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My mom lives alone in an upstairs apartment with stairs no elevator. Since August she had a caretaker for a couple hours a day four days a week. The caretaker broke her ankle a few day before Thanksgiving . My mom was able to live alone and was mostly fine except lonely and depressed. She has no serious medical problems but needed help with laundry, groceries and getting to doctors appointments. So the day after Thanksgiving she fell while getting up and landed face down on the couch and possibly hit her head on arm rest. I live an hour a way and at her doctors insistence drove down and took her to ER. After hours of running tests she was discharged, vitals good and no broken bones. I stayed with her over night . Two days later she fell again , back to urgent care, two days later fell and wasn’t found for 24 hours. I called 911 this time. Again vitals fine ,no broken bones. They discharged her but did send her to a SNF for in patient PT. Fast forward two weeks, my mom went from occasional forgetfulness to about an 8 on confusion. She also is having hallucinations, confusion and is nothing like she was a couple weeks ago. She has fallen twice since in the facility trying to get out of bed unassisted and taken to ER. CT scan etc. They now have to park her in a wheelchair near nurses station at night to keep her from climbing out of bed. Today I get a call from the doctor saying she was being discharged on Friday. I said to where and she said to her home. She said she can walk 125 feet with a walker and minimal assist. I said oh can she get up and go to the bathroom by herself and she said no she needs minimal assistance. So then she had the social worker call me, I said so how can she go home by herself, I said even if I can get her 4 hours a day caretaker, what does she do the other 20 hours? Beside the fact I don’t have a caretaker for her by Friday. My mom has Medicare and Medi-cal (for now). She is 80 years old. I asked if she could be placed in a nursing home and she says she doesn’t need that level of care. I told her my mom has $1400 a month that is it. She basically told me I needed to start calling around. I also told her if the doctor and her think she can be discharged to her home with limited in home services, fine I will get her home. But if not I will not be picking her up on Friday. So now what? If I don’t pick her up what happens, where does she go? I am sick with the thought of doing that to my mom. She is still aware enough to know what’s going on. Mostly... I am the only person my mom has. She is very difficult and last year when I took her home after a fall for a few weeks I was ready to Jump off a bridge. Everything about her is difficult including her refusing to go home. I have not brought her here since. I visit once a week, do her shopping, finances, appointments, clean apt. Etc. Talk to her daily. I had to take her home last time because it was either her or me but something had to give. She hates my husband of 20 years and the feeling is mutual. I can not take care of her 24/7 when she can’t even get up without falling . I asked social worker what are my options if they discharge her and I can not take care of her and refuse to take her, she said she could give me a number to a board and care facility that I could call. I told her my mom has no money and can not pay for that, and Medicaid doesn't cover that. She told me I need to put together a plan. We have no other family. I told her my plan was for her to stay there until she can get around, get up, and go to the bathroom by herself. And then, take her to her home with In Home Care. They are discharging her Friday . Can anyone help me? I am in California, she has Medicare and Medi-cal. If I take her I do not believe I will ever be able to get her to leave and within 2-3 days I will be looking for a bridge to jump off. Then What will they do ? Sorry for this long post. I am lost.

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Thanks for letting us know. Hope you and mom have a Happy New Year.
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Update: took my mom home yesterday after 8 Long days at my house.
I cleaned her apartment, got her groceries, labeled everything, setup her medications....wrote out lists, drink water, get up, use walker, take meds etc etc
Brought in a new Caretaker 4-6 hours a day.
Praying this solution will work as I have no other options.
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NeedHelpWithMom Dec 31, 2019
Best wishes, Jules.
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Jules...im so sorry the social worker bullied you into taking your mom home with you. I hate that people wont do what they are being paid to do. Please try to enjoy your holiday and deal with things next week....blessings to you💞🎄
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JulesNeedsHelp Dec 25, 2019
Thank you! You all cheered me up!
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Manage best you can over Christmas and then find an elder law attorney who specializes in Medicaid planning
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JulesNeedsHelp Dec 24, 2019
Thank you!

Merry Christmas and Happy Holidays.
Thanks for all of your responses.
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Jules, I'm so sorry you're in this situation. I read below that you buckled. You didn't need to. If APS was called they would have found placement for Mom, the only negative consequence for you would be that they would have obtained complete control (guardianship) and you wouldn't have any say in the matter. Which means they would have found a place or situation where Mom would have been cared for but it could have been 100 miles away and you wouldn't have a say. But that's it. You are not obligated if you are not able to care for her financially, physically or otherwise. You wouldn't be "charged" with anything, its not your legal responsibility like it is if you abandoned a child. There will be a next time. I wish you the best and hope you are able to manage.
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Jules, you said the board & care is $2000 a month? Has anyone brought up medi-cal? There is financial assistance for this. Medi-cal pays for LTC. Ask the rehab social worker/placement person to try to get her LTC medi-cal.
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JulesNeedsHelp Dec 23, 2019
They keep telling me she doesn’t qualify. I was Also told Medi-cal doesn’t pay for Board and Care.
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Cheriel, rehab follows Medicare rules. They have no say how long someone stays. But, I will admit its hard working with Social Workers and discharge staff. They tend not to think outside the box.

Why can't she be moved to LTC with Medicaid paying for her care?
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JulesNeedsHelp Dec 23, 2019
They tell me she doesn’t qualify for LTC.
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Stand strong today, Jules! Keep us updated.
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JulesNeedsHelp Dec 23, 2019
Thank you!
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I think your plan is good . Ihss should be able to get worker in your mom's home by Friday. As for Medicare I thought they could take your mom longer. My Dad's 82 in rehab nursing home for last 2 days and they just like to move them in, move them out it seems. I asked them to not release till he's more comfortable about not falling, he already wants out.
Luckily he lives bottom floor
And seniors tend to lie like children to get their way. it's amazing how the memory /dementia/alztheimers just appears. Alot of times not gradual or some days worse than others.
Balance issues are what my dad has, but if you don't use it, you lose it.hes layed on the floor refusing to call 911 a few times, such stubborness ! And I think if I removed his mobility wheelchair for week and say it's getting tune up, he'd be forced to use his walker ( that has a seat) to get strength up. Otherwise your doing what you can and I can't help with much advice because I'm going through it too and am only child with no help.
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worriedinCali Dec 23, 2019
IHSS will likely not have a worker in her home by Friday. It’s hard to find IHSS workers not already employed in this state. A lot of the time you have to find and hire someone yourself.
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I want you to remember that this crisis is in part fueled by your mother's difficult personality. She can't get along with your husband, doesnt cooperate when you try to figure out how to best get her needs met.

This pickle is not of YOUR making.
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It sounds like the discharge planner is trying to work on you to say "Oh, I must have mom near me! I'll pick her up".

Call his bluff. Tell him to find placement that she can afford with no regard to distance.
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JulesNeedsHelp Dec 22, 2019
Please give me strength to do that. She has been through a lot in two weeks. I’m so sad.
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Don't go pick her up. You can answer your phone, but you must repeat, I am not her guardian and I will not accept her. I will not pick her up. She cannot live with me, I cannot care for her.
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JulesNeedsHelp Dec 22, 2019
Thank you, I need the strength to do this. Being Christmas in two days is making it even harder. :(
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So, my mom is supposed to be discharged tomorrow to a Board and Care I was assured the placement coordinator would find her a place she could afford. I hadn’t heard back from him so I called today and he tells me he couldn’t find any thing near me and the only places he can find are at least $2000, she has $1447. Now it’s Sunday, and I am at a loss. I called and filed an appeal . So, if she can’t afford Board and Care and doesn’t qualify for SNF , can’t live alone. Then what?? If I don’t pick her up tomorrow where does she go? Help!
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Katsmihur Dec 22, 2019
I’m sorry to hear this . . . So much stress - I know! The appeal takes 48 hours, so placement coordinator has two days to find a place Mom can afford.

I don’t know the answer to your question, but do remember my mom’s nurse asking the same question of the social worker - if I wasn’t around - who would care for mom?
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When my dad had his stroke my mom told his doctor that she couldn’t care for him at home. His doctor placed him in a nursing home for awhile. He was able to do rehab there.

I think they should be responsible for helping you find a suitable solution. She shouldn’t be home alone. It’s dangerous for her.
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If you don't have POA and she is still competent in the eyes of the law, you can say that the discharge planner and your mom will have to make those decisions and you will not take her into your home or pick her up and take your mom back to her apartment. Tell this social worker to discuss options with your mother and set things up because you won't be involved in any of this. It's the social worker's job to make arrangements. Of course they will say they can make this work but they won't. Why? Because they are lazy pieces of crap.
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I think you need to make it clear to social services that you will not be taking Mom to your home, that you cannot afford her to go to her home with 24/7 care and that anything else constitutes "unsafe discharge". Those words only. Tell them they need to explore placement options for her with her income. Supply all you can regarding her assets and income. They cannot discharge her without someone to accept her, but if they can talk YOU into that then she is off their hands, which essentially is ALL THEY CARE ABOUT.
Do not let them discharge her to YOU and tell them that if they DISCHARGE HER HOME it constitutes an "unsafe discharge".
Now they may require that she pay her own daily rate as they likely already had agreed with medicare that she is no longer coverable, cannot progress further, cannot participate and rehab is no longer appropriate level of care. I think for now your Mom is headed to SNF or placement.
So sorry. This is very awful.
Just know, Medicare will not cover her until, as you say "she can get up and around and go to the bathroom by herself". In fact that may never happen again. She likely will need placement. You need THEM to begin to work on options available to her with her assets, her income, and etc.
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Jules, if it's any consolation at all (I'm none too sure about that) there are so many families wading through treacle over this question of Who Decides?

Last week a mother and son, in a somewhat tense shall-we-say atmosphere, were having the discussion about What To Do, Safety First, Are You Coping. My job that day was to explain what our service does - we go in for 3-6 weeks, support the person in getting back to or finding their new normal, and then we disappear. If the person still needs care or support after we've done all we can, it is time to hand over to other permanent services or consider a move to sheltered or residential accommodation. "And who makes that decision?" demanded the son. "Your mother does," I said confidently. At which point he turned away so I'm not sure if he bit his lip or not. Mother, of course, was delighted; I frowned and said "I sympathise with BOTH of you."

What Mother hadn't mentioned and son didn't know to mention was that son has Lasting Power of Attorney for her, both kinds. In the UK it works a bit differently, more like a springing DPOA, and at the point where you're pretty sure that your loved one's marbles are rattling down the drain you register your LPA officially and it comes into force. You don't need medical certification, but the safeguard is that specified people are notified by the officials of the registration, and if those people disagree that the Loved One is incompetent they have six weeks to say so. I've met that lady five days running and the bad news for the son is that she is not remotely demented. A nightmare, quite possibly, but in full - not to say flourishing - command of her arguments and aware of the consequences of not taking her antihypertensives. Also fully aware of the consequences of taking doctors to task over their pathetic inability to come up with an antihypertensive that doesn't have disagreeable side effects - namely, that they draw straws about who has to deal with her appointments. You tell 'em, lady!

Anyhooooooo, the point is that your mother has been pulling a fast one on you (by passively making you make all the decisions/take all the blame) for so long that the question of whether she is mentally capable of making these decisions is shrouded in mystery. Say she states that she wants to return to her apartment. Say we accept that she is able to make that decision. In that case, relying on her mental capacity, she is also able to be the decision-maker regarding discharge planning; and the rehab people must work with HER on it and not with you. The care plan, her safety needs, all of it - down to her. And if rehab are not satisfied that she is competent, then rehab must deal with it. They can't just dump it all on you, because you have no authority to make decisions on your mother's behalf (not yet anyway).

If you want that authority - well, now. Do you?
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BarbBrooklyn Dec 18, 2019
CM, the thing is, here in the US, there are plenty of discharge planners (NOT the ones I've encountered) who seem to be bullying adult children into taking charge and care of their parents when they are discharged.

My stance has always been "fine, YOU think she's fine to be discharged to her own responsibility, I'm not showing up. She's NOT my responsibility". In my case, this has always gotten them to back down. But they can be very manipulative...i.e., "don't you love your mother, don't you want the best for her?"
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I've been going through this with my mom too, for a few years. Wow, today I moved her into an assisted living facility. She would rather go home and repeat the cycle of poor self-care and falls (several broken bones in a year). The key wording to override and get the ball rolling was "unsafe discharge", not safe to live on her own. I had decided I would refuse to pick her up this time. I've had her forced back onto me several times. Like you, I am the ONLY one and I can't meet the care she needs without losing my own life (career, husband, home and health). Stress that she is unsafe and you will be placing the blame on them if she gets hurt at her home.
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NeedHelpWithMom Dec 18, 2019
Glad your mom is in assisted living now. Yay!
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Your mom is on medi-cal. Have you contacted her eligibility worker or the dept of social services for help? Medi-cal does pay or at least HELP pay for board & care homes. And just to confirm—you have a durable POA or a health care POA for your mom? Good luck!
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JulesNeedsHelp Dec 18, 2019
No I haven’t contacted Medi-cal , I will do that tomorrow. I was told Medi-cal wouldn’t help. I do have a POA and Health but have not used it yet since she hadn’t been assessed as incompetent. I got one for her years ago when she went on a spending spree and spent thousands of dollars on JTV and such because she was pissed at me. I said I’d bail her out only if she got a POA And that I take over her finances, cancel credit cards and a few other things.
Do I need to have her proven incompetent to use it?
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Please ask for the appeal immediately. I don’t know how nursing homes handle it but my friend who is a nurse at a local hospital here says those without families to pick them up are placed in a cab and sent home.

I wouldn’t want a confused, high risk individual going home where she will most likely fall again. So sad.
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I agree with Worried. OP has not said her mother is not able to decide on her own.
What does your mother say to a plan?
Worried is right, sounds like she needs a NH.
OP needs to make that clear to the DC planner. If there is conflict between mom’s decision vs OP, mom can’t be forced into a NH if she doesn’t want to go. She is already in rehab, can’t OP appeal to buy some time? If there are no SNF needs her insurance won’t pay.
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JulesNeedsHelp Dec 18, 2019
They say she does not qualify for nursing home, I talked to social worker today and asked for a Monday discharge for more time. Apparently my choices are find a Board and Care facility that’s will take her social security $1400 or send her home. I’m going down to see her today and try and talk her into the Board and Care facility with the caveat that if she can get herself up and about and her confusion settles down. I will keep her apartment and hopefully she can go back to it once she gets stronger. If she refuses then I’m not sure what happens.
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"When no one shows up for her, how is she going to feel? Now that she has such confusion she will be really lost going into another strange place. I'm drowning, I can't take her if I do, I will drown."

Does SHE think she is being released to her apartment? Is she still considered mentally competent? Remember the phrase, "I will drown" and repeat it to yourself if they try to guilt you into taking responsibility for her.

You CAN be a good daughter to her if she is in a LTC facility.

Keep us updated!
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JulesNeedsHelp Dec 18, 2019
She has not been declared incompetent. But I would say in the last few weeks she is. She thinks she is at a hotel right now. And doesn’t know why.
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Clear brain scans or not, if you find her “confused” you can request an evaluation by a psychiatrist/psychologist/social worker with a geriatric specialization.
If you go this route, request a document from the examiner detailing present cognitive status and potential prognosis for independent functioning.

Before the assessment is done write up the observations you have made about the type and increasing duration of the confusion you are seeing as related to the behaviors you have seen relating to her most recent hospitalization.

Notify the hospital social worker assigned to her case that you are researching potential solutions but that you as her only close relative are not able to assume responsibility for her care without accessing more information about her mental status and potential placement sites.

When my mother broke her hip at 89, a hospital social worker came to her room at 10 am and told me I had to get her out of the hospital and I to a rehab facility before 2 pm THE SAME DAY. One of the worst experiences of my life.

Good luck with this, and sending affirming thoughts. You are not alone in your sense of being lost. All you can do is your best. When there are no “good” choices, make the best choice that you can from the less than good ones.
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XenaJada Dec 18, 2019
WHY OH WHY do these discharge planners pull this CRAP?! How in the world did you find a rehab facility in four hours? Did the social worker help you at all? They infuriate me. They ALL do this crap too. I don't understand it, but it seems their ultimate goal is to either get family members to take the patient into their own home or go and live with the patient in his/her home. That is ALWAYS their goal. I fought this battle a LOT with the hospital in 2017.

When I was a guardian over an aunt, I did the time consuming work of visiting several SNFs nearby and trying to find the one that would be best suited for her, only to discover NONE of that mattered. We had to put her in the place that had a spot and would ACCEPT HER.
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Top reasons for delerium (google);
1. an infection – commonly urinary tract infections (UTIs) or chest infection
2. stroke or TIA ("mini-stroke")
3. low blood sugar level in people with diabetes
4. a head injury.

What's causing the delerium? How is her blood pressure? Sodium? Oxygen?

I have two relatives where initial CT failed to pickup stroke & TIA. Showed up on scans (MRI I think) a few days later. Weakness, slurring & slight confustion were symptoms.

ER have been quick to scan & move on. Rehab think they have done their bit. But there is something wrong - keep pushing for medical investigation & proper care. Stay firm.
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Tell the social worker it is an unsafe discharge (use these exact words) and you want to file an appeal with Medicare - ask for the Medicare bill of rights with how to do this
then get the phone number for the ombudsman - should be posted somewhere on a poster in the facility

also, call your county area on aging and ask for help - get a needs assessment

unfortunately, in my experience, it is difficult to find help and social workers at facilities may just hand you a pamphlet with listings for caregiver agencies

so sorry this is happening the week before the holidays - there are no easy answers and it can be time consuming and stressful especially when you're doing it alone
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Have you had a chance to speak to your mom? I know that you said your mom is confused so you may have to make decisions for her. Is she familiar with any of the nearby nursing homes? Does she have a preference or would she expect you plan for arrangements with prospective facilities? Do you have any place in particular in mind? If not start scheduling appointments to take tours.

I liked speaking to the head nurse on tours. My mom is living with my brother now. Prior to that she was living with me and I went to tour several different places. You will be able to get a wonderful perspective from the nurse.

Speaking to the director is fine but I felt that nurses addressed my questions about health in a more realistic way.
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Worried, you're quite right; only your points then raise the question: who is the authoritative decision-maker here, mother or the OP?

If it's still mother, even only in theory, then the discharge planner should be supporting mother in making the decision, and if mother's decision is to return home that needs to be done safely and it's down to them to help her put the required care in place. If it can't be done and she needs LTC, then mother will have to understand and agree to that.

If it's the OP, then that's different; but the OP hasn't said so. Responsibility without authority must always be firmly refused!
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Beatty Dec 18, 2019
Absolutely.
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I am sure they are trying to clear space with Christmas coming up and being short staffed over the holidays.

Ask the doctor and social worker what they consider the criteria for your mother needing a nursing home. Usually it is based on the Activities of Daily Living:
Take a bath or shower without help.
Go to the washroom by yourself.
Dress and undress without help.
Shave, comb your hair, and brush teeth on your own.
Get in and out of bed or a chair without help.
Feed yourself without help.
Medication management

Keep in mind these activities assume, the senior can get into the tub or shower without assistance.

Fully manage toileting on their own.

Dressing and undressing assumes that they are also able to do their laundry. Put on shoes and socks, manage buttons and zippers.

Grooming assumes they can stand at the sink, see what they are doing etc.

Transferring in and out of bed/chair is self evident.

Feeding includes preparing food, carrying it to the table, grocery shopping and washing up.

Knowing when to take which pills is a big concern. My former fil would put all the pills he had to take in a day in his shirt chest pocket. If it was empty at the end of the day, he assumed he had taken all his pills. Only problem was they would fall out and I would find them on the floor.

Which of these things can your mother do independently? Add to that she cannot manage the stairs to get into her home and they have some explaining to do.

Your Mum may be experiencing delirium due to her stay in the facility. It is not unusual and the doctors should have discussed this with you. It can take months to recover from it, and she may not fully recover.
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JulesNeedsHelp Dec 18, 2019
Seriously I would say she can’t do most of these by herself. But yet they told me she doesn’t qualify for LTC only a Board and Care. Are they lying to me ? Would it be a mistake to put her in a Board and Care?
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"She told me I need to put together a plan."

She's got that the wrong way round. THEY need to put together a plan, a plan for a safe discharge. Discharging your mother home, alone, without addressing her risks they cannot do; they are responsible for her. It sounds to me like they're playing "chicken" with you.

What does your mother say? Has she been able to express her wishes, and participate in the care plan?

Going back a bit: while she's been in rehab, what investigations have been done into the causes of her falls?
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NeedHelpWithMom Dec 18, 2019
I agree, CM. The social worker should be guiding the patient and family. How can this woman go home without assistance?

You are right. That was my advice. To be polite but firm by saying to the social worker that her mom will fall again without assistance.
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Well, when my mom was in rehab I had a meeting with the physical and occupational therapist along with the social worker. I specifically asked if she was ready to be released to go home. They told me to let her stay a couple of more days and we would have to pay privately, which we did.

If your mom is released it’s just another accident waiting to happen if she can’t use the bathroom alone. Even if she wears diapers she will need assistance changing them.

I’m so sorry that you are going through this.

I would continue to tell the social worker that she cannot go home. Tell her that you are fearful of another fall and it could be an even worse fall than the last time. Be polite but firm.

Can you go look at a few facilities? Easier to place her in the right one now rather than dealing with moving her at a later time.

The patients who receive the best care are the ones who have family speaking for them.

Do not take her to your home. You cannot provide what she needs. She needs a professional staff. Don’t stress yourself out. You and your husband would not be happy with her in your home. I know you feel responsible and I appreciate that but her care doesn’t have to be you personally. You already know that would not work.

Best wishes to you and your mom.
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