My dad refuses a nursing home (don't know how we'd afford it anyway) and we can't afford 24/7 care. He has been hospitalized numerous times for falling (no broken bones). Was in rehab for 4 weeks. He makes too much social security to qualify for Medicaid unless he pays $1000/month in a spend down. He only gets $1800/month and his bills leave him about $100/month. I live paycheck to paycheck and live in another state 1500 miles away. I am an only child. His nephew lives nearby and checks on him but he has his own medical issues. I am trying to hire someone to come in 1-2 hours a day to check on him and clean and do laundry, but everyone is telling me he needs 24/7 care. He gets home health care but that is only a few hours a week. He just got out of the hospital and he is very weak. We thought we had someone to stay with him -- that's what we told the hospital -- but she bailed on us and changed her mind. Not enough money. I'm afraid one of these times he ends up in the hospital I am going to get in trouble. He is with it enough to know what he doesn't want, but weak enough and confused enough to need help. I'm just a wreck. I don't know what to do. I want him safe, but can't afford the right thing.

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I ask the same question as Alva:  "Who is 'everyone?" Specifically?    And what is the source of their insights that are influencing your decisions?

I learned early on that literally "everyone" had an opinion.  One evening in the ER, a staffer (unknown if he was medical or not) told me he was calling ALs to find a place for Dad to live.  He never bothered to ask what our preference was, so I told him nicely but firmly that my father and I made decisions for his welfare and no way in hell was he going to be shoved off into an AL facility w/o our discussion and consent.

The best thing you can do to assist your father's physical stability is to take advantage of rehab post hospitalization.  He'll get decent treatment (assuming there are good rehabs in his area, and he'll be positioned to function more successfully alone, with moderate help as needed.   W/o rehab, he's far more vulnerable, and living alone is more dangerous.

Something you can do from afar is (a) read Medicare reports on rehabs (b) make a checklist of desirable services, features and issues (c) call the Administrator and get additional information, and prepare for a rehab referral from a hospital if he falls again.

Also, you can assess his living arrangements:   What changes have been made to avoid falls?   I think it's significant and positive that his falls haven't resulted in broken limbs.   

I think though that right now you're overwhelmed, assuming that everything needs to be handled by you (and I give you credit for being that dedicated), and unable at this time b/c of the emotional involvement to clearly analyze and pursue options.

Set aside relaxation time for yourself, clear your mind, and don't return to remote planning until you do have that clarity.    And, BTW, this isn't unique to you, or to other caregivers.    A friend of mind expressed similar reactions while working full time and going to law school 4 nights a week.  Pressure creates more pressure, as well as inability to think clearly.   You need an option to release all that mental pressure.

You might consider Meals on Wheels to alleviate the need for your father to prepare his own meals.    He'll also get a chance to meet other people, albeit through closed doors and at distance, when meals are delivered.   In addition, they provide a kind of check-in status.    In my father's area, the delivery folks notified the MOW coordinator if they couldn't reach someone when they delivered food.

Some of the backstops and support needed can be created at home, one at a time.   Creating  a network of care and support will alleviate some of the anxiety you're feeling.

Call the local Alzheimer's Assn. and ask if they have lists of companies providing home care.  Or if your father is religious, you might ask someone in the church.   Even just daily check-in calls will help him socialize, and the callers can provide updates to you.

Remember though that there could be a liability issue as church people would be considered "invitees" for the purpose of liability insurance and injury.
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The next time he's in the hospital/rehab, and they find that he can't live on his own, then let them figure it out. Or, you can call his local dept. of aging and talk with a social worker. You're are not responsible for placing him in a facility, unless you have guardianship.
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Ha! What's this "we" can't afford 24/7 care bit, then, eh?

The reason I sound flippant about this is that you are missing the point. Your father, at least legally and at least for now, is responsible for his care. YOU ARE NOT. So there's no "we" about it - it is for him to make decisions about where and how to live and how to pay for it. If he can't, there are professionals who will report any safeguarding issues and see to it that what's needed gets done.

So you can just let him rot and you're in the clear? No, of course not. But not because you have anything to fear from the law - you care because he's your Dad and you want him to be okay.

That's where it gets really tricky. It is a matter of realising and taking to heart that your father's situation is all about his choices. He may be extremely old and becoming confused now, but for many years he has been getting older, not at all confused, and just as capable as you are now of making decisions and expressing preferences about provision for his very old age. If he actively chose to ignore the issue and rejected advice and options as they were offered, that too was a choice. In short, he made his bed and now he's lying on it.

And it isn't just that you don't have the money or the access to provide him with 24/7 care, or to insist that he gets it in a nursing home. You don't have the authority to make that happen. In a way, it's almost as if it's none of your business - and it's your Dad who wanted it so.

What you can do, perhaps, is get your father's permission to talk to his doctors and his local hospital and find out what support is available to him locally. With no one to take care of him at home and no services set up, the next time he's admitted to hospital they can't just send him home unless they are satisfied that he's safe there (it's a pretty basic minimum, don't get excited); but in any case if you can just get in touch with the right people you'll have a much better idea of what might be possible. There will be options. Don't despair.
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No. You will not get in trouble for not forcing him into a nursing home. You can't force him to go to one either. Also if you don't have his legal POA/Health Representative you can't do anything legally.
Is your father mentally competent or does he have dementia?
I'm asking this because if he is no longer mentally competent you can go to the probate court where he lives and petition the court to appoint a conservator over him. If he's still of sound mind he may refuse to and that would be his right. You will have to explain to the probate judge that the reason for the petition is that you live 1500 miles away and because of this you are unable to adequately manage the care he needs. The court-appointed conservator would be responsible for his welfare and finances.
They would get placement for him in care facility since he cannot afford to pay 24-hour help at home. They will also manage the sale of his home and the 'spend down' of his assets. They will take care it with Medicaid too.
None of this is a free service. Conservators (even when it's family) charge a fee to this work, and that fee is not affected by a nursing home or Medicaid. They keep a record of all the hours they put in and the services they've performed. Sometimes they withhold a portion of the person's monthly income for their services too. A POA (even if it's family) also have this right to charge for their service.
Since you live so far away and your father from what you've said here really doesn't have assets to protect, then petitioning for a court-appointed conservator would probably be the best bet for both of you.
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No, you will not get in any trouble for not placing your father.
Who is "everyone" who is telling you he needs 24/7 care? You said that he was in rehab. Did the rehab discharge plan say he needs care?
As to paying for care, if he cannot afford it you should not be paying for it yourself because there will come a time when, if you do not save NOW, you will be where he is.
As to the info you have got on nursing home, there is something wrong with it. Your father will have to spend down his monetary assets (excluding home if he has one) to the amount your state requires; this can be done by paying for his first months in care. Then he will be on medicaid. There is no such thing as making too much Social Security to qualify for medicaid. His Social Security will go to the nursing home. Other bills are unlikely to get paid at that point. But he will be in care. Check medicaid rules for your State. You can begin by calling 1-800-Medicare as Medicaid is a joint state and government program which will pay for care for seniors without assets.
Dad was already in hospital and rehab once. If he is as fragile as you say then he will be again. Do know that the best place to seek placement from is hospital and rehab as they have Social Workers to assist with placement.
Meanwhile, one way to qualify and spend down for Medicaid is to hire care now. With HIS funds, not yours.
Are you POA? If not, while he is able to do this paperwork, it is crucial he get that done, and I think now covid is under more control, once vaccinated, it is time for you to plan a trip. Meanwhile time now to get educated as to Medicaid requirements.
Wishing you and your Dad the best of luck.
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Who told you that 1800 a month was too much to be able to get Medicaid? For Long term care in my state the cap is a little over 2300. Now the formula for in home care maybe a little different.

If he winds up in the hospital again and then rehab, have him evaluated for 24/7 care. Where I live the rehab and LTC are in the same building. So transition from one to the other is fairly easy. If you don't have POA, you may want to allow the State to take over his care. Once he is deemed 24/7, the rehab should not release him to home if its not safe. Its called an "unsafe discharge". You can tell them there is no one to care for him nor can he afford help. This happened to a friend of mine. She had no problems mentally but she needed 24/7 help and no one to care for her. The Nursing facility could not discharge her. She lost her apt and had to turn over her SS to the NH and Medicaid paid the rest of her care.
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There is nothing for you get in trouble for unless you are his court appointed guardian. If you were his guardian, you would be responsible for his well being. If not, you are not obligated to be his caregiver. For your information though, your father would absolutely qualify for Long Term Medicaid if it was deemed it was medically necessary. You say he was recently in the hospital and you let them send him home because you told them he had 24/7 care? It is not your financial responsibility to pay in home caregivers if you can't afford it. The next time he's in the hospital you tell them in home caregivers are unaffordable, there is no one that can be with him and they need to find placement. He will qualify for long term care Medicaid. All of his income save a small personal allowance ($60 or so) will go to the nursing home, and Medicaid will pay the difference. If he's at home now, call APS and let them know the situation and have them check on him. The home health care nurses actually should be doing this as well if they see that he is in a vulnerable and at risk situation. Agreed with Margaret
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Hi! It doesn’t sound as though you are in a position to do anything much for him – too far away, limited finances, he knows what he ‘doesn’t want’, there is no willing and able local support.

Perhaps the best thing to do would be to contact APS and let them sort it out. It would be good to talk it through first with his nephew (your cousin?), and see if you can both agree.

My take on it is that the more responsibility you take on, the more likely you are to be told that you are at fault when it isn’t enough. Perhaps I’m wrong, but it seems from your post that you simply can’t do this.
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If dad is competent he chooses his own place to live. It does sound like he needs 24/7 care, at least for now. Medicare will pay for rehab for a period of time. Call his doctor, he needs to be in rehab for help to build his strength.
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