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My mom has been in the nursing home for two months and her health has improved. She has Parkinsons and has always had a problem with overly self medicating herself - We lost my dad and sister within this last year. I unfortunately live 2 1/2 hours away. We begged her to live with us and she refused. She actually picked out the nursing home she wanted to go to. She is unable to live at home due to her falling, and unable to drive. What can I legally due to keep my mom safe from herself?

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As long she is mentally competent, yes she can sign herself out. POA doesn't give you control over her, it allows you to make decisions and carry out her wishes.
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AT1234 Sep 2019
Yes, there in lies the rub. Mental cognition and obtaining a diagnosis. Ask dr for new eval, go from there.
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WorriedinCali is correct. Without any authority over her you will have to stand on the sidelines and watch the train wreck in slow motion. When it comes to the point that she can no longer make decisions for herself and your PoA kicks in, then you can place her somewhere local to you. Most likely she is in danger of injuring herself from a fall. Then maybe she will make a better choice. We struggled with this with my stepFIL and his Parkinsons. He wanted to stay in his own home and have my husband and sons drive there in the middle of the weekday night to pick his 6'5" body up off the floor. That happened about twice then we called social services and they got guardianship of him and he went into a facility where he got the care he needed. Blessings!
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disgustedtoo Sep 2019
"When it comes to the point that she can no longer make decisions for herself and your PoA kicks in, then you can place her..." As I have posted to others, this isn't true. POA doesn't allow one to make that decision, even in cases of cognitive impairment. EC Atty told us this. Even staff at mom's MC unit said the residents still have rights, including the right to refuse medication, treatment, etc. The staff has to become very adept at coaxing the person to agree, they cannot be forced, POA or not.
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So, I take it she is making noise about wanting to go home? Has her health improved enough for her to be able to safely live alone at home? Is she mentally competent? Can her doc at the nursing home do an eval to state if she is able to live safely at home alone due to her physical and/or mental issues?

If you want her to stay in NH, do not take on ANY responsibility for helping in any way for her to move back home. NONE. If your mom has to make all the arrangements, perhaps that will help it NOT happen.

Have you talked to NH director or someone about this for advice on how to proceed? I guess they have a vested financial interest in her staying so you might be able to use that to your advantage.
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If she is competent she can sign herself out. If not done already, get Power of Attorney (POA). If you take her back home you can lock up the medication and have a close family member administer it instead, and institute fall prevention measures at home such as floor alarms, uncluttered home, well lit areas, and so on. If she refuses to these terms then you can refuse to have her live with you.

Have a pharmacist review fall risks with medications, and work with her doctor what can be done to make things more safe. Psychotropics and narcotics increase risk of fall substantially. IF she cannot be trusted with the medication, some close family member has to do it for her for the proper dose.
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Alert her friends and relatives and ask them not to pick her up from the nursing facility. Does she still have a key to her house or her car? You might consider changing the locks on the house and selling her car.

People with Parkinson's can sometimes improve their mobility with regular structured activity or PT. If she does go back home all alone, those improvements may be lost.
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Get a doctor evaluation to help decide if she is able to stay home by herself. Go with her to the appointment and tall doctor all the problems she has at home. If she is mentally incompetent or physically impaired, have doctor tell her and you.

If the decision is for nursing home, sell the house, sell the car. Help her decide which items to bring with her to make the nursing home more homelike and which to let go. Have her decide which items to give to family or friends and which to sell or donate. Have a realtor come give advice on staging her place and sell it soon. As soon as you act as if nursing home is "home," the sooner she'll come to accept it as home too,
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Perhaps take her to your house and let her visit some facilities closer to you. You mentioned you asked her to move in with you, but she chose a facility - which is really better for you for her to think like that.

You might try telling her that due to risk of falls, her doctors are not going to approve her going to her own home where she would be alone. And then suggest coming to your house to look at facilities close to you so you could visit more often.

About the only other option would be - can she afford 24/7 care at her house. Is there someone that would want to move in with her so she is not alone?
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I like the comment posted by my2cents. She refused moving in with you, but living alone will likely be an issue. Sure, she can hire help, but that is VERY expensive when needing more and more help (never mind the concerns!)

Check out some local AL places, and then arrange for a 'tour'. Usually they roll out the red carpet, show you around, have a meal and see what is offered, the cost (MUCH less than a NH would cost), including the cost of any additional assistance she would need (usually standard cost only covers certain items plus the room.)

If she still refuses, consider getting a locked/timed medication dispenser. It can be set to the times needed, has an alarm to alert her to take the meds and only allows that day/time of meds to be accessed. Depending on how many she takes and when (slot will hold multiple pills) you can get up to a month of medication in it. If there are different times of day needed, that will reduce the coverage to half, but it is better than having to deal with it daily! The aides that can be hired to "help" her generally cannot dispense meds, but they can point out that she hasn't taken them and suggest she take them.

Enlist help from her doctor, the nursing staff, social worker at the NH, ANYONE who can make her perhaps see some sense in that she cannot care for herself alone. Hearing it from someone else sometimes helps.... sometimes... For my mother, that wouldn't work, but dementia got in the way of her seeing 'reason'.
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If your Mom is mentally capable of making the decision she can not only make the decision to leave and go home, but she can remove any POA she gave. If not, then you are the one making decisions and she will need to be told that leaving without a discharge could result in Memory Care which would be a much less nice living situation and drain money so that she might end up with care not nearly as good. So it all depends on what Mom can absorb. If she is capable of being reasoned with then sit and speak with her, with doctor present if necessary.
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She can do anything that she can do. POA doesn't give you control only authority.

My dad wanted a thousand different things, I told him that he could do whatever he was able, that meant no help from me. Whatever he could pull off was okay with me.

If she wants to leave make it very clear that she will be in control of her own situation and you will not contribute anything because you totally disagree with her living on her own.

Remember that her choices DO NOT obligate you to do anything.

I think that parents try to force the issue of making their children their caregivers, by saying no and enforcing boundaries it can change their choices. If not they get to deal with the consequences not you.
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AT1234 Sep 2019
Unfortunately we do deal with the consequences. The hours in ER, the sorting out all the money that flew out of her account, the over dosage of pain meds, the angry drs who shame you for “letting” them live alone. Actually we DO deal with all of it. That’s the reality of being the only child of an independent, impaired adult.
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Yes
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Advise the Director of the facility that she is not to sign herself out.
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disgustedtoo is entirely correct. You cannot force your mom to do anything with a POA. She'd have to not be able to make her wishes known for your POA to allow you to decide where she lives. Even some people who get guardianship only have limited 'powers' - like maybe dealing with financial issues - paying her bills, etc. Judges are reluctant to strip a person of all of their rights. And a good EC attorney will point out that all people, even the elderly & the sick/impaired persons, are allowed to make "Bad choices." Leaving her nursing home might be seen as a "bad choice" but it is HER choice to make. (I know, this exact situation drove me crazy too!)
If she's not happy in her current NH, I agree with the other suggestions about taking her on a tour of several nursing homes or assisted living facilities near you. (Go to them yourself first and vet them.)
Nursing homes are restrictive and well - boring and depressing - a lot of pain & dying going on in there. She may be more likely to stay put in an AL, and they usually have increased levels of care and even physical therapy available, as they become necessary. They also generally have more activities she can participate in. If she's busy & happier, and makes a few friends there, she'll have fewer thoughts of leaving. It's also a lot less expensive than a NH.
I would be wary of bringing her into your home. I know a lot of fairly independent elderly persons who said they didn't want to live with relatives - then wouldn't leave. It disrupts your ability to function and it involves your whole family in ways you can't imagine if you've never done this before. And the guilt can keep you trapped in an unpleasant situation for many years.
Just remember that unless a judge strips her of her rights - including the ability to decide where she will reside, you have to try to appeal to her sensible side (hopefully she still has one). Having a doctor talk to her with you is a good idea, but make sure it's a doctor she has some respect for. The NH doctors aren't usually they type who inspire confidence in the elderly. Sometimes our LO thinks the NH is just trying to keep them there to make money. (I was in this situation & my LO was right about this!)
Good luck and sending you hugs!
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As POA, You have Rights and as A Professional Facility who Knows each Case and Face, They can Get into a Heap of Trouble with Adult Protective Services if they Let Mom OUT.
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