Elder care, such as it is

[NQAS]

Not an elder caregiver. Just a guy with an elder mother whose elder care is up in the air. My mother is 92, and until Monday I thought everything was just fine. Well, as fine as things could be for a 92-year-old.

She lives alone in an apartment in a complex in Florida. My sister talks to her every day or every few days. I call once every couple of weeks.

Long story short, she had a fall at some point between last Friday and Monday, and we ended up calling the police for a welfare check when she didn't answer her phone on Monday. They found her on the floor in her apartment, dehydrated and disoriented, but alive. Off to the hospital, where she feels like crap and according to my sister looks like she's at death's door. Living on her own is not really an option from this point on. Turns out her fridge was empty, and she was giving us a song and dance about how she gets out and about, takes a taxi to the grocery store, etc. That said, she always sounded fine. Alert, sharp as a tack. So that's a mystery.

In any case, in the hospital now, then to a rehab facility for 90 days, which is, I think, covered by Medicare. Maybe not. I'm not stupid, but I can't understand what is and isn't covered, and under what circumstances.

Then there's assisted living in her future. Maybe (see above, death's door). I can't afford it. My sister probably can't afford it. I have no fucking idea what to do now. I know my mother has been paying her rent reliably for more than 30 years, so that seems like a good sign. She has SS, SS survivor benefits, from my father, and whatever pension and/or survivor benefits from my father's pension and her own. What does that add up to? No idea. Maybe there's savings. Probably not.

Am I wrong in thinking this is like a version of Hunger Games for old people?

[elleng]

1. Sounds like there may be aequate resources to cover some sort of 'care,'

but you and your sister must examine local options (after assessing your mother's cash-flow.)

[Tomconroy]

2. I think you are right about the medicare coverage. Your mother

may be a candidate for medicaid and a nursing home. The hospital and the rehab place should have people who can help.

[snowybirdie]

3. Many hospitals have social service

departments that focus on discharge planning for older patients. Check with your mom's facility. They can help explain your options. Good luck.

[NQAS]

4. Thanks all

We're taking it one step at a time.

Step one. Hospital. So far, so good.

Step two. Rehab. Being lined up.

Step three. Nursing home/assisted living. The biggest challenge. Mainly because sibling and I don't agree on one basic decision. Where? She tells me mom can't travel - too frail - and so can't go to where sibling lives, and by extension, to where I live, slightly further away. IMO, anyone can travel. Wheelchair, relatively short trip with no layovers.

Points taken about the social services people at these facilities. I may not know what's possible, but they do. I'm going to start asking.

No less stressful, though, even with something resembling a game plan.

I think my end of life plan is to die unexpectedly from, well, from anything, but definitely before these same decisions have to be made by my children. Admittedly, maybe not the best plan. My Plan B involves an ice floe.

[zuul]

5. I don't have any advice but . . .

[slightlv]

6. We're a few blocks down that road, hon...

Our mom has dementia, so being alone in the house was a no/go for her. I brought her home to live with me. That lasted for a year. A 100 pound weight difference between us and her belligerence and violence in her dementia made living here completely untenable. She wanted what she wanted when she wanted it. Period. Most of the time, her wants could be accomodated. But certain things, like EMS to the hospital every few days... just because... became unworkable when Medicare stopped paying for them or the hospital stays. The last one put her in the hospital's elderly behavioral ward to try to get her violence under control. From there, she was rehabbed to a memory home. I ended up selling her house and everything in it to pay for her residence.

We are now finished with that money. She is broke. We are in KS. This is the way we have to be in order to apply for the KS form of Medicaid, which is called KanCare. Once you have spent down your assets, Kancare will pick up most (if not all) the extra cost of the nursing home costs that your Social Security check doesn't cover. The Social Security check goes straight to the Nursing Home. No longer makes a stop in your bank account, we discovered.

We're still trying to get this all figured out. It's a mess of paperwork, made necessarily more arcane by Brownback and company. Just writing it out has my heart beating faster. Thankfully, I have my sister to help me out on most of this, too... tho she goes into panic attacks with it, as well.

Medicaid is there to pick up the costs that are above and beyond whatever is left from your mom's Social Security check, which is why you are usually required to be basically flat broke before applying for it. I think they may give you a small stipend like $1200. But we got screwed up by the start of Covid-19 happening and no orientation at the nursing home. So some of this stuff, we missed.

Every rehab, assisted living facility, and/or nursing home has a social worker for your mom AND a finance department. Make sure you meet with BOTH of them. The Social Worker can tell you what your Mom will be introduced to as far as integration into the home - trips out, socialization with others, sleeping and eating schedules, etc. This was my Mom's downfall in the assisted living facility we first tried. We didn't realize her dementia made her far beyond their help. Talk honestly with the social worker and really know your Mom. Not knowing Mom's violent side cost us $13000 in the end.

Once you have finished with the Social Worker, talk with the Finance Department. Things to ask:
1. Will they be taking anything out of your Mom's bank account automatically? If so, how much and when?
2. At what point will she need to apply for Medicaid?
3. Will the Finance Department help you with the Medicaid paperwork and filing?
4. Will any expenses between Medicaid filing and when expenses are due be put on hold until Medicaid approval?
5. What about Medical Insurance? Will Medicaid cover all her insurance needs, including Medicare Parts A, B, C, and D?
6. If the answer to 5. if YES, at what point can you cancel her current Medicare Advance Plan (if she has one).
7. How are pensions and/or any other annuities that your mother may have coming in to her account handled by Nursing Home Finance and/or State Medicaid?

This gives you an idea of the complexity of Medicaid. Kancare is even worse. And we're up to our eyeballs in it right now. I just finished an email to the brand new finance director on our account as of last Friday. I'm terrified Mom's going to kicked out of THIS one, too, and back in with me again. I'm now disabled, so this isn't going to go well, if so. I've told Mom for years as healthy as her heart is, she's going to long out live me... and truth is, I'm probably right! (LOL)

NQAS... good luck. And DM me if I can help or you need a shoulder. This is a really scary journey. Just remember, you're trying to do your best for your Mom. You may not have all the answers, but as long as your trying that's all you can do. Don't EVER beat yourself up. Take it from someone who's been there!

[Rebl2]

7. Apply

for Medicaid. If she has little money or other assets, she may qualify.

[IbogaProject]

8. review her documents and finances

First review her documents and finances. Florida is looser with their regulatory burden, so the issue will be that she will be safe while the cost not being as excessive as other locations. She might only need assistive living and not full nursing care for now.

If she hasn't named you or a sibling to have power of attorney get that setup, get one that covers everything and then get two real short ones one to cover medical records and one to handle checking any financial accounts and to be able to speak to her creditors. Have two originals for each, one stored in a waterproof and fire resistant small lockbox and the other in something that will keep them dry in a downpour. make a set of copies of the travel ones, some places will take your copy others will want to scan the original.

The documents and totalling resources, assets and income can be done anywhere, the part about typical local costs and Medicaid for eldercare is very state specific.

Get her a medicaid workup. And once this is behind you, get you and your spouse worked up, it is best to get that all setup 5 or even more years ahead, as you can shield assets from being used up needlessly. The middle class are the ones who really get fleeced during this stage.

With rehab encourage her to make small but slow and steady progress with rehab. upto 100 days per incident per year is covered under medicare but the gotcha is they have to be making 'progress' towards reasonable (set by standards of care) progress. The inpatient rehab pros can guide her on how to do the progress over that set of time. The key is she tries and that she makes incremental progress. My mom was an athlete in her college years, so she overshot a couple of times and got discharged a little earlier than ideal, try to avoid that.

Get cracking, you won't have much time to find her a space, some good places might have waiting lists. Shop around, ask around, ask her where anyone she knows went and any feedback she heard. If she or you are part of an organized religion seek out a local church or temple.

[No Vested Interest]

9. You've received some good advice here. I'll add a few notes:

You and/or sister had best get down to FL to best determine Mom's condition/situation and state of mind. Consider her feelings re future living arrangements as much as practicable.

She should be located long-term near one or the other of you, her children. You will not want future problems, which there will be, coming as a complete surprise, if possible. Do your own research locally as to the best long-term living arrangements in your community. Proximity matters, both for you and for Mother.

Buy and pay for her funeral arrangements now, while she still has funds. This will help spend down her money.

[Trueblue Texan]

10. No one notices the situation of our elders...

...until they are dropped into the middle of it. I've seen so many middle aged folks have to quit their jobs to take care of aging parents. This puts them into abject poverty. It's a hidden issue in our society for the most part, but I see it all the time. The Biden plans address this issue. Pray they both pass.

[NQAS]

11. Update

Mom is fine. Or, more accurately, fine-ish. Was in the hospital for three days and now in rehab. I went down to Fl last week, and the place does seem nice, though understaffed.

We’re now looking for assisted living, in Florida to start with and then moving her to where I am or where my sister is.

My sister checked out a place in largo. Seems okay though the admissions person keeps calling with a hard sell. I talked to the admissions person today and got a better vibe. The hard sell might be because they only have two beds available. Or do she says. I hope she’s being honest. She sounded knowledgeable and seemed helpful, though, let’s face it, they want to fill beds.

I checked reviews online. Half of the 50 reviews are 5 star. The other half are 1 star. What gives?

So I have questions for people who have experience with these sorts of things.

Is a hard sell common?

Can reviews - good or bad - be believed?

Anyone with knowledge of Seasons Assisted Libing in Largo?

Any other comments/ insights welcome.

And to answer that age-old question- no, we are not having fun yet.

[dem in texas]

12. I don't know if this helps, but here's my story

My mother was living with my sister out in West Texas. My sister worked so Mother was alone during the day. She fell, same as your Mom, but was found by my sister when she got home from work. We knew she could not stay alone anymore, so we decided on assisted living. We thought it would be best to move her up to the DFW area where most of her kids lived. We visited 5 assisted living places and settled on 2 we liked best - we judged them on location, size and price. We selected 2 out of the 5 , then my sister drove Mother up to Dallas and she visited both and picked the one she liked best. It was close enough that my sister and I could visit her often, we decided to take turns visiting, so it worked out well.

It was a one floor building with a center that had the offices, kitchen and dinning rooms,meeting and craft room, plus a little beauty shop. The rooms for the clients went out in wings from the central area. Each wing had a station staffed 24 hrs a day. Mother lived there for 5 1/2 years until she passed away. She was not happy at first, but she ended up liking it.

The reason I am describing the facility to you is that many of the Assisted living places in the DFW are multistory buildings requiring the resident to take an elevator downstairs for meals. My sis is in one of these bigger assisted living places and it is hard for her to navigate, it is so large and she has trouble walking or using a wheelchair. Plus it is harder for a visitor to get in the building, have to make an appointment to visit and it takes a lot of planning to take her to the Doctor, etc.