Assisted living questions UPDATE

[Disney Doll]

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

Actually, I did recommend a few posts back a psychiatric evaluation.

 

[Disney Doll]

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

So "real" for you is a nasty sarcastic comment like "is that too deep for you?"

Interesting...

FTR, I have no problem with the fact that you disagree with me. To each his own. Your delivery leaves something to be desired.

 

[Disney Doll]

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).

As far as the rude thing, that "Or is that too deep for you" comment a few posts back pretty much covered "rude" for you.

As far as how I treat people, I treat them just fine. I'm not too worried about the karma I'll get back later in life.

OK, enough of Zipa...back to you Mushy.

You may have to use this time as an information gathering time. The suggestion about contacting an attorney specializing in geriatrics is a good one. Never thought of that, but having someone who knows the system as a consultant is good.

In terms of your mother, you may have to let the situation play out. Mom, if she is deemed competent, may have to make her decisions, good or bad, and suffer the consequences of them. I had a friend with a difficult mother, similar situation to you, where her mom wanted what she wanted, to be home, and was not at all cooperative with any other possibility. Family wanted to get mom a live-in at home so she could have stayed home, but mom "wouldn't have strangers in her house", refused any kind of care, fell etc. So they let mom do it her way. Mom fell, ended up with a broken hip in a nursing home, where she stayed permanently. Mom was deemed competent, BTW, and she was...she was just stubborn. Mom lived to regret that decision, which she actually verbalized to my friend...of course, by the time she realized that she had made the wrong decision, it was too late. She never bounced back from the broken hip like she should have and going home with homecare ended up not being an option.

So I would say start refusing to help the assisted living place get her in & out of bed...that is care they should be providing if they told you they could. Let them figure out the next step. Use this time to research Medicare, Medicaid etc. When she winds up back in the hospital, and she will, start the Title 19 process. But Mushy, I'm sorry to say that the situation is probably going to go downhill a bit more before mom realizes that she has only a few choices.

 

[MushyMushy]

Interesting update!

My sister called the AL place this morning and spoke with the woman who gave us all those assurances when we moved her in. She was stunned that the weekend staff did all that. And, get this. She said I was lied to about somebody being pregnant and unable to assist! They got my mother up and about this morning and ready for breakfast.

She was ticked off and she's calling in the supervisor on it and will want to hear what all they told us this weekend.

I forgot to mention this, with the whole thing about my mother being an RN for all those years. The aide spoke to her when they were first trying to get her out of the chair and said, "What would you have done with a patient behaving like you are?" and my mother replied that she would have been doing the exact same thing as they were. So the aide told us that she felt as long as they were firm with her, there wouldn't be a problem doing what needed to be done. Like I said, my mother knows the system and knows the drill.

We shall see! Keep your fingers crossed. I honestly think that this is the best place for my mother at this point, IF and only if she will work to get some mobility back. She has several friends there and it's such a lovely place (even if the weekend staff isn't so lovely ).

 

[Disney Doll]

That is an interesting update.
Methinks there will be some staffing changes at the AL place soon!!!!

Do yourself and the administrators there a favor and write it down.

 

[coles1mom]

Mushy, get your father to an estate planner.

Don't be too hard on yourself about her being placed. A social worker is trained to do what is best for both of your parents. After each hospital stay with Mom, I meet with the worker, and can bring her home. I know one day that is not going to be an option.

Disney Doll, you're on spot! This isn't the Walton's here. My Mom has just moved herself back home, because I made her follow doctor's orders, and the stories she's telling would scare the town to death, if they didn't know me.

Mushy, you need to be at that care meeting, along with the social worker.
Hang in there.

 

[MushyMushy]

Just another update -- they're not going to keep her at the AL place. The supervisor made that call this morning. They had her up and moving around a bit this morning, but then my mother started doing her dead weight thing and "I can't move" thing, so they just all gave up. Not surprising, because at her current condition, it's not the place for her. If she'd shown the least amount of effort or initiative, they would have gladly kept her.

So, DSis and the social worker at the hospital spent most of the day trying to see if insurance would cover anything, but it won't since there's nothing technically wrong with her. They weren't amused when I suggested she might qualify for a mental ward. Sorry. I know it's not really funny, but I'm so burnt out that I'm going to need the mental ward myself.

There's another nursing home that's actually $300 cheaper and just half a mile from my house, plus it's on the way to my sister's house. They don't have any free beds right now, but they're working on shuffling some people around to free it up. My sister did a surprise drop-in and was pretty impressed with it.

I'm keeping my fingers crossed. IMO, once she gets in a nursing home, she'll NEVER regain any mobility and she'll be bedridden the rest of her life. But it's really all up to her, isn't it?

 

[Disney Doll]

Just another update -- they're not going to keep her at the AL place. The supervisor made that call this morning. They had her up and moving around a bit this morning, but then my mother started doing her dead weight thing and "I can't move" thing, so they just all gave up. Not surprising, because at her current condition, it's not the place for her. If she'd shown the least amount of effort or initiative, they would have gladly kept her.

So, DSis and the social worker at the hospital spent most of the day trying to see if insurance would cover anything, but it won't since there's nothing technically wrong with her. They weren't amused when I suggested she might qualify for a mental ward. Sorry. I know it's not really funny, but I'm so burnt out that I'm going to need the mental ward myself.

There's another nursing home that's actually $300 cheaper and just half a mile from my house, plus it's on the way to my sister's house. They don't have any free beds right now, but they're working on shuffling some people around to free it up. My sister did a surprise drop-in and was pretty impressed with it.

I'm keeping my fingers crossed. IMO, once she gets in a nursing home, she'll NEVER regain any mobility and she'll be bedridden the rest of her life. But it's really all up to her, isn't it?

Yes it is.
You can only put her in a safe environment and then take care of your dad.

 

[MushyMushy]

Yes it is.
You can only put her in a safe environment and then take care of your dad.

I started planting the seeds with my dad of fixing up a room at our house for him and having him sell his house or rent it out (DH would be glad to manage it). He protested, but kind of weakly, like he would consider it.

See, I'm not totally evil. I'll take my dad in!

 

[mamacatnv]

MushyMushy

No one is in your exact shoes and until they have been in them they do not know where you are coming from and have no right to judge. It is easy to sit in the bleachers and coach, it is not so easy to be in that dugout calling the shots. I feel for you and I think of you often, I keep you in my prayers. This is suvch a difficult situation.

Your Mother has made her own bed and she will have to lay in it. I know that those of you out there who have not been in MushyMushy's shoes might view this as harsh but it is what it is.

The facility obviously did not take the needs of your Mother's care seriously. Whether they are valid needs or not, your Mother is presenting them with care challenges that they are not capable of or are unwilling to deal with. You and I both know, she is hoping if she is difficult enough that she will get her way. Time for a reality check for your Mother.

The advice to seek legal counsel is a good one, but be warned. Getting an adult declared incompetent is not easy nor is it something the courts consider lightly.

My Mother has suffered from schizophrenia since I was a small child (this went undiagnosed until about a year and a half ago) she made my life miserable. She and I have not had a relationship ever, she was mean and abusive and I haven't had anything to do with her since I was a teen. My father bailed out emotionally when I was very young and then he bailed physically when I was a young teen. We (my brother and I) were stuck with a loon. Everyone knew she was nuts, but no one wanted to deal with her so they ignored the issues and avoided contact.

Fast foward to about 7-8 years ago, she went off the deep end. Her behavior was now bizarre and destructive. My brother and I attempted to step in. She refused our help or assistance and would do nothing for herself.

We sought the advice of an attorney, we took her for psychological and physical exams and evaluations. Bottom line, there was nothing we could do. She had the right to be crazy, she had the right to refuse medical and psychological help and she had the right to been a loon.

The atty. advised us that until she became a true danger to herself or others there was nothing we could do. He advised us what to do when she did become a danger to herself and others. So, we spent 5 years stepping in to keep her from being evicted and trying to keep her out of trouble. We battled a legal system that is very resistent to take away someones personal freedom and a society that condemned us for not "taking care of her". I grew some really thick skin. I had to field phone calls from her siblings and church members who thought I wasn't doing enough and that I was being negligent and selfish. Little did they know, they had no clue.

She finally went over the cliff and I was able to get guardianship, I didn't want it but no one else would do it. Thankfully, the atty. we originally consulted had prepared us well and I had 5 years of a paper trail to fall back on. She had never remarried and had squandered away every penny she had ever had so dealing with estate issues was not part of our problem. We had to plug her into the social welfare system. We did get permission to place her into a care facility and the hunt began. She was resistant and violent, I finally got her medicated which made life simpler. Several homes would not take her and the facility she is currently in turned her away at first. I asked them to reevaluate her 6 months down the medicated road and they were then willing to take her.

She didn't like it, she cried, she screamed, she called my brother who finally stopped taking her calls because he couldn't take it. She threatened and then begged, she threw tantrums and attacked the aides at her facility, she spent a lot of time in the "quiet" room. I did not give in, I knew in my heart that placing her in a care facility was the only option to keep her safe. Keeping her safe is my #1 concern and that is the criteria I use for every decision I make. I ask myself, is she safe and being cared for. Whether or not she likes it does not enter into my equation. I have no love for her, she killed that a long time ago, what I do have is that she is sick and incapable of making decisions, thus I must do it for her because no one else will. I might add, I have done all of this from a distance. I am a 10 hour drive away, SWA and I are good friends, I fly alot. FWIW: My Mother was only 67 when I got guardianship. She is young and in good physical health, it is her brain that is gone.

My best advice is to decide with your siblings and your Dad what you all feel is the best course of action (with the help of a social worker who specializes in geriatrics) and then proceed forward. If your Dad is not onboard, you could run into more issues than just your Mothers resistance.

Good luck, this is a long road - I learned one thing from all this, when I turn 60 I am going to purchase a good long term care policy for DH and myself so we do not do this kind of thing to our kids.

 

[bumbershoot]

I don't understand why your mother wasn't placed in a skilled nursing unit at the hospital. Are these not in every hospital?

No, they aren't in every hospital. And even if they are in a hospital, they aren't going to accept everyone.

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.

That is SUCH good info. Thank you!

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

Didn't Mushy say that they had done some sort of eval on her, and put her on Prozac? Now I'm one that believes more in therapy than drugs for this sort of thing, but seriously, this woman doesn't really seem the type to tell the truth to a therapist, and she probably doesn't see the point in getting into her childhood and changing her ways NOW.

Interesting update!

My sister called the AL place this morning and spoke with the woman who gave us all those assurances when we moved her in. She was stunned that the weekend staff did all that. And, get this. She said I was lied to about somebody being pregnant and unable to assist! They got my mother up and about this morning and ready for breakfast.

NOt that surprising to me, that people are lying and mis-stating how/what a patient is doing or why the providers are doing things...same sort of thing happened with my FIL at the hospital.

Just another update -- they're not going to keep her at the AL place.

There's another nursing home that's actually $300 cheaper and just half a mile from my house, plus it's on the way to my sister's house. They don't have any free beds right now, but they're working on shuffling some people around to free it up. My sister did a surprise drop-in and was pretty impressed with it.

I'm keeping my fingers crossed. IMO, once she gets in a nursing home, she'll NEVER regain any mobility and she'll be bedridden the rest of her life. But it's really all up to her, isn't it?

Well, it's the care she needs, and GOOD for you for standing up for yourself! With that kind of mom I probably would have written her off LONG ago. My MIL convinced my husband (didn't know him at the time) to move in with her for over a year (maybe 2?) when she had 2 smallish heart attacks (so when I met him he was a 28 year old man living with his mommy). I suppose she appreciated it at the time, his putting his life on hold for that long, but from the time he moved out (almost 8 years ago) she has never given him a bit of appreciation for what he did for her.

Anyway, it's the care she needs, so there's just no point in putting her in an inappropriate place!

FIL's situation was the opposite. I'm not going to get into the whole mess, but he found himself in a situation while at the stupid hospital here in town that nearly killed me for no apparent reason while I was there having my son against my true will (coerced into agreeing to transfer). After a long serious of iatrogenic problems, he was finally reduced to a weak, frail, 79 year old man trying to recover from major heart surgery done at a hospital known for a HORRID heart surgery recovery rates. But his attitude was still very much "I won't go to a nursing home", and while no one was there he put on a show for the doctors and nurses, and managed to get himself into the hospital's cardiac care program, the one that was meant for otherwise-healthy 55 year old people who have one little heart attack, rather than a heart attack, open heart surgery, and dealing with a "blood infection" after he refused to take his antibiotics after a kidney something-or-other (he never told us just what they did, but it's what STARTED the whole thing, when he tried to pull out his balloon catheter while at home, and stopped taking his medications b/c the pain meds were codeine based and stopping him up, and he stopped taking the abx b/c he didn't know the difference and his wife can't read English and wasn't allowed to stand up to him) which required two solids weeks of IV abx that the nurses kept FORGETTING to give him (ooh I said I wouldn't get into it). He couldn't even walk to his door, but had them convinced he could do two laps around the nurses' station (he never DID it but SAID he could). So while we were off looking at nursing homes, he was convincing them of this.

And while he tried to prove himself worthy of the place but harming his health while doing it, the iatrogenic errors continued, and it didn't end well.



I think it is SO important that patients get the care they NEED in this sort of situation. If they can't do laps, don't put them in a program with twice a day intense PT. If they can't get out of bed, don't put them into simply assisted care (to me that means you live independently but have someone nearby "just in case"). Put them into the right care for their physical and mental problems.


So I hope you guys get this worked out, and I hope she gets into good, appropriate, care! And that the families make it out as unscathed mentally and emotionally as possible.

 

[Disney Doll]

I started planting the seeds with my dad of fixing up a room at our house for him and having him sell his house or rent it out (DH would be glad to manage it). He protested, but kind of weakly, like he would consider it.

See, I'm not totally evil. I'll take my dad in!

I've started planting those same seeds for my own parents, who, while they are still quite healthy and independent, are 80 & 82 so the day may come. My Dad would move here tomorrow. Mom is happy being independent and I am happy that they are independent and want them to remain that way for as long as possible.

Believe me Mushy, my nursing experiences have shown me the evil that some parents can inflict upon their children...I think the fact that you are trying to help at all is quite admirable.

 

[powellrj]

I just wanted to offer you We were in your situation with my FIL a few months ago and its not an easy place to be. I wanted to agree with advice to get a lawyer. I think the savings from the advise we have been given has more than paid his fees.

 

[Disney Doll]

The atty. advised us that until she became a true danger to herself or others there was nothing we could do. He advised us what to do when she did become a danger to herself and others. So, we spent 5 years stepping in to keep her from being evicted and trying to keep her out of trouble. We battled a legal system that is very resistent to take away someones personal freedom and a society that condemned us for not "taking care of her". I grew some really thick skin. I had to field phone calls from her siblings and church members who thought I wasn't doing enough and that I was being negligent and selfish. Little did they know, they had no clue.

I quoted only this part so as to save some space on the DIS.

Don't you just love when people do this?

My late DMIL had been a heavy smoker for years, had had cancer etc. a couple of times in the past. About a year before she died, she started failing...short of breath all the time, physically becoming more debilitated. I loved my DMIL dearly, so it was hard to watch. All of us...her children and children-in-law, would offer to take her to a doctor...anywhere she wanted to go. If she didn't want to get treated in our hometown for whatever reason, we'd take her out of town. I live within half an hour of Yale, within an hour of all the big hospitals in NYC, within 2 hours of Boston. She clearly had lung cancer. Nope, nope, nope...she refused. She was always "fine". She was a very strong-willed woman....if she didn't want to do something, she wasn't doing it and that was it. She was perfectly competent, she was a nurse, she knew the deal as far as what was happening with her, I am quite sure.

Yet her friends would call or bump into us somewhere and say "You know, your MIL doesn't look good. Aren't you kids going to do anything about it?" We would say "We have offered to take her wherever she wants to go for medical treatment and she refuses. What do you suggest we do?". They would say "Well, talk to her". We would say "We have talked till we're blue in the face. What do you suggest we do?". They would say "Well, I don't know but you need to do something". And we would say "Well, what do you suggest we do?" and they would say "I don't know" and we would say "Well neither do we".

I must have had this conversation 500 times in the local grocery store in that last year of my DMIL's life. Everyone thought we should do something, but no one had any good suggestion as to what. But we were the bad guys because we weren't doing anything in a situaiton where we couldn't do anything without her coooperation which she was not willing to give.

The only thing that finally got my DMIL into treatment was her daughter guilting her into it by saying "Before Daddy died (did I mention while this was going on with my DMIL that my DFIL was also dying?) we promised him we'd take care of you and you aren't letting us so we are breaking our promise to Daddy and that's a terrible thing for you to do to us...to make us feel guilty like that". At that point, MIL had a brain tumor growing (which we found out shortly thereafter) which I think changed her personality a bit to be more "malleable" so she agreed to go to the doctor. That first office visit showed a visible (without an x-ray...visible on her chest) breast tumor, a huge lung mass on chest x-ray, a brain tumor on CT scan. She wound up in the hospital to get anti-seizure meds regulated. While she was hospitalized, they also diagnosed anal cancer (very rare)...she had 3 primary cancers...anal, brain, and breast. Her doctor actually wrote journal article about her. She came after being told there was no amount of chemo that could save her and died 3 months later. She & my late DFIL actually died 9 months apart...he in March and she in December.

My DMIL actually loved her family very much, was a very good and devoted mother while they were growing up. She really was a very dear lady. She just decided that she was going to do it on her terms, and I guess we couldn't argue with that...we just had to keep her safe, which we did. We were able to care for her at home...her children felt that they wanted to "give back" to her all she had given to them, and of course, I supported my DH in his endeavor.

But I am quite sure there were people who didn't think we "did enough".

 

[CPT Tripss]

Sorry to get into this so late. A PP made a great point by pointing out that Assisted Living means so many things (state by state), that amounts to ithe term being nearly meanless in general.

In this case a number of people did not do their jobs (at least in retrospect). The hospital's discharge planner and the Al's admissions person both botched things and the AL staff failed to meet the persons needs. Depending on the state this all happened in and the licensing rules, formal complaints to state officials may be in order.

Also, depending on the state, there may be other options for the longer run, IF Mom decides to participate in rehab.

Good Luck!

 

[ZipaDeeDooDah]

MushyMushy:

Has mom ever been to a geriatric psychologist?

Not a family doctor, not a psychologist, but a psychologist with a specialty in geriatrics?

By the way, I read back, and I really hope the people who distended the truth about pregnancy and bad backs were punished severely...if not outright fired.

 

[barkley]

i have'nt read this entire thread but i did want to advise you that the person to speak to regarding medicaid (if that is what you are looking to as a means to help pay for skilled nursing care) is not a social worker-but whomever in your mom's county or state is charged with doing the application and eligibility process. this can be an 'eligibility worker' or 'benefits tech'-they go by a variety of titles. unless the 'social worker' in your mom's area is the person who does the eligibility determination he/she is not skilled to give you accurate information about what the criteria for eligibility is. they may know general information about what medicare or medicaid covers but unless they do the actual eligiblity review and determination they may not be aware of things that may exclude her from eligibility OR things you can assist her in doing to create legal and totaly appropriate eligibility.

i'm going to offer advise from the perspective of having supervised a medicaid unit and having dealt (still dealing with) an elderly parent. i strongly suggest you contact a GOOD elder law attny. to learn what the medicaid laws are in your state. a skilled attny. can look to what private insurance your mom may have, any medicare coverage she may have AND what medicaid coverage she may be eligible to-and advise you on how to help your father structure things such to benefit the both the of them. there are laws in place that permit (in some states) a person to have a medicaid eligiblity review of their current situation with an advisement of how to structure oneself (and spouse) in order to qualify at a future date. the information these reviews (or the information a skilled elder law attny can provide) can enable one spouse to receive the coverage they need while providing the financial security such that the other spouse does not have to become reliant on public assistance. your dad REALY needs to learn about the benefits of retaining his home over selling it-and the impact renting it out would have on his/your mom's eligibility to certain programs (exempt property vs. countable/have to spend down property).

i feel for you-neither assisted living nor nursing home care (sans the need for critical nursing care) is covered by many public or private insurances. it's hard to get someone who is not willing to help themselves get to a point where they can help themselves. it's like pounding your head against a wall. given that your father is still well and it sounds like open to discussion-perhaps you need to talk to him about at least taking the necessary steps to ensure that their assetts are structured in such a way that her current needs are covered-and his eventual are addressed (i have to imagine that given the cost of nursing home care, unless they have a phenominal amount of assetts-it's going to be eaten up pretty quickly, and i don't want to think of what you or he will be faced with when funds run out such that you could receive a call telling you to retrieve your mom ).

 

[MushyMushy]

MushyMushy:

Has mom ever been to a geriatric psychologist?

Not a family doctor, not a psychologist, but a psychologist with a specialty in geriatrics?

By the way, I read back, and I really hope the people who distended the truth about pregnancy and bad backs were punished severely...if not outright fired.

I thought I did answer that, but I may not have. I'm just so burnt out by all this. My DH and I have to declare a "no talking" zone about this at some point every evening because we're just so sick of it all.

Anyway, the only person who ever evaluated her was our family doctor. Now he's fine for monitoring meds for depression and such, but she needs something so much more intense. She refuses because she sees the psychiatric profession as BS. I'm trying to get my sister on board with a geriatric psychiatrist, but she said my mother will NOT go for it at all.

Barkley, maybe you can explain this to me. The nursing home where they want to send my mother is very expensive, but if they can get my mother medical assistance, it'll be very affordable. What is this? Is this the welfare assistance they're talking about? Or Medicaid? Or would that be one and the same? This is what my sister was bringing up today (she's handling all this because she works at the hospital).

I can tell you by the time it's all said and done, I'm going to need some heavy duty counseling. I just want to pack up and drive my car until I run out of gas and stay there.

 

[ZipaDeeDooDah]

I thought I did answer that, but I may not have. I'm just so burnt out by all this. My DH and I have to declare a "no talking" zone about this at some point every evening because we're just so sick of it all.

Anyway, the only person who ever evaluated her was our family doctor. Now he's fine for monitoring meds for depression and such, but she needs something so much more intense. She refuses because she sees the psychiatric profession as BS. I'm trying to get my sister on board with a geriatric psychiatrist, but she said my mother will NOT go for it at all.

A "No Talking Zone" - I love that

I can understand if you are having a hard time getting your family (mom and sis) to understand about psychiatrists. What if you can find a geriatric doctor - someone who specializes in geriatrics?

Do you have access to a geriatric doctor? The needs of the geriatric is so different than any other stage of life. It would be really nice if you could get a doctor that understood that particular stage of life.

 

[ZipaDeeDooDah]

I can tell you by the time it's all said and done, I'm going to need some heavy duty counseling. I just want to pack up and drive my car until I run out of gas and stay there.