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My sister and I disagree on our moms care. Our mom has mid grade dementia. She has been in a NH for 4 months since developing covid. She needs assistance to walk, bath, dress and sometimes eat. She toilets with help rarely as she is incontinent. Previously she lived alone with help of my sister and I along with several aids. She now needs 24/7 care. My sister wants her to go home. Her house has 2 sets of stairs to get to the main floor. I am concerned about getting her in and out for doctors appointments, lab work, or in case of an progressing. Also dont know how she would be able to get bathed in the bathroom she has. (Normal tub and small) She has gotten much better since getting over covid but her dementia is slowly proggressing. If she would be brought home, she has enough money for a live-in person for about 9 months. Her house can't be sold if she's living in it and at that point she would need the money from her house to continue care. I am struggling with this on a daily basis. I do think she is better off staying where she is. She has access to medical/and emergent care if needed, more socialization, and limited pt to help keep her moving. We also are able to sell her house if needed for her continued care. Having said that, I still feel like the bad guy in not wanting her to go home. It is really putting stress on my sister and my relationship. BTW, we are both POA's, which probably wasn't the best decision. Thank you for any and all opinions on this issue.

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Why do you feel like “the bad guy” for attempting to make the best choice you have available for her current level of care?

If your sister prefers that she be brought “home”, is she prepared to assume full responsibility for your mother’s needs, in a house with “2 sets of stairs”?

What is your sister’s reason(s) for bringing her home?

Your mother’s situation WILL PROGRESS. dementia may seem to plateau, but it doesn’t go away or get better. Is your sister VERY CLEAR on that?

It is ALWAYS difficult to establish a SAFE, STABLE lifestyle for geriatric patients with cognitive loss, and if Mom is comfortable now, what reason is there really, to change the setting she’s in now?

Hoping that you and your sister can come to a reasonable arrangement moving forward, but as caregivers for a vulnerable dependent person, also hoping that you both can put Mom’s needs first.
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Your mother has dementia. Dementia is progressive and life limiting. Mom is not going to "get better" the way a younger person, fundamentally healthy, with a temporary downturn due to covid might.

What does mom's care team at the NH think about your sister's idea to bring mom home?

What is your sister's plan once the money runs out? Is SHE going to move in and care for mom around the clock?

It is sad when our parents need nursing home care. Feel sad, not guilty. You didn't cause this to happen.
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Yes , mom is not going to improve .
Mom is settled in care home now .
I think if you took her home , the transition could very well cause her decline to speed up again . That will just have you doing the inevitable U turn back to the facility a bit sooner .
The back and forth is not good for your mom .
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If her money is going to run out in 9 months after bringing her home, that's not enough runway to justify bringing her home. There is no money to renovate the bathroom for her. This has "bad idea" written all over it. Leave her in the nursing home.
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You are not the bad guy here. You are the good guy. The reasonable and practical guy who is thinking clearly.
Keep your mother where she is. You say she needs 24/7 care. She's getting it where she is.
When someone doesn't use the toilet anymore and has to be fed by another person, that dementia is not mild to moderate dementia. That is advanced dementia and that will advance further quickly. She has been in the nursing home for four months. She's gotten used to it. Taking her home now may even cause serious setback in whatever independence and lucidity she has left. Also, she may not get it back.
Leave her where she is.
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Have your sister envision , your mom, not being able to navigate steps. Took myself and husband about 5 minutes to get my mom up 3 steps to my house , with her walker… have your sister envision when mom can no longer stand and pivot.. I think your sister is looking at the present…

maybe the conversation needs to be about selling the home at this point..
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I would tell your sister that if she insists on taking your mother home you will not participate in her care, and will resign your POA at once. What she wants to do is unreasonable. I doubt, with her having sunk into a mental state so unreasonable herself that YOU will be able to reason WITH her, so simply make it clear that what she is doing amounts to a sacrifice of both your lives that you are unwilling to make.

Then, if she DOES this, you will need NOT to enable it.
This isn't an argument. This is a simple case of a very bad decision making on your sister's part. If she makes it she will have to live with it so long as she's able.

You and your sister didn't cause this sad situation for your Mom and the two of you together cannot fix it. Your Mom has had a life and the two of you have a right to have your own, rather than sacrificing your lives on some altar of perpetual enslavement to caregiving.

I am so sorry. This has to be so hard. Do it gently and tell her you are sorry but your limitations are such that you cannot undertake this care, and you have zero intention of attempting to do so. Don't argue with her. Simply state that one sentence over and over. I wish you the best and hope you'll update us.
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NeedHelpWithMom Apr 2023
I love this answer! This makes total sense to me.
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If you have 9 months worth of money for home care use it for the NH. 3 months or so before its gone, start applying for Medicaid so when the money is gone, you go right into Medicaid. Her home and car are exempt assets while she is living. Just be aware, once she is on Medicaid, her SS and pension are required to pay her share of her care.

My Mom was living in an AL when her money got down to 20k. April I applied for Medicaid, May 1st I placed her into LTC. The 20k paid for May and June and spent her down. I confirmed with her caseworker that she was spent down and he had all the info needed. Her Medicaid started July 1st. In my state u have 90days from date of application to spend down, get Medicaid info needed and place the person.

You sister needs to realize that bringing Mom home is not workable. And, if she does, don't expect you to help. Its just not realistic. Maybe a sit down with a SW at the home would be a good idea. She can explain to Sis Moms needs that cannot be met by taking her back to her home. If she is a two person assist, I doubt u will find an aide to care for her anyway. I agree Mom is not mid stage. There are 7 stages and I would say your Mom is in the final 2.
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Are you also The Bad Guy to ambulance mom to the hospital if she was very sick? Yet you use such a statement to describe yourself bc mom is too ill to live at home w/o 24/7 care which is cost prohibitive and not the panacea people seem to think it is. "Aging in place" at home is actually a rarity that doesn't apply to elders with dementia. A managed care environment is safe, clean, medically supervised with nurses and doctors to come in to care for her at a moment's notice. My mother lived to 95 precisely BECAUSE she was in a memory care ALF where her care was monitored by an entire staff daily. They caught her pneumonia 3x, in fact, and her life was saved as a result.

Many times I was accused of being The Bad Guy with respect to mom's care. Normally by the Armchair Critics who didn't lift a finger to do a damn thing but Knew Better about what was best for mom. I ignored them and let their calls go to voicemail. Pfffft.

The REAL bad guy here is dementia, make no mistake. Its a lose lose situation for all concerned. Don't blame yourself for your sisters attitude, either. Or for a disease you can't control, cure and didn't cause. Unless your sister would like to have mom move in with HER where she can deal with the chaos 24/7, then suggest to her she hop on board with the only common sense answer here, which is to leave her where shes at.

Good luck to you
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NeedHelpWithMom Apr 2023
”The real bad guy is the dementia.” This is the bottom line here. That says it all!
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To be blunt, your sister is a knucklehead and lives in a fantasy world.

Why does she want to bring her home? Is it guilt? It she incapable of seeing the level of care Mom needs? I haven't seen you address her reasons.

Ask her why she wants Mom to receive substandard care at home and see what she says about that.

Who gets to make this decision anyway?
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Peeps83 Apr 2023
She has no real reason for bringing her home. She just doesn't want her in the NH. She doesn't think beyond that or what is best for her. I think the main reason she wants her home is because our father passed at home. The difference is that he was able to ambulate, and could still take care of most of his ADLs at 92. He had some short term memory loss due to a stroke, but only needed slight assistance. His lung cancer came back, but he didn't get bad until Hospice had to be called in. He only lasted about two weeks after that. My sister doesn't understand that the two situations are not comparable.
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Obviously, your sister is not thinking clearly.

You have received great responses so there is no need to repeat it.

I love AlvaDeer’s response! I would go that route. Her answer makes perfect sense to me.
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You stated her dementia is slowly progressing, she needs 24/7 care, she has money for live in caregiver for 9 months.
And then what? You need 5+ year plan or money.
You need to tell your sister it is not realistic and safe for Mom.
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I was in a similar situation, Mom in NH and brother and I joint POA. Having joint POA is a nightmare, and I would recommend to anyone reading this post planning for their future, not to have joint POA's. I live closer to my mom so had to take on more of the decision making and trying to involve him on this was frustrating and time consuming.

As we couldn't agree on what her care should be, I told my brother I would resign, he could move her closer to him (several states away) and he could manage all of the decision making. After doing some research and looking into alternatives, he realized that my mom was in the best possible place. He resigned from POA as this was the only way we could get any decisions made.

Based on what you say, your mom is not capable of living alone and if she does leave, will be back in less than a year. That is stressful for both her and you. I am incredibly grateful my mom is in a place that can deal with her level of care needs even though the decision to place her in the NH was a hard one.

If your sister doesn't agree, resign as POA and step away from any caregiving. It is a hard decision to resign but will at least allow for decisions to be made, even if you feel they aren't the right ones.
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Ask yourself these questions..and ask your sister.
I am going to assume that you mean that mom is in Memory Care not a "nursing home" aka Skilled Nursing facility.
Is mom safer where she is?
Is mom getting the care that she needs?
Is mom getting involved with activities?
Is she "reasonably" happy. (I know this is a loaded question as everyone wants to "go home")
Can mom get the same care, the same safe environment she has now, the same socialization at home?
It is not that you "don't want her to go home" it is that you realize that mom is declining, she will need more help not the same or less as she continues to decline.
If you bring her home and her money runs out in 8 or 9 months that you figure that she has to cover her care..what happens then?
Dual POA is possible but when the 2 do not have a meeting of the mind it can get tricky.
Playing the devils advocate here...
If you both disagree and your sister decides that she is right and takes this to court (highly unlikely but let's pretend here for a bit)
I think the judge would rule in your favor as mom is safer where she is, she is getting 24/7 care.
(By the way did you figure 24/7/365 care when figuring that mom's assets would last 9 months? Overnight and if mom is taking meds the cost will increase)
If you are tallying votes...I vote that mom stays in Memory Care.
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Leave her in the NH where she belongs. She's way past the point of home care. Incontinence alone should be the NH line in the sand, everything else just makes it more so.
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Leave mother where she is unless you get Acorn stairlift, lift machine, hospital bed & all other supplies…then you have to employ a schedule of Aides & be home to supervise & open door for them. All meds have to be administered by family as home health aides will not give meds or do wound care. Hugs 🤗
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Your concerns about your mother returning to live with your sister are valid ones. Your mothers needs are better met by living in a facility.

My mother and my sisters just placed my dad in a NH because we are unable to provide him with the care he needs at this stage of his life. I feel badly that it had to come to this, and I second guess whether we did the right thing sometimes, but after I visit and observe how he is, I know it was the right thing to do.

Hang in.
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