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In a skilled nursing facility or such? We are now on a time constraint as I have gotten called back to work sooner than expected. We were hoping to get her evaluated at her next Dr. appt but that doesn't fall til the end of August and do not think we can wait that long as I do not feel she can be left alone at home for an hour let alone the whole day. She refuses to get in home help so unfortunately that is not an option. Seems lately all she does sleep, sometimes 15+ hours a day and rarely eats or drinks unless we force stuff on her. I guess we are in panic mode right now as we thought more time to get this all in order but unfortunately that's not the case. I would have thought the Drs office would have been more help but they are not, so hoping this is the next step to take.

You seem to be in a similar situation I was in. The Dr's and nurses my father saw were no help at all. Dad couldn't be left alone anymore and I could not be there for much of the day. I had him taken by ambulance to the ER. Explained to case worker there that Dad was not safe at home anymore as he was alone and hospital worked to find placement. Before it came to that, the home health nurses were suggesting APS, but at the time I didn't like the sound of that. Perhaps they would have helped though. What I learned though is his Drs and nurses were really not helpful at all in helping guide me through the whole process. So I think your two options are through the hospital if you can get her there for a valid reason or yes, possibly APS.
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Maine127 Aug 20, 2020
Thanks that does sound very similar. The nurse even asked why I would want her in LTC with all the COVID etc. I said I totally get that but there is no one that can be there 24/7 and at this point looking for options.
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Maine, I'm sorry because I know this is going to sound unsympathetic (when I'm not, not at all), but what are you expecting APS to do about this situation? They can't force her into residential care or force her to accept in-home support.

I think you'll have to set up the in-home service regardless, and if your mother chooses to reject it in practice from day to day there's not much you can do about it.

Why don't you think she's safe to be left alone? What are the risks?
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Maine127 Aug 20, 2020
She will not answer the phone or door if someone comes is there is really no way to check on her when we are away from the house. I ran to the store for a few things the other day and she decided to make soup Ended up leaving the stove on with the pot on it. Luckily I arrived home before anything major happened. I feel being away for 8+ hours a day will be a disaster
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What specific acute symptoms is your mother exhibiting? Just her being a handful to care for is not enough reason.
How old is your mom?

If you take her to the ER and she has no symptoms of an acute illness she will be evaluated and discharged. In this pandemic hospital beds are full. I can’t see them really allowing you to refuse to take her home if she again has no acute symptoms (dementia doesn’t count & I’ll bet it won’t be an admitting diagnosis).
You may hear this as an option on this forum but it is used in reference to folks acutely ill or status post frequent falls or failure to thrive.

If you refuse they may apply for guardianship through the courts and the state will take over her care. They will call the police and get LE involved who will evaluate and notify the county Dept of Aging. The DOA will know how to handle what will be considered abandonment by her family if mother has no acute illness to treat.

Does she qualify for SNF admission? Do you have an option of placing her in assisted living or memory care?

Her PCP should evaluate her in the office (or one of his covering partners if he isn’t a solo practice) and then write orders for SNF placement. This rarely happens as usually the admit to the SNF is post acute treatment at the hospital.-the person gets ill, is taken to the ER and if she gets admitted then you can speak with the DC planner and let them know your goal is to have her placed.

I assume she has the resources to pay for a SNF? She’ll need insurance of course. Realize one can’t be admitted to a SNF without a doctor’s order. The hospitalist will most likely want to talk with her PCP to get mom’s history before writing the order which they will not do if mom does not exhibit any acute symptoms.

In the interim while mother may not like it, you will have to self pay for CG during the day if you are going back to work. Everything moves super slowly during this pandemic.

Have you tried adult day care?

I advise you work to develop a Plan B because I have heard this week that Covid-19 is making a comeback to LTC facilities/elderly folks. If this is true placement will take even more time. SNF beds are full.
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Maine127 Aug 20, 2020
Thanks for your info. Mom is 90 be 91 soon. She refuses to answer the phone or door when we are not home so there is no way to check on her for 8+ hours M-F. She does not have the means to pay for AL or a memory care unit as she barely gets by on what she has. From what I am being told we will need to apply for Medicaid and move forward. All the money she did have is gone from a lawsuit with a car accident they happened a few years back. I hate the thought of just dumping her but at this point we cannot be there to care for her 24/7.
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Well so much for getting any help from the Dr or his office. We called today and he is away til the week of her appointment. The nurse pretty much said why would we even want to consider a placement somewhere with all the COVID etc. going on. Of course she doesn't live it every day so really has no clue. I really would rather not call APS but not sure what other choices I have at the present time.
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We are going to try the Drs office Monday AM but am not counting on getting any help on that end. I am thinking if she ends up in the ER they can see for themselves that all she does is sleep and barely eat, honestly cannot believe that she is not de-hydrated yet. We have 6 in our household and she lives with us, there are no signs of COVID but I know that can change at the drop of a hat. The kids will be going back to school shortly as I will be back to work hence the rush.
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APS can be called if you leave thinking she is safe and come to fear she is NOT. But if you live in the area they will simply tell you to get her placed.
Doctor won't help? You are unfortunately down to the call to EMS and the Emergency Room Dump. I hate that. It is ugly to even say. But the truth is that it gets the elder to the hospital, it gets the elder admitted for eval if you say they are "dangerous to themselves, without care, and a discharge home would be an UNSAFE DISCHARGE". Then you must NOT agree to discharge with "help" and "We can make this work together" which is what the social workers will tell you. You will have to insist that placement is a necessity, and that discharge is unsafe.
This may work and it may not. If assessment is done and the elder is assessed as safe to make decisions on her own she may BE discharged. She may go home. And then that is where she is. And you are down to calling APS when she is failing to thrive or down to calling EMS when there is another catastrophe.
There should be a better way.
But there may not be.
You can try calling Doc on Monday and saying she is not safe at home. Whatever you need to say to get it through. And that you will be taking her to the ER if they cannot help you.
What a mess, isn't it? Because we are all trying to AVOID hospitals. I can tell you they are getting very good at separating out possible covid from not. So make it clear if you have to take her or call EMS to take her that there is no sx. of Covid-19. Hope you find an easier way. I can't think of one. Hope you update us and wishing you good luck.
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