Nursing home or in-home care?

I find myself wrestling with this difficult decision. My 102 year old mother fell at home in early July and broke her hip. She had surgery and is now in rehab with about two weeks to go. Her physical therapist told me their goal is to get her to only needing one person to assist when walking,toilet,bathing,etc. My mom is driven by anxiety and fear. The aides can’t even close the bathroom door for privacy before my mom starts screaming don’t leave me alone. This anxiety/fear is with her every moment. She doesn’t want to be in a facility,long term care, and wants to return home. She would need care 24/7 and financially could afford it for about eight months. Each day when I go visit she badgers me the entire time about going home. I know if allowed she would chase the aides out of the house. She is used to getting her way. I have been tending to my parents needs for pretty much the last four years. My dad passed away two years ago. Since that time I have tended to mom 24/7 with help from an aide four mornings and my sister here and there. I have printed out as notes everything going on to help my mom understand what is going on around her. She has read what I gave her,but doesn’t care and insists I allow her to go home. I said to her yesterday if I allow you to go home with care you will be broke except for the home which is in a trust and we will be putting you into assisted living in eight months or less. It makes visiting very difficult as from start to finish she badgers me. Her anxiety at night has her calling for the nurse all night long. She is afraid to be alone. She had roommates,but all asked to be moved except one who had been a nurse. They moved her for different reasons. My fear is that if I keep her where she is now she will cause trouble for the staff. I want her to be safe,but she is miserable and only wants to return home. What to do ?

Barbbrooklyn
have some savings, probably enough for about a year of NH.
trying to get Dad approved for VA aid & attendance.
will talk to elder care attorney next week concerning medicaid.

An additional question--what is their financial situation?

AL in Trenton appears to cost about 5-6K per month. NH care will be double that. Do your parents have long term care insurance? Will they qualify for Medicaid?

Can mom still drive herself to where dad is, or would the plan be for her to move as well?

What does the discharge team at the rehab say about what level of care dad needs, going forward? The discharge planners at my mom's post stroke rehab were very specific about what level of care she needed, which helped us find the right facility.

thank you for all your answers.
still no decision on where Dad will go.
problem is i live in Myrtle Beach and Dad is in Trenton, nj
flying in on tuesday 9th to help.
brothers and sister have really not investigated any SNH or assisted care facilities yet. nobody has talked to an Elder care attorney.
thinking about respite care until a decision can be made.
dkentz72
father takes about 10 meds a day.
mom takes about 5 a day.
mom still takes care of everything with the house. she was taking care of dad's meds for him. no problem taking her own meds.
am talking with 2 assisted care facilities that want to evaluate dad to see if they can take care of him.
i personally don't want him to go home, it will be too much for mom.
won't know until i see my dad how good/bad he is.
any other suggestions?
am starting new topic asking for SNH or assisted car recommendations for Trenton, nj area.
thanks again

Id say nursing home where people can be with your family member around the clock

Markevens999, WWYD if in their shoes?
There are good/bad things with in-home care just like assisted care/nursing homes, people who babysit your kids etc.
1. Does your Father take meds
2. Does Mom
3. Who takes care of the house, shopping, doctor appointments
Just in those 3 questions the first 2 cannot be done by in-home care. Unless they have an RN to administer meds, CNAs cannot even touch the RX bottle much less administer the meds. They can take them shopping, appointments, bath, cook, feed but no meds.
There are assisted living facilities which have apartment like rooms which both can live. My grandmother was residing in a facility like this. She had a beautiful master bedroom, private bath, living area, small eating area, tiny kitchen with a microwave only. There was a mailbox outside her door! Medical staff checked in on her and as her Alzheimers became worse, their visits became more. She lived in this cute apartment until she needed complete 24/7. She left us at 95.
I always thought my Uncle was the best son she had. Mom helped when she could but Mom's youngest brother was the caregiver his entire life.
Now that Mom/stepfather are in that same position, my Uncle has been my rock as well as my Aunt. I live out of State and they visit Mom at least 2x a week. We get together when I go home on my welfare trips. I call to cry because I'm/we are losing our Mother everyday. He's been there and helps to encourage me and that I've done my best for Mom.
My sweet Uncle/Aunt have told me so many times that I have Mom/stepfather in a wonderful assisted living group home. They have a suite that looks like a very expensive hotel room. They have their dog, the best ever caregivers who treat every resident like their parents/grandparents. These caregivers even provide me with care for what I'm going through. God most likely had my great grandma telling him to lead me to the best place to care for her grand baby girl.
The caregivers, manager, owner of 3 homes are all Romanian. Bridget's daughter helps me by providing playtime for the dog because stepfather thinks he takes the dog to the dog park every say.
All these people are Pentecostal and left Romania from persecution of their Faith. My great-grandma was a Pentecostal minister and we were all raised as such.
I do not have any doubt God was listening to grandma.
FYI, that suite had just become available the day I had to find a place to move them to. It is so hard, but the only thing(s) that help give me comfort are my Uncle/Aunt, all the employees, God/grandma.
Contact a State agency who will assign you a caseworker who will help to find a place for your parents that meet their needs to care for each other while being cared for too.

In-home care is going to eat up funds rapidly. Does dad intend to file for Medicaid, which - if he qualfies - will allow him the NH residence?

Can they afford in home care? If yes, in-home health care can do the same things at home that they do in a facility. Take him home. If you're going to go this route, you will have to prepare for the return by getting all the medical equipment lined up (bed, bed tray/table). Is the bathroom big enough to install a bath chair lift (doesn't have to be a huge room)? Check out 'safebathtub' online. My mom has very tiny bathroom and I installed one of these - best money ever spent. No more sitting on a bench freezing to death while showering.

If not financially doable, he is where he needs to be if she is unable to physically turn him, diaper him, and take care of him in the bed.

Our family decided home care was better for my 84 year young wife, suffering from seizures, than an extended care facility. Daughters interviewed and hired 6 aides to care for her almost 24/7 and did a great job of it. Aides were with her for almost 2 1/2 half years before she passed. For our family it was the right decision. Don

In home care is expensive. You’d need it 24/7 . In my area there are assisted living facilities with apartments . They have care but they could be together. If your mom already has memory problems my concern is how safe are they alone? If there was a fire could they escape? What if she forgot a pan on the stove?

Home health care workers are not miracle workers. Dad should be in a nursing home. The cost of 24 hour home care would outstrip the cost of a nursing home.
Your mom is 90 for God's sake! She cannot care for an invalid.
Things will only go downhill for both of them from here. Urine catheters lead to frequent UTIs. Recognizing the signs of a UTI in an elder is a constant thing to check.
If dad is a veteran, they will probably pay for his care at an approved home. Check into Medicaid if they have few savings. Time is not on their side. I think your mom will need assisted living or living with a younger relative within a year for her memory problems, as they only get worse. Been through both scenarios and it's sad and awful to see a loved one deteriorating physicality and mentally.

YOUR dad's doctor will do what you ask or recommend. He doesn't know your parents home situation. Get nursing home care in place before he is released from rehab. The people at rehab are there to help your dad and mom with everything.
GOD BLESS

If you have access to his present caregivers and therapists and rehab center social services team, collect as much information as you possibly can concerning his present needs and how they need to be addressed.
If Mom has what you characterize as “pretty bad short term memory problems” at 90, a proactive approach to providing care for BOTH of your parents is probably a necessity, if not now, soon.
Are you assuming that your father may regain control of his toileting needs upon returning home? This may or may not happen.
All said, it is probably the best approach to plan to provide over amply, have a sense of both residential placement AND in-home care, and observe as objectively as you can.
Your mom’s safety and welfare are at least as cautious a call as Dad’s, as you probably already realize.
Hopes for successful care for them both.

If they have the finances to pay someone for 24\7 care, he can be cared for perfectly fine at home. He will have to have the 24\7 care, it can not be left to your mom, no matter how badly she wants to care for him! My mom couldn’t do anything for herself other than self feed, and she got excellent care at home, from ladies that were NOT even CNA’s. BUT, it takes finding the right caregivers who are willing to work, and NOT call out all the time.

Perhaps the tactful way to put it to your mother might be "not yet"? If you can keep putting off his hypothetical return home, it's a lot gentler on her than saying "when you took care of him he landed in hospital with a leg infection. Great job." Brutal but true, after all.

Would funds allow for them both to move together into a facility?

Could the aides find jobs for your mother to do that she can manage? E.g. hold his hand while they're washing or dressing or transferring him, assist with eating, plump his pillows during bed changes, that kind of thing. It might be better to distract her with small contributions to his care than to leave her wringing her hands and then trying to do it all when they're not looking.

I can only imagine the frustration of what the family is going through, though. You can't ask your father to stop asking her for help. You can't explain to her that when he does ask, she needs to say "yes, I'll see to it" and call the aides.

Does she visit him every day and then return home alone?

Hopefully, LTC is attached to this rehab. I suggest that that u have Dad evaluated for LTC. He probably will qualify.

How are their finances? If paying privately will drain them you need to talk to Medicaid and ask about her becoming the Community spouse. This is just an overview. She will be able to stay in the home. Their assets will be split. His half will have to be spent down to the cap allowed in your state, my state is 2k. His SS and any pension will be used for his care. How much of it will be determined by what she needs to live.
There should be a Social Worker at the rehab that may becable to give you more info. But my feeling is, there is no way a Social Worker knows all the ins and outs of Medicaid. Everyones situation is different. I personally would talk to Medicaid. If this all seems overwhelming, contact a lawyer versed in Medicaid. You can use ur parents money for this.

I hope there are POAs in place. It will make this all so much easier.

You are never going to be able to find anyone who will just pop in several times a day (and night) to attend to his needs, and bathing, positioning, and transferring would be next to impossible. The only possible way he could return home would be with the help of 24/7 aides and having the house set up with all the features of a nursing home.

If he can't walk, has a catheter and wears diapers it is time for a nursing home, your mother will not be able to properly care for him. The aides at rehab are correct, she needs to tell him no, we have the same issue with my step dad, he thinks that his wife is his servant. They are now living in AL and he refuses to get a scooter, so she pushes him around in the wheel chair and he doesn't use his feet to help her, she doesn't have the backbone to say no to him, causing issues. The hospital actually sent her home when he was in the hospital, she always wanted to stay overnight and she was in their way...plus she would get lost and they were always looking for her.