Was awaked at 3 am by someone pounding on the front door, then heard him say “police!”. I saw the squad car so opened the door. Turns out a neighbor in the next block had opened the door to an elderly man wearing only underwear, confused and speaking German mixed with English. My husband is German so the police officer was hoping he could find out where the man lived. My husband determined that language was not the barrier, the man didn’t know where he was and was mumbling incoherently. It was apparent the police officer was unfamiliar with dementia, he kept asking for the man’s phone number and address. It left us wondering what the police would do with the man, would he be put in a hospital until relatives were located? What would happen if no relatives were located? I’m going to ask my mom’s AL facility about this. I doubt she could get far at this point, but she would be completely helpless if she got out and she thinks she lives in a different city. She had a “wander guard” anklet but it had to be removed when she got a leg infection. Do they make microchips for people, or would that be considered inhumane?
Wow, momsquad. I guess your neighbor knows that your husband is German, or you live in a very small town.
I suspect it is similar to training/lack of training in intervening in situation with mentally ill people. The officer was trying to be helpful, but didn’t know how. I’d think getting the poor guy someplace where he could be safe and warm would be the first action.
I’ve thought about the microchips for people, but I gather that isn’t allowed. Would a wander-guard bracelet be a possibility?
Some kind of ID necklace or bracelet?
It’s sad that the officer wasn’t trained to know that escaping their home and wandering in a confused state is common with elderly people with dementia. But as arabrab says, in many cases the police are woefully undertrained to deal with the mentally ill.
MIL flunked the AL test, but SNF is too expensive right now. Now we have to prepare for an intervention to address issues with their current situation 
Oh dear. So sorry to hear this - went through this with m-i-l in January - and luckily she did qualify for AL. Good luck to you and your family.
Sorry somemom! My mom flunked her AL test almost 2 years ago now, and in the long run it was better that we got her placed in memory care right away. I saw in one of your older posts that you inquired about medications for FIL. My mom’s gerontologist said that standard anti anxiety meds are avoided because they can lead to drowsiness and falls. My mom was put on a low dose or Seroquel (25 mg 2x day) and it worked wonders. Two neurologists told us to disregard the safety warnings that are in the media about Seroquel, they felt the med was very safe in their experience. Intervention will be painful but will be the start in the right direction. All the Best.
@somemom - one thing I thought of during these evaluations for my mom is it got everyone on the same page for her needs. We needed outsiders as we were all thinking something different. It’s astounding to me how many seniors have no plan for themselves as they age, (and many times not enough funds)
How many times do people want to avoid discussions of topics, and for the elderly they cannot fathom the changes in their ability to handle ‘status quo’. Mental and physical challenges and coping.
Hugs to all those dealing with these difficult issues and knowing your parents need to get into a better and safer living situation.
MIL has a good attitude. FIL has done better since he got past the anger in his physical decline and usually appreciates the fact that they are still living fairly independently in their own home.
Catholics pray for a ‘happy death’ for a reason too! Sometimes cannot avoid suffering, but out of ACTS (various prayers, T for Thanksgiving, C for Contrition, A for Adoration) many of us head right to S, Prayers of supplication.
I have read many forums here concerning retirement in which posters said that they planned to live in their homes and one day magically die in their sleep or otherwise keel over dead. Alas, it almost never works like that.
I just got my mom a handicapped parking placard and cane (she took two spills in Rome). Since I’m using a cane while my fibula heals, I’m an example for her and she uses it some now too. We get her to use it with her placard, so folks don’t wonder whybshe has the placard.
It takes time, but she’s getting used to having the cane around and wlaks with more confidence and longer strides with it.
My parents also had no plans for their elder days. Actually my mom - who always told me the world would end in 2000 and would be surprised if she could understand that it is now 2015 - “planned” that the very large pine tree that looms over their former house would crash down some night and take her and dad with it. Well, Dad is gone, the pine still stands, and her move to a nursing home is in process. Though Dad also failed to execute an actual plan, at least he left her with enough funds to keep her comfortable these final years.
I do understand where their generation’s plans, or lack of plans, has come from. In their growing up years not many folks lived into their 70s, 80s and 90s - and if they somehow did, they often just lived on with their children and grandchildren. I’m sure that was always somewhere in my mother’s mind, that if the tree didn’t get her - family would always take care of her, just as her mother had always taken care of the aging ladies of her time.
I am at my wit’s end dealing with mom’s incontinence. I spent hours over the weekend reading reviews and ordering a slew of new brands for pull on underwear, booster liners, washable and disposable bed underpads, and cleaning cloths. A few things arrived today and I’m crossing my fingers that something works. This is the stuff no one talks about - or even knows about (talking about other family and friends here). Taking a parent into your home and dealing with the slow decline. Mom has memory issues, but is otherwise healthy and at this rate, will likely outlive me. She seems to be clueless about when to change her garments (thank goodness she can do that herself!) and either waits too long, or sleeps too deeply for too long. I just bought a new mattress, have it triple zipped in waterproof covers, and am ready for another go at this problem.
somemom, good luck with the intervention. I hope you have some non-family members involved, such as doctors or social workers. The combination of family dynamics and our parents’ generation’s tendency to defer to medical and government workers means that anything coming from the doctor’s office gets much more response from FIL than anything coming from kids or their spouses.
And psychmomma - bless you for dealing with this. I can be a daughter/DIL, but don’t think I could handle the daily caregiving without breaking down. Maybe breaking bad.
[Part 1/2]
Guys, I need some help/advice.
This is in regard to my 85 year old grandmother, who had a major hemorrhagic at the end of last October. Right now my mom is doing most of the looking after her, and I’m pitching in where I can. My mom is not as sophisticated with managing this stuff as it appears some of you guys are, and she’s very prone to anxiety.
For some background, my mom and sister live with my grandmother in a home owned by my grandmother. I do not live with them.
So last October my grandmother has this major stroke. She has the stroke while my sister is home with her, and my sister calls an ambulance, which rushes her to the hospital. She has no advanced directives in place, and is full code. My mom, my sister, and myself, show up in the ER and they tell us the options and ask us what we want them to do. We choose emergency surgery since they said clot busting medication is unlikely to be effective. They perform it and she lives, but it takes over 4 hours from the time her stroke initiated (She spends like the last 3 of those incapacitated), and they don’t quite get all of “it” (I forget the technical term). They say that what’s left isn’t in a critical part of the brain.
She spends the next week or so in the hospital, with a tube stuck down her throat for 2 of those days. after that, it’s on to the acute rehab wing of that same hospital for 21 days (this potentially should have been longer, but we just did what they told us). She made some progress during that time, progressing from being completely helpless to being classified as “min assist”. From there they discharged her to a skilled nursing unit, which was more homely, but probably didn’t have as good or as frequent of rehab. She spent 100 days there, using up her full Medicare benefit for this benefit period. At this place it seemed like she was making very incremental progress at first, but then she sort of started regressing physically and mentally. Some days she was relatively sharp, and some she seemed either out of it, or occasionally delusional. She did have an esophageal widening surgery arranged which was supposed to help her talk and chew better. At the end of this stay, she was still min assist or worse, and my mom expressed concern about her coming home. On the basis of there being some optimism that the surgery would help her, they discharged her to a rehab hospital (but not the one she started at; they rejected her. Now I’m wondering why she didn’t just stay in acute rehab longer the first time).
I oversaw her transition from the nursing home to the rehab hospital, and she was acting very out of it, she said a couple delusional things, and she could only transfer from one wheelchair to another with someone holding her to maintain her balance. It’s been about 2 weeks since then that she’s been at the new rehab hospital. They’re saying she’s doing better and can stand on her own, and walk a certain distance with help before becoming fatigued. She also seemed mentally sharper when I visited her the other night.
My mom got a call today that they plan to release her back to the nursing facility one week from today. She’s out of skilled nursing days under Medicare for this benefit period, so I hope that is the suggestion of the social worker of the hospital, and not an order. I don’t have any reason to believe that the social worker has applied to be the guardian/custodian, so I wouldn’t think she could tell my grandmother where to live. To me it seems viable that my grandmother could go back home and have my mom and sister look after her. My mom teaches 8-5 and has the summer off. My sister works about 8-12 out of the house, then does contract work from home. It’s in my grandmother’s chart that she needs 24/7 care, because she can’t go to the bathroom on her own (yet. I’m hoping she gets there, but I’m not holding my breath) or bathe herself. I figure that we can fill the gaps in with a home health aide at $15/hr or whatever. My grandmother has some savings. Medicare would also cover in home rehab. We can order medical supplies and life alert. And I can take over paying her bills, and cook some meals at my apartment and put them in her freezer.
Remember how I said my mom and sister live in her house? It’s because my mom raised my sister and I as a single parent with the help of my grandparents (all 5 of us lived under one roof for parts of about 20 years). My grandfather died in 2013, and my grandmother had been healthy-ish up until her stroke, but wasn’t very good at maintaining her home and her finances. Because of my mom’s anxiety and the like, I guided my grandmother through probating my grandfather’s will, and I negotiated on her behalf for a contractor to come de-bug her house and paid for him to do it. My mom helped her in other ways.
All this is to say: She doesn’t have a long-term care insurance plan that I know of. If it’s possible and humane, I don’t want her to spend the rest of her life in a nursing home on Medicaid, and have the state seize all her assets (including the house my mom and sister are living in) as reimbursement. I love her very much and want her to be taken care of and as comfortable as possible, but I also feel like I have to be the one who looks out for the financial best interest of the family. When I helped my grandmother probate my grandfather’s will and I helped the attorney put together the inventory of their assets, I noted that she had about $42,000 in misc stocks (which some ■■■■■■■■■ financial adviser had invested in a handful of risky stocks at a high load expense) and savings, a decent sized acreage in rural Texas of unimproved land that timber grows on that was last appraised by the taxing authorities at ~$85,000, and 100% equity in her homestead, valued by Dallas CAD at $135,000 (which is probably conservative compared to the comps for the neighborhood), but which has to be too high based on all the deferred maintenance, structural issues, pet damage, and random stuff that would have to be brought up to code to sell the place. I’m actually really curious what an appraiser would mark it as.
Her will specifies a 50/50 split between my mom and my uncle, her 2 children. If she passes away without this Medicaid doomsday scenario unfolding, what I’m think is that my mom can keep the house, and my uncle can keep the rest. I think that would work out close enough to a 50/50 split, it would avoid transaction costs and sweat associated with selling the home, keep my mom from having a nervous breakdown from losing her mom and then having to move, and it would keep a roof over my mom’s (and sister’s) head and not put them in a position where they’re managing their own money and accountable to a landlord (My mom is terrible with money). My mom doesn’t have much, if anything saved up for retirement (or many pension benefits due), so she’ll probably be living with me some day. But I’m hoping that day isn’t tomorrow. I do realize there would be some advantages of my mom and uncle just selling the house and splitting the proceedings, such as my mom not having to maintain a household, paying a huge energy bill, paying high property tax (at least until she could get her own over 65 exemption). Nonetheless, I digress.
I have read that my grandmother could transfer the house to my mom without the house being subject to estate recovery or delaying my grandmother’s eligibility for Medicaid under this provision:
A home may be transferred, without penalty or lien, to:
The person’s adult child, if: (1) the child has lived in the house for at least two years prior to the parent moving into the nursing home; (2) during that time the child cared for the parent; and (3) that care allowed the parent to remain at home for that time instead of entering a nursing home.
Source: http://aspe.hhs.gov/daltcp/reports/hometreat.htm
[Part 2/2]
Now I don’t know if that means that the only way this can work is if she transfers it while she’s still alive, or if it also means that Medicaid wouldn’t take the house after her passing because my mom lived there and cared for her. I asked on an online attorney message board how one goes about “proving” that they met that third condition, and how strictly it is scrutinized. I would argue that even before the stroke, my grandmother couldn’t have lived on her own without the help of her family. Her house was rat infested until I stepped in and took control. Terminix was happy to charge her an indefinite monthly fee for a technician to come out to the house high and spray some febreeze in the hallway until I stepped in. So I think my mom should be able to give her statement that she lived in the house for 2 years provided care for my grandmother that kept her out of a nursing home. Even if my grandmother has to go to a nursing home a week from now, I think my mom should get the house. Although even with that said, my grandmother would rather be at home, and my mom is willing to care for her if possible. I need to talk to a local attorney who specializes in elder law/Medicaid about it this weekend and about how to avoid any pit falls in transferring the residence.
Circling back to her impending release from acute rehab, I also thought I read from the Medicare website that she got up to 60 days acute rehab per benefit period, plus up to 60 days lifetime reserve. And I thought I read that the standard for Medicare to keep her in rehab was that *her presence in rehab would keep her condition (post stroke complications) from deteriorating. I read that the standard had recently changed from “You can stay as long as you’re making progress” to “You can stay as long as the rehab is keeping your condition from worsening” because of a lawsuit settled by a court.
So to wrap up, here are my questions:
1.) I think more time in rehab will be good for her. One of her original doctors told me that people can recover from a stroke for about 6 months, and then after that, their progress kind of plateaus. It’s been about 4.5 months. How do we go about appealing her discharge from the rehab hospital to Medicare? Do I need to get in contact with a patient health advocate? Call AARP? Retain an attorney? I don’t know what all factors are at play here, but I have some suspicions (maybe unfounded) that the hospital she’s at is keeping a close eye on their reimbursement rate, and that they know she stays at min assist instead of going up to modified independent it will effect their health scores and reimbursement. I suspect they also like patients paying with private insurance to medicare patients. But if they want her gone, and Medicare agrees with us that her leaving will cause her condition to worsen, then I want us to advocate for her.
- For anyone who has legal training, does it sound like I'm on solid ground with at the very least my mom being able to keep the house if my grandmother goes on Medicaid? Medicare does not pay for long-term custodial care, only Medicaid does.
- That first rehab center discharged her after 21 days even though she was still min-assist, and even though it looks to be like she gets 60 days of acute rehab per benefit period. They transferred her to skill nursing (which is also called sub-acute rehab), where it looks like her physical and mental abilities atrophied somewhat (and she's had a cat scan since then, so it isn't attributed to a subsequent minor stroke or anything). Then after the new rehab center accepted her, my mom tried to get her into that first rehab center. They refused, and the doctor's assistant mentioned that they were concerned about how much progress my grandma could make, and how it would affect their health scores. Do we have any legitimate grievance or action against them, or should we just let that go?
- Is it reasonable to think that she can live in her home with my mom and grandmother? I'm hoping she has a breakthrough and can hit modified-independent status in the next month or so of rehab, but I think it's more likely she stays at min assist, or gets worse. With 2 adult family members living in the house, some savings to hire home health aides, and medical equipment like a hospital bed, lift chair, elevated toilet seat, walk in shower, wheelchair, rollator, life alert, etc, can we make this work? And if I pay all her bills and help make her food.
I really appreciate any and all advice you guys can offer. It seems like most people here are well educated, and at the age where they have a lot of life experience and are now responsible for taking care of a parent/parents. I personally feel overwhelmed as a 27 year old, and for as much as my Mom tries, I’m not confident in her ability to navigate this alone. She’s had a hard life, and she shies away from making difficult decisions, and instead goes back and forth between being paralyzed by anxiety and saying stuff like “God will take care of it”. She needs my help. I also should have mentioned that my grandmother has Medicare Part C private insurance that she pays over $200/mo premium for, and is supposed to fully cover all the “gaps” in Medicare coverage. So I’m hopeful that there won’t be any surprise bills in the mail from all this (but I’m nervous). I’ve also read stuff online that has me nervous, such as the fact that some of the more upscale nursing homes accept patients on a “non Medicare assignment” basis, meaning that they charge a rate that’s significantly above what Medicare reimburses, and they bill the patient the difference. Although my mom did stress our needs and the financial situation to the various business people and social workers, I know she didn’t fully research all the pitfalls, and I’m sure it would be easy for an unscrupulous person to take advantage of her.
Anyway, any and all advice is very much appreciated!
Someone else will chime in but on assets I am pretty sure the look back period is five years.
Yeah, five years is the lookback period I believe, but the rule about transferring your house to your adult child who lived there 2 years and provided you care keeping you away from a nursing home is an exception to that rule I believe. If the rationale has to do with balancing the budget, then it makes sense–someone who stays in their home longer saves the state/fed gov’t money compared to someone who goes to a nursing home on the government’s dime.
it’s a different circumstance.
States are prohibited from making estate recoveries:
…In the case of the former home of the recipient, when an adult child has lived in the home for at least 2 years immediately before the deceased Medicaid recipient was institutionalized, has lived there continuously since that time, and can establish to the satisfaction of the State that he or she provided care that may have delayed the recipient’s admission to the nursing home or other medical institution.
Some of this may change, depending on the state (eg, I’m not even sure my state recovers or that they do so in all cases or whole-heartedly.)
Part of my point is that, at 85, and with your mother there continuously, for years, Mom can likely show she did care for Grandma, prevent an earlier decline.
And here’s something for Texas http://www.dads.state.tx.us/services/estate_recovery/ Look at “Are there times when the state will not ask for money back?”
Also, to get to Medicaid, the assets (not including the house, I think,) have to be significantly depleted, so Uncle wouldn’t have that to inherit.