What should I be prepared for at a family care meeting with the staff & doctor at nursing home?

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We are planing the first family meeting at mothers nursing home this week. It will include myself, mother, NH social worker, nurse and staff doctor. The docor and myself have determined hat mother can no longer live in her home and has progressed to far to really be a good canidate for assisted living. I need to know what to expect and pros/cons of these meeting. I have been thur some bad experiences with social workers/case managers at hospitals. But this time I want to be ready and prepared to make decisions. The real possibility of guardainship is one area that I will have to address soon, since I am an only child and we have property and finances that must be dealt with.soon. I Plan to meet with the social worker tomorrow since I have not met her and kinda see what her take on this is. Other advise would be greatly appriecated.

Answers 1 to 7 of 7
THEY will answer all your questions. HOWEVER, you must decide if your MOTHER can live with you BEFORE you consider a Nursing Home. Good luck.
Write all your questions down. Make a list of everything you don't know, are not sure of or you just want to confirm. It will make it easier once you are there. Good Luck
It is wonderful that you and your doctor are on the same page as far as agreeing that your mother could no longer live at home but her safety and welfare would be best taken care of at an A.L. We did not have the support of a strong doctor in the beginning. He was not willing to recommend the above, so we found a geriatric doctor who supported the family's wishes as a whole. If your mother is present, I would take care to present the facts, but not to get into any arguments with her if she is having difficulties with the above. If she is still lucid enough to draw up papers and make you the P.O.A of her health care, take her out to lunch and have a discussion with her. I am also the only child; my mother made me her POA in 1994 for health care and all other needs. It has made the transition much smoother. Hopefully you are meeting with the social worker by yourself first to be sure you have their support before meeting with your mother. The social worker should be able to guide you as far as where you obtain the proper papers for your mother to sign, offer his/her support in other matters. We had a wonderful supportive social worker from Accent Care. You may not need to go through the expense of having to claim guardianship and may find that with the social worker's help can just get the POA's for health care and other financial needs in place. I keep my mother's Medicare card and Blue Shield card with me at all times, and have found that it was best to make 7 copies of her POA on hand to mail/fax to the various places when needed. After my mother went to her A.L. in August I notified the Post Office that I wanted to receive mom's mail. I asked that they have her name on the line w/a care of to my name. This made it easy to separate her bills and such from ours. I hope my reply was helpful. Please keep us updated!
Top Answer
I attended many of these "family care meetings" when my mom was at rehab. I'm also an only child and also had some bad experiences with social workers/case workers while she was in the hospital who thought THEY were in control. You stated you "want to be ready and prepared to make decisions". My suggestion - go into the meeting as the one in control of the situation - don't let them lead you to any decisions you may regret later. Listen to what they have to say - take notes and more notes; (I found that makes everyone in the room nervous because they know you are documenting everything and are more inclined to state facts relating specifically to your mom instead of general info). Write it ALL down and document which person stated it - better yet, ask if you can bring a tape recorder in to tape the meeting (there should be no objections if they have nothing to hide) - it can come in handy later when you're alone and want to review all that was said. And then if you have any questions you can go back directly to that person for further discussion. Remember you know mom better than anyone - and although many of the suggestions the staff makes is well and justified - it must be you & mom's decision about everything - or you will regret it. Listen to staff, make your concerns known and tell them you & mom will discuss things and you will get back to them - don't be pressured into signing or saying anything at the meeting. Sleep on it and let your heart guide you. Good luck!
Me again. The other four posts were posted while I was writing my post before and I just got a chance to read them. Yes, get a POA and durable POA (very different) signed by your mom. A POA gives you the power of attorney while mom is mentally capable of making decisions but when it is more convenient (banking, medical, etc.) for you to carry out the business. The durable POA takes effect the moment she becomes mentally incompetent - but must be signed by her and notarized while she is still mentally capable. Get them both done NOW. The social workers will have generic copies. I went online and basically took bits and pieces of POA & durable POA, expanded from there and made my own copy pertinent to mom's needs and situation. Here in Florida - a lawyer does not have to draw up or sign these papers, so check with your state. My mom signed them in front of a notary - that was all that was necessary her in Fl. - they will ask her basic questions to make sure she is mentally alert and aware of what she is signing. Also make sure she has a living will & a DNR (if that is her wish) signed and keep copies of everything with you at all times. I walked around with a folder all the time. If anything was questioned or needed to be signed and mom was unavailable - I took out my copy and got things done on the spot. Mom was very grateful that I was able to do everything. The durable POA, living will and DNR all came into play (mom was mentally alert & competent until 4 days before she died -- she was 88) when mom was rushed to the hospital - awake and alert - and within two hours was "out of it" due to a hole in her colon that was leaking toxins throughout her body. I needed the durable POA at that point; the DNR and living will helped me when the doctor asked "what do you want us to do?" Mom already made her decision by signing those papers and I was just carrying out her wishes - the final decision was hers and I was at peace with that. Glad that I had those papers signed years ago.
Also, someone in these posts mentioned that your mom may be ok in an assisted living facility. After spending 4 months between hospitals and rehab (she initially broke her hip and then developed MRSA, c-diff, pneumonia, blood clots, etc. - but beat them all) I wasn't sure if she would need a nursing home or ALF (she lived alone before). Upon visiting the ALF's I found many would not have been good for mom - she needed a lot more done for her and really couldn't be accommodated by staff there (and without adding on substantially to the cost). Nursing homes seemed too extreme. Luckily, I found a small (35 patient) ALF, that was just the right mix - sorta inbetween an ALF & nursing home. They did a lot for the residents - much more than any other large (big name) ALF and didn't charge for every little thing mom needed assistance with. The staff treated all the residents like one big family and mom loved the place. It was the perfect place - she spent a month there before dying. So do your research on ALF's if you think your mom might be able to handle it. Although moms ALF was not as fancy as some, it provided everything mom needed, and it was not depressing as some of the nursing homes were. Good luck.
So are you looking to place her in assisted living/AL or in a NH, which is now referred to as long term care/LTC? Where is she right now? You mention meeting at your mom's nursing home and then later in the post mention she's a candidate for AL? Which is it?

They are very different & the cost is also.

If this is all private pay by her and she has an estate with a good amount of money, then it's not so much of an issue as to where she is placed. But if she has limited means and you anticipate Medicaid then it's important that she is somewhere that takes Medicaid for LTC. You really don't want to have to move her again in a couple of years.

Take notes especially of what diseases they are using to admit her. It's important that you know if she had dementia or coronary artery disease or whatever as you may get a call or letter from her insurance company asking all this in order for them to pay. Just being old and not able to do is not enough, she needs to have things wrong with her that establishes "medical necessity". For example, my mom refused to take most prescriptions but she can really do alot for herself and can seem very competent and seems like she doesn't need LTC. But actually needs to have skilled nursing in order to monitor her Exelon patch and other medications
and her weight. Her weight loss while in IL (more than 10% in 6 months) was important in establishing her need for LTC.

My suggestion is to take:
-a list of all her medications even those OTC. Please go thru her room and cabinets, you never know what "health" tablet is out there.

- list her cognitive skills: she can/cannot - bathe, wash her hair, get dressed, understand what the weather is and dress appropriately, cut food with a fork or knive, use the restroom appropriately, knows basic current events, can tell time.

- list what she is good at or likes/liked to do. This will help social services to get her to the arts & crafts classes, or to Vespers or mass, or whatever.

- list unusual items - for us it was hallucinations...., my mom sees animals and patterns on the floor and has a distinctive shuffle when she walks, she probably has Lewy Body Dementia, which is quite different from Alz. This was helpful to the staff in how to deal with her and the type of medications.

- guardianship. If you are not DPOA & MPOA for her you should really meet with an eldercare attorney to get these done. All of her financial & medical issues can be handled by you within the power that POA"S do. True guardianship or conservatorship is a whole different legal status and is alot more regulated usually with court supervision. The facility will want a copy of your POA's or guardianship.

-DNR - most facilities will require this be on file and also sometimes in the residents room. If your mom is competent she will need to decide what to do and sign off on it and her MD will need to sign also. This is sticky but you need to discuss with her in advance of the meeting. If she wants to be DNR then fine but if she wants to be maintained on life support then fine but whatever it needs to have the paperwork done.This is a difficult subject for most of us but needs to be done.

- Funeral home info. Social services usually has a sheet to fill out for this. Just in case something happens and you cannot be reached. If you don't have this already in place most facilities will require you set something up within 30 days of her arrival. For example, my MIL is the spouse of a WWII vet and will be buried in the national cemetary in Santa Fe, we had to provide to the NH the name of the funeral home that will take and transfer her. This had not be done or dealt with but now has as it was required for admission.

- Most places have a "face sheet" which is the cover for the residents file with her general info and the info on the AR - authorized representative - which is you. Please look it over to make sure all the info especially insurance #'s are correct.

- Her birth certificate or info to establish citizenship. If she ever had a passport, that is the best even if it has expired. If she was naturialized then a copy of those papers. If she's private pay then they really don't care but if she ever needs to go on Medicaid then you will need to have that info anyway.

One thing that is real helpful is to make a copy for yourself & the facility of her:
drivers license or id, all insurance cards, her social security card, citizenship documentations, retirement/social security and any other annuity beginning of the year statement (this will be very important if you end up applying for Medicaid). If any of these are linked to a spouse, then all that information for them too. For example, my mom's annuity is based on my dead dad's retirement and I need his info to access the account, even though he died in the 1980's.

Also when she moves in mark everything with her name and also initials - not just her clothes, but the back of all pictures, her clock, watch, etc.. And only take what she really will need. Assume that 1/3 of it will disappear so leave those special things at home or give them away.

Good luck.

Good luck.
The above answers are great remember you are her advocate if you feel she would do well in AL go for it-even if it does not work out and later or sooner she has to go into a nursing home a good social worker will want what is best for her-and the final decision if she has to go on medicaide have the social worker do most of the leg work-one had to help me because I had a major meltdown in her office or go to an elder lawyer I had to pay a retainer of 5 hrs. so he probably would have spent about 2 hrs on-but my pride was at work and I spend 3 weeks trying to do it myself-very foolish-he dided before it was completed.

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