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I am named as my mother’s advanced healthcare director and my sister has financial power of attorney.
I am wondering can we make my mother go to an assisted living facility?
She has dementia and is unsafe at home. She refuses to believe she needs help or that she has severe cognitive impairment. We do not have conservatorship, but have several neuro cognitive assessments stating she is incompetent.

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An advance healthcare directive is a document completed by an individual giving directions "to whom it may concern" about what treatments and interventions s/he consents to in case of future illness or injury. For example, the directive may state whether the person wants to be given CPR in the event of a cardiac arrest; wants to be fed artificially if the swallowing reflex is impaired; and you can think of many other examples, I'm sure. I believe I'm right in saying that individual states have their own standard forms and their own rules for this, so that a properly drawn up directive becomes legally enforceable.

A medical power of attorney is authorisation given by an individual to someone else to make medical and healthcare decisions on the individual's behalf if s/he becomes unable to.
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cwillie Oct 2021
you beat me to it CM!
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I forgot to say - you can have both, of course. Your MPOA would be the ideal person to ensure that your healthcare directive gets read and complied with, for example.
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Your Health Care Directive (aka "Living Will") copy should be filed with your physician or oncologist or any other doctor with whom you are currently seeing. The older you get the more often you should review it with your doctor and make any revisions, since your health challenges may be changing and so the might your views regarding end of life care.
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rgelles Oct 2021
JIC: A living will is a type of advance directive, while “advance directive” is a broad term used to describe any legal document that addresses your future medical care. ... Living wills are advance directives, but not all advance directives are living wills.

Plus, Advance directives generally fall into three categories: living will, power of attorney and health care proxy. LIVING WILL: This is a written document that specifies what types of medical treatment are desired.

I hope this can also help.
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I think it depends on the lawyer how its done. With my nephew its an Advanced Directive for Healthcare with what he wants. For My Mom it was a Medical POA with a list of what she did and didn't want.
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Your fresh reply post a few minutes ago says “I am named as my mother’s advanced healthcare director and my sister has financial power of attorney. I am wondering can we make my mother go to an assisted living facility?“

That’s a very different question, and the answer is probably No. Moving her place of residence is very different from the issues covered in an Advanced Care Directive. A financial power of attorney is unlikely to help, though it might allow the sale of her house (or termination of a lease), which could force the issue. You and your sister need to seek legal advice on that.

This sounds like a ‘guardianship’ situation, but the legal advice should help with that as well.
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kahill1918 Oct 2021
Yes, guardianship would be the way to go. Unfortunately elder law attorneys charge high fees. It is said the area of elder law is one of the most profitable areas for an attorney.
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If you call the facility you’re thinking about placing your mom in, they will know whether you have the proper documentation to place her, and may be able to provide you with guidance.
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i would ask your self what are your trying to achieve. My father has been in the “system “ for 16 months against his will and it has literally killed him . He is now on his death bed and has little time left . The last 16 months have been pretty much hell for him . A person going against their will it can get very ugly . Physical Restraints and over medication are used to keep them in place .I will never forget the screams I have heard from him in my lifetime . Have you truly turned every stone over trying to get her help in place ?I have friends who had her dr can tell their mom during a moment of clarity and record it on video , to have it played back later when she didn’t remember . She may be more willing to accept help if coming from someone else . If she knows it’s a home or help in her home she may reluctantly accept . I’m sorry your going through this , but I speak from current experience . Better to make sure everything is tried before walking a potentially nasty path .
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disgustedtoo Oct 2021
Perhaps it was more a case of choosing the wrong place. Not all are created equal. While it is helpful, sometimes, to share bad experiences, postings like this are somewhat overdone.

My mother spent the last 4 years of her life in a MC place, and was happier than I'd even known her to be! No restraints. No medication to "control" her.
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The advanced directive tells all involved not to take any heroic measures to keep her alive if she is incapacitated ...no machines or feeding tubes...
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Geaton777 Oct 2021
An Advanced Healthcare Directive can be customized and very specific as to what medical intervention one DOES or does not want. That's why it's best to fill this out with your own doctor and not a lawyer. It's not the same as a DNR.
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Short answer No unless you get an expensive attorney to prove your mom doesn't have her mental faculties.
Sounds like she does and didn't want you or your sister to be able to remove her from her home.
I think the most loving and best thing you can do for your mom is let her live out the rest of her time in her own home, not die in some unfamiliar cold place thzt is understaffed,, where she will most definitely be over medicated.

Praters fir your mom.

The facilities you're thinking about putting your mom in are great from your view. You are shown and told exactly what you want to hear to put her in there.
Moustly it's all about money. Sad but True. Put yourself in your mom's place. What would you want done?
I would want to continue living in my own home with Caregiver help.
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disgustedtoo Oct 2021
"...not die in some unfamiliar cold place thzt is understaffed,, where she will most definitely be over medicated."

Again, a cold and unsupported statement. Jaded to say the least. NOT all places are like that and it IS incumbent on us to thoroughly check the places first.

FYI - my mother lived in the MC unit for 4 years and was NEVER medicated. EVER. The place also wasn't cold (not physically and not emotionally.)

"You are shown and told exactly what you want to hear to put her in there."

Refer to my last statement above this. Sure, you will get the song and dance if that's all you do in finding a place. It is up to us to CHECK the place out. Go there on your own. Wander around. Take in the sights, sounds and smells. Get a free meal. Talk with other residents (this works best if the MC is associated with AL and sometime IL units.) Talk with other family members you encounter there.

If you're that dumb not to take steps to check the places out, then you get what you deserve.

Not all can afford in-home care (yes, it IS more expensive than a facility.) Not all will ACCEPT in home care. That was tried for my mother, to allow her to remain in her own place a little longer. Less than 2 months later, only 1 hr/day to check on her and get her used to having them there she REFUSED to let them in. End of in home care. It was NOT safe to leave her in her own place.

On top of that, with dementia they drift back in time. Depending on how long they lived in the "current" home, their idea of "home" could be some home in the past, even the one they grew up in. My mother's first "step back" in time resulted in her forgetting her condo of 25 years and asking about a key for the home she/we lived in prior to that. Given more time, that "home" likely would have become some other place in the past (based on "discussions", statements and questions about various topics, I could tell she was living her life about 40 years ago. That condo would NOT have been home to her anymore, and she likely would've been wandering off to find that previous home!!!)

"I would want to continue living in my own home with Caregiver help.":

Good for you. That's what YOU want. I've told my kids that if I end up on the dementia train, the last stop should be a MC place. I do NOT expect them to care for me and it would be too expensive to remain in the home. If not the one my mother was in, then one like it.

The reality is that what you want and what you get may not be the same thing. We can want till the cows come home, but in the end it is more important to take care of what we NEED.
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Advanced director of healthcare will come in to play should she be incapacitated, becomes critically ill and maybe can't voice her desires. She fills it out to tell you what she wants: put me on ventilator or don't, do whatever it takes to keep me alive or only do this and this. The Medical POA would come in to play if you have to make decisions for her medical care -- and may use her directive instructions to assist you in following her desires.

If she has money to go into assisted living, why not use it to get her some in-home help for now. It will free you up a little so as not to have to be there 24/7. If her mind is gone, she may not be able to get into AL, but a memory care setting and eventually a regular NH if her money runs out.

if you only have the directive and sis has the POA for finances, it doesn't appear (to me) that you have enough to force her to leave her home.
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Remember this is an international group. Here in BC what is generally referred to as a Healthcare POA is a Healthcare Representative, who is in charge of making medical decisions based on the Advanced Directive when a person is deemed incompetent.

OP, are you and your sister on the same page, that Mum needs to be in a care facility? If yes, then it should be a simple process to put in place. Not that it will be easy at all to move Mum.
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As others noted, a healthcare directive is more about what one does/doesn't want for medical treatment under various circumstances, i.e. no CPR, no feeding tube, no extraordinary care to extend life.

Financial POA grants the person ability to manage financial affairs, and perhaps sign documents, etc.

A Medical POA would grant you the ability to be involved in her care, having access to her medical records and assist in making medical decisions if she needed help with that.

NONE of these give us power over another person. You will see there are a few who post comments on this site who are clueless about this (demanding you place a person, etc.)

I learned about what can/can't be done from my own experience. We tried bringing in aides, to get mom used to them and have a sanity check (I was too far away to check in daily, and sometimes she wouldn't hear the phone.) It was only 1 hr/day and other than confirming she took her BP meds from the timed/locked dispenser, they didn't need to do anything (some were more industrious and would do some light cleaning, but it wasn't required by me.) THAT didn't last 2 months - she refused to let them in. ANY discussion about AL was met was total disgust, despite AL being in her own plans BD (Before Dementia.) At this point, you'd think it was a dirt hovel in the ground, with scraps of food thrown in!

The Elder Law atty told me we could NOT force her to move and suggested guardianship. That takes time (on occasion it can be expedited) and money, lots of it! I'm not even convinced she was far enough on the dementia road to get guardianship. But, it was a moot point. The MC place chosen would NOT accept a committal, aka guardianship. We had to come up with a scenario (sometimes referred to as a fib or white lie) that she would "buy." In her case, a leg injury just prior to the move developed into cellulitis, a serious infection, so my YB used that to draft a letter from 'Elder Services' at the hospital where she was treated that said she chooses to move to a place we pick or they will place her. She was madder than a wet hen, but she went with my brothers.

That's just one example. Any number of scenarios might work - repairs needed, fumigation for infestation, a "holiday", aka hotel stay she won, etc. If you can arrange a furniture move while you or someone takes her out for the day, arrange a free meal at the facility, and pass it off as going to lunch/dinner at a restaurant, then when done, excuse yourself to use the bathroom and let the staff take over. The staff at mom's place told me to just get her there and they would take it from there. If you choose a good place, they can handle it. Whatever might work. You know your mother, we don't. Brainstorm with your sister to come up with something she might "buy."

You certainly can't ask her, she'll just say no. If it isn't safe for her to be in her own place, then find a way to get her moved. You also can't just "drag her out of the house" (the atty put it that way, like anyone would do that!) Get creative.

Meanwhile, you and sis should be thoroughly checking out places. Don't rely on reviews, esp online ones, or brochures. You need to go there, several times at different times of day and see for yourself. My mother's place was great (IL/AL/MC) and every I met there, staff and residents, were nice, pleasant and happy. There are plenty of places that are like that. There are bad places, but that's why you have to vet them. You can also chat with nurses at the facilities, to see if they have any good ideas about getting mom to choose moving (whatever the "reason" you come up with has to be something she will understand/accept, and therefore it makes the "decision" hers.)

Fun stuff, dementia is (not.)
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pbianchi: A health care directive benefits the elder, e.g. "I do not want measures taken to prolong my life." In contrast, a medical PoA lets the agent take over health care decisions for the principal when they can no longer do so.
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