I have decided to put my mother in a nursing home, where do I start to get her in one?

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My mother is 90 and still lives in her home, with my unemployed adult brother living with her. Without going into too many details, I'll just say that for financial reasons my brother has been trying to keep her at home for as long as possible. She's had a few stints in a rehab after being hospitalized for illnesses (pneumonia) and they've been nice places, with good food and activities and even visiting entertainers. Each time I've gently suggested that she might be able to stay there one day, but she would start crying and getting upset, saying she has her own home and doesn't EVER want to go in a NH. I think she remembers the awful places my grandmother and great-grandmother were in the 1960s and 70s. She is a very stubborn woman and I've been dreading this NH issue for many years. It certainly hasn't helped having my brother side with her - it's been two against one. I am her DPOA, but do not have a medical POA; stupid, I know.

It's been a rough road the past few years and both my mother and brother, for their own personal reasons, have fought her going in a NH. It's now becoming apparent that we're nearing the end of the road for her staying at home and she will need to go in a NH soon. She is on a cocktail of meds that are keeping her fairly healthy for her age, but she has mild to middling dementia and worsening arthritis in her knees. There was an awful flareup of pain last week and an ambulance took her to the ER. They were unable to do much else but give her a painkiller injection and a lidocaine shot, along with a cortisone shot which didn't work. We didn't think she'd be able to get around the house too well when she got home (get on and off the toilet, etc) so we pretty much begged her doc to admit her, which he refused to do for an arthritic knee. We brought her home (with difficulty, after that painkiller), and she's been in pain but stable ever since. We have an appt with an orthopedic this week.

The helplessness we felt that night in the ER when told they us they wouldn't admit her was just awful. It was really obvious my brother wouldn't be able to handle taking care of her and I work and have my own family to care for. I asked to speak to a social worker about moving her to a NH that very night but was told since it was a Sunday night, there weren't any available. I think that night, coupled with my mother's increasing hygiene problems and dementia, has shown my brother that our mother can no longer live at home. I spoke to an elder lawyer a while back and the house will probably be transferred to my brother, as a "caretaker child". From that moment on, he'll own the house and be responsible for all the bills, which is the reason he's been fighting putting my mother in a NH for so long. Hiring an in-home caretaker is out of the question due to the cluttered condition of the home and other problems which I won't go into. We now have a home health aide coming in twice a week to bathe my mother and, while I'm thrilled that she's finally getting clean, it's been causing it's own kind of problems having someone come into the house.

I always thought my mother would move into a NH after another stint in the hospital and then rehab. I had hoped that it would be a natural progression. But it's obvious to me now that she'll probably need to go in one not due to illness but because of my and my brother's inability to care for her ourselves. My question to the message board is: how do I get her into a NH directly from her home? I can't imagine just loading her up into my car and driving her there; she would most likely throw herself out of the car. Is there a procedure? (I've already picked the NH). Also, does anyone have any advice on what we should do if (more like when) we're back in the ER with our mother and they won't admit her and there's no way she should be going home that night because we can't care for her? We're in NJ, by the way.

Thank you in advance for any advice or stories about your own experiences when moving a parent to NH directly from their home and how you got through it. I really appreciate your support.

Thank you,

Sue

Answers 1 to 10 of 58
IF her doctor is willing to say that she cannot care for herself, she can be admitted to a NH with his orders. Some bring their family member right after a doctor visit when the doc does a history and physical for admission to the nursing home. I wish you the best in taking care of your mother.
My mother was fist admitted to the hospital when she kept falling. I toldher socia worker she was getting worce that I anted her to get 25 hour care I found a facility for her thats ho my mom got admitted to nh permittly because she was too difficult to take care of. either talk to her Droctors or social workers if your mom ha one tell them the situation. shop around for a good nursing home rehab first that's hat I did. my mom had acase orker through socail services for her being on medicaid global options and adult protecive sevics how that happened as mymom was living withmy nephew he negelcted her I took her out of bad situation.
My mother went to a nursing home permanently, directly from her home. I did not have medical power of attorney, or any other power of attorney. She had been paying caregivers, and when the money went down to Medicaid eligibility limits, I contacted the nursing home. Her doctor wrote orders. Someone, I can't remember who, contacted the Area Office on Aging, who came to evaluate her Activities of Daily Living, one day, and the next day I admitted her. It was the hardest thing I had to do. Since your brother is still living in the home, this could create problems. I had belonged to the Alzheimer's support group, and they were of great help. I had people who were on my side, and I had people who thought I was the worst person in the world. But, for me, I only pay attention to people with initials before or after their name, such as MD, PHd, LPN, RN, LSW, or someone in authority in the Church. You can contact the Area Office on Aging yourself. If you can't find the number, you can get it from the nursing home you plan to take her to. If the Office on Aging knew just how cluttered, and possibly dangerous it is at your mom's house, maybe there is something legally they can do. Is your mom on the waiting list? When you want to take her there, there may not be an opening. In the meantime, I would try to get more caregiver help. I realize that it will be awkward with your brother there, and he may be giving you trouble, but you need help. And they have seen clutter.
I'm sorry it took me so long to answer. I thank everyone who responded to my question. My mother took an even worse turn on Tuesday and we had to hasten her admission to a nursing home - thank God we were able to get her into the one of our choice that very night. I transported her from the ER to the NH myself, where the nurse on duty picked her up out of my car and put her in a wheelchair. My worries about her screaming and crying about leaving her house were all for nothing - she totally accepted going to the NH as she knew she really couldn't get around anymore without help. The arthritis in her knees is so severe, there's no way she can walk now. All I can say is I loved her more that night than ever before because of how understanding she was about going into the home. I always thought I would have a helluva fight on my hands but, in the end, she knew it was the best thing. She's very happy every time I see her now and she's making friends and playing bingo. Someday I'll tell this board the tale of the extremely uncooperative doctors, ER and hospital social workers, who all did absolutely nothing to help me that desperate day my brother and I knew we would be unable to bring her home from the ER. It was like being in hell that day, but it's over now. Now I face the financial and legal problems of dealing with my brother, who has lived in the home his entire life and been unemployed for almost ten years. We have an appointment with a lawyer next week and, after researching elderlaw and Medicaid apps for the past 5 years, I think I know what lies ahead. He has the option of taking over the house as a "caretaker child", but he does not have an income to pay the bills. I think he's hoping to get some kind of lump sum for being her caretaker these last few years, but I know doing that will put our Medicaid app in severe danger. Well, at least my mother is finally in a good, safe place.
Now you and your brother can wonder "who will put me in a nursing home and not have my family care about me?" If someone is unemployed how the heck can they not care for someone? I work full time and have been taking care of my Mom with the help of the county of aging for 7 years now. There are daycares they can transport them even if in wheel chairs to get them out of the house and around others for entertainment. There is no excuse for taking the easy way out like it sounds here. People don't know how to give up on the things and the people that take their time away from their family. I just say no to people that try to take my energy away from what I need to do for my Mom. She did it for me so I feel it's only right to do this for her. Very selfish country we live in that's what it's all about.
Your brother did what many elder children do -try to avoid NH because they want the home for themselves-I am glad things worked out and she is away from him when she gets medicaide they will own the house and your brother will have to find another place to live. You should write a letter to the hospital where the ER doc was so cluless -write it to the adminstrator and let them know in 2 weeks you will send it to the Board of health and to the Gov. of your state and to the media unless you hear from them within 2 weeks. Whatever is brought to the attention of the BOH will be included in the hospital's next inspection so even though they will try to whitewash the occurance they will not be able to avoid it comming back to bite them. If she had not been placed I would have encouraged you to report your brother to APS and they would have looked into her lack of care from your brother.
i came acrosss this message because I am in the exact same predicament. I am stuck with my mom now at my house for the last three months cause doc said she cant be by herself at home. she spent all her money down except house and refuses to sell it. even if she did it would last her one year in a NH and then what she still wont qualify for medicaid for 4 more years. What do I do. My husband left me my son is not staying home because of her I cant work am losing my house because I have to take care of her. I need help
deedee -
can you repost your question in the "ask a new question"
Your post comes up in a ? from back in 2011 so a lot of folks will just ignore it.OK.
wow alot of good advice from people that know wat I am going thru. THank you for your words of wisdom. I need now to grow a spine and figure out how to get her in to a nh . she makes too much money to qualify for medicaide but lacks 3500 to get into a nh. that is where I am stuck. do I just let them take her house and everything?They said that medicare would even cash in her life insurance policies. Well how in the world do I pay for her funeral?
Top Answer
Deedee this will be long.......NH (aka skilled nursing facility/SNF or long term care/LTC) is paid for 3 ways: 1) private pay by elder or their family; 2) from LTC insurance; or 3) by qualifying for MedicAID. Medicaid and not MediCARE.

MedicAID rules determined by each state & are state specific even though it is a federal & state program. Medicaid is needs-based. You are expected to spend your assets first and foremost before the state will pay. There are things you can do to reduce assets but these need to be done by someone qualified to do this that will pass your state's review. An certified elder law attorney is best.

For NH Medicaid eligibility, an individual must show that:
1) are 65+ (can be younger if qualified disability),
2) medical condition requires skilled level of nursing care,
3) monthly income at or below their states max (about 2K),
This is the “income test”– how much $ do you make. TX is $2,094.
4) all countable assets are at or below 2K
This is the “asset test” – how much $ do you own.
5) not gifted away anything of value during 5yr look-back period.
If you do, could be a “transfer penalty” when items are gifted. Penalty different for each state as it’s based on each state’s daily NH reimbursement rate. For Texas, it is $ 142.92 a day rate (2011).

Max look-back is 5 yrs. Most states require 3 – 6 mo. of financials with initial Medicaid application. Can require more financials if something pique’s interest. Financials are bank statements, social security and retirement statements, insurance policies, etc.

INCOME: If it is that every month they are over the states income limit BUT not enough to pay in full for the NH and qualifies for NH in every other way, then they can see an elder care attorney to do a "Miller Trust" or a "Qualified Income Trust". Say mom gets 1K from SS & 1,500K from retirement every mo. Income=$2,500. Basically $ 500 over ceiling for monthly income. No matter what is always is $500 over. So this excess $ 500 is what funds the trust and therefore mom’s income is now 2K and within the states income ceiling. The beneficiary of the trust is state's Medicaid program and upon death reverts to the state. Miller really has to be done by an attorney who does elder law as it needs to be flexible/adaptable and meet the criteria of each state's law on probate (death laws) & Medicaid rules.

ASSETS: All assets are counted, unless the assets fall within the short list of "noncountable" assets:
- personal possessions,
- a vehicle (some states have a limit on the value)
- their principal residence, provided it is in the same state in which the individual is applying & the house may be kept with no equity limit if the "community spouse" lives there; otherwise equity limit is 500K (750K in some). House does NOT need to be sold, is a "non countable" asset but elder will have no $ to pay for anything for house as all $ less a small personal allowance has to go to NH each mo.
- prepaid funeral(irrevocable, NCV, usually 10K max)
- small amount of life insurance (usually $1,500 & NCV)
All other assets (savings, stocks, whole life, rental property) are counted.Must “spend down” to get to their states max to qualify.

The financials are what most folks focus on. But remember that they also need to medically qualify for the need for skilled care for Medicaid.

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