S/O Elder care facility decisions

[skimomma]

Since this has been a hot topic lately, I thought I'd capitalize on that.

While not legally named as such, I am functioning (via DPOA) as the sole guardian for an elder with mid-stage dementia.  This person is elderly, is otherwise in decent health, and is currently living in assisted living 10 hours away from my home.  The distance means that I only get eyes on them about 4 times a year.  They are happy with the assisted living place where they currently live.  However, they are also running out of funds and will only be able to stay there for about one more year.  Their level of impairment is high enough that they would be eligible for a medicaid nursing home facility.  So that will be the next move.  They will not like this.  At all.  It will be a fight.

What I am hoping to get feedback on is whether I should find a facility in the area they currently reside or move them to my location.

Obviously, it would be FAR easier for me to supervise this person's care if they were in a facility near me.  That is about the only "pro" which I acknowledge would be for my benefit only....and perhaps marginally for them as I can ensure they are being properly cared for.  This person's memory is bad enough that they no longer remember when I have visited or called so my actual presence is not of any real benefit to them other than in the moment.  

Keeping them in their current area means that the few and rapidly aging friends and family that are still able to visit and/or take them out for outings can still do that.  They would be close to their church and therefore church friends that visit and the pastor.  They value this even if the visits are actually rare and get rarer by the day.  The area has greatly superior medical care. And the big one.....  It would not require a 10 hour drive to complete the move.

That sounds like a ridiculous obstacle but is indeed the thing I am most concerned about.  The person needs medications administered four times a day.  They can be very combative about this.  They do not give the nursing staff at their facility any problems but as soon as it is outside of the facility and involves anyone else, they have a track record of actively combating the person attempting to admin their meds.  It is so bad, that the current "policy" is that they skip their meds when not at home.  Since they only leave the facility for short periods of time and infrequently, this usually means missing only one dose, which we determined was an acceptable risk for the benefit of being able to go out.  Even if we *could* do the 10 hour drive in one shot, from a logistical standpoint, we would not really be able to check into the new facility on the same day.  So an overnight, either in a hotel on the way or at my home after the drive would be necessary.  That is a LOT of missed medications and I am not prepared to deal with the consequences.  Not to mention, most of the drive is through very remote locations, so no help is readily available.  Flying is not an option as my remote location would mean spending even more time in air travel than we would in the car.

And that overnight and drive also has me nervous because of how easily agitated this person gets during even much shorter outings involving things they very much want to do.  This move, whether local or not, is going to be very upsetting to them and even if it weren't, persons with dementia typically struggle with any change in their routine.  This would be the most disruptive thing to happen to them in years.  I would likely have at least one other adult with me to help, but I have nightmares about what could happen during the sundown period, in an unfamiliar location, with a person who is being moved 10 hours against their will.  I envision chasing them through gas station parking lots or waking up in a  hotel room to find them missing.  I am concerned that I just don't have the tools to handle this.

Ideas?  Thoughts?  Both on what nursing home location would be best as well as any ideas on how to move an angry person with dementia when it involves a long car ride.  

[Katy]

Unless something is extremely complex, medical care at end of life isn’t as important as comfort and hospice care. I would move them, but I wonder if flying would be a better option than driving. Staying in the area is irrelevant if they no longer remember who visited. 
 

ETA: even in the most questionable nursing homes I ever did a shift in, people whose families would show up at random, unpredictable and frequent times got priority care. That’s why closer to you is better. 

Edited May 5, 2023 by Katy
Important, not impossible. That’s got to be my worst autocorrect yet.

[almondbutterandjelly]

So it's a year away, and so it might not even come to fruition.  However, I feel you on the 10 hour thing.  Since they have a support system of sorts in their current location, and it's more people than just one (you), and the drive to your location would be so horrific, I would leave them in their current location.

Also, a thing to check on... in my dad's assisted living place, they will not make a person leave if they run out of funds.  Something covenant something.  They will keep them.

[skimomma]

10 minutes ago, Katy said:

 I would move them, but I wonder if flying would be a better option than driving.

Flying is not an option in this case.  It would actually take longer than driving due to my remote location.  And even if it were, I'd be even more nervous about bringing a potentially agitated person on a plane.  

[skimomma]

3 minutes ago, perky said:

 

Also, a thing to check on... in my dad's assisted living place, they will not make a person leave if they run out of funds.  Something covenant something.  They will keep them.

This is not something the current facility does.  I have been meeting with their care team about all of this and a move would have to happen within the targeted timeframe anyway because they do not do memory care (or skilled nursing) so my person would need to leave even if funding was not a factor.

[Harriet Vane]

Ease of management is the ONLY relevant factor here. Friends and church will stop engaging, I promise. And dementia will march  on. So the only relevant factor is how easy it is for the care manager. In other words, YOU. 

As my in-laws aged, we found that a six-hour drive was brutal. And even a one-hour drive (for my sister-in-law) was brutal.

Move your person to a location near to you, ideally 15 minutes or less. The ten-hour move is a one-time difficulty.

[Katy]

You can ask the doctor to prescribe a sedative or anxiety medication for the 10 jour trip.

[skimomma]

Just now, Harriet Vane said:

 

Move your person to a location near to you, ideally 15 minutes or less. The ten-hour move is a one-time difficulty.

Any ideas of how to actually do the move?

Is it a thing to hire someone trained to handle difficult dementia patients to assist and/or actually do the move?  This person does not like *me* and so I am the least likely to be able to get them to cooperate.  

[Harriet Vane]

9 minutes ago, skimomma said:

Any ideas of how to actually do the move?

Is it a thing to hire someone trained to handle difficult dementia patients to assist and/or actually do the move?  This person does not like *me* and so I am the least likely to be able to get them to cooperate.  

When we moved my father-in-law seven hours, dh did the move as he was the only person who had any prayer of controlling his dad. Poor fil was by that time in the full throes of paranoia, anger, and hitting. With the blessing of his doctor we drugged him to the gills. Dh had videos on his phone for fil to watch, and they had only one planned bathroom break. (At that point fil would consent to wear Depends but often wouldn’t “go” in them.) Dh also kept repeating that they were going to visit mil and dh’s sister, which fil was highly motivated by. 

I wouldn’t hesitate to either hire someone or have a full caravan of 2-3 cars to provide more choices and options if needed. I would also move based on ease of doing so and YOUR schedule, not based on when the money runs out.

Edited to add—Do it early, first thing in the morning. Sun downing and anxiety with end-of-day fatigue are real factors.

Edited May 5, 2023 by Harriet Vane

[skimomma]

15 minutes ago, Harriet Vane said:

When we moved my father-in-law seven hours, dh did the move as he was the only person who had any prayer of controlling his dad. Poor fil was by that time in the full throes of paranoia, anger, and hitting. With the blessing of his doctor we drugged him to the gills. Dh had videos on his phone for fil to watch, and they had only one planned bathroom break. (At that point fil would consent to wear Depends but often wouldn’t “go” in them.) Dh also kept repeating that they were going to visit mil and dh’s sister, which fil was highly motivated by. 

I wouldn’t hesitate to either hire someone or have a full caravan of 2-3 cars to provide more choices and options if needed. I would also move based on ease of doing so and YOUR schedule, not based on when the money runs out.

Edited to add—Do it early, first thing in the morning. Sun downing and anxiety with end-of-day fatigue are real factors.

I did not even think of the possibility of anxiety-reducing medications.  That might help.  But I do worry about toileting.  My person will not wear depends at this point. Can we expect normal sensation of needing to use the bathroom while on drugs like these?

I think the timing of the move is going to be 100% based on waiting lists and won't have anything to do with what works for me.  I don't think I have the manpower to caravan.  There are really only three people I can involve (including me) and at least one of them will have to stay behind to deal with this person's large collection of belongings.  So, I would have to hire someone(s).  I just don't even know how to go about finding someone to hire!  What are the search words I should use?

And like other logistical things.....  I realize a super early morning departure would be best but not sure that would work for the facility?  To have any chance to missing the sundown, we would need to be on the road at 5-6am.  Is it reasonable to expect a facility to work with us that early in the morning?

[Storygirl]

I understand the logistics seem nightmarish, but I would still move her. The difficulties will be temporary, but the move will permanently improve your ability to oversee her care.

My mom was in a nursing home for 9 years with Alzheimer's. She was 2-3 hours from me, and, due to taking care of my immediate family, I only got to see her every few months. My dad and sister, who lived in the same town, took care of working with the nursing home staff, and my sister did the most visiting. I really wished that she were closer to me.

Mom had a lot of friends. They stopped visiting her. The pastor at her long-time church only visited a couple of times per year. My brother and his family never visited Mom, even though they also lived close by. I think it's good that your mom has those connections now, but as time goes on, and as your mom becomes less communicative as the dementia progresses, visitors will drop off. This happens to virtually everyone.

I would also consider that in a year, she may be in a different stage of dementia. She may be incontinent (making the Depends issue moot) or have a personality change.

 

[Storygirl]

How much stuff does she have to move? Instead of having someone stay behind to do it, can someone go ahead of time, so they are ready to leave with all of the stuff when your Mom leaves? Can you make a preemptive visit a month or two ahead of time to pack up non-essentials, to minimize the stuff? Are you having to deal with furniture? The facility that you move her to may or may not already have furnishings in the room.

Can one of the relatives or friends who visits her faithfully travel with you? You could then pay for their airfare back home.

Also, it may be logistically easier to move her to a new facility while she is still self-pay. Some places have limits on Medicaid bed availability for incoming patients, but if they have a current patient who moves onto Medicaid, that person gets to stay.

[Katy]

Yes, with enough notice the night shift can probably help get you out the door at 5 am. 
 

You might consider renting a camper van & calling it “vacation” instead of “move”.

[Katy]

Usually the need for depends comes earlier than the dementia diagnosis. If not I’d expect to need them before the move. ETA: denying the need for them even when way past the need for them IS typical though.  

Edited May 5, 2023 by Katy

[Harriet Vane]

Actually, I would consider hiring someone to pack her stuff AFTER. Doing it before will ratchet up the anxiety and make the transition harder.

Consider hiring someone to box it up?

Don’t tell her ahead of time and don’t warn her. With dementia this only increases anxiety. Just get her to the vehicle and go. I like the idea to get a camper and call it vacation.

[skimomma]

42 minutes ago, Storygirl said:

How much stuff does she have to move? Instead of having someone stay behind to do it, can someone go ahead of time, so they are ready to leave with all of the stuff when your Mom leaves? Can you make a preemptive visit a month or two ahead of time to pack up non-essentials, to minimize the stuff? Are you having to deal with furniture? The facility that you move her to may or may not already have furnishings in the room.

Can one of the relatives or friends who visits her faithfully travel with you? You could then pay for their airfare back home.

Also, it may be logistically easier to move her to a new facility while she is still self-pay. Some places have limits on Medicaid bed availability for incoming patients, but if they have a current patient who moves onto Medicaid, that person gets to stay.

I think a lot of the logistics involving their stuff will be dependent on their awareness at the moment.  If I were moving them today, messing with their stuff would be very upsetting.  They were/are a hoarder.  Living in the facility has helped because they cannot go out and collect things and the staff requires some level of shoveling out the room on a regular basis.  But they took as much as could possibly be stuffed into the unit, including furniture and a freaking grandfather clock!  Then there is also a storage unit in the basement of the facility that is stuffed to the ceiling with more stuff.  All of it is garbage, really, and most will have to be thrown out or donated.  But someone will have to go through all of it because important stuff like family photos, jewelry, and sentimental items are all mixed in with garbage.  Ideally, yes, we'd go through it all *before* the move and be ready to roll with no looking back.  But realistically, touching any of it before we leave is likely to cause a LOT of distress.  Especially if we are using the "vacation" excuse for why we are going on a long car trip.  As it is, even taking whatever is needed to nest the new place is going to be difficult to collect.  And as you say, state of mind will matter here too.  The dementia is very slow moving in this case.  The diagnosis was 5 years ago and while there has been decline, it has not been rapid at all.

All of the people that currently visit are over the age of 80 and most have mobility issues.  So, no one in that group could even help with packing things, let alone travel with us.

And yes, my hope is that we hit to top of the waiting list as self-pay....before the full send down.  

[skimomma]

17 minutes ago, Harriet Vane said:

Actually, I would consider hiring someone to pack her stuff AFTER. Doing it before will ratchet up the anxiety and make the transition harder.

Consider hiring someone to box it up?

Don’t tell her ahead of time and don’t warn her. With dementia this only increases anxiety. Just get her to the vehicle and go. I like the idea to get a camper and call it vacation.

This is a possibility.  We could have someone come in and box it all up and supervise moving it to a storage unit.  We could go back some time in the future to sort through it all.

But, if one knows that someone's possessions are very important to them, I can see getting someone successfully out of the unit and into a car for a "vacation" without a bunch of stuff.  I assume it will be helpful to have a subset of this stuff with us as it will be a comfort in the new facility.  How do we get that packed up and out without upsetting anyone?

But this is all secondary if I cannot successfully get them tot he new location. I am seriously worried about a gas station runaway attempt!  Or a medical emergency because they won't allow me to admin meds.  

[Katy]

Anxiety meds. Is anyone in the family an RN? 

[skimomma]

20 minutes ago, Katy said:

Anxiety meds. Is anyone in the family an RN? 

Well.....  The person with dementia is (or was), but that is probably not very helpful!  Otherwise, no.

[skimomma]

Ideally, I would like to hire a "companion" that can supervise medications, toileting needs (if that becomes an issue), and overnight supervision (if we have to stop on the way).  My person is triggered by *me.*  I am the source of everything bad in their life.  I was the one who "took the car away" and "made them move" and "messed up their cable" and and and so my involvement in anything that might be contentious such as administering meds ("I don't need YOU to help me with this needle that I just grabbed out of your hand and am now swinging around wildly") or using the restroom (I don't need YOU telling me when I need to go!").  I am probably the worst person to be involved and probably should be the person to stay behind and deal with the stuff.  My very presence will be offensive.  But I am also on the legal and logistical hook.  I am the one who will need to be there to admit them into the new facility and making those on-the-ground decisions.  The other two people involved can help with grunt work like packing stuff and light supervision, but they are not at all willing or able to admin meds to deal with someone who might be lashing out in a public space.

Having also been through similar situations, such as the original move into the current facility, I know I will need to be on my game and getting enough sleep to complete the whole process.  I cannot stay up all night to be sure they don't run away and still safely drive long distances, for instance.

Anyone know if such a job exists?  Could I hire someone to travel with us and do all the things and fly them home afterwards?  Where would I even look for such a person?

[Katy]

See if there’s a nursing agency near you that might do this. Typically they help staff understaffed hospitals and nursing homes, and some have home nursing visits. The question is whether it’s legal to cross state lines for this kind of job. 

[Harriet Vane]

I would not under any circumstances extend the trip to two days. It’s one and done. You’re not likely to get compliance from her for longer. 

Another source of possible help might be her church? There may be people happy to be hired. 

Edited May 5, 2023 by Harriet Vane

[skimomma]

7 minutes ago, Katy said:

See if there’s a nursing agency near you that might do this. Typically they help staff understaffed hospitals and nursing homes, and some have home nursing visits. The question is whether it’s legal to cross state lines for this kind of job. 

No state lines.  Thanks goodness!

[skimomma]

3 minutes ago, Harriet Vane said:

I would not under any circumstances extend the trip to two days. It’s one and done. You’re not likely to get compliance from her for longer. 

Another source of possible help might be her church? There may be people happy to be hired. 

I would obviously very much prefer that an overnight is not involved.  But I feel like I need to plan for that possibility if either facility cannot handle a major after-hours check-out or check-in.  Or weather is involved.  Or if they simply cannot sit in a car for that many hours.

[prairiewindmomma]

How remote does being remote mean? There are people in my state who buy helicopter medical transport insurance because getting anywhere in a decent time frame by ambulance is a journey. I’d be exploring that angle a bit. She may not qualify for angel flight, but I would dig around a bit into professional medical transport—both flying and driving.

I’d also really look at the legal custody aspect of this, especially as you are crossing state lines. If you aren’t a child, or she hasn’t been declared incompetent, I would be talking with the care facility to see what they recommend needs to be done. If they raise hell on the transfer, or after, you need some kind of standing behind you.

[prairiewindmomma]

I will chime back in to say that if it looks insurmountable, waiting until they have mentally declined even further past the combative state is ok. Where a move has to happen, it is going to be disruptive, but there are safety things at play when we talk about a long trip and safety > ideal care to some extent, iykwim.

[skimomma]

7 minutes ago, prairiewindmomma said:

How remote does being remote mean? There are people in my state who buy helicopter medical transport insurance because getting anywhere in a decent time frame by ambulance is a journey. I’d be exploring that angle a bit. She may not qualify for angel flight, but I would dig around a bit into professional medical transport—both flying and driving.

I’d also really look at the legal custody aspect of this, especially as you are crossing state lines. If you aren’t a child, or she hasn’t been declared incompetent, I would be talking with the care facility to see what they recommend needs to be done. If they raise hell on the transfer, or after, you need some kind of standing behind you.

We would not be crossing state lines.  My area is rural and remote but does have a hospital.  Anything complicated does require travel to bigger medical centers, the closest of which would be about a 4 hour drive.  I do not anticipate this person will have medical needs that require out-of-area care given how their medical directive is set up.

Something like a medical transport to get them here is what I had in mind originally but would have to be paid OOP, which is not necessarily a deal breaker.  I'm just not sure it is even available for situations like these.  Or how I go about finding out?

[skimomma]

6 minutes ago, prairiewindmomma said:

I will chime back in to say that if it looks insurmountable, waiting until they have mentally declined even further past the combative state is ok. Where a move has to happen, it is going to be disruptive, but there are safety things at play when we talk about a long trip and safety > ideal care to some extent, iykwim.

I would love to wait until this would be easier but the money runs out in 1-2 years.  And it would be best to make the move before the money is all gone so we can start as self-pay.  I know things can change, but this has been an extremely slow decline so far.  They were formerly diagnosed 5 years ago, but the signs were there 15+ years ago.  I think there is a good chance this person could live for 10-20 more years if the decline remains this slow and if family history is any indication.  Their grandfather lived in a home with dementia for 30 years and died at age 101.

[prairiewindmomma]

For my state, there are service maps of who covers what region. I would Google the name of your city or region + medical transport, or name + air ambulance. Odds are there is a pad with a small office somewhere near you…if you know of an air strip that has an office, I would also ask there. 
 

If you are super remote, you may have a friend of a friend who flies, and would be willing to fly others also. My aunt flew herself and family to routine Dr visits, and would occasionally offer a ride to people in the community when she had extra seats. When you are super remote you tend to have a good community, but I know YMMV.

[skimomma]

1 minute ago, prairiewindmomma said:

For my state, there are service maps of who covers what region. I would Google the name of your city or region + medical transport, or name + air ambulance. Odds are there is a pad with a small office somewhere near you…if you know of an air strip that has an office, I would also ask there. 
 

If you are super remote, you may have a friend of a friend who flies, and would be willing to fly others also. My aunt flew herself and family to routine Dr visits, and would occasionally offer a ride to people in the community when she had extra seats. When you are super remote you tend to have a good community, but I know YMMV.

Thanks!  This is some good food for thought.

[prairiewindmomma]

Fwiw, we had to go super heavy on anti anxiety and other meds when we moved a relative (she broke a hip, and got transported, and then we transported back to where she had been), no regrets. I would be starting to explore conversations with whomever the medical director is at assisted living. You are going to need their support anyway. They may have additional ideas.

[Mrs Tiggywinkle Again]

2 hours ago, skimomma said:

We would not be crossing state lines.  My area is rural and remote but does have a hospital.  Anything complicated does require travel to bigger medical centers, the closest of which would be about a 4 hour drive.  I do not anticipate this person will have medical needs that require out-of-area care given how their medical directive is set up.

Something like a medical transport to get them here is what I had in mind originally but would have to be paid OOP, which is not necessarily a deal breaker.  I'm just not sure it is even available for situations like these.  Or how I go about finding out?

As someone who helps coordinate medical transport by ambulance and occasionally air ambulance, a ten hour journey would be extremely expensive whether by ground or air. Not to mention that ambulances are not set up for things like bathroom breaks and food, and your medical transport personnel are not likely to be able to sedate on a nursing home to nursing home journey without written orders from a doctor.  Private pay air ambulance for that far would be a fixed wing vs helicopter, and you’re probably talking tens of thousands out of pocket for that.

[prairiewindmomma]

Yup, a $30k flight is 3 months of care in Assisted Living, but I assume that is why OP is thinking of doing this now rather than when funds are exhausted.

It’s a 10 hour drive from the NE corner of my state to the SW one, but the flight time is 1 hr 10 min. The mountain passes add a lot of time.

[City Mouse]

I will be the one person to disagree (don’t we have to have at least one on every thread 😀). 
After having just been through a long distance situation with my dad and now with my mom, I would not do the move. The long distance (13 hr drive for me) is a pain, but a cannot imagine the stress and difficulty of transporting such a person such a long way. I don’t see any way to make the trip in one day and get checked in to a new facility the same day.

Especially since you said that your presence is of no comfort to the person, it might be better to find an appropriate new facility nearby. When my dad was moved from AL Memory Care to skilled nursing, the new facility came and picked him up. Then family members brought his belongings to his new location. This would allow you to bring only what is needed and avoid over stuffing the room. The rest of the belongings could be moved to a storage unit a later date when you have time to sort it out. My hoarder is easier to deal with when told that “everything” is going to storage. Even if she will never be able to get to the storage unit to see it all. 
If you are concerned that there is no one else to visit this person, you could hire someone for a few hours per week just to visit. Then, once you are more comfortable with the new facility or the dementia gets worse, you might decide this is unnecessary.

[skimomma]

Thanks all for the advice so far.  I would welcome more if anyone is still reading.

It does sound like hired transport is not going to be affordable.  And I am still very concerned about the logistics of travel.  There are so many ways it could go terribly wrong.

A couple of people suggested finding a nursing home in their current location.  Can anyone speak on what that actually looks like for the caregiver?  So far, it is tedious but it has been working.  I travel down 3-4 times a year.  I arrange for things like hair cuts, shopping for clothing, tidying up their room, etc.... while I am there.  They get their medical care from visiting doctors.  I realize people will stop visiting over time.  However, the only visits they would get in my location would be from me and dh.  And they do not remember when we do visit now.  Not even the next day.  Yes, we would have eyes on the facility, which is a huge pro, but otherwise, what should I be taking into consideration?

[BusyMom5]

I would move them, probably sooner than later, using their own money.  You need to look at transportation services.  Look at homes near you and choose the best option you can find.  

This is a very hard job, full of heartache and frustration.   

[City Mouse]

31 minutes ago, skimomma said:

Thanks all for the advice so far.  I would welcome more if anyone is still reading.

It does sound like hired transport is not going to be affordable.  And I am still very concerned about the logistics of travel.  There are so many ways it could go terribly wrong.

A couple of people suggested finding a nursing home in their current location.  Can anyone speak on what that actually looks like for the caregiver?  So far, it is tedious but it has been working.  I travel down 3-4 times a year.  I arrange for things like hair cuts, shopping for clothing, tidying up their room, etc.... while I am there.  They get their medical care from visiting doctors.  I realize people will stop visiting over time.  However, the only visits they would get in my location would be from me and dh.  And they do not remember when we do visit now.  Not even the next day.  Yes, we would have eyes on the facility, which is a huge pro, but otherwise, what should I be taking into consideration?

For the long distance situation, my suggestion is to spend as much time as you can at the NH when you are there. Be there at different times of day. Observe how the different staff members interact with the different patients. Basically the same stuff you would do if the person was closer to you to make sure that the facility is “good”. It makes me feel better after seeing all the different staff members that come into my mom’s room on a regular basis. Figure out who to call when you need help with different things. I have come quite well know to the social worker at my mom’s facility. In fact, I need to call her this morning to discuss and issue that came up over the weekend. Otherwise you just continue doing what you are doing. The only advantage/disadvantage to living closer is being able to respond in person to middle of the night hospital trips. The local person can visit more frequently for shorter time, but I have found that there are disadvantages to the shorter visits as well. It’s all “tedious” really no matter how close you live. It just changes.

[Scarlett]

I don’t know much, but I did just watch my former MIL die.  She was 92 and really had no one near her. She had enough money to stay in her huge home until the very end with 24/7 care the last few years. She also did not have dementia.  But she was a difficult personality and did not let her son (my xh) be involved in her care or finances until the last few years. He was about 6 hours away, and still working a very demanding job.  He went back and forth so so many times in the last few years.  It was very very difficult on him.   He has two other brothers but neither of them stepped up to help.  One not at all and one barely.  
 

25 years ago after her husband died we tried to get her to sell out and move near us.  She never would and so now even after she is gone my xh has a ton of work to do in emptying out a 4000 sf house stuffed to the brim with stuff.  She was not  really a hoarder and her home is beautiful and she has a lot of nice stuff.  But it is still a lot of work for xh. Then he has to get the house so,d.  It is all a big mess for sure.  
 

So I am all for getting them closer to the primary caregiver.  

[Katy]

The trip will be awful. Steel yourself that it will be awful but it’s necessary. With luck the facility she’s in now will get her in the car and the nurse will give her a shot of anxiety medication and she’ll mostly sleep for the first half. 

Better done with one awful trip than having to travel there 20-100 times before she dies and another 10-20 afterwards. 

Start with looking into nursing homes in your area. See how long the wait lists are, how many problems and fines they’ve had from the state, how it smells, and if most of the staff seems calm and friendly or stressed & harried. 

[Mrs Tiggywinkle Again]

I always suggest asking around to your friends and friends of friends if anyone can put you in touch with someone who works EMS in the area you’re looking for nursing homes.  Then talk to  them off the record as a friend of a friend and ask which local nursing home they’d put their parent in.

We see the good, the bad and the ugly of the nursing homes and know who does a good job taking care of the patients and who is low staffed or whatever. There is only one nursing home here I’d consider for my family based on what the inner workings of the nursing homes that I get to see.