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I am thinking she might just need too much care to continue to live at home with just her kids taking care of her. She lives with my brother, but he works and I live 45 min away and my other brother lives 90 min away.


I was wondering what the criteria is to get her into a nursing home?


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Hi,

I went thru pretty much everything out there.
Pay as you going Nursing homes stink, literally and factually.
AC facilities, Im sorry- $7k a month, plus up charges for incontinent care, etc? Really!

Elderly housing- ya, the waiting list is way too long. I visited 3 we have locally- old schools rehab into closet size apartments.

My mother mouth is not her best asset, nor is her need to belittle and berate....staff who have accents are her main target, 2nd to anyone with skin, different than her, no matter their professionalism, education or good heart.

I ended up finding a private apt complex that had handicap unit ( and that was a miracle) yet the bill is $ 2400 per month -heated. Her Soc Sec is 1500 per month- do the math- Ya, I am going broke, I have pretty much resigned myself to poverty and going bankrupt. Only child.

She has 44K in the bank, which isnt going to last long at this rate. I pick up as many bills as I can, but her out of pocket Medicare part D is the biggest problem- Ranexa is $500 ! Forget the discount coupon gimmick- its crap too. Such a rip, and now add all the other bills.

The Home for Mom website site, etc- they push to big money facilities.

For me it came down to pounding the pavement, scouring the internet before I tripped over this apt she is in. My problem is she is sane, 91, mean, spiteful, arrogant, foul mouth, nasty RAGING narcissist- and the problems she causes are never ending.
She gets on that phone and can stir up more crap than a tornado. I can only imagine when the time comes, her money is gone- I will have no choice to turn to masshealth and hand her over. This state is not elder friendly, I dont care what the ads' say, I dont care what the system has in place, there is always so block in place. The state takes everything, after you have beat yourself into the ground.
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RitaDenise Dec 7, 2018
wow! our mom sounds difficult! I'm sorry. I will do some research.
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I would avoid a place for mom. They will guilt you because you can't come up with the extra 3k monthly to put mom in an assisted living facility.

Find a local agency that can direct you to the facilities that fall within her budget.

Be prepared to sell her house to pay for her care long term. Either Medicaid spend down or Medicaid recovery, if they pay for her care they will take her assets one way or another. As it should be.
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RitaDenise Dec 7, 2018
I sent A Place for Mom, a little bit of info - quit when they wanted to know what her income is. then I had a difficult time getting all the phone calls and email to stop.

Maybe they are a good resource, but won't let go!
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RitaDenise, if your construction brother is going to be too busy for a longish conversation, where is he going to find time to take care of your-and-his mother? This does not sound good. When's the project's start date?

I'm sorry to hear about your other brother, too; though I hope the procedure goes smoothly.

Isn't that the sheer cussedness of it!? - We don't get to do caregiving when we're full of beans and in our thirties, oh no, it has to be decades later when we'd quite like to slow down ourselves...

If I were you I'd start researching possible facilities, just as homework.
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RitaDenise Dec 7, 2018
I just found out he has another large job when this one is finished. He really doesn't do much as he is out all day. He does sort out her pills weekly and picks up her scripts. He lives for the moment.

She has a life trust in his house. Now I am not sure what that means. I will do my own research to be ready if anything happens.
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Heart disease, long-term, does make a person vulnerable to vascular dementia; so if you think your mother is declining mentally that's the first culprit I'd look for.

This is a very hard thing to do. But if the three of you gang up and develop a plan for her, it's going to be difficult for her to put up much of a fight. You would also have the consolation of knowing that you will be finding her a place to live where her needs can be taken care of by a team of people who are trained, qualified, and not stressed out and completely knackered. Not just safer, but actually better.

Have a look round at a few places and see what's what; then go with one brother at a time to see the ones you think are good; then take your mother to the one you all agree would be best.

That's the idea. at least. The brother your mother lives with, has he said anything about a plan for the future?
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RitaDenise Dec 5, 2018
no, he lives for the moment. :( I may be the only one thinking of the future. I will have to get them on board. This is a difficult time of the year, one brother is facing a heart valve replacement next week and the one she lives with has gotten a large construction job. He will be too busy to discuss this.

I think I will continue on as is for the rest of this month. then I think I will try to get her into Adult daycare and drive her there one day a week. then I can either go home (45 min) or stay in her apt. until Dial-A-Ride brings her home. On Fridays, I take her out to a local Senior Center for the knitting group.
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She needs a geriatric doc, a family practice (GP) doc will not help. They are not as familiar with medical issues of aging.
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RitaDenise Dec 4, 2018
I agree - but there seem to be a shortage of geriatric doctors in her area. and her GP is young.
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If she owns the home I believe Medicaid will place a lien on it once she spends down to $2K and goes into a NH. There are many more posters here with more knowledge about Medicaid than I.
In the interim can you and your siblings pitch in and get her a home health aide?
But first she will have to be deemed medically needy. Does she have a PCP? They can guide you too. You can also review Massachusetts Medicaid requirements on their website so you can get a general understanding of how your mom can apply and her eligibility.
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RitaDenise Dec 3, 2018
she has 1 aide who comes in to bathe her twice a week and then once extra for a couple of hours to clean or whatever. she had someone who stole a lot of money from her and hates even the mention of getting an extra woman in.


She has a Primary Care Physician -
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Here are the criteria from a longer article - taken from the website of a commercial firm whom I am happy to acknowledge if they ask me to - explaining MassHealth (Medicaid in Mass.):

"When a Nursing Home Is Medically Necessary

MassHealth will pay for a nursing home only when it is medically necessary. You must show MassHealth that you "meet the nursing facility level of care," meaning that you need the kind of care that can only be provided in a nursing home. In Massachusetts, there are two ways to meet the nursing home level of care. First, you can show that you need at least one "skilled service" daily. Skilled services are usually provided by nurses. Examples of skilled services are injections, wound care, catheter care, and monitoring of unstable conditions.

The second way to meet the nursing home level of care is by showing that you have a medical or mental condition that requires a small amount of skilled nursing help but substantial assistance with activities of daily living. (Activities of daily living are bathing, dressing, toileting, eating, transferring, and mobility.) You must show that you need skilled nursing services at least three times a week."

This is the site for MassHealth itself, which has a lot more information on it:

https://www.mass.gov/topics/masshealth

Um. I'm sure you will have thought of this already. But if your mother is still of sound mind then the first criterion of all, of course, is her consent. How are things going on that score?
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RitaDenise Dec 3, 2018
thanks for the link and info! I will be doing a lot of reading. I don't know that she was ever of "sound" mind, so its difficult to tell now. I really don't think she has dementia - even though her heart is not good.

there are several problems: she has never had a timeline - things that happened in the past are brought up and discussed as if they happened yesterday. and its usually bad stuff.

Decision-making is not one of her skills; I believe my dad made all the decisions. when I say choose, she pouts and refuses.
She is illiterate - so she cannot write checks nor read books. She is still using the withdrawal amounts on a paper my dad wrote for her many,
many years ago.
She would never consent to go to a nursing home, even if I had to carry her to the toilet. :(
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Insurance will only pay for rehab care in a nursing home following a hospitalization and only for a very limited period of time. Long term care is self pay or Medicaid unless there is long term care insurance.

To enter long term care requires a doctor's order. Does she have POA's and other documents setup? That person is the one responsible for working with the doctor to make the determination that a higher level of care is necessary.
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RitaDenise Dec 3, 2018
she has a POA, but it is not me. Possibly my middle brother. It would have to be Medicaid, as she doesn't have a lot of $$.
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A doctors order to start. She will have to be determined by her doctors to need one. Talk with her PCP. There are criteria she needs to meet for insurance to pay.
Can you afford CG at home? That may be an option if she doesn’t qualify for LTC. Good luck! It’s difficult emotionally and very sad to see our loved ones decline.
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RitaDenise Dec 3, 2018
she is able to stay at home, barely. She can still get to the bathroom herself. its when she can't that makes me worry. thanks!
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