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My dad has been in a nursing home for about one month. Previous to this he lived in his own apartment on his own. He has been diagnosed with dementia and is going down pretty fast as far as his memory. He is in Texas and he is on Medicaid. For some reason he keeps getting up and falling and I don’t know if it’s because he doesn’t remember or he’s just stubborn. He also yells a lot for help and doing things uncommon for him. We were not close with him and this is been really hard to get him set up in this nursing home being that he has no retirement benefits or anything like that. The nursing home said we needed to get someone to sit with him from 10 to 7 each day which he absolutely cannot afford and neither can we. Are there any options for us if they do kick him out? There is no way that he can live with a family member. He is wheelchair bound at this point. Just wanted to know if anyone else had experienced this and any suggestions on what we can do.

'BarbBrooklyn', you nailed it!
The most unfortunate problem to be solved here is that the gentlemen needs 1/1 care for his own safety (and possibly the safety of others- which is very common given a severely impaired mental status where rational decision- making is known to be impaired due either to a reversible or irreversible disease process or both). In the hundreds of actual nursing homes that I have serviced in my career, I have never encountered one with the capability of providing ongoing 1/1 support without the utilization of family, outside agency, or a combination of both.

YES-He ABSOLUTELY needs the support and assessment of a Geriatric Behavioral Health Unit. It is entirely possible that his medications are even contributing to the exacerbated behaviors.

YES-Once he's been more successfully tested (infections, disease progression) and treated so far as possible with appropriate medicinal interventions that only Psych specialists can provide; a SPECIALIZED DEMENTIA COMMUNITY, WARD, or UNIT may be a much better solution for his needs moving forward. Pursuing one with a secure, yet open- feeling outdoor space where residents may enjoy fresh air can have an amazingly calming impact on everyone.
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Hello. I experienced the same thing with my elderly Aunt. When they threatened to kick her out of assisted living, I called the DEPT ON AGING in my state of Illinois. Check with that department where you reside, Here in Illinois, they STOPPED the nursing home from kicking her out. Hope this info helps.  GOOD LUCK
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SeniorCareAdvsr Feb 28, 2019
Hi Barb.

Was she in a Nursing Home or Assisted Living? You mentioned both in your experience.
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Medicaid will pay cost for some home care call one and ask. Also there are some nurse homes that have memory care areas they put people that give more watched after care, and its covered if he qualifies
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Renee - Facility cannot physically restrain them. They can do things to help him walk better, like a 4 legged walker; or place safeguards, like mats on the floor adjacent to his bed; lower his bed. They tag his with wrist with a “fall risk” band. But there is only so much that can be done if he is able and determined to get up and walk and then falls. Often the only way to lessen inclination to walk is via “medication management” so he’s placed on meds and doesn’t move as much..... it is why some residents seem to be somewhat zombie like. There should be a care plan meeting that you & sissy can have with the NH to discuss all this. Usually a care plan meeting is scheduled within the first 30 days of admission. If one hasn’t happened, try to get this done on your trip in.

wow he got approved for LTC Medicaid in abt a month, that is awesome. And imo it’s good that Sissy is controlling his checkbook. To me you all need to keep it that way..... where she writes a check for his required by Medicaid copay of all his monthly income less the $ 60. If he needs to move to another Medicaid accepting facility, this will make it easier to accomplish.

Btw the $60 is callled his PNA - personal needs allowance. It can stay in his checking account or some of it can go into a residents personal needs trust accounts set up at the NH. He or the DPOA can open this. It is $ for him to use to pay for a haircut or other small incidentals. My mom was in 2 NH & MIL as well in TX, all of them had a “shop” like to buy candy, barrettes, newspaper, or small size toiletries (aka like from DollarTree) and both had an on site beauty shoppe. They can buy stuff or get a haircut and have it deducted from the on site trust account.

If he still has costs incurring from his apt, or has credit cards or other debts, he’s just going to default on those. If he should have a funeral policy that still has premiums to be paid, you & Sissy will have to pick those up. Otherwise the policy cancels.

When he he broke his femur, did he have surgery and then get referred to have post hospitalization “rehab”? That’s the most common way that they enter a NH. Like for my MIL she broke a hip walking her way too big to handle & no obedience training dog; EMS got her; went to ER; stabilized then surgery; then discharged to NH for “rehab” & she could not return home so became LTC resident. Entering the NH this system puts the costs primarily onto Medicare as Medicare pays 20/21 days and can pay up to 100 days at 80% if he’s “progressing”. But IF he went home, that opportunity for Medicare “rehab” transition to living in a facility that’s paid by Medicare at the beginning doesn’t happen. Did he turn down going into a facility for post femur repair rehab?

Realize there is only so much you can do. My mom -Lewy Body. Dementia- was in a NH doing nicely but one day she was pulling her wheelchair from behind her and fell forward and broke her hip. The medical director of the NH was actually there doing rounds and called me. The choice was
1.hospitalized and surgery then an attempt at rehab (which was zero as her dementia was at the stage where doing anything repetitive wasn’t happening) OR
2. stay at the NH, in her room, on pain meds, become bedfast and let nature run it’s course and go onto hospice. Did choice 2 and she was on hospice in the NH 18 long months. I will say hospice in tandem with a good NH for my mom was beyond wonderful for a difficult situation. I mention this cause the probability is your dads going to fall again and one of the falls will have a significant break in which a surgery or no surgery choice must be made. Really you & Sussy need to think about this ahead of the event and be in agreement of what path to take.
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Sounds like he is in assisted living. He needs a higher level of care than that. He needs round the clock care.

He needs to be on Medicaid or medicare or military benifits.
He is falling because he does not have strength to stand, or walk. He is in a wheel chair. Who is taking care of his bowel and bladder needs? Hell probably need a hoyer lift soon. Doesnt matter if he is forgetting. If he fell he is 100% going to fall again. That is a fact. He could break a hip or worse. He needs to be in a nursing home pronto.
Someone is in denial, or fibbed and said he is higher functioning to get him in there, or some info is missing. They cant keep him in assisted living. He needs nursing care not the occassional aid care.
He is a danger to himself and the other residents if he is in an apartment or room unsupervised.

You need to talk with the manager, coordinator or someone in charge. To help move him and get started on the right paperwork for him. They might be able to help you with that, or steer you in the right direction. Good luck.
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Reneeb19 Feb 21, 2019
Thank you. Yes he is in a nursing home. He went from living in a senior apartment straight to the nursing home because he declined so fast. He fell and had to be put in a wheelchair but he still thinks he can get up. That is when he falls. I believe if I understand correctly, Texas is a "right to fall" state so that won't restrain him and keep him in his chair. I appreciate your input. Thank you.
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I feel like I'm missing something here. If he needs a facility and qualifies for this NH it seems like they should be able to and be providing the care he needs. If he needs more care than they can give maybe he's in the wrong type of facility? If that's the case and since he doesn't have another place to go or the funds to pay for it aren't they responsible for finding him a proper placement? But more to the point, a move like this is hard on patients and can be very hard on them taking some time to adjust. It's a totally new atmosphere for him and the NH should be very familiar with and skilled in the adapting for a new resident. Disorientation isn't uncommon when a patient has a big change in living and I don't think sudden cognitive decline is either, often it resolves as they become acclimated and less anxious/confused but not always. Checking for UTI as well as making sure he is getting enough fluids are 2 of the first line things I would want to check out too if I were you. They don't know him and he doesn't know them so the fluids can be overlooked easily and you would be amazed at the significant difference that can make quickly, same of course goes for UTI which by the sounds of it is even more common in NH situations, not necessarily anyone's fault just again changes...
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igloo572 Feb 21, 2019
The “responsibility” for placement happens IF they are actually on LTC Medicaid. If they are still Medicaid Pending..... like their application is still awaiting additional documentation or they are in appeal phase for either the medically or financially “at need” requirements for LTC Medicaid, they are NOT YET on LTC Medicaid. So the facility does not have to find a lateral transfer for him to go to.

What tends to happen is that - if the resident isn’t yet approved for LTC Medicaid & isn’t a good fit for the facility (either care needs are more than this place wants to deal with or they anticipate their not gonna get paid) - the facility can & will find a reason to have the resident go to the ER. Facility calls EMS or ambulance transfer co and has them go onto the ER. Then once in ER, faciltiy will not take them back. They then become a problem for the discharge dept of the hospital to deal with.

Its kinda why I asked the OP if their dad had actually cleared LTC Medicaid eligibility and how he entered the NH. If he came from living in his apt and not via a post hospitalization, then there is no - none - nada of MediCARE $ getting paid to the facility. Post hospitalization rehab is a MediCARE benefit and pays the NH like abt triple++ what TXs really low LTC Medicaid room & board rate. TX R&B last I looked was like $168 a day. When my late mom enter a NH in TX, it was like $145 a day. It’s really hard for a
NH to be profitable on Medicaid beds. If a resident looks like isn’t going to be LTC Medicaid eligibile and family isn’t going to private pay, they have to get them out and get that bed with a resident who actually can pay
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Is he actually on LTC Medicaid?
So he enter the NH and did the TX LTC NH Medicaid application with all the documents needed (to verify being both medically & financially “at need”) and has already gotten the LTC Medicaid approval / eligibility letter from the state as to eligibility and his to the penny required copay to the NH? All done within a month?

Please, please check on this. Either he or the NH will have a caseworker assigned. You need to speak with the state caseworker as to exactly what his status is for LTC Medicaid. Usually it takes 3-5 months to clear LTC eligibility for TX.

If he was on medicaid when he was living on his own, that’s community based Medicaid. It’s not the same program as LTC Medicaid. LTC Medicaid has lots narrower rules for being “at need” both medically and financially. 2k in non-exempt assets is the rule, he has to be basically impoverished. If he’s assets over 2k, he will be ineligible. If he’s over 2k, the NH may be wanting him to pay for sitters so that he can lower his $ ASAP and be able to clear Medicaid financial eligibility. Could this possibly be the situation?

His being approved for community based will imo speed up his LTC application as a lot of items are already in states database. But only until he actually is approved & eligible for LTC Medicaid will he have the required safeguards as to the facility having to find him another facility if they cannot provide the level of care he needs. If he’s actually only “Medicaid LTC Pending”, he’s still in the grey area for the facilities mandated responsibility for continuity of care.

Again You need to clearly speak with state caseworker as to his status. I’d try to do it this week. You want the state to CC you on all paperwork. I’d be really concerned if it’s just going to him at the NH as many of the items needed have a specific time frame for a document to be submitted by.

How did he enter the NH?
Was it from a hospitalization and he was discharged from hospital to the NH for “rehab”?
OR did he enter the NH directly from living in his home?
If it’s the latter, when you speak with the caseworker ask if a medically “at need” assessment will be needed or has been done.

if you find that he is still in the LTC Medicaid Pending phase, I’d really suggest you do whatever you can to get the NH happier with the situation. Try to find the $ to get the minimum # of “sitter” hours done. Until he’s fully eligible for LTC NH Medicaid, no other place that’s decent is going to admit him as a Pending resident.

Once he clears Medicaid, you can then find him another facility and move him. If that’s what you think will be the future, you imo have to have him pay the NH his copay each month as a check from his bank account that gets his SS direct deposited into. So say his SS is $700 a mo, he or you as a signatory on his checking account writes the NH a ck for $640 each mo. TX has a $60 personal needs allowance that he is allowed to keep. This way should he move NHs, he still has control over his funds. If he allows the NH to become his SS income payee, getting them to change that will not be simple..... they will footdrag doing it.

Good luck with the caseworker. In dealing with them for both my mom & MIL, I’ve found them to be wanting to get the elder approved; but they are under very precise documentation needed in a tight timeframe. So you have to get them whatever is needed. ASAP. No maybe manana can happen as the application will time out.
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Reneeb19 Feb 21, 2019
Thank you. I was off on the dates he entered the NH. After talking to my sister, he actually has been there 2 months. He was in a Sr. living apartment and severely depressed so did not move around. He fell and had to be hospitalized for a couple weeks. He has dementia and is confined to he wheelchair at this point. They are doing PT with him but he is still not strong but still wants to try and get up and move. My sister filled out all of the medicaid paperwork and he was approved within about 4 weeks. Don't know if that is fast but the paperwork was a nightmare. She just made his first payment and he did have $60 left over. She is handling his payments not the NH. He only has that 60 left over so there is no money to hire someone to sit with him. The only family is my sister that is there and she has a job. I am about 3 hours from him. We are just really frustrated and felt like we got him in a nice NH and we (my sister) could relax a little and not worry so much. Seems like it just keeps getting worse. Thank you for your information. I appreciate the help.
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Here's a link that might help with the getting kicked out problem and other NH problems. When you get there scroll down about half way on the left and click on "Read the Guide". Looks like you have to copy and paste it into your browser. It is aimed at California but should/may also apply in Texas. I hope.

https://cahealthadvocates.us1.list-manage.com/track/click?u=59b976be4ac0d7cf7a631e434&id=0114dd9213&e=7a08049303
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Reneeb19 Feb 21, 2019
Thanks!
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Talk to the social worker at the home. Ask if he can be sent to a psychiatric facility for meds to be trialed.

He also needs to be tested for a UTI if this is unusual behavior for him. Infections can cause psychiatric symptoms in the elderly.
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Reneeb19 Feb 21, 2019
Thank you, I will look into that.
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