Tough decision: LO finished short term rehab at nursing home and needs a place to live. Any advice?

Dear PAH321,

I was in a similar situation as you are finding yourself in now. After my dad died back in 2004, I started taking care of my mom who was 79 by going back and forth from our house to hers for ten years. In early 2015 right after turning 90 I had taken her car keys away, sold her car and moved her into an AL facility. She had early stages of Alzheimer's but since she was mobile, able to dress and feed herself I thought that was the right place for her at that time. Over the years, she had three or four falls but never had an injury.

Everything changed when the pandemic came along. One month after turning 95 the facility went into lockdown and there were so many positive COVID cases that they were on every local news station. They ended up with over 22 deaths - there's only an 85 resident capacity and the virus came from staff - two in particular that worked at another care facility down the street and ended up on the news as well. Not being able to do window visits because her apartment faced an inner courtyard area, my husband bought her an iPad so we could "see" if she looked ok. That worked until we couldn't get her on the iPad - she had become severely ill and we weren't told. It turned out she nearly died inside her apartment from severe dehydration and had COVID so I had her taken to ER. She did survive however, she's never been the same since. I had huge anger issues towards the facility and I told my husband I did not want my mother going back there. Once released from the hospital, she was taken to a rehab facility because she could no longer walk much less dress herself. The problem for us was the pandemic. We were right on the cusp of no facilities taking in new residents and some who were thinking about it. We were so desperate that at first when we worked with one placement agent, she said all she could find was a group home that was approximately 45 minutes away (the current facility was less than ten minutes away and directly across from one of our city's main hospitals). I was never at peace with moving her there as I knew she would hate it. The rehab facility's discharge case manager gave us a name of another placement agent and as time was running out at her being able to stay in rehab, she had three nearby leads which dwindled quickly. One changed their mind about taking in a new resident and one had a lot of violations when I checked them out on our Department of Health's website. That left one choice. We knew we were going to put her in a memory care unit so now the challenge would be - do they have an affordable room available. They had four and believe me we rushed down there after we looked at a map of the facility they had on their website. Since there was only one that would be a good location and was a small one bedroom with a window, I put a deposit down to hold the room. My mom had to take another COVID test and it had to come back negative before they would allow her to move in. She did test negative so we were able to have it ready as soon as the rehab facility discharged her. Due to the end result after COVID, she qualified for hospice care who arranged for the medical transport to the new facility. She moved in on May 19th and has had approximately six or seven falls but thankfully, she didn't suffer injuries and hospice has provided a fall mat.

Believe me I understand and empathize with you as to not being able to see her in person. I hadn't seen my mom since February 28th. I feel for your mom being upset and crying at not being able to have her family present causing her depression and crying episodes. The hospice doctor recommended a very low dose of a medication to help calm my mom and also, is effective for depression as well as getting her to sleep throughout the night and that has helped tremendously. Sleep plays a huge role in anyone's mood/behavior. Maybe your mom could benefit from something like that. I hope you get some clarity so you can make a decision real soon!

PAH, big ((((hugs)))))). There are no good answers these days, are there. I wonder if the docs at the facility can prescribe something for your mom's agitation, at least temporarily?

Please understand that if she goes into any facility and covid becomes present there, they will suffer staffing shortages. We just went through this in MN. MIL's facility (a very good, well-run one) locked down immediately in mid-March. At the beginning of May staff introduced covid in. They can't hire subs unless they can prove they were quarantined for 2 weeks. My MIL was very sick with covid for all of May (4 weeks). They moved her to a make-shift covid wing on the first floor so that families could have window visits. But she was so sick it was pointless. At one point they had 1 nurse to 16 covid patients. My MIL (because she had signed a DNR) was only given acetiminophen and 5 l. oxygen. When she stopped eating and drinking they did not give her IV fluids (because then her lungs would really struggle to clear the fluids). It was chaos for those weeks as the facility tried to keep up with sickness while keeping families informed. I pitied them -- they were exhausted. BUT my MIL did survive and recovered fully. Unfortunately 9 residents did pass away and who knows how many others had permanent damage (cognitive being one of them). My MIL didn't have any pre-existing conditions except frailty and short-term memory issues. She doesn't remember being on death's doorstep!

Just this Wednesday we had our first in-person meeting with her since March...5 months! They still insisted we be 6 ft apart and wear masks -- outside. MN just recently passed legislation that will allow anyone designated (and approved) as an Essential Caregiver to be able to come into the facility. You may want to check if NY state is working on this or not.

Your Option B may not be useful since it is the outside caregivers who bring the germs to the seniors. Unless you know for a fact that they are having no contact with the outside world, they are always a risk of infecting your LO. What if that caregiver tested positive? How would you find a replacement on such short notice?
And where would your send your LO if she did have covid in IL?

The reality is that there is no guarantee what will happen in either A or B options. Facilities can only do so much. Even if one of your family took in your mom temporarily, they'd have to follow quarantining-like lifestyle for who knows how long. If I were in your shoes I'd find the most well-managed facility with the lowest patient-to-staff ratio. I'd interview them on how they'd manage covid in the facility. That's as much as you can do other than having her in your home. I wish you peace in your hearts that there's no perfect answer in this situation and you are doing your best.