It is very apparent to myself and my two adult daughters that my mother is in serious mental decline and probably Alzheimer's. My mother lives alone in Nevada. No relatives or friends. None of our family is from there. She moved there years ago for work (in the 90's) on the advice of three family members who had also moved there for work. All three have since passed away. My mother has always been EXTREMELY paronoid and distrustful of people, so she has no friends. The one she had is incapacited due to a stroke. My mother is alone. Living in her own home. A paid for condo/townhouse.
I and one of my daughters live in North Carolina. The other lives in NYC.
On initial meeting, my mother presents well. However, her house has fallen into SERIOUS disrepair (ceiling caving in, toliets seriously backup and unattended to, possible electrical issues, etc.). She has had several auto accidents; the most recent one, she had no idea how it happened and she blamed others. She does not seem to be able to make good business decisions or choices - mostly due to almost instantly forgetting that she needs to attend to something, even if she was the one to mention it.
But my mother is adament that she does not want to move to North Carolina.
I do have power of attorney, but I'm wondering what is the real world, domino effect if and when the necessary trigger event occurs.
1) What can (or should) I do to set off the trigger event in order to activate the power of attorney?
1a) What would constitute a trigger event?
2) What, if anything, can be done to get her moved from Nevada to North Carolina? (I don't curently know her financial and insurance situation, but believe she has insurance through a state government employee plan tied to Medicare. Won't know for sure until the Power of Attorney lets me know.)
3) As she's not in any kind of assisted living or nursing home, if I could get her moved, how does one get her into a facility?
4) What the difference between Assisted Living and a Nursing Home?
5) If I can't legally, or she refuses to move, how do I research facilities in Nevada but I'm in NC.
1. Research of options. Where exactly could she live in NC? And where in Nevada? Narrow down your choices of facility so that you have a worked-out plan of her hypothetical move. Place. Level of care required + flexibility in future. Funding. Logistics. Then you'll know what you're facing and how the options compare. Plus this is all theoretical, so that for the time being you won't get sidetracked with worries about how to make your mother agree (that's a bridge you cross when you come to it).
2. Mother. Would it be possible for you to go and stay with her for a substantial visit? - say two weeks, a month? The idea is to get in step with her day to day routine so that she doesn't feel you're roaring into town like a tornado and upsetting her world. There will be time to have constructive conversations about things like financial and medical information that, crucially, you can always come back to if she's feeling uncomfortable; not to mention getting the loo fixed! So you go for a visit and let the discussions develop, rather than going there TO have the discussion, if you see what I mean. This should avoid putting her back up and making her defensive from the outset.
I appreciate that this may be simply impossible for you, not everybody can just drop everything and go off on tour. In that case, have you considered contacting her Area Agency on Aging or APS to take their advice?
FYI to communicate with her doctor you will need to present your original copy of PoA paperwork, as you also will need to present it for any banking, etc. Setting up her accounts online will help you immensely.
You should move her to a good, reputable care facility near you in NC. Again you may need to employ a therapeutic lie to get her there (and I do advise flying a direct flight if at all possible and do travel with a doctor's note stating her mental condition. Make sure she wears something like Depends or bring a change of clothes).
If she doesn't have enough funds to pay for her facility care you will need to apply for Medicaid on her behalf but since you'd be moving her to a new state, there might be a delay, so please check with your state's rules before doing this. There is a "look back" period of her finances so be sure to bring any and all of her financial paperwork for this application (bring a portable scanner if you don't want to pack this, or ship it to your home). In some states that look back period can be 5 years but not the same in every state so check your's.
I would do everything in my power to move her to NC since she doesn't know anyone in Nevada anyway. This will make YOUR life easier as you advocate for her. Assisted Living assumes she can carry out most ADLs. LTC is for those who physically can't and MC is for those who mentally can't. I wish you much success in getting your mom resettled and peace in your heart during this big change!