How can we help my father see that he can not live alone any longer?

Well done, rhody. I think some of us are dealing with people who would have to be physically forced to move to the next level of care, should that be required. I suspect that is what lostfamily is looking at. How do you get someone, who is mentally competent and adamantly refuses to move, into a facility. It may not be a question of buy-in, which would solve the problem if it could be accomplished, but of the physical transportation of someone against their wishes to another abode.
lostfamily's dad is refusing to move. His mind is still sharp. I don't think you can legally force someone to follow doctors orders if they are still competent. This general issue has arisen before here regarding mentally competent seniors refusing to comply with treatments their doctor has ordered. You can lead a horse to water but you can't make him drink.
I have read of others who simply take their parent for a drive and stop at the home and, as you did, explain this is their new home. My mother would not buy that nor would lostfamily's dad, from the sounds of it. In my mother's case I suspect she would, like lostfamily's dad simply refuse to move. What then? For now she is well enough off, and has been given "home care" in her ALF for life, but, one day that may not be enough. I totally agree as DPOA you have to act in your parent's best interests. So far my mother is considered competent. She would pick up on any subterfuge (she is a bit paranoid anyway) and resist it.
In some instances here, people have been advised to wait until "something" happens to convince the person that they need better care. No caregiver is comfortable with that, but, at times, it seems to be the only alternative, as seniors -even seniors with illnesses, but who are deemed competent, have the right to make decisions for themselves, even bad ones.
You are fortunate that your mum made the transition so easily. My mother has walked out of hospitals before being discharged, and would likely walk out of a facility if she didn't want to stay there, contact a lawyer, and rage about being kidnapped. She has done that already to a hospital who simply put her in a geriatric ward, after she took herself to the ER with electrolyte imbalance, when she was in her nineties, and got an apology. I think we are comparing apples and oranges.

As the DPOA you make the arrangements, you pack your loved ones things and you take them to the ALF or whereever you have selected. As DPOA you have the authority and as the doctor has ordered the care - it is your obligation in the best interest of the loved one that you carry this out without delay.

The ALF should be well able to handle the arrival. In my moms case (dementia) she was happy to go with me and I stayed to visit, showed her her new room etc. The staff made her welcome. I hugged her before leaving and told her I would be back again later.

I came back that evening and again each day. Everytime she asked when she would be going home, i explained that this is now her home. That I work and my husband works and we can not be with her during the day or give her the help she needs. This is now her home and because they care for her, we are able to come enjoy visits with her.

My sister and I selected a place that is an Adult Family Home for dementia and all the way through to hospice. She should not have to ever move. However, if she does we will do what is in her best interest as lovingly as possible. As the DPOA I do what is best for mom, no matter how much easier it would be not to have to - as I feel it is my duty as her legal decision maker. There is a reason for the POA. It is in place because Mom can not make her own decisions. In view of that, I don't need Mom's 'buy in' and if someone is waiting for a 'buy in' after the doctor says they need full time care, then they need to recognize that not acting is doing potential harm. If they can not act, they need to have someone else that can named as the POA. It really that simple.

Just as you would not allow a small child to live in an unsafe situation, as POA you cannot let your loved one either.

My neighbor handled the situation much the same way. They took the Mom to a new ALF and while she is still unhappy about it - she will adjust.

I love my Mom very much. Enough to make the tough decisions I have to for her safety. That is who she raised me to be.

You are so right that some of us have been advised to wait until they have a fall or "something happens." That's all we can do. Very sad.

After my brother, my sister and myself talked, talked and talked some more, we all decided that we could not keep giving everything to our dad, we realized that why should our father want to move into the ALF when everything, I mean everything was being done for him. He does not care about our health, or well being, as long as he is being taken care of and can stay in his home. So, we are making a few more changes to his home, for safety. My brother is going to move out of my dad's house, and we thought about moving in a caregiver, but so many walls come up. 1-background check, 2.- possible abuse 3.- They would have dad's ear on a 24/7 basis, and could take advantage. So I hope this can be helpful to others who might be struggling with this same issue. We decided to let him have his choice to stay in his home, but we could not continue to abandon our lives to keep spending every moment taking care of someone who does not care about anything but staying in his house. We realized that he is putting his house before himself, before us, and before cost. So we are closing up half of his house, we given him a way to reach the outside world "Lifeline and cell phone and Internet" we are having someone bring food and meals, and someone to come clean his home and do laundry, visiting nurse will still come to change his catheter, I will continue to pay his bills, etc. my sister will visit one day a week, take care of his medications and medical supplies, take him to his doctor's appointments, my brother will visit one day a week and keep up his repairs on his mobility scooter, and handle any personal needs, and we will hire outside services, yard work, pest control etc. Bottom line is that he will have to do for himself, and that is the only way he will ever see how much has to be done, or that there is to much to do. We cannot fight him, we are not walking away, but instead, trying to open his eyes.

Our authority and responsibilities as DPOA are different if the loved one is not legally competent to make their own decisions than if that is not the case. Emjo is right. It is apples and oranges. POA gives us authority to act on the loved one's behalf in financial matters. That may include contracting with an ALF, arranging the payments, etc. But if the person is still considered by law competent in other matters, it may not be as easy as dropping them off and saying "this is your new home." (Not that that would be easy, either, but it is at least possible.)

Therefore lostfamily's question is very valid. How can we convince someone to do what is clearly in their own best interests? (In the orange case, we don't have to convince them, in the apple case we can't act without their cooperation.)

I don't know the answer. :( I think it often is some kind of crisis that finally convinces the loved one that he or she must accept help. Or in the case of dementia, the person clearly becomes incompetent.

Lostfamily, if Dad can afford ALF, could he afford some in-home care instead? Or would he have to sell the house to move to ALF, and use the proceeds to pay for his stay? Does he have assets in addition to his house? I wonder if he would qualify for Medicaid (or could use his assets other than the house for his in-home care until he did qualify.) Mediciad isn't going to cover in-home care that winds up being more expensive than a care facility, but the Elderly Waiver portion of Medicaid may cover significant help to keep him in his home instead of a nursing home. It might be worth looking into. That is how my 92-year-old mother is managing to stay in her apartment. My sisters are keeping a close eye on her, and it may be necessary to move her to a nursing home before long. But as long as what she needs is "assisted" living, she can get that assistance right where she has spent the last three decades. It's a thought ...

jeanne -good suggestion! The voice of experience speaks!

palebluedot ((((((((((((((((((hugs)))))))))))))) I am sorry. Your situation, like lostfamily's, is not easy. However the Elder Waiver that jeanne mentions may be worth looking into.

I'm in a similar boat. My mom refuses help and would be considered competent if she had to go to court. Her drs have examined her within the last 3 mo and will not force her into anything. i worry about her because she doesn't eat or prepare meals as she should; she has no regard for spoiled food; undercooking; clean prep area, etc. She is able to keep herself clean and toilet herself. She has long periods where she is not lucid and living in fantasy world. She no longer answers the phone. I've been told similar, that you can't force even with POA or DPOA at this point and have to wait for an "event". It is hard. I don't have any answers either. I have friends who think I'm a bad daughter to not just force her into care or make her have in-home care, take away her license, etc. based on her current condition. They haven't had that struggle with their parent; and parent listened to reason and accepted help offered. My mom refuses all help and any offer for financial mgt. We worry constantly about unpaid bills, taxes, etc. but she has only missed a couple bill payments and then caught them up before they turned off the service. She has money to afford any care needed but refuses the help. I'm fortunate as she doesn't ask me or expect help from me -- but it still leaves me feeling neglectful. I think the only help she is willing to accept is for me to move and take care of her -- which I can't/won't do. I live with the guilt and come here for the support and understanding. One post here said we can't force them and as long as they are competent they can make bad decision for their living arrangements even if we don't agree. That is where my mom is. She says she is not unhappy and wants others to stop telling her how she "should live". I'm trying to honor her wishes even if doing otherwise would be easier for me.

I am back, and was glad that some people found my last post helpful. I wanted to give you all a update. My father moved into a ALF two weeks ago. We talked to him after he visited the ALF and he did not change his mind about moving, but we did something that we had never done before (it was the answer) we gave him food that he could fix himself, and my brother did not fix his meals, he just showed my dad how to fix meals, and my sister did not come but every other week to clean and do his laundry. We made sure his needs were being taken care of, but kept a distance, so that he was alone quite a bit, and then after 3 weeks had another family meeting, guess what, my dad told us that he could not do it by himself. We moved him into the ALF the next week, and he went willingly. Now that he has been in the ALF for two weeks, he loves the meals, the attention, and that there is staff there 24/7.

Ah. I misunderstood. I thought the major obstacle is how much it would cost to remodel for a live-in caregiver suite.

Yes, 24/7 care in a private home is prohibitively expensive for most middle class elders. Did you say he is not cognitively impaired? He was in on the cost discussions, he doesn't want to pay what skilled care would cost at home, and yet he refused to consider the more economical alternative. Hmmm ... What does he propose?

Wait ... I can guess. That his 70 year old daughter cleans a 2800 sq foot house for free (and continues cleaning it when she is 75, 80, etc). That family members empty his cath bag. That family members do his laundry. And change his sheets. And make his meals. And drive him around. All for free. Hmmm ... again.

What if you stop trying to convince him what he should do, but instead you tell him what you are/are not going to do? I have no idea if you could pull this off, or what the outcome would be, but what if you tell him your sister is retiring from cleaning any home but her own, that he is going to have to figure out how to get his meals, that if he spills his cath bag while emptying it he'll have to live with the urine smell, etc. etc. And if he can't do a decent job of taking care of himself, you will get authorities involved to assess his living conditions and they will determine where he needs to be.

Because when I really think about it, why should he want to change anything? He is comfortable right where he is, and the price of all the care he gets is certainly affordable. Going to ALF would be an improvement for all of you, but not necessarily for him, right? Now that the mice have been evicted and there is food in the house, he's got it better than he's had it for years! Why on earth would be agree to change?

But of course, you can't keep it up. I understand that. Your enormous efforts can't go on forever. But have you made that aspect of the situation perfectly clear to this man who is "still sharp in the mind"?

You've spoiled him. Totally understandable and probably appropriate at the time. I'm not blaming you or criticizing you. But seeing it in that light may help set the tone for what has to happen next.

My heart goes out to you and to your sister, and to your father, too. I hope this can be resolved soon.

Bless your heart, you hit the nail on the nail on the head. He knows that he is doing these things, he does not care, he knows they will be taken care of. But, we can not just walk away, after all, he is our father. The visiting home nurse has asked him many times what he can and can not do. They have to report (not sure to who) that he is not able to take care of himself. That report was also given to his doctor, so that is why the doctor's order was written. Everyone has explained this to him, and he said that they can not make him move. We have given him our concerns for his safety and that we can no longer do or continue to work like this. Now we are back to the original question. How can we help my father see that he can not live alone any more. My sister and I can not give up, we will talk to her pastor and hopefully he will be able to help. If not we are going to hire a Elder Care
Manager, they may be able to help us. If that does not work, we may have to go to court so that we can protect him from himself. I will keep everyone updated, and hopefully how we handle this may help others.