What is the criteria for no longer being able to live safely alone?

Dear 1SHaMae, If you have the Durable Financial and Medical POA's over your Mother, it would be a good idea to review the rights that they give you. Alternatively you can also call the lawyer that drew up the documents or contact your own lawyer to help you understand what you can or cannot legally do. In general, it is easier to transfer a person from a facility like an AL, or hospital directly to a NH. I would recommend that you enlist the advice of the Case Manager or Social Worker at the AL facility and they will help you with the process. Perhaps the Doctor and AL Director of Nursing and the Social worker can help you in talking to your Mom and make her understand that it is physically impossible and unsafe for her to go back to living alone in her home. She will be more likely to say OK to the Doctor than to you. At this point, considering all her medical conditions and mental state, it seems very clear that she should not be living alone. If she were in a hospital, they would be legally liable if they sent her home knowing that she would be unattended on a daily basis. For whatever reasons you cannot bring her to live with you or not being able to live with her, and she has no Longterm care insurance to cover bringing people into the home to assist her 24/7, then there appears to be no other resolution than for her to be in a facility. You already know she is making poor judgements regarding her own welfare, has considerable difficulties managing the normal activities of daily living, missing medications she needs to be taking, and is a physical threat to her own safetly. She also is not capable of making a realistic decision as to her own well being. I'll bet she also is not handling food safely or eating properly, and you probably have to deal with that as well as managing her house and laundry - not an easy task to oversee or personally handle without traveling frequently. These are all the criteria that go into making a decision whther a person is able to live safely alone. Everything you have described in your story indicates her having reached that point. My Mom mismanaged many of the normal activities of daily living as well as her meds and food, and although it was impossible for us to live together, I was constantly running back and forth to keep her on track, to the point that I basically burned out. When she finally ended up in the hospital (for the umpteenth time) due to a minor fall - also forgetting her walker in other rooms - (and she also had had hip surgery a few years prior), it was clear to everyone that she was no longer capable of living alone, and they would not release her to home unless she had 24/7 supervision. The recommendation was for her to go to rehab for 6 weeks, and after that if there was no significant improvement cognitively or physically, she would move directly into the long term care (NH) unit. I had not choice but to give my consent to that and also felt that it was the best choice for her. Of course as soon as she went into rehab, I started the application for insititutional Medicaid due to our lack of financial resources. I honestly believe that when your Mom can longer stay at the AL facility, you will have to convince her that the doctor wants her to have more physical therapy and she needs to go to a rehab facility for awhile. So basically you just move her a step at a time. She will most likely reach a point where she loses track of calendar time and you can just tell her "the doctor said another week or two". I was so guilt ridden over this myself that after a couple of weeks in the NH unit, we (doctor,SW, and myself) did have 'the conversation' with her and told her the truth that she would not be able to go back to her apt. The fallout was heartbreaking - tears on both sides and anger from her - that she needed a sedative for a couple of days. After that, she COMPLETELY FORGOT we ever had that conversation, and to this day (16 months later), she tells me frequently that she will probably be going home "next week". I just tell her that's wonderful, and to let me know when the doctor gives her the release date. She then forgets all about it for awhile, and then will get on another kick about it, and we repeat the "next week" scenario all over again. It works, and you just have to go with the flow. It's a tough transition, but if that's the way you have to go, you will get through it.

1ShaMae - You sure do have great genes! Your mother sounds wonderful and I wish I had known her in the prime of her life. However, having said that, immediate intervention needs to take place with the help of her doctors, social workers at the assisted living facility and adult protective services. Together she cannot leave the facility NO MATTER what she says. An incompetent person doesn't have the reasoning to make decisions, so others must do it for them. I hope you have a MPOA, DPOA, and Living Trust with a Will. Make sure all of those are in place (if they are not already), and proceed onward. As a nurse and social worker, she is either going to fall, take too many pills and/or she is not eating enough. Why would anyone who has had breast surgery be taking hormones? This case is much too complicated and needs professional intervention permanently. That's my best professional opinion...Best wishes.

The previous answer was exactly the right suggestion. I went through the same transition with my dad who had Alzheimer's. The difference is that once that disease progresses to a certain point that medication doesn't help keep them functioning cognitively, you, as the caregiver can have more control. We had him visit his sister for two weeks to prepare his transition into the AL facility. We just kept telling him that the doctor was coming by tomorrow to see when you will go back home. We just kept telling him that story and soon he stopped asking. The transition into the nursing home happened 2.5 years later and it was quicker because of his rapid decline at that point. I understand your heartache over this issue but take comfort in knowing that it is the safest place for her to be.

Hello, Mom had a serious UTI that put her in the hospital for nearly 2 weeks and then came to recovery to my home. Prior to the UTI she lived alone. She seemed perfectly capable so I thought living alone. However as she recovered I could see that really is was no longer safe to return home. I observed her cooking and showering and could see it was time to keep her with me. Because of previous falls it was just time. I refused to send her home again. She was careless with medication too. As difficult as it was for her she adjusted. I only had her best interest at heart. I felt it was time to just step in before we had an injury or bad fall or even an illness I found about too late. Had she been with me the UTI would not have gotten full blown out.

I seem to have read so many people , with the same problems. I do not know how things work in the States, can only speak for NZ and UK. My mother died at 87, she lived in a block of flats/apartments with a caretaker. There job was to monitor residents, ensure they were okay on a daily basis , alert authorities if required, ensure no unwelcome visitors disturbed the residents. Her next step would have been into full care facility. In NZ many people are choosing to move into purpose built accommodation, a house or apartment, built with the elderly in mind, still not a rest home by any means , but they often have access to day centres that the rest home provides - many will have helped out when they were newly retired, as in putting on concerts, library services or just visiting friends. They are already comfortable with being in the building, understand how it functions and see it more as a natural transition , than a prison! I am 64 husband 66 , we are concious of this ageing problem, we also have a son living with us who will also need care in the future. I think we will carry on in our own home until it sells, we may then look at a larger home where we can live with another sibling. I would consider cameras set up in strategic places in the home of an elderly person, making the home as safe as possible with soft furnishings, hand rails etc, pay a service to call in once a day for shower , meal and meds, if all that fails then a care facility or moving in with other more able people is the only way to go.

If she lacks balance she is a fall risk, adding her lack of judgement, I think she needs to not be alone.

Mother lives in Niagara Falls, I and one brother in SE MI, another brother in Jackson OH & sister in Austin, TX. Mother says, 'I can stay in my apartment, really. Just write down when & what meds I should take. I can do this.' Well guess what Mother, you can't and the need of 24/7 coverage is now. The notion that you 'can do this' has been proven wrong.....that train has long left the station.

There is no easy way and I won't lie to her. Mother has VERY selective memory; it surprises me just HOW SELECTIVE. Being married to the same woman for THIRTY-TWO years and not remembering there are FOUR adult grandsons; yet the faucet in the bathroom is in need of replacing ...... blows my mind.

Like so many of us here ask, 'when is it time to find "A Place for Mom"? Then there is the other all important; 'How do we pay for the care needed?' Funding is an issue for most of us, or so I believe, while the level of care is not always what we would like it to be.

So here I set in Michigan and wonder what to do and more importantly when. I have told Mother that "I be back and you will get no 'heads-up' as to when, so you know (not so much w/her Dementia) what I expect." Mother says, 'Why are coming here? You don't need to come here.'

This may be the toughest lesson we shall face in our lifetime. BUT, by the grace of GOD and loving care with understanding and people, such as are here, the journey won't be quite so rough.