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IMO, once a person needs someone with them 24/7, then they should be moved to a facility.

You will be amazed at how expensive it is to hire somebody for the overnights, That is the most difficult shift to fill.
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Geaton777 Jan 5, 2024
Yes! We crunched some numbers when I was trying to figure out care for my Aunt with dementia. 24/7 care will eventually be at least as expensive (and full of headaches and require a lot of management). It will exceed it at some point.
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You say you and your sibling are making decisions for her. That means she is not of sound mind. Being strong-willed is not the same thing as being rational and realistic. Also, a person who is bedridden is not independent. You are not doing your mother any favors if you're propping up her false sense of independence. In fact, it is enabling her to be put into potential harm.

A person who is unable to transfer from a bed to a wheelchair on their own cannot be left alone in a house. This is common sense.
Your mother is being stubborn. Normally, I'm all for letting a stubborn senior of sound mind rot in place because I don't play that game. This is different though.

Ask your mother what she would do if there's a fire? Or if an intruder breaks into her house?

She is bedridden and cannot transfer from her bed to a wheelchair independently. She can't get out of the burning house. She can't run or hide or try to defend herself in the event that she should have to. For these reasons alone she cannot be left alone at home.

Whether or not she is of sound mind as you say which I seriously doubt, she is still a vulnerable adult. The state can force her into care or force her to accept overnight help if she wants to remain in her home.

Don't be a fool and try to rationalize that her home is low-risk for a fire and that it's a "good" neighborhood and the risk of a home invasion is low. The Petit family in my state (Connecticut) lived in a very good neighborhood in a very nice town.
A fire can happen even in a very well-maintained home.

Your family members should be trying to help you, not criticie you. Either they are part of the solution or they are part of the problem. Let them know this.

Your mother may be more agreeable to having an aide for part of the overnight. Start with that.
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AliOJ58 Jan 11, 2024
Similar to sleep aid, we have 24h livein - paid for a 13-14h a day as they are allowed 6-8h for sleep and 3 1h meal periods - which they do in the house as mom cants be left alone.
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Tricky scenario. You are asking about legal status. This could vary somewhat state by state possibly. For that- the best answer would come from an elder care attorney in your state .

for other aspects beyond legality - that’s a different question .
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I'd look at this through a risk assessment lens. I would take into consideration what Mom wants too, but as she gets frailer & more forgetful, give priority to the risks.

Bedbound. So I presume/hope setup by care staff for nightime;
Telephone & alarm pendant on bedside table (or wearing a watch style). Water, tissues, spare blanket etc within reach. Continence pads worn or on bed.

Fire risk? If the home is usually neat & well maintained, no oxygen tanks, no smoking, then risk is probably low.

Burglary risk? Normal or a high risk area?

Natural disasters? If in any high risk zones for hurricane, wild fire, river flood, earthquake, blizzard?

You can't remove ALL risk.
You can just use what you know to assess likelihood of severe problems with dire outcome.

Moderate/low risks with moderate/low outcome can be planned for eg feeling unwell in the night can mean press the alarm button or call family.

Then add in extra safety. You already have care staff & falls alarm. Great.

Some people like to use cameras. They may offer some peace of mind if that is what you need. Otherwise the old fashioned check-in call every morning can work well.

Re-access every now & then.

Things I'd use as red flags for change are;
- Mom starts getting fearful alone in the evening/night
- Mom is getting poor with telephone skills
- Mom is frequently getting unwell or uncomfortable overnight
- Double incontinence frequently overnight

Regarding the Backseat Drivers;
"But some extended family members have suggested she should never be left alone for extended time and have been giving us a hard time".

Thank them for their concern.
Ask why they hold that view.
Thank them for sharing it.
Carry on.

I really don't know how you would get a legal opinion on this. I have heard that being charged for neglect takes both 1. holding duty of care plus 2. taking (or enabling) risks that most regular people in that position would not.

Your Mom is deemed competent to make her own decisions, therefore the duty of care is her own (to my thinking).
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KaseyL Jan 4, 2024
Thank you for that well thought out response. I really appreciate it! Yes, her caregiver sets her up for the night. The fire risk is low with the house being cared for by caregivers and kept tidy. And a very safe neighborhood.
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Who says Mom is of sound mind ?
Has a doctor said that recently ?
If not , Mom should have a cog test , so you know where she scores on that .

Bedbound and alone doesn’t sound safe to me , and if Mom is not of sound mind , she can not make the decision to be alone at night.

Even if you talk to a lawyer, I’m thinking he/she may ask to see a report of a recent cog test .
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Southernwaver Jan 4, 2024
Yes, OP said mom was sound mom and then listed all of the dementia symptoms she has. A bit of a disconnect there and is worrisome combined with bed bound
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Do the following please:
If her doctor agrees that she can be left alone during the night, then get the doctor to write that.

Then you’re covered. Boom. You followed doctor’s orders. She’s fine to be left alone for certain periods.
(This decision is not up to forum members here. This is a medical decision).

If I were you: I’d keep her happy the way she is. She’s happy having no caregiver at night.

The goal isn’t to live as long as possible. And there’s no point living longer, but unhappily. Let her be happy.

Later, in the future, the doctor might say: now 24/7 care (at home or facility) is necessary.

As for mental competence, one can - absolutely - be mentally competent, even though one’s memory for certain things isn’t good.
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KaseyL Jan 4, 2024
Thank you for your response, makes lots of sense. She has said something very similar to what you stated, that there's no point in living longer if she's miserable and unhappy. I do think getting the doctor more involved is a good idea too. I'm not sure how willing he would be to put something in writing, for fear of liability maybe, but we could ask.
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My much-loved MIL lived at home alone at night until she was about 93 (when she moved to a NH). She had a pendant alarm around her neck in bed, and at the end she pushed it when she fell three or four times. We worked out that she fell when she got up in the night to go to the toilet, and got confused about where she was in the room. We got her a touch light beside her bed, which she could turn on very very easily, and it stopped the falls and kept her at home for a while longer than would otherwise have been possible. She had no broken bones, the falls were more like gentle collapses onto the carpet, following which she couldn’t get up on her own.

Staying at home on her own was what she wanted, and she was very capable of most self-care. Some people would say this is far too old for her to be so much on her own, but it worked for us. You need to look at your own LO, because we have people aged less than 70 who need more supervision than Dora needed at 90.
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You have a really low standard of thinking your mom to be 'competent'. "Financial, medication & forgetfulness" what does she actually HAVE as per thinking skills. There aren't many more.

I think you've just grown used to the slow slide.

Probably she should not be alone during the night.

IDK what the state laws are on this--honestly, b/c it's kind of obvious, isn't it? that she shouldn't be left alone?

Are you really only scared that the law will step in? If nobody but family knows she's alone all night, then there's about no chance it's going to get 'solved'.

Safest thing for mom is moving to a 24/7 place, and you know that.

We checked into overnight CG for my MIL--and it was going to be between $10-$12K a month. More than the NH the kids were looking at.

End result has been that she's alone about 22 hrs per day. No, she's not safe, by any means, but she's getting her own way.

By no means is she competent. Try doing the BIMS test on her--you may get a real wake up call.

Good Luck--I'm kind of where you are, too.
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I think there needs to be someone there.
Just as you would not put a child to bed and go out for the evening just in case something happened. 99.99% of the time that child would sleep through the night and nothing would happen...
It is that small % that will be the problem if something happens and she can not call 911, can not get help in time. And I can almost bet in an emergency she would call one of you to help her rather than call 911.
I do not even think placing cameras to monitor her would make it any safer.
And I am thinking she is not as competent as you think she is. The list of cognitive skills being good "other than..." and you list several important items.
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KaseyL Jan 4, 2024
Hi, I appreciate your answer being considerately worded.
As far as cognitive skills and sound mind, which several people have brought up, I can elaborate some.
Financial stuff--My mom has never handled the financial aspect of things, so it would be a brand new thing for her to pick up and learn at this point. The finances are also rather complex at this point, making it harder for her to learn. I even find it challenging at times.
Medication management--The hired caregivers keep the medication organized, so there is no need for my mom to do anything with medication overnight when she is alone. So I'm not sure it is relevant since we have this taken care of. A lot of elderly people need help with medication but don't need 24/7 care necessarily.
Forgetfulness--A lot of elderly people find their memory is not as good as it used to be. I'm not sure that is a good determination of needing 24/7 care. Her level of forgetfulness seems similar to many elderly people I know who live at home and do not have 24/7 care.
I feel like the most relevant thing is that she cannot ambulate on her own. I agree with everyone that says that seems to point towards needing someone there. But it will make her soooooooooooooooo unhappy and right now she is very happy and thriving despite a lot of serious health conditions. I'm just worried that her emotional and mental health is what's keeping her going in many respects, and forcing 24/7 overnight care is going to cause her to become unhappy or depressed and then have a negative effect on her overall well-being and health.
If we were to find out that legally we should have 24/7 care, I think she would be more accepting of it, as it would just be a matter of fact, not something she could try to convince us is not right or needed. I think she'd have a different reaction and be more agreeable and adaptable.
Hopefully that makes sense.
I want her to be happy because I want her to be healthy. But I also want her to be safe of course.
The legal aspect came up recently with an extended relative, and I thought it would be good for all of us to be informed, including my mom as it would affect how she views the situation.
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Your mom is far from independent since she relies on caregivers.

You could tell your mom that you would feel better if she had an overnight caregiver with her. She may or may not be interested in hiring an additional caregiver for an overnight shift.

Why don’t you look at assisted living facilities in the area and compare prices against paying for caregivers in her home?

Often times, people will choose placing their family members in a facility over living at home.
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If your mom hasn't been found incompetent, you have no legal obligation to force any kind of care.

If you are satisfied that in an emergency (fire, burglary, storm);she has the wherewithal to call 911 or you all, then I don't see an issue.

If your mom gets diagnosed with dementia or other cognitive impairment, then, as POA, you may need to re-think.

If your decision is based solely on "mom doesn't want..." with no regard to the realities of her situation--(can she get out in a fire? Does she have the ability to assess if she's in danger?), then you are approaching to his the wrong way.
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KaseyL Jan 4, 2024
I appreciate your answer. She does have a lifeline call button she wears which she has used when needed, and she also has used the phone to call for help before.
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What happens if she gets sick at 2am and throws up and has diarrhea every 15 mins?
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KaseyL Jan 4, 2024
That is a good point. She has people she can call. But having someone right there in the house would provide a more immediate help if she were to get sick in the middle of the night. The last caregiver of the night usually has a good sense of how she's doing, and if there are issues, consults us and we try to arrange for someone to stay overnight that night but we are scrambling of course to figure things out.
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What happens if her roof is stuck by lightning and the house catches on fire at 1 am?
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KaseyL Jan 4, 2024
The fire thing is what I worry about too. My mom's answer to this is that she's lived in the house for 50 years and it has never caught fire so we are worrying about something that's not going to happen. I say "better safe than sorry" and houses do catch fire that haven't caught fire before, but she says she just wants to live her life the way she wants to and can't account for all the "what ifs." She already wishes she had less caregivers at the house than currently, so adding in time seems miserable to her.
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She's not of sound mind. So start over using that premise.

She's also not of sound body, and she can't ambulate herself.

My friend Marianna was considered of sound mind but was confined to bed due to lung disease (smoked all her life; don't do it). Caregivers came in and out on a schedule. Her family believed as you do that she was okay to stay alone for short periods. One day she was alone in her bed as usual, and the caregiver had left the dryer running and gone out to run errands. The lint that had built up in the dryer caught fire, and the house burned down with Marianna in it.

It was a horrific way to die.
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RLWG54 Jan 9, 2024
This would be my fear as well. We can’t always accommodate what our loved ones want. Safety must come first. As previously stated by others, you wouldn’t leave a child unattended overnight no matter how much they believed they could handle it. This is no different.
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Being bedridden and of sound mind isn't really of sound mind. She could not escape a fire.
When decision making is this bad I believe that the POA should act for the mom to have someone there.

The elder law attorney is paid by the principal who gave you POA> That is, your mom's funds pay for this.
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You say, " She is of sound mind and generally pretty sharp. Her cognitive skills are good other than financial stuff, medication organization, forgetfulness" which are ALL signs and symptoms of cognitive decline/dementia!

Not to mention an elder who is bedridden is not able to function alone at all, and therefore, should never BE left alone.

Your mother needs a full medical and cognitive workup to determine where she scores on a cognition exam. Based on her number, which I expect to show dementia, she needs 24/7 care at home or placement in Assisted Living or Memory Care Assisted Living. It's more about you wanting mom to be safe and properly cared for than about "legal" matters, I would think. But whoever holds POA for her is expected to provide a safe living environment for her, legally and morally.

Good luck to you.
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Igloocar Jan 9, 2024
Lealonnie, at 79, I have in-depth, immediate durable POAs for financial matters and in-depth POAs for health care. Nowhere is there any stated obligation to provide a safe living environment, and I would not want a POA to have or to assume that responsibility. My own preference--from childhood--has been to live a life that is pretty unencumbered by concerns for my safety and more concerned with having a lifestyle that is interesting and holds challenges. I think I may have learned this from my mother, who was widowed when I was a child and took responsibility for my brother, for me, and for herself. Our family decisions never placed much emphasis on safety, and as we grew up, my mother did not interfere with choices that my brother and I made that enriched our lives but did not always put us in what would generally be considered safe situations. Those choices have not changed for either of us at all in old age. (BTW, because of my family history, I am regularly checked cognitively and physiologically. I do not have dementia a this time!) I often think of all the things I've enjoyed doing that I wouldn't have done and places I wouldn't have gone if I were as concerned as some of my friends are about their safety.

As regards the O.P.'s mother, IF she chooses to live less safely than the O.P. and her siblings would like, that does not necessarily that she now has diminished capability to make these decisions. As I have written in another reply, I think a better criterion of the reasonableness of these decisions is how consistent they are with how her mother has lived for the past 84 years!
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