Follow
Share

Our mom suffered a terrible fall as a result of being sent home to deal with a burst appendix from the hospital. She incurred TBI (traumatic brain injury) as a result of the fall and had to spend 4 months in the hospital.. most of the time was spent there because it took her body so much time to recover from the surgery to remove her appendix and the TBI took a back seat unfortunately. We finally got our mom into a great subacute facility where she is getting PT OT and speech. Thu nurses, staff and rehab team have been wonderful really. She has yet to regain any movement on the left side of body nor can she talk much. She is also on a PEG for food. As a family our goal has been all along to get our mom back to her apartment while we apply for Homecare Medicaid. But the more we speak to the rehab facility and others about my moms needs which are 24-7 care, the more we are being told that its not safe and realistic to bring her home because we could end up getting very little care from Medicaid. If she could talk and or walk, it may feel different but we are worried that b/c no family member can be there and live with her in her studio apartment that an aide could very easily take advantage of a person who cant speak or walk. On the flip side, if we have our mom go from the subacute part of the nursing home into their long term care then my mom will have to give Medicaid all her $ and she won't have any $ left to go home and pay for extra help *potentially* down the line. As much as we want our mom home, we are also worried that the quality of care from Medicaid will be sub par and will jeopardize her ending up in the hospital and getting sick and never making it out. I am so torn as to what to do? Anyone been in this situation with a parent that can't speak or talk and has had to decide which direction to pivot to?

This question has been closed for answers. Ask a New Question.
Find Care & Housing
Staff is trying to give U a reality check.

Please realize that if - IF - she should be eligible for a Medicaid Community Based In Home Healthcare, these programs are NOT all encompassing. She will be evaluated 4 “need” w/max # of hours of service. Family does not determine # of hrs or care plan. Assessment based on real time & review of health chart. If high #, application can be declined as level of care is beyond scope of IHHS as determined best off as a custodial care LTC resident in a SNF with 24/7 oversight. Most IHHS do under 20 hrs wk; maybe 3-4 times wk an aide level of CG comes over to ck vitals & medication management, do bathing, do skin ck, reset the bed, with occasional visit by an RN or PT/OT. Your State law will matter as who can deal with PEG line, as many DO NOT allow for a CNA to deal with them. If so, family will have to deal with her PEG or hire a Nursing service. Higher # of hours can happen…. if limited facilities but otherwise it’s edging into being full time as there is agency administration time so beyond Community program guidelines. These programs REQUIRE a capable adult in the home / apt all other times to ensure safety & security of the client. FWiW in home hospice (Medicare benefit) has same requirement.

IHHS programs are done by agencies under contracts with State Medicaid division, workers tend to be “aides” (perhaps a CNA but perhaps not) who tend to make slightly above State’s minimum wage. If you are in a $7.25 hr min wage, difficult to retain workers. More requests for care than agencies can provide for. Workers on a time clock as probably seeing more than 1 person in their day…. Imo really don’t have time to “take advantage of” that you’re worried about (along with Medicaid copay rules).

- So if mom returned to her studio apt, situation would be there is NO family that is willing to be with her to fully provide 24/7 oversight and do whatever care needed, when there is not a private pay/paid by Medicaid caregiver, correct?
- So mom is unable to effectively communicate, has no movement on an entire side of her body, has a PEG line and is not able to walk on her own, would be left unattended at some point within the day, correct?
- So if there was a fire at the apt complex, your mom could not 100% on her own do whatever needed to call for assistance or get to a safe zone outside her apt?
???Why does moving her to her apt seem like a good plan???

Your mom has had 4 months of in-hospital care PLUS specialty subacute care. If she was able to get better, would have had signs that was happening by now. Yes, TBI do take longer but most of those successful in prolonged TBI rehab are younger & fit before that bad auto / motorcycle / sports or other fall that caused the TBI. Not to be harsh but for most elderly who fall, the path is: hospitalized (Medicare & health insurance pays), discharged to rehab (again Medicare & health insurance pays), stop progressing in rehab at week 5; majority transition from being a rehab patient (Medicare & health insurance) to a custodial care resident who remains at the same facility. Otherwise they return home. For a NH, custodial is private pay, LTC insurance or file for LTC Medicaid once they are financially “at need”. Abt 60-70% of custodial care NH residents are on State run LTC Medicaid.

I would HIGHLY recommend that you find out asap what her status is for health insurance coverage. Insurance will not pay indefinitely. When coverage ends, decision has to be made. Choices are narrow: 1. remains at this NH or moves to another NH and private pays till LTC Medicaid eligible, OR 2. returns home or a family members home, she uses her $ to pay for care or family cares for free or some combo of this OR 3. EMS called by the NH and she’s sent back 2 hospital & becomes their problem (old NH will not let her return). For those medically frail, this is often what happens.

Current facility will not let her stay there indefinitely without payment established.
Helpful Answer (4)
Report

Medicaid does not supply 24/7 care in the home. You would need to hire someone for hours not there or family would have to do her care.

I think Mom is better off where she is. Since I am 75 and DH 78 I don't consider us old but the medical community does. I lost a friend 2 years ago after he fell and hit his head causing a brain bleed. He was 73 and the doctor said his age had a lot to do with if he pulled thru.
Helpful Answer (2)
Report

I'm my state community home care Medicaid is not an entitlement program but rather there could be a wait for a limited number of slots. Don't know about ny, but something to look into. Also getting 3 shifts of people consistently is challenging, one could call out and then a replacement has to be found there could be a gap when mom is alone etc. I would be really concerned about being able to have coverage at all times. Tube feeding adds another layer of complexity. Even with hiring private where you would think you'd have the quality you speak of, these issues can occur. A friend of mine had virtually unlimited resources and still with 24/7 care for her husband she had to frequently "retrain" replacements, deal with aides running late, her spouse's agitation when new people showed up etc. It was still a big challenge.


It sounds like where she is now would be a good fit and you already know the care will be good.


I'm so sorry this is happening.
Helpful Answer (3)
Report
Seniorcareny Apr 19, 2025
It is the same with Medicaid in NY from what I understand... one is certainly not entitled and you have to reapply each year. Wow, thank you for sharing about the private care bc that is what we were planning on using for the first 3 months that my sister and I have been assuming it will take to get all the 24-7 care in place. I wish bringing home loved ones wasn't made so difficult and so costly. I honestly never imagined my mom being in this state, I just assumed she would get old if you know what I mean and then she'd come live with us even if we were still in our small apartment; my husband and I were find giving up our bedroom for her. The two subacute floors in the nursing home dare I say feel almost cheerful and active but when we went up to the 5th floor yesterday while visiting our mom for long term care to check it out it felt not as great. You can tell there isn't a "goal" here. The energy is different. We're going to have to change that! :)
(1)
Report
I am so very sorry but I can see no possible choice here but full and intensive care in facility with several shifts and several people on each shift to give the intensive care needed to your mom simply to sustain life. To me this isn't even a question; anything else would be utterly impossible. There could never be enough in home care and it would not be at all sustainable nor affordable.
Using your own funds at all is very unwise. It will take a lifetime of good luck, good jobs and hard saving to get to a place where you can sustain your own care needs for your own future.
Your mother may never recover from what has happened to her. I encourage family to seek help dealing with questions as to whether sustaining a life of this quality with little hope of recovery is in mom's best interests. Only you know her, her age, her prognosis from doctors. We don't.

I encourage you to stay on the site and read.
I welcome you to the forum.
And again, I am so sorry for what has happened for your mom.
Helpful Answer (4)
Report
Seniorcareny Apr 19, 2025
Thank you for the welcome! Im grateful to be here and will keep participating. My mom is present, she knows its me and my sister, her grandkids that come to visit her regularly. She is "in there" and understands when we speak to her and can speak but as of late her speech has diminished. In all fairness she recently caught pneumonia so she's more tired than usual but is improving. We will continue to do our best to keep her comfortable, safe and engaged as best we can.
(0)
Report
Mom needs more care than can be provided at home. One caregiver, even with family helping, wouldn’t be enough. Her family must start planning for her needs, not wants. Take the advice of those who are caring for her now. They’ve seen this before and know the trajectory it will take.

I’m very sorry.
Helpful Answer (3)
Report

I am so sorry for your families situation. Does she have a POA? Has she updated her MOLST or given a formal set of medical directives?

I had to make the difficult decision for my uncle to transfer rehabs skilled nursing to long term care when he reached his plateu but still couldn't walk or do a majority of DLA.

I was told he could have 24/7 care with medicaid home care. I absolutely knew from my FIL experience that this was severely understaffed and any gap in coverage would fall solely on family to find coverage of do the care themselves. It is not sustainable when family is working full-time and have families of their own.

Your mother requires a level of care best suited to a longterm care facility. You need to set aside emotion in this decision. It isn't what your mother or the family wants but what is needed.

While a long-term care facility has flaws, your mother is in a safer environment there than at home.
Helpful Answer (3)
Report
Seniorcareny Apr 19, 2025
I am my moms POA. Despite not being able to speak much she does understand everything you say that much is clear. No medical directives unfortunately but I've been working for months with lawyers and such to learn how to protect her assets so i can bring her home to her apartment. So you don't think homecare Medicaid will consistently provide the 24-7 care she needs? I always promised her when she got older she would live with me and my husband and kids. We've considered bringing her to live with us but we live in a small apartment ourselves with no elevator. It just doesn't feel safe. Although I feel good with the nursing home ( it blew all the others we toured out of the water) Im feeling incredibly sad and guilty that this seems to be where we may have to place her. My mom was incredibly healthy, fit, independent and active prior to this fall. Thank you for your advice its very helpful.
(0)
Report
She wouldn’t be getting care “from Medicaid” Her care would be paid for by Medicaid and chances are high the people involved in her care would not know or care who was paying as long as they got paid. My mom lost every physical ability from a stroke, was paralyzed, and tube fed (a much anticipated recovery never materialized after months of intense therapies) She went from private pay to using Medicaid in the best nursing home in her city, in the same room, same care, same experience. No one on the staff outside of the director knew or cared how the bill was paid. I’m sorry your mom is going through this, it sadly sounds like a rough road to any real recovery. I wish you both peace
Helpful Answer (1)
Report
Seniorcareny Apr 19, 2025
Im so sorry your mom experienced a stroke, as well. May I ask where she did her intense rehab? I'm assuming it was acute care rehab? We're in NYC and although all the nursing homes/subacute facilities we toured were abysmal, we did manage to find one where my mom is now that is stellar compared to the others. Im grateful we were able to get her in there. Does the nursing home provide for maintenance PT OT speech in your experience?
(0)
Report
See 1 more reply
I know that it's hard to accept, but your mother needs way more care now than anyone could give her at home, and it sounds like it's going to be a long tough road. So keep her in 24-7 care and don't go down the nightmare road of trying to cobble together something unsafe and inadequate. I'm sorry you and your family are going through this.
Helpful Answer (2)
Report
Seniorcareny Apr 19, 2025
really solid advice, thank you. Im incredibly grateful to literally have stumbled upon this site. My mom is half hour from us door to door on subway so that's good. Im just in shock still I suppose. My mom was the person getting up at 5am to clean her block and brought and planted gardens all along her block. Everyone in her community loved her. I miss her now that she can't speak much but I won't give up on improving her physically and cognitively.
(2)
Report
It sounds like she requires around the clock skilled nursing. Is that right? She’s paralyzed on one side and on a feeding tube? I’m not sure how you get that type of care in the home for a senior 24/7. What is her prognosis? How old is she? I just wonder how feasible it is for someone who needs her level of care, which would mean shifts of people, to return to the home.
Helpful Answer (1)
Report
Seniorcareny Apr 19, 2025
We are being told my the subacute - her rehab team- that my mom remains "total" and needs 24-7 care. It is more than obvious at this point. She remains paralyzed on her left side and has to be in a wheelchair or bed. She can swallow but not enough to get necessary calories in a day so she has been on a PEG feed for many months now. Rehab won't give us a clear prognosis as she improved very much when she first came to subacute as she was literally languishing in a hospital bed for 4 months prior to coming to subacute for rehab. My mom is 78. Ive reached out to all sorts of agencies, people and they all told me yes I could access such care but as time passes and I dig deeper and speak to more people like yourselves it feels less safe and secure to relay on trying to make that all happen. I was planning on applying to a waiver Medicaid program called NHTD- its for people who need 24-7 care but would rather be home than in a skilled nursing home.
(1)
Report
This question has been closed for answers. Ask a New Question.
Ask a Question
Subscribe to
Our Newsletter