Mom, nearly 89 and with mild dementia, wants to go back home. She has lived with me since January, recovering from pneumonia. My siblings have barely helped out, especially given Coronavirus. She can't remember to take her meds. That's the biggest issue. Phone call reminders won't work. She leaves a pill or two behind or gets distracted and leaves them on counter. Someone needs to physically be there. In-home companies want an average of $25/hour with a weekly minimum of 10-30 hours. None of us can afford that. My siblings can't agree to even sell her car and get rid of that payment/insurance, so it will be nearly impossible to agree on anything. Are volunteers really reliable? I suppose we are stuck just dividing up the week and taking turns being there every day. Two of us live an hour away.

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Check out what this page has to say about Medicaid in PA. I understood that Medicaid does not cover the monthly rental fee for an assisted living apartment, it pays for a nursing home room, or in home caregivers under some circumstances (but not 24/7 caregivers and it seems that medication administration is not part of the deal.) As one other person advised, consult an elder care attorney for information/advice on what to do next.
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There comes a time when its not what the person wants, its what they need. I understand that you don't plan on Mom living with you forever. And thats OK. I placed Mom inba nice AL. Her going back to her home is not an option. So like said, you need to sell her house and car. At Fair Market Value if Medicaid is ever needed. The proceeds from that may keep her in a nice AL for a while.

Is Moms income more than the cap Medicaid has set for in home care?Lets say for argument the cap is 2300. Your Mom makes more than that with SS and pension?
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Consult with an elder care attorney. Your first appointment should be free. You don't have to follow up but you should get some good information from him/her. Other sources are your local Area Agency on Aging and your state Dept of Aging. These offer free services.

You said her income is too high for "free" (I assume you mean Medicaid) in home care. I'm confused. If her income is too high for Medicaid, why wouldn't it be used for home care? You shouldn't be paying for that. I believe the ideal situation would be for her to sell the house and car and use that money to pay for assisted living. Having dementia, she should not be driving. Eventually, she may not be able to safely remain in the home and will have to seek placement in a care facility.
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What meds is she taking?
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Binlme, you are in the classic crossroads that many with aging parents find themselves, so you are not alone. BarbBrooklyn is correct in saying that the base level (least expensive) aids cannot minister meds. Rates increase with necessary skill requirements. I will address that later.

I have been through what you are experiencing right now. I strongly recommend you have a family meeting of your siblings and their spouses (but not your mom). Come to this meeting prepared with a short, uncomplicated agenda with a goal in mind. If you can't meet in person do it over speaker phone or Zoom, FaceTime, whatever. Come to the meeting with no expectations or judgements as this will just derail the meeting and burn your own energy in an unproductive way.

The info you need to provide prior to the meeting (email) is:
- the fact that your mom can no longer live by herself (she will not remember to eat and will begin to forgot how to use appliances safely or at all). The goal of the meeting is to decide what is a realistic, affordable solution to this problem. This needs to be solved asap. It is not possible for her to remain in her home, and here is why.
- you are operating on the assumption that she will not be living with you and you will not be providing the daily care or the majority of her care yourself.
- put an accurate number on your mom's income and assets so everyone knows what they're working from.
- do research on the cost of in-home care by the appropriate level helpers. Put that cost on the agenda by the week, month and year.
- inform them that privately hired people are less expensive by the hour, but it makes the financial PoA for your mom an employer, with all the responsibilities and liabilities. It requires background checks, management and record keeping, finding subs, paying taxes, and exposes your mom and family to risks you do not think you should take. There is not much legal recourse when you encounter problems with a private hire. An agency protects your from this.
- gather info on MC facilities that are good quality and near you or other siblings. You may have to physically visit these places to get costs. You must ask if they have waiting lists and accept Medicaid. She can enter the facility on private pay and when her funds are low enough you will help her apply for Medicaid and she cannot be removed.
- you can offer up that any family member that wishes to care for her in their home will be paid from her income and assets.

These are the choices, which one do they choose? Keep referring them back to her income and the cost of the options, and remind them that you are not going to be providing the full-time care. Don't let the meeting end without consensus on a decision of what to do next. Then follow up with everyone. Transparency is very important.

No one should be paying for your mom's care from their own funds. This is not sustainable. It is optimal to place her within 10 miles of the PoA. If there is more than 1 PoA the location can be negotiable. It is no longer about what your mom wants, it's about what she needs (and her breaking mind will be less and less able to make rational choices).

If all your mom needs is a companion, that person can do light housework, remind about meds, make her meals, take her on walks, entertain her and drive her places. This is what they do for my 2 aunts in FL and they have a very lovely person that they really adore (and so do I). But the minute one of them becomes a "fall risk", the agency needs to send out a different person with different qualifications who works at a higher rate. And then if anything medical has to happen it increases further. Overnight medical I think is the most expensive.

I hope this info helps. It worked for our family, some local and some out of state. It's very important that emotions and any past baggage be kept out of the family discussion or your mom will be the one who suffers most. I wish you all the best!
Helpful Answer (4)
Geaton777 May 2020
I also want to add that volunteers are a very short-term solution but in the long run are not a reliable option. Few people are willing to do much on a regular basis. It will require a ton of effort on your part to find willing people and you will eventually run out of helpers or burn them out. It's not a realistic or safe solution. The money your mom has saved is what should be paying for her care.
Aides can not administer meds, they can only remind.

It sounds as though your mom needs to be in Assisted Living. Will Medicaid in her state pay for that?

Have you applied for Medicaid?
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