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Old 11-10-2019, 02:15 AM
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My mother is being booted out of the assisted living home


She has ALZ. i don't know what level actually, but her short term is less than a minute. Otherwise she's healthy as hell. Takes no meds other than an anti-depressant and Aricept. She is gleefully incontinent. (if you've been there, you understand)

But she's nasty and mean. Really mean. She's on the regular assisted living floor, but needs more care. The facility does have memory care facilities, but they want her gone. They've advised us that they will not continue caring for her, and they've extended us 30 days to move her.

She's combative and agressive, even towards us, her children. And Og help the poor underpaid and overworked staff. And then there's The Patient's Bill of Rights that says she cannot be forced to shower, change her poopy briefs, etc. Short - she's out.

They suggest a group home or behavioural facility. We ( her 4 kids ) havn't a clue what to do. Anyone have any thoughts??
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Old 11-10-2019, 02:28 AM
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Only one thing I found with my inlaws. The mean stage is usually limited.
My FIL was a mean S.O.B. before his dementia set in, but we did see improvement after awhile. MIL was the sweetist person ever. She got mean as a wet wasp for a few weeks. It was hard dealing with her. She hated everybody and everything. She passed through that phase, finally.
I wish you good luck. Look for a dedicated memory assisted place. They'll understand her case better.
Some doctor or health professional may answer your O.P., so I'm gonna ask this; Is there not some medicine that could smooth them through the angry, mean phase?
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Old 11-10-2019, 07:46 AM
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Your situation is pretty common. Happened in my family with my Gma. There are assisted living facilities out there that are for alzheimer's patients exclusively. I would be surprised if the place that is booting her out doesn't have at least a few listed somewhere. But that's what you need is a home that specializes in alzheimer's
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Old 11-10-2019, 10:47 AM
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Isn't a "home that specializes in ALZ" just Memory Care? In my experience, Memory Care facilities won't take a combative or violent resident. I was "lucky" in that my mom's physical condition deteriorated as well as her cognition, so she was moved into a skilled nursing facility when she wasn't able to live at home. I did go through a nightmarish couple of weeks, talking to many Memory Care facilities who all refused to take her. It's a horrible situation to be in. My first step would be to talk to the social worker at her current facility and see if they have ideas about other facilities who would be able to care for your mom. The social workers should have a good idea of the policies and capabilities of other facilities in the area.
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Old 11-10-2019, 10:52 AM
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There's also this web site which purports to match patients to appropriate facilities: https://www.aplaceformom.com/
I used them with mixed results. They did refer me to some nice places, but none of them were able to care for my mom. If you use them, be crystal clear about what the issues are so you don't waste time looking at inappropriate places.
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Old 11-10-2019, 11:57 AM
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Have you asked them directly what they suggest? It sounds like they just want her to somebody else's problem, but that's not acceptable. You can't just ditch a human.

"I know Mom is next to impossible. The thing is, we don't think she'll last long on the streets, and we can't find any other options. Where do you suggest we take her?"
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Old 11-10-2019, 12:02 PM
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Takes no meds other than an anti-depressant and Aricept. She is gleefully incontinent.
I would definitely look into additional meds. My mother has had dementia for about the last seven years. About four years ago she began to get seriously mean and disturbed. If you contradicted her or tried to get her to do something she didn't want to do, she would physically attack you. She tried to scratch me, and tried to hit my sister with her cane. She hallucinated hearing babies crying, and if you refused to help them, she would accuse you of being in on the conspiracy to kill them.

We got her doctor to adjust her meds, and she calmed down. She still hears the babies sometimes, but if you tell her they're alright, she lets it drop. I assume you have a medical proxy and can make decisions for her?

We were fortunate enough to be able to get 24-hour care for her at home. (She's the only one who lives there, besides her aides when they are on duty, although a friend of the family lives in the downstairs apartment of the house.) Although she can walk, at this point she rarely gets out of bed.
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Old 11-10-2019, 12:16 PM
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Well, we've gotten our 30 day notice, legally they only need give us 15 days, but even with their Memory Care dedicated facilities, they want her gone. Yes, I would love it if more, stronger different meds would help, getting a pill into her is a battle every time, she hides them in her mouth and spits them out, we found pills all over the floor under her bed. And of course there is the sibling dynamic, my one sister doesn't think Mom needs more meds, just more understanding care, which is horseshit. She even pulled her off the anti's cold turkey, which caused a small riot.

I think that at this point the family dynamic is the biggest problem, my brother has POA, both legal and medical, but he'll need to grow a pair to go up against my sister who just wants more love. In the meantime, IDK what the fuck.
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Old 11-10-2019, 12:18 PM
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I'm with Colibri. Your mother needs to see a doctor who specializes in dementia. Anti-depressants and anti-anxiety drugs are tricky with elderly people generally, and dementia patients in particular. Some combination of something might help.

I'm really sorry you're going through this. My mother just became sweeter (and more anxious) as her dementia progressed, and that was hard enough.

ETA: Sorry, we cross-posted. Yeah, your brother needs to step up. Or you could send your mother to your sister's house for the love.

Last edited by Emiliana; 11-10-2019 at 12:20 PM.
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Old 11-10-2019, 12:46 PM
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I would definitely look into additional meds.
This is a complex area. Chemical control is frowned upon, and the benefit to the patient must exceed the risks, without regards to the effect the behavior has on the caretakers. Of course, risk of harm to caretakers must be minimized, but other means should be exhausted first. The Medical POA must work closely with the prescribing practitioner to do the right thing here. Disruptive behavior by itself is not a threat to the patient's life or health, after all.

I hate dealing with these issues; I have been in lawsuits testifying for infirmaries that have had to handle such patients.
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Old 11-10-2019, 12:58 PM
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Yes, I would love it if more, stronger different meds would help, getting a pill into her is a battle every time, she hides them in her mouth and spits them out, we found pills all over the floor under her bed.
Fortunately my mother hasn't been too resistant to taking meds. She takes a handful in the morning, but takes the antipsychotic in the evening separately. Sometimes she asks what it is, and we tell her it's her "memory pill." Since she's very distressed by her memory loss, she takes it willingly. (Among my siblings, we refer to it as her "crazy pill.")

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And of course there is the sibling dynamic, my one sister doesn't think Mom needs more meds, just more understanding care, which is horseshit. She even pulled her off the anti's cold turkey, which caused a small riot.

I think that at this point the family dynamic is the biggest problem, my brother has POA, both legal and medical, but he'll need to grow a pair to go up against my sister who just wants more love. In the meantime, IDK what the fuck.
Sorry to hear this. Fortunately my siblings (who include among them a psychologist in a mental hospital, a social worker, and a nurse) are all in agreement.
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Old 11-10-2019, 01:09 PM
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This is a complex area. Chemical control is frowned upon, and the benefit to the patient must exceed the risks, without regards to the effect the behavior has on the caretakers. Of course, risk of harm to caretakers must be minimized, but other means should be exhausted first.
As I said, she physically attacked people (fortunately not her caretakers), and would also would try to get down the stairs, which if she had fallen would have been the end of her. When I was minding her overnight I had to keep the door to my bedroom locked. And she was in constant mental agony about the babies she thought were being tortured. She would spend hours screaming out the window in the middle of the night for the police to come and rescue them.

I'm well aware of these issues. My father was a sometimes violent schizophrenic. Once more effective anti-psychotics came along, I think his life and the lives of those who had to deal with him vastly improved.
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Old 11-10-2019, 01:20 PM
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As I said, she physically attacked people (fortunately not her caretakers), and would also would try to get down the stairs, which if she had fallen would have been the end of her. When I was minding her overnight I had to keep the door to my bedroom locked. And she was in constant mental agony about the babies she thought were being tortured. She would spend hours screaming out the window in the middle of the night for the police to come and rescue them.

I'm well aware of these issues. My father was a sometimes violent schizophrenic. Once more effective anti-psychotics came along, I think his life and the lives of those who had to deal with him vastly improved.
Treating patient distress is a legit reason for such med use, but quite often they're not distressed, just angry. As I said it's a challenging area to navigate and I'm glad it worked out favorably for your mom's situation. It's a horror for everyone. Especially when the doc gets sued by some public advocacy agency for the elderly about prescribing such meds with the agreement of MPOA and family.

Last edited by Qadgop the Mercotan; 11-10-2019 at 01:22 PM.
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Old 11-10-2019, 01:40 PM
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Isn't a "home that specializes in ALZ" just Memory Care? In my experience, Memory Care facilities won't take a combative or violent resident. I was "lucky" in that my mom's physical condition deteriorated as well as her cognition, so she was moved into a skilled nursing facility when she wasn't able to live at home. I did go through a nightmarish couple of weeks, talking to many Memory Care facilities who all refused to take her. It's a horrible situation to be in. My first step would be to talk to the social worker at her current facility and see if they have ideas about other facilities who would be able to care for your mom. The social workers should have a good idea of the policies and capabilities of other facilities in the area.
No, even though they are quite similar, homes that specialize in Alzheimer's (in my experience I should say) have staff that are trained to deal with ALL aspects of the disease, in the case of my Gma, the home she went to that included a ... case worker? Advocate? Company Representative? I don't really know what her job title was but at least part of her job was dealing, and working with family.
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Old 11-10-2019, 02:04 PM
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I must add another ugly thing. The majority of help at the facility, esp. in memory care, is black. Mom is especially, viscously nasty with them, and you can imagine how she speaks and reacts to them.
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Old 11-10-2019, 02:22 PM
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viciously, sorry
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Old 11-10-2019, 02:28 PM
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viciously, sorry
Yeah, glad it's not liquid-based.


(bit of [very] tiny humor to maybe help a bit on the stress)
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Old 11-10-2019, 02:29 PM
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I remember a newspaper article a few months ago about a similar situation in this rural state. The wife just systematically starting calling up places and finally found one over 100 miles away. This is what I suggest you do and if they say they are not interested ask for recommendations. There might be a local ALZ organization or specialists you can ask.
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Old 11-10-2019, 02:46 PM
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We are in the midst of something similar with my mother-in-law. The place she is in will keep her, but the costs are now extremely high. Unfortunately, it's easy to see that they will keep rising from here. We are covering this and we can't keep doing it.

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There's also this web site which purports to match patients to appropriate facilities: https://www.aplaceformom.com/
I used them with mixed results. They did refer me to some nice places, but none of them were able to care for my mom. If you use them, be crystal clear about what the issues are so you don't waste time looking at inappropriate places.
I am using several of these sites right now and I have come to the conclusion that they are essentially useless. Most homes are not listed.

I am finding more useful information by finding the county group that handles elder issues. Usually, if I start at the county website I can look for social services and then find something. The elder services offices often have housing services. I have also thought about finding local senior centers and calling them to see if they have any referrals to make. I haven't gotten that far.

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I'm with Colibri. Your mother needs to see a doctor who specializes in dementia. Anti-depressants and anti-anxiety drugs are tricky with elderly people generally, and dementia patients in particular. Some combination of something might help.

I'm really sorry you're going through this. My mother just became sweeter (and more anxious) as her dementia progressed, and that was hard enough.

ETA: Sorry, we cross-posted. Yeah, your brother needs to step up. Or you could send your mother to your sister's house for the love.
I agree with Emiliana. If your family cannot agree on sending her to a dementia doctor (who should also have good suggestions on where to find housing), then the sister who thinks she just needs love needs to take her.

In our case, I am starting to have luck by looking at religious homes. I should note that my MiL is very religious and has been her whole life. She recently asked me if she could move to a religious home. They are not listed with any of the services, so it's taken more digging to find them. The ones I am finding though are less expensive and more accommodating. It's something to look into, if your mom was ever at all religiously inclined.

We are also exploring at home care with us.
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Old 11-10-2019, 02:46 PM
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In my experience, when you call a facility you will be transferred to a marketing person, who will be more than happy to invite you to come in, talk to them and tour the facility, regardless of whether they can actually provide the needed care. Again, you need to be very clear about the issues, maybe describe a few specific incidents, and ask them if they can handle that behavior.
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Old 11-10-2019, 09:55 PM
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Try finding a care manager - the county agency for aging where you live may have a list of them. I used one for getting my parents into a nursing home. They will know a lot more about what's available in your area than just about anyone else. The Aging Life Care Association is a professional organization that certifies care managers - they have a look-up on their site here and there's lots of other resources on the site as well.
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Old 11-10-2019, 11:29 PM
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See if there's a psych facility in your area that has a geriatric psychiatrist on staff. A geriatric psychiatrist could address both the combativeness and the medication issues. She probably does need to be medicated, and a geriatric psychiatrist would be best equipped to figure out what meds she needs and how to get them into her. Once she's on meds for a week or two, she may become more tractable, which may make her more inclined to take and swallow meds. She could then be transferred to a regular nursing home with a memory care unit.
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Old 11-10-2019, 11:39 PM
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I appreciate all the suggestions. The facility that she is in now has been pleading with the family for additional medications. It comes down to a power struggle between 2 of my sibs. She has seen a gerontologist, but will no longer go to any medical appointments. I think, yes, I will call the State and County agency on aging, and the ALZ Association, but I am pretty much powerless, when my brother holds POA and backs down to my sister who actually is in denial.
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Old 11-11-2019, 10:10 AM
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I appreciate all the suggestions. The facility that she is in now has been pleading with the family for additional medications. It comes down to a power struggle between 2 of my sibs. She has seen a gerontologist, but will no longer go to any medical appointments. I think, yes, I will call the State and County agency on aging, and the ALZ Association, but I am pretty much powerless, when my brother holds POA and backs down to my sister who actually is in denial.
I am an only child, and more than one social worker I spoke with about my parents said "good!" when they asked about any siblings who might need to be in on the decision-making process - for exactly this reason. I'm sorry that this is going to be even harder than it already is.
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Old 11-11-2019, 11:00 AM
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Those social workers are jerks, or forgetting, on one hand, that a family which is in agreement is much better in that kind of situations than a single person, and on the other, that some people manage to have arguments with themselves which make parliament debates look like majorette displays.
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Old 11-11-2019, 12:16 PM
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I appreciate all the suggestions. The facility that she is in now has been pleading with the family for additional medications. It comes down to a power struggle between 2 of my sibs. She has seen a gerontologist, but will no longer go to any medical appointments. I think, yes, I will call the State and County agency on aging, and the ALZ Association, but I am pretty much powerless, when my brother holds POA and backs down to my sister who actually is in denial.
So what really needs to happen is that POA Brother and Sister need to meet, together, with the care staff. You can't change either one of them, but if she's local, you can force her to face the people paying for her denial.

Does POA need to make everyone happy? Because he can either make his sister unhappy or you unhappy. Is there some reason he would rather placate the sister than you?
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Old 11-11-2019, 01:24 PM
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Does POA need to make everyone happy? Because he can either make his sister unhappy or you unhappy. Is there some reason he would rather placate the sister than you?
His job is not to make either sibling happy. It is to do what in his opinion is best for the mother. Period. If he doesn't want the responsibility he needs to pass it on the the alternate POA.

Short term of less than a minute is far beyond the capability of a regular assisted living facility to handle. However, I am not sure they can just turn her out onto the street after 30 days - that would be an "unsafe discharge". Don't know if that applies to assisted living facilities.

My MIL qualified for a Medicaid funded nursing home once her dementia progressed to the point where she was incontinent. Her other medical needs could have been handled without skilled nursing care. Others in her section of the nursing home were likewise not medically frail but definitely mentally not there.
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Old 11-11-2019, 03:33 PM
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His job is not to make either sibling happy. It is to do what in his opinion is best for the mother. Period. If he doesn't want the responsibility he needs to pass it on the the alternate POA.

Short term of less than a minute is far beyond the capability of a regular assisted living facility to handle. However, I am not sure they can just turn her out onto the street after 30 days - that would be an "unsafe discharge". Don't know if that applies to assisted living facilities.

My MIL qualified for a Medicaid funded nursing home once her dementia progressed to the point where she was incontinent. Her other medical needs could have been handled without skilled nursing care. Others in her section of the nursing home were likewise not medically frail but definitely mentally not there.
He says he wants to keep the family peace, he's failing miserably.

The facility she is in, as I said, has memory care for ALZ patients on site. They just don't want her.They have quoted the appicable law to us regarding booting her out, legally they need only give us 15 days notice, we have 30.
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Old 11-11-2019, 04:03 PM
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He says he wants to keep the family peace, he's failing miserably.
Right, so that's the point: he's failing to keep the peace with you, and he's failing your mother. So the only one happy is your sister-in-denial.

So why is he prioritizing her over you or your mother or your other sibling? Is he also in denial and using her as a pretext? Is she the one who is most likely to give him grief for not placating her? (Because, although it's not ideal, you can outdo her in this regard if you need to and become the one to be placated.)

Anyway, it sounds like the healthiest thing to do is to withdraw from the discussion. "POA, if you're going to cave to Sister-in-Denial, I'm out. You can deal with all of this on your own, with no support."

Practically, you can't intervene on your mother's behalf without taking everyone to court, and by the time that's settled she will be dead. Her quality of life is, it sounds like, entirely in the now, and so even a poor outcome doesn't greatly increase her suffering: it's already pretty bad for reasons that are nobody's fault.
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Old 11-12-2019, 11:15 AM
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Conference call with all sibs today (4 of us). Give me the strength to STFU.
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Old 11-12-2019, 02:27 PM
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Good luck. Thankfully my mom was a happy smiling calm turnip - all the staff loved her, she never gave them any trouble.

As opposed to our roomies mother. Charlotte was just starting the slide into dementia at 82, but she was *nasty*, alcoholic and passive-aggressive. At one point when she had to be transported to a hospital because of a fall she had managed to convince one of the ambulance crew that she was being abused. *sigh* When we had her regular social worker over to talk with us, she commented that she had never seen such a well set up house - we had a stair lift, a very nice custom handicapped roll in shower stall and it wasn't a freaking mobile home next to the Tar River in Greenville South Carolina [where we had moved her from] it was a 4 bedroom, 1.5 bathroom mid 60s tract house in western NY. We had to move her because she had antagonized every single social services bunch and both residence facilities down there. [And I had the house, and we had plenty of space for her.] Several times when she was in and out of the hospital she tried the whole abusive household deal, and her social worker shot down every single attempt [as if we would send her back to live on her own 800 miles away...]
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Old 11-12-2019, 03:31 PM
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So more of the story..........

The facility she is in now determined she needed their memory care unit. But first they wanted to evaluate her. She got combative in the evaluation. So my brother suggested he sit in. Same result, throwing something down on the table. Yelling.

So she's to be moved. There is a memory care facility my brother liked and had an initial meeting with. He and my sister, who is an RN, are going to look at it manana. However, they will need to do their own evaluation. Brother said he gave them a short rundown on the issues where she is, they didn't seem concerned, but then again, I suspect he spoke with a marketing person who wants to fill a bed.

And I wouldn't be surprised if new facility spoke with current facility. So she has to sit for a new evaluation. And not throw things and act out.

I suggested and was astonished when my suggestion was met with approval, that they get her some stronger meds at least to get her thru the eval. One issue is she spits out meds. Dunno how that will work.

My sister is going to call the ALZ assocation and the county aging people as well as a list of people her current facility recommended. Because if we can't get her in somewhere, she will be living with my brother and chaos will ensue. Or murder. Thank og I live in a teeny house with no room.
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Old 11-12-2019, 06:03 PM
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One area to keep an eye on is how things are categorized vs. the details given. "Combative" sounds serious. Throwing something on the table and yelling doesn't sound serious to me -- it sounds like what I would call as a lay person, agitated, or something similar. Oppositional or agitated or uncooperative is not the same as physically attacking or fighting with caregivers or others, which is how I would take "combative."

(I come at this not from experience with the healthcare side, but as a parent of a kid with some behavioral issues. I've been called by the school to pick up my kid for "stabbing" another kid with a pencil. I pictured a serious intentional penetration wound. What she actually did was more like "hit another kid while she had a pencil in her hand." One time the other kid was entirely uninjured, the other time a slight scratch. Still big issues to address, but different from what "stabbing" evokes for me.)

Last edited by eschrodinger; 11-12-2019 at 06:04 PM.
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Old 11-14-2019, 04:34 AM
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I've had that some meds can be administered as a lotion absorbed into the skin.

My dad was diagnosed originally with Alzheimer's, but a neurologist today changed that to Picks Disease. My mother had a stroke with a broken pelvis last December. While she was recovering well, she fell in September and broke her leg. Right now, they have 24/7 home health care. If dad gets more aggressive and tries to leave, the home health care people will drop them for their worker's safety. I hope the Depakote calms him down. Given the choice of mom living with the stress or dad accidentally causing her to have an accident vs dad being possibly over medicated, I have to go for mom having a better quality of life.

The fact that they live in an isolated rural community doesn't help at all. We tried assisted living for a couple of months in Austin, but dad's constant moving things around and "packing" things up made mom's life miserable so when she was physically able i took them back home.

My brother and I are on the same page and share POA, but he's in Brooklyn and I'm 350 miles away from mom and dad. Christmas is going to be spent convincing mom that he will have to go away soon. And next year, brother and i will have to consider having ourselves tested for the Picks gene. I already lost the macular degeneration gene lotto.

One thing no one ever seems to address is how do you tell someone he has to go into memory care. We did it temporarily last year while mom was in the hospital. It was a miserable experience for everyone. I'm afraid we're going to have to wait for some event to push us into "the we have no other choice" situation again before mom will agree. And terrified that that situation will be so severe that mom will permanently lose her mobility, suffer a second stroke, or die.
  #35  
Old 11-14-2019, 11:07 AM
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Originally Posted by Sunny Daze View Post
We are in the midst of something similar with my mother-in-law. The place she is in will keep her, but the costs are now extremely high. Unfortunately, it's easy to see that they will keep rising from here. We are covering this and we can't keep doing it.
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Sunny, I was in this situation with my mother last year. I highly recommend that you consult with a specialized elder care attorney.

In most areas at least, Medicaid will pick up nursing home expenses after the patients assets are completely depleted. But you have to apply and itís complicated. And expensive, although in our case the attorney fees came out of money that would have otherwise ended up with the nursing home.

You should definitely consult with an attorney before you start selling off large assets, such as her house, to pay the nursing home bills. Because you may not have to. Medicaid may lien it and try to take it after she passes to reimburse themselves, but the additional ownership time increases the value and works in your favor. And the asset forfeiture laws may even change before her death.

And our church had people on staff that assisted us with finding a nursing home.
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Old 11-14-2019, 11:19 AM
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Sad to say, but your mom simply needs more care than this facility can provide. You'll have to find a nursing home facility that has a specialized dementia unit.
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Old 11-14-2019, 01:39 PM
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One thing no one ever seems to address is how do you tell someone he has to go into memory care. We did it temporarily last year while mom was in the hospital. It was a miserable experience for everyone. I'm afraid we're going to have to wait for some event to push us into "the we have no other choice" situation again before mom will agree. And terrified that that situation will be so severe that mom will permanently lose her mobility, suffer a second stroke, or die.
My sympathies on your difficult situation. I assume someone has POA. If not, get that ASAP and contact an eldercare attorney about starting the Medicaid process (unless you're wealthy enough to pay OOP) which is complex and time-consuming.

But how do you get someone into a memory care facility if she refuses to go? And at some point, 80% of dementia patients don't recognize they have an issue: the executive functioning part of the brain is too damaged to allow this. There are two issues here, the legal and the practical. I went through this last summer. Practices vary from state to state, but hopefully my experience will help you.

We first had to take "Cousin Freddie" to the ER to get "medically cleared," i.e., for a doctor to confirm Freddie had dementia and commit him. You can't commit someone to a memory care facility, so they faxed the papers to a psych facility Freddie's wife had previously selected because it dealt with lots of dementia patients. The psych hospital then submitted paperwork to the state. A few weeks later, the state sent papers allowing him to be transferred to a nursing home.

But how did we get Freddie to go? We did what most people do: we lied, sort of. His wife told him he was going to the ER to get his meds adjusted. (True, but at psych unit.) At the ER, we told him we had to "go see a different doctor" (at a psych unit) to get his meds adjusted. I tipped off the psych facility nursing staff in advance not to ask or tell him anything about getting admitted or even that it was a psych hospital. Really, MUCH easier on everyone to have a nurse do this. After Freddie's wife answered a few questions and signed papers, we slipped out, telling him we'd be back. The nurse then gently broke the news to him. He was upset at first but calmed down quickly.

I hope this helps. If you have more questions, feel free to PM me.
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Old 11-14-2019, 02:44 PM
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In most areas at least, Medicaid will pick up nursing home expenses after the patients assets are completely depleted. But you have to apply and itís complicated. And expensive, although in our case the attorney fees came out of money that would have otherwise ended up with the nursing home.
We were originally paying for my mother's caretakers directly, using her retirement income (Social Security and pensions). Once she needed 24-hour care, it began to deplete her savings rapidly, and once those were gone it would have bankrupted us (or at least have caused very serious financial problems) if we had had to pay for it ourselves.

Fortunately my brother hired a lawyer and we were able to get her on Medicaid, although it took a long time. We were lucky to be able to get her 24-hour home care. But basically she can't have more than very limited assets, and most of whatever retirement income she has is taken by Medicaid.

Quote:
You should definitely consult with an attorney before you start selling off large assets, such as her house, to pay the nursing home bills. Because you may not have to. Medicaid may lien it and try to take it after she passes to reimburse themselves, but the additional ownership time increases the value and works in your favor. And the asset forfeiture laws may even change before her death.
My mother had the foresight to realize this before she began to decline, and had a lawyer create a family trust to which she transferred the title. Her six children are the official owners, but she is allowed to live there until her death. If we sell the house, we'll split the proceeds. But you have to do it well in advance, since there is a "look-back" time when they are checking for assets.
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Old 11-14-2019, 04:13 PM
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Originally Posted by Colibri View Post
We were originally paying for my mother's caretakers directly, using her retirement income (Social Security and pensions). Once she needed 24-hour care, it began to deplete her savings rapidly, and once those were gone it would have bankrupted us (or at least have caused very serious financial problems) if we had had to pay for it ourselves.
Similar situation with my MIL. We had bought a condo jointly with her, but after about a year it was clear that she was not safe living on her own. We sold the condo and moved her into assisted living, where she was quite happy once she adjusted to apartment living. Paid for out of her retirement income and saving. Fortunately by the time she had burned through her savings she was ready for a nursing home.

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Originally Posted by Colibri View Post
Fortunately my brother hired a lawyer and we were able to get her on Medicaid, although it took a long time. We were lucky to be able to get her 24-hour home care. But basically she can't have more than very limited assets, and most of whatever retirement income she has is taken by Medicaid.
A fortunate happenstance is that my MIL was taken to the hospital for a COPD episode. We were able to get her discharged directly into a nursing home for "recovery", which is covered by Medicare for up to 60 days (or some other finite
period). While there, the social worker and the business office helped us get her Medicaid qualified. She went directly to a Medicaid funded bed in the dementia unit of the same facility.

It may have helped that the medical director for the nursing home was my MIL's PCP, as well as the PCP for both my wife and me. We had to do some quick legwork to get the paperwork needed for Medicaid (one bank had messed up a burial reserve account that she had set up) but we got it done.

Regarding medication to keep her calm: sounds like your mother's dementia is advanced enough that she is "not all there". The choice is she can be "not all there" without further medication and be angry and belligerent, or "not all there" with medication and at least be calm and contented. maybe medically it would he healthier for her to not be on medication, but at this point keeping her in some state of contentment should be the priority as opposed to maximizing lifespan.

We had a similar issue with my MIL and her (our) PCP: he changed her to a low-sodium diet that she hated. My wife convinced him that the diet was making her unhappy, and what's the point? He changed her back to a regular diet.
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Old 11-14-2019, 05:00 PM
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Originally Posted by Colibri View Post
We were originally paying for my mother's caretakers directly, using her retirement income (Social Security and pensions). Once she needed 24-hour care, it began to deplete her savings rapidly, and once those were gone it would have bankrupted us (or at least have caused very serious financial problems) if we had had to pay for it ourselves.

Fortunately my brother hired a lawyer and we were able to get her on Medicaid, although it took a long time. We were lucky to be able to get her 24-hour home care. But basically she can't have more than very limited assets, and most of whatever retirement income she has is taken by Medicaid.



My mother had the foresight to realize this before she began to decline, and had a lawyer create a family trust to which she transferred the title. Her six children are the official owners, but she is allowed to live there until her death. If we sell the house, we'll split the proceeds. But you have to do it well in advance, since there is a "look-back" time when they are checking for assets.
We had done the retirement planning, including the title transfer, properly. But our efforts were thwarted when the family home burned down. As typical with the type of trust that held the deed, the insurance policy was in my mother's name. So the new house ended up in her name, and she never transferred it.

As it turned out, the house fire was inside the lookback period. Which was a new and different level of hell. There were lots of very large amounts of money going in and out of the bank accounts during that time, and I made several large loans to my mom that were repaid from insurance. The insurance company had a contractor that found temporary housing and fronted the money - for a rather hefty cut, so I decided not to use them as I had the resources to do everything they did.

So I spent my summer hunting down 4 year old housing and furniture rental receipts to develop a balance sheets of the payouts and repayments. As well of copies of every single financial transaction she had made in the last 5 years. And they were serious about it, I had issues over a couple of missing check copies ( bank error, no copies) that were for really small amounts.

However, my brother is legally disabled and he was also her primary caregiver for several years. So she was allowed to transfer the house to his name.

I’ve talked about this before but it’s important that people know about this. We would’ve been in a much better position if we had contacted the attorney sooner. Skilled nursing care can burn through a large nest egg really fast and the family often has no idea what to do and what services are available.

Last edited by Ann Hedonia; 11-14-2019 at 05:01 PM.
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