I’ve posted about my mom’s situation several times along with the family dynamics. Feel free to look up the background.
In a nutshell, my mom was declining at home, needed someone to be there 24/7, was on oxygen, could barely toilet herself, obsessed with toileting, has heart disease, some form of lung disease, and she fell out of bed almost 2 weeks ago. She broke her hip (that she had had had replaced several years ago). After being in the hospital a week, having bad delirium after, not being weight-bearing on that leg for six weeks, with a Foley catheter, she was placed in rehab.
I have to say my mom's delirium got better; she was brighter and more herself after she got to the rehab facility. I saw her the day after she went and I felt like she gave me a gift because we could actually have a conversation. Even before she broke her hip at home she was not able to have a real conversation. I was so upbeat to at least have my mom back again somewhat mentally and cognitively. I really felt like she was better off than she was at home before the fall. She seemed happy to be there. No mention was made of going home.
Today we had our first visit with the social worker from the facility about her assessment with therapy. She was so anxious. We couldn’t even have a conversation with the social worker and therapist because she wanted to constantly have us repeat it. She was insistent on hearing everything that was said, even when they were not talking to her. She even had her hearing aids in. My brother, sister-in-law and I were present, along with the therapist and the social worker.
My mom has become so condescending to me any time I say something in front of my brother and sister in law. I’m the only girl in the family. My brother can speak and she’ll be good with anything he says, but just tells me "I know!" any time I say anything to her.
Basically, the therapist said she has not made any progress after almost a week. She can’t do anything because of the pain. She said she’s determined she’s gonna be able to do the therapy because she wants to go home and my brother is telling her and I tried to tell her that she’s got to work through this. They did say that there is some drainage from her wound so maybe the pain is worse than it should be so will be getting a follow up. She is counting on going home in 3 weeks as that is the timeframe they gave right now as they had to throw something out there. Then she could go back home. Right…
She has become so incredibly demanding and so anxious even on meds and so condescending to me that I just can’t and won’t deal with her at home. I’m fine to let them take it over. Last week even they were feeling overwhelmed with the thought of her going home. Nothing has changed that I can see except she is aware of enough to just make it difficult for us.
Anyway is there anything wrong with a discussion with the social worker apart from my mother, if we are power of attorney?
UGH! Great big warm hug. This must be so challenging for you.
If you have POA use it. Make an appt with SW and therapist alone. Ask her without therapy, what does that mean for Mom? If it means 24/7 care, and your not willing to do it and she can't afford to pay "in home" aides, then she will need placement after Rehab. Hopefully, a LTC unit is in the same building as Rehab so an easy transition.
I suggest having a phone/zoom conference with the social worker. That way your mother won’t be involved and you can talk candidly about her situation.Also email them ahead of time with questions that you have so they are prepared as well and have it documented.
Underlying issue:
Not being taken seriously as the only daughter.
Get some support through a caregiver support group or individual therapy. Your perspective is important!
Re Mom
Look up on Medicare website the ratings for LTC affiliated w Rehab. Sometimes really good rehabs have not so good LTC facilities, and the Rehab is a natural funnel to LTC.
Both entities — Rehab and LTC — get distinct scores on staffing, cleanliness, etc.
It sounds like your brother has more influence with your mother. It would be good for your brother and you to talk together and come up with how you both can work with your mother. It would be good to include your mother at one point but maybe talk together first before you do this.
Then it's important that you both talk with the social worker about your concerns. If your mother is coming 'home' to your place or own home you need to set your boundaries. What would work for you and/or what you'll agree on her care?
When my mother was discharged from the hospital a plan was made that involved home health care. My brother is total decision maker for our mother's medical decision and won't talk with me or let me be involved. BUT I can share my concerns with the medical personnel.
If your Mom should get released, who will she be released to? If it is either you or your brother, then you need to have that talk privately, even if all it is is to discuss what needs and requirements your Mom will have after she is released.
I suspect, your Mom knows that she will not be released on her own after the rehab. Hence, she is just very anxious about what will be happening to her after she leaves rehab.
In fact, all family members should be encouraged to speak with the social worker and tell what they know about the real circumstances involved in home going, support or lack of it, and history in the past. This will help her gather information.
She will be free to tell your loved one she discussed their opinion of homegoing supports with family, or NOT. But she will be privy to information.
The social worker herself/himself will tell you directly if she/he feels that there are any boundaries in place in discussion.
Absolutely, have private conversations with both the social worker and the key physician assigned to her at the facility. You must make it clear to both, that you are NOT stepping in to care for her (sounds harsh, but one has to say it as clearly and directly as possible). And you need to also say, "a discharge back to her home is NOT a safe discharge" and that a placement in a qualified Medicare and Medicaid long term nursing home facility is best at this point. Make sure the SNF (skilled nursing facility) is both Medicare and Medicaid qualified. If there is NOT one attached to the Rehab facility where she is; ask the social worker for recommendations on the best facilities in the area.
Also, if you have a POA and are also her health agent, now is the time to get with an elder care attorney licensed where she is located (each State has different laws, not sure if you two are in the same State). These attorneys also, know the best SNFs and often have close relationships with the "business managers" at these facilities which helps.
Have the lawyer review the documents (POA, health agent forms, Wills, Trusts, etc) and start (if you do NOT have) online access to all her accounts: bank, IRA, Social Security, credit cards, investment accounts, utilities, taxes (State/Fed) all of it. As the facilities will need to know about how she can pay or not. Also, most facilities like private pay placements for several months or longer as that is a "sweetener" to them.
If she can pay fully, great! Most cannot but selling the home could go a long way to covering the costs. Medicare does NOT pay for permanent SNF care. Medicaid ONLY pays if one qualifies after spending down all assets to about $2K (some States more). Once all the assets are spent down, Medicaid expects the vast majority of any Social Security or retirement funds to pay the monthly fee to the SNF and the State's Medicaid program covers the rest. Folks generally are allowed to keep about $80 dollars spend on personal items.
If Medicaid is indeed needed; you'll need access to all here financial account to download five years of prior statements (they require this), and tax failing as well. And moving forward, once qualified for Medicaid (if that is indeed needed), you will need to make sure her account NEVER goes about the State's assess threshold. Where we live, it was $2.4K. My mom's bank account could NEVER go above that amount, so from time to time, I would buy her -- from her funds -- a lot of candy or other things just to make sure that threshold was never breached.
There are lots of things the lawyer can/should also do, such as to review ALL the paperwork for the facility they will want you to sign. There are "trick" questions and legal language and there is no do over after signing, as those documents are a contract. A lawyer should review it before you sign anything.
Lastly, as others have said; hopefully you and your brother are on the same page. If you both can say, neither will provide her the direct care she needs now and a discharge back home is NOT safe, all the better.
Best of luck with this, it is NOT fun. And you might consider working with a great therapist. Helped me when I was going through this. It is so easy to beat yourself up about these really tough choices. The objective here is to get her the best care she needs now and NO ONE person can handle this all by themselves with out full time 24/7 help (more expensive, than a SNF). Aides a few hours on a few days is NOT a realistic option from what you have described. She may become oppositional, but just like dealing with a little kid (candy for dinner is not good), sometimes hard decisions must be made with our older parents (no mom, going home is not good for you now, not safe). Try not to explain too much, just say "it is not feasible."