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How will I know when it is time to put Mother in a "Facility"?

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    How will I know when it is time to put Mother in a "Facility"?

    59yr old woman caring for her 81yr old mother who has recently had some slight strokes.
    Mom's memory and ability to concentrate is impaired to some degree.
    She knows where she is,knows how to pretty much care for herself but does wear an adult diaper which sometimes is barely used and sometimes pretty soiled.
    Incapable of doing chores in my home either due to her slightly failing eyesight or issues with Arthritis.

    I maintain a fairly routine schedule for her,I take care of dispensing her medications,I prepare her meals,give her baths and take her to her Dr appts etc.

    At what point will I know if she should be living in a "Facility" vs living with me? How do I make that decision?

    #2
    If you cannot provide the care she needs: it is too much burden on you, your health is suffering, etc.

    Of course she will never get as good care in a nursing home as she will from you, but you can only do what you are able to do.

    If you do get to that point, get some good advice on how to find the right facility, including using the Medicare score cards you can find on the Medicare (and in some states, Medicaid) websites. In addition, be sure it is close by so you can visit often. Visit at different times of day prior to placing her so you can get an idea of how the facility is actually run. Once she is placed, go often, again at different times, and check carefully to be sure she is getting out of bed, is not allowed to develop preventable pressure ulcers, is clean, has proper management of bowel and bladder, is free of restraints, and that her personal belongings (clothing, etc.) are not being stolen. Take her out on passes if allowed (short visits to your home, out to a restaurant or for a brief shopping expedition).

    Keep in mind that you may also be responsible to pay for the nursing home care. Medicare rarely if ever covers this. Unless she is eligible for Medicaid, other insurances rarely pay for it either. Nursing home care is not cheap, and many of the better homes will only take her if there is some assurance of sufficient resources to pay for care for a prescribed period of time. I had to place an elderly relative a number of years ago, and the nursing home I choose required to see her financial records to assure that she had the assets to private pay for 2 years. She was 98 years old at the time. Fortunately she had this type of income and assets.

    I visited my relative 3X a week, but only on Sunday afternoons was it the same day and time. At that time, we always had a nice chat and I did her nails (manicure) for her. It was a ritual we both enjoyed, and continued until her death there 2 years later. The nurses knew me, and knew that I checked up on her care needs being met, and that I was the one who took her to doctors appointments and out for short outings. They knew that I followed up on problems too.

    I hope that you don't have to take that step, but if you do, stay involved and hold the facility accountable for the care for which they are being paid, regardless of the source of funding.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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      #3
      Thank you for your post KLD. It is very helpful.

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        #4
        It is NEVER necessary to put anyone in a "facility", you just need to find the right supports to assist your mother with HOME & COMMUNITY based care. As KLD mentioned, nursing homes aren't free nor is home health care, but if your mother is eligible for Medicaid then in most states she is eligible for home and community based care. Nursing homes are jails for the elderly and people with disabilities, like jails some are worse than others, but "homelike" will never be home.
        http://about.me/joshuawinkler

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          #5
          'Keep in mind that you may also be responsible to pay for the nursing home care."

          Just to clarify, as the daughter, YOU are not responsible for the charges at a nursing home. You would likely be assisting your mother with bill paying but are required only to use up her funds until she has spent down to a level where she may be eligible for Medicaid.

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            #6
            Originally posted by Cripple Concepts View Post
            It is NEVER necessary to put anyone in a "facility", you just need to find the right supports to assist your mother with HOME & COMMUNITY based care. As KLD mentioned, nursing homes aren't free nor is home health care, but if your mother is eligible for Medicaid then in most states she is eligible for home and community based care. Nursing homes are jails for the elderly and people with disabilities, like jails some are worse than others, but "homelike" will never be home.
            Never???? Give me a break. My grandmother has advanced Alheimer's and had to go to a nursing home before it became advanced. It IS necessary in some cases. Not everyone can be a 24/7 caregiver for someone who has Alheimer's / severe dementia. Stop being so judgmental!
            Wife of Chad (C4/5 since 1988), mom of a great teenager

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              #7
              Originally posted by zillazangel View Post
              Never???? Give me a break. My grandmother has advanced Alheimer's and had to go to a nursing home before it became advanced. It IS necessary in some cases. Not everyone can be a 24/7 caregiver for someone who has Alheimer's / severe dementia. Stop being so judgmental!
              Agreed on all counts.

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                #8
                Originally posted by zillazangel View Post
                Never???? Give me a break. My grandmother has advanced Alheimer's and had to go to a nursing home before it became advanced. It IS necessary in some cases. Not everyone can be a 24/7 caregiver for someone who has Alheimer's / severe dementia. Stop being so judgmental!
                My mother had Alzheimer and in the end she was like a baby. It was impossible for me to take care of her. My father had her home but in the end he got so tired and he died three month after she came to the nursing home. She survieved three years there. I am still surprised how she could live there so long but she didn't know where she was, she did not recognize me the last two years, she couldn't speak and she was using diapers. How could I have her home? So I think zillazangel is right.
                TH 12, 43 years post

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                  #9
                  Clarification

                  I might not have been clear enough in my first post, I think everyone can live in the community provided they have the right support and care. I think it is unfair to expect any one person to provide 24/7 care, however with the right combination of attendants, nurses, family, friends, roommates, and volunteers I do believe even folks with dementia or very complex medical needs can be served at home. Without Medicaid this is difficult, and depending on the state even with Medicaid it is tough, but I think home and community based services for everyone should be our long-term goal.

                  Originally posted by zillazangel View Post
                  Never???? Give me a break. My grandmother has advanced Alheimer's and had to go to a nursing home before it became advanced. It IS necessary in some cases. Not everyone can be a 24/7 caregiver for someone who has Alheimer's / severe dementia. Stop being so judgmental!
                  http://about.me/joshuawinkler

                  Comment


                    #10
                    Originally posted by Cripple Concepts View Post
                    I might not have been clear enough in my first post, I think everyone can live in the community provided they have the right support and care. I think it is unfair to expect any one person to provide 24/7 care, however with the right combination of attendants, nurses, family, friends, roommates, and volunteers I do believe even folks with dementia or very complex medical needs can be served at home. Without Medicaid this is difficult, and depending on the state even with Medicaid it is tough, but I think home and community based services for everyone should be our long-term goal.

                    It is very very hard to afford and hire and train and screen 24 hour caregivers that are competent, don't steal from you, that don't abuse you, that don't quit, that are strong enough to help you in case of a fall, and that your family and loved one get along with. To juggle all of the appointments, personal needs, emergencies, finances, insurance claims, medications.... it can be utterly staggering. You may need a full time person to organize the right combination of attendants, nurses, family, friends, roommate, and volunteers. But ultimately, the management of a complex patients has to lie in the hands of one person, or mistakes happen. And as we age with SCI or many other medical problems, we can become incredibly complex.

                    Even if you can afford to hire through an agency, many have all learned those caregivers are no better.

                    Often homes are not safe, or truly accessible for emergency situations/all situations.

                    Sometimes you simply need 24 hour nursing level care, and no one can afford that, and Medicaid will not pay for it in the home.

                    Often patients will not tolerate having many different people coming in/out of their home at all hours, and find this more upsetting/confusing/scary.

                    Resources available vary drastically from city to city, state to state. If you are not immediately Medicaid eligible, sometimes it is the worst position to be in, as you cannot be linked in to a system of organized resources. Although their quality may be questionable.

                    KLD's post is excellent.

                    I abhor nursing homes, and have even been shocked by the poor care that I saw at some of the "very good" hospitals that I have experienced in the past few years. I do agree that no one will ever take care of your family member as well as you do. I do agree that we should make every effort to re-direct federal/state resources to allow people to stay at home with support... to "age in place".

                    But come ON...... I suspect you have never organized the care of a complex medical patient before, trying to live at home. Sure everyone CAN live at home with the right support. But do you understand that it can be impossible to have that support in any sort of stable, reliable, affordable fashion?

                    Sorry if you are surprised that some of us are sensitive to your posts, but you clearly haven't been on the other side.
                    Last edited by hlh; 20 Jun 2012, 11:00 AM.

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                      #11
                      Both of my parents ended up in nursing homes before they died. It was an agonizingly tough decisions, but when we got to that point, there was no other choice. The both needed 24/7 care and the resources to provide it were not available except for big bucks. Paying for 24/7 home care comes to $175,000 at today's prices, around double a nursing home.

                      It's a tough decision and you'll probably feel lousy about it, but it will do neither of you and good if you start running yourself into the ground. Good luck and God Bless...
                      Tom

                      "Blessed are the pessimists, for they hath made backups." Exasperated 20:12

                      Comment


                        #12
                        What if you live in an area where there are no agencies that will accept them?
                        We have several agencies here, but if for instance would not accept my husband.
                        I find aides on my own which is tricky and sometimes unreliable.
                        A friend of mine cared for her father at home several months and even with medicaid and an agency she had to take a leave of absence from her job and put herself in financial peril. She needed her job to keep health care for her daughter.
                        None of her siblings wanted to help.
                        Having to make a choice about nursing homes is agonizing for people.
                        I am doing everything possible to keep my husband out of one, but what if I die?
                        My adult children can't give up their lives, his family are scattered and in denial.
                        My 45 year old cousin has MD and it has progessed to the point where she can not even live in a group home. Her sister brought her home and on top of raising 3 boys and working managed for a few months, but their home is a split and my cousin broke her foot.
                        She is getting rehab and staying in a very nice NH and has decided on her own she might stay there.
                        Her sister is so torn by all of this and thankfully no one has been judgemental to her.

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                          #13
                          Originally posted by hlh View Post
                          Sorry if you are surprised that some of us are sensitive to your posts, but you clearly haven't been on the other side.
                          AMEN! I find it TOTALLY unrealistic to say that ALL people with advanced dementia can stay out of nursing homes with community based resources. FAIL! There AREN'T such resources. Period. If there were, I would be using them to help take care of my high quad husband.

                          Nursing homes can be deplorable, they can be mediocre, they can be good. But they are necessary in some cases. Get off your high horse and don't lecture those of us in the trenches.
                          Wife of Chad (C4/5 since 1988), mom of a great teenager

                          Comment


                            #14
                            Originally posted by Cripple Concepts View Post
                            .....the right combination of attendants, nurses, family, friends, roommates, and volunteers I do believe even folks with dementia or very complex medical needs can be served at home. ...
                            You'll pardon me while I spit my soda at my screen.... Volunteers. Yah right. Friends. Nurses, paid by who? Roommates? Give me a break! Sorry to be so rude, but you clearly have not dealt with this before. (and if you have, please enlighten us)
                            Wife of Chad (C4/5 since 1988), mom of a great teenager

                            Comment


                              #15
                              I have been fortunate to have never spent time in a nursing home, however I have friends who haven't been as lucky. Several folks mentioned home health services are not free, do you think nursing homes are? I understand 24/7 care is difficult to arrange, and some areas of the country are worse than others. The original post said "At what point will I know if she should be living in a "Facility" vs living with me?", my point was there is no point when someone "should" be institutionalized and that there other potential options available.

                              Instead of complaining that the services aren't available to serve a loved one at home so they "have" to be incarcerated, sorry institutionalized, I think more of us should be fighting to get funding to make home health services available to all people who need them in all 50 states. I rely on Medicaid funded, consumer directed home health service for my daily survival. I am fortunate to only require a few hours of care a day, but know others who need 24/7 care and get it covered by being creative with who can provide care. It isn't easy, but it is getting better, things like Community First Choice (part of the affordable care act) will help make it possible to live in and receive care in the community. Freedom doesn't come free, I spend 2-4 days every week in Medicaid meetings trying to make things better in Colorado.
                              http://about.me/joshuawinkler

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