How can we move someone with dementia if she does not want to go to a facility?

Just because she sounds lucid to you doesn't mean she's competent. I can't tell you how many people thought nothing was wrong with my mother, yet when it came to competency, she couldn't remember the year she got married, her address or other essential details that help determine competency. If she is not competent, a guardian should be appointed for her.

Unless her daughters are willing to declare her incompetent, they are in a bind. I had to wait it out, until my mother fell and went to the hospital. Then, the doctor refused to let her go home.

Will she at least go to the AL and have a look?

Depending on the progression of her dementia, she might now be a candidate for AL, though.

NO ONE wants to go to an assisted living facility. In the case with my dad, the doctor said that he could not live alone. My dad had every reason in the book and then some why it would not work. His arguments were exhausting. So we left the hospital and rehab and went to straight to assisted living. I already had his furniture moved in and his clothes in the closet. He pouted for about three weeks and that was tortuous for me, but he says now it is where he needs to be. My suggestion would be to get her doctor to talk to her, take her to the facility and let her look at it, and see if she will just "try it". Trust me, it is NOT an easy move for anyone involved, but sometimes we have to do what is best and safest.

You may be well-served seeing an elder law attorney. The issue of competency needs to be resolved. It is difficult to "make" someone do something if they are legally competent - even if you disagree with their decisions and think they should do something else.

I pleased and pleaded to have my husband in a nursing home. Finally I gave up and then one day a VA emergency room doctor came and said to me "do you really want to take care of this old man? I said no, and that go the ball rolling. They transferred him to a nursing home. At that time he had vascular dementia, was tube feed and had urinary incontinence. So, find a nice doctor, explain the situation, and hope for things to happen on the next routine doctor appointment. Beware, they take them wherever they find an open spot. Mine was 37 miles from our home.

I'll try this again. --- You need to get her declared incompetent. This process varies from state to state so check with your local office on aging and they can assist you. -- My mom has dementia too and for a very long time she sounded competent if you talked to her and people who didn't know her wondered why the family considered her incompetent. They'd say, "She seems fine." Don't go by that. I took her to a neuropsychologist and he tested her. He wrote a report that said that she definitely has dementia and Alzheimer's and detailed what she can and can't do. That's a legal document you can use to proceed to put your aunt in a facility that will properly care for her.

Her daughters need to talk to her doctor, and have HIM tell her it's time to go to assisted living. I have sometimes found that the older generation takes the word of doctors as gospel and will listen to them before they'll listen to their own family. Just a thought.

A formal declaration of incompetency is a last resort. If it's not plainly obvious, and it sounds like it wouldn't be, it can be arduous to get (as it should be) and can take awhile.
I'd meet with your aunt's children and formulate a 'plan of attack' – if your aunt is thrifty, appeal to that "you paid a lot of money for your long term care insurance and you could be one of the few people who actually get to take advantage of it and live for free!" If your aunt is able to be persuaded by a guilt trip, have her children make the appeal "I can't believe you won't even consider this for me. Knowing how I worry about you and how much I love you, how can you not even give this a chance. You are taking support away from your grandchildren - I can't provide for them as I could if you would use your insurance...). But, given that her resistance sounds 'toddler-like', you may be most successful by just laying down the law. Her kids could meet with her together (to show how serious they are) "We can no longer afford to support you. You must use your insurance. We are going to look at a community today."
Personally, even if I had money to burn, I'd be damned if I'd spend it on aides for someone who has long-term care insurance!
Her children need to confront her with reality or just move ahead and make the plans without her. It's hard being a parent to your parent!

Purplesushi you are SO RIGHT. My mother who was falling frequently was refusing to consider a walker until the doctor told her she needed one. I kind of laughed when she said, "Oh, doctor...if you think I need one then ok." All I could think to myself was you've been my mother for 61 years but your doctor of less than 10 years has more sway. Regardless, though....it solved the problem for now, at least.

Depending on her stage of dementia, has she seen a geriatrician that has diagnosed her with dementia? or is this something you think? In any event, you could try to start with getting her into respite care and tell her it is a break for the daughters and caregivers, and from there she could just transition into a residential setting.

Definitely a good idea to get your aunt's doctor on board. Send him a written note explaining the situation first - that worked really well for me.
However, much as the older generation respects their doctors, I've found that dad digs in his heels once he leaves the office! It's all "yes, doctor. I will, doctor." until we try to actually execute the 'doctor's orders'.

Is that private insurance you think will pay for an assisted living facility? Think again. She will have to pay unless she is indigent and on Medicaid. If she is lucid enough to sound "normal", then short of bodily taking her to a facility which she will pay for (with funds she gets from selling her house or savings), then she can stay put. If she truly has Alzheimer's dementia, she has to be in a locked facility which is more costly than an assisted living one. Get her doctor to verify which stage of dementia she is in, and then go from there. You have time.

As a professional caretaker I've seen many elderly who did not want to enter a facility till after a medical disaster {falls, etc.} They would give many reasons to stay home, except one:: The FEAR of change. To some degree they are aware of their memory loss, hence are afraid of having to get used to, and MEMORIZE , a different life situation...That is DEEP DOWN absolutely scary to them.... but they can't put it into words....often don't fully realize that this is the core-fear. .....Reassurance, stating in a loving way that they will not have to remember a thing, that the personnel at the home will remind + help. DELAYING present visits - to make them realize how much more help they now need - is another way to convince...!!! Explaining the need for PoA to keep them safe should something happen,+ the often not realized fact, that without PoA, Doctors + Hospitals cannot talk to family about the elderly's heath condition at any point in the future also emphasizes that Families should discuss end of life possibilities very EARLY, while reasoning is no problem yet... and explain that secrecy toward Family can only lead to disaster ...Get the elderly + family to understand their financially possible choices + keep suggesting that memory status, not only physical disability, is a big reason for timely change.... keep stating how Family will have LESS WORRY about their safety, would have more time for pleasant visits, instead of chores + expense to keep the old house running. Emphasize the fact of no longer having to get oilchanges and pay car insurance, Emphasize the much safer travel choices the AL-Home provides, that would reduce FAMILY WORRY !!! Emphasize fun weekend vacations spent with family... and how important those easy visits are to the whole family Unit... Convincing them of all those facts, makes the eventual change easier for them...and spares them the HUMILIATION of HAVING to APPEAR BEFORE A DOCTOR/psychologist TO BE CHECKED FOR MEMORY ABILITY AND REASONING prior to a PUBLIC competency hearing..not to speak of the initial expense and the constant reports +expense that the courts require there-after. Wishing best outcome to all !

I am in a similiar situation. My father is 90 has good days/bad days. recently moved my mothers diabetic medicine (which I had to find), and other things that mysteriously disappear but yet "he claims he didn't have them". I am going to check with our office of aging for some guidance, but not "all" older people think doctors are "gospel in their words". My father HATES all doctors so its hard for me to get him to go to one for just a regular checkup, only if he has an issue will he go anywhere. So I can't answer your question other than I guess get some guidance from someone (doctor, elder attorney, ?) to help you make your decision easier.

This is so difficult...and near and dear to my heart...my aunt, who is like a mother to me, is in a rehab after breaking her hip. We are not sure where she will go from here..she fully expects to go back home, with help, but I think the rehab feels a NH or AL is the appropriate place. My aunt has not been declared incompetent because she can have a nice little talk with you for a short time and can answer basic questions like what year it is.....however, she has almost NO short term memory and makes really bad decisions, like paying someone over and over again to clean a clean, empty apartment....to the tune of 650.00$ in 4 months time. She doesn't pay her bills, etc. etc. tells me the same thing multiple times in a short conversation, etc. I don't know what to do either, it's a tough situation. She doesn't even think she has a problem with her memory. How do you tell a 90 year old person that they are so impaired? I am trying to keep her from getting depressed....not make her more depressed. I think I am in that waiting it out phase that someone mentioned earlier...

Cindy-
in some ways you are fortunate. Perhaps the dementia has progressed to the point that she doesn't think she has a memory problem. Imagine early in the disease how difficult it must be for them, knowing something is wrong but not knowing what. My moms disease has progressed to the point that she really believes there is nothing wrong with her which is much better than where she was a few years ago, terribly depressed.

Often times people with dementia are very successful in covering up what is occurring. Is there a friend or family member that spends a significant of time with her. I do not mean a few hours each week, a few hours a day would be required at a minimum.

You can't make her go anywhere as long as she is still in her right mind. Assisted living is probably NOT covered, read the insurance policy.
Her MD would have to recommend aides covered by Medicaid if she is eligible.

Yes, gladimhere , you may be right...except that she gets very upset when we suggest that she is having difficulties...she is great at making excuses for forgetting to pay bills etc. even when I straight out tell her of an error she has made...she brushes it off (or gets upset). There is no one close...I am really the only one...I am 45 min away...there is a neighbor upstairs in her apt that has been "helping" her for the past few years but through all of this I have discovered she has taken a fair amount of money from my aunt..in the form of loans...which she has not and can not pay back...so I feel she is using my aunt for her financial needs. The neighbor is also very controlling and gave my sister and I a VERY difficult time when we began getting more involved after the fall. She has been quite verbally abusive to us. I have to report her to elder services to protect my aunt....my aunt, thinks she "needs" her because she has been thoroughly brain washed by her. It's all so complicated. I don't want her to go back home and be unsafe, but I can not put her in a NH ....maybe ALL, if she will go...but I know she won't....I am sure she would come live with me but I am unsure I could handle that...full time job, two young boys, dog, upstairs bedrooms...we would have to move and still get lots and lots of in home help.....just not sure what to do....

This subject is near and dear to my heart as well. I can't tell you how many people told me that I could not move my father into a nursing home "against his will". I personally think there is a great deal of confusion about this subject and people make it harder than it has to be. My father had been driving erratically even before his wife passed and once she passed it was even worse. He could not find his way home. God knows what a danger he was to other drivers. He lived in my hometown 4 hours away. We had already had him sign a MPOA in case of emergency with me as the designee. My father lasted 9 months after his wife passed falling down, driving around erratically, having delusional episodes where he had left his house and was stumbling around in the dark with no shoes on and terrified that ppl were in his house that meant him harm. Even still with him in this condition, I went to several dr visits with him and his GP finally did a short memory test and determined that he had dementia. he then ordered a bunch of diagnostic testing like MRI and such. Well, I had to call upon family members to take him to these tests but he would get there and assert his will that he didn't want to do it etc. etc. These are the same folks who think that told me repeatedly that they didn't think you can make someone go into a nursing home if they protest. Finally my father started falling all the time and he told me on the phone that he thought this must be the end- that he was dying. He couldn't stand up without feeling dizzy etc. My Aunt and cousin kept asking him if he wanted to go to the ER, Dr etc. Of course he said :NO.
I would be on the phone and so exasperated because I couldn't get my family to override this man who could not make decisions for himself! arggggh. Eventually I talked to him and he couldn't even make one decision so since I was MPOA, I told them to take him to the ER. My aunt is a devout christian had trouble telling him a white lie that she was taking him to the ER because I told him he had a dr visit. :( Once he got to the hospital, his blood sugar was 700+. It was so high that it didn't register on the machine. Of course he's feeling messed up. He was very agitated cursing so they moved him to a behavioral unit. By this time the dr had told me he can no longer live alone. Up to this point I had agonized over how to get him into a safer environment because we had been through this with my aunt and she kept falling and laying on her floor for hours or days and my fahter and I were upset about that happening and I was determined that that would not be the case for him.
Even AFTER the dr told me he could not live alone, a nurse at the behavioral unit told me the same thing. She almost scolded me that I could not just drive up and deposit my father at a nursing home and that it was a misconception blahblahblah. I was very distressed by this because I was on this forum and people would say, oh it's very costly to get guardianship, you have to get a lawyer $$ go to the court and the person has to go before a judge and the judge has to determine him to be incompetent. I was mortified that this was the system because I didn't want my father to stand there and be humiliated in this fashion after living his whole life. I was so frustrated that they could let someone who couldn't make decisions decide about his care.
Well, I'm here to tell you: someone contacted adult protective services anonymously. I suspect it was the dr's office. That too sounds scary to me but it turned out to be the best thing that could have happened. The drs at the behavioral unit were the ones to do the evaluation and declare my father incompetent. There was no lawyer, no judge. The woman at adult protective services told me that my father HAD to go into full time care or else I would be liable for elder abuse. She followed up with me after I moved him into a nursing home near where I live and finally he is safer than he was at home by himself. The nurse who preached at me was the one to get his paperwork ready to go and she didn't utter a peep to me. I was really angry about this because it was so unnecessary. The whole situation is emotionally charged anyway and it really isn't up to family members to make these calls. If your aunt is unsafe or you feel that she needs AL, then this needs to be brought to her Drs attention and then she be evaluated. No matter even if she can talk pleasantly, these drs have tests to determine their competency and they will tell the family if she is at the point where she needs this care. If so, they can declare her incompetent for the purpose of making big decisions and once it gets in motion, it has a momentum. They didn't go to my dad and announce " you are incompetent!" or anything like that. They treated it like a drs order. I was so relieved. In this region, Texas, louisiana, it is considered elder abuse if they determine they cannot be alone. You can be charged with it so you are forced to resolve the situation. In our case, I could not manage my father from 4 hours away and the family was so wishy washy on it I am happy that he is near me. I would not go paying a bunch of lawyers and getting all of these papers drawn up because of course they will initiate it for you, it lines their pockets. I would talk to her drs. If she is at the point where she cannot be alone, then it isn't up to her anymore.
One thing they told me is that it is much easier on them if they go straight from a hospital to the NH rather than home and then decide. I personally think you have to proceed as if they are like toddlers ONLY in that they can't really make proper decisions because their brain doesn't have the capacity to. Sometimes, you have to trick toddlers into eating or bathing/going to bed. Personally, I didn't sit around asking my father what he thought about it. After the authorities got involved, it was done and I am so glad. If your Aunt has dementia, it will progress so it's not a matter of if, it's a matter of when. It is so much easier without all of this upheaval and I can't tell you how much heartache it caused for people to tell me that he could do what he wanted. I wish the best of luck and PM me if I can help sort it out. hugs BG

Oh and BTW, all the POA stuff we printed out and he signed with witnesses. The DPOA I did at the nursing home who had a notary. End of story. So whoever is going to be the designee doesn't need a lawyer for that either. Every place I take him they ask for copies and I have had no problems. Even SS office and the HMO he was on took the copies and I have had no problems. NO lawyers. thank god cause I can't afferd it. :P

Butterfly girl,

Thank you for the response...sooo helpful...my one question...how did you deal with the decision , or, nit, to take your dad into your own home vs. A nursing home or Al? My aunt raised me and I feel I can't put her in a NZh or naybe even AL...but....I don't know if I can care for her at my home....so hard.....

Butterflygrl is right. The other way to get incompetency declared is to take the "emergency" route. However, it doesn't sound like your aunt is in the state you'd need to be in to do it that way.
So, again, if I or my loved one had LONG TERM CARE INSURANCE (I assume that's what you're talking about when you say "insurance"), I'd be beating a path to the door of the most luxurious AL in town!
Read her policy carefully – many of them cover AL (doesn't need to be SNF) and most have set limits (per day or lifetime). If you're confused by the language, take it to the AL you're considering, they've seen plenty of them. Even if her policy covers a set daily limit, she'd only have to make up the difference and it surely would be less expensive (and BETTER for her and her family in every way) than paying for private aids at her children's expense.

p.s. - A visit to the elder law attorney is advisable, too.

I understand where your dilemma comes in because no one wants their loved one in a place like a nursing home if they can manage at home. I guess you have to figure out what will fit into your own life and what you feel comfortable with. I have and still have a lot of guilt feelings about my dad even though he was not that great of a father. Since I was the MPOA, I am responsible for him being there and he of course doesn't like it. If I had more backup from family it might be different but I don't. I do know this: My father needs 3 meals a day, plus snacks, bloodsugar checks and medicine adjustments, He also has hi bp, is agitated beyond belief. He gets up at night and falls. When he could walk he spent all of his time trying to leave. I knew that unless I could clone myself 3 times I would quickly burn out. The dr visits alone for someone with my father's kidney disease, diabetes, gout, dementia, and now stroke, I knew that I cannot keep up with all of these things. I am thankful that he is overseen by professionals. He has meals that he can take in his room. He can do pretty much the same as he was doing at home which is to sit and watch TV in his chair. If I was ultra rich and had the money I would set that up at home but I'm not. Plus he gets the social aspect of it too. I can focus on enjoying the remaining time he has and he gets fresh aides and nurses around the clock who bathe him, feed him, minister to him where I cant. My father needs that but perhaps your Aunt isn't at that place.

There are groups around that have Gerontology Case Managers and there are Gerontologists and Neurologists that can help you have your Aunt evaluated and assist you with have her put into an Assisted Living Facility or Nursing Home. My mother was hospitalized and I had to tell everyone and their dog that she "has dementia." They would come in an begin asking her questions and she gave wrong answers and I would have to jump in and explain, "My mother has dementia and you have to understand the answers she gives you will most likely be wrong!" When she began sundowning in the evening we asked for medication to calm her and it reacted the reverse on her and she went wild! Then everyone realized they had a person with a problem on their hands....up to that point she seemed absolutely fine and could carry on a conversation and even joke a bit with the nurses, so I looked like I was an idiot and Mom was fine! When this happened day after day, one doctor took me to the side and said, "You need to put this woman in a nursing home, you cannot take care of her alone, you will fail, you will hate yourself and you will make yourself sick....put her in a home!"

If this happened or happens to you, this is exactly where you jump in and say, "Okay I need someone to assist me with having her admitted!" You are doing it on the advice of a doctor!

It does not sound like your aunt ever had a Trust or a Power of Attorney, if she did the POA could have her admitted, without that you have to seek to be her guardian and she will have to have testing done to provide the evidence that she is legally incompetent and needs someone to make these decisions for her.

I doubt that there are very many people at all who will willingly say, "sure I will agree to move from my home into assisted living or a nursing home, and that is especially true if they have dementia or Alzheimer's.

I would speak to my aunts doctor and lay out the situation to him and see if he can offer any assistance. Perhaps getting a social worker in place or finding a gerontologist who specializes in dementia or Alz to help would work as well. Do not stop asking everyone you know for help. You really will need to have her tested for competency, this is a must. I think when you tell them, she can no longer stay in her home, her daughters can no longer care for her and she is financially broke so hiring a caregiver is no longer an option, I think some doctor will listen and help you.

In my mother's case, she was brought home, we got her to a good doctor who prescribed the correct medications for her and she is doing very well at home with me caring for her. The correct medications in my mother instance where a game changer!!! She sleeps and we no longer have angry outbursts, she is calm and easy to handle. Thank God!!!

Stephan, my sister and I are in the same boat as you. Our mother has mild dementia and is living alone but shouldn't be. She has always told us she NEVER wants to move out of her house. She has told us that if we move her to AL, she will cry and cry, and then she will die within two days. She refuses to even go on a tour of an AL to see what it is like. Until she gets to the point of getting her POA activated by two doctors, there is nothing we can do about it. More than one professional and friends have told us that we are just going to have to "wait until something happens to her" and then we can get her moved. It's very frustrating. I understand what you are going through. Good luck.

Cindy - while it might seem like the compassionate decision for you to move your aunt into your home, you have to consider the effect it would have on your life. Whstever you see right now in terms of her behavior and medical conditions will soon not be the case. Unless she develop some kind of disease or illness it kills her before the dementia progresses, you are looking at a future of homecare taking which includes confusion, disagreement, obstinance, incontinence, hygiene problems (refusing showers, insisting on NOT changing their depends), sundowning (up all night _ how will YOU get any sleep?), exit seeking and attempts to wander (get out, get away, "go home" when they're already home), depression, and on and on. Unless you have a huge support system at home (which will quickly become damaging to your family life) or lots and lots of money to hire in home help that you still need to supervise and evaluate and sometimes replace, you can't afford psychologically to have her in your home. It may seem like a good idea right now but at some point in the near future you will be wishing you hadn't done it.

Why does she have dementia in the first place? is it caused by the prescribed drugs and vaccines that her doctor is pushing on her? is she taking a statin? If so, then FYI, statins do cause dementia, along with congestive heart failure, muscle wasting, cancer, kidney and liver damage, etc. Instead of forcing her into a nursing home, you should consider advocating on her behalf AND questioning the doctor on the drugs she is taking. You should even consider weaning her OFF of all of her drugs and switching her over to a more healthy regimen of supplements and non processed foods. You might be surprised at how much your aunt will improve in her abilities to care for herself once those toxic/deadly drugs are flushed out of her system. A lot of people on this list are pro the medical system but according to the famous Starfield Study, JAMA, 2000, the US medical system is the THIRD leading cause of death and over 100,000 people are killed each year due to taking properly prescribed drugs. The nursing home IS NOT the answer for your aunt. In fact, the nursing home could be very dangerous for her. Best to keep her at home and keep her away from any drug and vaccinating pushing doctors. I provide this advice based on the very bad experiences we had with drug pushing doctors, a nursing home and hospital. Our mother is home now and doing much better. Aloha and good luck.

Simple answer, your Aunt, unless she raised you.... is NOT your responsibility...................period.

Yes, my aunt raised me and she is my responsibility....even more so than a "real" mom....she didn't have to raise me....

Wow Beachlover. What is the point in voicing your heartless answer to this thread. I just can never understand people who go to the effort of writing hurtful words where there were none.
Cindyy, I agree the MPOA is important for any older person to have in place. Even if your Aunt doesn't go into AL, she should designate at least that so that someone can make her final wishes known. I would speak to the dr for sure like we talked about. I don't look at a nursing home like most people do. My father had a great many years where he completely took care of himself and managed his diabetes injections just fine. He ate horribly and junked out on sweets albeit ones with artificial sweetners. He right where he needs to be at this point because every time it tears at my heart to bring him home, I go to Nursing home to visit and help him try to just go to the toilet and with me helping him, He cannot even lift himself and he has even dropped a LOT of the weight that he had put on. So, I am not naive enough to think I can take care of him. If I were to suddenly become rich, I could insource it but at this point I am far from being well off.
In your case, maybe your aunt is still mobile and functional. If that is the case then maybe you can take her into your home. Some people do this for a while until it gets to the point that they can no longer handle their loved one.
My father has fallen 4 times this week because his obsession is to walk and who can blame him, his brain wants to get up. He wants to do what he has always done but his body can no longer do that. They are working on strengthening his legs in PT and I have hope that he will get more mobile at least. He still does not know where he is- he cannot remember that his wife passed away. He often thinks she is still alive. It is very sad, and I guess I get mildly offended when ppl propose to take an elder off of all drugs and that the simple solution is to bring them home and remove them from toxins etc. It sounds great on paper and perhaps that person is able to do that. Perhaps she has the bandwidth and the capital to pull it off. Perhaps that person is married and has a spouse that can help life the person to the bathroom and out of bed, into bed, get meals, wash their clothes and maybe theyhave children around that can watch the elder while they shop for groceries or port children to school.
I for one, don't have those resources. I also don't think you can speak to a person's condition when you don't know their history and you haven't watched their digression. That's just what I think. Srry for this mean person being short with you. Most people are nice on here. xoxo BG