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I'll try to be as brief as possible.


My uncle, age 94, is nearing the end of his life. Along with diabetes, neuropathy, and on his second pacemaker, he was recently hospitalized for pneumonia. The resulting coughing left him with a stress fracture in his back. He was hospitalized again this morning as he is in excruciating pain from the fracture, which cannot be treated with anything buy Tylenol due to his limited kidney function.


Uncle's wife is in her late 70s, with Stage 7 Alzheimer's. She and my uncle are still in their home, with home care providers. My aunt has been approved for Memory Care, but is Medicaid pending. No nursing home in this area will admit pending Medicaid, Even if they did, there is nowhere for her to go. There is a waiting list of over 100 people. AND she has become aggressive, and unless that can be controlled, the nursing home would not take her even if they have an opening.


My uncle cannot return home if his wife is still there. She is unable to control her violent outbursts, even with Seroquel. Several aides have quit due to her attacking them. It is too dangerous for my uncle to be at home with her. He has never said she has attacked him, but we are sure she has. My uncle would never tell anyone this, or admit it if asked.


What if anything can be done to get one or both of them into a nursing home if there is no Medicaid (they can pay privately while waiting for Medicaid approval) and no room, they are unable to be safe at home, and there are not enough aids to cover them 24/7? They have one daughter who is married, has a three year old, and both she and her husband work full time. They live nearby, but still 35 minutes away. I know some will say "well the daughter just has to quit her job, abandon her family and move in with them". NOT happening. Even it she could quit her job and let her husband fully support the family, she cannot and will not abandon her toddler. She cannot take her daughter with her, as she cannot trust her mother not to hurt her. And separating the child from her father to care for grandma and grandpa is also not happening.


What does an elderly person who cannot care for themselves do when the nursing home says "no room, go home"?

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Their needs are different.

It sounds like the wife needs to be admitted to a psych facility. Caregiver should call 911 the next time she lashes out.

Placement for Dad is the responsibility of the hospital Social Worker. Refuse to accept discharge.

The daughter should under NO circumstances try to care for them herself.
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Reply to BarbBrooklyn
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A few weeks ago my MIL was stuck on the toilet. She had a UTI, and was confused and sat there for 7 hours. I called the telehealth line and spoke to a nurse. She asked if I could physically get her up, and I explained that she would attack me if I tried. The RN told me to call 911, as she is a danger to herself and others.

If you are her caregiver, and she can no longer look after herself, when she is in one of her fighting moods, you call 911 and ask for help. Then when they want you to pick her up from the hospital, you say NO.
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Reply to Lizbitty
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rovana Dec 5, 2021
Don't be shy about reporting violence to you or others. Call the cops. It may well be the thing that gets her help.
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Take Auntie to the E.R., or transport by calling 911.

1) Get her checked and treated for a UTI, which we know presents with behavior problems.
2) E.R. will arrange to have her evaluated and treated in a behavioral unit.
After being stabilized on medications that may help, they will discharge her to an approved facility. Easier if the discharge planning finds the facility for you.
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Reply to Sendhelp
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Boll, has anyone asked for a Palliative care or Hospice evaluation?

The criteria has changed.

I was driving before but wanted to get you an answer quickly.

Please tell the daughter to hang tough, especially if the discharge department is telling her that it's her job to solve this problem.

As long as dad is "in a bed" leave him there. I was told that many years ago by a wise and compassionate discharge planner. If someone says they are discharging him, ask if it meets the criteria for a "safe discharge". It won't.

Make sure dad does not sign himself out.

And make sure dad is admitted, not under observation.

Getting mom into a psych hospital might be a good solution to DAD's problem.
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Reply to BarbBrooklyn
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Newbie to this forum. Are different states different Medicaid? In my state if "they can afford to private pay," they will not qualify for Medcaid until such monies are spent.

Most Nursing Homes limit the number of Medicaid beds because the payments are quite low.

IF you request a "self-pay" bed, you will pay MUCH more but will have a better chance of "getting in." Then, when the funds run out & you qualify for Medicaid, you are already "in."

Also, UTI's are (in my experience) way more likely to be the "cause" of anger, meaness in Alz than the Doctor's seem to realize. & tests are so simple.
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Mellcan Dec 5, 2021
Yes, that was unfortunately written into the Medicaid amendment to the Social Security Act in the 1960s-allowing state discretion on their contributions to this shared- cost program with the feds. Some states are notoriously low in their contributions and reimbursemnts-and believe it or not elder care is better than many other areas (well- woman care, midwives, etc.) Many but not all are in the South. So yes there is a fair amount of variation in Medicaid eligibility rules. A great resource here is the Kaiser Family Foundation, kff.org.
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"Daughter was there every day. Constant contact with doctors. She repeated "unsafe discharge" like a broken robot. THEY. DO. NOT. CARE. Sent him home. She could have opted to leave him on the street, but other than that, taking him home was the only option."

Boll, you and the daughter need to understand this "game" of chicken.

She needs to say "no" and walk away.

If they send him home in a cab in a nightshirt, she calls 911, APS, the cops and the press.
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Beatty Dec 6, 2021
Yup. Friend's G'Ma was wheeled out front (near midnight) to await a taxi home. Except staff forgot to call one...

Eventually a passerby wheeled her back into the hospital, half frozen.. Made the news. Got a BIG apology for her trouble but hopefully safer discharge for all!
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Take him to a different hospital if needs be.

The story you tell does NOT mean APS is a joke. There are criteria for taking away a person's right of self determination.

The naked lady isn't hurting anyone.

The person in your story is a danger to others. There IS a difference.
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Reply to BarbBrooklyn
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State social worker (APS) needs to be called. APS needs to intervene on behalf of 2 vulnerable adults, and possibly take guardianship of both. Uncle must not be discharged to an unsafe environment, and family or anyone else for that matter is under no obligation (nor should they in this case) to take either one into their home or care for them. Make sure this time hospital does not release uncle this time, first call APS if hospital social worker or hospital administration pushes to release uncle back home, that should make a difference but if it doesn't, I would strongly suggest consulting an attorney for possible lawsuit against the hospital.
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Reply to mstrbill
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Is your aunt and uncle's daughter the POA? She or you should get connected with a local social worker to explore your aunt and uncle's options. A social worker may be able to help expedite the Medicaid. Perhaps hospice is an option for your uncle, if his doctor or hospital will certify that he is nearing the end of his life. Many hospice services are covered by Medicare. Hospice is supposed to be for the last 6 months of life, but my mother, who has advanced dementia has been on hospice care for more than a year. Hospice has been recertified every 6 months. You or your aunt's daughter must talk to her doctor about her aggression. Calming medications may help. And you should also consider placing her in an assisted living/memory care/skilled nursing home where professional staff know how to care for people with aggressive behavior. An attorney specializing in elder matters might also help. The socal worker may give you some names of pro bono attorneys if your aunt and uncle have a low income. There is nothing that you can do about the waiting lists for assisted living in your area. But perhaps medications can help your aunt in the meantime. All the best to all of you!
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Reply to NancyIS
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rovana Dec 5, 2021
I think in this case the big issue is that uncle and aunt are living in an isolated, rural area, with few services for elders. And they don't want to leave that area. I live in a small town and facts are facts: at some point I will not be able to manage here. But my wanting to stay here should not burden family.
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I would get the wife involuntarily admitted to an inpatient psych ward for evaluation and treatment. Call 911 when she has one of her outbursts so the authorities can bring her in and have her admitted.

While she is spending time getting her behavior medications sorted out on the unit, allow uncle to move back home with round the clock home health care. He probably qualifies for hospice with his multiple health issues.

Get a social worker consult for wife to place her into a memory care unit that can provide care for her through Medicaid - even if it is "quite a drive" from home. This way they can both be cared for safely.
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