# Dementia Care Village - Monthly Costs, high end



## milhouse (Nov 16, 2016)

I came across this article in the Vancouver Sun and segment on the news about a dementia care village that's being developed. The key figure that caught my attention is that the price tag is about $6000 to $7500 a month per person. Ideally there'd be some government subsidies. However, it kind of illustrates how pricey specialized seniors care can be, though this is on the high end of the spectrum. Personally, that's why I'm keeping some financial options in my back pocket like using the house the fund something like this if needed.


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## OnlyMyOpinion (Sep 1, 2013)

I saw that too. This place, being built by Verve is not a government-funded long term care home, that is why. It's like their seniors living places which you pay for yourself. The village seems like a nice (and expensive) concept for senior living but my experience with dementia says that I would not be 'enjoying' living there anyway because of the illness. Without quality of life, if we can DIY financially, I'm confident I'll be able to make a DIY departure when it becomes necessary.


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## Plugging Along (Jan 3, 2011)

I have been researching many facilities on my city for my parents and mom who now needs long term care. The range for many places we have looked for privately is $5 to $8k. This is not for anything special. If it is a placement from our health services (from the hospital) then it is deemed necessary and then it’s capped at $54/day. 

from what I can tell, the cost of the facilities is not just on how nice it is but the staffing ratios leading to how much attention you may get, the types of activities, etc. When we first started researching we thought a lot like OnlyMyOpinion. We could do it ourselves with home care and tommes of family support since my mom would enjoy the extra fancy food or activities. Nope, there may be a time that this is not realistic despite having a spouse that tends to you almost 24 hours, home care, additional nursing aid private hired, home maintenance, etc, and children that visit 5-7 days a week. 

What we have learned is that the social activies and additional staff in a facilities will not stop or reverse dementia, but rather slow further deterioration of body and mind. We are seeing the other side of this right now as my mother waits for a long term care spot in the hospital where the staff are so busy they they drop off her food and medication for her to take (which she forgets) until one of us arrives (yes almost every day). Some times she is eaten sometimes the medicine is still there and she still has to take the s come dose with the first, and she is starving because she hasn’t eaten all day. We take her for walks, but there is no activies, so she gets little interaction or exercise unless we are there. We are in the process of hiring extra help so we can gaurentee two meals and some extra interaction. We see that mentally she is deteriorating and physically she Is getting weaker. 

We would it her in a private care, but there are wait lists for the ones we want, and if we do it ourslves, we fall off the priority list. We would pay for it if we could get in and if it didn’t move her down lower. It’s not money that is our issue. 

My point is that these facility’s are very expensive, but the other parts or care when you are a senior are so much worst.


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## milhouse (Nov 16, 2016)

Very insightful. Thanks for sharing PA.


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## OnlyMyOpinion (Sep 1, 2013)

Sorry to hear about your challenges PA. You are doing the right thing, investigating the options and advocating for your mom. It is a confusing system, different for each province. I can't imagine seniors managing without an advocate.

My comment on DIY didn't relate to trying to care for someone yourself, I agree with you that is just not tenable in most cases and you need to seek out assistance and/or a facility (as we did). My comment related to when I reach the point where I am creating a burden on my children/family, and my quality of life has declined. At that point I will provide a DIY solution by leaving this life.


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## Jaberwock (Aug 22, 2012)

OnlyMyOpinion said:


> Sorry to hear about your challenges PA. You are doing the right thing, investigating the options and advocating for your mom. It is a confusing system, different for each province. I can't imagine seniors managing without an advocate.
> 
> My comment on DIY didn't relate to trying to care for someone yourself, I agree with you that is just not tenable in most cases and you need to seek out assistance and/or a facility (as we did). My comment related to when I reach the point where I am creating a burden on my children/family, and my quality of life has declined. At that point I will provide a DIY solution by leaving this life.


I would do that too, but if I have dementia, I won't know that I have reached that stage


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## OnlyMyOpinion (Sep 1, 2013)

Jaberwock said:


> I would do that too, but if I have dementia, I won't know that I have reached that stage


Cognition and awareness do decline over time. DIY does require a commitment to leaving "before you really need to".


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## canew90 (Jul 13, 2016)

In Edmonton the private facilities range from $4,500 to $7,500 per month and the average about $6,000. For Provincial Health Services one has to complete an assessment, be approved then put on a waiting list, listing three locations of choice. These are not guaranteed and one must take the opening that becomes available. One does have the option of moving should another more suitable choice come up later. But that means forcing the person to be up-rooted and trying to adjusted to another facility. The cost is around $3,000 to $3,500 per month.


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## AltaRed (Jun 8, 2009)

Our game plan would be to foot the bill for private facilities. That said, it would be up to those with POA on our Health Directive to make the decision of where.....given that we wouldn't have the mental capacity to make that decision for ourselves anyway.


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## Plugging Along (Jan 3, 2011)

canew90 said:


> In Edmonton the private facilities range from $4,500 to $7,500 per month and the average about $6,000. For Provincial Health Services one has to complete an assessment, be approved then put on a waiting list, listing three locations of choice. These are not guaranteed and one must take the opening that becomes available. One does have the option of moving should another more suitable choice come up later. But that means forcing the person to be up-rooted and trying to adjusted to another facility. The cost is around $3,000 to $3,500 per month.


The max is $53.8 a day plus incidentals like having your laundry done, meds, etc. 

The more challenging part is not the assessment but where the assessment comes from. If the assessment is when you are in a private home (at a lower level) or your own home you are at the bottom of a wait list. It’s only if you are in the hospital waiting, which also has a wait list, then you have a priority. A senior could be in the hospital for months just waiting. Since the hospitals directive to essentially keep you alive, there are very little activies and interaction. This becomes a problem becuase you can further deteriorate physically and mentally especially if you have lower levels of dementia. Currently, we try to have someone visit everyday for a few hours. Now will will be hiring our own support to have some help and do some more excersizes. Its really hard.

This makes me really think how can I not be a burden to my kids. I don’t think the DIY is much of an option. If something suddenly happens like a stroke or a heart attack, you can’t plan that. Mental health is a detoriation.

The only way I see it is having enough monthly to go comely private or hiring nursing in two shifts, plus home help. Either case I calculated to be an $80k to $120k option


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## OnlyMyOpinion (Sep 1, 2013)

Plugging Along said:


> ... This makes me really think how can I not be a burden to my kids. I don’t think the DIY is much of an option. If something suddenly happens like a stroke or a heart attack, you can’t plan that. Mental health is a detoriation...


Definitely not easy and definitely a personal decision. 
One 'easy' thing is to make sure you have a current PofA for personal care/health (and for property and a will of course). Many Personal PofA's are 'generic' and not overly instructive but they don't have to be. You can clearly state that you don't want cpr in the event of a heart attack, and you don't want a feeding tube in the event of an incapacitating stroke, etc. It is important that you've had a talk with the named attorney(s) so your expectations are clear. It is very hard for family at the time to 'give up' and not expect heroic intervention to try to keep someone alive, especially if they are 'young', because certainly sometimes in hindsight it is justified and recovery occurs.
I don't intend to discuss plans here wrt exiting before dementia progresses too far.
A very powerful book worth reading if a person hasn't is _Still Alice_ (also a movie, but movies are never as good as the book IMO).


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## milhouse (Nov 16, 2016)

I thought I'd revisit this thread as I just came across another news segment on the Village dementia care facility. However, this time, there's a walk-through of the completed compound as the site is about to open. It looks nice, all things considered. The segment quotes $88-$100k/year. There's about 76 beds with apparently 65 of them already rented out. The demand looks to be there with the ability to pay those rates.


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## Trex (Apr 6, 2009)

Thought I would chip in.

My mother, who lived in her own condo in Vancouver was diagnosed with dementia a little over 2 1/2 years ago.
My wife and I were starting to keep a pretty close eye on her as she was forgetting to pay bills, her cable kept getting cut off etc etc.
I had a POA and decided to activate it with the banks and various utilities after it became obvious she was struggling.
We then noticed that she had "given" over $30,000 to a new found friend who lived down the hall at her condo complex.
At that point my wife and I basically took over her day to day fiscal requirements and duties.
We shut down the credit cards,nicked her drivers license, brought in caregivers twice a day for 3 hour intervals, arranged for a geriatric nurse to visit once a week and hired a meal delivery service.
My mother fought everything we did tooth and nail.
She was convinced there was absolutely nothing wrong and she was terrified of her independence being taken away.
She absolutely refused to move into a private seniors village or complex.
Then she started falling.
Three falls in just over a year, multiple broken bones, three hospitalizations, heavy duty narcotics and so on and all this happening to a little old lady approaching 90.
The last fall resulted in a moderately severe brain injury which obviously was compounded by her advancing dementia.
My wife and I who did not live in Vancouver were flying back and forth and renting cars and hotel rooms basically non stop for 2 years, luckily we were retired and had sufficient monetary assets.
We then sold our house and moved into a rental in Vancouver as the back and forth travel was killing us and obviously my mother was requiring ever increasing attention. 
My POA did not include a medical clause and that as noted above by another poster later became a problem for my wife and I.

After the third fall the geriatric doctors and social workers at the hospital decided she was not going back to her apartment.
She needed a home in what is now called a "memory care" facility.
We also found out that in most of these facilities be they private or public there can be fairly lengthy wait lists.

Because most hospitals have major influence( they can cut the wait list line at will) with the province's health care system and associated elder care facilities my mother was transferred quite quickly to a public/private complex care facility.
The cost was $ 7,000 per month and we were told this was not at the high end of the scale.
This did not include visits by dentists,podiatrists, hair dressers etc etc.
Or a fund to provide for snacks and treats as well as clothing and bedding requirements.
Cable was extra and so was a phone. 
And that was when I also learned just how expensive medical supplies (like a custom wheelchair) can be.

Unfortunately several months after being moved into the complex care facility my mother passed from medical complications.

My advice if you have elderly parents is to make sure you have a POA and make sure it includes the medical care form or clause.
Investigate seniors elder care facilities in your area long before you think you will need them.
Be aware that if you do not have sufficient funding available your parents may end up in a public facility where multiple people may be sharing the same bedroom and bathroom facilities and where if your parents go together they probably will not be in the same room.
And the food while nutritious may be less than attractive or tasty.


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## AltaRed (Jun 8, 2009)

Thank you for your story. It is not atypical of what can happen. Fortunately you had the financial and emotional resources to be able to respond.

I can't say it enough. In BC, my Enduring POA can be invoked in discussion with the lawyer (firm) who did my papers, and I have both a Personal Representation Agreement (pertaining to my health decisions and end-of-life) and an Advance Directive (end-of-life) in place for me to avoid prolonged life. It can get very messy NOT having both of those things in place. People avoid them at their peril.

Added: Meant to also say that yes, $7k plus is not out of the question for 'upscale' long term care in the Okanagan as well. A place such as https://www.verveseniorliving.com/hawthorn-park/


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## james4beach (Nov 15, 2012)

Trex said:


> My advice if you have elderly parents is to make sure you have a POA and make sure it includes the medical care form or clause.


Can someone help me understand... how do these legal mechanisms both allow someone to take over / help out if you lose your capacities, but at the same time, protect you against potentially malicious family who tries to seize control?


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## AltaRed (Jun 8, 2009)

james4beach said:


> Can someone help me understand... how do these legal mechanisms both allow someone to take over / help out if you lose your capacities, but at the same time, protect you against potentially malicious family who tries to seize control?


There are various types of POA. You need to become familiar with them so as to pick the right type.

In my case, my Attorneys need my doctor's signature that in his/her opinion, I am no longer capable of managing my affairs to invoke the Enduring POA. Not that I don't trust my POAs to do what is right, but it is a step they need to take to obtain the originally signed POA forms they signed from my lawyer.

Added: You should be able to trust your POA from the 'get go'. Otherwise, why pick him/her in the first place?


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## OnlyMyOpinion (Sep 1, 2013)

Trex said:


> ...
> My advice if you have elderly parents is to make sure you have a POA and make sure it includes the medical care form or clause.
> Investigate seniors elder care facilities in your area long before you think you will need them.
> Be aware that if you do not have sufficient funding available your parents may end up in a public facility where multiple people may be sharing the same bedroom and bathroom facilities and where if your parents go together they probably will not be in the same room.
> And the food while nutritious may be less than attractive or tasty.


Sorry to hear of your experience. It's a very stressful time. My first four years of retirement were spent similarly caring for my parents and I have still not fully gotte over it.

I agree with checking out facilities before you (or your senior) needs them, and with ensuring there is both a POA (financial) and Personal Care Directive (calledby various names). Also learn how the 'elderly care system' works in your province and check if there is an elderly care advocacy org in your province (e.g. ACE).

It sounds like you may have been dealing with a private care or 'assisted living' home? Senior's care differs somewhat by province and I can speak only of Ontario. There is private assisted living, often a floor in an otherwise independent living senior's place. You need to be able to 'transfer' yourself (bed to walker or wheelchair) and to feed yourself. I can easily see those running to $7k/mo plus.

There are also Long Term Care Homes (LTCH) and their rates are established by the  Ministry of Health. The most you currently pay is $2,702/mo for a private room and $2,280 forsemi-private. Except for a few older LTCH's, most semi-private now is actually a private room with shared washroom. There are essentially no additional costs except phone/tv (very cheap, $45/mo as I recall) and dentist/hairdresser. Based on your income, if you cannot afford the fee, you can apply to be further subsidized, even to the point of paying $0, but you'll be in semi-private. You cannot be refused due to low/no income.

Of course staffing adequate to what we'd expect is a current and growing problem in both instances. Couples are assessed individually, commonly one goes into LTCH before the other. The at-home spouse is moved to a Cat 2 priority but that could still entail a long separation (and living costs) and there is no assurance they will be in adjoining rooms.

Now someone who has gone through the application proccess with their regional LHIN and has been wait-listed for a LTCH(s) who goes into the hospital and cannot return home safely will move to a higher priority wait-list (Cat 1) for their LTCH(s) choice. The hospital may try to force/convince you to go to an available alternate that has a bed available (often because it is a poorly regarded LTCH) but you *cannot* be forced to accept it. You can demand to wait in hospital and get into one of your chosen homes. At this point it may be the POA-for-care that has to advocate for and make decisions for the elderly. 

If you have not already gone through the LHIN assessment and been wait-listed and are in the hospital unable to go home - then you may be forced to go where ever there is a bed - and not necessarily nearby.

A double-edged sword because it is a difficult call as to when to be assessed and wait-listed. when they do eventully call with a bed, you have a very limited time to accept and move, or be dropped from the wait-list and go through the whole assessment process again.

Based on my experiences, I do know of someone who decided to get assessed and wait-listed. They chose only 1 new, highly-regarded LTCH (highly discouraged, they want you to choose 4), so that they have themselves covered if they end up in the hospital and are unable to return home. Meanwhile, it has a wait-list of nearly 800 and a wait time of nearly 5 years. The gamble is that when the availability call comes, they'll be at a point of needing to make the move. Otherwise I can assure you, a LTCH is not a place I would choose to live.


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## Trex (Apr 6, 2009)

james4beach said:


> Can someone help me understand... how do these legal mechanisms both allow someone to take over / help out if you lose your capacities, but at the same time, protect you against potentially malicious family who tries to seize control?


If someone has a POA ( say acting on your behalf)they can act on your needs by dealing with banks and other institutions in your name. Keep in mind that a person of sound mind and will can revoke a POA at will, it is a simple one page form. Banks can be tricky to deal with regarding POA's ( or for that matter probating estates), the bank will probably tend to try and act in the best interests of the original account holder in question, usually by doing nothing and letting the account in question just sit there . If a person has their name on your accounts as well as a POA regarding you they will be able to do whatever they wish with your assets however once again POA,s and joint accounts can be quickly revoked by the original account holder. If you have been declared incompetent ( takes a minimum of 2 medical doctors opinions) or if you have signed the medical waiver on your POA there is the possible issue of your assets being used or disposed of against your wishes. Most provinces have a seniors ombudsmen or some such agency that acts in vulnerable seniors interest , if they are called in they can and will get a judges order to size control of the estate on your behalf to prevent misuse of your assets.

Altared seems to have a much better grip of the actual legal structures of POA's than I do and probably could go into the various structures of the documents in question.

In the case of a debilitating disease or accident POA's can be an enormously helpful , I would almost go so far as to say vital.
Better to have it and never need it then to desperately need it and not have it.


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## Plugging Along (Jan 3, 2011)

Trex said:


> Thought I would chip in.
> 
> My POA did not include a medical clause and that as noted above by another poster later became a problem for my wife and I.
> 
> ...


Thanks for sharing Trex. I have been dealing with this with one of my parents over the last 3 years. Fortunately, I have good sibling/family support, and my parents had all the paper work in order from the POA to the PD (Personal Directive). My parents have been sharing their wishes since before their retirement (30 years ago), and as a family we have been well planned, and it was still really stressful. The most difficult part for us was navigating through the system, even though we had all our ducks in a row, and seeing the effects of age and diminishing mental capacity in once very capable and stubborn parents. It was a very fine line to help my parent transition into a safer environment which meant losing some of their comforts and independence.


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## Plugging Along (Jan 3, 2011)

james4beach said:


> Can someone help me understand... how do these legal mechanisms both allow someone to take over / help out if you lose your capacities, but at the same time, protect you against potentially malicious family who tries to seize control?


POA is for the finances and the legal stuff, but does not include the medical choices. One needs a PD (Personal Directive) to make medical choices. A POA can be revoked if the person is of sound mind. However, if they are a home or do not have access to their accounts, then it makes it difficult to monitor malicious intent. That's why it's important to ensure that the person you check is trust worthy, and have a system. In my case, I have my parent's POA, there is 100 trust between themselves, myself and my siblings. I provide an accounting and tracking of everything because I don't want any one to question my intents. My family thinks it's over kill, but I have been asked by the banks for information, and I make sure I keep good records.

I don't know what else to say about malicious intent. In our family, we were brought up to never screw any one over, and have pretty high values. I guess raise the kids well and teach them family above all else?


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## AltaRed (Jun 8, 2009)

Here is a link to types of POA https://www.lawdepot.ca/law-library/faq/power-of-attorney-faq-canada/ and something a bit more specific, e.g. for BC http://www.nidus.ca/PDFs/Nidus_Info_POA-EPA_Differences.pdf and http://seniorsfirstbc.ca/for-professionals/enduring-power-attorney/ I recommend folks read a bunch of online stuff before visiting with their lawyer about the form and character of what goes into the EPOA, e.g. the lawyer's boiler plate version, or something a bit more tailored such as form and character of clarifying incompetency (if there is any legal leeway from provincial statute).

Generally speaking, EPOAs (Enduring Powers of Attorney) are the form and character we are talking about here... meant to come into force upon the doctor (medical system) deems one to be incompetent. These can be grey areas where a donor varies between competency and incompetency, etc. the Attorney may correctly think that the old man is losing it, or has lost it, but it is not apparent to the doctor this is the case (an Assessment may be needed) or worse, the old man himself thinks he is perfectly capable. This is where the Attorney should enlist assistance of the lawyer/notary who prepared the EPOA in the first place, as a sort of intervention.

There is nothing I can add about malicious intent. The best I can suggest is that the EPOA include a provision for annual accounting of the 'books' to the children and/or spouse of the donor and/or nearest relative whatever may be the case so that everyone understands there is at least one other set of eyes. It serves the Attorney well too to not be suspected of nefarious acts.

Plugging Along talks about harmony in her family. It is great when it happens, and it did between my bro and myself with our mother, but I have also seen some pretty ugly cases where fighting breaks out as soon as the donor goes cuckoo, especially the bigger the size of the pie is. It is a lot different dealing with a $0.5M asset level than with a $10M or $100M asset level.


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## OnlyMyOpinion (Sep 1, 2013)

I would add that an EPOA does not have to 'spring' from a medical assessment. My parents executed one when they were in their early-mid-80's and still quite capable. 

We met with their estate lawyer when they were being executed/implemented and with their bank branch manager & FA for introductions, signing their req'd paper, issuing a POA access card, etc. (no joint accs!).

They continued to act on their finances for a few more years but gradually lost interest and capacity, so the assumption of the POA role was a gradual one.

Again full trust of you POA is paramount.


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## AltaRed (Jun 8, 2009)

OnlyMyOpinion said:


> I would add that an EPOA does not have to 'spring' from a medical assessment. My parents executed one when they were in their early-mid-80's and still quite capable.
> 
> We met with their estate lawyer when they were being executed/implemented and with their bank branch manager & FA for introductions, signing their req'd paper, issuing a POA access card, etc. (no joint accs!).
> 
> ...


I agree it does not have to 'spring' from a medical assessment, particularly if the donor wants to relinquish the reins slowly, and does as in your parent's case, but the medical assessment would be required if control had to be 'forced' from the donor's hands. I suspect that a number of CMFers will fall into the latter category given some of the personalities and control freaks that participate in this forum. It is easy to say one will be pragmatic and rational about it, but is another thing to fear losing control when things are actually starting to spiral out of control.


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## OnlyMyOpinion (Sep 1, 2013)

Our EPOA comes into effect with mental incapacity, or physical (noncommunicative) incapacity, upon a Dr's assessment for the period of incapacity - or upon executing a written declaration that it is in effect. If things proceed similar to my parents, I will reach the point where I (and my wife) are willing and wanting to implement our EPOA's while we still have some capacity to do a 'handover' to our son. 

My Personal Directive differs in that after the wife, both our dau & son act jointly after a Dr assesses mental incapacity for personal decisions (health, accomodation, who I live & associate with, activities, and legal matters).


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## Retired Peasant (Apr 22, 2013)

Plugging Along said:


> I provide an accounting and tracking of everything because I don't want any one to question my intents. My family thinks it's over kill, but I have been asked by the banks for information, and I make sure I keep good records.


It's very wise to do so. I believe someone acting as POA could be asked to pass accounts, just as an executor might.


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## Plugging Along (Jan 3, 2011)

AltaRed said:


> I agree it does not have to 'spring' from a medical assessment, particularly if the donor wants to relinquish the reins slowly, and does as in your parent's case, but the medical assessment would be required if control had to be 'forced' from the donor's hands. I suspect that a number of CMFers will fall into the latter category given some of the personalities and control freaks that participate in this forum. It is easy to say one will be pragmatic and rational about it, but is another thing to fear losing control when things are actually starting to spiral out of control.


So very true. I am so grateful that my parents had the foresight to have everything set up years ahead of time. The irony was as my mothers mental condition worsened, she did not recognize it and started to become more paranoid. That's the problem with mental health, is one doesn't know what they don't know, and will want to keep control and independence. Even when she had her stroke and deemed that she needed 24 hour care, she felt that she was fine to take care of herself. We had 2 doctors and psychiatrist sign off on her mental capacities. With my dad seeing this, he is working through getting us access to everything before that happens.


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