My father is completely immobile and refuses therapy. Is a nursing home the next step? If so, what happens if it's not in the budget?

If your dad does not have funds to pay for a NH, then you will have to apply for medicaid. That is all you can do. When a person refuses the help offered, they have little recourse. You will not, have not been, doing him a favor to take care of him when he refuses the only help that will allow him to take care of himself. Perhaps you should consult with hospice. When you allow an obviously very ill person to make his own decisions, you can't expect him to get better. I understand it can be beyond your control. Regardless, if he refuses to allow himself to get better, there is little to be done. Nature will take its course.

Dear abc,

I'm so sorry to hear what you are going through with your dad. He has been through so much. My dad was also very stubborn and independent. After his stroke he wasn't the same person. I would suggest having his doctor, counsellor, therapist try and talk to him. Is it all the medication affecting this mood and thinking as well? I know its hard to see our parents in this condition. I became so frustrated and just gave up. But in hindsight, I needed to dig a little deeper. If he truly has had enough and only wants hospice, I guess there is nothing more that can be done, but at least you tried.

Yes, I think the next step is a nursing home. Do your parents have a lot of assets? How about income? Are there good pensions?

If they cannot afford a nursing home, dad should apply for Medicaid. Even if they have too many assets or income to qualify, they can spend down to get under the threshold. The application process and rules are more complicated for a couple than for an individual. Medicaid's goal is not to impoverish the well spouse.

Since you are so far away, if you think your mother might need guidance, it would be good for her to consult an Elder Law attorney. Or, once a nursing home is selected, someone there may be able to help with the application process.

Is there any one local who could help them select a good nursing home that accepts Medicaid?

This is very difficult for everyone involved. It is hard for you to be so far away. But this can all be worked out. Hang in there!

ABC I'm sure you would be there to help if you could; but since you can't - do you know what kind of support your mother is getting locally? If you suspect it's none, or virtually none, perhaps you could find out online contact details for social services so that she has somebody to advise and help her with things like Medicaid applications and NH admissions.

Oh! - Jeanne's just said that! But perhaps it bears repetition :) Finding someone to help her is the next best thing to doing it yourself.

My mom is actually the only person caring for him in the 3 days or so he's been home this year. I live 2,000 miles from them and I'm an only child. I wish I could be there for my mom. I don't think he believes his choices are life threatening. He is obese with diabetes. He has Afib and his feet are always grossly swollen. He has been on pain meds for years. I agree, his decisions are not in the best interest of his health and I also believe my mom has quickly realized she cannot care for him. The next step is a big decision. It also seems like his immune system has become very weak, which makes sense with his lack of movement and results in week long stays in the hospital.

Another idea, if there are funds, is to hire a local geriatric care manager to help mom navigate this transition for dad into the nursing home.

I feel all I can do is research and help guide my mom, so thank you for your responses. I feel comfort in at least having a clue of what the next step could be.