I don't know where my mom goes next. Insurance runs out on Sunday. Rehab seems to be giving her the minimum on help.

Your mother needs now to enter long term care.
She is apparently still not diagnosed with dementia? That must be done.
Contact Social Services so that you can work with them on placement and on applications to Medicaid. Important now to gather all information on her assets. That will be step one in getting her applications done.

I don't know if anyone is POA; in seven years of knowing this was on the way that would have been crucial. But if not done, it is too late if there is dementia; ask the social workers about being appointed as her conservator or guardian to get her safely into care now. You will be working closely with them, and this should have been started on DAY one of rehab when it was likely clear that problems now will be ongoing.

Do know, in my experience as an RN and as a daughter, falls can represent the beginning of the end, and for my own mom that was the case with fall leading to catheter leading in infection, to rehospitalization, to pneumonia, to hospice and so on.
I wish you the best. You will need to work as closely with the social worker as you are able.

I am her POA, and I do have authority to sell her home per the POA, She only has $15K in total, so her home is her only other asset. That's why I'm not sure if I just need to sell the home as quickly as possible since most nursing homes will eat that up in the first two months.

Sell her house and use the proceeds to provide care for her. If you change the deed now you will cause a medicaid penalty and they won't help her until that penalty is done.

The best way to get her into a good facility is to be able to self pay for a time. Make sure they accept medicaid and find out what their rules are, ie self pay for 2 years to get a medicaid bed, etc.

Best of luck, the beginning is always the hardest as we find out how much we didn't know we didn't know.

Edit: i found that I had to stand over the twit that was supposed to send information to the new facility. Promised, promised and didn't do diddly until I stood at her shoulder to ensure it was done. Right now, they are being paid by Medicare and do not want to give that up. You have to be a strong, determined advocate to get this done for mom. Call the Ombudsman if you don't get assistance today from the facility. File a complaint with Medicare about the lack of PT and OT, this facility is defrauding the system by keeping her as a rehab patient and not providing rehab.

Unfortunately, I hate to say it - but it sounds like actual OT and PT may not be feasible at this point. If they don't believe they can get her back to her "baseline" (where she was before she entered the hospital), they can only do what is physically possible for her. If her dementia actually impedes her ability to participate in PT and OT, then rehab is just not where she needs to be. She may not be able to regain her physical abilities. She may be a candidate for SNF, with memory care. But I will also say that that my FIL was in a regular SNF, but they also managed the memory issues, by ensuring that he had access to medications for agitation etc.

Unfortunately, there is also something called "institutional dementia". Which on top of "regular" types of dementia - is compounded by isolation or a hospital stay, or a move to rehab or LTC. It is sometimes reversible, but in my experience, once someone has moved from location to location to location with dementia -it is an uphill battle of epic proportions. My FIL's doctor advised that each move from home to hospital, hospital to home or rehab, rehab to home or LTC, LTC to hospital....each one essentially sets someone with dementia back irrevocably and its like they are starting at square one with their healing, settling in, etc.

Sadly, it may be time to consider LTC as others have suggested. My grandmother was very independent - until she wasn't. And once she wasn't - she needed 24/7 care for the rest of her life.

Elder care is a strange mix of waiting for the other shoe to drop and waiting for that switch to flip - and honestly - in our case for both my FIL and my grandmother - the flip of the switch...was just that fast. Day and night difference in just the blink of an eye.

Ok. Thank you all for the helpful answers. If I may, I have one more question. I will only have about $120K for her LTC once the house is sold. The nicest memory care in our area is available and willing to take her, and got a waiver to be able to use a Hoyer lift for her if I want her to go there. The downside is that it is also the MOST EXPENSIVE of all the places, and I'd only be able to pay for about one year exactly. They are not on the Medicaid list that I am aware of, so if she runs out of $, she'd have to move again in a year. So would you rather give your mom the best care while she has any cognition left and then be forced to move her when she has even less cognitive ability than today? Or should I put her in a Medicaid facility now--knowing the funds will last about two to three months longer, and she probably won't have to move once they run out? If there was a really nice Medicaid facility around here, this wouldn't be such a difficult question...

It’s important to recognize that your mother was not, in fact, living independently before her fall. You and your sister were scaffolding her, supporting most of her needs. The fact that she became dehydrated leading to her fall is proof that she needed more hands on care and direct supervision than could be provided at home. I’m not blaming you; the same thing happened to my mom leading to hospitalization, then rehab, then assisted living. Her cognition actually improved and her chronic dizziness disappeared. It really is important to recognize that your mom was slowly deteriorating and now that this disruption has happened the severity of her dementia is laid bare. You can’t rehab someone who you can’t communicate with easily, and who has such severe mobility issues even pre-fall. Give yourself some grace and be sure to ask for the help YOU need to get through the maze and marathon that you are facing. Does her GP’s office have a care coordinator you can help guide and explain what your options are and what needs to be done next? Do you have friends who can help you by bringing food, helping with errands or laundry so you can catch a little bit of rest?

I’m sorry you’re in this place. A few thoughts…mom was not independent before the fall, she was being given the illusion of independence by the help you and sister were providing. Nothing wrong with that, but it’s not independence. A fall is often a complete game changer and days in the hospital equal a big loss in mobility. I saw this so many times with my dad. One day in a hospital bed equaled a week trying to get back where he was on walking with a rollator. About your follow-up question, have you visited the place that takes Medicaid? Sometimes they are not bad just because they participate in the program. If you’re not pleased with what you see, I’d move mom to the better place. Sadly, her cognition will be far less in a year and another move might not be as traumatic as you think. A medical opinion of her stage of dementia may help further guide you on this. Selling her house will be a load off you and help provide needed funds for care. I wish you rest and peace in such a hard journey, mom is blessed to have you in her corner

A problem with waiting until she runs out of money is that most facilities want some months privately paid before going on Medicaid. Letting her run out of money may limit the number of Medicaid facilities willing to take her.

Perhaps a compromise . Ask the Medicaid facilities how many months of private pay they require to get her in.
Maybe then Mom could go to the nice memory care for 6 months or so .

The other issue is multiple moves for someone with dementia can be confusing and stressful depending on the level of cognition . But perhaps she would not even notice 6 months from now . Tough decisions.

Myothermother, I would encourage you to go visit every facility that is an option for your mom, do this at varying times and at least one weekend day, visit multiple times and walk through the facility. Just because some place looks nice doesn't mean it is a good care facility.

Both my grandmother and granny were is good facilities, on medicaid. Both were new and sparkling, they never smelled and the staff and residents were all content. Happiness is not a thing in a LTC facility, just so you know, so you don't have that expectation. Then fast forward to current day and both facilities are still nice and sparkling but, the care is abysmal, you can see and feel the bitterness in the staff and the residents are just there waiting to die, that's the environment you want to avoid.

Use this as a guide post for a good facility. People should be getting compassionate, quality care, decent food and staff that aren't bitter. The management is in control of all this, so look beyond the nice and look at what you can smell, feel and perceive in a facility. Often you will get better care in a religion based facility because it's the people that get the extras, not the building or property. Look for one that doesn't appear to be a morgue, you want the residents to be out and about in the facility, not drugged until they can't get out of bed, seen that and oh my.

Mostly know that you can move mom at any time if your 1st choice isn't a good fit.

For my dad, I chose a small board and care home because all the great amenities at a bigger facility were a waste of money, he would not use them, so why pay for them. You get better caregiver to resident ratio as well. They had and used a hoyer lift for residents requiring that assistance.

You are going to be very busy until she is placed, take a deep breath and begin, you got this!

My husband and sibs paid for a few hours with a geriatric care manager approx $200 per hour. The manager indicated there were 3 very good LTCs that took Medicaid. MIL had less than a year in funds. Family put her on all of those wait lists and she got admitted to #1 choice. The Medicaid application was done by one of the sons, with the education from the care manager. She lived there for 5 years.

Check out aginglifecare.org to see who is in your area. Each one has a specialty profile.

Having been in the same position, you won't be able to put the house into a trust to protect the asset and put your mother on Medicaid. They have a strict 5 year look back and all assets, including the sale of the house, must be used before accepted on Medicaid.

When my mother was in a similar position, we found a place that would take her as a private pay resident with an agreement to keep her in the same location once she did become eligible for Medicaid. No local memory care places accepted Medicaid near me so our only option was a nursing home.

I would look for somewhere she can stay, even if on Medicaid as it is hard to change and take time for them (and You) to feel comfortable.

I'm sorry you are facing all these decisions suddenly. It is confusing to anyone who doesn't already know the system.
Rehab can only keep her for a limited number of days, and is not the best choice for her care needs, such as toileting.
The admin tried to guide you, but without explaining for your understanding, by asking if you want her moved to memory care.
The answer is, YES. Have her transferred to a memory care of long term skilled nursing facility! This rehab facility is Not meeting her needs!
Follow through with the Medicaid application. It could be that she is denied because of the house. You will have to sell the house and use the proceeds to pay for her care, and you should seek the advice of a Certified Elder Law attorney about protecting her house with a trust. It may be too late for that, and Medicaid looks back 5 years to see if she unloaded any assets to qualify for Medicaid. So see a lawyer before you do anything.
Have her transferred to a more appropriate care facility NOW! Then, worry about how to pay for it. They may be willing to wait for payment, pending Medicaid acceptance. That will buy you some time, either she will be approved for Medicaid, or you will have sold the house.

Your mother did not progress but plateaued once you explained about the hoyer lift. That means after rehab she never returned to baseline. Hoyer lifts usually means NH. I will assume here that the state scope of care will not allow any lifts for the next level down because it might mean 2 or more staff to remain safe. It is what it is and her predicament of moving to MC is wishful. You might discover that MCs are mostly self pay.
An extreme instance, my neighbor was over 350 lb. That severely limited her to just one LTC that had special equipment 90 minutes away. She stayed there until she was moved to another state over the border where she lived.. Her one advantage to move her was that she had some funds for private pay before Medicaid.

I was in your shoes a few years ago. In my case, the person who fell was me (while trying to handle repairs in my mother's home)
and I could no longer care for my mom from a wheelchair, even with live-in help.
Is there a senior resource center in your community that can help to guide you? I discovered through the years of caring for a mother with dementia, that what works this month may not work next month. It sounds like you are going through that transition now.
I found a facility that would keep her as a private pay patient for 14 months, then accept Medicare. I hired someone to help me clean out and pack up her home, sold it and used that money to cover the 14 months. At the same time, I found someone to help me navigate the Medicaid application process. Her Medicaid came through just as I was running out of money for private care. She died a month later.
I am thinking of you and hoping you will find peace. People who have not been through this do not understand how difficult it can be. Today I am back on my feet but still traumatized by the experience.

MyOtherMother: Prayers forthcoming.

I am very sympathetic to your situation since I had a very similar experience with my mother. To make matters worse, it was during COVID when you couldn’t even visit. In the end, I took my mother into my home where she has been since October of 2020. I am telling you these details only to give you context. She is bedridden and I use a Hoyer. I hired help during the day M - F. When this happened, I was already retired so I am home. I am married so this was a joint decision with my husband. Still, it has been rocky at times. I also moved my Dad to a nearby AL. I have two brothers who do what they can. Fortunately, my parents bought LTC insurance - that has been a godsend. But, that doesn’t last forever, and with two to manage I have to be very conscious of making the best decisions to make their $ last. I am going to try to give you some good advice based on my experience.

From your post, you seem to be ready to handle this and are asking the right questions and asserting yourself when you need to as your mother’s advocate. You apparently have a sister who is able and willing to help. You don’t say whether you are both working or if you have a significant other or kids to worry about. Those are importantly factors. You do have POA which is critical. I completely understand your disappointment re the need for the Hoyer making your mother only eligible for SNF placement. My mother left rehab unable to stand or pivot but with her mind still mostly intact. She had only mild dementia at the time and no severe medical problems or conditions. She did not need advanced medical care but every AL or MC facility in my area said they could not take her. That, and the fact that the rehab, which was a SNF, gave her the beginnings of a bedsore, led me to move her to my home. And yes, their failure to re-position her and to change her pants when wet directly caused this skin breakdown. Fortunately, with the help of my Primary Care doctor, I have been able to keep the damage under control and prevent further damage. Homecare is really difficult if you don’t have the finances to hire part-time help. But, the reality of institutional care is you will have to stay on top of the care all the time and will learn more medical knowledge than you ever wanted to. Sometimes it seems there are no good choices - only the best of the worst.

Some people have advised you to team up with a social worker and/or contact the state ombudsman. Nothing wrong with that, but personally, I would not consider either of those ideas to be my first priorities. Your priorities are finding a suitable facility and figuring out how to pay for it. You and your sister are the best ones to make those decisions. Input from others “experts” can be helpful, but don’t expect anyone else to care like you do and don’t turn the reins over to a social worker or anyone else. That said, you will need a qualified attorney to guide you through the Medicaid process and other legal matters such as selling her house. My to-do list:

1) I would not 100% rely on the facility social worker to find a SNF. Do your own homework on this and then feed the names of the best ones you can find to her so she can give you feedback. Visit the facilities unannounced - more than once if you can. Remember, sometimes having proximity and convenience to drop in and visit takes precedence over a top of the list facility that is a longer drive. But ratings and inspections are also an important guide. You can compare facilities on Medicare.gov. Make sure the facility social worker makes calls for you to get the transfer going. Sit there with her while she does (as one poster suggested) and take notes. Make the calls yourself if she doesn’t. It is ALWAYS easier to transfer in from a hospital or rehab facility than it is to go from a personal residence.
2) Get an attorney as stated above.
3) Do not rush to get a dementia diagnoses unless advised by the attorney.

So what happened on Sunday?

Firstly, see elder law atty asap. If you don’t already have POA and Health Proxy, get from atty…since your mom needs lift machine, not all memory care facilities have license for that..only nursing homes. If you want to keep mom home, you can consider type of lift like I had for my mom in house..stand assist, which requires sling ..but I used another sling under tush..I had private pay aides , but knew how to use lift machine myself. If you want to leave her in rehab which transition to long term care ..an elder law atty can help with Medicaid nursing home application. However, if she stays at home, either you or sister should be there WITH aide ..you can’t leave mom alone with aide 24/7 at this point if she this disabled. What if aides don’t show up? You are one that has to do everything: transfer, toilet, bed bath or roll in shower 🚿. You’re lucky to have loving supportive sister..I had only me & aides. My mom, 98 years old w/ dementia, immobile, incontinent in long term care nursing home & the other day came when they didn’t expect me. Stay strong.. buckle your seatbelt..you are all in for a bumpy ride. Sorry. Good luck and hugs 🤗

The short & blunt version here is an elder was living at home. Dependant on family but doing well. A fall. An injury. Loss of function, cognitive & mobility.

I can't see any alternative to finding a place with 24/7 care at this stage. Hopefully there will be recovery from the injury. However, this could be the 'new normal'. I am so sorry!

I would look to find the nicest place you can, close to your home. Make it homely for Mother. Start to build connections with regular staff, help Mother to get to know them too.

Even the simple things can bring comfort. My Mother likes having a rug from home on the bed & family photos around.

MyOtherMother,"keep her in the nice facility for 6-12 months, and she's already level 6 on the dementia scale, will it make much difference if I move her then?"

You may have already decided but I wanted to tell you this.

I met a family recently. The Mother was living in a very nice, quite posh, aged care place for a while (through the earlier dementia stages). The family felt it was better suited to those stages & now as the Mother progressed they were not so happy. A bad fall worsened the dementia & stole her ability to walk. They moved her to a facility for bed-bound care & were really pleased they did.

From my Google research:

Are there Monetary Limits / Maximums to a Home’s Value for the Child Caregiver Exemption? 
While all states, with the exception of California, have a home equity interest limit for long-term care Medicaid eligibility (Nursing Home Medicaid or Home and Community Based Services via a Medicaid Waiver), there is no home equity limit when a home is transferred to an adult child via the Child Caretaker Exception. Home equity is the value of one’s home minus any home debts, such as a mortgage. One’s home equity interest is the amount of home equity that is owned by the Medicaid applicant.
If one is trying to establish Medicaid eligibility prior to transferring the home and the parent’s home equity interest is over the state’s limit, this could become an issue. See state-specific home equity interest limits.

The only thing I can say is that I don't think you can do the trust thing you mentioned as it has to be inplace a few years prior. But they recommend to me to contact an elder care attorney. Personally I think that a memory unit would have ppl experienced in the things you've mentioned. The nursing home has told me that basically... no one cares about the patient.... not if she lives alone, can't get out of bed , can't get to the toilet, can't get food. NOT THEIR PROBLEMS, it's yours. (&hers, so yours) I couldn't believe it when they told me that insurance or anybody didn't care, once the coverage was over, she was outta there, it didn't matter what shape she was in. And of course they aren't invested in getting her well like a person would (kids, friends, partners I mean) I've collected a few numbers of places to call, but idk if I'm allowed to put that info here. Idk if there's a way to contact each other. I haven't called yet, but there are agencies to guide you & I'm just waiting for the weekend to be over.

Ask her doctor what is needed for her to be cared for at home. If the task are what you were doing before - and you and sister agree to do the care - then take her home. If the care is more than what you can do at home, ask to speak with case manager/social services to make arrangements to long term care, based on her insurance.

I would think by now OPs decision had to be made. Insurance ran out the 7th, 9 days ago. Would be nice if OP updated us.