What are all of the steps involved in getting an obstinate Mom (89) with dementia into AL?

Well, I don't think you are going to find a book that says do A,B,C and poof they are in an AL.First some homework, do you have POA,DPOA,MPOA, if you don't know what those terms are start looking them up on the internet.Also , if your finances allow find an attorney that specializes in elder care if your mother has assets,her house, and how to protect them because AL care runs about $3500-5000 a month depending on the level of care she needs and they want their money, an NH you would be looking at about anywhere from $4000-7000 a month and I think I am being conservative.I don't know if you have siblings, if you do and they are not on board with your plans it could get messy. However, if the care of your mother is going to be left up to you I would refuse to do it unless you have the legal documents I mentioned above,be adamant about this if you have an uncooperative sibling, it will save you a lot of grief.Start calling AL facilities in your area, take notes, ask what level of care they provide,staffing to patient ratios,what resources they have at the facility,actually tour the facilities yourself,it takes homework and legwork.Just make sure to get those legal papers first,also add a living will, even with MPOA it is still best to also have a living will because it is more specific about the patient's wishes about end of life care and takes a lot of pressure off of you.Do this before her mental status changes for the worse.Also,even though an AL may have a great reputation doesn't mean it is true. Consumer beware as always.I take care of my mom at home(I am a retired nurse) I was curious so I called one of these $5000/month ALs and basically the rep kept telling what all they didn't do, I was still going to have to go do her laundry, set up her meds, get groceries, get her to the MD, I didn't want to be a smart *ss with the woman but I almost asked her what the h*ll do you do for $5000/month. I could put her up at the Hampton Inn and get room service ,plus they do the laundry and have a buffet for cheaper than this.When I explained about some of my moms mobility issues the rep said well it sounded like my mom needed to much care and should go to a NH.What a laugh,she's been with me for 2 yrs. now and despite mobility issues she goes to PT twice a week,out to eat,church,she's not bedbound but is on hi dose morphine for osteoarthritis,now dementia thank god, that would be a game changer.I had to get my mom out of her home because it just wasn't feasible for her to live by herself anymore and I couldn't get my house to sell but hers would and believe me it was a big emotional upheaval, I never want to go thru something like that again, I felt like the worst child in the world but I knew in the long run I could give her a better quality of life living with me and now 2yrs later she now agrees but it was rough at first.But once you get your documents together ,and I am basing this on you being the one that will have the basic POA(power of attorney) and you find an AL that hopefully isn't far from where you live so it is feasible for you to drop in and visit/check on her(while you are getting your paperwork together and checking these places out I wouldn't mention all this to your mother until you had all your ducks in a row.As far as the paperwork explain her that you need it so you can help her with bill,shopping and MD appointments.When the day comes to go to the AL,play it by ear, some people have tried just simply driving there after they take mom out to lunch and suggest hey let's visit this place nonchalantly.She may actually like it outright,this does happen,if not steel yourself,make sure you have a good relationship with the Al's manager so they can help you with the transition. My mom was going to have to go to an AL if I hadn't taken her in and I only did so because I am a nurse and so is my husband so that gave us a unique edge.There was no way that she was going to be able to stay in her home and like yours she time and again stated she planned to die in her home but it just wasn't going to happen as she could not be left by herself. So keep coming to this site , you are not alone,there are so many here that are right where you are right now and many that are a few years down the road from this. You are not alone,take a deep breath,you can do this. You are a good daughter, your mom will probably get angry at you, throw a lot of guilt at you , you are still a good person. I used to work a side job at a rehab/NH and we got a lady in her first day and the family was beside themselves with guilt, the old lady was mad as h*ll,cursing them out and when they left the little old lady called 911(all the residents had phones at their bedsides)well of course here come the police, and the firetruck and the best,good looking firemen I have ever seen.Well,of course they have to come and check on her , and I was in charge that night and talked with the police lieut. about what was going on so after about 3 more times of her calling 911 and everybody coming(cute firemen included) only the police lieut. would show up because he had to make out a report, that woman was mad, but she eventually settled down and things evened out, it can be rough that first day, we even told the family maybe not come by for a few days which worked out well because she was a lot calmer when they came to visit: it was fine with me her calling 911, sure did like those firemen.But I could tell it was not an easy decision for her family, there were in a lot of emotional pain so you are not alone, so many families have had to make these painful decisions, it doesn't make them bad people, and they are not abdoning their loved one, they are just trying to get them to a safe place.

Durable POA and Healthcare directive are most important. The directive tells the medical community what she wants when she can't communicate that, and with Dementia is very important. It is activated if she has a terminal illness or 6 mos, and Alzheimer's is terminal. One of the important considerations is does she want to be kept alive artificially and be one of those immobile, unaware people in a chair all day. Many years ago, mthr said she did not want that, so she refused all treatments except pain and comfort measures for when she was terminal. That means no CPR, which actually breaks elders bones anyway. Once she's terminal, she wants to depart in as gentle way as possible.

The POA needs to be taken to the bank so you can get on her accounts, and that can only be done while she's relatively ok. Same with stockbroker accounts.

These are the first steps to help mom. They are relatively painless, but very important for later use.

Start Guardianship petition ASAP. Without that court order, she doesn't have to go anywhere. The surrogate's court will appoint a court evaluator and agree or disagree that she needs placement.

Texarkana pretty much covered it. Another retired RN....makes me wonder why this keeps happening to us??! When working on this for my dad, my daughter and I took a clipboard and made a paper for each place for comparisons. Took notes on each place. But, yes...first the elder care lawyer as you want to protect Mom's assets. My parents had a living trust and a plan and all that paperwork re: POA etc done so it was only a matter of them going in and signing over responsibility to me (only child left so no fighting...but also no support either!) Both wanted to stay in their home til they died. Not possible for Dad. Mom still there but on the edge. When Dad needed lots of help, we got in home help first and they had assets to pay for that. Parents refused, but finally, I said, and lawyer helped to say it..... a home care plan is a safeguard because then, if anyone calls adult protective services because they are alone, there is a case worker and home care plan in place, and no one will force them to leave their house. I'll soon be giving that same argument to my Mom. You will NOT be able to provide 24/7 care yourself at home, so start with in home help. Agency aids coming in as needed....can be had for as little as 4 hours/week, but then, can be increased as needed. Tell Mom...there is no choice if she wants to stay in home and not AL placement. Learn about the dementias....no arguing, no explaining...just give choices in a loving way. My dad's initial placement places in memory care cost between $4800 and $5600/month and that will need to be paid until your Mom qualifies for Medicaid. There are lots of rules, which is why an eldercare attorney can help and also help safeguard her resources as well. If you make mistakes, there can be years delay before Medicaid will pay and you will use up more resources than you need to. In my case, with lots of arguing coming from parents, the lawyer just told me to tell them that HE said we had to do thus and so and he would be the 'bad guy'. My Dad respected the lawyer's authority more than his 'little girl's' authority so that worked well. As for getting her to cooperate, you tell her you WANT to help her stay at home....but you cannot do it alone. I've actually said to my Mom...." If I die first from all this stress, then who do think is going to help you??" as a way to get her to see that even though SHE doesn't think SHE needs help.....I am the one who needs help. Then a choice....home means in help home ....to 'help you' if need be..... and if she cannot cooperate with that, then it's AL. If she ever actually agrees to AL or even to consider it, then take her with you to look or at least to look at the 3 you have pre screened as appropriate and let her choose. If no agreement and that's the decision, you have to just take her there under any pretense, and leave her there. These agencies know how to pull that off...ask for their help in how to get her there. It will be very hard for a few weeks, and yes, they may recommend that you not visit in the beginning. My Dad was agitated, needed meds increased etc, but finally adjusted. After almost 2 years, he still sometimes asks why he has to be where he is. He is happy when I simply say that the doctor wants him to stay there because they can help him with the problems in his brain. So then he thinks it's some kind of hospital treatment and again he is happy to go along with what 'the doctor' wants him to do. It all hurts and it's very hard....and my caseworker at the law firm had to help me understand that my only real responsibility for my parents is to keep them safe until they die. I had to be clearly told, many times, and over anger and tears, that I was not responsible for making them happy; nor was I responsible for doing what they wanted. They put me in charge, because they were no longer able to make good decisions and all decisions can only be about keeping them safe and dispersing of their finances in sensible ways that both give them what they each need, but protect their money and assets as long as possible. It took a long time to step out of being the 'good little daughter who does as she is told to make her parents happy' to being 'in charge and essentially their parent'.

This dilemma, and the stories caregivers are telling here, remind me of when my kids were little and didn't want to go to the doctor for shots or didn't want me to leave them at preschool or kindergarten. They "pitched a fit" just the way some of our parents are now responding to the need for specialized care/housing. When it was our children, we had to persevere, knowing that we were doing the right thing for them in spite of their resistance. Our aged and ill parents no longer have the ability to care for themselves properly, nor can they make rational decisions in their own best interest. That responsibility falls to us, and though it hurts to see them unhappy just as it hurt us to leave a sobbing toddler at daycare, they will adjust. Stay calm, don't blame yourself, don't feel guilt-ridden. You are doing the appropriate, loving thing in both instances to keep them safe, healthy, and even entertained. There are values in living in a larger community that cannot be provided in a private family residence, and most people in these facilities come to appreciate these things given a little patience on the part of their family members. We can convey our feelings of guilt, grief and indecisiveness to our parents and they will exploit it, just as our kids did when we wouldn't buy them something at the store and they threw a tantrum--if you're not confident in the correctness of your position, you'll get steamrolled!

I may be in the minority here and I don't have a stubborn elder. My mom knows that we all the very best for her. In your situation, if my mother fought me tooth and nail when I was trying to get good care for her, I would take care of myself first and foremost and tell her doctor that her needs were beyond my capacity. I would get her to an ER when she became combative and tell them that she was a danger to herself and the small children living at home.

The hard thing is that when the dementia advances, they can't have a say in how they're cared for, and unless you can take out her gall bladder or unclog an artery, you don't have the training to care for her at home. The psych floors of good hospitals have senior adult behavior modification programs (it sounds horrible, I know, but it's not) where she can go to transition into an assisted living place, they have therapy, they have anti-anxiety drugs, etc, not to turn her into an inanimate object, but to help her deal with her fears, which are many and rampant, it will help her accept the move and help her deal with these terrifying changes to her body and mind that she just can't process. Meanwhile, be VERY CAREFUL about Assisted Living, they are sharks and predators and they use dementia patients like cash cows and they haven't a clue how to care for them--I'm talking from brutal experience. If you don't have an elder care lawyer, get one, and get a recommendation for a professional care manager, they're worth the money if they are good, they know which places stink and which meet your needs, and they'll help you every step of the way, you have to pay for it, but you'll need someone on your side, so it's money well-spent, because that smiling sweetheart who takes you on a facility tour and blows all that sweet smoke up your dress at the assisted living place is more often than not swine.

One problem is that you are living in her home. Where are you going to go, when she moves to a nursing home? You have to take care of yourself first, or she will outlive you. But, as long as you are in her home, she has full time care and a doctor might not help you admit her.

My sister died the day before her 70th birthday, trying to take care of mother. With no one there, she fell and was taken to the hospital. She could no longer live alone and she is now very healthy, clean and happy at the local NH. Good luck. Both my husband and my mothers are in their 90s.