Mom has broken leg, will be discharged from rehab soon. What to do?

This will not solve the primary problem, but I would think it would be helpful to go out and find some friends. I don't have a lot of friends, but I have several good friends who have been helpful as I deal with my own situation with my mom. Perhaps easier said than done, but it seems like you are a person with a good soul and could find friends if you went to places to meet people.

You aren't financially responsible for where your mother resides.

First of all, she won't "die of a broken heart in a Medicaid Nursing Home." You should keep in mind that many nursing homes have Medicaid beds. In other words, if mom moved in on Medicaid, the person in the next room may be paying $12,000 per month, private pay. Also, if she can get into the 'county home', they often have very good care because their employees are county employees and retention is better.

So, stop with the 'scary nursing home' nonsense. Mom needs social interaction and she'll get it in a nursing home. It also sounds like she needs SNF care rather than AL anyway. Mom is not in any position to determine where she'll live. YOU must decide and be firm about it.

DO NOT LET THEM DISCHARGE HER. Make it clear that she lives alone. Make it clear that you can only visit and run errands for her. You cannot provide care. The hospital discharge planner is simply looking for the path of least resistance. If mom makes it sound like you're going to care for her at home and you don't speak up, you'll wind up on discharge day with a fully disabled mom on your hands.

She's got to go to rehab anyway. Make sure it's one that has Medicaid beds in case she doesn't improve enough to leave.

Obviously your Mother cannot live alone. If you or another relative cannot live with her then your choice is a NH. Keep in mind that none of these places are a holiday inn. Case Workers are a dime a dozen. It is too bad you do not have any prior experience with a similar situation. You are not going to resolve this situation within two weeks. Your Mother will have to go home with nursing or go to a some sort of nursing residence with help upon release.

Medicaid processing takes about a few months. Some places will not take a patient “pending” Medicaid approval. Start the application ASAP, even if you do not use it. Sometimes you have to go on a waiting list for Medicaid NH residence. If your Mother still has good cognitive ability she probably will not agree to go to the NH. It will be difficult for you and her.

I was in a similar situation with my 98 year old grandmother and still in the situation with my 78 year old mother. Best advise I received is sign nothing when going in a nursing home or otherwise to protect yourself. This came directly from our representatives Peter Lucido and Doug Wozniak. Doug is a good resource to contact as our local congressman and elder care lawyer. First thing I did was find a place with a Medicare / Medicaid bed. Medicaid beds are hard to find and go quick. I was able to place my grandmother at Fraser Villa and had a guardianship company take over. I know that sounds harsh but I need to keep my health intact as a caregiver for my 5 year old daughter. Being 50 years old myself it is even more important to keep up my health for others around me that need me. Hope this helps? Shelby Twp

Withe Medicaid COMMUNITY - ie IN HOME CARE - you can spend down this month and then apply next month since there is only a 1 or 2 month lookback......She can only have $15k in assets to apply and can only make $under $900 per month.....IF SHE MAKES MORE, she can spend down the excess monthly and continue to get services...the spend down can be used on medical stuff OR you can do a POOLED INCOME TRUST and use the excess for rent, etc.......you can go directly to Senior Home Health Aide agencies and they usually have people "in house" to help you with application and answer questions - usually FREE of charge....just as long as you use their services once mom is approved.....if you can keep mom in a rehab for 3 months - covered by medicare - you can apply for medicaid during this same period and hopefully be approved by the time she gets out of rehab.....the medicaid application for NURSING HOME ie Institutional has a 5 yr lookback so its a bit more challenging if you have assets or have given assets away within the last 5 yrs......

One possible solution is to keep her in the Rehab/Nursing Home and apply her for Medicaid Long-Term Care. There is a box on the application where you can indicate that she plans to return to her home. Once she spends down and she doesn't have money to pay her property taxes, you can defer those taxes (until she passes and the home is sold.) Then, she stays in the NH for the duration or until she is able to discharge. The ball is in her court; the responsibility is hers to work at physical therapy. IMHO she is not capable of living at home, and this femur break could be a turning point. Time will tell. But if, low and behold, she improves enough, the house is still there.

Before she gets released, go to the social worker at the rehab and ask them to help you with paperwork to move her to a long term care facility. Assisted living usually means the person can walk, get around on their own and has medical staff on hand only to 'assist'. If you are unable to continue providing care, probably more than she needed before, you simply can't. You could explain to your mom that until she is moving around a little better she is going to another rehab type facility. And she can get PT at the long term care facility. A medicaid nursing home is the same facility as private pay people use. The only difference is how the patient is getting the bill paid. The care, good or bad, will be about the same as she gets at the current rehab because it's all about making a profit in most facilities. Plus you will have more energy to visit and see what's going on.
I don't really see the point in paying someone to assess her when that can be done where she is right now and with her doctor assessing as well. They do it for free.
She doesn't really need foster care (she has you to help with decisions) unless that type of care means something different where you live. The social worker can explain it to you.
Be clear when you are filling out paperwork that her intent is to go back home. That should keep the house on the back burner for now and you would be liquidating other assets to pay for her care....when it runs out, she should become eligible for the medicaid paid bed.
Did the elder care attorney talk with you about a lady bird deed on the house or tell you how the house would be handled in your state? If not, ask him. When you fill out paperwork for medicaid (even though it won't start until assets gone), you will also be signing a Medicaid recovery document which says if the estate is worth XX dollars, the state may recovery monies they paid for the NH care. Basically, that what any savings or assets in your life are for - to pay for your care in old age. She's there.

It's tough & heart wrenching but you have done amazingly well to this point and you continue to research for solution. You are there. Talk with the social worker.
The care your mother requires, you can't do it. Your mother will need the touch of professional medical care 24/7. Act now. The social worker is your laison and will guide you through the course.
Blessings

To be frank, the fraught relationship and the history of abuse leaves, to my mind, Mom not having much to say about this. Especially with your saying you were abused, and with your history of depression. To me in your home or hers is not at present an option. I think that a Social Worker or Case Worker speaking with Mom is not going to help in this decision. She should be speaking with you. You express that you are uncertain in your decisions, so I would spend that money with someone speaking with you about this. The answer is almost certain your mother spending down her assets now on either assisted living or extended care, then moving on to medicare/medical. Sorry to be so blunt; I feel it is time now for your to think about the rest of your OWN life. Your Mom is facing end of life issues. She could EASILY live another 15 or 20 years in your care; whether you would survive yourself is, for me another question.

I feel so much for you. You can’t do it. It’s too much and you’ve already gotten yourself I’ll over it. The case worker might be able to help with navigating Medicaid. It’s a hard hard boat to row. If you can get her placed then do it. But only you can decide. Much love and all my sympathies. You are a good daughter. Reach out to any friends you may have. But when you’re depressed that’s so hard. Get yourself some assistance. You cannot do it all like this. Get office if Aging and any social services in your town involved. I’m so sorry.

"I'm at the point that I pray for one of us to die in our sleep, and while my goal has been to outlive her by a week so I don't abandon her, I don't know if I can stay the course."

That's heart-wrenching and while I don't have any solid advice for your problem, I really hope and pray you find one. Nobody should have to live like that.

Why oh why do people keep calling nursing homes depressing? Maybe some are but all are not like that. My mother in law and my mom did fine and the places were great. But you do need to take an active roll. . That said, if you don't take care of yourself then who's going to be left to help her? You can't bring her home. Don't let someone guilt you into it by making think you are a bad person for putting her in a "depressing" nursing home. Shame on them. How is that helping you? You do what you have to do. Yes, your mom will complain but don't forget, if she gets upset you can always leave. You don't have to be at the nursing home 24/7.

You need to Sit down with a caseworker from the Facility(Nursing Home, Rehab)And find out what is Best for Mom. You are in Between a Rock and a Hard Place with no "Displace." She can get 21 days of Medicare Help in the house but in those days, when time is nearly up, They will most likely Suggest a facility for her that will Take care of her 24'7 and Yes...Spend down. Sad, Isn't it? If you can Get some Help in the Hose, Or a Family or friend, No Money, Honey, This is a Big help. But if Mom needs More care than you can Possibly do or pay for, I say Do things Wisely First and Then make Plans for Mom's Long Term Care.....

Hi Darkseaglass,

First off, I just want to say thank you for taking care of her. I know you probably don’t get much thank yous. I can imagine 9 years of your commitment to her is taking a toll. Don’t forget to take care of yourself. See a counselor. There is a way out. I too am an only child and had to live through my dad getting brain cancer and dying and then my mom completely losing herself over the past three years. She suffers from trauma of losing my dad and dementia. I can hardly go out and keep my job. My only hope is that God made me for this time and will help to sustain me.

Shes not as bad as your mom in terms of needing care, but I decided to enroll her her in a PACE program for both my sanity and hers. I work for the program and I know the care they give is amazing. You can get 24/7 care if you need it. I would recommend joining a pool trust agency if your state has that option. It basically means you are able to participate in the Medicaid spend down without losing assets. Ask the PACE program about it. They should know. At least in New York, Medicaid doesn’t do a 5 year look back as long as she receives in-home care. Once she’s in a facility all bets are off.

I’m praying that you’ll get through this time and that you’ll find something to live for! There is hope. I know it hard to believe, but things will get better. You’re not alone!!

God bless,
Christine

When I was read your question/letter I had nothing but empathy for you.It was like I had written it.My husband and I are going through a similar situation with his Mom.Up until 18 months (when we married)ago my husband (like you)was doing it alone.My MIL is 92 with dementia.He moved in with her after his divorce because she was falling a lot and lived alone. He had promised his Dad before he passed that he would take care of her.His older sister had passed away a year before his Dad.As time flew by while we were dating she got worse.It got harder when she decided not to renew her drivers license.When we spoke of getting married he felt it wouldn’t be fair to bring me into his situation. In our 9th year,she was 90,healthy aside from dementia and arthritis,Takes no medication.I thought she could live another 10 years.Do I want to wait? No! Although I thought I knew how much he did for his mom because a lot of our ‘together’time was planned around her needs.
When we got married,moved in,thinking I knew how much he did for her.I was wrong!!! It was such a small fraction of what he does! I don’t know how he managed to date me! Today in the present,she got shingles,went into the hospital for something different. She was there for 3-4 days.Came home,5 hours later she got up (was told not to) to get some water.We have cameras in the house so we can watch her when we’re not at home. I was in our room and he was there in the dining area.He turned to go in his office. He had only taken 3 steps when she got up and fell on the kitchen floor.She ended up breaking her hip!
Called 911,the same firemen,paramedics from the first time,back to ER.2days later she had surgery, 3 days after surgery she’s in a skilled nursing home for her rehabilitation.This is her 8th day at this facility.Convenient that it’s a 7 minute drive.Nice place. She’s in isolation because of the shingles. We have to wear gloves and gown to enter. She’s wearing a diaper cause she can’t walk let alone share a bathroom with anyone.Because she’s a risk of getting out of bed my husband had to hire a babysitter per the NH suggestion.The sitter comes from 11pm to 8 pm.Between her Medicare and secondary insurance the NH is covered.The sitter is out of pocket. I’ve heard so many stories from many of my clients in regards to NH,caregivers etc. I also have a soft spot for elderly people as a majority of my clients were seniors. When someone has dementia someone has to be their advocate. My husband with his culture and his personality its going to take something really big for him to speak up. One of us gets there about 9:30 10:00am so we can be there for her PT and one of us stays until the sitter comes at 11 pm. I am shocked, pissed and sick in regards to how poorly some of the staff is let alone the lack of compassion. Which is how I came across this website and your letter. Go to California Department of Aging. Or whatever state you live in. It’s to help guide people like you in situations like this. Many resources that many of us aren’t aware of! Please do yourself that favor. I was so relieved to get information I was looking for!!! Take care of yourself too💕 I will be updating myself on your situation! Take Care.

I'm so so SO sorry that you are suffering like this, my friend. My heart goes out to you in a BIG way. I don't have 'the answer' for you here, I just wanted to let you know something: my cousin was caring for my aunt in her home for well over a year. Her mom was bed bound and pretty immobile. My cousin called in the family members to say 'goodbye' to my aunt, as it appeared she was getting ready to pass away. For some reason, and memory escapes me now, my aunt was placed in a Medicaid nursing home right after that family visit. Instead of passing away, she flourished in the NH, living another 3 or 4 years and she did just fine. So, I seriously doubt your mom would 'die of a broken heart' if you were to place her in a LTC facility! Since she refuses to do for herself, she MUST be placed in a safe situation where you can go visit her from time to time. That's the kindest thing you can do. And then, you can see about taking care of YOU!

All the best of luck.

An update on my mom, who this post is about. But first, thank you all from the very bottom of my heart for your responses. It's a lifeline to have someone to talk to.

The caseworker came out yesterday and talked to mom about her options. While I'd prepped mom beforehand, she was very, very upset. She said she can't believe that conversation was her mother's day present this year. She won't admit being angry with me, but clearly is, and I expected that. I haven't heard back from the caseworker yet to hear the caseworker's side of the story, and I called the SNF social worker a couple days ago but haven't heard back yet.

I did get a call from physical therapy, and they said that she's not making much progress, that she's not motivated, that she'll say she'll do exercises in her room, time and again, but then doesn't--just wants to be put back in the bed. This has been my experience for the past 9 years--she will not do anything to help herself. She's fallen and had in-home rehab at least four times. While they're there and doting on her, she wants their approval and affection, but she does nothing when they're not around. Her tentative discharge date is 5/23, and they don't think she'll be walking or standing yet. They don't know if she will be walking or standing in three months or ever. There are alot of physical mobility problems that have been there for years.

Mom only wants to go home. I explained that she needs 24/7 care, which would cost a fortune. She counters with we can put a potty chair next to the bed, and have someone come in a couple hours a couple times a week.

I have a doctor's appointment this afternoon, and I'm hoping he can give me something to help me function better, so I can make a sound decision. When I think about going to visit her tonight I get bile in the back of my mouth and I can't stop crying. Being this much of a mess is really not helpful to anyone.

I thank you all for your responses. I know nobody can fix this or tell me what to do, but I really appreciate you listening and trying. God bless.

Please let her stay in her home and recoup. There are agencies that have CNAs care for them at home. Long Term Care it is called under Medicare.

Seaglass,
I'm a bit worried for you. You have to get yourself into therapy pronto. You have to take care of yourself in order to be a positive advocate for your mom.
You can stop blaming yourself about how much money you have, or have saved, or doing the right thing, or whatever. It wasn't your job to do this. It's not your fault that the system is unfairly stacked against less fortunate families. You did nothing wrong, and now you are trying to care for an aging parent. There is nothing but kudos involved here, so you please try to be kind to yourself.
Ok, so about your mom. What you have to keep in mind is this. It is your job to make sure she is safe and cared for. You are not able to do that yourself now, and no one would be. She's a fall risk and she's recovering from a serious broken leg. She's still got some months of recovery, and hopefully she'll be able to walk again but that remains to be seen.
Every adult child on this site describes a parent who does not want to go to a facility. I won't either, but I don't know what will happen when I am 80 or 90. No one wants to give up their independence because it means truly facing mortality and that is scary.
What is this $750. fee for? What do you get for that? Does this person act as your liaison indefinitely? Is there some sort of hourly fee within that price? You need more information about this.
Personally, I was able to get help last year at the Jewish Federation in my city. They have a dedicated person who assists seniors only. There was no cost to me, and I got a lot of excellent, warm, and loving advice based on experience. Whoever helps you needs to be up to date on the particulars of your area. You don't have to be Jewish to call the Jewish Federation, but there is probably a Council on Aging in your state and/or city. Before you spend that $750., please see if there's an agency that can help you for free or for a much smaller fee.

Thanks Barb and JoAnn for sharing your experiences. It truly is helpful. I appreciate it and I am sure many others do as well. I get emotional reading some of these posts and feel the poster’s pain. I get scared too because I wonder where my mom’s situation will end up. It’s terribly hard dealing with all of this. I just want to make sure I thank both of you for being positive voices on this forum. Happy Mother’s Day to both of you!

Seaglass,

First of all, ignore Shad. Do listen to Barb and JoAnn. They both have experience with nursing home care. I do not. My mom lives in my home but given your circumstances I feel I wouldn’t have any other choice but a nursing home. You can’t possibly do all that is needed for your mom all by yourself. It’s too much for you to deal with, even with hired help. My heart goes out to you. I’m so sorry you are in this predicament. Many, many hugs and I hope that you get the answers you need soon. Take care. I wish you all the best.

First DarkSeaglass you were not and are not responsible for "planning" and saving for your mom's future care so relieve yourself of that guilt and any sense that it's you responsibility or fault that she is in the financial position she is, abuse or not.

The first thing I would do is check with this case worker you are thinking of hiring to make sure that his or her fee will count toward/be acceptable for any spend down should she end up needing the Medicaid route. I think it should as long as this isn't an exurbanite amount for the fee in your area but if not that might tell you something too. Then providing it is an acceptable expenditure to Medicaid it's probably money well spent, by your MOTHER not from your funds. It does sound like some professional guidance (working for you) would be helpful at this juncture. If for whatever reason it wont be covered in that process there are other options. Whatever care the doctor orders and want set up, like VNA/PT should have a case worker/social worker available to send out to meet with you and help guide you and might even visit you at rehab to do that as you figure out what to set up. Then of course there is a coordinate of some sort at the rehab facility and most states Agency on Aging have services as well making social workers/case workers available to help elders and families navigate these things too. Check these all out and set up appointments before she is ready for release so you can make an informed decision about the best way to proceed from rehab, I think you are clear that it can't be you moving in as her full time caregiver and that is more than ok. In fact owning that simplifies things and helps the professionals guide you better so it's a positive to feel good about not a negative to feel guilty about and you don't need excuses for this either. You certainly haven't and aren't abandoning your mom, just the opposite you are making sure she has the best, safest care possible. So many of us think that is us and don't learn we are wrong until we have gotten in deep with too many mistakes, not an reprimand and doesn't mean we were wrong at the time because we are all just doing the best we can to do right by our loved ones and that's all anyone can ask or expect. Truth is you are already doing the hard work right now and giving your mom more support than anyone has the right to expect.

Dark, sent you a private message. Click on ur icon, then profile.

I would talk to the Social Worker at the rehab. Tell her that you are not able to care for Mom in her home or yours. That you feel LTC is the option you need to explore.

With My Mom I had cashed in all her CDs. She was in an AL for 8 months. Money was running out so she paid 2 months privately in LTC and went into Medicaid from there. I think ur Mom is past an AL.

Her house won't be considered an asset but she also, once on Medicaid, won't be able to pay taxes, bills or upkeep on it. If sold, it has to go at Market Value and the proceeds to her care,

Mom in NH, very good chance she will decline rapidly, sad to say. NH are still the depressing end of the road places they have always been, just wrapped in nicer packaging.

Are your finances entangled?

I think a caseworker or elder care attorney are well worth the money. SOMEONE (and it shouldn't be you) needs to explain that she needs more care than YOU can give at home.

Is your depression being treated?

I don't quite understand why someone who was abused by their parent as a child thinks that they should do hands' on caregiving. It must be soul-murdering.

I had a "good enough mother" but would never have allowed myself to be hands on simply because I was told "suck it up" "offer it up" "don't make mountains out of molehills" so often as a child that it was my first (unspoken) and not very charitable response to any and all of my mother's problems. Had I lived with her or vice versa, it would have killed me.

The fact that you are thinking that the best outcome is for you to die is an indication that you are severely depressed and in need of immediate treatment. If nothing else, talk to the social work department at rehab and get a referral for counseling to help you through this hard time.