How does one go about researching Assisted Living? UPDATE last post

[Ginevra]

I have little influence (MIL), but can present info to dh, which he could (in theory) present to his siblings. 

My MIL has been staying with her kids on a rotating basis, which has been working acceptably well for the past three years. But now it is, IMO, approaching not working acceptably well. She has gotten hurt or had a medical emergency at each house for the past...hmm, maybe four or so different stays. Yesterday she fell and broke her collarbone and a couple of ribs. She is in hospital now. In the past year, her care when staying with someone has elevated to a level similar to having an infant. She is not to be left unattended any more. She needs personal care (intimate) help. She requires constant assistance to prevent falls, which is how she has been getting hurt. She takes around nine daily medications and has blood pressure monitored daily. 

Anyway - all that to say in my personal and unspoken opinion, it would be wise to consider a different living situation where her needs can be appropriately managed at all times. My dh agrees with me but we both know certain family members would be vehemently against it. It seems to me, though, that having some info solidly in hand could help if/when this conversation (the one nobody wishes to have) is addressed. I think it would be good if he can give numbers and avenues as possibilities and as a solid plan. 

Advice? BTDT? 

UPDATE: Social worker is directing the family to skilled nursing. Thanks everyone, so much for info and PMs. 

Edited December 10, 2018 by Quill

[itsheresomewhere]

Are you on any local Facebook groups?  If so, ask on there as you will get some really good opinions and details.  

AsK the hospital social worker if they have any recommendations.  Then research them. 

[Annie G]

I’m no help when it comes to researching options, but I do want to commiserate with you about how difficult it is when a sibling group can’t agree on something. We cared for MIL and did a really good job up until the last six months of her life. I knew I was beyond my skill ability to provide her the care she needed, but sister in law wouldn’t even consider letting other people come in to help, and a facility was out of the question. That last year was so difficult and it took me about 8 months to recover from it.  

I hope your dh can influence his siblings and you can find a good solution. Honestly, caring for a loved one on your own at home isn’t always the best choice. She’s falling, she needs a lot of one on one care, and it might be time to bring in the professionals or find a facility where she can be safe and well cared for. I know...preaching to the choir. 

[Guest]

1 minute ago, Seasider too said:

First thing is to assess her finances. That will help you know what options can even be considered. 

FWIW, I appreciate the devotion you and your sibs-in-law have demonstrated these years. But as a person becomes elderly, familiar surroundings are really important. Should MIL’s memory decline, routine will be her default. It’s important to give her enough time in one place for that routine to become somewhat automatic- routine of schedule, routine of movement, routine of caregivers... This would be a big point for dh to present, along with the need for medically qualified caregivers. 

I do know the one BIL is her financial executor and he has a good handle on her finances. There is quite ample money available (I don’t know the details but I do know it’s ample), and that would be true even if no kids put a penny towards help. But that possibility also exists, as none of her children are in a grim financial position, although how well-supplied does vary. 

She has dementia now and the consistency issue has been a problem (IMO) already, when she shifts to a different family home. She has had visits from a care nurse twice a week for maybe a year, which has helped, but it (obviously) doesn’t help when she falls or her blood pressure goes bananas. 

[Suzanne in ABQ]

There are a couple of online services that are free referral agencies. You talk to them about your MIL's needs, and they assess what level/types of care she requires.  Then, they match those needs with the facilities in your area.  They know all the services offered and the published service fees.  I found them very helpful when I was looking for a place for my mom.

APlaceForMom.com

Caring.com

Then, from there, you call the facilities you're interested in (or they call you), and you go in for a visit/tour/interview.  Your MIL doesn't need to be involved until you have narrowed them down.  Some places will offer you limited time special offers.  I hate those high pressure tactics, but they may be unavoidable. 

[PeterPan]

She may be beyond the level assisted living will take. It's also something to consider. We put a loved one into assisted living two years ago, and we didn't really spend a lot of time dickering over the virtues. There are significant, well-documented issues with assisted living, and what it boils down to is the family being cognizant of what care is NOT provided. AL is not a skilled nursing facility. It's independent living with meals, a concierge, housekeeping, on-call assistance, and the optional upgrades of assistance (bathing, laundry, etc.). The average stay for AL is the same as skilled nursing facility, 3 years. Some AL facilities are joined with skilled nursing or dementia units, which can lessen the number of transitions.

We put our loved one in assisted living because the level of service fit the level of need. At the time, the way the facility was structured, the were VERY strict that if you had ANY injury that required skill nursing (an injury that required you to leave to go to the hospital), you did not come back. It was just over, toast, out you go. However they got bought out by another chain, and frankly things have changed. Strange things are happening, with lots of rooms (apartments) empty and this shift in emphasis on nursing. So they may be acknowledging the dangers of needing care and not having access to care. If you are there and your health declines, they will let you finish your days by bringing in your own nurses, etc. So in that way, it can be a really peaceful, nice place to be.

Assisted living is particularly nice for people who thrive on or are ready to participate in activities. It's not that it's required, but that's part of what is provided. Where our loved on lives, there are activities every day of the week, shuttle buses, group outings (trips to other cities, nice stuff!), etc. There are also lots of social opportunities, with in-facility concerts and programs, nightly self-initiated card game clubs, etc. For our loved one, their health actually *improved* with the stability and good living situation. Your MIL might find something similar, that she enjoys the social of being in with her peers and the independence of having her own apartment, etc. Yes, they'll nail meds, house keeping, etc. 

AL is almost as expensive as some skilled nursing facilities. Many people use long-term care insurance to pay for it, so maybe your MIL has that. We purposely went on the higher end, because we wanted better food, better activities, and safe, interesting people to be with. It has worked out well, no regrets. 

[PeterPan]

6 minutes ago, Quill said:

She has dementia now

So you're looking for a unit that can handle dementia. Not all AL have that. 

12 minutes ago, Quill said:

There is quite ample money available

You're probably talking at least $4k a month and that's in a very modest COL area. 

Fwiw, one of the things I looked for was stability in staffing. I saw reviews online of places with really high turnover, and to me stability in the staffing is part of what makes the experience comforting and dependable for the resident. Also it's a good sign if it's hard to get in. Like I said, I'm really concerned that this other company bought out where my loved one lives and things have changed and so many rooms are open. Tells me there may be something going on that my loved one can't tell me about, because before it was hard to get in, with openings going very quickly. 

I can tell you, from my own experience as the person who signed on the line, that some administrations are easier to work with than others. The previous owners/company were very easy to work with. I could write them and say how is so and so, and I'd get a reply. They actually wanted to hear from me. With the new ownership, I'm a number, another dollar in, and frankly if my loved one were any less independent I probably would not choose this place. They've ruined the personal touch and personal level of interaction by going so corporate/national. It's really a shame. And when you see the exposes on tv/youtube, it will be really big, national chains. So put some stock in just that gut level wow they really responded to my concerns and I could get a hold of them. So much easier than a corporate manager who's never around and gorilla nurses who don't return your emails.

[PeterPan]

6 minutes ago, Seasider too said:

Also, I’m wondering if she is actually at the point if needing skilled nursing rather than assisted living, considering the dementia. Her doc should weigh in on that, he would have to write orders for skilled nursing admission. I’d act on that pretty quick, as the swiftest way to get a placement is directly from the hospital discharge. 

Bingo. There are AL facilities that can handle dementia, but it sounds like she's on the line toward needing at least an AL facility with a skilled nursing facility wing. Then they just transfer from one side to the other as needs change.

[PeterPan]

I looked on glassdoor to get employee reviews. I wanted to see happy employees who were adequately paid, without high turnover. My theory was that would help lessen stealing, etc.

[Frances]

One you have an initial list to consider, I would check to see if any of the facilities have a volunteer ombudsman and if you can talk to them. The program exists in every state, but not all areas have enough volunteers for every facility to have one. They are patient advocates who have 24/7 unrestricted access to the facilities and interact regularly with staff, residents, and management, so they really know the true nature of a facility.

[livetoread]

My folks are on a waiting list for an AL place now. After a lot of research, they decided to pursue the two places that are affiliated with denominations and avoid the corporate owned ones. The two religious ones have been operating under the same management for decades, while the others seem to be bought out often. You agree to certain terms, then they get bought out, and who knows? 

Also, I agree that it sounds like she is past assisted living. 

[Guest]

30 minutes ago, Æthelthryth the Texan said:

ITA. If y'all haven't already, I'd pay a visit to an elder care attorney to see what you can do to protect any remaining assets, or how to deal with assets that may prevent her from qualifying for other programs. There are things you can do to shift titles, etc. that may be worth exploring. 

That’s part of why I’m hampered; I’m not in a position to do anything this assertive. The BIL in control of the money seems, to me, one of the teo least likely siblings to think about, let alone plan to place her in any facility. 

[prairiewindmomma]

We have a relative in a dementia facility (it’s a small group home), and it runs $8k/month. She still has had falls—the most recent was a broken hip from trying to get out of bed by herself in the night. 

A few thoughts in addition to the above pp’s.

1. I think there comes a point where even with good care falls can happen. Skin becomes fragile, bones are weaker, balance goes, and impulsiveness increases. Balance training and PT/OT are good ideas if funds and enough awareness is there.

2. There are tests to assess where one qualifies for nursing home care. Based on what you share, I think that’s likely the more appropriate placement. She would not qualify for the AL facilities we’ve toured.

3. Sibling disagreements seem to be the norm more often than agreement. I have stories I won’t share here, but I understand how hard it is to sit back when you don’t agree. 

[Guest]

1 minute ago, Seasider too said:

 

The others making a firm statement about not participating in the housing rotation any longer might sway him, unless he actually wants her at his home full time. 

The minority of siblings (dh and one brother) have said we can’t bring her here, and in our case, it is more because of my cancer diagnosis than just saying no, we cannot. She was scheduled to come here when I was dxed. So there are two siblings who seem to completely accept her being there (money brother is one) and two that seem to go along with it somewhat grudgingly, and two who, at the moment are saying it just does not work for us (including us, but with my cancer as the “excuse”). 

Basically, the two siblings who are saying it doesn’t work for us are being framed as the “bad guys”, except we are a little bit escaping that lable at the moment because I have cancer. The other “no go” sibling has two employed people and that is their “excuse”. 

I am not sure we can all get through this without some hard feelings. 

[gardenmom5]

I wasn't ready to post . . .

 

some questions to ask.  my mother was in two different sr. living, and an assisted living facility.

call buttons in their rooms (and especially bathrooms!)

how much support do they offer?  and what are the charges for different "extras"?

what meals are served in their dining room?  can they have meals in their room?  is the food appetizing?

    special diets?   low salt?  finely minced (swallowing difficulties)?

maid service?  what does it  include? how often?

medicine?

is there a RN on staff? 

escorts?  some get lost easily.

what activities do they offer?  how often?  do they offer exercise classes?  field trips? (where?)   transportation to dr appointments?

how clean is the place?  is the air fresh?

how many do they have on their support staff?  enough for the needs of the residents?

Edited December 10, 2018 by gardenmom5

[gardenmom5]

7 minutes ago, Patty Joanna said:

  i mentioned that my dad fell and my mom and sister couldn’t help him up. 

 

even in a rehab center (and sr. living/assisted living) - they will ONLY help lift if they HAVE a lift device.  the risk of injury to the staff is too great.  they will call 911.

my mother fell.

 

if your mil is falling - she needs to be somewhere with 24/7 medical support on site.  the likelihood is her condition will continue to decline and onsite will be better able to help with medical needs.  the last place my mother was, they dispensed her her thrice daily meds (she was able to administer her own albuterol  - which was very $$eek$$ for them to do it.)

[fairfarmhand]

A social worker may actually be a huge help in making “official” suggestions. These people are professionals who see lots of old people.

[Guest]

1 minute ago, fairfarmhand said:

A social worker may actually be a huge help in making “official” suggestions. These people are professionals who see lots of old people.

Yeah, but my feeling is they will talk to Bright Capable Brother, who will assure them there is a better-than-average support system (which is true) for MIL, and will most likely put any social worker off the scent trail of “this is a family who needs help.” 

[gardenmom5]

10 minutes ago, Quill said:

Yeah, but my feeling is they will talk to Bright Capable Brother, who will assure them there is a better-than-average support system (which is true) for MIL, and will most likely put any social worker off the scent trail of “this is a family who needs help.” 

condolences - the last three months of my mothers life - I spent most of my time fighting my brother's "attempts" to care for her (while making hospital, sr. living, and rehab center staff nuts and begging me to shut him up).  he was a huge hindrance, even though I had her medical poa, and dh had her financial poa.  and I was recovering from pelvic surgery and had a kidney infection.  fun times.

my biggest regret - when the ER dr wanted to have hospital security toss him out on his posterior because  he was manipulating her IN FRONT OF THE DR!  he was that brazen.  hey, he'd already suckered a nurse into thinking he was wonderful, and I was the one who didn't care about my mother. (after the dr. consulted with the hospital attorneys - then the dr called me to tell me what was going on and get my input.) - I regret telling the dr to tell him he could have what he wanted, and he'd leave (at 12:30am.  which he did - brother left.)   I wish I'd have said 'throw the @>>> off the hospital campus.  It might have humbled him.

Edited December 10, 2018 by gardenmom5

[moonflower]

For $4k or $5k a month, it might make more sense to hire someone to help out in the home as a personal assistant to her when whoever is supposed to be taking care of her cannot be there with her physically.

[gardenmom5]

3 minutes ago, moonflower said:

For $4k or $5k a month, it might make more sense to hire someone to help out in the home as a personal assistant to her when whoever is supposed to be taking care of her cannot be there with her physically.

depends upon the needs.  just some help?  or 24 hour care?   what equipment would be needed?  special diet?  (royal pain to prepare if you're also cooking for a family.)  and a family member who has to do everything else to run their life while caring for the elderly family member's needs - is quite taxing.

depending upon her condition, it can be considered as an option.   but we tried that with both my mother and grandmother - neither of them liked the people and would complain.  

[Storygirl]

My mother has Alzheimer's and has been living in a skilled living nursing home for seven years. Before that, I cared for her in my home for close to a year.

First, I don't think she will qualify for assisted living. My grandmother lived in assisted living for the last six months before her death. Think hotel room with a call button and staff handling your meds and offering food. You could pay extra for someone to help you shower. You could hire private nursing on your own. But the staff is kind of checking on you at occasional times. I'm not sure they will do bathroom assistance (this probably depends upon the facility) and be there whenever she needs to go. It is not constant attention, which you say she needs. Basically, it is still living on your own within the facility, with some care provided.

When my mom entered skilled living, she was higher functioning than they usually admitted, but they made an exception, because they knew she could not do assisted living, and they knew that she would do better if she didn't have to transition twice and would end up in skilled nursing after not too long. Really, she could not have done well in assisted living, because she needed more help than that. At that time, Mom could still talk, but only would talk about what she wanted (couldn't carry on a meaningful conversation with her). She would ask the same questions over and over and argue over my answers. She could wash herself in the shower with my prompting, but she resisted showering vehemently and needed help managing her clothing. She was incontinent and starting to lose bowel control. She was still mobile and physically agile (she was in her early 70s at the time), so I could take her out and about with me. But she needed supervision during the day, and she would wake up and wander the house at night while we were sleeping. She liked to sort through the closets and in fact would go into the other residents' rooms and look in their closets when she was first in the nursing home. She was anxious and couldn't sit still much, so it was a lot of effort to keep her occupied in my home.

That's just to give you an idea of where she was with the dementia. If your MIL is at that stage, assisted living is probably not going to be enough oversight. If she is worse than that, AL is definitely not going to be enough oversight, and most places would not accept her.

You are probably looking at skilled living or a facility that deals specifically with dementia and has continuity of care and provides greater services than a typical assisted living place. We found the dementia places to be more expensive, and Dad couldn't afford one, though he wanted to.

About finances.... At full pay, Mom's nursing home costs $100,000 per year.

She was full pay until assets were exhausted and she qualified for Medicaid. Under Medicaid, Dad still has to pay a portion, and it's still steep for him, as you would expect for someone who has had to spend down assets, but his portion is much less now.

Someone mentioned consulting an attorney to see about protecting assets. It's a realy good idea. But keep in mind that Medicaid has a five year look back period, so they examine all changes in finances for the previous five years. Personal assets have to be used before Medicaid will assist, and this usually means liquidating the home, if there still is one.

The level of care that a dementia patient needs cannot be forced upon someone who is not able or willing to take it on. I was willing to take it on for my mom. My siblings were not and did not help (they lived three hours away, so they did not help even for an hour here or there). Even though I was willing to take it on and was the one who did not want her to go into nursing care, it became too much for me. It's very, very hard. Families often don't agree on the decisions that are made, which is also tough.

If siblings are adamant that a facility is not going to happen, I think the next best choice is to place her in one stable home -- either hers or one of the siblings who is willing -- and hire in as much personal nursing assistance as is needed. It will also be expensive, but since she has assets, it is appropriate to use them to get good and stable care for her that will not cripple the care-taking family members. This is the first choice plan for ME, when/if the time comes, since Alzheimer's runs in my family.

A stable and safe living situation is needed, and it is wise to use the funds to provide it, one way or another.

I'm sorry your family is dealing with this.

[Guest]

10 minutes ago, gardenmom5 said:

depends upon the needs.  just some help?  or 24 hour care?   what equipment would be needed?  special diet?  (royal pain to prepare if you're also cooking for a family.)  and a family member who has to do everything else to run their life while caring for the elderly family member's needs - is quite taxing.

depending upon her condition, it can be considered as an option.   but we tried that with both my mother and grandmother - neither of them liked the people and would complain.  

Yeah, it is pretty much 24-care...well, it is 24-hour *alertness* to the possibility of her needing something, in the same way having a newborn is. Like, one doesn’t actually care for a newborn continuously round the clock, but one must be always alert to whatever the baby needs. MIL will wake in the middle of the night and the watcher is supposed to intervene so she does not fall going to/in/coming from the bathroom. (The last time she stayed here, we were not at that level yet. We did not walk her to/from the bathroom nor help her IN the bathroom.) 

interestingly, she doesn’t have a special diet, although nothing deliberately salty and one must keep salt shakers out of her reach or she’ll salt her meals repeatedly. 

[moonflower]

Yes, it will be a period of heavy work for the main caretaker in the home she is living in (the non-working spouse, generally), mostly of the waking up at all hours of the night variety, like with a baby or small child.  It will also be more work to prepare meals, etc.

But if possible, I think the value of being in a home with people who love you, even if someone else is doing the bulk of the work during the day, is superior to an institution.  Similarly, having a live-in nanny is better than sending your kids to an orphanage and visiting them once a week.  In this case, the institution is not even cheaper (usually).  I have watched this process with DH's grandmother - they put her in Assisted, then Skilled, until her money ran out, then brought her home to take care of her.  She is much happier now, finally, after years of being quite depressed and lonely (this is what she expresses, I'm not guessing).  DH and the kids went to see her every week in the nursing home and they were the only regular visitors she had for years.  In 5 years or so they went through hundreds of thousands of dollars in care.

[Guest]

Thank you so much, @Storygirl for sharing that personal story. I do know she has had a will and legal financial documentation for quite a while, so it is probable that things are set up appropriately. I have known for a while that there is a look-back period. 

[gardenmom5]

16 minutes ago, Patty Joanna said:

We agree.  It’s in the works.  This fall was due to bleeding ulcer/passout which was surgically fixed.   :0)

glad it was treatable.  cause really does matter.

[PeterPan]

5 hours ago, prairiewindmomma said:

Sibling disagreements seem to be the norm more often than agreement.

Just to bring down that point, does the MIL have a signed Health Care POA? It's SO important for people to sign this stuff while they're of sound mind. The siblings might want to look at who has each POA (health care, regular) and then defer to that. If you don't trust the person's judgment, that's rough, sigh.

[Suzanne in ABQ]

10 hours ago, PeterPan said:

So you're looking for a unit that can handle dementia. Not all AL have that. 

You're probably talking at least $4k a month and that's in a very modest COL area. 

Fwiw, one of the things I looked for was stability in staffing. I saw reviews online of places with really high turnover, and to me stability in the staffing is part of what makes the experience comforting and dependable for the resident. Also it's a good sign if it's hard to get in. Like I said, I'm really concerned that this other company bought out where my loved one lives and things have changed and so many rooms are open. Tells me there may be something going on that my loved one can't tell me about, because before it was hard to get in, with openings going very quickly. 

I can tell you, from my own experience as the person who signed on the line, that some administrations are easier to work with than others. The previous owners/company were very easy to work with. I could write them and say how is so and so, and I'd get a reply. They actually wanted to hear from me. With the new ownership, I'm a number, another dollar in, and frankly if my loved one were any less independent I probably would not choose this place. They've ruined the personal touch and personal level of interaction by going so corporate/national. It's really a shame. And when you see the exposes on tv/youtube, it will be really big, national chains. So put some stock in just that gut level wow they really responded to my concerns and I could get a hold of them. So much easier than a corporate manager who's never around and gorilla nurses who don't return your emails.

 

Hi PeterPan,
I'm wondering about your reference here about how the corporation has come in and made a bunch of changes at your loved one's facility.  We have experienced the same thing at my mom's independent living facility (Brookdale).  When she moved there, 5 1/2 years ago, the staff was wonderful and caring.  Most of the managers had been there 10-20 years!  She fell in love with the place initially because they had regular live dance music.  She loves to dance, even at age 88!  She came to love the staff, and they loved her. Well, in the last year, "corporate" has come in and run out every single manager: the chef, the activities director, the general manager, sales manager (different title that I can't remember), even the maintenance manager!  The desk clerk, who had been there for almost a decade, quit because he couldn't stand working with the new people.  My mom calls the new activities director "the baracuda".  The new general manager screamed at me just for walking in the door because I didn't do it right. The barracuda activities director unilaterally cancelled all the live performers.  The little therapy pool was closed for six months because it needed a new pump.  It's been crazy!  Slowly they have brought some of the music back (only 2x a month), and they finally fixed the pool (so they can have their water aerobics back), but the staff is cold and uncaring. 

Anyway, I'm wondering if your loved one is at a Brookdale place.  Is this corporate takeover of senior facilities just happening at Brookdale, or is it a trend?

[QueenCat]

Is she likely going to be sent to rehab from the hospital? Social workers at both the hospital and rehab can give good guidance on assisted living homes. In my experience, a social worker at the rehab center was the one that was able to convince my mom & certain family members that she really needed assisted living arrangements. 

[Tiberia]

Stand firm in your decision to not take her. It is very wise to know when to say "no" and stick with that decision. If you can quietly encourage the other wavering siblings to make the decision they need to make, do it. We had FIL at our house until he started falling and we could never leave him alone. He ended up going into assisted living, and it was a great fit for him.

If money brother wants to care for MIL in his home, great, let him do it, but that's his decision. He can't make your decision for you. He shouldn't be bullying the other siblings either, but that's not in your control. Feelings will get hurt, and maybe relationships will be strained, but you must stand by what you know is right for you, and for MIL. It sounds like she needs more care than a family can offer right now.

And yes, your cancer diagnosis is a great "excuse." It's a legitimate excuse, even if you feel fine. You're under stress that will continue to surface even when your treatment is done. Give yourself a year after treatment is all done before you stop using "cancer" as an excuse.  

Sorry you're dealing with all this right now. All the best.

Edited December 10, 2018 by Tiberia

[PeterPan]

40 minutes ago, Suzanne in ABQ said:

Anyway, I'm wondering if your loved one is at a Brookdale place.  Is this corporate takeover of senior facilities just happening at Brookdale, or is it a trend?

It's not Brookdale, but it seems like it's another corp that wants to be like Brookdale. I haven't really researched it, because I was trying to give it time this year to see how it would pan out. It has been pretty dissatisfactory though, and that's pretty much how it went down, a bigger corp coming in and all the good people with heart leaving and an emphasis on things that didn't necessarily improve quality of life but did improve the looks, the outside. (uniforms, procedures, etc) Only 2 of the original people remain, and this had been a place with very low turnover before, sigh.

 

[Guest]

UPDATE: Thankfully, the social workers have intervened just as some of you said was likely. I think it is also likely that the sibling whose home she is currently at may have expressed something like, “I don’t see how she can come back to our home; I am not physically capable of doing the care that she needs right now.” The hospital, of course, wants to discharge her within a day or two. We all know they don’t let patients just hang around there once their condition is stable. 

So the direction is to nursing home. We are all being pointed that way by the social workers. Honestly, it is a mercy, because it is providing a path that cuts through a lot of the uncertainty. The one brother is using the term “rehab facility,” but conceeded that really that is another word for nursing home, but that he thought it better not to use NH with mom. I agree that the semantics matter. 

One of the SILs is checking out a place today. It is all very sad and tense, but I am happy that a lot of the conflict over where she needs to go has been rectified really quite smoothly because of the social worker and hospital recommendations on what kind of help she needs right now. She cannot even sit up by herself because of the broken bones. 

Please don’t quote. I am going to delete details within a day. 

[Scarlett]

Wow, Quill that is really sad but I am so proud the whole family so easily agreed. 

[May]

I’m glad the social worker and hospital intervened. Blessings🎄

[Nicholas_mom]

Having going through this with my mom, and knowing the injuries, your MIL is going to rehab first.  From rehab, after she is walking again, then social workers will direct to nursing homes.  They are separate places probably insurance driven. 

My mom was hospitalized for possible stroke/mild heart attack.  After the hospital, she went to rehab to walk, at the same time developed a very deep bed sore.  The rehab could not keep her for the bedsore, but still needed bandages changed daily and she was not swallowing, so she was tube feed temporarily.  She was sent to a nursing home, until the bed sore completely heals, she walks on her own (they have been difficulties with this) and was able to eat and swallow foods again.  She is doing better now that the social worker is talking about when she is able to walk to the dining rm and dress herself, go to the bathroom herself, to maybe move her to another floor of the nursing home, where more patients are self-sufficient but still need to take meds and have blood pressure taken, etc.

[Guest]

12 minutes ago, Nicholas_mom said:

Having going through this with my mom, and knowing the injuries, your MIL is going to rehab first.  From rehab, after she is walking again, then social workers will direct to nursing homes.  They are separate places probably insurance driven. 

My mom was hospitalized for possible stroke/mild heart attack.  After the hospital, she went to rehab to walk, at the same time developed a very deep bed sore.  The rehab could not keep her for the bedsore, but still needed bandages changed daily and she was not swallowing, so she was tube feed temporarily.  She was sent to a nursing home, until the bed sore completely heals, she walks on her own (they have been difficulties with this) and was able to eat and swallow foods again.  She is doing better now that the social worker is talking about when she is able to walk to the dining rm and dress herself, go to the bathroom herself, to maybe move her to another floor of the nursing home, where more patients are self-sufficient but still need to take meds and have blood pressure taken, etc.

I think, though, that the social worker is directing us directly to a nursing home and maybe they are couching it as “rehab” to soften the  transition. The Bil basically said they are using the term “rehab” but the actual listings we are receiving are nursing homes. I do not think much rehabilitation is realistically expected at her age and condition. Her strength and balance are alrèady substantially poor and my understanding is that the set back of broken bones leading to immobility leads directly to atrophy. She may not be ever fully rehabilitated from this point. (This is my own non-medical person laymen understanding of what is likely.) 

I don’t even know how much bones mend in a 92yo with osteoporosis. 

[Guest]

@Æthelthryth the Texan yes, I know you are 100% correct. I heard dh disputing something on the phone today with a client and I was just silently wishing nobody would be a douchebag right now. 

There’s a comically absurd amount of negative health stuff getting dealt out right now. In addition to my cancer and my MIL’s problems, my mom just had a lung biopsy and my dad has a bulge in his aorta. And my parents are “La-la-la-Nothing-is-wrong” people in the first place, so I feel I must physically go to these appointments or they do crazy things like how my dad just told the docs he is too busy to worry about that little aorta thing and he will come back in six months. 🤨 So I am determined to go to my mom’s consultation because who knows what nutty things will come out of their mouths if the results are not good. 

[QueenCat]

3 hours ago, Quill said:

I think, though, that the social worker is directing us directly to a nursing home and maybe they are couching it as “rehab” to soften the  transition. The Bil basically said they are using the term “rehab” but the actual listings we are receiving are nursing homes. I do not think much rehabilitation is realistically expected at her age and condition. Her strength and balance are alrèady substantially poor and my understanding is that the set back of broken bones leading to immobility leads directly to atrophy. She may not be ever fully rehabilitated from this point. (This is my own non-medical person laymen understanding of what is likely.) 

I don’t even know how much bones mend in a 92yo with osteoporosis. 

 

Many nursing homes also do rehab so the listings don't surprise me. Medicare will pay for a certain number of days in rehab (100% for the 20 days, then a co-pay comes into play). Once the resident is no longer getting any therapies, they become self-paying (unless they qualify for Medicaid). Not all nursing homes take Medicaid. 

[prairiewindmomma]

4 minutes ago, QueenCat said:

 

Many nursing homes also do rehab so the listings don't surprise me. Medicare will pay for a certain number of days in rehab (100% for the 20 days, then a co-pay comes into play). Once the resident is no longer getting any therapies, they become self-paying (unless they qualify for Medicaid). Not all nursing homes take Medicaid. 

This is a good point. If you can find a facility where she can stay in the same room but her care changes, so much the better. Sometimes rehab is a separate wing or building on campus, but sometimes it just means that PT and OT show up to work with you or they wheel you down the hall to their rehab gym.

The fewer the transitions, the better. We have always seen increased confusion and other issues when we’ve had to send relative out to a hospital for additional care. It takes weeks to settle back down again.