Parents caring for the parent support thread (Part 1)

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<p>The house is listed. This is enough to tell her she needs to move in September. What if she gets a cash offer?</p>

<p>Please simplify this for you and her. No more convincing her with financial facts. Don’t vacillate on the Plaza-- don’t let her doubts become your doubts. Act.</p>

<p>I find it is easy to overestimate what our elderly parents are able to do. We thought my FIL (whose mind was clear) was really on top of things, but after his death we found his checkbook register a mess, with thousands unaccounted for, and his window casings rotten. This is a man who would not have allowed either of these things to happen, had he been as sharp as we thought he was.</p>

<p>I’m saying this to point out that your mother may not be quite as capable of assessing her situation (financial and otherwise) as she may have been only a few months ago. She may actually be relieved to have the decision over and done with, rather than prolonging the period of indecision and uncertainty. </p>

<p>Even we who are younger find periods of uncertainly and indecision to be stressful-- how much more so the elderly/frail?</p>

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<p>Tomorrow after I see the MD I will tell her she is moving in September. I will not show her a cost breakdown but I will have to do it myself for my own "keeping track"of her assets.I had to email Payroll forsome figures Imisplaced…</p>

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<p>When she complains, you jump. It costs time. When things get distracted, it costs time and efficiency. It’s been about 3 weeks since she agreed at the lawyer’s. We made some easy, efficient suggestions. Eg, you vet the places, then give Mom the two (or 3) choices that you approved, that you feel give care you can live with and that she can afford. This turned into taking a frail, persnickety, woman with some sort of digestive issues for grand rounds of three. Sounds like you still don’t know costs because 2 (or all 3?) care-level evals aren’t done? You still have questions. She has some complaints. Bottom line: you are not ready to leap. </p>

<p>The aide will be paid for more weeks, sounds like you want to rework numbers again, you want to take Mom back for another meal. You are considering one place where, to save money, you will set up her meds. You are considering a place you think will, going forward, (indefinitely?,) drive this problematic woman some long distance to doctors appts, which I am concerned can’t last. (If she acts up or gets demanding, the driver cannot control her in the van. If it is so critical she keep the exact same docs, I personally wouldn’t have chosen a distant facility- not unless I was prepared for the eventuality that I will be the driver. Even writing that makes me wonder why that location is on the table.)</p>

<p>Dharma, it’s confusing. She promised to decide by Sunday and you rewarded her for that. I believe you described a situation where there are limited available rooms. You talk about nice police who picked you up n a rain storm and APS- and you still aren’t ready to leap. So, that’s why I said, seems the urgency is playing second fiddle to the desire to, somehow, do all this perfectly. </p>

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<p>The only reason I can understand that Dharma is still thinking about the place in CT is this: when my stepbrother was considering his options for his mother once we knew my dad wasn’t coming home, ever, he looked into nursing homes and such in NY. Now why he did this, I have no idea; he lives in CO and I hope he didn’t think I would continue to manage her care. But he soon found out that the laws in CO are less restrictive than the laws in NY and she could be in a much more pleasant and less expensive setting in CO than in NY. So he took a deep breath and got her on the plane to CO and to the place his wife selected, half an hour from his house in CO.</p>

<p>If the single only reason to choose the place in NY is access to the psychiatrist that has to see her [how often, Dharma? Every month? Every three months?] then it may be worth it to commit to the drive FOR THAT APPOINTMENT ONLY and for as long as it make sense. E.g., if she gets to the degree of dementia that she doesn’t recognize the psychiatrist, then she doens’t need to continue seeing that psychiatrist.</p>

<p>This is a person with a documented mental illness and I can see the point of keeping that one connection with its inconveniences. Dharma, if that place is cheaper, it may make sense to pay for a driver and companion when you can’t or really don’t want to do it. It can’t cost $$$$$$$$$. </p>

<p>But to fill the pill boxes? Probably not. Make it easy on yourself. What happens when she needs someone to watch her swallow the pills so she doesn’t forget? I don’t care if you could walk there, you certainly don’t want to trap yourself into doing it twice a day!</p>

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<p>That connection to the psychiatrist, yes! For now. I can see Dharma doing that driving. Plus, Dharma herself needs the connex to that doc, for input, no reinventing the wheel with a new shrink. But to assume the AL driver and facility are just going to up and take her to all her doc appts does not jive with my experiences. (IME, these rides to docs, CVS, the market, etc, were for those who could get into the van and manage themselves- and on a schedule- eg, Tues, they go to the shopping center, Thurs to the doc complex. My grandmother could get an on-demand ride, IF there was no conflict. But 10 minutes down the road.) And if there is an aide assigned for her mom, what is the cost? I don’t think the question was asked yet. </p>

<p>Plus, no mention whether regulations and practices in CT are, in fact, more “user friendly” than in NY. Does it also mean shifting her Medicaid (and re-enrolling in any supplemental Medicaid? If my mother moves to AZ, she has to restart at least the supp, because of different offerrings.)</p>

<p>Plus, of course, the distance, itself. My MIL was 20 minutes away and after a while, what a drag to get out there. </p>

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<p>lookingforward, Dharmamom’s mother is not on Medicaid yet and won’t be until her money runs out, and that won’t be until she’s been a CT resident for a long time if she moves to CT in September. CT and NY are both generous Medicaid states. Colorado not so much, but my stepmother is not likely qualify for Medicaid ever because she has a lot of assets.</p>

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<p>Sorry, meant Medicare and any supps.</p>

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<p>I am sure that all the AL places are used to dealing with Medicare and the changes necessary for residents–it is not unusual for a senior citizen to move states when they enter AL. Unlike Medicaid which is administered by the states, Medicare a federal program. If she has to change her internist/family doctor/gerontologist, so be it, but the shrink is important, especially for now.</p>

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<p>Medicare is Federal, but handled by different carriers in different states. And the reimbursement rates and copay s differ.</p>

4450

<p>LF, you are not being fair to me. The day after we saw the lawyer I made two appointments, Maplewood in Danbrry and The Plaza in Carmel. This industry is hot now and we had to wait weeks for an appt/tour/meal. I had no control over having to wait for the appts. Also I got a kind PM on CC highly recommending The Gardens in Danbury,so I made an appt there too. I’m sorry to the nice woman who recommended it,but this is the place where we would have to fill the pill boxes ourselves. For that and several other reasons we ruled it out. (So you were wrong to say we were contemplating a place where I would do meds.) The Plaza pushed our 8/22 appt to 8/29. We saw Maplewood on 6//18 first said the nursing assessment was 'a breeze but waslater embarassed to admit that the nurse who does the assessments was on vacation. I am waiting for a call or email back from her to have the assement done this week, critically, asap. The Plaza cannot do it until the 5th. We CANNOT–they will not LET US secure a room-until after the nursing assessment was done.</p>

<p>IfI had any idea a nursing assessment was part of the picture I would have pleaded to have it done on the day of the tour after comparing the two and fulfilled all requirements,we would have struck a deal. </p>

<p>LF wrote: “YoShe promised to decide by Sunday and you rewarded her for that.” This is not true because neither place has done the nursing assessment,vital to being accepted,which I thought could be done by 8/30.Donna at Maplewood made it sound like a 5 minute breeze but her nurse went on vacation for 2 weeks! The Plaza pushed us back to 6/5! If both facilities have a room available after the nursing assessments, she can choose. If only one has a room available, she goes there. But I infer WE are first in line at both places becausse I am strving so hard to get that nursing assement done --without it, no other applicantcan “skip over” us.</p>

<p>LF: You point out correctly that we will be paying the caregiver one more pay period thanI would have liked to?</p>

<p>LF: Even writing that makes me wonder why that location is on the table. LF, Danbury is not far. The way you worded that sentence hurts my feelings. Maplewood is exactly across the street from Danbury Hospital. I can always arrange for her to switch MDS. Like with everyone, she is always putting down her MDs and saying they don’t know anything. </p>

<p>LF " Bottom line: you are not ready to leap." LF,as soon as the nursing assessments are done, of course I am ready to leap. As I’ve explained, I could not control the timing of the nursing assessments. </p>

<p>Yes, its confusing because things keep changing over which I have no control. I know I write one thing and it changes the next week. </p>

<p>Allow me my little ramble about walking my dog in the rain. My mind was just wandering. What is APS?</p>

<p>I am glad to acknowledge one dimension in which I am making this more complicated than perhaps need be; I am giving my mother the choice to choose between two places, the place she prefers. I could simply it and say “You are going here. End of discussion.” And what will determine that choice. Simply, the impression she has of where she will be happiest. Not the ratio of aides to patients; not the number of 24hr RNs (Maplewood has them; Plaza has only aides at night). Not even the cost. Am I giving my mother too much power? Control? Let it be.</p>

<p>LF,I like you and I know you personally. Try to overlook my deficiencies, and I thank you deeply for reading my posts.</p>

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<p>Just catching up on what missed while I was typing. Thanks for the input. MOST certainly, I will be driving my mother to her shrink in Westchester once a month.</p>

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<p>And after I come home from the MD tomorrow morning , hopefully with an RX for antibiotics,I will research small local movers (actually first I will see if Donna at Maplewood can give me a firm date for a nurses appraisal) and “tie down” a few moving dates with the movers.</p>

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<p>Sounds good, Dharma.</p>

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<p>Maplewood does not keep patients on with Medicaid;. BUT the Plaza DOES. I will try to reemphasize this important difference to my mother. But to speak the truth, after she depletes her assets,she will certainly be ready for a NH. The Plaza allows you to stay if you can turn the wheels of your wheelchair yourself. In a few years,my mother will probably not have the strength.</p>

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<p><a href=“Assisted Living Questions and Answers - AgingCare.com”>http://www.agingcare.com/Articles/assisted-living-questions-137146.htm&lt;/a&gt;
before reading up on movers, be sure they will aept her. the care assessment is their way of determining if they can manage your mom. On many levels. And they dont have to say yes.</p>

<p>Also, didnt ytou say your mom was frail and feeble and falls? But she can walt to you house when the house is being shown? I am confused.</p>

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<p>“And what will determine that choice. Simply, the impression she has of where she will be happiest. Not the ratio of aides to patients; not the number of 24hr RNs (Maplewood has them; Plaza has only aides at night). Not even the cost. Am I giving my mother too much power? Control? Let it be.”</p>

<p>Lots of water over the dam here. I believe we are all trying in our own way, with our own experiences and approaches, to help, DW. People have contributed in order to enhance your quality of life while ensuring that your mother is at the most appropriate place for her with the greatest likelihood that she will have needed care going forward as assets and perhaps health diminish. From where I sit, the process can be hard to follow. Some processes are complex. So we must bear with each other as the outcome unfolds. </p>

<p>Dharmawheel, I have walked this walk, both as a daughter/d-i-l of 4 in AL and NH (one now deceased) and as a professional. My strongest recommendation is that your mother go to place with the most sustainable, highest level of care. Perhaps this is complicated if one will keep her in AL post-asset depletion and one will only allow financial assistance at the NH level. In this case, given your mother’s age and health, I would choose and help her to choose, the highest level of nursing care possible for the AL placement, assuming that she access to NH and betting as you say, that she will need it. Staff ratio higher, built-in wake up and bedtime help, supervised showers, medication management, etc. They are also likely to have both greater patience and greater expertise dealing with her complications. A woman who needs full time aides in a home setting should not be in a hotel style assisted living with one aide serving many. You can compute this with the information available to you. You may not be able to anticipate the impact that this choice will have on you or your mother. I get that. I couldn’t fully either, despite indirect exposure to these issues. I get it now. Do not feel guilty about steering her a bit. She is not focussed on the big picture the way a person who has yet to need so much care can be. </p>

<p>I have also lost track of the possibility of your mother moving to AL the minute they accept her. I would hope that a simple pack up and go to AL, where little is needed, would greatly simplify the process of dealing with the sale and emptying of the house. Do not set her expectation that she will completely orchestrate that either way. It will be taken care of, but not by her spending days out of AL and choosing tea cups. </p>

<p>She has you afraid of the wrong things, DW. Focus on how finding the best care is the gift, not pleasing a mercurial woman in the moment. </p>

<p>All my best. This is a huge challenge. I know you have navigated huger ones. Keep your eye on the prize. Be forthright with her. Tell her you know moving is a nuisance and want there to be as few as possible for her. You can do it. </p>

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<p>jyym,i will take your thoughts into consideration.But,no,in fact, my mother never falls. She has the strength of mind and body to prevent a fall. She is slow, but she is always very careful. Before she had a caregiver she woud ON HER OWN, in the winter, put on her warm coat, hat, and gloves, and walk from her house down to the Greenhouse/Nursery|/ Florist shop at the end of the block. It is a long walk. I credit her; she has an amazing willl to live and keep herself as healthy and strong as possible. In the eyes of many, she is a remarkable woman.</p>

<p>Travelnut, as always, I treasure your kind-hearted posts. You are a rare spirit. I skimmed it, but I rrwill close down now and read it carefully tomorrow am. DD2 is sure to get me up at 7:30 (School starts on Wed ( whenDD2 and DD3and I have their alarm go off at 6 am!)</p>

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<p>Dharmawheel, you know your mother is more fragile than she was before her recent hospitalization. She’s not going to get less fragile and that includes mobility.</p>

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<p>Oldmom, I heartily agree, and as i mentioned before, she is clearly more aged and fragile than the average AL residents we have met. I felt this with great sorrow. </p>

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<p>Dharma,</p>

<p>My mother never fell, either…until she did, and broke her hip. </p>

<p>Many things can cause a lack of balance leading to a fall. Being strong and careful may not be enough.</p>