Assisted living questions UPDATE

[Disney Doll]

Tina, it doesn't sound like that's an option, if Mushy's mom wants someone waiting on her, then there'd be 19 hours a day left for...who???? to do that?

Is your dad competent Mushy? Why won't he share their finances with you? Or is he difficult as well?

 

[Disney Doll]

See bolded.

Our skilled nursing unit was hell on wheels on my step dad's father and they had to be. He is a mean SOB. He'd throw things and rip out IVs and just generally abuse them in all ways possible he could after he broke his hip. The physical therapy set up a schedule where family could only come see him for about 2 hours a day, one in the morning and one in the evening. After about 3 days he finally broke and the physical therapy got down to doing what they were supposed to do. It took the family not showing up and taking the phone out of his room before his will would bend. This is called limit-setting and it does work. People complain that it is treating an adult like a 2 year old, but that is what they are acting like.

Honestly lets face it. Until everyone stops running to your mother's side to help when she is being ugly and she has to start doing for herself, it's not going to stop.You are quite right.

 

[MushyMushy]

What do you think she needs?

Would it be out of the question for a kick in the... nevermind.

She needs mental help, first and foremost, but she'll never get it because she thinks it's B.S. She's had an "elderly" state of mind her entire life and has been waiting for the day when she could be cared for. She only ever regresses, never progresses. She will not make the least bit of effort for her own health and just wants the world to take care of her. If we'd allow it, she'd lie in bed 24/7 and would have us hand feed her. She weighs over 300 pounds and needs to lose weight so that it doesn't take a team to pick her up. She needs some pretty intensive rehab to regain some semblance of mobility again.

IMO, she is capable of gaining enough mobility to be in that home. But mentally she'll not do it. And that's that. She's got her mind made up and the rest of us are left to pick up the pieces. I think DD is right and we all need to get on the same page with this tough love thing.

 

[ZipaDeeDooDah]

Would it be out of the question for a kick in the... nevermind.

Unfortunately, I think your mommy might be due for a kick in the...nevermind.

She needs mental help, first and foremost, but she'll never get it because she thinks it's B.S. She's had an "elderly" state of mind her entire life and has been waiting for the day when she could be cared for. She only ever regresses, never progresses. She will not make the least bit of effort for her own health and just wants the world to take care of her. If we'd allow it, she'd lie in bed 24/7 and would have us hand feed her. She weighs over 300 pounds and needs to lose weight so that it doesn't take a team to pick her up. She needs some pretty intensive rehab to regain some semblance of mobility again.

Agreed. Nobody should have to take on that responsibility.

IMO, she is capable of gaining enough mobility to be in that home. But mentally she'll not do it. And that's that. She's got her mind made up and the rest of us are left to pick up the pieces. I think DD is right and we all need to get on the same page with this tough love thing.

Tough love is so hard, but if it helps the person you are trying to help, it might be worth considering.

 

[MushyMushy]

Well of course she didn't want to look at it because she wants what she wants, but yet sounds as if she is so nasty and difficult that no one would be able to deal with her.

I know Hallmark has us convinced that all mothers are angelic, sweet and loving. I have been a nurse for 25+ years, and let me tell you, I have seen some parents...mothers and fathers...whose treatment of their family would curl your hair. I have had women as patients who made the statement to me "I expect all 3 of my daughters to be here with me around the clock. I suffered having them and gave up my life for them, now it's their turn and I don't care whether they like it or not". I have had mothers say to me "My son can wait until after I die to get married. I don't need another woman taking time and attention away from me". Paragons of virtue and motherhood??? Hardly. Mushy says there is a long and difficult history with her mother. I believe her. Perhaps her mother is now reaping what she sowed.

She is choosing not to be independent. She is choosing to try and have everyone wait on her hand and foot. Well, the place to get that kind of care is in a nursing home...they have people there who get paid to wait on you.

You've got it NAILED on the head. Nailed. You know the son and mother you just mentioned? You just described my grandmother to a tee. She raised my uncle to be her caregiver, and when he met a woman he wanted to marry, my grandmother put her foot down and said "I'll have no strangers in MY home." He took care of my grandparents until the day they died. He spent his entire life doing elder care, and I mean EVERY aspect of it. That's the kind of environment my mother is from. Oh, and she was an RN for 40 years, so she knows the system pretty much inside and out.

Our relationship has been hard and volatile. 41 years of that can't change just because she's old and in need.

Tina, it doesn't sound like that's an option, if Mushy's mom wants someone waiting on her, then there'd be 19 hours a day left for...who???? to do that?

Is your dad competent Mushy? Why won't he share their finances with you? Or is he difficult as well?

My dad is beaten down and abused by my mother. I personally think it's good for him that she's out of the house because he can just sit and relax for the first time in his retirement! He's not entirely mentally competent, but he can do okay on his own. He's very confused by all this. All he can see with the whole nursing home thing is that they're going to take every dang thing he's ever owned and worked for. I mean, for us, we see that it'll be necessary, but for him, he's not thinking clearly about it. It would kill him to lose his car (an antique).

He won't share the financial info because of pride, I guess. It's just "not done." It'll have to come out sooner or later, but it'll be a fight getting there.

Thanks for your words of wisdom. Always very valuable!

 

[ZipaDeeDooDah]

Ack,

I happen to feel that people in their most vulnerable (elderly) years will vocalize or act out their true thoughts and feelings (just as when we are in pain of any kind). Pain of growing old, pain of labour, pain of stones, pain of twisting or spraining a limb.

How do you act when you are in pain?

Why can we not acknowledge each individual and their pain and find a comprise-able solution to each painful situation???

Pain, whether mental or physical, hurts just the same.

Please try to be compassionate to the mental and physical pains of this particular situation.

 

[Disney Doll]

You've got it NAILED on the head. Nailed. You know the son and mother you just mentioned? You just described my grandmother to a tee. She raised my uncle to be her caregiver, and when he met a woman he wanted to marry, my grandmother put her foot down and said "I'll have no strangers in MY home." He took care of my grandparents until the day they died. He spent his entire life doing elder care, and I mean EVERY aspect of it. That's the kind of environment my mother is from. Oh, and she was an RN for 40 years, so she knows the system pretty much inside and out.

Our relationship has been hard and volatile. 41 years of that can't change just because she's old and in need.

My dad is beaten down and abused by my mother. I personally think it's good for him that she's out of the house because he can just sit and relax for the first time in his retirement! He's not entirely mentally competent, but he can do okay on his own. He's very confused by all this. All he can see with the whole nursing home thing is that they're going to take every dang thing he's ever owned and worked for. I mean, for us, we see that it'll be necessary, but for him, he's not thinking clearly about it. It would kill him to lose his car (an antique).

He won't share the financial info because of pride, I guess. It's just "not done." It'll have to come out sooner or later, but it'll be a fight getting there.

Thanks for your words of wisdom. Always very valuable!

If she was an RN for 40 years, then she knows that at some point she's going to be told what to do, whether she likes it or not.

As far as them losing everything they have...I am not well-versed in Title 19, but there is a misconception that the remaining spouse is left destitute. They will have to "spend down" a certain amount of their money. I do not believe that he will have to sell belongings, the house etc. There will be a lien of some sort put on the house, so that when the time comes that both Mom and Dad are gone, the proceeds from their estate will go to "pay off" the Title 19 lien first. If there is anything left beyond that, it would be distributed as per their will. The person to speak to would be the social worker...you do not necessarily need to know the exact details of your parents' financial holdings to get information about how Title 19 is handled/administered. They can give you the basic overview.

But, the assisted living place has to be costing a fair amount of money too. Perhaps not quite as much as a nursing home, but the ones near me aren't cheap. So one way or the other, they are going to spend down their money.

 

[Disney Doll]

see bolded

Ack,

I happen to feel that people in their most vulnerable (elderly) years will vocalize or act out their true thoughts and feelings (just as when we are in pain of any kind). Sounds like Mom has been doing this for years. Pain of growing old, pain of labour, pain of stones, pain of twisting or spraining a limb.

How do you act when you are in pain?

Why can we not acknowledge each individual and their pain and find a comprise-able solution to each painful situation??? Because Mom doesn't want a compromise. She wants what she wants.
Pain, whether mental or physical, hurts just the same. Yes, it hurts all parties involved, not just some of them.

 

[lsyorke]

My take on the situation is that assisted living is not the correct level of care for her. Most assisted livings require a modicum of independence to qualify. If more assistance is needed, some provide this at additional cost, ie. showering, medication administration, toileting. But the reality of the situation is if she isn't willing to get out of bed, or is physically unable to, then she is in the wrong facility at the wrong level of care.

Since the assisted living accepted her, they're going to have to deal with it until other arrangements can be made, but it sounds like she is quite different from what they saw on their evaluation. Meet with the director and discuss this. They may be able to provide additional caretaking, at a cost, until other arrangements can be made.

Nursing home is going to be your next option, and she is going to have to deal with that and know that it's her refusal to move that created this transfer. Time for some tough love.

Just to comment on the skilled nursing facility.....she may have qualified for some time under Medicare(for physical therapy) at a facility such as this, BUT if she is refusing to help herself Medicare would cut off reimbursement VERY quickly. I ran a skilled nursing facility and we had team meetings twice a week...once someone stopped showing progress, they were discharged or transferred to long term care.

I know how hard this is...I went through the assisted living/nursing home decision with my Dad and his wife. Sadly he passed while in the hospital, so the decision was made for me.

 

[ZipaDeeDooDah]

see bolded

Of course mom wants what she wants, have you never heard the expression "If mama ain't happy..."

I am pretty sure you know the rest?

Or am I being too deep for you?

 

[Disney Doll]

Of course mom wants what she wants, have you never heard the expression "If mama ain't happy..."

I am pretty sure you know the rest?

Or am I being too deep for you?

Look Zip, I'm not being sarcastic with you, so cut the crap, OK???? I'm not stupid, I had elderly, ill in-laws, I have elderly parents, I spent 5 years working for an insurance company doing case management for these kinds of patients, I have also done homecare and have done medical nursing for 25 years in between all the other stuff. Now you have my resume, so don't insult my intelligence. It makes you seem ignorant, which I am quite sure you are not.

You have the Hallmark version of motherhood in mind, which may be because that is all you have ever been exposed to. Consider yourself lucky if that is the case. My experience with many of my patients has been that every mother is not self-sacrificing, warm and cuddly. I am quite fortunate that, at this point, my own parents are the type who would cooperate with what their healthcare needs dictated because they do not want to be a burden to their children. Every parent is not like that. My parents have also been so very good to me all my life that I would do my utmost to make them happy & take care of them. They have earned that from me, by virtue of the fact that they have been warm, wonderful, loving, self-sacrificing people, who always made me feel extraordinarily well-loved, so for me to sacrifice for them for a while would be no problem. I realize how fortunate I have been to have them for parents. They will reap what they have sown.

Mushy's Mama ain't gonna be happy here, which may very well mean that nobody is going to be happy for a while. But the bottom line is that elder protective services requires every elderly person to be in a safe environmant, so that's the ultimate goal, whether it makes Mama happy or not.

Mama being in an assisted living facility where the staff is incapable of getting her out of bed, and she is incapable or unwilling to get herself out of bed, is not safe.

Mama being cared for by a husband who seems to be a bit confused but OK as long as there is no huge stress level, which Mama causes, is not safe.

Mama being cared for by people who love her but don't necessarily like her is not safe because it cannot last that long before we are back to square one trying to find Mama a new place to live so she doesn't drive everyone around her insane.

Mama chooses not to care for herself, or make any effort toward that end. Therefore Mama needs to be someplace where she can be cared for. People who are unable to perform the activities of daily living (feeding, bathing, dressing, toileting) independently need to be kept safe and therefore need some sort of care, whether it be at home with 24 hour live-in homecare, at home with 24 hour family care, in an assisted living facility or in a nursing home. Those are the 4 choices. There are no more.

24 hour family care does not seem to be an option. Assisted living does not seem to be an option. That leaves 24 hour homecare and nursing home.

If they decide to try 24 hour homecare, the first time Mama decides not to let the homecare nurse in, protective services is called and it is then out of Mama's (and everyone else's) hands. Protective services tells you what you will be doing, end of discussion. Call me crazy or "not deep" but my hunch is that Mama would agree to 24 hour homecare, get home and then decide to tell the nurse to go away. So Mama is home, not safe, and look where we are...back to square one...yet again. And Mama winds up in a nursing home. Kind of seems like all roads lead to a nursing home in Mama's case, doesn't it?????

It would be nice if we could all live our lives exactly as we wanted to up until the end, but unfortunately that is not always the case. It would have been nice if Mama had decided to live her life differently so her family would have wanted to take care of her, but she didn't. It would have been nice if Mama had decided to try and help herself instead of getting waited on hand and foot and sitting there getting fatter and fatter, and more and more dependent but Mama didn't do that either.

So if Mama ain't happy, it seems to me like she has no one to blame but herself.

 

[ZipaDeeDooDah]

Look Zip, I'm not being sarcastic with you, so cut the crap, OK????

No crap here, just being real, OK????

 

[ZipaDeeDooDah]

Why has nobody answered about geriatric psychology, maybe there are deeper issues here?

 

[ZipaDeeDooDah]

Look Zip, I'm not being sarcastic with you, so cut the crap, OK???? I'm not stupid, I had elderly, ill in-laws, I have elderly parents, I spent 5 years working for an insurance company doing case management for these kinds of patients, I have also done homecare and have done medical nursing for 25 years in between all the other stuff. Now you have my resume, so don't insult my intelligence. It makes you seem ignorant, which I am quite sure you are not.

You have the Hallmark version of motherhood in mind, which may be because that is all you have ever been exposed to. Consider yourself lucky if that is the case. My experience with many of my patients has been that every mother is not self-sacrificing, warm and cuddly. I am quite fortunate that, at this point, my own parents are the type who would cooperate with what their healthcare needs dictated because they do not want to be a burden to their children. Every parent is not like that. My parents have also been so very good to me all my life that I would do my utmost to make them happy & take care of them. They have earned that from me, by virtue of the fact that they have been warm, wonderful, loving, self-sacrificing people, who always made me feel extraordinarily well-loved, so for me to sacrifice for them for a while would be no problem. I realize how fortunate I have been to have them for parents. They will reap what they have sown.

Mushy's Mama ain't gonna be happy here, which may very well mean that nobody is going to be happy for a while. But the bottom line is that elder protective services requires every elderly person to be in a safe environmant, so that's the ultimate goal, whether it makes Mama happy or not.

Mama being in an assisted living facility where the staff is incapable of getting her out of bed, and she is incapable or unwilling to get herself out of bed, is not safe.

Mama being cared for by a husband who seems to be a bit confused but OK as long as there is no huge stress level, which Mama causes, is not safe.

Mama being cared for by people who love her but don't necessarily like her is not safe because it cannot last that long before we are back to square one trying to find Mama a new place to live so she doesn't drive everyone around her insane.

Mama chooses not to care for herself, or make any effort toward that end. Therefore Mama needs to be someplace where she can be cared for. People who are unable to perform the activities of daily living (feeding, bathing, dressing, toileting) independently need to be kept safe and therefore need some sort of care, whether it be at home with 24 hour live-in homecare, at home with 24 hour family care, in an assisted living facility or in a nursing home. Those are the 4 choices. There are no more.

24 hour family care does not seem to be an option. Assisted living does not seem to be an option. That leaves 24 hour homecare and nursing home.

If they decide to try 24 hour homecare, the first time Mama decides not to let the homecare nurse in, protective services is called and it is then out of Mama's (and everyone else's) hands. Protective services tells you what you will be doing, end of discussion. Call me crazy or "not deep" but my hunch is that Mama would agree to 24 hour homecare, get home and then decide to tell the nurse to go away. So Mama is home, not safe, and look where we are...back to square one...yet again. And Mama winds up in a nursing home. Kind of seems like all roads lead to a nursing home in Mama's case, doesn't it?????

It would be nice if we could all live our lives exactly as we wanted to up until the end, but unfortunately that is not always the case. It would have been nice if Mama had decided to live her life differently so her family would have wanted to take care of her, but she didn't. It would have been nice if Mama had decided to try and help herself instead of getting waited on hand and foot and sitting there getting fatter and fatter, and more and more dependent but Mama didn't do that either.

So if Mama ain't happy, it seems to me like she has no one to blame but herself.

I am going to leave this thread, because I soooooooooo do not agree with you and do not want to be rude.

But, I can only hope that you are treating people the way that you hope to be treated (today or some day).

 

[sha_lyn]

DD I completely get what you are saying. My p-grandmother was very abrasive and judgemental before she was in bad health or started losing her mind. When her mind started going she lost that "filter" that most of us have that keep us from saying everything that is on our minds. I don't believe she suddenly became racist, critical etc. I believe she just had enough common sense to shut up before her mind started going. It got to the point that I was imbarrased to take her out in public. The best example that comes to mind was eating in a restaurant one day after a Dr appointment. There was this very obese african american lady on the other side of the restaurant. My grandmother pointed at her and said really loud "look at that big fat (insert very bad word for african americans here), why would anyone get so fat, can you believe how fat she is" she just went on and on. I wanted to crawl under the table and die right there. Other things happened over the yrs, like asking both my cousin and I why we gave our kids made up names instead of real names. DD's name and my cousin's DD's name are both very popular names. My cousin's DS has a fairly common name. One that probably everyone has heard, but not everyone knows someone with that name.

 

[agnes!]

MushyMushy -

You have my sympathy. I know your heart's in the right place and you & your DSis will try to make all the right decisions. It almost doesn't matter what you two decide...someone will be unhappy with the outcome(your DMom, maybe other relatives or family friends who don't really understand what's going on and won't help out but who are more than willing to complain about the situation), so you have to do what you think is right and what *you* can live with. Dealing with aging parents is not easy, especially when they put up emotional/behavioral roadblocks that can end up making the entire family's lives very sad and quite difficult.

Prayers said for you & yours.
agnes!

 

[sha_lyn]

agnes brings up a good point.... I spent a lot of time with my GM. I was the one who took her to the Dr, grocery shopping, talked to her home health aid etc. Therefore I saw just how bad things were getting. She had a stroke the same day (actually I think it was the day after) my other GM died. I begged for help from my dads family and finally got my dad to agree to stay with her when she went home (I believe she was in the hospital for about 48 hrs). Turned out my dad only planned on staying one night. He, his brother, my cousins etc all said things like "she seems fine" etc. Well sure she seems fine if you only spend 5 min with her 4-5 times a yr. It was clear I had no help. It got to the point where I was afraid for her life. She almost set the apartment on fire on a couple of occasions, passed out from low blood sugar every other week or so etc. I finally convinced her to go itno assisted live, to only have family members tell her I was doing it to steal her money. I know that at least her sisters were saying it, and i believe my uncle and his 3 adult children were too. Well that makes me the dumbest crook on the books then. move her from an apartment that rented for $250 a month to a place that cost $2250 a month. Not to mention she would have probably died soon because she wasn't eating or taking her meds when left alone. Other than a few bonds that had my uncle and dad on them, all her CDs bank accoutns etc had me as the benificiary. If I wanted her money, wouldn't I have left her somewhere where she would have died sooner? Oh it swtill pisses me off to think about it.

 

[Pea-n-Me]

Part of the reason it's difficult to define what Assisted Living is, is that the definition of Assisted Living varies from state to state.

AARP - Assisted Living in the United States

I've spent the last 4 years helping my cousin navigate the assisted living/nursing home roads for my aunt and have learned a little bit along the way (I'm also an RN myself).

One thing you might consider is something we had to do. Before you say it sounds crazy - like we did - hear me out. Many people hire private aides in assisted living facilities. Sure, you say - why hire a private aide if you're paying them for her to be in assisted living? Here's where it gets convoluted. Basically, the way it was for us in MA is that a person has to be able to do for himself, and if he cannot, by definition put forth by the state for licensing, then he has to leave, generally to a nursing home for skilled care. However, sometimes hiring an aide to help them do the things they cannot makes the difference between them staying there or not.

So, for example, if the biggest problem is that your mother cannot (or will not) get in and out of bed without maximum assistance, then perhaps hiring someone to come in for those times, for that purpose, might help. We thought it sounded outrageous, but sure enough, several people in the assisted living facility had them, and we "had to" as well if she was to stay (yes, it had become an ulitimatum). Unfortunately, the hard part is that it costs money (doesn't everything??) However, if it's only for a short time from someone who maybe lives in the neighborhood and wouldn't mind doing it morning and night, then it might not be too bad financially (you can compare it to costs of a nsg home). Oftentimes, the patient and caregiver form a relationship and this in and of itself can be helpful if a patient is depressed.

The big thing here, IMO, is that no one person, truly, can lift a 300 lb person in and out of bed by themselves, of course there would be injuries (I bet your husband's back is sore as we speak). But hopefully she'd be strong enough to position and swing herself around with just some guidance, which would be my hope, anyway (and possibly the definition in your state). Two people working well together can usually accomplish this if the person has the strength and willingness to participate. However, if your mother truly is incapable of helping, then she would need a lift, and that would be something that I believe would only be available at a nursing home. We had a morning aide complain my aunt was becoming difficult to get out of bed, ie she was hurting her back, and this was when we had to begin looking for nursing homes.

BTW, I think a geriatric psych consult is a great idea. It seems to me there's a lot of long term stuff going on here, perhaps a power struggle as well. If this is still fairly new, there'll be a period of adjustment, and Mom (who I recall didn't want any part of this to begin with), is going to raise the stakes as high as she can to to get what she wants. But as others have said, this type of behavior is not going to benefit her in the long run. A good care team will put together a "plan of care" for her, and even a "contract", so that she's aware that she needs to play by the rules or she'll be out. Call a team meeting and work with them on this. It sounds like it would be beneficial for her to find someone she can "connect with" at the facility who can perhaps get her to do the things she needs to do for herself. I sincerely hope she can find that person. (Wish I could give it a stab myself - I often, for whatever reason, get along great with people like this.) Best of luck.

 

[marypoppinswannabe]

OP,

You are in a hard place right now. I hope and pray that you all can find a resolution soon.

I just wanted to send this link to you. You may have already seen it, but if you scroll down the page, on the right-hand side, there a place to compare nursing homes in your area, but you can also put the range out as far 100 miles. This is an excellent tool to compare nursing facilities and see how they all did in the last survey.

http://www.medicare.gov/


Also, the link below, is referring to retirement communities, however, if you scroll down to the bottom of the page, there are many links that discuss Assisted living facilities.

http://www.helpguide.org/elder/continuing_care_retirement_communities.htm


At any rate, I hope these links are beneficial.

 

[golfgal]

It also might be time to consult an attorney, one that specialized in geriatric issues. It may by you need to get your parents declared incompetent and get a power of attorney assigned to take care of all this mess. That in itself creates some issues as well.

One word of warning, if somehow mom does come home, be very careful about how she is treated. I know that when my mom was living with my sister she had every trick up her sleeve too. She was also an RN and knew the system. At one point she had social workers breathing down my sister's neck claiming that my mom was a 'vulnerable' adult and if they proceeded to take the vacation they planned they would be arrested for abuse. That is when I made a call to the social workers and straightened things out as far as exactly how 'vulnerable' my mom was and her past tricks every time my sister and her family went away. Keep in mind they had someone come in and stay with my mom each and every time--not that she needed it.