Parent in nursing home

[Rough Edge racing]

  My wife's mom is 92 years old and dementia is  taking hold, never mind congestive heart failure. My wife goes over to her house every day for a few hours to help her. One of my wife's two useless brothers lives at home with the old woman but he's little help and contributes nothing to the upkeep of the home.......
...Make a long story short...My wife is at wits end taking care of her mother...Besides my suggestion to fill her pockets with rocks and push her into the pond, it might be time for a nursing home.
  We are somewhat aware of the financial dealings of nursing homes.....if any of you have personal experiences to share with putting a parent in a home I would appreciate the advice....We live in NY state if that makes a difference...Thanks

[Lannis]

I've been through it.   My mom had the choice of living with us and we'd care for her, living at home and we'd have someone there caring for her, or living in an assissted living home.

She wouldn't accept any of those.  She wanted to stay by herself, the way things always were. That's why they call it "dementia" - at some point, rational decisions are no longer possible and you have to do what is the best and least intrusive thing for the ones you love.

After the third time of being carried out of the house on a gurney, we chose to move her essential furniture into an assisted living home, made it as home-like as possible.   Took her about 2 months to get used to it, then it was OK.   HUGE peace of mind on our part knowing she wasn't just laying on the floor between our calls and visits.

Cost about $3500 a month.

Your situation may vary.   I and her other children were 100% together on it, that helped a lot. 

Good luck!

Lannis

[Tobit]

If it's any help, you're not alone in this.  My mother-in-law has Parkinson's and is unable to live alone anymore in her house.  We moved her from her home in Kentucky to a senior high-rise here in Memphis two years ago where she gets meals, laundry done but still has her own efficiency apt.  The stress has been tremendous for my wife, and me, as wife's sister has written the mother off and will not even talk with her.  

On the other side of the fence, since my dad passed away, my mother (81) will be moving to a small house near us next weekend.  I'll by flying to Florida to drive her back.  She's in and out of the hospital frequently but insists on being self sufficient but is very needy for time, loves to spend money, which she won't accept is in finite supply, and with two teen agers, we're pretty swamped on a daily basis.  Neither one of the mom's are anywhere near being declared incompetent so are free to make their own choices.  Something my mom never had to do while dad was alive.

The sandwich generation.  Care givers to younger and older family.

Sincere wishes that you get the answers you need.

Tobit

[Rough Edge racing]

 Thanks...and if she live longer than her money....Medicade takes over???

[Gliderjohn]

I can only comment on Kansas. About six years ago when my mother was in her 90s she was getting significant dementia and then had a suspected stroke. It was then we had to use a nursing home. We are lucky to have several decent nursing homes close to us and was able to put her in on about 10 miles from our house. Average cost about 6-7K per month depending upon services that particular month.
Although this home was a good one as far as nursing homes go it was still a nursing home. Here are some suggestions from our experiences.
1. Do your best to work with the staff in a supportive and tactful way. Most really do want to provide the best care possible.
2. Drop in at different times and days.
3. Check the state inspection reports. Most states require them to either be posted or available upon request.
4. There usually is not much closet space so try to rotate clothing for the season.
5. Visit on a regular basis, not only to support your loved one but to impress on staff that you care and will be around.
6. Try to assist so that the room does not become cluttered.
7. Minimise temptation by not having expensive jewelry, etc. in the room.
8. Let the staff know you appreciate their efforts with a verbal thank you or occasional card.
9. We always tried to bring appropriate treats for the staff on holidays.

A nursing home is never going to be ideal but is sometimes needed. YMMV.
GliderJohn

[Tobit]

Thanks...and if she live longer than her money....Medicade takes over???

That's the concern.  Like or not, both women have longevity in their genes.  My grandmother lived to 103, my wife's made it to her late 90s.  We're aware that after our kids have gone off to college, that one of the mother's will be living with us.  

The MIL has a house to sell in Kentucky after thinking renting it out would be a good idea.  The biker couple stiffed her on rent, broke out all of the windows and stole the appliances when eviction was near.

Fortunately, my sister lives a few hours away so I do have some family support, but I know I can't control her finances and will only frustrate myself if I think otherwise.  Lots of heart to hearts about money but denial is powerful and well entrenched.

I take it one day at a time and try not to borrow trouble.  GliderJohn gives solid advice above.

Best of luck to you.

Tobit

[neverquit]

I went through a similar situation more than once.  Eventually something will happen, there are two categories.  One is a fall or some other health related problem that will put her in the hospital.  Once there the hospital may consult adult services or whatever it is called in NY and they will only discharge her to a nursing home.  The second scenario with dementia is that she will start calling 911 or doing some other behavior that will attract the attention of some government entity that will in turn call adult services and they will pressure you to place her in a nursing home.

There is a huge difference in nursing homes.  What you should do now is start visiting them.  Some of the better ones even have waiting lists, you can sign up at any time even if you are not ready to do it, when her name comes up they just call you first each time there is an opening.  Some advertise care for dementia patients but charge extra, a lot extra, find a place that treats and bills dementia patients the same as everyone else.  After all, most people in a rest home have some degree of dementia anyway.

Tour the facilities, look mostly at the personnel.  The people tending the patients are more important than any fancy plantings, rec rooms etc.  Once in a home older people tend to stay in their rooms anyway.  Talk cost with them, find out rates for single and double rooms.  Find out the cost for things like laundry, Kleenexes, haircuts, all of it is extra.  Find out if you can provide some of those things yourself, cheaper.

You'll be amazed at the differences in homes.  So start shopping now, the day is coming when she'll have to go.  

[Lannis]

Thanks...and if she live longer than her money....Medicade takes over???

That's the really hard part.   Medicare/Medicaid will "take over" in a sense, but they don't provide anything besides a bare competence and the facilities aren't generally one you would pick for Mom.

It usually falls on the family.   Very few are prepared for it ....

Lannis

[jreagan]

My Mom wanted to live by herself until she fell in the bathroom.  Fortunately, no damage.  However, it scared her enough to say she wasn't safe at home.  One of her hips is missing (temporary spacer in place) and the other has severe arthritis.  She uses a wheelchair for mobility.  With a history of MRSA etc. no further surgery is planned.  

She has no money (and neither do we) for assisted living.  We barely covered her rent.  So is now in Medicaid-paid bed in a local nursing home.  It is rather nice if understaffed at times.  We got in via a hospital visit covered by Medicare and then discharged to the nursing home.  They end up taking her entire $900 SS check (minus $40 for personal needs) and the state picks up the rest of the cost.

The Kentucky state process for getting Medicaid approval was rather intensive.  I don't know how one could scam it.  I have a portable filing box and they wanted tax returns, financial information, bills, birth certificate, bank statements, etc.  They scanned at least 80 pages of stuff into their system.  My Mom did gift us some money several years ago before her health turned worse.  That wasn't a plan to work around the system, but it was within their 5 year window.  That got figured into the process as well as a 'delay' to begin coverage.  They have a yearly review as well (just went to the state offices last week where they scanned another 10 pages of stuff).

[Gliderjohn]

I might add that if your loved one is in a home for any length of time you will probably get to know and become attached to other residents. It is heartbreaking to see how many nursing home residents that have no one to see them or support them or at best relatives may come by at a birthday or holiday. We tried hard to interact with those folk. I about broke down when one resident that we always made a point to interact with just grabbed my hand one day and kissed it.
One other female resident in her upper 90s was as sharp as a tack and had a Masters degree. She was very physically fragile however. We were visiting one day when she said to me that she wished she could jump on the Guzzi with me. If there would have been any reasonable possible way I would have done it in a New York second. She also knew about everything concerning KU basketball and rarely missed a televised game.
GliderJohn

[Rough Edge racing]

That's the really hard part.   Medicare/Medicaid will "take over" in a sense, but they don't provide anything besides a bare competence and the facilities aren't generally one you would pick for Mom.

It usually falls on the family.   Very few are prepared for it ....

Lannis

 My mother in law has about 100 grand, Social Security and a crappy old house worth 75K. So let's say she goes into a home or assisted living at 4-10 grand a month...After a year or so her money is gone...They don't kick her out but the home has to accept Medicaid at that point? I believe Medicaid pays about $3000 a month??
 My wife has had Power of attorney over her affairs for several years....

[Gliderjohn]

I think Medicaid payouts may be different in different states. In Kansas most nursing homes are non-profits including the one my mother was in and all as far as I know accept Medicaid patients. Her costs were covered my Medicaid since she had no assets at the time. Medicaid would cover costs except for personal services like getting her hair done. Medicaid allows the resident to keep $30 dollars a month, her SS, etc. would go to the state.
GliderJohn

[Petrov]

  My wife's mom is 92 years old and dementia is  taking hold, never mind congestive heart failure. My wife goes over to her house every day for a few hours to help her. One of my wife's two useless brothers lives at home with the old woman but he's little help and contributes nothing to the upkeep of the home.......
...Make a long story short...My wife is at wits end taking care of her mother...Besides my suggestion to fill her pockets with rocks and push her into the pond, it might be time for a nursing home.
  We are somewhat aware of the financial dealings of nursing homes.....if any of you have personal experiences to share with putting a parent in a home I would appreciate the advice....We live in NY state if that makes a difference...Thanks

You in Rochester area?

[neverquit]

I thought of a few more practical issues that deserve mention.

In my area the nursing homes run about $160 to $200 a day.  Then you still have to pay for medicare supplemental and any other expenses such as property tax on her house etc. So it will cost you roughly $60000 to $80000 per year to keep her in a home.  The first several months can be covered by medicare if during the admission process you have her admitted for rehabilitation.  If for example she has had a fall ask for physical therapy and maintain the premise that she is there to get better.  Medicare will then pay for the first 90 days or something like that.

If you can, keep her in her home as long as possible.  People go down hill rapidly and don't last long in rest homes.  They survive better and function better in their own homes.  Home health assistants may become necessary.  They take a big burden off the family and the patient also likes a break from family members who tend to get involved in arguments and generally become grumpy due to the stress of the situation.  The health aides will run about $15 an hour or more.  Round the clock health aides will quickly surpass the cost of a nursing home.  So you may be able to get by with having health aides in the morning for dressing, shower, breakfast etc. and again in the evening to get the patient ready for bed.  That way your only paying for roughly 4 hours per day or $60+.  It will all work out.

[Rough Edge racing]

You in Rochester area?

Yes,Ontario...ride over and share a beer  ;D

[Petrov]

Yes,Ontario...ride over and share a beer  ;D

My wife took care of her grandma for a while. Her dementia has gotten really bad and they had to move her to a nursing home. They moved her to a place called "The friendly home", it is expensive from what I have been told but every time we visited there the place was clean and well run and the staff seemed nice. I can ask my wife for more details but I had a good impression of the place.

Sadly I cant ride over, need to change the oil pump in my Norge first but thank you for the invite.

[PeteS]

Yes,Ontario...ride over and share a beer  ;D

I am in Monroe County. There are a number of good homes in the area but prices in NY tend to be considerably higher than other states. Some have three tiers of care. First is a live alone apartment with access to on site meals and health care, then assisted living with full time staff for those who can get around by themselves, then full nursing home where meals have to brought to the room. Each one gets more expensive. All require full financial disclosure. Many won't accept them unless they have the equivalent of two to three years of full payments ($200K-300K typical) covered before Medicare kicks in. St Anns on Portland Ave is one of the good places. Friends have experience with others if you need more names.

Pete

[slowmover]

On the lighter side, my father was in a facility and called 911 from his cell phone to get an ambulance there because the nurses were ignoring him.They told me he couldn't have his phone no more.

[Lannis]

Sit down with the social worker at one of the nursing homes and get them to explain how "spend down" works.  An elder person's assets are used to pay almost all of the nursing home's costs until the "spend down" limit has been met.  The nursing home may have different levels of "care" depending on the person's funding source.  It is important to know what level of "care" (including room situation) will be enforced when a person's assets are gone ("Medicaid only" funding).

Here's a problematic wrinkle, the son who is still in the house may be out of a place to live.  If he sees that coming things may get really ugly.

Good luck!

Good advice.   The admissions and business people at my Mom's assisted living place were really good about explaining it all, and what they would accept and what they wouldn't, and it worked out well.

Mer Personal? If life happens such that I'm alone, and it's getting hard to "do for myself" - I'm forgetting my medications, and it's hard to get dressed, and hard to fix meals - I'd sell the house and move into that place in a second.    People looking after you, and cleaning your rooms (she had a kitchen, bathroom, living room, and bedroom), and fixing your meals for you, and washing your clothes - you don't have to hit a lick if you don't want to, and if there's no family to carry you places, there are car services that will take you anywhere in town you like for not much money.

But if your mind is starting to warp, and you don't think you NEED help even though you desperately DO, that transition can be tough.

Lannis

[lucydad]

RoughE,

Lots of excellent advice already given.  We have gone thru the "crisis health event" and move to hospital, then rehab, then assisted living small room, and last week assisted living large room.  I have also rented out mom's house after basically giving away most of her stuff. 

It is not easy and the balance can be very frustrating.  The oldsters tend to erupt in anger due to loss of control and rapid changes. 

I think if I could turn the clock back for a re-do:  I would have insisted mom sell the house and stuff and move closer to us while still healthy enough to travel.  We burn huge time, money, energy just traveling to CO from TX (3 times in last 9 months).  My older brother is zero to negative-drag due to his own anxiety/depression issues.

Next up is my wife's father with Alzheimer's.  Fortunately he is local and has an extended family to help. But they are ignoring the situation (mistake in my opinion) waiting for the inevitable crisis event.

Good luck, keep your poise, and keep your emotional boundaries.  Don't burn out or give your life away.

[blackcat]

My father wanted to stay at home and other than a somewhat mild case of Parkinson's he was in reasonably good health given a lifetime of smoking. My brother had other ideas and dad ended up in a series of nursing homes from good to bad and his mental health collapsed. Me being the younger brother living out of state and not having power of attorney, there was nothing I could do and I tried.

I say throw the brother out and bring in some outside help for as long as possible before putting mom in a home. Personally, I hate the places and even the good ones give me the creeps.

[toma nova]

Location, location, location.

Make sure she is as close to you and your wife as possible - you want a five minute drive to visit her, not 20-30.  The closer she is, the easier to visit / check on her which will make the situation better.  Good suggestions about interviewing places now.

My GM was at St. John's next to Highland for a couple of years (103 y.o.) - good care and reasonable cost but too far from Ontario for convenient visits.

BTW, I used to work at Mott's on 104 - I loved driving in with the windows down when we were running cinnamon apple sauce!

Good luck,
Tom

[jreagan]

The first several months can be covered by medicare if during the admission process you have her admitted for rehabilitation.  If for example she has had a fall ask for physical therapy and maintain the premise that she is there to get better.  Medicare will then pay for the first 90 days or something like that.

Medicare has a 100 day limit.  The first 20 days at 100%; the next 80 days at 80%.  Then there is a 90 day gap before you can get another 100 days for a different medical event.  So don't have another medical issue for 90 days.

[Sasquatch Jim]

  This thread should be posted in an Ann Slanders forum.

[Rough Edge racing]

BTW, I used to work at Mott's on 104 - I loved driving in with the windows down when we were running cinnamon apple sauce!

Good luck,
Tom

 I was an electrician and did contract work at Mott's and many of nursing homes in the area....Some of what I saw makes me think if I get like that just sit me on a motorcycle to stave to death...... The sticky part is my wife and her mother never got along well..and now my wife gets stressed and pissed off at her mother's stupidity,mostly caused by dementia. But the old bat still is capable of being devious at times...I can see being a caretaker is taking it's toll on my bride...she cringes when the phone rings and it her mom or the dumb ass brother complaining about mom....It's really a shame when a person outlives their usefulness......On a lighter note, my mother in law was a woman Marine during WW2....

 I appreciate the advice and will pass it on....

[Lannis]

I say throw the brother out and bring in some outside help for as long as possible before putting mom in a home. Personally, I hate the places and even the good ones give me the creeps.

"Putting Mom in a home" sounds "heartless" but might be the only option sometimes.

If Mom is still able to reason and to make rational choices, then you can work with her and take whatever path SHE wants to take - whether to have someone in at her home and convert it to disable-accessable, or to convert part of your house to a nursing home and have Mom in with you.

But if she is frantic and panicky and completely unaccepting of either of those options, because her "social filters" are gone, and all that she can express is fear and paranoia, then professional care, away from you, may be all that is possible.   

Most people aren't blessed with caring for an older relative who can make rational decisions.

I've heard people say "It's 100% the family's responsibility to take care of their parents, and anyone who 'puts them in a home' is a heartless slacker."

What that means is that they've never had to deal with the situation where Mom is not only miserable but frantic at the idea of family caring for her, but who can live with the idea of "being on her own" in another place, where other people are caring for her and you oversee it.

There ARE nice places that don't smell of urine all the time.

Lannis

[Rough Edge racing]

"Putting Mom in a home" sounds "heartless" but might be the only option sometimes.



But if she is frantic and panicky and completely unaccepting of either of those options, because her "social filters" are gone, and all that she can express is fear and paranoia, then professional care, away from you, may be all that is possible.   

Most people aren't blessed with caring for an older relative who can make rational decisions.

I've heard people say "It's 100% the family's responsibility to take care of their parents, and anyone who 'puts

them in a home' is a heartless slacker."

What that means is that they've never had to deal with the situation where Mom is not only miserable but frantic at the idea of family caring for her, but who can live with the idea of "being on her own" in another place, where other people are caring for her and you oversee it.

There ARE nice places that that don't smell of urine all the time.


Lannis

  She never was able to makes decisions and old age has only made it worse. She can drive you nuts with asking the same question thirty times in a row.........
   I don't care where she lives except caring for her is running my wife into the ground.  A lot of drama.....

[nunzio]

We had my mother stay with us for 5 years.

Felt really bad about her going to a nursing home until I came in one day I came in her room and saw how they were able to handle her, physically and emotionally.

They handled her in a way that we could not....Less stress for her and them.

I visited at ALL times of the day or night to check on them.

Just to make sure she was well taken care of...Alan

[Rough Edge racing]

 Follow up.....At 3 am on Christmas Day my mother in law was doing the dementia wandering around and fell down. Call the ambulance and into the hospital. Her leg was pinned,  amazing a 93 year old survives surgery....Two weeks in the hospital and then we talked to the hospital social worker and got her into a local nursing home for supposed rehabilitation....
 This nursing home is unreal, a five star "Ritz" hotel with plush carpets and art  on the walls  I want to check in  ;D. The cost is also unreal, $411 a day. But around here even the more typical institutional type homes are 350 and up per day. Her insurance will stop paying pretty soon and then.....We talked the the social worker at the Ritz and we're told the minimum assess for admission for long term care is 300 grand. However, they said my wife's mom can't be kicked out so to speak unless another place is found. She has enough money to stay at the Ritz for about 14 months, they  might let her stay anyways.....We have appointments with several more homes.
  We now what goes on from first hand experience...Thanks for those who contributed information here...Tony

[hammick]

One other female resident in her upper 90s was as sharp as a tack and had a Masters degree. She was very physically fragile however. We were visiting one day when she said to me that she wished she could jump on the Guzzi with me. If there would have been any reasonable possible way I would have done it in a New York second. She also knew about everything concerning KU basketball and rarely missed a televised game.
GliderJohn

You had me until that Chickenhawk stuff ;D. Go Tigers?