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He and his wife are 80 years old. There are only 2 nursing homes in their small town I can find records on from health.USnews.com senior care website. Their scores are 1 out of 5 and 3 out of 5. He has tachycardia and has a pacemaker and has had severe sleep apnea for at least 40 years that I can myself recall and has had a sudden onset of severe dementia and doesn't know what is going on. I have a real concern that he will be strapped down to a bed and have a heart attack or that he will be kept too sedated to possibly recover and go home for any length of time. The inspections for one show the same fire code violations since 2013: walls not capable of containing a fire for one hour , non existent or not functioning sprinkler systems , no fire extinguisher. If it hasn't been repaired in 3 years why is this facility still open. There is one additional facility but it is not listed on that website which concerns me. There are more facilities in neighboring towns but she is too old to drive there daily alone which she will do. I'm not completely up to date on what all they have but va benefits and Medicare for sure. Possibly Medicaid. Additionally I think he might have vascular dementia as he has spots on his arms and legs that he was told were exzema but they look more like vasculitis to me. I will be leaving my family in a couple days to go stay with his wife to make sure she finds the best care for him and don't want to mislead her. All family there is in their 80-90's and don't quite have the snap they did 20 years ago. What would the maximum benefits for home care he can receive with va and Medicare ? I am thinking if he can get home visits from the psychiatrist and physical therapy and any additional therapy he needs in addition to some daily assistance that they might be able to pay someone the additional help. Just a thought. This is all new to me. Their daughter died from als and she made these decisions in the past.

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I just lost a post I've been working on for quite some time. I'll start over later, after typing it in a word processor first. I did have some suggestions in addition to those of CMagnum and Igloo but need a break before I start over after losing all that information. Darn computer gremlins!
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To be able to do anything, You need to become their DPOA. Will they allow for this and can they appear competent & cognitive enough to sign off on a newly drawn up by an atty DPOA? Once you get dpoa, I’d suggest next step is for them to have you added on as a signature to all their bankng and with you as the POD on all accounts. Again they need to seem competent as bank officer will want to speak with them without your presence.

Personally to me, having him go into a facility & her staying at home is asking for a disaster. They currently manage at home as they do for each other. In many ways they are on auto-pilot as they know where everything is and there’s neighbors who know them . I’d look to get both of them moved into a facility - IL, AL, NH - together.

If their rural, there’s probably not going to be very many choices. That 1 star place could be just fine but not all shiny new updated like a NH in a city that has to actually compete for residents. There may not be any choIce as only 1 has a double occupancy room available.

I’d suggest you look to see what VA LTC facility could be available for them. There’s one by us in Biloxi (VA) and one in central TX (Air Force Village); they both have long waiting lists. That seems to be standard. If there’s one even somewhat close to them, that takes couples, I’d suggest you put them on the list. You will need to find his military records and his area VFW  has someone who knows what’s needed & how to file.

If this is your first foray into elder care, you will be astounded at the cost. National Average annual NH cost per person is 93k, so run between 5k -15k a month. AL about half the cost. VAs aid & attendance program - if they qualify - could pay about $ 1700 a mo to them of which they can use to pay for an at home caregiver or towards AL rent. Do they have $$$? & $$$ to pay for 2 -3 years each?

Medicare does NOT pay for LTC at a NH or for living at IL or AL. 
Medicare may pay an agency for a home health aide once or twice a week if they are determine medically to need it. Medicare is health insurance that pays for MD or other medical professionals for services provided under specific codes. If they are on Original Medicare, it pays 80% of the cost paid under Medicare rates. If they are rural, there may be no choices on vendors.

If they do not have the $ to private pay for AL (if their states Medicaid pays AL) or a NH, they will need to become impoverished to qualify for Medicaid. Medicaid will pay for LTC once eligible in a facility that takes Medicaid & Medicare. If it looks like only he will medically show “at need” for NH, it will get very complicated to get her finances done as a community spouse. They will need an elder law atty. In some states now have PACE programs for duals (on both M&Ms) in which they go to a PACE center 2-4 days a week but all other care dealt with by them, their family or paid caregivers. 

It’s going to be overwhelming..... take 2 notebooks (his hers) & binders with a set of those clear insert sheets to put their paperwork into. Find a copy center so you take a set back with you. Probably the most important to find is their awards letters..... those are trifold that SS, pensions, VA mail put in Nov/dec that state what monthly income will be paid to them each mo. for the incoming year and then last 6 mos of bank statements. Almost all programs will require some sort of financial “at need” circumstance. Which the awards letters & bank statements provide verification for.

Facilities cannot strap them down. I doubt you would ever find a psychiatrist who does House calls unless it’s concierge practice. Good luck!
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It is very nice of you to be seeking help for them. 

Are you his POA? If not, then who is? 

What level of care does his doctor say that he needs?

Psychiatrists don't make house calls, but physical therapists do.

Have you contacted the VA and asked them?
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