93-year-old cousin refusing to be placed in a home but needs constant care. What do I do now?

I would follow your husbands lead and I'd give up POA too. Listen to your exhausted body!

Unless someone who is TRAINED and CREDENTIALED to assess how “far along” she is has told you specifically what that statement is based on, it’s not worth trusting for decision making purposes.

Can you or one of the nearby “helpers” make arrangements to have someone do an evaluation while she’s in rehab? Worth a call to the rehab facility to find out whom they use or would recommend.

As POA you may be the only person who can do this.

It is VERY TOUGH for loved ones and interested friends to make any long term decision without this kind of documentation, but if you can get a written report you will find it helpful in arranging for her safety, which of course is the bottom line.

Although she can say whatever she wants to say, she may be approaching the point where someone WILL need to make decisions for her, and right now, that person will be you, and “demanding and cranky” don’t count as determiners of what is actually the best way to help her or for her to help herself.

Safety is ALWAYS the bottom line, and a fall requiring hospitalization and rehab is ALWAYS a warning.

She’s lucky to have you. Get the assessments and see what recommendations are for her returning to her old lifestyle or developing a plan for a new one.

If she is still competent and your POA is "springing" then it's not activated until she's been declared incompetent by one or more doctors. If your POA is not yet active then she is just like any other adult in the world, free to make as dumb of decisions as she can. This is the exact position I'm in with my mom. She is both competent and unwilling to listen to any reason so she remains alone in her gross house until (yet another) terrible accident sends her to the hospital or worse.

Think for a moment about all the phenomenally awful decisions people make every single day. Substance use and abuse, gambling, risky sexual behavior, becoming hundreds of thousands in debt, you name it people are messing it up. What I've had to accept is that my mom and maybe your cousin aren't going to do what's best for us. They're going to do what they think is best for themselves even when they're wrong. All this is to say give up on being God or Superman, resign your POA, and make a good faith effort to make sure she assigns POAs to someone else. Someone young, ideally. There's an expression I love: you're not required to set yourself on fire to keep someone else warm.

Read your POA. See if the word Immediate is used. If so, your cousin put you in charge at the time she signed the paperwork.
If it says that a Dr or 2 are need to make it effective, then you cannot do anything if she is still cognitive and can make informed decisions. If she still can make informed decisions, then your POA in not in effect.

While she is in Rehab, have her evaluated for 24/7 care. If found she needs it, tell the Social Worker that it would be "unsafe" to send her home where there is no one to care for her. Because u live so far way, you are not in the position to care for her either. Rehab should not release her based on this info. She then can be transferred to LTC. You maybe then able to pay her bills out of her money. Sell her house house for her care. When the money is gone, then apply for Medicaid. Maybe instead of LTC u can place her in a nice AL.

Or, maybe the niece would not mind taking over the duties of POA if cousin is still of sound mind to assign her. Your POA will be revoked when cousin assigns a new POA.

You being 4 states away is too far for someone who holds complete POA, financial and Medical. POA needs to be held by someone who lives much closer. If the lawyer who drew up the paperwork is still practising I would contact him and tell him its getting too much and you are too far away to continue to hold the POA and you want to revoke it. I would do the same thing in your place.

I agree with everyone's responses so far. While she's in rehab, she will be evaluated and determinations will be made whether she can return home. In my state, adult services are usually involved if you are stubborn, and they will oversee that you have adequate home services in place before you go back home. At her age, even if she's still spry, they most likely will suggest she seek a full time care facility for her safety. Maybe she can move in with you 4 states away......HAhahha...just kidding. :-) People think being the POA is easy. It's really not, it's an aggravating position to be in...Especially if the person you are representing still wants to control everything.

I agree with everyone's responses so far. While she's in rehab, she will be evaluated and determinations will be made whether she can return home. In my state, adult services are usually involved if you are stubborn, and they will oversee that you have adequate home services in place before you go back home. At her age, even if she's still spry, they most likely will suggest she seek a full time care facility for her safety. Maybe she can move in with you 4 states away......HAhahha...just kidding. :-) People think being the POA is easy. It's really not, it's an aggravating position to be in...Especially if the person you are representing still wants to control everything.

I agree with everyone's responses so far. While she's in rehab, she will be evaluated and determinations will be made whether she can return home. In my state, adult services are usually involved if you are stubborn, and they will oversee that you have adequate home services in place before you go back home. At her age, even if she's still spry, they most likely will suggest she seek a full time care facility for her safety. Maybe she can move in with you 4 states away......HA ha ha...just kidding. :-) People think being the POA is easy. It's really not, it's an aggravating position to be in...Especially if the person you are representing still wants to control everything.

Give up the PoA. This is way too much to go through, especially for a cousin.

I'll be surprised if rehab agrees to release her back to living alone and doesn't insist she move into managed care of some kind. If they do agree to release her back home, to smoking and driving, falling and refusing this that and the other, then I agree with the others. Relinquish your POA and let her live what's left of her life on HER terms, safe or not. You can't save a person from herself, or you can wind up in need of medical care yourself trying to accomplish the impossible.

Step back.
Resist trying to fix or save.
Allow your cousin the dignity to fight her own battle - to negotiate a safe discharge with rehab herself. Don't get in the way.

Are you convinced rehab will really evaluate her? Is it safe for others if she smokes and drives? I would certainly be concerned about how much rehab knows about her when at home. Giving up
POA is great, but I assume she asked you to do it in case she couldn’t make her own decisions. I would make it clear to her and the rehab your reasons for your decision to stop. Not doubting the decision, just thinking about the best manner in which to execute it.

As others have said, I recommend allowing the rehab/hospital system to determine whether she is safe to return home, and then just letting them do what they have to do. It is not a POA's job to ensure a competent person's safety, it's that person's job. When talking to the hospital/rehab, though, you CAN be clear to them about what services she has at home. She may tell them, "yes, I have people who help me at home, sure!", giving them the impression that she has 24/7 help, when in reality she just has neighbors that check in a few times a week. Knowing the facts will help them determine what she needs and may affect when/to where they release her.

Similarly, she may run out of money, yes. That's, frankly, her problem and not yours, until she is declared incompetent. Until that point, you have no legal power to restrict her spending. It may feel like watching a train wreck, but that's unavoidable. Still, you may want to contact her Area Agency on Aging or similar and ask them what your/her options are when she does run out of money/needs to move into a facility/etc.

Also, consider that being POA does not HAVE to require you to manage her. Your power of attorney does not override her choices. If she is competent, then her decisions can be all her own. If anyone contacts you, and it's a decision you don't want to make, just say, "my cousin is competent and should be allowed to make this decision." I'm not a lawyer, but I believe you could just "keep" the POA, but stand back and not "use" it. I say this because keeping the POA authority, even if you don't use it and instead defer to her for all decisions, will allow you to step in easily when/if she IS declared incompetent. At that point, it would be a hassle for you to regain POA (if you want it). (If you're Done With This, on the other hand, then of course, by all means, give it up officially.)

Good luck.

First thing - before she gets released from rehab - talk to the rehab coordinators and discharge coordinator - they must provide an assessment of her abilities and will likely recommend further in home rehab for her when she is released. Tell them your concerns. They will make recommendations on everything from conversation techniques and places to contact.
They may recommend she not go back home if you explain the situation.

If you do not want the POA duties you can legally give them up to someone else or a lawyer.
1) How broad is the POA? Do you have power over her medical decisions or just financial? If it's only financial; you are in a much tougher spot.
2) Would your niece take on the POA?
3) Have you told her how difficult her remaining at home is for the rest of you? I think you should have a reasonable discussion with her (don't let it evolve into a shouting match). Tell her that you are concerned for her well being; but you also understand her need for independence. There are many levels of 'care' beyond living at home. Has she considered 'independent living'? It's much like apartment living; people have freedom to come/go as they please (yes, they can still have their cars there); but they provide meals (included or extra); they have vans for transport to local stores; activities; doctors etc. Look online and get some brochures before you discuss options.
4) If her answer is still no - you should bring your niece in and explain that she will not get any more help other than a weekly check in visitExplain that it's too difficult for your niece to get all her own things done as well as from her.
Offer to call a caregiving facility for her; maybe pick up a brochure or two that explains what they will do for her (grocery, laundry, general wellness checks etc.). At a minimum, tell your niece to start ordering anything/everything your cousin needs online and have it delivered to her at her home. Your niece has to take the first step of 'backing away from a caregiver roll'. When your niece puts her foot down and limits her time to 'visits only' this will help your cousin understand that her options for help are limited to bringing someone in.

Praying for you - this is a tough situation to be in and the conversations are not easy to get started - we are on the other side of it now; so I understand what you are going through and hope these suggestions help.

Instead of giving up the POA, use it! It's time for you to make the decisions regarding where this woman resides, and your POA should give you the legal power to do so.

"Squalor Syndrome"--what a perfect phrase to describe what MANY of us experience with our elder LO's.

If my mother did not live in an attached apartment to my YB's home, she would fall into that category.

Enough people come and go through her place in a week---everyone will do something small and that's all that's kept mom from living in squalor.

I think there is also a diametrically opposed syndrome--called 'empty house syndrome'. My MIL's house is so bare, if you did not know someone was actively living in her home, you would think it was staged for a real estate showing. She has NOTHING in her basement but a W/D and one bottle of detergent and 1 bottle of fabric softener. Her kitchen counters are totally bare. Bathrooms are empty.

As far as your situation--I agree that you need to step away from this responsibility. You can't enact it with any kind of ease. Just the fact you're 4 states away--that makes it nearly impossible to actually be of any help.

Good Luck!

What did your cousin intend when she gave you POA? What did she want you to be able to do on her behalf? Is there anything you're able to do for her that she will agree to, such as hiring in-home support, getting a falls alarm, asking an OT to visit the home and advise on adaptations?

If there isn't, and the reality is that the OP is refusing to consider any practical support, then it's pretty pointless your having POA and you may as well resign it on those grounds - it isn't a matter of pique, but your having POA may mislead other agencies or services into believing that your cousin has a stronger support network than she really does have.

Meanwhile, the neighbours and step-niece should start the laborious and tedious process of reporting every incident to APS, APS saying they can't do anything because the cousin has mental capacity, neighbours/step-niece keep reporting, APS keeps asking, and so on and so on until...

something happens that even your cousin can't argue with, such as a broken hip or a stroke, or
your cousin has a nasty moment followed by a change of heart or
your cousin passes the point where anybody can continue to consider her competent.

To avoid swallowing their own tongues and tearing their hair out in frustration, *everybody* should remember:
that it is cousin who will break her hip and be sorry, and not them;
that this is cousin's life which is becoming a daily challenge, and not theirs;
that no one individual is under any obligation to run cousin's errands, do her laundry, take her to appointments, or answer emergency phone calls. Encourage them to step back if they're providing more support than they are able and happy to, and be frank with your cousin about what demands she is placing on people.

Treat her like an adult, respect her decisions, but don't spare her feelings when it comes to discussing choices and consequences. If the situation blows up in her face, it'll be her responsibility and nobody else's.

You'll probably find she changes the subject, and it gets extremely irritating I can tell you. But then again, it is also not your responsibility if the local volunteers keep volunteering - you can only advise them not to if it's becoming too much.

This discussion could not be more timely for me. My Uncle is 92, lives in a 55+ apartment community and still drives a car even though he’s getting lost all the time. He falls in his home several times a week. His wife, my maternal Aunt, died several years ago and I stood by to support him. 3.5 years later - here we are. I do everything for him. Until last week when he got lost and wrecked his car for the third time, was found wandering by the police and they called EMT and us. He spent a week in the hospital for testing. Basically he came out fine was not declared incompetent etc. and he was discharged. I’m his POA but he doesn’t and doesn’t have to listen or do anything I say. I’ve decided at this point he should now live his own life as he demanded. So, he is and I’m out of the picture per his request. He CANNOT manage is self care or finances but I’ve turned it over to him as requested. My husband keeps telling me he is making me his useful idiot. Sounds harsh, but … if the shoe fits, right? I’m leaving his legal paperwork as is. Just stepping aside. He has another party named as alternate POA who can step in if he wishes. The problem is I FEEL GUILTY and continue to worry myself over him. The above answers from others have been very confirming and helpful in showing me what if anything I can do until he is declared incompetent. Thank you ALL so much!!! ❤️

I agree with everyone else here. Just make sure you tell the Rehab exactly what her living conditions are - where you live as the POA, how often someone checks on her, that she still drives and smokes, how often she falls (if it’s more than just this time), is she eating correctly, taking her meds as directed?

They need the full picture to decide if she can return home. She may let them think she has full time support, anything to go home. Don’t give up your POA until after their assessment and decision.

Maryt66: As your cousin is currently in a rehabilitation facility, it should be noted that she is an UNSAFE discharge to her home. She then needs to go to a managed care facility.

The fact that your cousin is still alive and somewhat with it at 93 that is remarkable. The fact that she still smokes even moreso. She's not quitting smoking at 93 and no one should expect her to.
You as POA need to have a talk with her. That either she allows a live-in companion to move into her house to help her, or you will surrender POA over to the state. The state will most likley "place" her due to her age alone.
She lives in a gated golf community. That is heaven on earth. I wish I could take the position myself because your cousin and me would be on that course every day. I was a smoker too. I don't think it will be too difficult to find live-in companion help for her.
Advertise and look for a fellow smoker. Believe me when smokers know they can smoke on the job, they're be lining up for that job.

POIA only kicks in when she is deemed mentally incompetent. Seems she is well on her way to getting that "definition." Ask rehab to get her "mental competency" evaluated while she is their responsibility. She will need a doctor to deem her incompetent - and put it in writing in her chart - before you can step in to change anything.

Inform the DMV and hope they revoke her license. She probably shouldn’t be driving now. A doctor can do that for you, at least in Florida. Happens often after someone has been in rehab.