Hi, so I recently moved my mother in law into my house. I have a 5mo baby, and a 1000sq ft house so its crazy packed and is getting to be a little overwhelming. Its me and my wife attempting to work, raise our baby, and now take care of a frail Mother.
My question is, when is it time to go to the hospital? She can no longer walk more than about 15 feet. She basically collapses onto the toilet after her 15ft walk to the bathroom. She is in constant agonizing pain. So much so, she can barely eat. She can't load a toothbrush, open her pill box. nothing, total full time assistance.
She has diagnosed stage 3/4 COPD, active Hep C, osteoporosis (-3.9t), severe anemia. Weighs maybe 80lbs now down from her usual 90. Shes on 24/7 oxygen. We also have reason to believe she has Multiple Myloma but when we brought that up with the doctor, he said he'd check, but he was more concerned about just getting sodium in her.
We've taken her to the ER a month ago, right before she moved in. They did some imaging but couldn't do much more because there wasn't much to fix. She was just in pain.
She has declined big time since. I'm worried that she should be in a hospital setting and that we may be hurting her more trying to keep her at home. But I'm also worried they're just going to turn us out again. Last week her PCP mentioned maybe doing a blood transfusion but COVID is making things tough. A big fear if we dont take her is I can't see her going a week without falling and hurting herself badly.
Anyways, any sort of advice would be good. We can't afford care that isn't done through insurance. But we are totally at our wits end and about to crack. This feels inhumane and dangerous. And deeply saddening
Thanks
-M
You may want to ask her PCP about referring her to a pain specialist.
If this gets too much for you, you may want to consider LTC with Medicaid paying. This means Moms SS and any pension will go towards her care. The easiest way to do this is if rehab is offered the next time she is hospitalized take advantage of it. Have her evaluated for 24/7 care. If found she needs 24/7 care, then tell the SW that you can no longer care for her and she needs to be transferred to LTC. Then start the Medicaid application. A SW can help with that but be very involved with the process. Don't depend on someone else to do their job. In my state you only have 90 days once u apply to get what paperwork is needed together, spend down and get the person placed in a NH.
She is 64, yes. She has good insurance right now and will switch to medicare when she turns 65. She has 0 income so that shouldnt be a problem. Do we need a medical diagnosis to get inhome medicaid care?
We have applied for SS and SSDI but neither have been approved yet. So Im footing all of her bills and its not gonna last long.
She sees a pain specialist. She is currently on Oxycodone, Gabapentin, Spriva, Albuterol inhaler, Advair, BoneUp, and tons of Advil. They have no altered her Rx even though she is in more and more pain.
Im planning on calling our local Hospice in town who Ive heard good things about to see if they can counsel.
Can all of these diagnoses for LTC and rehab be done at the ER? because im guessing her next stop will be the ER, before we can get into her PCP. In fact, if the ER can make these diagnoses for her, Id rather just take her there ASAP.
Thanks again
M
It sounds like mom is in need of a good facility. They will need what's called a needs assessment. Some places do this themselves and others require a doctor or nurse practitioner to provide. It is a good place to start.
Unless mom has a long term care insurance policy she will have to pay out of pocket for in home caregiver. Her health insurance will not cover 24/7 in home care and will only cover rehabilitation care in a long term care facility after a hospitalization.
The easiest way to transition her is that you tell the hospital that she is unsafe to be at home and they will help guide you to getting her placed and then the facility will help you navigate Medicaid.
If you want to keep her home, I would ask her doctor about hospice. Then interview the ones in your area. Failure to thrive is a diagnosis that should qualify her for this service. It doesn't provide 24/7 care, it provides bath aides and a nurse in home to help her comfortably die. She will not be going to the hospital or doctors to receive curative treatment.
You have some decisions that need to be made. Has your mom ever talked to you about her end of life wishes? Has she prepared the paperwork that gives you the power to help her?
Again, I am so sorry for your family. God bless and guide you through this difficult time.
We can't do any sort of out of pocket care at this time. We will be relying on Medicaid and her private insurance.
I will look into the hospital avenue and see if they can get her placed or point us in a direction.
We have not addressed really any of the questions you asked. Mainly because only 45 days ago this seemed like it would be treatable, but her condition has fallen off a cliff. But yeah I will look into addressing that stuff too.
Thankyou for your well wishes.
M
No hospitals keep patients for more than a day or two now, and that counts true even if you have open heart surgery. One quickly leaves the hospital to either home, extended care in Skilled Nursing Facility, or rehabilitation in a Rehab or Long Term Care in Nursing Home.
However Mom has good reason to ENTER hospital through the ER with any of the above you mention, especially uncontrolled pain.
At the instant of entry and every time you speak with doctor or nurse after that, it is crucial that you tell medical personnel that you can not longer "safely care for MIL at home, and will not accept her back into your home". Those exact words. Ask for a social worker to "help us with placement." To "Help us with care choices".
If you do not have POA, this Social Worker can quickly make you "temporary guardian" for your MIL. Then she will find a facility now accepting people, which will be difficult for her in Covid-19 times, (and IMPOSSIBLE for you). She/he will help you negotiate getting Mom on medicaid to help in payment. Be ready to give them a five year lookback on Mom's assets and expenditures (2 1/2 in CA).
If you wish instead to research what hospice care is on the internet, speak with MIL and try to do this inhome you will have a lot of help with care in her last days.
Crucial is that you and your wife recognize and accept, with these diagnoses adn this weight you tell us about, that Mom is likely dying, and crucial also is whether or not you accept that, as going into hospice stops treatment toward cure. Hospice and Comfort care is what is given in a person's last days. If a doctor believes that Mom's Hep C can be cured (there is now medication for this, very costly and not always successful) and COPD treated. That is to say is MIL now "end stage" in her illness, or is there hope with treatment. Whatever the outcome in those predictions by the doctor, her care now is too much for you to accept her back home. Don't allow them to convince you they will help; they won't. In home care is basically paid by your MIL's own assets. Not many can afford this.
You have a lot on your plate. Contact your Mom's doctor. Make an appointment if you are POA. If you are not first get a POA if mom is rational and can give you that permission. Get the information on Mom's current condition and your choices. Make yourselves a list. 1. POA 2. Doctor appointment for prognosis 3. Hospitalization. 4. Social worker for placement. 5. Gather financial records.
Wishing you luck.
So the POA stuff, no we have looked into none of it. Mostly because this has come on in the blink of an eye and we're extremely busy even outside of this. But I will make it a priority, it seems like most people suggest this.
The doctor does think we can 'cure' her, or at least he did a few months ago. The Hep C treatment is possibly going to be Rx'd this week. Now if insurance covers it? Dont know.
The otseo is being treated by Tymlos. Though that can take years.
I'm not sure we're ready to stop care. I know MiL isn't. She is still very hopeful. The main issue is she is definitely not safe in our house, at least as of 2 days ago and unless she improves it will continue. My wife and I also are struggling with the responsibility of it. It's no ones fault, its just unfortunately and we would never leave someone to neglect.
Thank you again, this is all very helpful.
It also seems, especially when talking about elderly patients and diagnoses of illnesses, that one doctor "begets" another - ie: you see a cardiologist, who sends you to a pulmonologist, who sends you to a nephrologist, who sends you to a gastroenterologist, and so on and so forth, until it seems your life is one long visit to a doctor's waiting room. So the other option you might want to consider, if there is one available and your mom is agreeable , is to seek a geriatric specialist instead of continuing with her PCP. They seem to be better at narrowing down what's "necessary" and what isn't, as far as doctor visits and test, etc.
It's going to be difficult for you and your wife, especially with a 5 month old baby. Your first priority must be to your child and wife; there is no shame with admitting to yourself that you can no longer keep mom at home and need to seek a care facility for her. I doubt there's ever been an elderly person who, given a choice of staying home or entering a facility said "oh my, I'd much rather be in a facility than the comfort of my own home." When it gets to be too much to handle, please keep in mind that there are other options for mom.
I wish you the best.
Get her a gait belt (she wears around her waist and someone can hang on to the belt as she walks) if she needs assistance when walking. She cannot open the plastic daily pill sorting boxes? They are much easier than opening a pill bottle. You can also check w/her insurance to see if they will do pill packs for her meds. All pills taken at certain time of day are sealed in a pack together. A bedside potty chari (if she can manage a short transfer) may allow you to sleep at night without having to walk her all the way to the bathroom.
You can also talk with doctor about hospice type assistance and palliative care to help with her comfort. If she really needs to be in a facility for round the clock available medical care, the doctor can answer those questions, too.
That does not address the problem that you have with a house bursting at the seams and caring for 2 vulnerable individuals.
By the way if/when she falls call non emergency number and ask for a “lift assist” the Paramedics will come and lift her. If there is no transport to the hospital in most cases there is no charge. They are trained to lift someone without hurting themselves or the person being lifted.
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