Parents caring for the parent support thread (Part 1)

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<p>In order to have Medicaid pay for long term nursing home care, there is a certification process involved to document need for that level of care. A nurse may be sent to do this independent assessment. Ability to ambulate safely, manage activities of daily living (bathe, food prep, take care of medical needs), cognitive status and medical diagnosis are considered. There is a process of being approved for Medicaid funding once the medical criteria is met and it requires a lot of paperwork gathering and a “look back” period of many years (forget exact number-all on-line) to ensure that assets were not gifted to avoid nursing home payment. There are organizations that will help with this and some facilities absorb the fee (though not all). There can also be complex legalities when one spouse requires skilled nursing and the other must retain a residence. Elder law attorneys can be helpful in anticipation of this. It can take time to have application processed. </p>

<p>Now here’s the thing about nursing homes - many want private pay time in their place in advance of a resident potentially going on Medicaid. I was told ten years ago to reserve at least $60,000 per parent as a way to increase likelihood that they get into excellent care and have more choice. This may vary by facility and location, with that number potentially low for today. I would assume nothing and talk with intake people at all desired places in advance. How is one admitted? What percentage of new residents start as private pay and how long are most residents private pay? Do they offer help with the Medicaid application? Pro-activity is important. I would not want to be approaching facilities for the first time with a completely depleted bank account and a jumble of financial records, as there could be a lot of pressure added. For my parents, entering a comprehensive facility at an Assisted Living plus level (included med dispensing and ordering, nurse around until 10 pm daily, ability to manage viruses, oxygen, etc) worked well, with my father entering skilled nursing level memory care at age 88. I also suggest that one not rely solely on one place. Management can change and turn over rates aren’t always a sure thing. I moved my father to skilled nursing in part because the year before I moved him, there was not a bed available there for over 10 months. He was entitled to be there as the place makes a lifelong commitment to their residents (go non-profits), but it wouldn’t have mattered. If he became ineligible for assisted living due to deterioration during that time, it would have been highly problematic. </p>

<p>I wish us all the best with this. It is not for the faint of heart. I agree with others who say at a certain point people are not making enough sense to drive the bus. We have to fortify ourselves to re-define what honoring and caring for our parents in this phase of life means. There is such a thing as enough rope to hang themselves. It may just be about not making the wrong thing possible, which fortunately helps make the right answer emerge. And when it’s our turn, I hope I have the grace not to demand the impossible from our kids. </p>

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<p>The positive, that one glimmer, is that she does claim (for the purposes of the ongoing argument,) to like the NH. It’s in contrast to this idea “homes” are prisons. No, I don’t think it will last. Her goal seems to be to stay at odds with her daughter, not work together. It’s Taming of the Shrew, where, once Petruchio gets Katherine to agree the sun is the moon, he doubles back on her, “Nay, then you lie. It is the blessèd sun.”</p>

<p>The irony is that, as challenged as this relationship is, the mom would probably get better bits of support if Dharma weren’t constantly being pushed into a corner. I’m tempted to suggest Dharma play her at her own game, use some reverse psych. </p>

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<p>I believe that Dharmawheel’s mother-in-law is or was in a Medicaid nursing facility. </p>

<p>Dharma, if this is true, has your mother seen your MIL’s living conditions there? Probably not the same as a patient paid via Medicare for a limited time after hospitalization.</p>

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<p>Caregiver and mother in place in her house. She sees her PCP on Tuesday. She looks and seems NOW ready for a SNF. But to ease my mind about where she goes when her money runs out I will call her MD after she sees him and run her scenario by him; I’m sure he would certainly call her a candidate for a SNF in 3 years, and very possibly sooner. </p>

<p>Your posts today FINALLY hit home that she will not listen to a shred of reason. I left for her to read two internet printouts of her role as Employer and her responsibilities and a cost summary. But of course now I see I shouldn’t have even bothered. I had this fantasy this afternoon of sending the cost comparisons to her shrink with a cover note and asking HIM to talk the future over with her. But now I see how ludicrous and pointless that would be and I told myself it is OVER. OVER!</p>

<p>Actually, I do see a therapist and I cry in her chair for 45 minutes. Its always been about my mother. I remember a few years ago she said to me, Stop worrying-your mother sounds quite capable of doing for herself. Except 7 weeks ago she became NOT capable of doing for herself. But now I’ve got her SET UP and can begin a “new normal.” I am going to dedicate August to my daughters, online college research for DD2, several college visits and interviews for her (but some of the schools she’s interested in only interview incoming Seniors…she will be a Jr.) Curl up with my Standard Poodle and read, read, read the books I love!</p>

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<p>True, but it’s odd to me that she likes nursing homes but won’t even listen to AL talk.</p>

<p>So travelnut, it sounds like DharmaMom cannot simply use up her assets and then waltz into the nursing home of her choosing. And no doubt all the planning and preparation you describe would fall to Dharma. :frowning: </p>

<p>ETA – Dharma, it sounds like you’re getting fed up. Good!!!</p>

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<p>Dharma, Off topic, but it sounds like you’re a bookworm, so I wanted to make sure you know about the CC Book Club. We do one book every other month, and tomorrow we start discussing our August book, Lonesome Dove. If you’ve read it, join us. If you haven’t, read it because it’s wonderful, and then join us for our October book.</p>

<p><a href=“Lonesome Dove - August CC Book Club Selection - #46 by PlantMom - Parent Cafe - College Confidential Forums”>http://talk.collegeconfidential.com/parent-cafe/1658247-lonesome-dove-august-cc-book-club-selection-p4.html&lt;/a&gt;&lt;/p&gt;

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<p>LM, It’s just to argue, I think. A perpetual power struggle from Mom. If she runs out of money, she pretty much gets the living situation that will take her. Maybe some little control, depends on the area. Could be sharing a room, too. Wonder how that would fly. </p>

<p>Dharma, remember the great line from Dangerous Liaisons: * It’s…beyond…my…control.* When the time comes, you shrug your shoulders and say, the doctor insists, that’s what I was told. Or the bank or the state. 3rd party load sharing. Or it’s mandatory I take care of this need for the kids, I have no choices. She could be out of funds, the house sold, and still fight. </p>

<p>And with all her care folks, a NH, visiting social worker, doctor, shrink, whatever, you tow the line that works for you. If you give them logical choices (well, she can afford home for 3 years, she can get the RM,) you’re not steering them. That gives them a different picture, different options than, “I can no longer run interference for her. She is unable to manage her caregivers. You will be sending her home to live alone with one person on duty, when that person can show up.” Just thoughts.</p>

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<p>HI Mom, yes my mind has been racing with so many thoughts, I was wondering if this NH she likes accepts Medicaid. And yes I agree with the comment above that it makes no sense that she “likes” this NS and hates to a passion the idea of AL.</p>

<p>I’ll be answering in a haphazard way, sorry. MIL had some money and was in Independent Living in the same “Resort” where I was asking my mother to consider AL. So no, old mom, this place decidedly did NOT take Medicaid. Over the past five years or so, with both mothers, siblings, children, etc., --everybody healthy–we would have holiday meals in their restaurant-style dining room and later, in the car, at home, etc., my mother spoke with nothing but aversion about the place, which looks like a millionaire’s estate. To hazard a guess, I think she was saying “The only way I will leave my home will be to go to your home.” She acted out her fear of being “put there” by maliciously putting it down. My husband and I used to laugh, because this place is lavish and we will never be able to afford anything like it. As it happened, almost to the very month MILs money ran out, she fell very ill and went to the hospital and then to the NH where she has been and, of course, will stay. But here you are right, old mom, this NH DOES take Medicaid. It was the first one my own mother was in, for “rehab,” yes, in a different wing. It was perfectly fine but she “likes” the second one. (Sorry, I realize this was the question you were asking, about the NH MIL is in NOW.)</p>

<p>GTalum, I hear you. The best I can say is “Im stopping.” When we came home (me, mother and caregiver,) mother headed straight for the bathroom (chronic diarrhea) and then sat in the kitchen chair she sits in all day without the strength to move. Her next move, perhaps soon judging from appearances, might be Nursing Home/private pay. She is very weak.</p>

<p>Travelnut, excellent analysis of the need-of-care factor in NH and the private pay and waiting list issues. Luckily, the fine NH MIL is in took her right in, with a teeny bit of money she spent in a few months. My husband went through the travails of the Medicaid documentation for her. As I wrote once before, I think, we were so foolish not to give this over to an elder-care attorney because it was so onerous.</p>

<p>I love your quotation, LF. I used to teach that play. I remember one guy in a class saying to a girl, “Yo, Kate.” I sympathized with Hamlet, but the students had not a jot of patience for him. Such different generations!</p>

<p>LasMa, GREAT to hear about the book club. I will definitely check it out. DD2 is a very deep and mature reader and when she was in 7th grade she saw me reading Nien Cheng’s Life and Death in Shanghai and then she read it after me. A magnificent book of a highly-educated victim of Mao’s Cultural Revolution. I was so in awe of DD2 that I wrote to Nien Cheng (she had relocated to DC) about my daughter and her reading, sent pictures. Two weeks after I sent the envelope, Nien Cheng’s obit was in the NYT (by then she was like 92.) I wrote to the estate to ask if they got the letter but no one ever replied. </p>

<p>I finished the bio of Queen Elizabeth I and the writer, historian Alison Weir, goes into painstaking detail to leave no fact unturned. It took the emaciated Queen weeks to die, and at one point, to the horror of her ladies and courtiers, she used her formidable will to stay STANDING for 18 hours. Finally she agreed to go to her bed and men stood on horses at stations on the way to Scotland to tell King James the VI of Scotland that he was King James I of England. </p>

<p>LasMa’s remark about what if mother is considered not up to standard for SNF got me thinking, so I broke the silence with my sister (I keep her updated with emails but she does not reply) and called her on the phone, which she hates. Her recording luckily ran long so I told her of my concern and wanted her feedback and please call. She is a BSN (Bachelor of Nursing); so is her husband. She will know a lot about this. One of her jobs (seems perfectly ghastly to me ) was to go as a Visiting Nurse to people’s homes and treat their wounds, etc. Over the years she has seen unimaginable things and every possible scenario. If need be, I can take mom to Reno where my sister is and she can find an MD to put her in a Medicaid NH in Reno!!. </p>

<p>Just to mention, I realized I was in a writing compulsion and started a thread on Elder Care on a Forum I belong to about, of all things, Bob Dylan (I am a compulsive fan). This site is followed by young ones and a hardy group of oldies like me. Well, my thread unleashed a torrent of stories of young, suffering parents and helpless children (it is a world-wide site and stories came from everywhere), stories of wearied caregivers, people seeking help and guidance across the globe. One woman in Germany said her mother had her stomach removed (cancer) at age 50, now had MS, and was dying. And not a jot of this was on the “hip” online chat. My thread opened a torrent of writing. It was very moving. Several people wanted to PM with me. </p>

<p>I attend this. But LasMa, you’re right–at home–I am getting fed up!</p>

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<p>I’m glad to hear it! Stay that way!!</p>

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<p>Yeah, I bet that is her endgame. </p>

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<p>Yes, please stay “fed up,” and move to the next phase. You owe it to yourself and your H & Ds. It’s time for your mom to be more realistic about her options.</p>

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<p>I don’t think her mom is ever going to be realistic. That’s why Dharma is going to start driving the bus.</p>

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<p>/ot. Willing to bet cash money my boss is on the Dylan forum.</p>

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<p>Parents are like very young children in many ways–they can and will be unreasonable as they are allowed. Agree that Dharmawheel has to just stop doing all the many things she is doing to make this all possible, which will blow up sooner than later, leaving everyone exhausted and mom totally broke.</p>

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<p>Does “start driving the bus” mean take care of me and mine/stop driving mother’s bus? Because it so, yes that’s right. </p>

<p>Wanted it to start today but got caught up. New life starts tomorrow. Problem started last night when mother said she got a call from the oil company that she did not pay her bill. So somehow “I screwed up.” I had been scrupulously paying her bills. So went over this morning and got out her record book and showed her how I had recorded the bill number, date, paid to, amount, and got out the co’s envelope with the receipt and all the paid info on it. Because her eyesight and handwriting are so bad I wrote out the check for part of the oil bill that had come in the other day and got her to sign the contract with the Polish rep and I wrote out the check.</p>

<p>Then she said, Do you think I can go with you to DD2s piano lesson on Sun? Now, she can hardly walk, and the teacher’s front steps are hard. Years ago she and DDs took a weekly lesson until mother gave them up because fingers got too bad and steps were too hard. My daughter would HATE to bring grandma. So I said , We’ll have to ask DD2. But then she hits me with the bombshell. "I always promised (my sister’s name) a baby grand piano. I think I will ask (name of piano teacher) to find me one. She told me she would if I wanted her to. I was dumbfounded and said Mom! You can’t do this! You are on the edge financially and must watch every penny! Sister does not want a piano and you can no longer play! She said, oh there are a lot of people out there looking to sell a baby grand. I expressed to my Social Worker friend my disbelief–she works with the elderly with Medicare–and her reply is so good I will paste it in:</p>

<p>Speak to the teacher, tell her pvtly that A is becoming senile and she should just humor her if she should contact her about a piano. This petulant behavior sounds like a senior version of a tantrum. She probably doesn’t even want a piano. She just wants to get you upset because she feels rejected that you won’t invite her to live with you. </p>

<p>Yesterday I asked the Social Worker friend about the concern that LasMa raised that mother is found “fit” and not qualified to go to a nursing home in three years. SW friend is VERY experienced w/old people. Her reply:</p>

<p>At her age she is not safe at home ALONE period. She no longer drives, she needs help w/ ADLs- possibly bathing, dressing , cooking, laundry, groc shopping, transportation to the MDs etc. The suicide attempt after your father’s death on it’s own is enough to require that she must have supervision by someone for the rest of her life -which you have been doing for these past years… You are good to do what you do and w/o you she would be lost. The state does not necessarily expect you be her PCG. Of course she is eligible for a SNF-(NH) under Medicaid if she became indigent.</p>

<p>(I wrote asking friend what ADLs and PCG meant…)</p>

<p>Then I realized, given upcoming expenses that will be done electronically, that I stupidly did not put enough from the IRA into checking, so got her ok to drive all the long way to her bank, make the transfer with power of attorney, etc, and the long drive back. The bank was short of staff-so I even had to walk to another bank to get the paper notarized. Plus buy her bagels at her favorite bagel store. </p>

<p>The caregiver is wonderful. She had made my mother a beautiful breakfast, my mother was the picture of contentment, and the caregiver in rubber gloves was doing laundry and couldn’t get the kitchen clean and organized enough. When I came back in the pm she had all the meds organized into compartments, and there are a LOT of meds. She even pointed out to me that the name of a med listed in the discharge sheet was not among the meds I had picked up at CVS so I called the pharmacy. The guy said , oh that’s <> and he gave me the long generic name. And we had it. </p>

<p>Baby grand piano???</p>

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<p>Dharma, don’t try to prove anything to her (that you didn’t screw up the oil payment.) Next time, maybe, “The bill is on the table. You and [nice Polish lady] can take care of that this afternoon.” </p>

<p>No matter what my mother did for my grandmother, it was fodder for another rejection. At one point, eg, I chose the gifts she sent- and GM still complained. Because that was her goal. (If she had known I picked it out, it would have been “lovely.”)</p>

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<p>She’s trying to punish you by pretending to promise something to your sister, because you didn’t move her right into your house. Maybe you should suggest that she ask your sister to take her in with the grand piano and they can play together.</p>

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<p>You know, there will always be something. Maybe the right expression is to “get off the bus” and stop driving. Ha, ha, baby grand. It’s like my dad threatening to drive a long way to get me hot and bothered. She now knows talk of spending money will drive you crazy. Get ready for more. </p>

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<p>I LIKE this new Dharma we’re seeing!</p>

<p>I guess “driving the bus” could mean lots of things. One thing could be that you don’t stop driving the bus, so much as you start driving it in a direction that makes some sense. As long as your mom is driving, it’s headed toward a cliff.</p>

<p>You’re probably not going to be able to wash your hands of your mom (tempting as that sounds!), but driving the bus might mean, for example, instead of spending your time and energy setting up this caregiver/reverse mortgage business, you start shopping around for a good AL. You’re more of an arranger of things that will help her, instead of a doer of things that will hurt her. You arrange for the sale of the house. You see that her money is someplace that will stretch it as far as possible. And then – heres the best part – you step back and let the professionals do their jobs, at the AL, at the real estate office, at the bank. And you get your life back. :)</p>

<p>Taking care of you and yours - #1 priority! They need you and you need them. </p>

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<p>Last weekend was at my 40th HS reunion, so was off line for days. We had some other dysfunctional family situations with classmates - and I could imagine how tough some situations were while some classmates didn’t have significant family issues. I think a few of my classmates were shocked by brief stories on how my mother actually was (she was in almost a manic high, but you didn’t dare cross what she wanted during my HS years). My dad owned a business, and she was on a social whirlwind. </p>

<p>One classmate had an alcoholic traveling salesman dad (fortunately his mom was a pharmacist and could provide for the kids - she absolutely was the glue for that family) - this classmate’s younger sister actually had very bad alcohol and drug issues, while the three sons did not follow father’s problems. </p>

<p>We had several classmates (or other people that we knew) where the father/grandfather built up a successful business, handed over ownership or management to son/grandson, only to have forced sale, big losses/gambling or overspending-embezzlement of employee 401K money, etc. </p>

<p>One fellow from my class is single and psychiatrist - he was the father figure (from 7th or 8th grade) with his younger brothers - physician dad died (suicide), alcoholic mother. Younger brothers all successful and married with families. I asked if he only did adult psychiatry, and he said no his youngest patient was 3 and oldest in 90’s.</p>

<p>My younger sister (who is bi-polar and has had psych hospitalizations herself) is extremely damaged by my mother. She is not currently on medication, but is highly stressed. She now isolates herself some from family members - just has run out of emotional energy for rest of the family (maybe too many memories) - I shielded her from my mother’s viciousness to her (but sister would engage mother instead of keep a low profile like I did). Situation deteriorated further when I went away to college and no longer was there to protect sister.</p>

<p>@dharmawheel it sounds like the roller coaster continues. Sounds like lovely Polish caregivers, but everything else is ca-putt.</p>

<p>I am not surprised by your mother’s past discussions about the SIL’s death - due to her mental history and the other things you have said.</p>

<p>I would absolutely not go further on this financial drain. Do not go through with RM. Perhaps you will see an opportunity to have her moved into AL, perhaps after a month of focus on DD’s college stuff.</p>

<p>I agree with the others - your mother is not concerned about running out of money because she really thinks you will let her move in with you. </p>

<p>You are spending way too much time on all of this stuff with your mother. Reset - go down the path of AL. That is where your energies need to be because that is best in short and long run.</p>

<p>Also you do not want your family ‘damaged’ any further - the remark to DD starting her down the eating disorder path. Comment about not liking H was just plain out in left field - he obviously has tolerated an awful lot with this whole scenario.</p>

<p>Glad you have a therapist. Look at what your mother’s toxic behavior - words and actions, use of history on you, etc is doing to you. </p>

<p>Hugs to you and your nuclear family, but especially to you. You have to be the driver; do not let this go into the ditch. Glad you are getting your sister in on the conversation.</p>

<p>I think the baby grand piano comment was in part just thrown out there as a power play comment; also living in the past. Obviously not in tune (not meant as play on words) with current scenario, but saying it was empowering to your mom. She enjoys her fantasies.</p>

<p>What is holding you back? Why are you doing so much enabling?</p>

<p>I got the Boundaries book used via Amazon ($3.99 shipping). You need to have this book to access 24/7 - read this book and refer back to it with all these mom situations. </p>

<p>You are pretty good at analyzing, and you are getting stronger. Do not let your mom use you up. You deserve happiness with your nuclear family, and your family needs you!</p>

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<p>And do not even entertain taking her to the D’s piano lesson. “I’m sorry, Mom, you won’t be able to handle the stairs.” Period. Don’t put DD into this equation, it makes her the bad guy. And she has already suffered grandma’s lack of filter. She doesn’t need the potential exposure to critiques of her playing. Protect her. Plus you want to keep the drive and lesson for you and your girl.</p>

<p>“You are on the edge financially and must watch every penny” just restarts the conflict she loves. </p>

<p>Just say No. </p>