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Hugs Emjo! I'd like to second Countrymouse's idea of writing down for the niece or whoever asks about all the moves that have already happened and the results of each one. Maybe the pattern will make itself clear? This has got to be so hard having this responsibility and dealing with triangulation on top of it.

What is it specifically that your mother hopes will improve with this move anyway? Is it some vague desire for change, a new crop of people who don't have her number yet, or is their something concrete that she wants that could possibly be negotiated where she is?
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cm it is called "relocation stress syndrome"

may be worth posting as a separate post for people who are moving family members
quote:
Over the past two decades, increasing attention has been paid to relocation stress syndrome (RSS), which is also known as transfer trauma. RSS is a formal nursing diagnosis characterized by a combination of physiologic and psychologic disturbances that occur as a result of transferring a person from one environment to another. Symptoms of relocation stress syndrome include exhaustion, sleep disturbances, anxiety, grief and loss, depression and disorientation. In seniors, these symptoms are exacerbated by dementia, mild cognitive impairment, poor physical health, frailty, lack of a support system, and sensory impairment. For these seniors in particular, the resulting confusion, depression and agitation have led to increased falls, undesirable weight loss and self-care deficits.

Although initial studies on RSS focused on outcomes of individuals moved to nursing homes and assisted living facilities without their involvement or consent, it is now generally understood that RSS can affect those who have chosen to move, been involuntarily relocated, or been placed in a care facility for mental or medical needs."

It can be alleviated by:
Involving the senior in the decision and planning process.
Providing the senior with an opportunity to ask questions and discuss his or her concerns.
Honoring the individual’s preferences and allowing him or her to maintain control.
Paying attention to details and maintain the senior’s daily routine as much as possible.
Safeguarding the senior’s personal possessions.
Involving the senior in setting up the new room or apartment.
Making the new home resemble (as much as possible) the old home.
Helping the resident become acclimated
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Unfortunately I think mother is moving because she is fleeing the old place and has a conviction that the new pace is "better". She hasn't voiced any concerns except to move, I don't know anything about the new home care providers she would have or the new case manager nor does she. She would undoubtedly be involved in setting a new place up. I doubt she would feel any grief or loss and she is not particularly frail.

Mother used to assess herself very well. When I showed her her new computer with Windows 8 she said she would just have to learn it. I offered to take it to the shop and have them install Windows 7 so it would be more like her old one, but she refused, thinking she could learn it. She has hardly used the new computer. 6-7 years ago she taught herself the basics of computer use, with a little help from a few people, I think she is not capable anymore. This summer I set up the new one so she could access her new email program with about 3 clicks and showed her how to "reply", She practiced it while I was there and sent a few emails over the next few weeks and then nothing since. Amazing really that she did it in the first place, but that she cannot now is one outward sign of inward decline.

Just thinking on paper here...
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Interesting - the place mother wants to go does have independent living units after all, that mother does qualify for, so she could apply there, but the manager will not entertain an application if two family members disagree. He doesn't care about the PD at all. Ha -That is funny. The wait list is about 8 months.

He also said that moving a senior is very hard on them.

He said re sis and mother they seem to have some confusion. I guess! They have not researched what the facility offers and what mother qualifies for. I know mother is probably not capable, but my sister is, at least, I think she is

I found out the apartment units, have meals supplied in a dining room,and security, and they do have kitchens which mother needs as she does not eat in the dining room, but has all her meals made by home care, Any home care is contracted out. But there is no nurse on the floor. That makes me comfortable for a 101 yr. old. Where she is there are nursing aids available 24/7.

I have more messages on f/b probably from my niece, but am not even looking at them so don't even know who they are from. I have no intention of being sucked into a question/answer session with her.



I told the manager that mother has BPD and narcissism as well as paranoia and then he started sounding nervous.
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Haven't dug around it. Tsk.
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Knowledge Exchange Institute for Geriatric Nursing, Medical & Social Work Education

Emjo, have you come across these people? It's a Canadian organisation, quite high-end academics/professionals, but maybe if you chucked a question at them they might have specific answers? Looks like they have a searchable website, though I have dug around it properly (yet).

Besides getting back-up on how detrimental another move would make, don't forget you can point to your mother's "form" in this respect. How many moves in how short a time has it been? Not only potentially detrimental to her welfare, but also utterly futile in terms of hoping to achieve a better environment for her. Try not to worry. Everybody rational is on your side, and the world's not THAT crazy. (I hope…)
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Nicely played as regards your niece. It's very difficult. It's a reasonable question, put by a reasonable person, and all else being equal of course you'd be happy to explain; but as things are, you know that once your answer filters through to the end-enquirer, so to speak, it's going to get bent and chucked back at you. And when the niece is a nice person but not in possession of all the facts…

Gosh you must get weary.

When you say the EPA was activated, is that the same as "registered" in the UK? Because here, once it is, the donor strictly speaking can no longer control the funds and must do it through his/her attorney. In the age of debit cards, internet shopping etc. obviously this doesn't immediately get followed to the letter, but that is the law. You can if you like ask the ALF Director to remove debit cards, credit cards, cheque books etc. "for safe keeping", leaving your mother with pocket money - that's not only fine but also what you are actually meant to do. Then, for as long as she has capacity, you must use her money as she directs within the restraints of responsible financial management; but it is you who's meant to be doing the using, as her agent, not she herself. Gives you a fair old bit of leverage.

Ah, her mistress's voice I hear… Back later.
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Thanks Jeanne, I wish so too.

Can you or anyone reading point me to some literature about the effects of moving on someone in mother's condition. She does not have Alz and no doctor has mentioned dementia, but she has pretty severe short term memory loss, and paranoia along with her BPD and narcissism.
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Hugs to you, emjo! You are definitely doing the right thing. I just wish it weren't so hard!
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update - a little anxiety here

sis has found out I called the ALF (Vanguard) and told them not to admit mother - not that I really have a say as she has to be qualified by our health system and she doesn't fit the criteria, AND the PD is not activated at present.

Her daughter (my niece) has contacted me and said she needs to know if I did this. I guess sis realises that she may not get a response from me. I will respond to her if we can discuss things civilly and without accusations. At the moment, I am gathering information to help them understand the health system here, the environment mother would be in if by some stretch of chance she did get into the place she wants to, and also what the effect of the move would be on her according to the mental health nurse and literature in general regarding the effect of another move on some one in her mental state. I got back to niece saying it is not that simple and I will be in touch her and the family - being everyone I cced this summer when we were going through the flight to Ontario crisis.. As others have said it takes, I can't remember the phrase, but the parallel for a senior of it takes a village to raise a child. I do believe that family should be informed at least and at best, included of they wish.

Another chat with the ALF director let me know he would be happy to speak with mother's doctor about their concerns for her, so I will call her doctor this morning. Also, he said that if mother was applying to another place at the proper level of care - which for her is supported living in our health care system terms - that it would be correct and even advisable for me to have a chat with the director of that place about the problems mother has e.g. the BPD and narcissism which makes the paranoia more difficult to deal with, to see if he feels they are equipped to deal with her. He also said that he thinks I am doing the right things, which was good to hear.

Deep breaths - There is no doubt some of these interactions and the anticipated reactions trigger off the PTSD I have due to my family dysfunction. I had a lot of anxiety growing up. Home was definitely not a safe place. In fact, it was a dangerous place. I know many of you understand that. One hour at a time, one day at a time...
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thx cm - just talked with the medicenter head nurse, and mother is still seeing her doctor there which is a relief. She checked the records and mother's liver is fine - it is only her brain function that is in question lol. That woman (mother) has the stamina of an ox. The nurse has had a similar experience with her disabled incompetent brother trying to fly across the country, only he made it and is now shacked up with a drinking buddy who leeches off him. I got the whole nine yards from the nurse and it was helpful. When mother tried to fly, she only made it to the airport then was intercepted and taken to hospital. The nurse said that I would just have to get mother assessed incompetent and the ALFs doctor was the best person to do that. She warned me to watch for any regular drain on mother's bank account, as did the ALF director.
One does need enough cooperation to get the person in for the assessment. A few years ago one young doctor in another medicenter started to assess mother and she faced him down and shamed him for trying to do it, and left that center. Poor guy was just doing his job.
Yes, mother is amazing and a mixture of good and bad. On retiring she went to Haiti for about 6 months each year until she was over 80. She is a physiotherapist and volunteered with handicapped children. She would come back to Canada and give slide shows to groups to raise money for the school. I got mail from her once saying “It is me and 200 men again” This time it was the Kiwanis I think. She stayed in Haiti through the revolution although Canadians were advised to return home. She said the soldiers were not concerned about an old person like herself, and that she was more afraid of the cockroaches as they did not care how old you were. She would write and say that she could not use her balcony that night as the canons were going off. My sister’s comment was that mother was enjoying the revolution. There are more stories and mother has written them down. I think my sister has them. Unfortunately all that ability now is being sucked into the vortex of paranoia. Mother was awarded an honorary PhD from the University of Windsor for her work in Haiti and also some advocacy she did for of seniors in Ontario when she was there. It adds to her elitism.
How would mother flit? She and my sister would hire someone to pack and move her. She has a decent amount of furniture some of which would need to be sold/disposed of. I think she is still quite capable of packing personal items. Certainly my sister is if she wants to. Mother orders cabs for herself all the time. She has a favourite one who looks after her very well. I think she has an account with them,
Hope your mum is OK – no disaster, I trust. Let us know.

Thanks brandy - yeah, it is a mess. I think I would be in the same position as you are if I gave up POA. One of the things that keeps me going now is believing that mother is incompetent and that she needs someone to make decisions in her best interests, as opposed to making decisions that will save the inheritance. for the next generation.

(((((((((((((hugs to all))))))))))))

Times like this, I wish I was a drinker. but it just doesn't do it for me. Sigh…

]
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Emjo, what a mess. And here I thought my sister was a problem. I really don't know what to tell you. I don't think you should give up your positions of authority. Then you will be like me, the next door neighbor's cousin, twice removed. I gave up POA and look where it got me.
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Emjo I'm glad you're liaising so closely with the the home's professional staff. Lean on them heavily. I wouldn't be too downhearted about the mental capacity assessment hitch. How much co-operation do the assessors expect from people who are losing capacity? They must know their way around the problem. You've mentioned before that your mother can be very convincing…

You know, I have to say, I know it doesn't help you, but your mother is pretty amazing. Just wish it was in a good way, instead of devoted to being a universal thorn in the flesh. I can see why you feel you can't just wash your hands and walk away. I think.

… but with consistent back up from the care home staff's records, she's not going to get away with just staging a command performance.

If your mother attempts another midnight flit, how is she going to move her stuff? It may be a mean trick to pull, but if you order a firm "nolle prosequi" to those around her she's going to have a job packing her things, ordering the cab and getting herself shifted, isn't she?

Another Friday night spent waiting for mother to finish her supper - I think she's going for a record - instead of down the pub. Guy did offer to watch her, I'm not complaining, but she's very wobbly and I'm afraid there might be something brewing (no pun intended), not the best time for me to be downing the real ale. Oh my word what is she up to? - got to go… x
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Thanks, Veronica. I have to consciously take mental/emotional breaks from this. I am a sherry person, but a bottle can last me a year or more. That may change lol! ;)
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After receiving the lawyer’s letter, I contacted the director of mother's ALF and he said he will consult with his nursing staff. Apparently, they can bring in a doctor who could assess mother's condition and take into account the records the ALF has kept of her. The assessment of last summer took none of that into account. Mother is very bright and she passed the tests - barely. I believe that she is so well physically biases people in favour of judging her competent. She is already on the ALF’s "at risk" list and he said they will "amp up" their observations and recording. At times, they can make this happen i.e. obtain an assessment of incompetence/incapability. In his view, mother is not capable of making good decisions for herself and I agree. The paranoia is what is driving her now and that is irrational. Again, I believe that he is acting with mother’s best interests in mind. He also said he would be willing to discuss objectively the pros and cons of a move with my sister, if she was interested. I believe I need to draw up an email to the family outlining what has been conveyed to me about the inadvisability of moving mother and the effect it would have on her mental state. Then, at least, the information is shared with a larger group. I will also share the director’s email and phone number so my sister can contact him independently.

Maybe some progress is being made. If mother moves, this process starts all over again, which I think is part of her agenda. Maintaining control is extremely important to her, and that is usual for many people in her situation, and more so to her because of her personality disorder. She has moved from one doctor to another in the 16 years she has been west. I can recall 6 doctors off hand that she has been to in that time...
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No suggestions Emjo just sympathy. Go to bed with a hot toddy and turn off the phone
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I have heard from the lawyer. The EPA was activated this summer. The PD is not active until mother is assessed as being incapable by her physician. Then I have to make a written declaration of that and can act on it. Mother was assessed as being borderline competent last summer at a hospital. I am assuming that competent and capable are equivalent terms and used interchangeably. I have a call into the physicians office to speak with the head nurse to see if mother is still a patient there, and a call into the mental health nurse to see if she has any suggestions. In any case, I am certain that mother will not agree to any re-assessment at present, so the assessment of competency of last summer will stand, This means I have no authority to make decisions as to where mother lives, and she can move wherever she likes. In terms of the EPA, it is active at present and if I deem mother not capable of managing her financial affairs, the lawyer stated that I should step in and not permit her to continue to deal with them, In all honesty, I cannot say that I think that she is incapable of managing her funds. She lost/misplaced $90 recently, and another similar sum in the summer, but all else is in order last time I looked. I will check her accounts again shortly.

So, until she is assessed as being incompetent/incapable, my hands are tied and, although I am concerned for her, there is really nothing I can do. I suspect she is aware of the consequences of being assessed incompetent as she cancelled an appointment her case manager set up with her at a geriatric clinic, and has not shared with the case manager what doctor she is using.

This brings me back to square one and whether or not it is wise for me to continue as EPA/ PD (potential) because of the stress it causes me. I suspect that mother will dodge another assessment to the greatest of her ability. Due to mother's personality disorder she turns everything into a battle and my sister is the same.

Any more suggestions?
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Thanks Veronica. Dealing with family stress has been a lifetime occupation. I always think of hitting people between the eyes with a 2x4 to get their attention, metaphorically speaking, of course. Actually, I can still wield a piece of firewood decently well. :)

Lifespan - thank you. My mother is indeed still quite bright, but totally non compliant as regards taking the medication that has been prescribed her for paranoia. As far as I am aware, there is no way to ensure that she does. It would make her life and that of others, including me, much easier of she would comply. Since being part of this forum. I am not surprised that the problem that I am facing is more common than many think. You are correct, I am not in the US, but in Alberta, Canada. The lawyer, who I have informed about the situation, is mother's lawyer, who drew up the documents, and who is pledged to act in mother's best interests. She has been helpful previously. I feel she needs to be kept informed. If I require another lawyer, I will obtain one. I have found the names of 2 lawyers in my mother's city who include elder law as part of their areas of expertise. I am not aware of anything that states that I will be compensated and reimbursed, and that is not my main concern. Whatever it has cost me to carry out my duties, I have paid for so far and am fine with that. I thank you again for pointing out to me that it is my duty to "step forward," Only days ago, I was considering dropping the role of agent, but after seeing, amongst other things, how my sister alienated the people who deal with my mother, I feel that I must continue in this role. Knowing the two of us very well, mother chose me. Will she be furious at me for stopping the move? Yes, but it is in her best interests. I appreciate your feedback.

I emailed mother's lawyer this morning asking her advice as to how to ensure that my sister does not carry out her plans to move mother. Any prayers from those of you who do pray, are welcome. I know that this lies in greater hands than mine, but I need to do my part.
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Hello EMJO,
I have some understanding of your problems. I practice Elder Law and also set up special needs trusts for individuals with disabilities like those facing some of your family members. I also have clients with the same "disabilities" and with the help of medication, and a good doctor, do quite well in life, and more accomplished than most others.
Seeing a lawyer is not "pulling out the big guns." It is your fiduciary duty under the documents making you agent. While the problem you are facing is unfamiliar to you, it is more common than you would think. The agent under the documents must step forward.
I assume that you are not in the U.S. and I am not familiar with your laws. But in our state (Pennsylvania) the agent is compensated and reimbursed for enforcing the documents that were drafted earlier.
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Emjo you are doing a fantastic job try not to let it stress you out too much.

Capt what happened to hitting people over the head with a 2x4. Us old ladies have a hard job lifting a log of firewood. we don't spend our day breaking rock. Changing diapers is more our speed !
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fibromyalgia averted, thankfully

Jeanne, you mentioned specifying to the bank that mother's funds are not to be used for any other facility. That might work. I will need to contact the bank for that, I have a lady there who has been very helpful. It would not make me popular, but then this is not a popularity contest.
glad - yes, just one sis in Scotland, a letter to sis and copy or similar to the ALF would probably be the best step at present. It would be very difficult for me to take steps to keep sis and mother apart. I don't think there is anything I can do about the monies, but I can discuss it with her financial advisor. Yes, we are in similar situations. We want our mothers to be where they are best taken care of even if it uses up much of her financial resources.
Bermuda - as I wrote to Jeanne, I don't see an end to this. I know there is one - one of us will die, but neither event seems imminent. You would do well to deal with the things that are most troubling to you, as these situations can go on for a long time. Never did I expect to be dealing with this at my age.
Mother's funds are not in a trust. Her will, of which I am the executor, is very simple as far as I know. What she has is to be divided equally between my sis and me, with a few small bequests. I think what needs to be accomplished can be done via the lawyer.
cap - no, it shouldn't be necessary, sigh, but that has nothing to do with the realities. It is what it is and I have to deal with it. The support here is invaluable.

The mental health nurse gave me her phone numbers, and I will share any more info I gain with her and will find out her assessment. She is trying to gather results of the tests mother had in the summer to get a baseline, especially of mother's memory, which is the one thing mother admits has deteriorated. Mother might agree to go for more testing in future, on the basis of that, though it would be more extensive than memory tests. The nurse said that what she has to deal with is mother's non compliance i.e. not taking her meds. Mother could be hospitalized and stabilized, but then, when released, she will revert to not taking her meds.There are no easy answers to that. The nurse was very strong about not moving mother due to the effects of a move on her mental state. That helps me. I mentioned the concern I had about my sis charging me with not doing my job and she laughed and said seeing that mother was so well looked after she didn't think it would sell. However, she also said she will be gathering as much info as she can, so that if it came to anything legal, the evidence of my involvement is available. It was recommended to me by the ex actually, who has a good mind for legalities, that I document everything I have done for mother since she moved west (about 15 years) and also what it has cost me, It may be helpful at some point.

I want to thank you all for your suggestions and support. I am considering them all seriously - except the firewood one lol. My next step is to write the lawyer,bring her up to date and ask her what can be done to prevent my sister from moving mother.

Once that has been accomplished I think I will take a holiday, whether G is free or not!

Anymore suggestions/comments most welcome. You have opened my eyes to some possibilities I had not thought of.

(((((((((((((((hugs))))))))))))) and thanks to all..
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I just lost another post - will try again in a bit. I can feel the fibromyalgia trying to kick in. Haven't had that in a long time.

I had a long, long chat with the mental health nurse today which stirred up a lot of feelings, but was good and we are mutually supportive, She agrees that mother should be left where she is and moving her would likely increase her memory loss and paranoia.

Thanks for all your suggestions. - even you cap, It gave me a good visual. I will answer what each of you has written but need a break now. More later!
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Jeanne, I did write above that in all conscience, I could not give up EPA/PD to my sister who is the alternate, and I won't. You mention the short distance... There are no signs that mother in on her way out physically. The exam she had before her latest hip op rated her as A1 physically. She is not frail. The only thing that is not A1 at present is her liver, but people can live independent lives on 10% liver function, and she has, as I understand it, at least 50%. I researched it and they take 60% for liver transplant leaving the donor with 40% so she is fine in that department for sometime as far as I know. In any case, according to my reading, the progress of liver disease in the elderly is very related to co morbidities, of which she has none. Her heart, lungs, kidneys etc are fine. She had full anaesthetic less than 2 years ago for the hip op and it did not negatively affect her. She discharged herself early from rehab. So I cannot hang my hat on the hope that this will end soon, unless you consider 8-10 years soon. At my age I don't. Five years doesn't even look soon to me. I could be dealing with this until I am over 80 (4 years) . I hate to think what the stress is doing to my brain lol.

I hope it is obvious that I am doing my best, and I will continue to do that. Thanks for the wisdom and support.
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Emjo
Bermuda has a good idea. If I remember there is a trust for your mom. Is there language in there that will remove a beneficiary of the trust if they unsuccessfully challenge it?
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bust her over the head with about a 3-1/2 inch hunk of firewood. emjo, you understand firewood and dominance, this shouldent be necessary.
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My hat is off to you Emjo! I feel like I can't deal after a lifetime of dysfunctional family craziness and I'm only my 40's. Clearly I've got to find some stamina as this all may go on for quite a while. Your sister definitely sounds like she is not helping the situation but odds are she'll never agree of her own free will just to step out of it - looks like you'll need legal help to set the boundaries. I wonder if there's a way to set up your mother's money so that your sister feels less motivated by it? Some kind of trust or fixed inheritance amount?
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EMJO-
Glad you decided to keep the EPA! You have done a great job for years making sure you moms need are met. I too, am hoping for a volcanic eruption. Is there just the one sister in Scotland?

I also understand about not wanting to keep sister from your mother. Hopefully it will not come to that. Yes have the attorney write your sister and use his legal mumbo jumbo to keep mom where she is. It may also be wise to have him copy the facility where mom is to also let them know that they are permitted to take whatever action is necessary to prevent sis from moving mom, including calling the police to arrest sister.

So similar, to my situation, but shoe on other foot so to speak.
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I can see why it is tempting to give up the EPA/PD. It is stressful, for sure! But you have worked so hard for so long to "do the right thing" by mother, and it would be a shame not to go the short distance to the finish line for her.

See what the lawyer suggests. I suppose it could be made clear that EPA will not be paying for any care center other than the one she is in. Whatever it takes, I hope you can do your best under very trying circumstances. Good luck!
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good thoughts cm. The lawyer will know what steps have to be taken to prevent her and what the repercussions are of not respecting the EPA and PD.

I just looked up Guardianship and EPA/PD in Alberta. Guardianship can be applied for if there is no EPA/PD/

quote from a government site

"The AGTA (Alberta Guardianship and Trustee Act) applies in situations where an adult has lost capacity and does not have a personal directive or enduring power of attorney. In these circumstances, a relative or friend would have to apply to court to become the adult's co-decision maker/guardian (for personal decisions) or trustee (for financial/property decisions). When an adult has no family member or friend who can take on these roles, the Public Guardian or Public Trustee may act as the adult's decision maker(s)."

So it appears they have similar purposes and probably similar powers.
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Thanks Jessie - It is a mess and not the first one I have been in with mother and my sister. My sister and I have never been "on board" - or I could say I could count the number of times on the fingers of one hand with some left over. We do have guardianship here and that is another thing I need to ask the lawyer about. Is it stronger than EPA and PD? Would it make it easier to prevent my sis from doing things like moving mother. I hate the thought of limiting sis's access to mother, yet can see that she is doing mother no good. I am waiting on the recommendations of the mental heath nurse. Unfortunately mother will not take her meds regularly, if at all. If she would her life would be manageable.
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Isn't this injunction territory? Armed with an injunction, the current NH staff could prevent your mother from leaving the premises in your sister's custody, couldn't they? Heaven knows how you get one or how much it'd cost - or your lawyer would, I guess. It's either that or arrange for Icelandic volcanoes to start erupting again so your sister can't fly over (unless she's got a broomstick…)
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