We're 6 years into a journey after a sibling suffered 2 strokes. One side is virtually useless and he made a choice to move into Assisted Living rather than have us and caregivers help him in his own home. We supported him as it seemed best for his overall well-being at the time (note: his home was sold to help pay for this arrangement). He's been on a slow decline and currently needs help getting in/out of bed, bathing, meals and med management. He watches TV all day with no interest in helping with simple things like opening mail, or preparing a list of needed supplies. Everything is left to me or my siblings (like the bill paying on his behalf - we have POA). Prior to Covid he refused to participate in PT, or even talk to anyone (aka, depression). Getting to the point -- he's running out of money, so he needs to move as quickly as possible to another facility that will accept him (he may be forced into a nursing home as most AL won't accept him now). Despite multiple attempts to discuss and engage him, he's making no decisions. Our Elder Care Attorney advised the POA is really only for when he's incapable/incapacitated, and if we make a decision for him that he disagrees with, there could be problems (he's not incapable of making decisions -- as a matter of fact he surprises us with what he can arrange/do when he puts his mind to it, especially when we're not around). We've already been told if he runs out of money, that we aren't financially responsible for his bills (as long as we've signed nothing stating such). That doesn't mean the ALF facility won't be after US though. We're simply at a loss as to what to do. No disrespect to him, but it's stressing us out...
How does he do with "now it's time to..." statements? Does he go along or resist?
How does he do with choices? "Would you like to go outside or go to the crafts room?"
Question 2... he is verify particular so he has no trouble expressing yes/no or I don't want to do that. However, in situations where doesn't want to participate he will then default to shoulder shrugging or clam up.
1. understanding of the situation 2. appreciation of the consequences of their decision 3. reasoning in their thought process 4. be able to communicate their wishes.
Capacity can vary for different decisions too.
I have been told my relative has capacity to make medical decisions for herself. But also that while she can say she doesn't want to move into a nursing home, she lacks points 2-3 & cannot reason the alternatives. So she lacks capacity for that particular lifestyle decision.
We are a family of perfectionists to varying degrees and I'd aruge he's the most perfectionistic of us siblings. There isn't a good choice regarding his move, so I suspect part of it is he simply doesn't want to make a decision.
There isn't a choice here. Rather there IS one, and that is that he moves out onto the street. What does the lawyer think of that option for him? Can you give me another choice to consider? Because at some point he will be evicted from his room.
Speak this week with the admins; get their recommends. Whatever you do, you siblings being close in age, do not use your own funds or you may face this same position sooner rather than later.
I am certain this is hard to face.
I don't know personally if a Board and Care ever accepts medicaid, so it is a question for him. Some seniors who are quite with it might like being with about 5 or 6 others preferrable. Do attempt to talk to him about this. That's all you can do. At the point he will not/can not discuss it is on you. You have already, by the way, implemented you POA by paying his bills. I was in that same position when I POA for my brother. He was quite with it in his "early Lewy's; I let him decide things when he could/I did when he couldn't.
The muscles and process of holding a pen and writing are a whole different kettle of fish from the process of opening, closing and twisting things. All fine motor skills are not created equal.
I would suggest taking what money he has left and place him in Longterm care. I am surprised the AL allowed him to stay this long. If he did not realize that PT would help him improve, then there was a problem back then. The brain has to be retaught. They found with my grandson, if his left side of his brain was damaged in his operation, his right side could have taken over with PT.
LTC may not take ur brother with Medicaid pending. With my Mom she had 20k left and was in an AL. I took that 20k and placed her in LTC. That gave me the time to apply for Medicaid and get them info needed. I started the application in April and placed Mom May 1st. She paid privately for May and June. I was able to get all the info Medicaid needed and prove she was spent down and confirmed all this with her caseworker in June. July 1st Medicaid started. My State only allows 90 days to get everything to Medicaid.
It is not what brother wants now, its what he needs. Its not do you want to do this, its he has to do this. So thats how you approach it. Brother you are running out of money and because of that you need to transfer to LTC.
As POA you cannot be held responsible for his bills. The AL will just have to sue him and SS cannot be garnished. Plus his SS and any pension will be needed to offset his care in LTC.
This is nothing you can sit on waiting for him to agree. ALs are private facilities. I guess the AL does not offer, after privately paying after at least 2 yrs, the ability to use Medicaid to allow him to stay there?
Curious: What does the attorney say about your financial liability if your brother cannot pay for AL?
Before I would take what a SW says, I would call a Medicaid caseworker to see if your State Medicaid pays for AL at all.
I have used an independent placement agency three times, twice with my mom, once for my in laws . An invaluable service. Look up carepatrol… there may be an agency near you. Google care placement etc.. it might take a little digging. Carepatrol I used here twice, Arizona I found a different independent. These people know the in and outs of facilities., who has openings, who takes Medicaid and their requirements, cost etc. The agent met me for tours. The agent gets paid by the facility that you place in. I would never have found where my mom is on my own…
How explicitly have you told him he has to move? Have you given him a deadline?
It’s maddening for the patient’s loved ones. We want them to just “do something already”. But, they just can’t.
This video is about the early signs of dementia, but it has a section about that lack of initiative problem.
https://youtu.be/pqmqC-702Yg
It also has a good section about caregiver stress, that all of us could benefit from reviewing.
So sorry you are going through this.
Start a conversation with the AL and ask if they can still handle his needs and give them update on the money balance. Their social worker should be able to take it from there to start the process of moving him. Or to tell you he has to go to another facility and when that move needs to take place.
Then there are the 'shruggers' or 'I'll manage just fine' folk who CAN'T decide, may even know they are losing skills in this area but are still able to 'show-time' & bluff quite well. Some with vascular dementia (evident as calcification as past TIAs on scans) can still be quite crafty at showtiming. The old "I forgot my glasses" or "I can't hold a pen" to cover for not understanding the paper put in front to sign.
After strokes & TIAs (mini strokes) I may guess showtiming & vascular dementia.
Arrange what you need to.
I would try to sit down with him, and record the meeting with your phone and go through what you need to address with him. Tell him you'll start making decisions if he won't.
https://www.agingcare.com/questions/things-to-think-about-move-mom-at-97-with-dementia-474059.htm