Need advice on where to start to look for help?

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My Mom has dementia and suffers from depression. She is not taking care of her personal hygiene and her house is a cluttered mess. It is getting worse. Piles on piles of things laying around. Sometimes it is old food. A health hazard. My dad is her primary caregiver, he gives her her medicine and gets her fed, but he is 87 and can only do so much. I am the only daughter I do what I can but I work full time and have dependents at home myself. I need help. Should I first go to her PC doctor and ask if she could prescribe a nurse coming in to help with possibly some insurance paying for it? Or should I go to the local Dept of Aging to see if they qualify for some sort of help? Or should I just go to a private Home Health Care Agency and pay out of pocket? What should my first step be? PLEASE help!

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Dear Sue, so the answer to all of your questions really rely on what state you live in. Different states have different regulations about Medicaid, waiver programs and assistance to the elderly.

I'd start by getting a visit set up with mom and dad's doctor. Hopefully, they see a geriatrics doctor who understands how to get assistance for her/his patients. Explain what is needed ( dont let your parents put on a "show" for the doctor). Take cell phone pictures of what the house looks like.

If the doctor can order some home health services, paid for by Medicare, that would be great. Medicare is a Federal program and the regs are consistent throughout the country.

If the doctor isn't helpful, you're going to contact the county Area Agency on Aging and ask for a " needs assessment". They shouldn't need financial information to do that. But they WILL need to know about finances you want them to offer help for your parents that is being paid for with public money.

Do your parents have the funds to pay for in home help?

https://www.medicare.gov/coverage/home-health-services.html
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Reply to BarbBrooklyn
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Yes, Suelord

Start with Mom’s Primary.
Ask him to order HH to come in. They will do an evaluation and if they feel your mom qualifies they will provide a weekly nurse to set up your mom’s meds and check her vitals. They will also send a certified nurses assistant to help her with her hygiene. The CNA can help with changing the linens, shampooing mom’s hair etc. The nurse can also request a physical therapist come and evaluate her for physical and occupational therapy and advise on safety hazards.

This is a service paid for by Medicare. I had absolutely no problem getting this service for my mother for several years before her death and now my aunt has had it for about five years. I have had it through four different doctors. If I needed to change doctors I simply informed them we worked with HH and made them aware we would need a doctor to work HH. My aunt uses a geriatric primary now and it works great.
I would also suggest you look into Meals on Wheels for your parents.
Next you need to find a housekeeper. If they come in once a quarter, once a month, once a week, whatever they can afford it will really make a difference in their life and yours. Medicare does not pay for this service.

Every layer of help will make a big difference.
It’s helpful if you can be the primary contact with the HH and be there the first few times they come to help answer questions and make sure your parents don’t dismiss them. Since you work you may need to ask them to call you when they come. Usually our nurses and aides come the same day and same time of the day each week.
Also call your local Area Agency on Aging to see what services may be available in your community for your parents.
Get your dad help soon as many caregivers pass before their loved ones. He needs this help. You may find you’ll need to have someone come in a few hours a day to help them even more but start with these services and make sure your dad is on board with getting the help in so that he is working with you.
Good luck and let us know how it goes.
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Reply to 97yroldmom
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There has to be a need for skilled nursing care for a doctor to write an order for a RN to come in. If she has no skilled need (post hospitalization need for disease management, teaching the family wound care, medication education) a MD won’t write the order. Plus a SN can go in once and determine there is no skilled need & leave. I am a former VNA RN, it doesn’t work that way.
Physicians are under pressure to medically justify any service provided by Medicare these days. The OP would have more luck with asking the county dept of aging for a needs assessment & provide financial info per their request as payment for any county services is based on income. 
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Reply to Shane1124
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Medicare will pay for at least 8 visits by a visiting nurse so start with that. Ask the doctor for an order for a nurse and a social worker (medicare will also pay for that). The social worker will assess the situation, give you options and can arrange needed services.
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Reply to tacy022
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Maybe explaining the situation to your dad, or to the aging agency. AD is not something that can be dealt with on your own. That's my opinion. And I am not your dad's age, I couldn't even imagine doing everything and trying to keep up. My mil acts like a toddler, she lives here, and I have a 4 year old granddaughter who is here every day also and I can't keep up with anything.
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Reply to Lostinthemix
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I can understand your dad's reluctance to give income information, but I think he needs to get over it for you and your mom's sake. Your poor mom's dementia is only going to get worse, unfortunately, and the demands on your time (which with your own family and full-time job you don't have much of, understandably) are only going to grow.
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Reply to SnoopyLove
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I called our local social service agency for the elderly. They wanted income information, I talked to my dad about that and he is reluctant to give out that information. I would be ready to have a local home health care agency come in, but I don't have the money.
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Reply to SueJord159
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Personally, I would begin by making phone calls - and I still have trouble with who handles what, so I just call and at least they can direct me. I think your dad needs some assistance to keep up the house, etc.
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Reply to Lostinthemix
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