I’m conservator for my Sister who had a stroke is bedridden, cannot communicate well and on a feeding tube. Finding a facility that cares for patients with a feeding tube is challenging and costly due to liability. I called many facilities until a Catholic facility manager gave me a recommendation.
A small, comfortable healing Nursing Care facility, has healed her wounds and stabilized her weight and medication. She was prescribed many meds and is down to 2 along with supplements. The Severe bed wounds happened while hospitalized over 60 days.
Plan A: Because her funds are dwindling, I’m considering moving her to my home and hire a 8 hour/day CNA.
She is currently paying mortgage, taxes etc and nursing care. The home needs to be sold.
Plan B: Sell the home, use all funds to continue the comfortable outside care until all assets are spent. Then apply for Medicaid.
Any advisement is appreciated.
Definitely for me it is plan B.
She currently is in quite dire condition.
At any time the bedsore problem could/would become an issue. Tube feedings are notorious for out of control diarrhea and sores. Sepsis from decubiti is a leading cause of death for those who are bedridden.
If she is getting good care where she is I would do all I could be have her stay there. You have been witness to the amount of skill and perseverance it takes to care for her. Do you really feel you can take that on for 16 hours a day while a CNA cost takes the money quickly that she still has?
Just on the face of this, with the facts you have given, I would go with plan B. I am not certain how long your sister would even WISH to live in this condition; nor how long she CAN live in it, and I would make the time she has as pleasant as you are able.
I hope your sister had a good advance directive and you know her wishes well for end of life, so that, if she becomes terrible ill and debilitated you will be able to withdraw the forced feedings and allow hospice to ease her exit with minimal pain. The prognosis for her, I know you already understand, is very dire.
Hiring a CNA to be in your home for eight hours a day has its own problems. For one thing, that's not nearly enough care. For another, it's a Certified Nurse Assistant, and they're not qualified to do all the things your sister will probably need - tube feeding, for instance, may not be something the CNA can do. There will be crises, symptoms that crop up and you won't understand, emergencies one after the other, things that will be required of you to do. The peace of your home is shattered when you bring in a sick person who must be cared for. You'd be exhausted in no time.
She's in a good care facility now. Leave her there. You can be supportive in many ways, but they shouldn't include turning your house into a nursing home or your life into a caregiving nightmare.
Plan A is not sustainable . You would need a CNA more than 8 hours a day , which is sometimes problematic . It will get old quickly .
Additionally , with the problems with the mentally ill nephew you could be getting nuisance visits at your home.
Keep this situation out of your home . Place your sister and keep in touch eldercare lawyer throughout all steps .
Good luck .
Bill wise, you know she gets utility bills and she pays a Mortgage. Contact them, ask that monthly bills be sent to you. You may have to prove guardianship. If she has doctors, call them to see whatvis owed. Call Medicare and her insurance and see if statements can be sent to your home. Ask if you can have a statement for last 6 months to help you determine if the providers have billed correctly. You should be payee on her SS. I think Guardian is excepted by SS but POA is not. Pension too. If nephew has access to his Moms acct, change that or set up new accts. Making sure that SS is going to new acct before old is shut down. SS needs to be made aware of the new acct.
With my Conservator and Guardian papers, SS, Pension etc, and the bank were timely, they all have a good process with their legal staffs. Took about 3 weeks to get access to all her finances. The banks have checks and accounts showing “Protected Individual” and my name, Conservator. I’m all set on what to do for the house also. Once I get a buyers contract, then I can Petition the Probate judge for approval.
Her assets are for HER, so use them as such.
Your Plan A, followed by Plan B is a sound one, however, check with your local Medicaid office beforehand, regarding eligibility rules and let them know of your plan to dispose of her assets in this way. There is usually a 5 year look back, meant to prevent fraudsters from giving away all their assets to qualify for Medicaid. But if the funds have been used for her care, and have been depleted,
I don't see why she wouldn't qualify.
Second important factor to consider: Are YOU able to provide the care she needs when a hired care attendant is not there? It will be harder than you imagine and will change your life forever! Become familiar with what exactly you will need to do, and what accommodations will need to be made for her.
I change my previous answer. Go with Plan B! :)
Find a good Skilled Nursing Facility where she is comfortable, and gets good care.
Plan B alternative. Find a really good SNF while she can still private pay. Make sure it has Medicaid beds. When she qualifies for Medicaid as a private pay she goes to the top of the list. Otherwise If you wait too long, she gets put on a wait list for the really good ones. If you miss that window of opportunity then she goes to the first open bed in the state...good or crappy. You might hire a patient care advocate for a couple of hours session to determine how to search and go on the wait list for quality SNFs . The advicate can educate you on this.
Being a Conservator and Guardian is challenging. I have bills and monies under control. It took 3 months to get control. More bills may appear. The Bank took 2 months. Social Sec, pension and other accounts took a few weeks. Excel spreadsheets file folders etc. It’s Like being at work.
Post Office forwarding is really helpful.
Finding an attorney isn’t easy. I phone and leave messages or email. No response. The assigned Probate attorney ad liem hasn’t responded. An attorney is about $3500 to start and $200/$400 per hour. Paralegals by phone have assisted me a lot.
Finding a home that manages feeding tubes is a challenge. I have a list of facilities from our state website and so far the ones I contacted do not manage tube feeding and most don’t take toileting. There are many facilities on the state website that have closed.
Currently Sis is in a beautiful 6 patient foster care home healing. The owner/nurse lives in the home. Owner cannot live in the foster home to accept Medicaid patients.She ministers, plays the harp and sings to my sis.
I’ve contacted facilities for recommendations but the ones in my area have 50-100 beds. NOT!
The current care home was a blessing at the last minute when she was being discharged from the hospital. As you all know hospitals give 24-48 hours for a patient to be released.
I'm taking y’all’s advisement to search for a nice small home that accepts Medicaid. It will be sad to leave the home where she’s at now.
Selling the home: As Conservator, paralegals advise that I can get a real estate agent, contract, set closing date, then petition the Judge for approval.
You will need a CNA who is specialty trained on how to work with a feeding tube and the hygiene of it. Also one who has experience with stroke care. Visiting nursing will also be a good idea in case medication needs to be ordered or other supplies. CNA's don't have access to doing that.
If you're looking at 8 hours a day of aide care, that time should be broken up into different times and not all at once. This way repositioning, hygiene care, feedings, and changing her can be done regularly.
My other option is to ask the owner if she will accept a lower amount. She knows the situation.
As advised, I’ll hire a patient advocate to assist with finding a Medicaid facility. Y’all’s advice is sooo helpful. Hugs.
Please be sure your Plan B is one your sister fully understands and is accepting of the change should there have to be one.
Prayers for you and your sister. It is a hard situation and I hope you have a good support system in place. Your friends and family will be wonderful help.
🙏🙏🙏🙏
When she is no longer paying for the house her money will last longer. Then the money from the sale can be put into an interest bearing account and that can increase her self pay time.