My mom is about to be released from rehab following a fall. I feel she is no longer safe living independently, what do I do?

You call the discharge planner at the facility and tell them that mom lives alone, that her house is in disrepair and that she "self-neglects". And that discharging her to her home, alone, is an unsafe discharge.

And most importantly, that you are not living with her and cannot provide care for her.

Some discharge planners will try to guilt you into providing care, ie, say "Don't you love your mother?"

You say "Yes, and that's why I want her to be provided with the care she needs from professionals."

Do NOT pick her up.
Do NOT move her into your home.

If the rehab sends her home alone, call Adult Protective Services and report a vulnerable adult living alone.

Please consider a few things:

- that your Mom's depression is not being treated enough (or at all). If she's on meds, she may not be taking them. If she's not on meds... why not? If she's on meds, is it possible she is over- or under-medicating herself? Is she on any other meds to your knowledge? Same goes for those meds.

- maybe your Mom has something other than depression going on. Something cognitive, like dementia or some other medical issue that presents dementia-like symptoms (thyroid problem, vitamin deficiency, addiction, diabetes, high blood pressure, stroke, tumor, etc)

- her friends maybe ARE checking in on her but she's resisting their help, too.

- no one can force an uncooperative person to do things against their will without being their legal representative -- and even then it is extremely challenging.

Right now, if you (or no one) is her PoA and she doesn't cooperate with anything to help herself, then you have no power in this situation. Sure, you can try to go there and do everything for her but I think you already are seeing how exhausting and pointless this is. You won't be able to nag her into doing it.

Without an accurate diagnosis and her being willing to even go to the doctor, you will need to step away and keep sending APS to her home. Even they won't be able to force her to take care of herself. They may eventually acquire guardianship for her. Or, you (or some other family member) can pursue guardianship through the courts for her. She still may not cooperate but you'll have the legal power to make beneficial things come about for her care.

Ultimately, if you choose to become her manager/caregiver, this arrangement MUST work for you. If it doesn't, you'll be on your way to burn out pretty fast. Keep in mind that your life, your spouse (and your kids if you have any at home) are your #1 priority.

BarbBrooklyn gave a strategy to you that you can use. I'm sure you love your Mom a lot. But your love won't be enough to get her to want and participate in her own care. Stepping away from attempting to manager her life and health seems counter-intuitive but it is the beginning of a strategy that will work.

Regarding her broken hip and rehab: she has probably used up her days that Medicare will cover her rehab stay. They might send her home with prescription pain meds. If she needs someone to run errands for her, you can teach her how to order groceries for home delivery. She can pay for an aid through Care.com. Do not get sucked into her care vortex unless she is willing to have a plan that doesn't come at the cost of you and your family's wellbeing.

I agree with Barb. On two separate occasions, one a hospital and one a rehab, all I had to do way SAY I was going to appeal mom's discharge and the social workers got on the phone and got Medicare to extend her stay. I guess appeals are a lot of paperwork and not a good look for the facility, so they tried to avoid that. This will only buy you a little more time, maybe a couple of weeks.

In the meantime you will have to consider the longer term questions that Geaton has proposed. I know this isn't easy. Please don't overextend yourself like so many of us here have. Know your limits, and know that mom's health will continue to decline over time, even if the hip gets better.

I’m baffled by the last couple of sentences in your post. You say that your mom is in pretty good health.

All of the above statements in your post do not indicate that she is doing well at home. She falls often.

You are working full time and live further away. You aren’t able to easily check in on her. I can see how frustrating this is for you.

You’re going to have to speak with the rehab facility and come up with a plan. Be honest with them.

Tell the rehab staff that your mother is not able to manage well at home and that you are concerned for her safety. Explain that you live too far away to be available for her needs. Make sure they know that you will not be caring for her in your home.

You aren’t responsible for your mom’s care but you can be an advocate for her by planning for her future care.

Wishing you and your mother all the best.

Its called an "unsafe discharge". Tell them you want a 24/7 evaluation. If found she needs 24/7 care tell them to transfer her to the NH wing. Is she has money, pay privately. If not, start the Medicaid application. In the meantime, the NH will probably want any SS and pension she receives.

Your Mom cannot return to her home. She needs care u cannot give her. Setting up in home care would be a nightmare from a distance. They may tell u there is help but ur on ur own once u walk out that door with her.

Scroll down to Barb's response to you. She's exactly right.
However, DO KNOW and understand that, if your mother is diagnosed ONLY with mental problems, she cannot be held. A person can be totally incapacitated mentally and still insist on their own discharge. Under the law a person who is mentally unable to care for self because of DIAGNOSED dementia can be held in care. If mentally disabled because of mental illness they really cannot. The law considers it to be someone's "right" to be mentally ill, and live as they see fit if they are not self harming or harming others. And harming others won't get them a stay in hospital but rather in jail. Our jails are full of the mentally ill because there are no longer asylums to care for them. And no longer the will to take their "rights from them" under the law.

This is a sad fact that anyone dealing with the mentally challenged needs to face up to.

I refer you to the memoir written by Liz Scheier called Never Simple.
Ms Scheier attempted to help her mentally challenged Mom for decades and had the help of the city and state of New York Social Services department. It nearly ruined her life. And it was ALL TO NO AVAIL.

tjfielding: Tell the discharge planner that it would be an unsafe discharge to home.

And I suppose if Protective Services enters the scene, at some point, if you continue not to want involvement, they will take over & arrange something for her. Not sure how that all works out but they will step in I believe. I’d maybe post about that if that’s the route you prefer.
I personally brought mom home after her hip break because mine also lives far (2 hrs away). And she also is now totally dependent on help so can’t be alone. I’m in the same boat as you. 7 months later, she’s still at my house and I still have no idea what to do.

Interesting, was she picked up at home? If so, the responding EMTs should have noted this in their report to the hospital and/or rehab facility, thereby she would get a visit from the social worker. Social Worker would then in turn contact you, if mom was hesitant on doing anything.

If she is mentally competent, she gets to make these decisions - and deal with the consequences. Ask for your mom if she would consider allowing psychiatric evaluation and treatment. Many seniors have depression and there are medications that can help. Talk therapy sessions can help her sort out the issues your mentioned and help her come up with plans to address her issues.

When she is deemed mentally incompetent, then you may be able to step in and help her with decision-making. Ask her to legally appoint you - or somebody she trusts - to have Powers of Attorney (medical and financial) or a Health Care Proxy (medical) for the day she needs somebody to step in and handle her affairs. Set her up with an appointment with a lawyer near her to get those legal documents completed.

As for what to do to help her now, research resources in her area for the issues you mentioned. Make a list of the things that need to be addressed and give it to your mom with the list of people who can help. Since she worries about money, see if there is Habitat for Humanity that might help with repairs or local church groups. Ask family and friends to volunteer to help visit weekly and clean or do other chores. Decide with your spouse what tasks you are able to help with given your other responsibilities. Let your mom know how you are able to help - and stick to those areas.