Mom (age 90) is in skilled nursing (Medicaid). She is pretty lucid (diagnosed with mild dementia but since the diagnosis she has improved) however most of the people around her are a lot less so. She complains that there are few people around her who are capable of conversation, so she is bored. She doesn't like the nh activities (bingo etc). She's in a wheel chair but can walk, though unsteady, with a walker. She wants to go home but I live far away. She has had several falls, the last a broken hip. NH staff say she needs 24/7 care. We can't afford that and I don't think Medicaid will give it. I have warned her of risks of returning home but she is determined. I don't feel I have a right to dictate where she lives but I want her to be safe. On the other hand, quality of life is a factor. She is getting EXCELLENT nh care (great staff) but it isn't her home. I don't know what to do -- let her return home with the maximum care we can get from Medicaid or can afford out of pocket or have her stay in the nh where she feels isolated. It's a real dilemma for me. My fear is that if she returns home and can't handle it or has an accident she will lose her place in the nh and the alternative nursing homes will be poor.
In your shoes, my real question would be, does your mom actually have dementia. That's progressive, and she would be well advised to stay put.
There are probably volunteers who would visit maybe take her out for a meal or a drive in the country, push her outside to sit in the sun. Does she have hobbies she used to enjoy. perhaps she knitted sweaters well maybe she can knit squares that can be made into blankets for the homeless. There are many hobbies that can be miniturized as we get older. Can she still see to read. If not how about books on tape of if the TV is limited CDs of current or old movies. Did she love horses? Well someone could take to a local horse show. Whether she stays or goes home she is going to have to become content with being 90 years old. So loose the guilt Trevor and do what is best for her.
Is there any possibility of moving her closer to where you live, so that you could visit more frequently ?
Talk to the staff about whether assisted living would be enough care for her. Could she sell her house and fund that?
But I would get her dementia status clarified first.
And please note once an elder gets into their 90's, every year of life is like 10 years. I've seen that with my parents. My Dad always says they will manage. This year for the first time Dad realizes he can't do the yard work, nor the house maintenance.... he wants me to do it, sorry Dad, that ship sailed a few years ago because I had aged, too. My calendar doesn't shop going forward.
I know you are grateful you found a nursing home that has so many positive things going for it. And that you know if Mom moves out, she might not be available to move back in and has to go elsewhere. The tough part is convincing her. Thinking ahead, does this nursing home take Medicaid?
As for her mind, I know after I had surgery, I had brain fog for quite some time.... eventually it cleared up, but it came back after I had a serious fall and sustained a bad injury. The pain kept interrupting my train of thought :P Maybe that is what your Mom is experiencing.
And if I were put to bed at half past six in the evening I'd be pretty bloody resentful too. What are they thinking???
It's an incredibly difficult decision, but - I hope this is a comfort - from your description of your mother's mental state it is, you are correct, actually hers to make. What you can get very stern with her about is the self-defeating stupidity of ignoring medical advice and discharging herself against recommendation. That will be a very useful delaying tactic until you can do a bit more research and get all of her options down on paper, with prices and pros and cons as FF suggested. Best of luck, please update.
Can you quantify those factors? If so it would make the analysis easier.
There is a program called PACE (http://www.medicare.gov/your-medicare-costs/help-paying-costs/pace/pace.html), which as I understand it helps people to stay at home (or as described on the Medicare site "in the community") as opposed to going to a facility.
I've had it bookmarked but never thoroughly investigated it. It might help narrow down the variables in your analysis.
As to the issue of falls, my personal opinion is that someone can fall anywhere, including in a facility. The question is how quickly can someone get assistance - if your mother were to fall in the middle of the night, what would alert the staff?
During my mother's rehab, her roommate fell. The attention needed was provided when my sister (a nurse) called out "PATIENT DOWN in room ....". Then staff came running.
Had we not been there, who knows how long this woman would have laid on the floor? She wasn't screaming.
It may be that one of the solutions is for your mother to return home, until and unless such time as any dementia changes her ability to live alone. If that occurs, your decision will be easier.
If quality of life is the issue (and it is a major one), will she have a better quality of life at home in her own surroundings or at a nursing home where she doesn't want to stay? And it is HER life so she does have a right to participate in the decision making process.
It also depends on your own situation and plans for your future.
Don't push or chide yourself for being unable to resolve this dilemma; it's probably one of the most challenging ones you'll face. It would probably be easier to go back to work where the dilemmas are more analytical and solvable.
Does your mother have good social connections at home? My mother kept saying she didn't want to go to a facility because she would miss talking to her neighbors. But in reality, she never talked to the neighbors anymore, the ones she'd been friendly with had died. She only really talked to the mailman.
Bring a few things from home, but not so many that it appears she is going to be there for the rest of her life.
Bring a CD player (not an iPad) if she's used to one and can operate it. Otherwise bring a radio and mark her favorite channels. Music is a great soothing therapy.
I don't know if this would exist or not, but there might be some church groups or children's groups that visit people in rehab centers. You might try calling the United Way helpline, 211, to ask about things like visiting Samaritans.
If you do decide to bring her back to her home, I would get as much oversight as I could - life alert monitor, lock box for first responders on the outside of the house, internal surveillance so that you can monitor her from afar.
If she's friendly with the neighbors, ask that one or another bring her mail, call or check on her during the day. If she's a churchgoer, contact someone in the relief group or something similar and arrange for visits.
I would also ask her regular treating physician to script for home care - nursing, PT, OT and a home health aide. Add grab bars, remove trip hazards and do whatever you have to to upgrade the safety situation.
Get Meals on Wheels as well.
Good luck; these situations are always so tough - neither option is that desirable for one reason or the other.
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