First Post -where to place Dad, if we can get him there

MsReliable

Been reading the boards and I am so impressed by the wisdom you all share. Hoping I can contribute in time -for the moment I am new at this and struggling.

Dad had his 3rd? 2nd? stroke 2 months ago, plus he has a history of TIAs. Diagnosis last week by neurologist of moderate cognitive decline, which I presume is stemming from vascular dementia (ischemic stroke from hypertension, he stopped his BP meds without telling me). Big physical improvement since the stroke -from crawling and unable to feed himself to walking w walker and eating normally. Main physical issues are stamina and fatigue, and delayed awareness of the need to urinate. I do a lot of laundry

Prior to the stroke he lived w his GF. She has physical problems (3 years dealing w broken legs) and her son is trying to decide what to do. Like me, he lives far away -for him, other side of the country. For me, Europe. 

Dad's cognitive issues are the core of the problem. V little short term memory left.  I orient him to day and time almost hourly. Worst is the deficit blindness -he cannot see that he is not able to drive or live alone, even if the Dr tells him. Plus he has always been strong-willed and independent, never really faced a challenge he couldn't overcome.

It's clear that he would be best in MC/AL - and I have the usual guilt, reluctance and drama around making that happen. I have a medical POA and a durable POA already, and a court would see that he needs a guardian, but doing that feels like stabbing him in the back. I can only imagine how he would feel. Fortunately my sister agrees (And she's an atty) so no issue there and we will get through it.

My q is---if the GF breaks it off with him, but he loves it here in NV (though he has only 1 other friend here), is it best to put him into a place here, or in NY where my sister lives and where  a couple of his childhood friends still live? It would be another big disruption to move him from here, but easier for my sister to be there quickly, vs. both of us having to fly in during a crisis. 

It's a balance of what is easier for us and what will make him happier  -plus the fact that I have seen some lovely places here where he is, which cost far less than the equivalent in NY. He has LTC and I have resources, but I am also responsible for my own future and my sister is responsible for herself and my mother. So some reality has to come into this.

Thanks for any advice -and just for being there

Stuck in the middle

Hello, Ms. Reliable.  Welcome aboard.  

I think you should take your father to New York.  I have found it very useful to be able to make unannounced visits to care facilities.  Your father will receive better care in a second class facility near a daughter who visits and acts as a squeaky wheel than in a first class facility thousands of miles away.  

The GF vs. the childhood friends is a non-issue to me.  Neither are going to be any real help to him or to you.

Don't use your money for his care.  If he outlives his LTC, there are public resources for his care.  Life is not kind to old people, and you will be one of us one day.  Money helps.

Cynbar

There is no substitute for having family close by. Your dad needs to be in a place where relatives can visit him, develop a relationship with the staff, monitor the care, get there quickly in an emergency. Friends or even a GF are not the same, they have no authority and usually drop off anyway. Find him the best place near your sister. And don't feel you need to use any of your own resources, you don't, those are for your future. When his assets run out, he can apply for Medicaid ---- just make sure the place you select accepts Medicaid, or accepts it after a resident has been private pay for a certain period of time.

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MN Chickadee

I would say absolutely move him to a place near one of you. As dementia progresses he may not even realize she is his GF as he starts to live more and more in past memories. Local friends drop away with dementia. Happiness can become elusive for the PWD, even for those who remain in their home with a spouse. Safe and sometimes content is really the goal. And honestly once he settles into a place he likely will not notice or care if it is New York or Nevada. A quality facility is what matters. Finances and the state's medicaid rules needs to be considered (sounds like you need medicaid planning for long term care with an elder law attorney) but if there is no family able to make decisions nearby then living across the country is simply not an option IMHO. As dementia progresses it will become apparent that you need someone nearby. As Cynbar pointed out it is crucial to ensuring good care, and I can also nearly guarantee there will be an emergency sooner or later, and having to catch a flight and be there in (at best) 8 hours while he is in an ER unable to advocate for himself or answer basic health questions would be terrible for all of you. My mother entered memory care very physically healthy yet I have still gotten those middle of the night calls and been in the ER with her many times, and even the half hour I need to drive feels long when I know she is in an ambulance. The dementia starts to affect all aspects of the body so things just start to happen in addition fall related injuries. And with vascular dementia you may not get a lot of warning of a decline - it can often look like plateaus followed by sudden drop off and a sudden, permanent new normal of functioning. This stage you are in is chock full of hard decisions no one wants to make. It takes grit and strength and tears. Just remember the decisions need to be based on his health and safety, not what-ifs and regret and wishful thinking. I would look into if it's possible to also put your sister on the POA paperwork as well if she is going to be the local family member. There are posts here on moving a PWD long distance. Many call it a "visit" or "family trip" and make it seem temporary. Once in a facility the usual tactics may be needed. The doctor wants you to stay here a while to get stronger, you can go home when the apartment is ready, maybe next week when the home repairs are done, weather is better etc. Rinse and repeat. For now I would focus on the big decisions. Financial planning and selecting a few facilities near your sister.

zauberflote

MsR, everyone has said what I would have, so I'm really just an echo here or a signal repeater. 

My mother had names all three of us kids as POA's, and how it fell out was that we worked as a team, often making joint decisions, but each able to go solo in emergency. Mom moved to be near sis when Dad died in 1997, and was sturdily independent for 12-15 years. Sis started "helping out" with laundry (a physical challenge; the steps were too much for Mom's knees and heart), then the checkbook, then a few ER visits, then cleaning the bathroom-- and there she quit from burnout. She pretty much resigned her POA, and bro and I took over..... long and very long distance. 

That seemed to work, until the hospitalization from hell. Nine weeks of our lives chewed up, and every single hour of that could have been avoided if I or bro had been at the ER with her at the outset. Bro and I tightened up our protocols, and made plans to move Mom to my city. I met my goal of preventing unnecessary hospitalizations. 

Mom's friend network had continued to see that she had church twice a week, and the occasional errand, but I had to provide the concerts and opera broadcasts. When she moved to my city, I had to be about 12 people. It worked out alright, mostly because Mom declined past being able to cope with those activities. 

All that to say, moving your dad near your sister would likely give you less cause for regret than other options. 

MsReliable

Thank you everyone for the great advice. My sister is already #2 on the POA and Health POA so that's covered. Looking for a place near my sister is the obvious best choice. Looks like my next step is to contact a knowledgeable atty in NV to see if the DPOA covers me without need for guardianship  -would be a huge relief -and what the answer to the same question would be in NY. Have the atty's name again so that's easy. Can also ask about filial duty for payment.

Yesterday the GF dropped a bombshell in convo w a 3rd party, that she wants to move closer to her son, on the east coast but not in NY. Son was not aware. Dad seems to have missed it -or just forgotten. But it does give me a clear and easy way to explain a plane trip...pennies from heaven!

Feeling like I can take one more step forward now. Thank you everyone.

MN Chickadee

MsReliable wrote:

Thank you everyone for the great advice. My sister is already #2 on the POA and Health POA so that's covered. Looking for a place near my sister is the obvious best choice. Looks like my next step is to contact a knowledgeable atty in NV to see if the DPOA covers me without need for guardianship  -would be a huge relief -and what the answer to the same question would be in NY. Have the atty's name again so that's easy. Can also ask about filial duty for payment.

Yesterday the GF dropped a bombshell in convo w a 3rd party, that she wants to move closer to her son, on the east coast but not in NY. Son was not aware. Dad seems to have missed it -or just forgotten. But it does give me a clear and easy way to explain a plane trip...pennies from heaven!

Feeling like I can take one more step forward now. Thank you everyone.

You will want to consult an attorney familiar in NY state Long Term Care Medicaid laws as they likely differ from Nevada. Family does not have to foot the bill, but professional advice is generally needed to do things properly and not run into delays or issues. An attorney can look at his finances and advise the course to spend down assets to NY's cutoff and when to apply for Medicaid. Many facilities have a benevolence policy though it may not be in writing or advertised. Some do say upfront they will accept medicaid. If the person is private pay for number of months/years they will let them stay when the money runs out and accept medicaid as payment. An attorney local to your sis who practices a lot in elder law should have good advice on this. You can get a sense of it by googling NY state long term care medicaid 2021.