Does it get easier once senior is admitted to a nursing home vs. 24/7 home care? Does it get easier for the HCP?

I was told by a co-worker that it does not get easier on the family, as she has to constantly check behind the nursing aids. Her dad was getting bad sores and she was considering getting a camera into his room to see if he's being neglected.

When my mom, with dementia, required 24/7 care, my sister and I took turns 2 days at a time staying with her. It was horrendous. I was 68 and my sister was 70 at the time. After many weeks of this, we decided to have her placed. When we first started looking, we were not familiar with private care homes. We were helped by an agency and found one that was 1/2 the price of a NH. She has been there just over a year now. It was the best decision we could have made. Her transition was a lot easier than we could have imagined. There are choices out there beyond 24/7 home care or nursing home. Even though the brother is not doing the actual care, it must have had a very negative effect on him dealing with this for 10 years. I know I'd be burned out. Promising an elderly parent to stay in their home is just not practical when nobody knows the level of care they might need.

dnajaras: Your MOTHER pays for her own care in what is now appropriately called a Skilled Nursing Facility if it is decided as such. Wherein then lies the cash for you and your siblings' aged years if you've wrongly spent it on your mother's care? Reverse mortgages may seem like a 'fix all,' but indeed are nothing but since that loan will be required to be paid back. You also unfortunately have a subpar POA in place.

So… Brother wants you to pay for the nursing home so he can continue to live the way he has always lived? Is that the way I’m reading it?

Someone with complex medical needs would have a tough time with the stress of living with a senior in need of any kind of medical supervision. But he cannot continue his lifestyle while you put out money for Mom’s care. That can’t happen.

Family meeting with an Elder Law Attorney who will give you an education on end of life care and how to finance it. It is important to know the facts.

I don't know how old your mom is and what other issues may have been going on for the last ten years. Did the brother move in because no one was there to help mom live alone? Was mom 80 when he moved in and now she is 90 and he is burned out and she has dementia? He may feel he doesn't deserve to be homeless after giving the last decade of his time to be with your mom. I am sure you all were fine with him moving in with her because it meant you didn't have to worry about mom or do anything for her because he was there. And if it were easy, you all would have already been taking care of mom and there would be no reason for him to move in. Has he been cutting the grass and making the repairs and taking mom to appointments, grocery shopping and filing her taxes, etc? Him living there is not total compensation for dealing with mom. Would you work/be available 672 hours a month in exchange for an apartment and consider that an even trade?

I think the focus should be 1) what are moms needs..what level of care does she require and finding a place to provide that care 2) what is fair to brother who has been there for mom for a decade.

Your brother being POA means he can do banking for her, he can sign things for her, he can talk to the doctor about her care, etc. It doesn't mean all of the sudden your mom doesn't have other children who don't need to help with her end of life decisions and all the work that entails. Being POA doesn't make your brother an only child.

Compensation for your brother should have been put into place a long time ago. When you get around to looking at what it costs just to have someone sit with your mom...let alone all of the other things that your mom requires, you are going to see that "living with mom and driving moms car" was not a cake walk.

If your mom is placed, she will need to use her assets to pay for that care. Your brother needs to use moms money to talk with an Elder Care Lawyer to see what makes sense. Does a reverse mortgage make sense? I don't know. Him expecting you two to pay for her care is not appropriate. Him expecting you two to be involved in her transition and the work it is going to take to get her things sold and move her is 100% appropriate. Once she is placed, there is still a lot to be done on a regular basis.

Lots of great answers here! Anther thought is this... the house your brother and mother live in... who is it deeded to? Cannot get a reverse mortgage if the deeded person is in a facility - been there tried it. If moms assets include the house then brother will need to move. If brother is POA he is in charge of moms care and how it is handled, mom needs to be in her right mind to change POA to someone else.

If your brother has POA(should have a legal document for this), he gets to make the decisions about her care. As for paying for your mom's care, he can not "make" you or anybody else pay for her care. If he is in her home 24/7. he could be her caregiver and ask - not demand - help from the rest of the family, friends, and paid help.

As for which is better, that really depends on the person. Every person with cognitive issues does better with a consistent routine and an environment he/she is familiar with. So home care can be better since your mom knows her house. However, many folks with progressive cognitive issues become harder to care for as their ability to move or stay on a consistent day-night schedule erode. In this case, a residential facility may be easier.

dnajaras, what exactly are you doing to help with your mother’s care? It seems like your brother has full responsibility & he’s getting burnt out. As far as being easier in nursing home…there are different responsibilities such as dealing with a million people..the CNAs, Nurses, administrators, & attending care plan meetings, overseeing everything. I was caring for my 96 year old mother at home for many years..6 years being immobile, more years being incontinent & dementia. The nursing home that I discharged her from 6 years ago took her back. I still go every day to clean her denture & repaste it. She gets very combative when I take her denture out. So none of the aides there will do anything if she is fighting them. They don’t always give her the calming medicine if she refuses ..& they added a medicine that they neglected to tell me about…to which I called for an immediate meeting about. I feel I have more control over everything in house…but I’m going to be 65 at year end & the private pay aide needed more time off . Luckily the place is 1.7 miles away & also convenient with bus ride. So I can get there either way. I take her laundry home. My mother is on 2 person assist hoyer lift there. Sadly, also she poops 💩 in diaper instead of when she was at home & going in commode. I have different lift at home but she required to hold on to handles..& she can’t since her hands are now contracted & curled. So I constantly have to advocate for her & correct problems & issues. This can be frustrating & aggravating. It’s a toss up. However, on the flip side, your brother can concentrate on getting his health improved & take care of himself. This must not be ignored. He paid his dues. I encourage you to support him 💯 %
Hugs 🤗

Perspective from one being in one. It has its good and bad points. You can have wonderful caregivers. The administration is one that tries to avoid interacting with residents unless necessary.

All in all if it should be the very last choice after other agencies have been exhausted.

The reality of getting 24/7 hired help to come in the home on a consistent basis is not as easy as it sounds . The staff call out sick , or don’t show up at times . This leaves it up to family to do the caregiving in the absence of hired help .

Perhaps assisted living or memory care would be what she needs as opposed to a skilled nursing home .

As far as Mom wanting to stay at home. Most of us would but it’s not always possible .

If your mother was in assisted living or memory care it relieves the family of providing meals , housekeeping , laundry . These facilities also have primary doctors , podiatrist , hair dresser , activities , the lab comes to the facility , X-ray , psychologist , social worker , nurses . Thus relieving the family of these appointments .

As far as your worries about phone calls. It takes a lot less time to take a phone call than it does to take a parent out to appointments and the lab . If your Mom would need to see a specialist . Most of these facilities will take them to that appointment . My father in law is in assisted living . They bring him to the cardiology appointment . My husband meets him there because my father in law can’t hear . It saves my husband a ton of time . He doesn’t have to pick up his Dad , put him in the car , or drive him back again . He just meets him there and then after the appts goes back to work. The facility takes his Dad back to his apartment.

I saw your reply at the bottom of this thread about maybe needing 24/7 at her side for falls. That is not possible even at home . The caregiver could be getting your Moms lunch ready and your mother gets up and falls ( exactly what happened to my grandmother while living with my aunt ). You would have to have two people in order for one to be at her side all the time . Very unrealistic. The truth is elderly people fall , just a fact of life . Just like toddlers fall when walking .

No facility is going to assign your mother her own aide to prevent falling . Paying for an extra aide to be a 24/7 “ fall spotter “ on top of paying for a facility would be expensive . You would have to hire a private duty aide .

You need to know your mother’s care needs and tour facilities and get educated about where she belongs if she doesn’t stay at home .

I know you have legitimate concerns about your brother regarding your moms money/ house . Others have given you suggestions on how to deal with that like an elder care lawyer .

I also know that it can be impossible to live with someone with dementia even if there are caregivers coming to the house , which is why there are Memory care facilities . Mom may need memory care . Your brother may be burnt and can’t live with her anymore . Her care should be paid for by your mother.

If you want Mom to die at “ home “ instead of a facility perhaps you should get guardianship and take her to your house.

Chances are that brother doesn’t actually want these miraculously helpful and reliable 24 hour carers in the house all the time. ‘Pay for it out of your own pockets’ is pressure to finish it, not to keep it going. BUT he may not end up permanently “comfortable living in her home and driving her car”.

It might help resolve things if you all stop talking about mother’s wishes to die in her own home, and start talking about the money. There’s a good chance that’s what it’s really all about.

Most people die in one room, looking at four walls, and it matters very little where the room is. My mother died at home with me sleeping just outside her bedroom door a few feet from her. My ex died in a NH which provided for our children to sleep in his room during the long wait. Family faces are more important than the walls.

IMO: Your mother is much better staying at home - for a variety of reasons.
(1) A NH has 24 hour staff, but residents can't expect attention more than a few times a day.
(2) With home care, YOU manage the care. In a NH, management manages the care and it is pretty much out of your hands. You can request things, but there is no guarantee.
(3) Moving will likely be traumatic for her.
(4) She will lose what independence she currently has. Meals, care, activities, etc. will all be on a schedule. Food choices will be limited.
(5) If she would benefit from outside activities, look for an adult day care program in your area.

It is my experience (5+ years daily and extensively (avg 8 hrs/day) in a "high end" Care Center (NH, AL, Memory) that these "facilities" are more like warehouses for the elderly, and institutional neglect is rampant. Many other residents' familiy members and various professionals concur with my perspective.

IF you can find a small adult care home, some of those are better - more personal - and may be worth a look. But you are still left with less choices, a major change that can be traumatic, and less personal oversight of the care.

Good luck.

Does it make it easier once a senior is admitted to a SNF? It depends entirely on the situation. Are they different than in the 80s? Many are, yes. Some aren't.

There is a lot to unpack here. So I'll just share our experience. My FIL was hellbent on staying home. SIL and BIL lived with him for a lot of reasons. And his care began to become too much for the 4 of us to juggle. He was ready to sacrifice all of us to stay home.

The opportunity arose to move him to a Skilled Nursing Facility. He was still hellbent on staying home - but we told him and the rehab facility where he was at the time that if he was going home - he had to hire 24/7 caregivers or it was an Unsafe Discharge - because we could no longer ensure his safety or provide his care. We forced his hand and he did choose a SNF.

He has been in the SNF for 6 months. Has it been easier? To an extent yes. His physical care is no longer our responsibility. He is a 300lb nearly immobile 90 y ear old man. There are a lot of things that people don't think about caregiving that you have to really plan for someone of his age, mobility and size. Two family members had to accompany him everywhere. We did everything by committee, and any time he left his home someone had to take a day off of work. Anytime he fell, the fire department had to be called - every single time. He had to have bath aides scheduled, and physical therapy at home, and had to be overwatched to avoid scams, and random technicians would show up at the house "unannounced" because he would schedule them and forget about it - all in the middle of the night when BIL/SIL were sleeping. Every bit of his care had to be carefully scheduled and planned. And emergencies were always a huge deal.

When we moved him it was a huge weight off of us. But then he decided to make sure that we stayed involved. And I have not been able to teach my DH and SIL how to let their phones go to voice mail. They answer every single call every single time. He calls 10, 15, 20 times a day. His expectation has been that we would facilitate for him instead of him advocating for his own needs. He calls for them to call the nurse's station instead of just pushing his call button. We are slowly getting them to stop answering every single time he calls. And he is slowly beginning to either advocate for himself or just not get whatever it is that he needs. (Silly things like "I need more water." "Dad did you hit the call button?" "No, I want you to call them, they won't bring me water." "Dad they don't know that you need water!" )

So...does it get easier? It should and it can. But that depends on if you put them somewhere that you feel comfortable with, and you back away enough that you can let go some. Otherwise you will stay entangled and it won't get any easier. You have to find a happy medium of what works for you in your involvement and allowing them to care for your loved one. And then it can get easier.

My MIL Is currently 'dying in place' at her home.

The energy and devotion it takes from her 3 kids to keep her in her home to the end has been phenomenal and also very depressing.

She has a Hospice co. that comes in twice a week to bathe her and bring her oxyygen and her meds. She hates them, and wishes she didn't have to let them in, but w/o them, she'd be out of luck.

The 'kids' have vacillated between 24 hrs shifts, to morning shifts to afternoon shifts to evening shifts--with the accompanying 'jobs' that go along with whatever part of the day she wants them there.

It's been upsetting, to put it mildly. She doesn't recognize how much she is sucking out of these kids (aged 74, 71 and 67). They have families and spouses and grandkids and LIVES. But for the last 9 months it has been all about MIL and will continue to be so until she dies.

She is not nice to anyone. She is kept semi-sedated all day, everyday and completely knocked out every night. She changes her mind constantly and YS does the best she can to do everything in her power to make mom happy.

Never mind that all the spouses are sick to death of this. I know my SIL is ready to call a halt to her DH's involvement in this. I'm with her.

The time to move her into care was 10 months ago when she had a bad fall and she was moved into Hospice care. Once they took her back home--they signed their own 'death warrant'. She is firmly in place at home and will never leave.

She has plenty of money to pay for years of care at the best of the best ALF's. She won't go.

She doesn't have complex medical issues. She's mentally very unstable, and that alone would land her in a facility with round the clock care, which is what she needs.

I'm waiting for my DH or BIL to have heart attacks from the stress. Both have already had them---MIL does not care about anyone but herself.

Realistically, IF the kids could move her to an ALF, they would still visit her every single day. But perhaps it wouldn't be so wearing. IDK, we'll never know.

When I moved back to the state where my Mom lives, it was always our intention to do whatever it took to let her die in her own home. Alas, it is not going to happen that way.

Your post keeps on saying Nursing Home. For memory issues, there are many other options than Nursing Home. Each one has a different living arrangement. There is Assisted Living, AL where the person can still mostly function on their own and make decisions regarding their life. However, they may need help remembering to take their medication or might need help preparing meals. Then there is Memory Care, MC, where it is typically a locked facility so that people cannot leave on their own. These people may or may not be able to feed themself, keep up hygiene, etc. Both AL and MC have daytime appropriate activities to keep the brain stimulated. Within the AL and MCs, there are some who live in clusters of houses and some that look like hotels, with or without roommates. Then there is Nursing Home, where people are totally dependent on someone else. I would suggest that you visit a few of each type, there are no standards unless your state has them.

In my state, once a person enters a Nursing Home or MC, it is assumed that the person can no longer make rational decisions and POA is generally assumed.

When my Mom lived in her own home. I did medication management, helped her with her bath, cooked meals, drove her to all her appointments, helped her write checks, filed her taxes, etc. We had caregivers 9 hours during the night, and she went to senior day care during the weekday (she was a fall risk so she had to have someone available to her 24 hours a day). No POA involved. The biggest headache during this time was finding reliable, compassionate, dependable people for that 9 hours. Even though we used an agency, once or twice a month, they couldn't find someone to take care of my Mom for the shift (my Mom was up and down all throughout the night)

Once my Mom started becoming incontinent, she would try to hide her incontinence by putting her wet clothes back with her dry clothes, go through the hamper and pull out dirty clothes to wear, etc. Now when she was with me, I had to keep a closer eye on her. When I added up the cost, we were playing more her her upkeep in her own house, than it would be for me to move her into a care homes. Now, that once or twice a month that there were no caregivers, became even more of a headache to me.

So I moved her into MC. I did NOT sign the document transferring her PCP and pharmacy to the facility's PCP and pharmacy. I get texts whenever something major happens, like her blood pressure dropped. or that they found a bedsore. I still take her to the doctor (they could take her to the doctor for me for a fee). So overall, I am doing less. They do her laundry, all her meals, bathe her and do daily activities. I see her everyday to brush her teeth and get her to exercise. About once a week, I take her out and do something "different", whether it is a run to Costco or just accompanying me on my errands.

Apparently, most people take their person to the AL or MC, and see them maybe once a month or once a week. They put the facility in full charge of the person's health.

If my Mom was bed-bound, I wouldn't be able to take her out.

So, depending upon what level of care your Mom needs, she could have a lot of different experiences that are not Nursing Home level. I would go and research a few places. The different care levels and different environments at the managed care facilities are quite different than the early 2000s and even 2010s. However, that doesn't mean that all managed care has improved. Some homes still operate as if they are in the 1950s.

So check them out just to get a sense of what is available. Then you can make a more informed decision about the future care of your Mom.

What does HCP stand for in the context of this question?

Suggesting that living rent free is equal to the emotional, practical and stressful time sink that caregiving requires is offensive. He may be burnt out and it’s not healthy to think “gee, will mom die today so I can get my life back or is it back on the hamster wheel?” You owe him your gratitude and support.

That said he cannot demand you pay for mom’s care any more than you can demand he stay to care for mom — or insist mom stays in her home just because she wants to.

Your brother has siblings. Let them take care of mom in their house or hers … or get her into assisted living.

Sorry. Zero sympathy for family members who let one person do all the heavy lifting and do nothing but complain when that person has had enough.

If you and sister are right and mother only has mild cognitive decline then an attorney will be able to make a determination if she is still able to understand and if she wants you and sister to make decisions for her finances instead of brother .

If mom is able to sign the POA, then you can evict brother.

If your mom is like most moms, she may not want him evicted and you will probably have to throw him under the bus to gain her compliance. This won’t be easy for any of you.

If brother has his ducks in a row and has been to an elder law attorney who understands Medicaid for your state, then he may know that he can remain in her home and keep her car as he may have presented himself as her caregiver for over two years and the laws of moms state may allow adult children who have been caring for their parent to remain in the home without Medicaid trying to recover her charges through the MediCaid estate recovery program. Sorry for that long sentence.
Indeed, he may have already started the spend down. the car and house don’t have to be sold.

I know you want to honor your mothers wishes to remain in her home. Most elders do live in their homes until death. But mom is the one who appointed him and that was her wish as well….that he make the decisions for her finances.

I do remember a long time poster, Jeanie Gibbs, saying that the agent for the health care poa makes the decision for where the principal lives. It’s the job of the financial poa to pay the bills. I’m not sure that this is true for all states but please do read your poa carefully and know that an hour with a qualified licensed (CELA level) elder care attorney for your mothers state is money well spent.

But you can be right and still not prevail. It happens.

As has already been mentioned, a reverse mortgage is not a sound financial decision in most cases although it might work in this case with the right provisions. As brother is also. a resident, he might be able to remain being a resident until his death.

It is difficult to know exactly how much brothers presence has benefited your mom. You can bet he has declined partially due to the circumstance of living with an elder for 10 years. If he is at the end of his tolerance and has no place to go, is unable to take care of himself on his own, then what would mom want?

It is also difficult to care for an elder in a facility. Different issues but not free of responsibility as he may be imagining.
Well, perhaps he sees his part as easier if he isn’t going to visit her.

I would personally keep her at home as long as possible but brother’s issues need to be addressed.

Please do let us know how you resolve this. Wishing you all peace.

A few thoughts—reverse mortgages are nearly always a bad idea. Nursing homes and/or memory care facilities are like people, best evaluated one at a time and not lumped into a category of good or bad. Nothing beats a personal visit, especially at varied times of day. Having a senior in care doesn’t make life easy, just different as it still requires hands on advocacy and supervision of the caregiving (at least when the family is involved and doing what everyone in care deserves and needs) Mom’s finances should always pay for mom’s care, no exceptions. A senior’s wish to age and die in place is often superseded by the need to provide for their safety and the well being of the family members providing care. And our family received great care for our mother for which we remain grateful and I’m fully aware it can be hard to find. Family arguments never help. I wish your family the best.

You and your siblings need to have a sit down with your brother and make it clear to him that it is his obligation to pay for your mother's care with her money. He needs to be made to understand that he will not hold your mother's money hostage and will not dictate to you and your siblings the terms of paying for your mother's home care. If he refuses, then you and your siblings need to make it clear to him that he cannot fulfill his duty as your mother's POA and one of you will file for guardianship. I doubt a judge will look kindly on your brother as you describe him. This could get ugly quickly once he realizes that you and your siblings might be putting an end to his gravy train. Your obligation is to your mother.

You state she has enough assets. What exactly do you mean by that? Enough assets for how long. You know what it is costing now.

No the family does not pay for her care. You save your money for your present and future needs unless you are fabulously wealthy which I doubt is the case. You all tell your brother this also pointing out all the benefits he has had living rent free and driving her car.

This may be semantics but...there is a difference between:
**1.) Nursing Homes (now more appropriately called Skilled Nursing Facilities)
These are typically for people that have chronic health care needs or need equipment to be able to move them from one location to another.

**2.) Memory Care This is for people that have cognitive issues, either from a form of dementia or possibly TBI. Often these units are locked to prevent a person from wandering.

**3.) Assisted Living this would be for people that need some help with medications, ADL's. These are typically NOT locked and a person can sign themselves out if they wish to leave the facility.

**4.) Independent Living as the name implies a person living here would have no help. A lot of the time IL is part of a CCC (continuing care community, where all levels of living are available)

so the "nursing home" you recall from your childhood probably does not exist as you knew it. (yes some of the same practices happen, you may find people in wheelchairs at each level of care "parked" at the nurses station often this is for safety. These may be people that try to get up un assisted or may have other needs)

If your brother who is POA is not doing what he should be doing to provide mom with the care that she needs then there are a few things that you can do.
Petition to become her Guardian. Have documentation as to what he is not doing to provide proper care or if the issue is safety document that.
A report to APS would result in an investigation, the person would evaluate the situation and make recommendations.
Becoming a Guardian is not something to take on lightly.
The most important think is mom's safety.
If at anytime you do not think she is safe make a report.
If mom is taken to the hospital you can inform the Social Worker, the Discharge planner that you do not think mom is safe at home.

If your brother is the POA then it's his legal responsibility to act in your mother's best interests.
This means properly administering her money and paying her bills. Homecare services is one of her bills.

I agree that your brother has grown comfortable living rent-free in her house and driving her car for the last ten years.
His comfort doesn't matter and should not even be considered.

If your mother gets placed as the POA the nursing home will harass him both night and day if he doesn't give them full access to her bank accounts the second she goes through their door.
It will also be up to him to sell her house (and any other real estate) and to pay the nursing home in cash with whatever money she has (including the proceeds from the sale of her house and car) until everything she has has been spent down and she gets on Medicaid.

Make sure your brother knows all of this.

If it's possible for your mother to not have to be placed and it's what everyone else, including her wants, take her to a lawyer and get the POA changed.
Ot petition the court for conservatorship/guardianship because your brother is not acting in her best interests as the current POA.

My two cents --

My mother went into a nursing home after my dad (her caregiver) died. I could have kept her in her home with 24/7 care, constantly trying to ensure someone showed up to work every day for every hour, driving back and forth from my home more than an hour away to take her to doctor appointments, keep an eye on the caregivers, gardeners, do the grocery shopping, housecleaning, and laundry, but that wasn't feasible. (I had already been doing all that for the two months I lived with my parents during my father's illness, lost 10 pounds just from the stress, and never had more than four hours of sleep per night.)

However, it wasn't just for my convenience that I chose to move my mother but rather for her safety, her health, and most important, to give her the mental stimulation she had been missing for the previous four years as dementia crept up on her and led her to stay housebound and unwilling to go anywhere. My dad was consumed with doing all the cooking, cleaning, and shopping to keep the household going and was unable to spend much time keeping Mom awake and finding things to interest her. One-on-one care with dementia is, in my opinion,
not the best thing.

Once she was moved to memory care, she was not happy, but she also had caregivers who were trained to socialize their patients and not to merely hand out medications and go on their way. My mother was much more alert and went from sleeping 18 hours a day to not taking any naps during the day, because the policy of the MC was to bring the residents into the common room during the day, not allow them to just stay in their rooms.

Her place was sunny, happy, and friendly, and I don't have a single complaint about the facility. Because I didn't know the difference between types of nursing homes, she was first placed in a skilled nursing facility which was not a good experience, but the MC was wonderful. I rarely had a call about a crisis as they were properly trained to handle them.

Respectfully, I would say your brother has a better grasp on what's going on with Mom than you do from afar. He's dealing with all the things I mentioned above, Mom is not improving in any way, and you haven't even checked out what nursing home care is like 40 years after you last stepped in one.

That said, you have no obligation to pay for your mother's care, so if he wants things to change, then he needs to make it happen with her assets. It IS a lot to deal with when he has his own issues, so is there a named back-up POA who can step in? Also, what is the plan for his future if he's unable to work and has nowhere to live once Mom's gone and a reverse mortgage is going to have to be paid off with the sale of her (and his) home?

Seems to me like there needs to be a major face-to-face meeting with all the siblings to try to get onto the same page, and I hate to say it, but Mom's desire to die at home is the least of the concerns here.

If your mom is ready for a NH or managed care and your brother is the boots on the ground caregiver, you and your siblings should go live with mom for a couple of months before you make it harder on him. You only think you know what this entails. FYI, you have no clue.

Being afar off and putting up resistance to care options is just wrong. You just get to put your 2 cents in and go about your life but, your brother lives this 24/7/365 for 10 years.

To everyone jumping on the brother, SERIOUSLY? If he came here saying that his siblings are long distance, don't provide any hands on care and are stopping him from placing mom, you ALL would be telling him to tell her to go pound sand, he has the POA and mom did that because she knew he would make sure her care requirements were met. Instead your encouraging her, afar off sibling, to interfere with something that doesn't affect her life in the least. Really?

Original poster, if you want mom to stay in her home, go make that happen on your back or leave him to do what's best for him and your mom, because he matters to, regardless of what you think has been happening for the 10 years he's been there for your mom.

Nursing homes today can be nice. No one wants to be there, but they serve a need for many people. It's possible for residents to socialize, go on outings, make friends, and get care for serious health problems. It's better than being home stuck in a recliner and never seeing anyone but the family caregiver (who is burned out).

You mentioned that you are "afar." From "afar" you don't know what goes on in that home on a day-to-day basis. Surely your stressed-out brother with his complex medical issues knows better, and he says she should go to a nursing home. If you're comfortable with brother wiping mom's private parts to clean them when she can't do it anymore, and you can support this from "afar" even though he says she should be elsewhere, maybe you need to visit more often and be the primary caregiver for several weeks while brother is on a vacation from his duties.

Mom's assets should pay for her care. Not her family. Brother needs a reality check - mom's house and car are not to provide him with an easy lifestyle. They're to take care of her.

If Mom has money, why do her children need to pay for her care? The POA pays for the care out of Moms money.

Mom will have to use her money to pay for care in an AL or NH until its spent down. My Mom had no problem getting into a NH. She had Dementia and was 24/7care. She took blood pressure medication, otherwise healthy. Once spent down Medicaid will be applied for. I think u should go and look at places near you to determine whats best for Mom.

The house? Brother thinks he will be able to remain in it? Not really. Was he Moms Caregiver in any way? Once Mom is on Medicaid, her SS and any pension, go to the NH towards her care. The house is an exempt asset. Your brother can claim a Caregiver allowance or claim disability to remain in the house but in both instances, he has to prove that he can pay bills, taxes and upkeep to be able to remain in the home. He will not have Moms monthly income to depend on.

Well, lots to unpack here. You have a bad POA in place and that is an enormous problem in and of itself. Now as to placement, it is likely time and a good move....
BUT..........................
As to family PAYING for placement, that needs to be a clear, loud and resounding "N-O!!!" You ALL will need all the savings you can muster now for your own old age. When you Mom passes you will understand how soon your own time for retirement support is coming. It is terribly wrong for children with limited income and a need to save to put money on a parent. Your Mom has resources. So the POA needs to be told to use those resources (other than the home) for her care, and then have her on Medicaid. There will be clawback on the home, but he apparently believes that he is major heir here, and not wanting Mom's money to go to her care.

Worst case screnario here is that someone in family more upstanding is going to need to get guardianship away from the brother, or at least have an examination of his bookkeeping and POA records requested through the court.

All that to the aside we come now to your question. Is it better. Yes, sometimes. Other times not. And that' can't be predicted. My own brother was diagnosed after a vehicle accident with probable early Lewy's Dementia. He was in his last little beloved and downsized home and in his mid 80s. He loved his neighbors and it was a tight community and because I, his only support, lived across the state he had a tough decision to make about entering care in ALF or waiting until he "had to". He had so many saying "Stay here; we will help" but he was wise and understood his accepting help would quickly move to his being a burden and he assigned me his POA and Trustee, and went into care.

There he thrives. He had lived a rather reclusive almost monk-like life, very private all his life. He thought he would have a terrible time adjusting. He said "You know, hon, kind of like I was young and in the Army; I don't much like it but I make the best out of it". However, he did more than make the best. He came to enjoy going to movies, on tours of the homes of the stars, to bingo, to social hour, to watch the news in the common room, to play a few games. Because I was now handling all his bills and business papers he was free of them. He began to have fewer, not more hallucinations. He got nothing but better. He died of Sepsis before his diagnosis could progress, so who knows what changes otherwise would have occurred.

You will find that the questions you have will be guessed at and answered by more than a few of us in more than a few ways. Your own experiences will be unique to you as your own thumbprint.

I sure do wish you the very best of luck.

When family members disagree about what the best thing for a person's care it can get really messy and tear families apart. Apparently, your brother is not doing the home care, but holds down the fort so to speak by living with her. Try not to jump to conclusions about his intentions, rather get him to explain his point of view on the matter per her actions and state of mind, what he perceives as her needs. Living with someone with dementia is difficult, even with having free rent. And since he is the one in contact with her daily, he might know best her needs. She would have to qualify medically for nursing home care according to her doctor. Assisted living or memory care might be what your brother means, and they tend to be less expensive than nursing homes. I suggest you all check some out, get all the information on what would be provided, what the costs would be compared to 24/7 home care, visit the ones you like, taking mom along, and then decide. It doesn't seem an emergency situation right now, so a good time to get acquainted with options. Keep in mind that what your mother wants may not be possible.