Where to start looking for home care for my mom?

ALA - you have been given some very good advice, I'd like to address your "care funded by the state" & moms refusal of surgery aspect.

If mom or family cannot private pay for care at some point in her aftercare, then Medicaid aka MediCal will be involved. I'm assuming that mom is not currently on medicaid. Right now as mom is hospitalized she is probably using a combo of MediCARE and a secondary insurance (like BCBS) or a MediCARE supplement plan as those insurances cover hospitalization. Medicare will cover rehab at a facility for 20/21 days at 100% and then at 80% up to 100 days IF the patient is progressing in their rehab. The 20% is paid via their secondary policy, private pay or they can apply for Medi-Cal.

Now hospice is a mediCARE benefit but usually the room & board aspect of their stay in a hospice facility is NOT covered by MediCARE. You need to ckearly find out what those costs will be and figure out a plan as to how it is going to be paid - other insurance, private pay, or MediCal.

Medicaid rules are very exacting & someone will need to be the point person in doing this. Mom could be required to provide for up to 5 years of financials -like bank statements, life insurance policies, funeral/burial policies, awards letters, info on her home, land, car....really anything of value. Medicaid requires them to be "at need" both financially & medically. Financially means basically they are impoverished and must show impoverishment. Someone must provide this. If all this is at Sissys house or Sissy lives at moms house or Sissy is moms DPOA & MPOA then either she is going to be the point person in this or you are going to have to work with Sissy to get the documentation needed for Medicaid & get new DPOA & MPOA done as well.

About the "at need" medically. If mom is refusing care, refusing surgery, then she could be discharged AMA - against medical advice. This is pretty serious as often insurers will NOT cover costs for an AMA post care. Placement for hospice care can be extra complicated for AMA & non-compliant individuals as some facilities just will not take them as a resident. If there seems to be a delay in getting info with social services, it could well be that they are running into a wall to find a place for a non-compliant & AMA discharge.

My crystal ball is hazy, but I'd bet that mom has been a difficult non-compliant diabetic for decades. Gangrene moves slowly at first, so this has been an issue for a while. Mom probably has been all unaccepting on her diabetes and what she must do & must change in her behavior. I'd bet she has other diabetic related issues....her care needs are pretty complex. Wound care for diabetics especially so and can be fruitless if the patient won't work with you in their care.

Cut Sissy some slack as dealing with non-compliant diabetics is difficult.

Right now moms gangrene - if it could be resolved by just a foot amputation - is still pretty manageable. Her pain is manageable. But very very soon as it goes up her leg, it likely will take off & will be very very painful. Gangrene takes a long long time to actually kill you. The pain will be excruciating. The odor awful. Eventually she will give in and low & behold to her it's not just the foot. Surgery will be above the knee. Mom will be totally bedfast. Post Surgery like this for diabetics is very complicated. If she continues to be non-compliant, you can forget getting any PT, OT or prosthetic. My dad had to deal with this with his very stubborn, diabetic mom who cut a toenail to the quick and got a simple infection which morphed into gangrene... Grammie just refused care...all this "not going to cut off my toe & I was born with all my toes" & "I'm making a novena" blather...well eventually pain was beyond what she could take & she relented to surgery; it was above the knee and the gangene ended up with complications to her genitals and abdomen. The wound care & transfusions needed was constant. Gag a maggot odor. Even now when I remember this (1980's) it still makes me shudder. Grammie ended up post surgery in isolated ward NH care in a very very painful & totally avoidable type of death.

At 84 she is young elderly. Please do whatever to get mom to have surgery.

The hospital can't discharge your mom until they have a plan. Please find out the social worker at the hospital and call that person asap... And calm down yourself. This will work out for you and your mom.

i would think the social worker at the hospital should have a list of agencies available in her area

The hospital will have social workers/discharge planners whose job it is to place your mom. Get in touch with them asap. I know you can't relocate, but if you could manage going to the hospital for a few days, you might be able to persuade her to get the surgery. If that is impossible, get in touch with the discharge planner by phone.

Alaborin, read Igloo's advice carefully, and repeatedly. This IS what will happen if your mother refuses surgery. It's a scary situation now, I'm sure of that, and I'm sure it's also difficult to try to reason with your mother. No one wants to endure an amputation. But it could save her life.

Prosthetics and amputees have so many more choices now than several years ago. I don't know if she's eligible for a prosthetic foot, but do some research on amputation of veterans and see how they've adapted and moved on with their life. Granted, though, that they're much younger and have the military gung ho adaptability training to inspire them.

Your mother is probably frightened, but also unwilling to change, so she needs to be convinced. If she's religious, perhaps a pastor or clergywoman/man could counsel her. Perhaps grandchildren could help support her with their love and care for her, encouraging her to accept the consequences so that she can move forward and still live as normal a life as possible.

There was a man in the rehab facility at the same time as my mother. He was a noncompliant diabetic. When we first met him, he had already had one below the knee amputation. We learned that he was still refusing to comply, eating food he shouldn't have been eating. During the time my mother was there, his situation worsened and the other leg was amputated below the knee.

We were observers, casual acquaintances by virtue of propinquity, but we witnessed the agony the family endured. And of course we saw the truncated leg, first the one originally amputated, then the second one after the second amputation.

I can't describe in words the unsettling, horrific, sad, situation we witnessed, and we weren't even that close to the family. After we left, we learned the father then went on dialysis. I honestly doubt he lived much longer as he just refused to accept the limitations diabetes imposes.

I really feel so badly for you; it's difficult to face something like amputation under any circumstances, but even more when the loved one refuses to accept recommendations which are best for her.

And although I wouldn't recommend bringing in the denial of care and self payment of all medical costs, it has to be a consideration unless your family is independently wealthy.

I wish you some peace to think over the situation and how best to proceed, and then wish you success in convincing your mother to accept the best course of action so that she can have more years of life with her family.

I have five amputees in my acquaintance. Four men. One, a nephew with diabetes. Non compliant until he lost his leg. He is healthier now than before. Off his meds as he totally changed his diet. Doesn't need them anymore. He's in his 50s and gets around fine. Another was a man in his 80's. Lost toes and then the foot. Diabetic. Did fine until he died of a heart attack five years later out running errands. The loss of his foot did not slow him down. The other two men, one a leg and the other a foot, had accidents. In their 40's. Doing fine except that one of them suffered through a terrible burning accident. He would tell you that the loss of the foot was mild in comparison. A woman in her 70s lost her husband and then her leg due to noncompliance and now is in a wheel chair but has lost weight and seems in a better mood than for a long time before.
People sometimes suffer great loss and yet are amazingly resilient. But as all the others have said. She will die if she goes untreated and it will not be easy for anyone. Convince mom that she is making the best decision to take the foot off. So now you know about people who have not followed orders and people who have. You can do this and mom can do it. Don't forget to Breathe.

Well, she will be going on Hospice, so the discharge coordinator will call nearby hospice facilities and hope they have a bed available. Maybe she didn't tell you all the details.

Home wound care is a specialization that requires an extremely motivated 24x7 caregiver. If that is not available, then a skilled nursing facility may be optimum.

Igloo said it all perfectly. The sister probably did all she could, but you cannot make someone take their medications/insulin.

Igloos answer gives you an idea how complicated and time consuming this is going to be. There isn't a quick fix/simple answer. Believe me- me and my 3 brothers have been managing 2 parents health and living situations for a year now and it's exhausting emotionally and physically and financially.
Medicaid (called Medi-Cal in California) is available after a person has basically zero assets and income is some percentage of the poverty level- 138%? Medicaid programs have a 5 year lookback for people who want to hide substantial assets.
Good luck and most to your mother who is handling a tough health situation. Is your mother a veteran or spouse of a veteran? If so funding and services can be available there .