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My mom has been in a nursing home since December. She has mild vascular dementia, diabetes, heart trouble, etc. She can walk with the aid of a walker and can do most things for herself. She needs help remembering to take her medications, taking blood pressure prior to determine which ones not to take and which ones to take, etc. She also needs help preparing meals and laundry. She has just been approved for Medicaid chronic care, so she could soon be going home with home health care.

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I remember my Mom returning home after being in the hospital for a couple of days due to a fall. I had set up caregivers through a private Agency, and I was not surprised when Mom shooed the caregivers [3 full-time shifts] out the door. She said that her husband [my Dad] could take care of her.

Oh I left out that both my parents were in their 90's and were fall risks. If Mom was falling there was no way my Dad could get out of his chair quick enough to catch her... if he could catch her, chances are both would land on the floor.

Oh yes, elders are usually in denial that they can no longer keep up a home like they did years ago. My folks were the same way. Dad refused the medical alert, like what is said on the commercial "that's for old people".

My Mom was also one that thought "what does she know??" about her primary doctor.

Sadly we usually need to wait for another medical emergency, 911, and another stay in the hospital before we can move the elder into a safer environment.... hospital to rehab to Assisted Living or long-term-care [nursing home] :(
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Does your mother's doctor understand that she is going home with just an aide? Giving these sorts of complex instructions is, to me, a clear indication that mom needs nursing care.

The doctor needs to discuss this with mom.
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It is definitely difficult. We cannot hire private pay. I believe the biggest hurdle is that she doesn't feel she needs the help. She feels like I "stuck" her in the rehab/nursing home, even though she signed herself in from the hospital. She argues with me about everything, doesn't feel that the doctors know what they are talking about unless she gets one that says she is doing well. She doesn't want me helping her, she wants my brother to help her. However, he doesn't call and will stand her up when she is waiting for him to take her out or come over to set up her meds when she was home. When she then asks me to pick up the pieces from him not doing what he said, she is abusive towards me. Speaks to me very aggressively, tells me to leaver her the "f" alone, etc. I am at my breaking point. I honestly believe she is better off in the nursing home, but my brother and her just want her to go home. That means that I will have to take over a lot of her care, which almost cost me my job last year. I just don't know what to do.
Before she went into the rehab, we were calling and having her take her bp on the phone and then would tell her which meds to take. That kind of worked, but then my brother decided it wasn't necessary because he kept getting readings where she could take all of her meds. So they just stopped taking it. That could have contributed to all the falling that happened before she went to the hospital. She did have one of those medical alert buttons with fall detection, but she refused to wear it. She said it kept going off. I have a feeling that is because she kept falling.
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Yes. my mother came home after rehab a few times. Never after three months. 6 weeks was the longest she was in hospital and rehab. The big difference right off the bat is she could take her own meds. She couldn't cook or clean. She had Medicare provided home health which is much less than Medicaid can provide but she didn't qualify for Medicaid. Medicare provided a bath aid and a nurse to check vitals and set up her meds. She had PT several times a week ongoing. Medicare home health made all the difference for her. We also had a private pay relative to come in on a daily basis to check things out and cook and clean for awhile. She continued with home health for several years although we had to take over the food prep and cleaning due to her being so difficult to deal with.
My aunt, who has dementia, came home with Medicare home health and was doing fine with that set up until she began to have problems with taking her meds. She now has private pay help two hours each day to see that she takes her meds correctly and make her breakfast and get her day started. Her meds are not as complicated as your moms bp meds. She does have to take one on an empty stomach which proved to be too difficult for her on her own. (dementia )
I think I would try to get a second opinion on your moms bp meds., regardless of what you do about home care. I've been through that with aunt on chasing the bp. Taking bp several times a day. Take this if it is too high. Etc.
We finally got her back on the three pills that work perfectly for her (if they are taken). A new doc had changed them up and we couldn't get the bp straight for about a month. I took her to a cardiologist and he ran every test he could come up with. Decided she was fine except for her bp. ( which is why we went in ) and gave us a busy schedule to follow the bp. I had to stay with her at that point to keep the bp in a safe zone. Bp can be hard to regulate but there are many medications to try before accepting your current arrangement is what I learned. I'm off topic. Sorry.
With your moms condition it sounds like you will need someone to handle her meds in addition to the Medicaid help. I'm glad you were able to get that help. The Medicare aids always take the bp before bathing. So, although they don't give meds they could take her bp and call you ( or tell your mom) if the extra med needs to be taken. That might work for awhile. Personally I would want to be there for awhile anyway after she gets home to see how she acclimates and how the aids work out. 
Mistakes happen. Elders are vulnerable. You might hit the jack pot with your aids. You might not. Your mothers care has to be managed wherever she lives. Good luck to you both.
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After all that time away your mom may need a higher level of care. It will take her time to reacclimate back to her home surroundings.
If her medication regimen requires a blood pressure check before administration she will need more than a home health aide. Home health aides/CNA's aren't licensed to administer meds- they can remind the patient to take them usually from a pre-filled mediplanner, but unless they are licensed they can't dispense medications- that is a nurse's job. If someone has to check her blood pressure every day and she has parameters from her doctor that depend on the reading, that's going to be more complicated.
Some pharmacies provide medications in blister packs that make it easier for the patient to take but if she has to take out certain meds if her blood pressure is low, who will do this? Can she?
Home health aides will help with laundry, meals, hygiene and toileting.
Please consider getting her a Lifeline device that she can use if she falls.
I would think about arranging for more coverage via an agency or family members to stay overnight with her for a few weeks. The cost will probably be private pay to augment the hours provided by Medicaid.  Or, assisted living/NH until she gets more physically and mentally healthy.
She may not be able to be left alone overnight. What do the staff at the rehab center recommend?
Good luck to you. It's hard I know, but if she falls or takes her meds incorrectly she will have a set back.
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Dear Staar,

It sounds like your mom might need more help than home care can offer. Are you able to hire a live in caregiver? Or perhaps it might be safer to consider assisted living or a nursing home?

When my dad went home from rehab, I was there every day to check on him and even then it was not easy. It was tough seeing him so vulnerable. I hope you are able to arrange more care for your mom.
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