They will give you some warning signs.

http://www.pbs.org/wgbh/pages/frontline/life-and-death-in-assisted-living/

Best wishes for you and your family.

I'll watch that with breakfast.

It looks like your Gran needs 24 hour companionship if not assisted living.

There should be public agencies that can help with the decision and with ratings, and social workers at area hospitals.

You also need to visit the candidate venues and ask questions, talk to residents, etc.

You can also dicker with them, I had to for my folks to be sure that they didn't run out of money.

Beyond that, good advice requires more details, I can only share what my parents needed and what was available.

Your needs and resources could be much different.

Good luck!

We've been trying to get full time care for a while. Gran can be... difficult. (Not initially, but she has always been more than a little passive-aggressive and it ramps up as she gets more comfortable with someone. She's really good at undermining relationships.) And this is her autonomy, so she's justifiably fighting having someone live in. Plus, her house is pretty old, pretty deep into the rural, and rather expensive to keep going because it's propane heat.

We know the local to her assisted living facility very well; my great-uncle spent his last few years there and they're great. My grandmother only wants to be there for rehab or short-term. Until she retired, she was herself head of nursing in a geriatrics facility. So there's that.

I'll be checking local to me facilities; Mom's doing the same near her.

We know we can't bring her care into either of our homes -- Mom's got an almost tiny house (600 sq feet, 1 bedroom) and I'm not much better (1000 sq feet on two floors) and Gran is not small. Mom and I physically cannot take care of her.

Complicated. Always.

Thanks!

And I know the type, my mom was that way, she loved the helpers one day, would fire them the next, and her background was as a social worker so she couldn't be told anything (I don't think it helped our situation).

Glad to hear that she isn't resistant to the idea of assisted living.

Good luck!

Being a research psychologist. Nursing and social work have to be exponentially worse.

I think with the right facility, she'll be fine, it's just finding that place.

MIL always was nicer to the paid staff than she was to her daughters-in-law. So, once she makes up her mind that she needs the care, your Gran might behave herself with the assisted living staff if she wants the best care.

She was sweetness and light to caregivers and saved all her venom for me. I still dropped everything and went to Florida to care for her at the end. By then, she was pretty much nonverbal, which was a blessing.

The best way to insure good care in a long term care facility is to be close by and visit unpredictably.

she was visiting us. So the logical next step was an assisted living place close by. It would have been much harder to supervise her care if she was far away.

I can't go, though -- I'm a PI on my project, and this is my first PI, so dropping this means the end of my work -- so she's gotta come here, or go to Mom.

I can count on 6 months of good behavior, during which there will be a psych, a neuro, occupational therapy, proper nutrition, activities and hopefully, getting the whole neurochemical stew to mellow.

It also helps that paid staff go away (time off or to different jobs) which alters the relationship. We don't go away, which means we're either powerless (because we can't leave) or too powerful (because we know where the bodies are buried.) And which side of that power balance depends on teeny tiny tipping points in the neurochemstry.

I am truly hoping that once she's in care, getting regular meds and proper to her endocrine system meals, that she'll mellow back to where she was thirty years ago.

(Maybe this is the argument for getting her to Colorado. Mellow grows on plants around here.)

who's returning home from rehab/AL in a few weeks (broke both hips, now walking, 78) and guess what? They are accustomed to dealing with cranky elderly people @ AL! Remind G'ma that these folks can help her if she's nice to them and that if she acts too bitchy they will think she has dementia.

My Mom has had more fun and been more social in AL than in the last 20 years alone at home. Not sure how long she'll be home but no longer mortified at the prospect of AL. Bonus fact: there's just enough to complain about there (minor nits about the food, whatever) to keep her happy.

They'll tell you the truth if you approach them right....don't be steered by anyone giving you the guided tour.

Some places are the next best thing to independent living, with only the care the person needs being provided, and the person being able to have options (delivered meals, meals in the dining room, or screw that, I'll make my own, for example).

I'm guessing, like everything from restaurants to resorts, that there are reviews of these places on the net from sandwich kids. I'd look for those, too, and ask questions if you can.

Good luck. It's never easy, but you need to get her somewhere where she's safe.

Also, does she have one of those LIFE ALERT type bracelets or pendants? They make one that can detect a fall -- that might be an option for now, anyway.

As for the farm, is it a working farm or just a heritage type locale? Can you rent it out to pay for gran's care?

He rents the buildings and the land and lives across the road. We have decades of partnership. He's really good about checking in and keeping an eye on her, but this is harvest time and checking in is no longer enough.

The rent is about half of her income. Half of the problem with the memory money hole was that her house is old, and expensive to maintain and operate, and she's within spitting distance of BFE. She had a few things go wrong with house and car, which led to one bounced check, which led to a dozen bounced checks. (Because Banks -- if they're not chaotic evil, they're lawful evil.) Selling the house/land is really not an option between the trust and the capital gains. But for what it costs to maintain and operate that house and her car, she could probably live on a cruise ship. (Not a functional option, but...)

Funny enough, she does have a life-alert thingy, and a cellphone on a lanyard that she's supposed to wear. She doesn't. The life-alert thing is usually on the charger, and the phone also. She truly does not recognize that batteries last more than a couple hours. (I blame a lifetime of crappy D-cells.) As I said above, she's fighting this loss of autonomy really hard. (And I don't blame her for that.) Wearing the bracelet or carrying the phone is an admission that she's losing the battle with entropy, and she wants to deny that for as long as possible.

It is a difficult situation, and never easy on anyone--not you nor her nor anyone who is involved.

I can empathize with your situation, I hope you can find a way for her to transition to a safe place for her where she's happy. I think unless you can find a full time carer (perhaps a "room mate" who can keep an eye out in exchange for rent? Of course, these kinds of arrangements are more desirable in places like NYC, where rents are through the roof...), then she will need to go to a more community based situation.

I'm guessing there's no good cook/reasonable housekeeper-type relative who might have a mind to "move in" and maybe keep an eye out...?

FWIW, I hate banks who stick it to people for bounced checks--that's the biggest scam they've got going, especially nowadays with electronic transactions...no one is slaving away, mailing documents back and forth--if the thing bounces, it's like a credit card being denied, and they overcharge when that happens, the thieves.

It's 130+ years old, and a product of the renowned contracting company of "That'll hold 'er & Good 'nuff." It's safe enough, but it needs work before it can be rented because any reasonable tenant will expect things like upstairs windows that don't rattle and basement stairs one need not jump over. (She doesn't go either up or down.) Upstairs has been entirely closed off for several years. That's in the plans, but it's hard to do with someone living there. Mom and I already have plans.

As for a relative... Here's what happens when a farm family has aspirations for their clever children -- they send them to college, and not to ag school. And the kids get good educations and choose city jobs that don't require 5 AM milkings or 140 decibel tractor cabs. We're a pretty clever bunch -- lots of good scholarships. The few who stayed didn't stay because they wanted to stay. Disappointed aspirations and few opportunities have hurt those left behind pretty deeply -- addiction, military injuries and even more tenuous health. There's nobody left, because for the last two generations, we've been cranking out engineers and accountants and diplomats. We're why the Midwest is littered with dying small towns.

Don't get me started on what evil the former Union Farmers' Bank (now a wholly owned subsidiary of a Giant Pool of Evil) has done. My bile has no bounds.

for me!" Maybe a writer or someone who can do their work from home, who likes the "idea" of farming but doesn't want to actually DO any...who can watch your tenant farmer do all the work and feel a sense of accomplishment from the visual inspiration!

Actually, the plan is to get it fully certified for organics when we transition from the current farm manager. We currently have organic non-gmo cert on all of our fields (because g'gr'pa never made the switch -- free fertilizer falls out of a cow's butt, after all) but our manager does both (he rents several fields near ours). When he's ready to retire, we'll move forward.

Ideally, I'd like to find some idealistic young make a go of it farmer who wants to go all out integrated -- bring back some hand-reared livestock, vegetables, chickens, pasture and get out of soy and corn altogether. But not now.

is not really an option because of capital gains. Capital gains is a profit. Yes, it is taxed, but only after you take $250,000 in profit. Only the additional amount above that quarter million dollars in profit (and original cost and capital improvements get to be deducted from the final purchase price) will be taxed. I am not entirely certain what that tax rate will be, but it's less than ordinary income.

So if there has been a huge gain in value, perhaps selling the house and taking the money and setting up a fund to pay for her expenses would be a good idea. Especially if it's instead a money pit.

And the house & land are non-separable by the wording of the trust. But we don't actually have to pour more money into the house.

There has been a huge increase in the value of the land and it's right at the edge of being in the ugly zone where cashing out may not be enough to cover several years of expenses plus the taxes* (which will be well above the $250K -- farmland is way overpriced right now). There are also two other beneficiaries of the trust who have to agree to the voluntary sale (unlikely - family dynamics suck). The rental income will cover her care, but if we sell and something goes sideways that exceeds the cash out and buying out the cousins' half and the taxes, then the assets and the income are gone. And I don't think the whole parcel is worth enough to cover an estimated $30K a year for 3-10 years, plus the same for my mother in twenty years. (This is all before we get into the emotional aspects of selling a 130 year old asset.)

It's complicated because Family and money don't mix. And drought has made it worse.

Time for a real property expert to sort it out.

* I don't mind taxes, not at all. I don't especially like them supporting the rapacious IND-GOP fail machine, but I don't mind paying them.

Yes, as others have also suggested, get an attorney who is knowledgeable about wills and trusts as well as land stuff, but if there are other beneficiaries of the trust, this thing may forever be a problem. I know just enough about trusts to know that they cannot be in perpetuity, that eventually they come to an end. Make sure you also know what the ultimate outcome is when the last beneficiary dies.

While I certainly understand that what the property can fetch in price may not be enough to cover the future expenses for gram and mom, there seems to be a lot of money tied up in the property, which could all go away if farmland loses value.

No matter what you wind up doing, this sounds like a very difficult and complicated situation all around. Best of luck to you.

Thanks much. Half the problem with the 1500 miles of distance is I don't deal with her insurance more than to pay the premium. Not that Medicare and her supplemental haven't been an absolute life-saver, but they're still not the same as being there and dealing with it day to day.

Does she attend any senior centers? Ask if they know any seniors who would like to live with another senior. So many women in their 60-70's are single and becoming a "helper" roommate might solve a lot of problems.

The last thing my MIL, my mother, or their friends would have wanted would have been to spend their last years of relatively good health living with a stranger in her home at the end of her life.

Certainly not for a "stipend."

Or an old, dear friend.

Part of the problem is she's in the declining part of the midwest, and there are a lot more people in her condition than people willing to be a companion. (Also, big, expensive house that eats most of her income. Letting the house sit empty -- even knowing that it will be more expensive to renovate afterwards -- will still be cheaper in the long run than continuing to pay for it.)

There is a senior center, but it's 15 miles away, only open for limited hours, and my grandmother spent her working life as a Geriatrics RN. For her, elderly people are clients, not peers -- she hasn't been able to code-switch. (The ironies get really interesting at times.)

But I'll give it another shot.

and we also considered a third.

There were two that were very close to us. One charged more per month, but that charge covered everything (including a lot of stuff she didn't need). So someone who needed a lot of care might have been better off there. My mother in law thought the residents in the dining room looked dull. (And they weren't very lively -- she was right!)

Unlike the first place, the second place had a "retirement" level of care that only gave meals and access to their bus. But then there were a few higher levels of care you could opt for. Depending on the type of add-on care you needed, it might make more sense to sign up for a higher tier of care.

She started there right after major surgery, so she at first needed a lot of help; but after a month she switched to retirement level and stayed there for a year. Then management changed and she didn't like the new people and also wanted to live with a more lively group.

So then we moved her into another place. It was farther away (in the next town) but had a higher percentage of "with it" residents -- those just using retirement care. When she needed it, she started using them to help put her compression stockings on -- the hardest part of dressing for her. And in the end, when she had cancer, we were able to get the hospice people in there and she died in her familiar bed.

That's one thing to check on, if you like the idea of hospice. I've read that some places don't want that and will kick out residents who need it. We did have to pay for the hospice nurses, but at least the assisted living place had no problem with our bringing our own staff in to help her through that, and the assisted living people and the hired nurses worked together to take care of her.

That's kind of where we're at. Gran needs some nutritional support (she's diabetic, but has a lifetime of cooking the midwest diet, so carb-control has been really difficult for her), driving support, but she's not ready for chronic care. And yes, she needs stimulation. I truly think half of her issues are a combination of boredom (she's real close to the middle of nowhere) and loneliness.

We are big fans of hospice. We've been through both in-home and in-facility several times as a family. That's what Gran did while she worked -- Geriatrics RN. (Which is why she's fighting assistance so hard -- she knows the worst case scenarios.) That's a question I'll put on my notes. Thanks for the reminder.

they don't have the staff for the 24 hour care she needed toward the end. But they were fine with us bringing extra help in.

We were happy that we didn't have to move her to the hospital at the end. By then she was very comfortable with the hospice people, so she died in a place that felt like home (after a few years there) with family and other familiar people.

I rented my condo and moved in with her when she needed it, I hired a caregiver to stay with her during the day and I took care of her the rest of the time. I'm single but it didn't really get difficult until she started home hospice, after she was bedbound I did everything from feeding her to changing her adult diapers.

It was tough, I didn't have much of a life and got stressed quite often but they people from hospice were incredible, they even sent someone out to bath her 5 times a week. One morning I woke up and she had died during the night that was really hard. I thought about it after everything was over and I'm really glad I did it, I know I stressed her out when I was younger and felt I had really paid her back with that. I know doing this sort of thing yourself isn't for everyone but don't discount it out of hand, it may be one of the most satisfying things you do in your life.

He was two weeks shy of 100 when he died in 2005. My gran was his primary care-taker, and we had the end of life discussion a couple months later. She does not want us to take on that responsibility. For all of her faults, she's a solid feminist and is delighted that my mother and I have careers. In 2005, she said she didn't want us to return to the Midwest -- she doesn't see opportunities there, and she really doesn't want my mother to be unable to work again. (Which, taking time now would probably end my mother's career.)

There's also a level of independence at play -- paying someone to vacuum or make her meals is less emotionally risky because if she gets unhappy, she can move to another facility. Having her child or grandchild do so means having to fully engage with that relationship. Ideally, she doesn't want to leave her home, but she also wants her space.

She made us make the opposite promise -- that we would not abandon our lives for her, that we would not make her a guest in our houses.

Of course, this would have been much easier if she had decided what she did want and planned for it, but that takes half the fun out of making us scramble. *wry grin*

One that knows real property and probate. I stress one that knows real property. Meaning a title attorney. If you care to share what state the home is in, I might be able to steer you towards someone.

Keep in mind that far too many probate attorneys, and trust attorneys, and otherwise family law attorneys know Jack F'n Shit about real property law and title.

Explain the financial situuation. There may be options you have not considered with the properties involved.

I'll do that, first thing in the morning.

a neurological eval as well as a psychological eval? Because if she is suffering from dementia, late onset Alzheimer's, that training just goes out the window. I don't know her, but it sounds like she may not be trusted at all to make her own decisions. Her behavior is a detriment to her well being. Also sounds like someone may need to go through her house and do an assessment for impaired mobility. Like getting rid of throw rugs, night-lights, etc., any mobility aids she might need. I know people hate to use them but they are simply tools for living, and can be a valuable resource
Good luck, it sounds like you have your hands full.

About 6 months ago, I made the appointment with her GP for both referrals, and reminded her to go. Her GP made the appointment for the geriatric-neuro and the psych. I reminded her to go and I honestly don't know if she did. Her GP never got a report back, but I don't know if that's because she didn't go, or the neurologist didn't send a report, or didn't think it was serious. The problem with her having the training is she knows all the tricks.

I'll ping her companion and remind her companion that a neuro eval is needed next time she's in hospital. The social worker is not sufficient. (I can't get there within the next few days.)

Oh, yes. Handful. And no, her decision-making capacity is compromised. That's why I have her POA.

Two years ago, I did a mobility sweep after she had knee surgery. Her companion hasn't mentioned a return of the rugs, but I'll ping that.

She was in her early 80's and having memory loss. She wasn't eating right (only ice cream for lunch) and she fell and broke her hip. This required a hip replacement and a long recovery period. She was living with my sister, but my sister did not want to leave her alone in the day because she was afraid she'd fall again. We searched around and looked at assisted living in the Dallas area. We found one place in Grand Prairie that we liked and that she liked. It had a wash room where the tenants could do their own wash. My mother liked that although she was barely able to walk let alone do her wash. The assisted living had a dinning room and served 3 meals a day. It had activities, would take the tenants shopping and it had a beauty shop where a beautician would come in one or two days a week to do the ladies hair. She had a large room with a bed and plenty of room for a desk and tv and some chairs plus a kitchen area with a small fridge and a microwave. The bathroom was disabled safe and wide enough for a wheel chair. The workers would clean the room twice a week and do her wash for her. My sister and I would go by everyday to see her and give her a show, although the workers are also available to help them shower. Overall it was a good set up.

My mother lived there almost five until she passed away. I can't praise the people who worked there enough. It ran about $1,800 a month. We used my mother's social security plus her five children chipped into each month to cover the assisted living and her medicine. I think her living at that place gave her a few extra years.

Do you happen to recall which organization ran it? I've noticed there are several chains? franchises? in the business. I've got two that are local to me that I plan to look at tomorrow, but several within a short drive.

PM is fine if you don't want to share publicly.

The laundry facility is a big one. She has a real thing for fabric softener. (I'm going to bet that it's aa sense-memory trigger.)

Safe Harbor, the Verandas. I can't tell if they're actually under a larger mgmt like the funeral services industry, or if they've been infected with a virulent naming meme.

The place is run by an Adventist organization. They have several assisted living places in the Dallas/Fort Worth area.

We looked at quite a few. Some were for people who were really frail, some were for people who were independent. This one fell in the middle. We gave them her medication and they administered it at the right time each day. That was good because her memory was failing and she'd forget to take it.

They held a weekly church service in the community room and they celebrated all the holidays with parties and decorations. They held daily excise classes too.

I know it not easy to move your mom into assisted living, we felt guilty, but at the same time we worried about her safety. She fussed some when we did it, but she knew she needed to be there. We took as many of her things as we could to decorate her room and made sure she had cable where she could watch the Cowboys and Rangers games.

Good luck to you.

I really have a personal grudge against Paula Deen and everyone on the Food Network and HGTV. The latter is a major cause of over-spending (since it's nothing but not-so-cleverly disguised ads with more ads mixed in) but Deen is responsible for much of my grandmother's worsening diabetes.

I'd like TV to become less important -- if she's got actual, live people to interact with, the little ones in the glass box will go away.

If she didn't get a physical therapy/occupational therapy evaluation during hospitalization, she needs one. These are the experts who can help guide you as to what level of care she needs. Following their eval, social work can get on board and help find placement and start to sort out costs. Social work will give you a list of facilities. Do your homework. Ask around for opinions. Check to see if the homes have any citations. Visit ones you are considering.

Good luck. I'm an MD, FWIW.

Is there a time limit on the re-admit? I thought it was 72 hours? (Or am I recalling invol psych hold?)

As far as I know, there was only a social worker eval with a minimum PT eval -- she managed to mostly walk 80 feet of hospital corridor without assistance. (Which to my shrink's brain, is not an actual eval, but that's another day.) I'll check with those who are on the ground.

I'll try to get her sent back in for now.

Thanks, I really appreciate it.

He or she should know about the repeated falls and could be your guide regarding potential readmission. She could be a direct admit by her MD. It sounds like a more thorough PT/OT eval is warranted to make sure she's stable when standing, sitting, navigating stairs, etc. And to be sure what kind of living arrangement is a good match for her abilities. I just really hope, for your whole family, that these pieces fall into place before she seriously injures herself.

Thanks much. Have a good night!

for 3 or 4 days (I forget which), then Medicare will pay for a certain period of needed nursing home care, which could include rehab. They won't do this if you don't stay at a hospital first.

At least 3 days with full inpatient status and a complete PT/OT eval.

And the point would be rehab and nursing care, not supervision.

Also I don't believe gifting allows the step up that you get once a person passes.

The trust has been set up for longer, so as long as the trust isn't junk, it should protect itself. But it may not protect from a forced sell-down.

Lawyer up. Tomorrow. accountant, also. We've got enough cash to get things started at least, so breathing room.

Thanks for the reminder -- if a facility is putting too much into pretty, they may be cutting corners in care.

Alteration requires the agreement of all three current beneficiaries. (It's a 52/24/24 split.)

Two won't agree that the sky is blue and water is wet, so while I can pay the taxes, collect the income, maintain the infrastructure, there is no selling, and part of it is inseparable. I can use the 52 as collateral for revolving credit or a cash flow account, but I don't trust Indiana banking laws. I think we're okay on money for now.

The trust reads a lot like an English Regency entail, to be honest, but that's where property law comes from.

See if there's a website, as my experience 8 years ago before my mother died was that the 800-number goes straight to your local office, and you have to plead with them to give you a transfer number if your mom is someplace else. Also, in my location there are a stack of AAA resource booklets at every public library, but where mom was heading (near my brother) they put nothing on paper. Aside from that aggravation, I have to say they were a terrific resource -- using the printed material from my local agency I was able to ask about similar services in the other location.

Aside from that, I agree with the others: You need a lawyer. If your mother is co-operative, you may even be able to change the trust -- I had to ask an estate lawyer once about "legal competence" because I was helping a friend with mild to moderate dementia, and he said the bar is set pretty low and my friend had sailed right over it. (OTOH, my mother was not the co-operative type at the end.)

The other thing is to make sure wherever your grandma lives, it's close to you because you will be wanting to drop in frequently. Things go much, much better if a family member makes an appearance.

Try to get as much help as you can from trusted resources, i.e. whatever friends and relatives are able. It's a lot of work dismantling the accumulations of a lifetime. Which brings me to another point: Grandma should not be there for the estate sale.

Best of luck. My thoughts are with you.

Yeah. The sucktastic thing there is Mom and I get along much better when we live in separate states, and Mom and Gran get along much better when they live in separate states, and Gran and I get along much better when we're in separate states. But this is reality, and no matter how poorly we do with regular local contact, we don't throw each other under buses. (Although we consider it and we make really horrible black jokes to relieve the angst.)

Fortunately, Mom and I are on the same page and we work together fine. (I'm the executor and trustee because of my miserable excuse for a sperm donor, who is now long out of the picture, but who destroyed my mother's financial life.) My attitude on this all is as long as the bills get paid and we're not hocking my niece and nephew's future retirement to pay for something now, it's fine. I've been praying* for a tornado for years to deal with some of the "infrastructure."

Oh, FSM. Estate sale. Not yet. Not now. And no way we're letting her within three states of it when it happens. Good point! Thanks!

*for some value of praying that doesn't actually include faith, church or deities.

I could tell you stories that would curl your hair, LOL.

We all do the very best we can. You are doing the best you can, and it will be okay.

I'll laugh. Because seriously, this crap is absurd. We have thousands of people who need jobs. We have thousands more who need caretakers, or live in facilities that need care. We have CEOs of medical and carer corps making obscene salaries and bonuses. The Money to pay the workers is there, just misallocated into a score keeping account instead of operating expenses. We bar people from doing the jobs for a failed pot test, or a poor credit score (hello, they've been unemployed?!) or we pay them so poorly they can't make a living. It's like we've designed the system to operate as poorly as possible.

Once they start falling they need 24 hour supervision, especially if they are diabetic and not eating, medicating, properly. It's hard enough to remember to take all your medicines with a good memory. If she has dementia, I highly doubt everything is being taken precisely.

It's so hard when you know what you should do is not what your grandmother wants. But I had to suck it up when I realized my uncle's habits were actually harmful to him (he loved his wine, beer and sweets).

This last 24 months (since I took over finances) was a way of seeing if she could handle the important stuff if the piddly shit happened automatically. (So, diet-safe meals delivered, bills paid, pill & appt reminders to her tablet -- thanks, Google tools) For the most part... She did okay until very recently.

There is dementia, or at least confusion, but I think it might be cardiovascular/diabetic rather than organic brain disease. The rate of changes came very fast.

What is necessary will happen, and she can sulk at me or yell after the fact. Not like I've never seen that before...

But he was so territorial about his own house we were a bit nervous what he would say to a nurse he didn't recognize. Thus we let him stay at home til he got a lot more fuzzy in his thinking, which I still debate about.

My Aunty was going through something similar and we were horrified to find out she was taking her pills but she kept forgetting she had taken them and was over medicating which I think contributed to her confusion. This was when she had her daughter in law call in the morning and evening to remind her. Then we tried one of those pill box set ups which ring and dispense pills and then sends a report via the Internet. That was helpful.

I have to tell you...the best advice we got was to find a facility where my uncle could "age in place". This is a facility that had the ability to take care of him til the end, including hospice. In the beginning he kept asking to go home, which broke my heart. But as his memory got fuzzier he honestly thought the care home WAS his home and that eased the anxiety. Just think of how awful it is to wake up in a place that is completely unfamiliar to you. Because he arrived when he still had some ability to remember, he was able to gain that familiarity with the place and the people.

And another word of advice...have her somewhere around you. If you are going to take POA, especially over medical decisions, you need to be decently close to gauge her progress, especially in emergencies. This was the part that weighed most heavily for me. Going to doctor visits and being able to ask questions was also a big deal, at least for me.

this is it.

After looking through this thread, it's clear that you have gotten some good advice, but what is also clear is that none, some or all of it may be of any help.

End of life care and how it relates to family assets and estates is NOT TO BE TAKEN LIGHTLY, (not that you are) and is definitely something that needs professional guidance.

I hope for nothing but the best outcome for you and your grandmother.

Please check your PM's

I do appreciate.

(And for truly flippant... she's likely to be less of a long-term commitment than getting a kitten. /snark.)

These are (amazing!) people that can evaluate the situation, make recommendations and research options for you. I just consulted with an agency about my mother who is 250 miles away. There is a per hour consulting fee, of course, but with the long distance between you and your grandmother, a professional who knows the area could be worth every penny.

National Association of Professional Geriatric Care Managers
http://www.caremanager.org/

We're trying to locate one within 90 miles of her.

your mother's care, your own care, and retirement for your niece and nephew? That is, to provide for the family for several more decades? It really does sound as if you need some very knowledgeable advice from specialized experts in estate planning, taxes, real estate, and elder law.

As far as assisted living, I agree with the comment above that you shouldn't be overly focused on the appearance of the facility. At the very end of his life, my father was in an Alzheimer's care unit that was part of a larger assisted living facility. The larger facility was beautiful in every detail, but the Alzheimer's unit was less pretty and less grand. At first I was worried, but then I realized that the Alzheimer's staff was focused on what really mattered for the patient's, and not concerned about trying to make everything look "normal." The patients were very much at home there and felt secure. I think my father was actually happier there than he had been when we were taking care of him at home.

Best of luck to you and your family.

If we go longer, great. It's pretty profitable, as these things go (we're GMO-free and organic, but it's grain commodities. Someday we'll transition again to pasture and local production, but not now.) We've got a decent trust that worked fine the last time it was needed, but it should have been altered about 9 years ago when something happened, and wasn't. It's not hugely critical, it's more annoying than anything.

I don't want my generation or the next gen hocking their futures to pay for the previous generation. My generation is doing fine economically (relatively speaking) but we're Xers, so we've been suspicious of 401ks and mutuals basically from day one of our working lives and been careful. It's been worse for my mother (who had a pension evaporate, then a 401k). Their care is all I care about.

1. Smell
2. Appearance of residents
3. Cleanliness of rooms, food areas, laundry and of course, bathrooms
4. Quality of food, availability of snacks
5. Staff/resident ratio (depending on level of care)

In the last 3 years of his life, I had to put my Dad in an assisted living facility because he had dementia and would wander off. Fortunately, he had prepared financially for such an eventuality and I could place him in a decent facility.

Still, it is important to be vigilant, visit frequently and at different times. All the staff came to know me and I them. I was a regular and made sure my Dad was clean, comfortable and cared for. I say all that not to pat myself on the back, but to let you know that the best thing you can do is be there and be vigilant.

Reading your post, it's clear you are not geographically close enough to do for your grandmother what I did for my dad. If moving her near you or your mom is an option, that's worth considering.

It's such a tough situation because it's clear that your grandmother can no longer live alone and yet the options are scary. A good facility is a godsend but depending on where you or she lives, it can be extremely costly. In home care is equally difficult because finding a suitable person who won't abuse you grandmom or rob you blind is equally difficult and agencies can be more costly than a home.

If your state, or hers, has an office on aging as part of its public health services, you might find some great resources there. Believe it or not, in my red state, there is the Lt. Governor's Office on Aging which amazingly, really did have several helpful services and references.

I wish you all the best in resolving this. I know what you're going through and aside from the logistics and costs, there is always the emotion. Take care

Us moving is not an option. Mom's got a pretty regional profession that doesn't translate well to the midwest, and she's really good at it. I'm not quite so tied regionally, but I am a scientist in a research facility, and just made Primary Investigator. If I leave, I have to start over in a new institution, and there isn't one in my field within reasonable distance of my grandmother. On the other hand, Mom and I are both in locales with far superior geriatrics care. Given some of the failures we've dealt with over the last few years, moving her may be much better for her quality of care. That's the next few weeks' decisions.

I'll check with her state and mine. Thanks for the tip!