PWD needs to go into AL, says she wants to, but won't cooperate.

autumn-leaves

I have DPOA, and I'm my PWD's only remaining kin.

Once a very prim and proper woman, she now yells verbal abuse at me regularly and even curses sometimes - completely opposite her former behavior.

We had toured a facility last year, and first she said she liked it, then later she said absolutely not.

Recently, she's been saying she wants to sell her house "as is" - just take her cat and some personal items and go. I said we could probably arrange for that, and then I made some calls and emailed the AL facility asking for the admissions procedure, availability, cost, and timeframe for moving in.

While I wait for their answer, my PWD flips between "I wish I could just go there now" to "I'm staying in my home with my kitty until we both die."

Today she accused me of pushing things on her - like her doctor appts and wound care appts. Then she blamed me for not being available whenever she wants to "run errands", insisting that she'd take a cab (she's been threatening this for a couple months).

She argues both sides against the middle, screaming at me - and at the end says "I love you very much." When it happens this behavior is exhausting for me even after just a few minutes.

It's not safe for her to remain at home (and her WCN documented this to her PCP), but I don't know how to get her moved to the facility (assuming they have room) because she's paranoid and suspicious as hell, and I'm a horrible liar. But I am spread so thin with her dementia and her verbal abuse, and I have my own family also, and trying to look after my own health (which isn't great) …. but she truly has no one in her life.

I'm hoping, if I can get her into the facility, that she can be around other people, maybe make a friend or two, and be less miserable about herself and others.

I am hoping for solid cooperation from her PCP with the documentation of the WCN. Has anyone been in a similar situation? Is it difficult to get admission into AL at a CCRC? What might I expect in this process?

She told me today to just leave her alone about doctors and due dates, that it's her right to decide when it's time to die. I don't know what to do with this.

I've also taken over most of her bills, as she can no longer manage her finances. The bills that can't easily be paid online are the ones that she still clings to, but I still have to help her with them.

I can't argue with her reasoning, but as DPOA I believe that leaving her to herself is illegal, even if stopping medical care is what she claims she wants. Feeling a bit lost and increasingly desperate. Sorry for the long post, but I need to get her placed soon - for her wellbeing and safety, and for my sanity and health.

SDianeL

welcome. So sorry you are going through this with your PWD. I would speak with an attorney. A DPOA might not give you the authority to place her if she refuses. Same with doctor appointments. Depends on how it’s worded. Could you try day care first? If she enjoys it you could use that to get her to move to AL. Look for a County senior day care facility.

Victoriaredux

I'm sorry you are going through this - it is very hard especially when the PWD is a forceful person—BUT one powered by a decaying brain. You can't count on what she expresses as her wishes-in the moment- -you have to work around her to get her safe.

As SDianeL suggested first stop for you as her DPOA [do you also hold her health care proxy?] is to take the documents you have ASAP to an elder law attorney to have your duties and powers explained to you.

Why "ASAP" - because :"The bills that can't easily be paid online are the ones that she still clings to, but I still have to help her with them. " That implies she still has access to her mail & her money- so she could be scammed or make bad decisions that wipe her out. Are you receiving her tax documents at your location- can't count on her to save them and this is the month they land .

The attorney can also explain if the DPOA is strong enough to allow you to place her in her state or if you'll have to go to court and conserve her. The attorney can probably also recommend a case manager that you as DPOA could hire to help get her placed if that is too much for you. Also they can give you tax advise on how to manage her assets for her care and medicaid if needed down the road.

Since she lives alone trying day care doesn't seem a safe possibility - the WCN says she isn't safe living alone and who would get her dressed and transported?

[What facilities call their care levels varies but she seems beyond AL and more MC level].

harshedbuzz

Hi and welcome.

You've already gotten some excellent advice, so a couple random thoughts.

Please have an elder law attorney vet the actual documents. You'll need to know what your obligation is to this woman and what powers they allow. If they are not sufficiently robust, they may need to be rewritten or guardianship obtained.

If you accept this role, it is critical your shut down her access to money and reroute mail to your house or a PO box. Banks and investment houses will want to make a copy of the POA to be vetted by their legal teams. Some do not accept boilerplate or downloadable POAs and will require the individual sign their own forms. This can take upwards of a couple weeks, so you want to be proactive about setting up up.

Lock down her credit with the 3 reporting bureaus to avoid her, or a scammer, from obtaining credit in her name.

My dad behaved as you are describing. Medication helped a lot. I suggest a geripsych for psychoactive meds. If she is agitated around folks other than you, this will need addressing ahead of any placement.

Understanding how dementia impacts thinking is critical to interacting with a PWD successfully. I recommend this as a quick read.

Understanding the Dementia Experience

Cobbling off the above, you are breaking the cardinal rule of Dementia Fight Club— never try to reason with a person whose reasoner is broken. We've all done this. She likely has anosognosia and no awareness of her deficits and won't see the need to move. And even if you get her to agree, she's likely to forget.

It's very likely your aunt is beyond being happy despite your efforts. Safety is job one. If you get to content and settled you've knocked it out of the park.

With dad, I found it better to take a more forceful approach as it reduced his anxiety and made him more inclined to accept restrictions. I initially tried to be collaborative and engage dad, but it just upset him and made things harder for both of us.

To that end, I toured solo. If your aunt hasn't already made the move to a CCRC, she is likely beyond making a rational choice, so you'll need to. Try to think of this as something you are doing for her, not to her.

One caveat, it's often said here that by the time family is willing to consider AL, a MCF is needed. Even people who live with their LOs get fooled not realizing how much scaffolding they are supplying for their PWD. Don't be surprised if the DON who interviews you aunt suggests a higher level of care than you expect or insists on moving her to that level within weeks of moving day. From you description, your aunt may be too impaired to be successful in a hospitality-model AL. My cousin made that mistake with her mom and it went very badly— she missed meals, other ladies were mean to her and a daily well check wasn't enough to keep her safe.

The other piece to CCRCs is that some will assess the cognition of newcomers to avoid PWD joining their communities. This may be baked into their business model to have enough beds in the MCU for current residents or it may be to maintain an image of a desirable community for active adults. My aunt's very tony religiously affiliated (Jewish) CCRC did accept MC residents off-the-street and offered a terrific day program that covered a typical workday. The lovely Quaker CCRC near me wouldn't consider a PWD for residency and has since shut down their MCU turfing the few remaining PWD to the small on-site SNF.

HB