My mom is getting out of ICU and into a regular room. But they said she might be released this week. She is 80 years old, has emphysema and getting over the flu. She is shaking and would not be able to care for herself. I think we have passed that time.
Does anyone have experiences about what are the options and what happens now? I haven’t talked to the Dr or her caseworker yet.
Talk to her Doctor and caseworker. They can talk about what care she needs now, and what care she will need in the future. There are probably a number of options depending on where you live and your level of financial resources.
Second the advice to talk to her caseworker or the hospital social worker. They’ll know what options are available in your locale.
In the U.S., many areas have nursing homes that specialize in short-term rehab stays, to get somebody back on their feet after an illness (and Medicare pays 100% for several weeks after a qualifying hospital stay, and then a percentage for another several months as long as she is making progress). However, she may not be able to benefit from rehab, depending on her overall physical and mental health, so you’ll need to know what the prognosis is too. (And if you haven’t already, start getting your ducks in a row re: power of attorney for health care, etc.)
Good luck!
I had a mother who was crippled with rheumatoid arthritis and she needed a lot of help with daily life. Seeing that my brother and sisters could care less about her I stayed home and became her personal aide.
Both my sisters dumped their kids to live with my mom so the sisters can run around. We had to deal with them but my mom loved the kids and they trashed the house.
At 78 my mom had a heart failure and we met up at the hospital. After listening to them bitching about financial difficulties I pulled the doctor aside and told him to pull the plug.
She had suffered long enough.
Probably better in IMHO rather than General Questions. Moved.
samclem, moderator.
Not my parent, but my mother-in-law. Very important: Under no circumstances sign anything as the financially responsible party. If you have POA, be absolutely certain you sign as POA (i.e., “Your Signature, POA”) and not in your name. If you don’t have POA, both medical and durable, see a lawyer ASAP to set it up. If you wait too long, she might be deemed too incapacitated to be able to grant you POA - then you need to go and get a court decree.
Get with an elder law attorney ASAP - the same one who sets up the POAs. He/she will know better what the options are in your state.
Convince the doctor/caseworker that she needs to be discharged to a rehab facility until she can care for herself. That will get you some time to work out a long-term plan, which will depend on her finances. For my mother-in-law, after a medical scare we got her into an assisted living facility, completely self-funded (Medicaire/Medicaid do not cover assisted living, at least in Pennsylvania). She lived there for a number of years, we did not have to worry about her getting fed or taking her meds. As she declined, she was lucky enough to require full-time nursing care (i.e., nursing home) just as her money (and mental capability) ran out. She had an episode of COPD which required a hospital stay, we had her discharged into a rehab facility which also had a nursing home (and dementia ward). While she was in rehab we successfully got her approved for Medicaid and admitted to their dementia unit. It helped that we knew the medical director of the rehab/nursing facility (and he was my MIL’s primary care provider as well).
Not sure if this helps.
My MiL has had two episodes, both of which have resolved, but the time is coming…
First up was a heart attack. She required triple bypass and then a stay a short term care facility. She then transitioned to staying with us until she was cleared to go home by herself. This was several weeks.
Just a few weeks ago, she had a fall while she was home in Texas. She was completely bedridden and required a healthcare worker stay with her. This time we’ve had her set up the POA documents for both of her sons, so that someone can make medical decisions for her. Fortunately this seems to be healing and she’s back on her feet.
It looks like it’s just a matter of time before she’s living with us or needing a home. My husband and her brother are starting to look at her long term care options, just in case. There is elder care insurance available now, which I am pushing them both to look at. Some companies offer it as a benefit. I imagine you can also just buy it on the private market. She also has some benefits through her retirement plan, but we don’t fully understand what they are, and need to find out.
Thanks to everyone who is responding I really appreciate it.
Marvin: So a good goal would be to have her released to a rehab facility. I don’t foresee her getting more able at this point. If that’s true, why do I need time? Is this a limited benefit under medicare? Is there a clock running on this? What will she be paying, and will she have to sell her condominium?
Medicare pays the full cost for 20 days of rehab in a skilled nursing facility, then (as long as she is making adequate progress), they’ll pay part of the cost for days 21-100, during which time she’ll have a co-pay, currently ~$165/day (although many Medigap plans will pay all or most of this). After that, Medicare won’t pay, and Medigap won’t either unless she bought long-term care insurance.
What happens next depends on her health, her financial resources (including any insurance), and what state she lives in. She may be able to get by with a home health aide for a few hours a week or a day, or she may need to consider residential options such as assisted living or a nursing home. The costs of those will likely have to be met out of her own resources, at least at first.
If she exhausts her resources and still needs care, then Medicaid will step in. This is state-administered, however, and different states have different rules. Some will pay for assisted-living, some won’t (they all pay for nursing homes at some level). Some will make her sell the condo and use the proceeds to pay for care, and some will let her keep it, at least for awhile (although that’s usually pretty pointless, since they won’t leave her funds to pay the taxes and condo fees, and will have a lien against her estate). If you don’t mind, what state is she in?
She’s in MA.
What do you mean “At least at first”?
Does “Exhausting resources” mean that she must sell her home?
At least in PA it does especially once she reaches a stage/condition/disease where return to that home is unlikely or impossible.
Okay, I have no direct experience there, so I can make only general statements, and would encourage you to consult somebody locally who knows the nuances of how MassHealth does things. Here is a guide for them that may be helpful. (PDF)
It means she is allowed to have no more than $2,000 in “countable resources.” Per the link I gave above, the first ~$800K in home equity is not countable if she expresses intent to return home someday*, and her personal effects and household goods are likewise exempt, as are most prepaid burial plans. Cash, stocks and bonds, insurance policies with cash value, vacation properties, and home equity above the limit are countable, and all of those will have to be liquidated and spent on her care before Medicaid kicks in.
*In my own state of Kansas, an intent to return home does not need to be realistic (that is, if somebody is moving into a nursing home because of irreversible decline, but they state they intend to go home, the state is required to accept their intention without challenge). If, on the other hand, they tell the state of Kansas they are never moving back home, they have just three months to put it up for sale. As near as I can tell, Massachusetts is very similar: the expressed intent to return home is enough to preserve the property. You should verify that with somebody who knows MA, though, as some states have time limits (in Ohio, e.g., you’ve got 13 months to either go back home or sell up).
To answer the title question, Yes. But I don’t think my case scenario would be very relevant for this forum.
When my mother was 98, my wife and I were both retired. She had a bad turn, and her doctors wouldn’t let her go back to her apartment, so she was assigned to a nursing home. After one day, I decided to take her to my own home, 400 miles away, and we were able to provide all the day-to-day domestic care she needed until she died in her sleep.
Fifty years earlier, her own parents lived out their last days under pretty much the same circumstances – that’s how things were done in those days. It was a great comfort to her to know that when she died, her body would be found by loved ones, and not complete strangers on their assigned rounds…
My parents are from Missouri, and their case was convoluted for various reasons, but I may have some helpful info.
Dad went into a nursing home while Mom was still living at home. To get him on Medicaid (pays all nursing home expenses), we hired a specialist lawyer at a cost of about $8,000 (but it counted toward Dad spending down). The lawyer knew how to play the game. I doubt that the family could’ve succeeded on our own.
The parents’ finances were split apart, much as if they’d gotten a divorce. Mom got to stay in the house, but Medicaid was to get the house when she died. Each parent got to keep their Social Security and retirement incomes, but Dad’s went straight to the nursing home.
The main convolution was that the house was destroyed in a tornado and Mom went to live with my brother in another state. She recently died, and we’re waiting to see if Medicaid will come after anything she had left, which wasn’t much since she was hospitalized several times. She was on Medicare, not Medicaid, and she didn’t have Medigap insurance. The bills were incredible.
Just before she died, she was hospitalized and then put in an alleged rehabilitation place. Medicare paid in full for 20 days, and then Mom was expected to pay 20% (~$165/day). The full 100% was over $800/day, over $300,000/year. She had to be taken home for financial reasons, and she died a few days later. I blame the rehab place for her death (not money-related, but I won’t go into that now).
I’m in MA, OP, and went through exactly this when my husband and I cared for my mother. Basically, I had to spend down all her $ save the house to the 2K limit before MassHealth kicked in. If I hadn’t, I would’ve had to have sold her house in order to pay for the nursing home.
I was lucky. MA has a “caretaker clause” in their elder law which states that if a child/caregiver of said parent has lived continuously in the parent’s residence for X period of time, the residence is exempt from the spend-down because selling it would be a hardship on the child/caregiver. I don’t remember what X is other than it’s a number of years. Given that I lived with my mother for most of my life, and my husband I lived with her through the first five years of our marriage, there were no questions as far as MassHealth was concerned.
I was exceedingly fortunate to have a stepfather who took devoted care of my mother when she was in the last throes of parkinson’s and suffering dementia as well. He was a saint.
Now my kids are afraid that my wife and I will be in that state and want us to move to near one of them. But we’ll be damned if we move to Trumplandia.
Just stay healthy another 3 years and 11 months. And counting down. 
My mom isn’t on the supreme court, but i get the drift.