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My mom has been with me 15 years and on a slow course of deterioration. She is anti-social with crippling anxiety. She's fallen twice over the last few years and now has a fractured wrist. She has very little use of her arms and can barely walk. She's always been an emotional wreck but is now unmanageable. She cries and screams in pain frequently and I don't know how much of it is legit. Maybe all of it, IDK. She's 91. I have caregivers 20/hrs a week and I cover the rest. I think it's time for long term care facility as she needs assistance with everything. How do I know for sure and if so, what can I say to get her there without freaking out?

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Thank you freqflyer. I was hoping for an event that would send her to the hospital and rehab and then a white lie from there but she hasn't seen the inside of a hospital in 7 years. She's super resilient and tough and so the decline continues. It's escalated in the last month and I'm running on fumes. She's been with me nearly 15 years (never did I think it would be this long) and her needs get longer and longer. The whole thing sucks as she's not receptive to anything but staying home. I was hoping it wouldn't get to this point but of course it did, this is the story of my mom's life. One expectation after the other with absolutely no insight. I want her to be happy but I'm tired of paying the price for it.
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If you think it is time for a long term facility do not question yourself, you are right.
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AgingYogi, getting Mom to enter a nursing home [don't call it a nursing home in front of Mom] will not be easy. Usually one has to wait until an elder has another fall or doesn't feel well, thus dial 911... go to hospital... go to Rehab... then from there she can be placed in a nursing home. One can use what are called "therapeutic fibs" where we fib for the best interest of our elder, like telling Mom that where she is now is an extension of the Rehab center so that she can get better.

Your Mom having a fractured wrist is very painful. I remember a couple years ago breaking my arm in a fall, and I never experienced such pain. Healing was very slow as we don't heal as fast as we did when younger.

Being that your Mom is 91 years old, she probably remembers half a century ago when nursing homes were county asylums, most were terrible. If an elder had dementia they were placed in with those patients who had major disturbances. Thus, what elder would want to go there? My great-great-grandfather had lived in one for many years as he went into such a place in his 30's after a terrible accident that damaged his brain, his wife was his caregiver until she passed in her 30's from being in a fire.

If your Mom can be self-pay then she can take her pick of the "Assisted Living" facilities. If the cost of Assisted Living cannot be budgeted then Mom would need to apply to Medicaid [which is different from Medicare] where she can go into a skilled nursing home that accepts Medicaid. Medicaid has found it cost them less to have someone in a nursing home then to pay for many hours of care at home.

My own Dad liked senior living, he was in Assisted Living/Memory Care. He was so happy being around people of his own generation. And he loved the food !!
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im sure not an expert on anything

but has she seen a doctor? she cries/screams in pain?

is she receiving caregivers thru Medicaid? maybe time to get increased hours?
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