Could my 71 yr old brother successfully transfer from a nursing home to his own apartment?

There has been a lot of burnout in the care industry. Medicaid at home only covers a few hours a few days a week. If you are able to hire caregivers, chances are you would not be able to cover all of them. Plus if there are frequent call outs, you might be out of luck for replacements. Costs are $25 to 30 per hour for pro services. Nurses to dispense meds unless he does not need supervision here, are even more difficult to get. If you go private, then you will need to hand tax w2s. And purchase insurance like workman's comp.

Go back to the basiscs: Why.

Why does your brother want his own apartment?

My relative IS in their own apartment. They believe living alone means they are still *independant*. WRONG.
Yes they live alone, but are completely DEPENDANT on family & others.

A cobbled together plan is in place, taking a village of people to run. From aides for ADLS, cleaner, driver, deliveries & a dedicated 'Case Manager' to oversee & arrange everything. The care bill is staggering! And this is WITH family acting as the Case Manager. Without that, wowsers, game over.

All Professionals, from GP, RNs & OT have advised *supported accomodation* instead. Why?
1. To better meet LO's needs with less gaps in service. (Any agency will have no-shows, lates, cancellations)
2. LO cannot self-manage.
3. To take this enormous burden off family.

Anyway, that's my view, of MY situation.

Ask YOUR brother his whys?

You will hear how his problem solving skills are - if he is realistic or in wishful thinking land.

If there are things he wants in his current accomodation, he would be better to work towards goals on how to add them.

Bottom line is, if he wants to move - he needs to be able to arrange it. He needs to be able to self-manage his new accomodation & his care plan. Explain that to him.

It sounds as though your brother has little money. Unfortunately, money equals options. And so, without lots of money, there are fewer options. Any apartment runs the risk of him being unable to pay the rent unless he gets one that's rent-controlled. How many of those are around where he lives? Now, you say he needs nursing help on a daily basis. What needs to be done that can only be done by a nurse? That is going to get harder and harder to find - home healthcare agencies are already shutting down/dialing back because of how hard it is to find staff.

It sounds like what needs to happen at least short term is putting him in a situation that meets his current needs. Should things change, maybe revisit the discussion. But, putting him in a situation that will fail isn't going to help him.

Thank you to those who gave kind and thoughtful responses. I am his only relative and I am at my wits end to know what to do for him; it's very depressing for us both. He has also been diagnosed bipolar but he refuses to accept any meds. The heart of my question was in the details, i.e., would Medicaid pay for nursing and CNA help on a daily basis?

We are in California where the benefits are better than most states. If he were to live on his own, the funds he would receive from SSA and SSI, as well as food stamps, housing assistance, etc., would cover his expenses. The big question which must be answered is how much assistance would Medicaid provide on a daily basis?

The LTC facilities paid by Medicaid in California are seriously deficient. Others I know with family members in a similar situation have the same complaints about the level/quality of care, food, staff, etc., with Medicaid facilities. In California LTC facilities are BIG business. The corporation that owns the one my brother is in owns over 70 facilities in the state and has been 'reprimanded' repeatedly (never seriously) by the state - with no improvement in services - while the administrators/senior staff drive new Mercedes and other luxury cars.

Based on the responses, I would agree he needs to be in a LTC facility. It's just so difficult to keep a clear vision of what is best for him when he constantly calls and complains about everything - much of which is justified. The important advantage of LTC or Assisted Living is they manage medications (he has many) and someone is always there in a medical emergency. So the only alternative I can see now is to find another LTC Medicaid facility to move him to - which are extremely limited in our area.

Thank you again.

I could see this working for a very self motivated person who is adaptable and financially independent. If he is relying on a patchwork of programs to pay for housing, food, utilities, transportation, medical care, medications, and ADL assistance …. I would not recommend that you step in to get it all set up for him unless you are willing to maintain it all indefinitely, which is probably not in your best interests.

I suspect there is more to it than you are aware of.

Someone who relies on a walker or wheelchair may need help with ADLs frequently (toileting, continence, transferring, and eating) or may be able to defer their needs if caregivers don’t show up as scheduled (bathing and dressing).

INR testing may be done using a home device if one is willing and able to do so and can communicate the results and follow instructions to adjust medication and diet (Vitamin K from leafy green consumption needs to be considered).

What is your personal knowledge of your brother’s care needs and level of personal independence? Does he have any cognitive or mental health needs that limit his adaptability?

Sometimes it is better to accept the bureaucratic bundle of care rather than do it yourself; if he can do it all himself, that could be different.

I can’t imagine how he would be able to afford living in his own home.

Why does your brother wish to leave his facility? Is he receiving poor care? If so, is there another facility nearby where he could move to?

Unless he is rolling in dough, no chance. You would be talking about $300,000 a year.

When you add all that is wrong with him this is shear fantasy.

What he wants and what he needs are two different things.

IMO, supporting this idea would be irresponsible at best.

Carol, this will go according to the policies of medicaid in your state. Some states are very stingey and some are quite generous. MI, I hear, often provides a lot to keep seniors in their homes.

I hope you will find a care manager, case worker to help you iron out the possibilities.

Where is this gentleman living NOW? Or is he in care. If he is in care for rehab or an SNF you should have him contact Social Services discharge planning to describe his needs at home and any family who can perhaps assist. The plan should start early. Remember also to consider any veteran benefits he may have. And good luck.

What he wants and what is possible are two different things.

If he can't do most of his ADLs, he doesn't belong in his apartment. You are describing what seems to be a 24/7 caregiving job. If you pay a CNA $30 an hour (and I have no idea if that's reasonable in your area), you're paying $720 per day. You have to pay a CNA who lives in whether sleeping or not, because their duty is to take care of whatever comes up all 24 hours, and lots of things happen. Boy, do they, any time of day or night.

So $720 per day x 30 days in a month, which isn't always 30 days but let's go with it. That's $21,600 per month for brother's care. Which is $259,200 per year. Do you really think Medicaid would pay for this for one person, when he is already in a nursing home where he is being taken care of already? Presumably by Medicaid?

And of course, he'd have to pay apartment rent and utilities. Where's that money going to come from? Not you, I hope. And don't even think about taking him into your home. It's beyond what any one person can handle, especially after he has the knee surgeries.

Please don't encourage his thinking in this direction. Help him accept where he is and his situation.

Carol, to my knowledge, the only place in the US that will pay for 24/7 aides is NYC, through Medicaid.

Does your brother have the money to rent an apartment?

Perhaps you and he need to obtain an independent "Needs Assessment " from his local Area Agency on Aging.