Mother has Advanced Parkinson's and dementia. She currently is in Rehab from a geriatric evaluation gone bad (over medicated/ messed all her PD meds up where she couldn’t walk or talk.) Pulled her to a different hospital to detox and get back to baseline. Rehab has required a 24/7 sitter. This is $600 a day! Trying to figure out MC or SN for her level of care. Since a sitter has been on her record since her detox hospitalization I feel like anywhere we go will require a 24/7 sitter. She is a fall risk and roams. Her balance is off from her PD and she’s going through delirium from all the medication and moving around. Anyone been through this and have advice? How in the world can we afford $7K a month for MC or $10K a month for SN + 24/7 sitter? Dad is on Medicare and worked SO hard his entire career- what to blow it on a sitter b/c facilities see it as an easy out to not provide care. Let the family pay for a sitter so they don’t have to go in the room and check on my mother as frequent. I’m so frustrated with the system the last 60 days have been a rollercoaster!
I have read many stories here where once the correct medications were found to balance the PD they have seen their loved ones do a 180 so I am wishing the same for you because I also like you see the choices out there are not great options.
How long have you been on this detox/rehab route? Is she improving yet or still trying to figure things out? Is she doing her physical rehab? I can see where maybe rehab would not be able to handle her symptoms at this time. Hopefully she will continue to improve and will not always require a 24/7 sitter. That sure is expensive!
When she is straightened out, I don't know if she will need a 24/7 sitter. Seems like MC or SNF would be better equipped to deal with people with dementia. I know hospitals have bed alarms that go off if people who are not allowed to get out of bed alone try to do so. Maybe other facilities also have these? Sometimes they set up cameras so they can see what the patient is trying to do.
Although the sitter is expensive, it may be necessary at rehab to keep her safe and well cared for.
The long term financial impact of this, I agree that your dad should consult someone that specializes in elder law and can guide him about what to do. At some point your mom will likely end up on Medicare to pay for her care. You might want to put her in a facility that accepts it. That's what we did with my MIL. She's in one now and my hubby is finishing up the application and providing them with everything they need to approve it so they can start paying the nursing home. She had less than 20k when she had a fall and a broken bone and decided not to go back to her senior housing apartment.
Good luck. Definitely a rollercoaster.
"In addition to their core expertise managing the clinical problems of acutely ill, hospitalized patients, hospital medicine practitioners actively support the implementation of evidence-based guidelines and practices to facilitate optimal continuity of care and enhance the performance of hospitals and healthcare systems by:
Managing day-to-day care and providing prompt and complete attention to all patient care needs including diagnosis, treatment, and the performance of medical procedures (within their scope of practice)
Employing quality and process improvement techniques and practices to make the hospital a safer place and improve patient outcomes
Facilitating collaboration, communication, and coordination with all physicians, healthcare personnel, and care team members caring for hospitalized patients
Supporting safe transitioning of patient care within the hospital, and from the hospital to the community, which may include oversight of care in post-acute care facilities
Practicing efficient and judicious use of hospital and healthcare resources
Through these practices, hospitalists provide efficient care delivery and improve clinical outcomes, reducing mortality rates, enhancing care coordination, preventing hospital-acquired infections, and facilitating comprehensive transitions of care. The hospitalist’s extensive clinical experience in caring for some of the most complex medically ill patients as well as the hospitalist’s focus on providing patient-centered care translates into safer, higher quality care for hospitalized patients." Society Hospital Medicine.
My husband was one of the first hospitalist practioner in the country. He taught, trained, mentored many doctors in this field-including one who was a past president of the hospitalist association.
Hospitalists are trained to untangle messed up meds, get everyone on board to streamline care and to work with patient's families.
Not my experience with hospitalists in the least.
I wish that was what they still did.
Your husband would be appalled at what it has devolved to be.
You don't provide enough info about your Mom's health insurance but I assume she is old enough to be on Medicare, with a secondary (spousal) insurance from your Dad's employer. If your mom needs a sitter while in rehab, why isn't the rehab providing supports? Wandering, dementia, and fall risks are all very common in the elderly in any hospital/rehab setting. Why you are paying for a sitter - did you volunteer or were you requested to? Some piece of this situation is missing.
As for long term care in any facility, it would be wise to contact an attorney who is well versed in elder care and Medicaid. Medicaid will pay for LTC in a facility or at home if your parent's finances allow. The attorney can advise if she qualifies for Medicaid, and help set her up. At the very least, you will have the legal guidance you need to get the proper care for both your parents. Many of these specialized attorneys give free consultations - don't delay.
The rehab will send her to the hospital and they will keep her there until a facility is found that can meet her needs.
This rehab is playing a game of chicken with you and are waiting for you to blink first. Don't do it. Your mother was accepted into the rehab facility. They knew when they accepted her that she suffers from advanced Parkinson's disease and dementia. This information was not kept from them. Now they want privately paid outside staff to be there 24-hours a day for her, but they'll still collect the full amount for her stay with them. What a sham.
Tell them to send her to the ER and the hospital will find an appropriate facility for her. While she's there, they will provide a sitter that is employed by the hospital and paid for by insurance. You won't have to find and pay one.
And yes, I can promise, as a lifelong nurse, we would LOVE for all patients on Q15 minute checks to have a sitter. Would certainly get OUR votes, and we would not be concerned about WHO is paying for it.
Certainly Riley's peer group knew that, which is what she's trying to tell us. It's enough to have children who care for you enough to even get you situated. All these seniors should be grateful for that.
hygienic care. He spent a couple of weeks there (on my job insurance) before being discharged to a skilled nursing facility (for which I have no end of praise) before coming home disabled but cognitive. Beware of rehab facilities. Our experience was that the one we got stuck with ran the clock on private insurance for rehab and then hasta la vista baby.
I’d likely say “I appreciate your concern but this is your business, not mine. You hire employees to care for your customers. I don’t. If you need additional resources, I suggest you talk to management. With all due respect, this is your problem, not mine.”
Now the statement made by some that this is a facility problem without enough caregivers, which could be part of it. My mom needed one on one to keep her engaged and out of trouble. It is unfair to the other residents to expect care be taken from them to transfer that to your mom. My mom was a danger to herself and others.
Eventually mom was kicked out and hospice recommended a much smaller, homier care home. It was cheaper than the large facility, it had a better care ratio and worked much better for mom. She still needed a 24/7 on occasion but the total cost became more manageable.
First, I'd recommend memory care for Mom, not skilled nursing. My mom was originally in SN, and they simply ignored her because she didn't really need that level of care but she also had dementia and they didn't want to deal with it. As a result, she slept about 18 hours a day to just shut out the world.
I moved her to a MC care facility, and they did a couple of things -- first, they moved her into a wheelchair full-time because walking and falling were simply too much of a risk, and they brought her out of her room and involved her in the activities whether she could participate or not. Her dementia didn't faze them, thank goodness.
The other decision I made was a year ago after a traumatic hospital stay much like your mom's where they didn't know what to do with a dementia patient. Once she was done in the rehab place and back at her MC, I had her put on hospice, and I made the decision that whatever ailed her would be treated where she was with no more hospitals brought into the mix. (Of course, if she'd broken a hip or something, we would have gone to the hospital.) It made her last months much less stressful for everyone, because she wasn't subjected to the agonies of being in an unfamiliar place. That's the hardest thing on a dementia patient -- scary, unfamiliar places.
You have to decide what the most important thing is you want to address in your mom's care. I decided that her heart failure and creaky knees weren't going to get better, so I focused on keeping her mind stimulated. That's what led me to Memory Care, and honestly, I wasn't even 100% sure she was qualified for it at the time. (She turned out to be MORE than qualified for it.) In Memory Care, she wasn't treated like a patient, which is what you're going to get in Skilled Nursing. In MC she was in a friendly, homey environment, and she thrived as much as she could. She literally never slept more than the normal eight hours at night and a small nap after leaving Skilled Nursing because there were things to keep her engaged and stimulated. I can't stress how important that is.
Yes, it's horrifically expensive, but if Dad can't afford it, get with someone to help them apply for Medicaid. Otherwise, yes, it's sad that he worked so hard for so long to save for retirement and that's not what they expected to spend that money on, but life doesn't always go as we'd like.
Good luck.