand, or call the local Area on Agency and ask if they can email you blank copies of the documents.
A hospital or nursing home or ALF may have a notary on staff, or have contact information to give you so that you can contact that person and have them visit you and your mom to have you explain what the form is about and what you cannot do if it is not signed.Calmly, simply.You or notary then asks her if she understands and agrees with this information. THEN she can sign it, in the notary's presence.
Set the visit up in advance. 10-11AM is usually the best part of the day..and making sure she is not coming back from PT or a test or receives medication that AM will make it go easier.
You can prepay for a funeral now if your name is on her credit card or bank account...or do it once you get the POAs done.
Keep track of where her money goes, so that if you need to apply for Medicaid ini the future, you will be able to provide 5 years of documents and there will be no unexplained expenses.
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First, my sympathies. These things are hard enough to deal with when there are plans in place and there is a vague notion of what options are preferred. I would suggest that you give yourself a bit of time to take some deep breaths and brew yourself a cup of tea or coffee. You did your best, this is NOT your fault. The disorder is of your mother's making.

Then make a list of all the things that you think might be issues. First and foremost, top of the list is to ask for a social worker or your mother's doctor to request an assessment of your mother's abilities for self-care. Under this write a statement that for xy and z reasons you cannot be relied upon for any care beyond managing your mother's finances (unless you want a court-appointed guardian to care for them, too). You write all of these things down and have them in front of you during your phone calls and meetings with others so that you can look at them and remind yourself of your position.

Take all the time YOU need to get yourself prepared for the meetings you will probably have. You will need to take care of yourself, get your rest, keep your resolve. It actually helps a lot to refuse to accept a meeting until you are ready for it. You will also need to make sure that your mother understands that you absolutely will NOT become her physical caregiver. Be prepared to repeat yourself a lot. It doesn't sound as though she listens to you very well.

By the way, you are not the "complete idiot" in your family. You did try to plan and prepare. It is not your fault if your mother was uncooperative. When (not if) others try to compel you to step in and care for your Mom tell them that you already tried that and it did not work.
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I got my mom's POA online, had a notary come to the house, done. This was CA, no witnesses were required. Some banks have their own, some states as well. But something is better than nothing. I got both a Financial and Medical completed, I have had no issues with the Doctor or Bank...except her trying to take me off but since the POA says I have to be notified and the Bank says she has to come in person, she'll never get it done on her own. Dementia sucks.
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You can find a generic form for a POA for your state online, download and fill it out. Get Mom to sign it. Make sure she hears you say that if she doesn't sign this you cannot legally take care of her or follow her wishes if she is unable to articulate them (too sick to talk, heart attack or stroke). If she resists, at least get a medical POA or (your state) Orders for Life Sustaining Treatment.

As others have said, if she won't cooperate you can't do anything but protect yourself. Don't worry about funeral arrangements. That will take care of itself when the time comes.

Let the hospital know that you cannot provide care. Period. Ask them to send Mom to rehab. Rehab can do a neuro-psych evaluation to determine if she is safe to discharge home alone. If Mom is sent home, get her an alert bracelet that stays on full time.

If she self-discharges AMA (against medical advice) she is on her own. Insurance can deny further care. Make sure she hears this.

Try to find a copy of her will no matter when it was written so you are prepared for the worst.

Pray.
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AlvaDeer Jan 2022
I myself highly recommend AGAINST getting online POA. It is not good enough if a lawyer is not involved and most financial institutions will question or refuse it. Even a notary will not help as they only testify that the SIGNATURE is real, not that the person was competent. A POA is a legal document that gives broad powers over finances, and is not taken lightly by banks, real estate places, Nursing Homes, and etc. It needs to be ironclad. Don't use online for this would be my recommendation. Attorneys examine a patients ABILITY to do this with competency. It must not be done if the patient is not fully competent to sign.
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You do have a little time, but first thing I would do is get Medical POA completed. In the event she can't tell doctors what she wants, you can do it.

Let dr know that there is no one to help her in her home, so after rehab maybe they can just move her to NH or assisted living facility from the rehab. It's very possible the rehab also has NH beds and you won't have to have the big discussion with her about final living destination. (She will want to go home, but dr recommends NH. If care just changes from rehab to permanent, she may not see the difference and will think she is still rehabbing)

If you have siblings, you can talk to them to see if they want her to move in with them. Without some kind of financial situation that will afford 24/7 care or other family 24/7 involvement, she's probably going to need to stay with facility care. Once at rehab, you can talk to social workers about applying for Medicaid NH bed to see if she qualifies. She'll have to use her own money for payment until she gets under the limit allowed in savings, checking, or other assets like that. If she makes too much money each month, she may just become self pay for the NH. Also if over the income limit, you might need to talk to an elder atty to set up a trust - where some of her income goes to the trust for med expenses and the rest goes to pay the NH. Atty can also discuss funeral cost/payment and how to set that up.
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Is your Mom competent? Ask the Social Worker to help you do the advanced directive, to discuss Mom's wishes, to assign you to act for her in emergency. Tell the Social Worker what you have told us. Discuss this now with your Mom and tell her that it can no longer be avoided. You need to know what she wants NOW, just in case, and you need to be assigned to protect her wishes should she be temporarily out of commission.
That is step one.
Tell the social worker that you have suspected Mom is no longer OK alone. That you may need a temporary guardianship. Ask if she can help you obtain that.
A lawyer WILL come to the hospital to help you and Mom do a POA. It will be expensive (think 2,000 to 3,000) and in some jurisdictions a temporary guardianship would be quicker and easier; some social workers can get them by a phone call.
So that is your ability to act for Mom in an emergency as a start.
The problem now becomes getting the POA for health care directive/advanced directive so that doctors can discuss diagnosis with you.
When things are left to come to this it is always a mess. But try not to get terrified and realize that only a few things need to be addressed right now so you can act for your Mother. Those few things are what is crucial for the next days and the testing that will go on. And the Social Worker can be your touchstone for them. I hope you have a really good one at this hospital.
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It is too late to tell you that all discussions and plans should have been made before something happens. You are disabled and while I don't know the details, you will need help. Contact the Office on Aging or Adult Protective Services and an eldercare specialist and a social worker in the hospital. They can advise what you can do to get help in tending to all the needs that need to be looked after. You do need help. And whatever happens, DO NOT LET HER GO HOME - OTHER THINGS WILL HAPPEN OR YOU WILL BE FORCED TO CARE FOR HER AND TAKE HER HOME WITH YOU - do not do this no matter how they scare and pressure you - you must not do this. Seek help as above indicated and listen to them.
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Ask hospital social worker if they have PoA paperwork. Hospitals have notaries on staff. If they can’t provide the blank PoA docs I strongly suggest downloading it from Legalzoom or Rocketlawyer.com because it’s better than nothing & you can have mom sign it & notarized in the hospital. Much less expensive than going through a lawyer. Make sure it is “durable” so it is in effect immediately so you can start advocating for her and managing her affairs.

make sure discharge knows she is an unsafe discharge & you are disabled and WILL NOT be able to care for her. They will intensely pressure you, even make promises to “help” but do not believe this.

Work on getting HIPAA form to become your mom’s Medical Representative, and help her create her Advance Healthcare Directive.
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As bad as a fall is, it gives you ample excuse to get everything in writing for her. Many parents don't like to admit that they are getting older, but it's inevitable. Don't let her make excuses! If need be, go to a doctor appointment with her (slip a note to the Dr. explaining what you need), and let the doctor convince her.
Dizzerth had the best advice! You need to get it done before she is unable to give any kind of consent. If it goes that far, you may have to have a judge give you a conservatorship, and that takes time.
You're getting goo advice here. I pray all goes well for you. You are among friends who've been there!
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I would start with a POA. You will definitely need that. Your mom, if she does not have a will can do that at the same time. Believe me get this done fast. You should also be added as an owner/ signer to her bank accounts. Also have her doctor give her a release to sign so they can discuss her health care needs with you. This is very important. I would worry less about funeral costs and more about the cost of long term care or other assistance you may need. You should familiarize yourself with all her bills, debts, insurance, stocks, retirement account or any other assets she has. Once dementia progresses she won’t be able to tell you about any of this and it can make taking care of her estate very hard. I’m speaking from experience.
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Try your best to at least get a POA in place - the hardest part is that it must be witnessed & notarized. Then you can at least make some informed health decisions for your Mom. Once you have that, and the dust settles - contact an attorney and get advice on next steps.
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If she is in the early stages of dementia, where she can still make legal decisions, it is not too late to help her get all of her paperwork in order with powers of attorney for medical and financial matters, a living will, etc. If she is no longer capable of making legal decisions, you can request guardianship. If you don't do this, the State will assign someone to be her guardian, and if that happens you will no longer have any control over her financial and medical decisions. Talk to the social worker at the hospital to help explain your mother's options. Also get connected with a local social worker or organization that can advise on senior care options, who you can turn to for advice on an ongoing basis. Can your mother spend some time in a rehab facility while you make other arrangements for her? It sounds like you will not be capable of giving her the care she needs. You have 2 choices: have aides come in to help her, or she can move to an assisted living / memory care facility. What you choose will partly depend on her financial situation and what your state offers. If she does go to rehab, Medicare will pay for it for 90 days, which will give you time to find a memory care residence for her, or aides, whichever you decide to do.
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I don’t know what state you live in, but here it South Carolina, it is my understanding, that once a person is diagnosed with dementia they cannot sign a POA. If your mother does not have an official diagnosis then she may very well be capable of executing a POA. Please check with an elder care attorney.

As for her end of life stages and subsequent final arrangements, it is important you do all you can to get her to give you the power to act on her behalf. If she will not, you have no choice but to let her eat the fruit of her own way.

My mother is 89. She us more stubborn than a mule. Evidence of age related dementia is showing. Yet, in all my efforts, she refuses to give me any authority to act on her behalf. She claims I’m just going to lock her up and throw away the key. Therefore, I am unable to make any decisions once she gets beyond a place where she is not cognitive enough to care for herself. The state where she lives (Colorado) will end up making all her arrangements for care and she’s not going to like it. As for her passing, I will simply tell the state to cremate her and ship her cre-mains to me.

I want to help, but her stubbornness won’t allow me to do as such.

Give your mom the facts and move on. Tell her you love her and move on. While as a child you have the desire to help her, you are not responsible for her bad choices.
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PatsyN Jan 2022
My parents refused to consider a reverse mortgage years ago for the same reason. For no reason. Now, my mom is burning through their savings (Dad died 18 months ago. COVID. Before there was a vax.) She's at home now, but we won't be able to afford 24/7 care much longer...
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va assists with veterans ans spouse of veterans home care. there are many medicaid resoùces and private insurance options. the hospital can connect you to all the help in your area ..or should be able to. aarp and aging organizations can offer assistance. you might be surprised at the savings to hire a private caregiver vs nursing home or agency mng care.
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i was faced with a.simar situation at work. there is always a source of help or avenue to pursue with home care. especially if that is important to your family member. when small setbacks cause us to jump to.conclusions amd not get all the necessary research and info to male a soumd decision we are setting ourselves up for alot of regret and possible guilt when our decisions tirn out to not be the best thing. there is so much fumding and free and reduced caregiving and home health resources out there. i wosh id have known about them at an earlier point in my life. there is alot of info and alot of wonderful caregibers who have a knack for dealing with dementia care and can help your mother and you see thenlught at the endnof the tumnel and if your mom would desire to be at home then try and find a way to make that a doable and aďvantageous choice for your life. end of life care doesnt have to be so traumatic for either of you.
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Discuss with her doctor and the hospital Social Worker that it is unsafe for her to be discharged to her home.
If she has been diagnosed with dementia she can not assign POA since she is not cognizant. If it is not an "official" diagnosis you can try to get her to sign papers appointing you or someone else as POA.
You may have to discuss with an Elder Care Attorney the best course of action. Could be application for Medicaid. If she is a Veteran the VA may be of help if that is the case contact your local Veterans Assistance Commission to determine how much help you/she can get.
The important thing now is to make it very clear that to discharge her to her home is unsafe and that you can not care for her.
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Rick10 Jan 2022
I was in that situation with my sister. After her son and caregiver died suddenly, I was the last man standing. She had on her records "cognitive impairment". I was able to get a POA signed/witnessed but even to those present it was very clear that she was having problems. Eventually, after moving to AL, she was sent for mental evaluation after becoming difficult and combative. She was found to have moderate to severe dementia. With meds, she is very manageable for now in AL. I do NOT have a medical POA. But for whatever reason, no one asks about it so far. I had to give permission for her 10 day stay for that mental evaluation. But since she has no other family, I don't expect this to become an issue. Sometimes I wonder if I am doing the right thing for her. But I have managed to get her into a nice apartment in AL, got her VA benefits reinstated after they were suspended..suspended because her caregiver son, didn't work, was not only bleeding her savings down to less than 2 dollars but also spending her monthly retirement of about $3,000 a month on drugs, he never kept her VA medical appointments so they suspended her. He had dropped her Medicare prescription part and I needed the VA for at least prescription coverage which is now 7 different meds for her dementia. I wish I had contacted DHS to check on her as I was not aware that she was having memory issues. I didn't live in her city. When DHS did get involved because Regions Bank refused to accept the POA (no one is required to accept it), they found that he had been withdrawing cash rather than just writing checks and that he was paying almost $800 a month for drug treatment for his wife, among other things. He had also charged over $20,000 on her credit cards which had been cancelled and demanding payment. Utility bills unpaid. His free ride was coming to an end and I'm sure he would have simply moved back to Florida and left her. DHS said if he hadn't died at age 40 from a heart attack, he would have been charged with elder abuse and most likely gone to jail. Vaccine...she is not vaccinated and now I have made the decision for her to schedule her shots. I hope I'm doing the right thing, I have no other family to discuss with. I am thankful that her retirement is fully paying her AL expenses. I was also able to get her into the VA community care program and a local doctor can write prescriptions directly to the VA and they ship them to me. She has to go twice a year to a VA clinic for evaluation for now. I don't know how that will work as her dementia progresses. Right now I pick her up and she enjoys the drive of about 40 miles. See the VA psychiatrist, then have lunch and I let her pick where she wants to eat. Very easy to manage...for now. I was fortunate that she knew when I got involved that she couldn't live alone and AL was a good alternative to a NH since otherwise her health is pretty good. She could very well outlive me. The only thing that really bothers me is that I have no one to do for me the things I found necessary for my sister. I do have a son, but at age 42 is now homeless, living with friends, and never seemed to find his footing. Not a good situation for him or for me to depend on him.
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The good news about no POA is that it means you are not responsible for any of this. Tell anyone who will listen that you are not and cannot be your mother's caregiver and that any choices your mother makes must be manageable by her on her own. And then stay out of it.

About her possible return to her apartment: that's up to her. Just because you can't provide the care or support she needs doesn't mean that nobody can. (She doesn't have "early onset" dementia, by the way, seeing as she's 91; you mean she is in the early stages of dementia, and that shouldn't incapacitate her too much to discuss her arrangements with social workers and discharge planners.)

Pay attention to whatever discussions are taking place but only to make sure that any proposed plans do NOT rely on your participation; beyond that, if your mother can sort things out to suit herself, good luck to her.

You're also not responsible for paying for her funeral: her estate is, and if there is no estate then your local municipal authorities must manage it. So sit easy and find something more cheerful to talk to her about.
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JoAnn29 Jan 2022
Local municipalities are not responsible for covering someones burial in the US. The State government usually does that.
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What you need to do now is meet with the hospital social worker. Make sure you are clear with the SW that you are unable to safely take care of her in your home, that she cannot be released to you. It should be clear to the SW that she cannot be released home to her apartment either, that would be an unsafe discharge. She likely will be discharged to a SNF for rehab and if is determined that she is no longer able to live on her own, than plan to have her stay there. You can help apply her for LTC Medicaid, but remember you do not have to take her home with you and they cannot release her to an unsafe environment.
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One more thing.....don't worry about the money and care. As you said, you cannot care for her well now.....trust me it won't get any better. It is easier to place someone direct from the hospital than it is to change you mind later and place from home. A lot more leg work from you. If she is on small money and can't pay....you will likely be on a waiting list. A hospital can get it done.

All you can do is all you can do.
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dear laura,

hug!!

i hope many people on this website have great advice for you.

i just want to say, i'm sorry for your mother and for you -- her falling, kidney, etc.
i hope she pulls through!!

some elderly people have enormous strength and pull through, despite emergencies. i hope she recovers very soon!!

bundle of joy
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Deep breath....it'll all get done. Did she injure herself during the fall? Start a conversation with the hospital that she is an unsafe discharge and will not have adequate care at home. They will deal with placement. Do find an elder/estate/probate type attorney to get the POAs taken care of...
.sooner than later because she is probably still mentally able to sign the documents. Start there.

If she's going to another living arrangement, she will have to pay for that. Its not required that you sell a home (if she has one), but you have to be able to maintain it out of the available funds as well. In other words, the assisted living/nursing home gets paid first until the money is gone. She then can apply for Medicaid and I believe is still allowed to keep like $2000 for funeral costs. I'm not sure that you can pre-pay a funeral now to avoid it going to a care home.

What other sort of bills does she have other than the standard lights, heat, phone?

And again...just take a deep breath. One step at a time.
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JoAnn29 Jan 2022
The 2k is not for funeral costs, it is what Medicaid allows in assets. Not that it can't be used towards funeral costs when the time comes, but you can prepay for a funeral to help spend the persons assets down for Medicaid.
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