The time has come for long term care. What is my first step?
Hi, My 86 yo mom was recently hospitalized for septic shock. She survived and went to a rehab where she has gotten bedsores, edema and remains incontinent (bladder and bowel) and has yet to get back on her feet. The rehab told me today that mom will be ready to come home on 12/23. I don't live in the same state as my mother. My husband does and he won't be home till the 26 at least and we cannot care for someone who is incontinent and barely able to move around. She lived with us in an apartment prior to getting sick, but we had come to the conclusion that she had too much alone time and wasn't caring for herself properly and were taking steps to make sure she got more attention. However, I am back in the state where I work and live most of the time and hubby is not going to take care of my mom full time as he works 10 hours a day. The nursing home said, ''that's fine, our business office will be in touch to quote a price for us to keep her through your husband's visit". She needs to go to assisted living we all agree, but I have no idea how to go about this move. She has Medicare and a supplement. What is my first step?
AL for someone who is doubly incontinent? That doesnt sound like the apprpriate level of support.
Can you check out some local ALs and ask that they assess her for admission? That's the usual process. Alternatively, see if the local Area Agency on Aging will do a "needs assessment" and advise.
It sounds like your mother is in need of long term care in a Skilled Nursing Facility with Medicaid footing the bill if she doesn't have sufficient income to foot the bill. Speak to the social worker at the SNF she's current at for rehab; s/he can steer you in the right direction, most likely. You may also want to speak to an Elder Care attorney about the Medicaid requirements and lookback period in your state.
Like BarbB said, you can get a needs assessment done as well, but a doubly incontinent person is not likely to be accepted into AL. If you have Morningstar AL in your area, they DO take elders with more needs than most other ALs, but the monthly costs are also quite a bit higher. Your first step should be to speak with the social worker at the SNF mom is currently at, to get some guidance as to how to move forward.
Best of luck with a difficult situation.
If she has any assets, she will have to self pay until she has less then 2k cash. Insurance doesn't pay for LTC.
Someone is going to have to find a facility that meets her current needs and hopefully, her increasing needs until death. I wouldn't leave that to a stranger, I would have someone that loves mom do this. Even if you need to take a break from work. Because facilities vary so much, you want to make sure she is going to what seems to be the best choice for her. It may not work out that way but, you have to start there. look for some place that has obvious good interactions with the residents. Does it pass the smell test, how is the food? Do they have activities daily? It isn't necessarily going to be a new, fancy building, that is the least important thing.
Best of luck, this is such a difficult transition and the most stressful for you.
Call her doctor, admit to a NH until bedsores are treated.
Mom has zero assets and I’ve been charging her rent for the time she’s lived with me so she would have living expenses to show should this day come.
Ill reach out to the state APD as no one at the rehab has been even slightly helpful.
I would ask for a care conference and ask to see the PT and OT goals. Talk to the therapists and ask for documentation that she has met those goals.
Make them demonstrate to you that mom can walk 50 feet without assistance, for example.
Call the Ombudsman and report the bedsores and ask what can be done about them.
Is a wound care doctor tending them? Ask for mom to be seen by one asap. Or transfered back to the hospital for treatment.
And discharge to a defferent rehab.
YOU are not responsible for your mothers care financially. Those bed sores are a big problem for Rehab if that is where she got them. They have to take care of them and it needs to be done by a woundcare Nurse. I would tell the SW that she needs to start the application for Medicaid and that Mom needs to be transferred to Skilled Nursing. That you live out of State and that husband cannot care for her because he works 60 hrs a week and there is no money for in home care. Be careful about getting APS involved. They could take over Moms care and become her guardian. You lose the right to make decisions for her. Start with the Ombudsman. See if they can address the problem and the bed sores. Bed sores are very important. It means they are not shifting Moms position. Its their responsibility to treat them. Once sent home, you have taken over that responsibility. This is not something a layman takes on. If the Ombudsman doesn't address it, then APS should be called in.
If Mom has any assets, you need to spend them down. My Mom had 20k that was used for 2 months of care. It gave me time to get Medicaid applied for and started by the 3rd month. There is a criteria that has to be met. Certain info Medicaid needs. In my State you have 90days from date of application to spend down any assets, supply info needed and have a place set up. If not done in that time, u start over. So, you need to keep on top of that application. The SW can get the ball rolling but I would not trust her/him to follow thru in a timely manner. Keep in touch with the Medicaid caseworker. You email/fax any info needed. If need to, you mail and certify paperwork. You can keep the SW in the loop, but you make sure everything that needs to be done is done. You may need to take some family leave (FMLA) to be able to do what is needed. Be aware, that any Social Security or pension Mom receives will need to go to her care.
Not sure what state you are in, but if your mother is single and has less than $2000 or $2,500 (depending on state) in total assets, she may qualify for Medicaid long term care now. Nursing homes will not advise on spenddown strategies other than just pay her assets to them until she qualifies. If there are assets, reach out to an attorney in your state.
The NH is a business, so they will focus on billing.
The details of Medicaid vary from state to state, so contact a free health insurance navigator (program similar to Ombudsmen for nursing homes, funded by federal money) to see if you can get more information.
Call Eldercare Locator at 1-800-677-1116 and ask for State Health Insurance Programs for her state. They can connect you to people who are trained to help people understand what insurance programs do/don't cover, and how to fill out applications. They don't give advice on a particular situation. They may be able to help walk you through the application and figure out where to find supporting documents.
The application requires your mother to
show who she is with supporting documents as to her identity.
show what her income is now, with supporting documents
show where her money has gone in the past 5 years, with documentation (bank statements, etc).
Once I realized that the form was 3 different parts with different purposes, and that each part needed documentation from the government or bank or tax records, it was easier to keep track of the whole mess.
Also, copy everything you send in, and send the package with delivery confirmation, so that it can be located if it 'gets lost' somewhere. Good luck.
and don't use your money for her bills. If the nursing home loses money, I wouldn't worry. and you are not responsible for her bills, even if they try to convince you that you are.
Ombudsmen, like social workers, come in 2 varieties; great and terrible. Glad you've got at least one good one!
I know this from experience.
They are all understaffed and you can literally lay in your urine and feeces for up to an hour.
They have special blow up mattresses that your mom should have been on to help with bed sores and they should have been applying butt paste ointment to help with not getting bed sores.
You should check with her Insurance and find our exactly what your options are and what is covered.
Your mom will continue to go downhill in a Nursing Home.
Please work something else out.
She needs to be taken out of the Nursing Home like yesterday!
You can have her signed up with Home Health where Audes will come 3 times a week to give her a Shower Bath or Bed Bath.
Mom can have In Home Therapy.
A Nurse will come by once a week to check on her and take her vital signs and she'll report to a Dr that can give rx's for healing the butt sores.
I found that virgin coconut oil does wonders for it but you must keep a thick layer of thick butt paste on the skin to keep moisture out.
If she can't get up to go to the bathroom. While in bed, she keep her laying on a diaper but keep the diaper opened so air can get to her.
You can check around and find Care help for $10 an hr you don't need a Nurse for Caregiver.
Praters your mom doesn't have to spend her end of life in a Nursing Home as it's a slow and painful death sentence in both physical and mentally.
Also, if your Dad was in the Military, your mom could qualify for up to 30 hrs of Caregiver Help a week.
If they say she’s not a candidate, your next step would be to go to the Medicare website where you’ll find ratings for nursing care facilities. Bedsores and staffing are among the criteria that Medicare looks at in their inspections. I found a great one for my brother who has Medicare (covers his hospice care) and Medicaid (covers nursing home care)—it had an overall rating of four stars and five stars for resident care—and they have lived up to it. Medicare has a limit to the number of days they cover for nursing home care. I would definitely look for a place—AL or NH near you so you can visit her and keep an eye on her. Unfortunately that will entail clearing out her home sooner or later. It can be hard to recognize a nursing home may be the next step but it may be the best for her. After finding facilities that look promising work with the social worker where she is now. Have them make the calls.
Your mom would definitely have more social interaction in a facility—NH or AL. My brother was diagnosed with brain cancer and we noticed how much he brightened up in the hospital. People were checking on him throughout the day. Way better than holing up in his apartment by himself all time.
I would find a geriatric social worker who can assess her—will she even be able to live on her own again? They can can also help you make the financial decisions independent of what the facility might tell you. Some facilities are great at transparency, others not so much. The social worker can also help you figure out the financial end of things too. Another source would be an elder law attorney. Ours even recommended an excellent assisted living facility when it looked like that was the ideal setup for my brother. Do you have a Power of Attorney for finances and health in place? Good luck!
If she got bedsores, she might get them anywhere..you have to address this issue with Nursing Supervisor to change her diaper more often, put A&D ointment & the Desitin cream..& turn her every so often to get off her backside.
Hugs 🤗