older sister is primary poa on our mothers Durable Power of Attorney. I am secondary in the event she is unable, unwilling or unavailable

While the agent under a Durable Power of Attorney has authority over the person's finances, the agent under a Medical Power of Attorney has authority over their person, including communicating their wishes when they are unable to do so.  Are you the agent under your mother's Medical Power of Attorney?  If so, you may be able to get her discharged to her care.  Please note that caring for someone with Alzheimer's is a very difficult, 24/7 task which often becomes impossible.  For example, you may not be able to keep your mother from wandering, possibly out the door and down the street while you are asleep.  You cannot keep her from falling, which could result in a serious injury.  You may exhaust yourself with all the hand feeding, toileting, diaper changing and cleaning. There may be some help available at home through Medicare if your mother needs a scheduled visit by a registered or licensed nurse, a physical or speech-and-language therapist.  Typically we see the nurse come once a week, the therapist twice and a certified nurse's assistant come three times to help with bathing.  Some states offer more under Medicaid waiver programs but there are waiting lists. The reason many people wind up in a skilled nursing facility is that this is no longer enough. If you are the agent under your mother's Medical Power of Attorney and can get your mother discharged with your care, please get everything in place first.  You may want to talk with people at your local Alzheimer's Association, call the Alzheimer's Association hotline, talk with a geriatric care manager and determine just what kind and how much care you can pay for out of pocket.  You may want to join a support group for you and put together a group using lotsahelpinghands or sharethecaring.  Once all this is set up, you may want to talk to an elder lawyer about getting your mother discharged to your care.  You can find one near you on the website of the National Academy of Elder Law Attorneys (www.naela.org)