<p>Dharmawheel, find out how much it costs to take a taxi from the train station to your mother’s house and add it to the cost! You are NOT the chauffeur, you do NOT have to adjust your schedule for the changeover 2x every week!</p>
<p>You really should have caregivers who drive. You will have to run for every emergency/drs appt, pick up meds, do the shopping, you name it., Are you really prepared to do this? Can she afford taxi cab rides for all this? You really should think about all these issues before getting sucked into her idea of an acceptable D/C plan. Are these caregivers hired and in place? Have you/your mom met and interviewed them? These are all important steps.</p>
<p>Its not a Medicare “rule”. A patient who needs readmission will be admitted. The hospital runs the risk of being hit with penalties for readmits within 30 days. They don’t like it.</p>
<p>If worse comes to worse, you have her come home with caregivers, and when you run into problems or she gets readmitted, then AL is brought up more intensely. You can agree for a trial period. If it fails- plan B. </p>
<p>I am telling you- I managed case managers and caregivers (week day/weekend) with my dad for 7 years. This is not for the faint of heart.</p>
<p>Does your mom have long term care insurance?</p>
<p>WIll the caregivers trains going in oech directyio be arriving at the station at the same time? Will you be making multiple trips to/from the station, and can you mom be left unsupervised if their train schedules dont overlap? In my dad’s case, they changed at 7 in the morning Monday morning, and 6 at night Friday night. (the weekend coverage) Will yours be like that? You really prepared to be at the station at 6:30 Monday mornings?</p>
<p>You shouldn’t do that, Dharma. Calculate the cost of taxi rides for these women and add it to the daily cost. Because that’s what it is. I do not want you to be a free taxi service on top of everything else. If your mom insists on staying at home, anything you do to reduce or disguise the full cost is only enabling her. </p>
<p>With my stepmother’s caregivers, they took taxis from the train station and the cab waited for the one going off-duty. Because they were substitutes for when the regular aide took a few days off, there was 25=30 minutes of transition time. The agency paid for the cabs and the aides were employees of the agency.</p>
<p>Dharmawheel, I would call some taxi services that serve your railroad station and ask them what they would charge for that service, and add it to your spreadsheet.</p>
<p>The aides my stepmother had were very experienced caring for old people. The only thing I had to do was buy food for them. But of course my dad was competent enough that he could stay with my stepmother while I took the aide to the local supermarket once every 2 weeks. My father cooked for himself and my stepmother and I took him shopping for food, but the aides knew a lot about healthy eating and menu planning, which they discussed with my dad. </p>
<p>The last aide we had took care of a couple whose son was out of town. She gave the son a shopping list every week and he ordered food online through Peapod or some such service.</p>
<p>I am sure that in assisted living or in nursing homes, registered nurses don’t do a lot of hands-on care for the patients; aides do the hands-on work. Not to say that their presence isn’t a good thing, to supervise the aides and to be there when skilled judgments are necessary, but my stepmother’s aides were very capable of taking care of my stepmother (who needed quite a bit of daily care, bathing, feeding, etc.), kept the house clean, and watched out for my dad too (although he wasn’t their patient). They knew how to call 911 in an emergency. When the 911 call resulted in a hospital visit, the aide rode in the ambulance with my stepmother. Of course they knew how to call me too but they really didn’t bother me with every little thing.</p>
<p>If you remember we moved my mom to an apartment and she seems to be enjoying the simpler way of living. However, here is what I’m finding really odd. She piles things up in her bed, and doesn’t clear it off to sleep. When we first moved her she had cleaned out dresser drawers, there were cords, papers, etc. My sis says it’s piled up again. Apparently she doesn’t have the energy or desire to clear off her bed to sleep in at night. We’re going up for her birthday this weekend. She has piles and piles of boxes in closets she claims she’ll go through. My sis wants it sorted through while we’re there. The way I figure it, if she isn’t missing it, why bother? </p>
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<p>What SOS says is important. For some reason, you are working very hard to put your mother in a situation which is not in her best interest. You now have a medical and legal opinion that your mom would be better served in an AL. It’s not really a case of your mom “won’t go.” Without you, she is unable to gather the support necessary for moving back home. Why are you working so hard to move her back?</p>
<p>Agree with everyone that it is best for you to be more honest with yourself and your mom about the situation and REAL costs. She will need to include taxi fares for her workers as well as for shopping and getting to & from medical appointments as part of her expenses for living at home. This will definitely deplete her assets even faster than estimated. </p>
<p>It is clearly NOT in her best interests financially OR medically for her to live in her home when she cannot pay for the care she needs and will deplete her ability to pay going forward. </p>
<p>When we twist ourselves to make things “work out” but it really won’t work, we aren’t helping ourselves or anyone else. You, your family, your mom will all resent that it isn’t working and the drain on finances will allow for fewer options after “trying” living home alone with paid help.</p>
<p>Plan A is really AL. Your mom really needs to try this for a few weeks. It may be best for her to speak directly with the lawyer and discharge planners about this (after you cue them about the situation). </p>
<p>Remember too that even if the house is paid for,you will be carrying the cost of the house (the cost of taxes, insurance, pest control, utilities, etc) and have to fix it up to put on the market and pay the realtor their %, so the net you get from the sale may be less than you expect. There are a TON of hidden costs. In the home, you’d have to feed the caregivers as well as your mom. And laundry and water use, etc for 2 is higher. Ca-ching…</p>
<p>To answer the very last post, jym626, yes I learned enough here to include in the two pages of cost-comparisons every last detail you mentioned and then some, like lawn mowing and snow plowing. I even included cost of food for TWO people. Yes, after all the internet research and help of the people here who have contributed (I can’t thank you enough) the comparative cost analysis were exhaustive and spared nothing. As I wrote above, the lawyer read them and said, “You did my work for me.” It was my intention that, after the lawyer’s visit, combined with the lawyer’s advice relayed to her, my mother read these two pages (she is thoroughly competent to do so), but as I wrote yesterday, she angrily refused to do so on the basis of the fact that from her point of view AL was completely out of the picture, and that by reintroducing it, I was treating her like “an item” and not like "a mother. But I said all that yesterday.</p>
<p>I forgot to mention that the agency manager performs a criminal check. Of course, how can I prove to myself that he does that, but he is licensed and has proved correct and legal in the many aspects of all this we have discussed.</p>
<p>I asked him to find, if at all possible, women who drive. The first woman we interviewed and agreed to the job at $150 a day, did drive from her home in Westchester. A few days later she accepted a job at $200 a day because, according to my agency rep, she has a car for the client. He said it is nearly impossible to find women who drive and they get more money. I’m sure all these women live in Queens, the Bronx, maybe Brooklyn. They will have a long commute. They have been paying for their tickets for interviews and I am not offering to pay for train fare.</p>
<p>As for taxis, I feel resigned to fetch and return. I figure there will have to be times when both women are in the home, one waiting for her train home, that scenario. Importantly, the house is within easy walking distance from the train station for when I am unavailable but I feel resigned to do the driving. I order many books for me and the girls from the library and am always in the village anyway. Asking for taxis vis a vis the artificial cordiality of my relationship with my mother (“happy” phone calls exchanged every night), feels like going to far. I would far prefer a driver to do her weekly, sometimes twice weekly shopping. This curiously depresses me in some funny ways because mother is so exacting. On her list she will write ARNOLD white bread, BIRDS EYE frozen green beans, KRAKUS ham, Colombia salami, ASK THEM TO SLICE IT THIN. I feel like a second grader who has been put in the corner. But I have been doing this for at least five years, when she sold her car.</p>
<p>Another note someone asked about her compliance, yes she is compliant, and it is okay with her MD that she uses the cane in the house and the walker to appts and outside. She is obsessively complaint about her meds. One day when she was home between hospital visits and weak, I asked her if she wanted me to get out her am pills. She said no and did them herself. She has “macular degeneration” which seems impossible because the writing on the RX bottles is minuscule and on one of my own I can’t read the drug’s name, only know its the one to take because it says 10 mg. </p>
<p>To my mother’s credit, she calls the local Community Center for free rides to the MDs, instead of me. If there is an aide, she can go with her for the elbow support etc. Frankly, I think it is less a gesture of charity towards me than that she enjoys the company of the retired gregarious volunteers who drive and chat with her. Like many crazy people, she is very articulate, well informed, and loves to be the center of attention which, ironically, makes it sound like she’d be ideal for AL, but as my husband pointed out last night, she has a superiority complex and would look down on other infirm people, ignoring her own infirmaties. </p>
<p>But by no means does all this mean I am giving up on the AL option as being what the lawyer recommended and what I, from intimately knowing her finances, feel is best for her. I plan to bring it up in the room with all the “team” around us, because up till now it has only been discussed between us privately (I cannot truly say “discussed” because she immediately refuses to talk about it. </p>
<p>As I have been cautioned by the SW, I cannot bring up 24/7 caregivers up myself at the meeting. She wants me to hide it as an option. My mother will certainly bring it up, and I suppose at that time I can present the two cost comparisons to the table and in the presence of the group urge her to read them and hope for their support.</p>
<p>Last week, when we interviewed two women in the NH, I typed up a page of rules and regulations and a page of rules, down to the last minuscule thing I could think of, quite lengthy and unsparing. Both women had no objections, and in contrast to the cost analysis papers, my mother read them fully absorbed. </p>
<p>To answer G Talum 3466, I don’t understand how I can insist my mother go to AL and forego 24/7 care. How could I literally get her in the car and force her to go, move her furniture, put her house on the market, and so forth, while she will literally be screaming at me and abusing me, possibly hitting and kicking me? To quote the lawyer, it is her decision. The lawyer said she has seen many families facing the same choice: some go one way, some the other. If my mother wants to sink her ship, then so be it. </p>
<p>We interview Barbara at the NM at 11 who can do 7 days, and the rep says he has another woman in the wings. To Barbara I will also take the two pages of duties and rules. The caregiver meeting is at 1 when I will introduce the AL bomb before witnesses and urge my mother to compare and contrast the costs between that and 24/7, which she will certainly bring up.</p>
<p>A small, but important consideration for me is that the caregivers would free me from making a nightly phone call to make sure she hasn’t fallen and is “all right.” I hate these calls. Frequently, I have to walk over around dinner time when the phone rings 30 times in her house and she doesn’t pick up. I find she is simply watching TV with the volume up and can’t hear the phone. I repeatedly ask HER to call ME when it is convenient for HER but she claims to forget which I don’t believe given her acuity, so I am forced to call. I sometimes think of how it would cost my sister nothing to “share” these nightly calls with me, but she has never offered and I have asked her for nothingI think it is my mother’s passive-agressive gesture of controlling me.</p>
<p>By “rules” above, I meant to write “duties”, e.g., cook three hot meals a day, thoroughly clean up and put away dishes .
A little OCD but I wanted it all down on paper.</p>
<p>Still thinking about G Talum’s post, if anyone can think of a magical way I can “insist” on my mother going to
AL, I would be thrilled to hear. Another thought just came to me that I can go into her psychiatrists room with her after I talk all this over with him on the phone, and see if he can influence her. He is a good guy-after her suicide attempt he went far beyond the line of duty to be helpful to me.</p>
<p>Have been offline this week, but best to all this week. </p>
<p>Dharmawheel- you will likely not have this much “leverage” to nudge your mother in the right direction until her next admission. Sometimes people can be persuaded to choose the safest, healthiest and most financially prudent option and sometimes they must be lovingly shepherded to it. Engaging her psychiatrist could be very helpful. Being a rapid cycler with bi-polar disorder is likely to create additional complications with home care over time. I have known people who refuse to make the wrong alternative possible for their elders and in that way ensure appropriate placement- they simply don’t do the leg work. Some of my friends have had to discuss that while that may work for you, it doesn’t for me and going forward, it is important to consider both of us and professional input. Another approach is to ask that professional advice be followed, for more peace of mind, assuring them that you will keep an eye on things. Maybe find out specifically what her biggest fear or concern is about AL and see if it can be addressed. Your description of her present status doesn’t suggest a likelihood of home care proceeding successfully for very long, which makes the aggravation and expense of a reverse mortgage all the more odious. Rest assured, I say this knowing full well that there are no crystal balls and I have had a relative return to AL very ill, didn’t think she’d be out of a nursing home for 2 weeks, and yet because of her spouse, she lasted over three years before going to skilled nursing. I personally would find it nearly impossible to honor requests that my efforts be directed to something I viewed as inappropriate for the situation. Here’s to engaging the psychiatrist in the best way forward and trying to buy a bit of time before discharge so the transition is as direct as possible. While money is at stake, it is also very taxing on elders to transition, </p>
<p>Eyeamom- I am with you. Given what you describe with her room, her ability to organize and sort ship has sailed. I am concerned that she is actually sleeping on a pile of stuff, as that seems a bit confused. Hopefully, her floors are clear. I wouldn’t sort it in front of her or ask her to do so while I watched, unless it would be helpful to see how she approached such a task. That may give you info about what type of support she is likely to need going forward. I’d try to reduce the boxes without disrupting her. People at this point are usually much better off with as little as possible to deal with in their space. My father used to pick up all forms of written materials, books, magazines, pamphlets when in assisted living. Weekly, I would bring a stack 2 feet high out of his room. Best this birthday weekend. </p>
<p>You can tell her that you can’t commit to continue doing the things you currently do–pick up aides from rr station, food shopping, etc. and you want her to know that that will shorten the period that she can afford the aides by x amount of time. If she needs aides that drive because you won’t do this stuff, make up a number for how much that would cost (if you don’t know) and give her the new timetable for running out of assets.</p>
<p>And you can tell her that you can’t commit to helping her live at home because you love her and you know and have been advised that assisted living is the best plan for her, that you can’t help her create a situation that is dangerous to her.</p>
<p>@Dharmawheel you are a daughter that has done beyond a good daughter’s duty to your mother. If you tell any of the professionals that you are unable to manage your mother’s care at her home (even with all the things you have investigated) but you would support the AL situation in light of her finances hopefully holding out to pay for her care until her natural death, then the professionals will have to essentially say discharge to AL.</p>
<p>Your mother may be very angry with you for a while, and it may take her a long while to ‘adjust’ to AL; she may be unpleasant there too - and then she will need to be told the options which will be less pleasant - some people are their own worst enemy - however if she has any narcissistic tendencies, she will figure it out. </p>
<p>If you were in your mother’s situation, you would not impose on your DDs nor take the option to run out of funds for your care. Do not go down the road with assisting your mother to return to her home.</p>
<p>My mother was bipolar (and then had dementia; death certificate said Alzheimer’s) and could be very manipulative; all 5 of us children were on-board for the most part however only one lived in the same town and two were in the same state.</p>
<p>Saw from another thread about your talented DDs - one that is a junior in HS and would greatly benefit from you to be available to help sort out colleges this year to research and visit. You owe it to your nuclear family and yourself, and also to your mom to stand up for the best care for her - which is the AL route - even though it does not ‘feel’ like being a good daughter, it is!</p>
<p>Dharmawheel, if your mother returns to her own home, it will be because of the things you did: you set up the caretakers, you agreed to taxi them, to do grocery shopping, to ensure that the bookkeeping and record-keeping is handled. You didn’t have to do those things; you could have not set up home care, and then she would have no caretakers, and the hospital would not discharge her to her house alone.</p>
<p>Next time she goes back to the hospital, you can consider not doing the things you did this time that made it possible for her to go home. If she has no caretakers, she can’t go home, and if you don’t hire caretakers (or re-hire, after a hospital stay), she won’t have them and she can’t live in her house.</p>
<p>Dharma - can I say this in the nicest way possible - You are allowing your mom to manipulate you. Please reread what Cardinal Fang wrote. And then stop doing all the things you do which allow your mother to manipulate you.</p>
<p>You mentioned that you call your mother everyday. Your mother refuses to call you (manipulation #1) so you acquiesce and call her. Then she often refuses to pick up the phone so you walk over (manipulation #2). You need to start living a life apart from your mother and her many demands. Go care for your family and let your mother care for herself. Yes, she is old and frail and needs additional care, but she is refusing to do what is necessary to get that care. So, you do all the work and then you allow her to be nasty to you (for example,she said unkind things about your husband recently). </p>
<p>Please understand that I am not trying to dump on you. I am simply trying to hold up a flashlight to some issues that you may have a hard time seeing because you are so close to this situation. Stop being her rescuer. That is not your job (I know that your mom wants you to play this role) and it does your family no favors. </p>
<p>Dharma, you don’t have to do this. She will only be able to stay in her house if you twist yourself into pretzel to make it possible. Please don’t do that. </p>
<p>The way you “insist” on her going to AL is by simply not doing the back-breaking, soul-crushing, family-destroying work it would take to appease her. Just don’t do it. </p>
<p>There’s always a history with a parent, and that’s why I always recommend therapy.</p>