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I live out of state. She is living with someone who just had quadruple bypass and he is not wanting to stay with her much longer. I took her car keys away last time I saw her. She went to see her friend in the hospital, during Covid. Security told her she could not see him. She went to the parking lot and could not find her car. She thinks nothing is wrong. I do not want to anger her as I have access to her bank in the event I need to put her in assisted living. Also have Medical and Financial POA, but I believe I need a letter from a doctor stating she needs help. Correct?

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AndreaVH, yes, you are at the point where you need your PoA to kick in so you can act in her best interests. You should have an original copy of the PoA. In it you can read exactly what is required to activate your authority. If you are unsure then yes, you should contact an attorney like suggested by Sunnygirl.

Your profile says your mom has dementia...is this your opinion, or an actual medical diagnosis that would be in her records? If she hasn't yet had an official diagnosis (and even if it's not required by the PoA doc) this needs to happen so she can't block you out of accounts. Right now you need to step gingerly with her and appease her. You probably won't "convince" her of anything going forward -- you must come to understand that the way you interacted with your mother in the past is not how you will be able to work with her from now on. This is hard, and everyone on this forum has walked in those shoes. We get it. My MIL was a very similar story to yours.

IMO you will need to plan to take time off to spend a week at your mom's. You must have your PoA paperwork with you. You will need to make an appointment with her doc to get her a cognitive exam and also test for a UTI, just to discount this problem. Don't wait for your mom to make the appointment -- she will forget! It is ok to employ a "therapeutic fib" to get her to the doctor, like "a new Medicare mandate says everyone must have an annual physical", or whatever it takes. Once there, present a pre-written note discretely to the staff outlining your concerns about her decline and letting them know you are her medical PoA. It is ok to sit behind her during the physical and what (non-cognitive exam) questions the doc asks, you can give correct answers behind her back by your head movements. This is exactly how I did it with my MIL. The docs are happy to accommodate family in this way.

Once this first hurdle is passed, you will need to think carefully about how you will provide her care going forward. I personally do not recommend attempting to have your LO live far from you after this point. This may mean moving her to your home state (but not into your home). Your ability to advocate for her will be greatly improved and your stress reduced (eventually!) If you have any siblings you should discuss what's about to happen with them, even if they aren't PoAs, just so they aren't shocked or suspicious. You will need their help.

Depending upon the severity of her memory loss, she may not be able to be in AL, only MC. You will need to visit the places in person (and not sure your mom needs to be involved in this - she won't remember and she's not making decisions in her own best interests. It will only stress her out). Hopefully you have a complete knowledge of her financial situation so you can plan accordingly. Please know that the vast majority of people who go into facilities eventually need Medicaid to pay for their care. Therefore, a consult with an elder law attorney who specializes in estate planning and Medicaid will be money well spent (and should be paid for by your mom's assets, including any travel expenses on her behalf). Keep receipts to reimburse yourself later. There is much to know so that you don't endanger her ability to qualify for Medicaid, since their "lookback" period can be up to 5 years.

The start of this journey with your mom can feel very overwhelming. This is normal. Eat the elephant one bite at a time. My MIL was not remembering to eat, even though we were 6 miles away and supplying groceries, cooked meals, all types of services. She is now in a facility 3 miles away and doing well. I wish you much success in figuring out the pathway and peace in your heart that there are no "wrong" decisions as this point.
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AndreaVH Jul 2020
Thank you so very much!! Many of these things I am aware of. I was out there a few weeks ago. I did take her to a Primary Care Doc. I did share my concerns on paper prior to her seeing him. I wish I would have thought to ask at that time for a referral. He will give me one, but I think in her presents it would have been better. Now if I get one and set an appt she will think I am butting in her business. I am going again in a few weeks and will ease into the conversation. Get her to agree and then go back when the appt is set. I dont want to upset her this next time so that she gets mad. Do you recommend a referral for a Psychologist or Neurologist. Perhaps I get the doctor to call her and recommends she goes to a specialist? Once again. Thanks
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I'd immediately consult with an Elder Law attorney in the county where she lives. They should be able to do phone call or online consults. I'd have them review the documents you have to confirm what they say and what actions you can take now that are legal, regarding her care. You'll need to be able to intervene safely, but, keeping her from getting angry is probably going to be difficult. I'd try to have things in place for when that happens. You will need someone who is not long distanced, in order to intervene. You may need to retain the services of a professional for that if you can't be there. Covid makes all of this much more complicated.
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AndreaVH Jul 2020
Thanks so much! I do have a call with an Elder Care Attorney for Aug 5. :) So far it seems I am on the right track.
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