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Old 06-26-2020, 11:32 AM
agfsteve agfsteve is offline
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Default Need advice on getting in-law with Alzheimer's into nursing home in USA

My mother in-law, Margie, has Alzheimer's disease, and my wife and wife's sister are trying to get her into a nursing home in Indiana,
but are being told that she cannot go in unless she has physical disabilities, which she mostly does not. The biggest problem
with taking care of her (being done by my wife's sister's family) is that she is constantly roaming around at night, making it
very difficult for anyone in the household to sleep. Medication is only helping out in a limited way.

We believe Margie is an extreme flight risk, and she has gotten away from three of my wife's other sibling's families,
at various times, including getting lost in the woods for over an hour.

Margie is on Medicare, and will apparently need to be on Medicaid after being admitted, but we can't get her admitted, due
to the fact that she does not have physical disabilities as mentioned above.

She also has a very limited, fixed pension, partly from her late husband's company.

Can anyone who has been through this situation please offer any advice on how we can get Margie admitted to a nursing home?

Thanks.
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Old 06-26-2020, 11:44 AM
marty bradbury marty bradbury is offline
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I have worked in Skilled nursing facilities along with Memory care and ALU for quite a while. There are some nursing facilities that are not equipped to accept folks with dementia/memory care issues. There are certain state and federal guidelines that these places need to abide by. What you should search for are facilities that specialize in memory care as these would assure you that your Mother in Law would get the proper care needed. If you have any other questions you can message me and I would be glad to help further if you wish. The best to Margie and family as it is a tough place to be in.
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Old 06-26-2020, 12:10 PM
keith.rogers keith.rogers is offline
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Sadly, there are very few options. Medicaid rules can vary state-by-state, and because the nursing homes that accept Medicaid tend to be operating on low budgets, a separate memory unit is probably rare.

Someone like your mother-in-law really needs a nursing home with a memory unit, but if it doesn't accept Medicaid, then you'd be in the position of trying to pay for that care. We had our mom in one for her last couple of years. Even 10 years ago it was a stunning amount. Can't imagine it's gotten any cheaper.

The only other alternative is to try and find a live-in or maybe half-day in-home care, just to give the relatives some peace. It can be very hard for the dementia patient to accept/adjust to, though, if that is even an option.
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Old 06-26-2020, 12:24 PM
Neil K Walk Neil K Walk is offline
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Does your wife or her sister have power of attorney for their mother's financial and health care decision making?
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Old 06-26-2020, 12:44 PM
agfsteve agfsteve is offline
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Originally Posted by Neil K Walk View Post
Does your wife or her sister have power of attorney for their mother's financial and health care decision making?
Yes, between the two of them they have both financial and medical POA, although I'm not sure who has which one.
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Old 06-26-2020, 12:59 PM
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As others have mentioned - not all facilities take Medicaid or accept patients with your M-I-L's needs.

First thing to do is probably contact a local Senior Services office for help with placement.

If you're M-I-L is on her own (widow) She'll have to have only 2k in her account before she can get on Medicaid. She can keep a house and a car and have that savings total. You can get help on this from an elder law attorney.

I went through this with Dad 3 1/2 years ago - it was a very rough time for sure. We kept him home about 4-5 months longer than we should have and Mom ended up in the hospital 3 times with near breakdowns (lifelong anxiety and depression issues that made her "guilty" for putting Dad in a home)

I would try to find a local (maybe county run agency) that can offer you help specific to your area - there has to be something in your area. Here we are VERY fortunate to have lots of help.
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Old 06-26-2020, 01:19 PM
Neil K Walk Neil K Walk is offline
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Originally Posted by agfsteve View Post
Yes, between the two of them they have both financial and medical POA, although I'm not sure who has which one.
I hope they get along. I'm an only child and my mom is widowed so I have the joy of not having to share that burden. In addition to that I have the joy of having an intellectually disabled son whom I also have in assisted living so a lot of the legal matters overlap. My next questions would be:

- does your MIL have more than one pension?
- does your MIL have VA benefits of her own or from your FIL?
- does your MIL receive SSI because of the Alzheimer's diagnosis?
- has your wife and/or SIL set up a trust with your MIL as a beneficiary?

The crux of this is not only that your MIL get Medicaid but also gets SSI to subsidize living expenses. In order to do this, any financial assets in her name have to be valued less than $2K - hence the trust.

As for choosing the actual facility, does your wife or her sister have one in mind? That facility should have a coordinator who can help you navigate the system. I would also reach out to your MIL's health care provider and see if they offer advisory services for elderly housing and memory care.

Thankfully, my mother was able to go that route on her own despite being 80 years old. She just moved into a senior living facility - and ironically because of COVID the pricing actually went down. My son OTOH receives SSI and I had to coordinate with the Office of Intellectual Disabilities in our county's Dept of Health and Human services in order to petition for a waiver because of his mental diagnoses. The result has been that instead of being institutionalized he now lives in a supervised residence with 24/7 care with two caregivers at all times. Neither my mother or my son are physically disabled and my son is a flight risk because his level 3 autism spectrum disorder has symptomology similar to dementia or schizophrenia (from a logistical perspective.)

So to sum it all up, you need to contact your county and/or state dept of health and human services and look for loopholes that your MIL may be eligible for due to her dementia.
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Old 06-26-2020, 01:24 PM
guitar12 guitar12 is offline
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My siblings and I just went thru something similar with my Mom who has Lewy Body Dementia and just moved to Assisted Living in February. She was in a complex that had independent living, assisted living, and memory care. She was determined at that time not to need memory care as she could eat/swallow and was not a flight risk. Prior to her landing where she is now I hired an eldercare consultant to help us weed thru the options. My Mom is in the D.C. area and there are literally dozens of facilities that are available to pick from and the eldercare consulting company helped us filter down to the ones with the best records of care and availability. I'm on the West Coast and I did all the research and initial phone calls from here and then I had my siblings and their spouses check out the actual facilities. We looked at everything from big corporate structures (like Sunrise) to board/care places (typically 6-8 patients in a house like setting) before making our decision. I think that trying to navigate this jungle on one's own is very difficult and it is worth it to have a professional guide you. From what I learned thru this journey it seems like most people in assisted living have some level of dementia and can usually be managed there but since your MIL is a flight risk that could possibly point to a memory care unit as your best option.

Best of luck.

Rob
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Old 06-26-2020, 02:00 PM
seannx seannx is offline
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Unfortunately, if you MIL doesn’t have enough income to cover a memory care facility, you don’t have good options through Medicare or Medicare, as she’s in good health. My first wife’s mom (93) is in the same condition. She came to live with her about 3 years ago, and steadily deteriorated. My daughter, her partner, and our two grandkids live there too, and as you know it’s a lot of work. When she got to the point of leaving a few times, having some difficult nights, and recognizing hardly anyone but her daughter, and two grandsons in their 40’s that she had lots of contact with over the years. It reached a breaking point after the new year. There wasn’t much money to get outside help, which she didn’t understand and resented, and they tried trying to place her, with no success. She had periods where some memory would return and could name people in old photos, but had no clue who her great grandkids, my daughter, my younger son, or I was.

It got to the point where she was so disoriented that she fixated on her daughter, and constantly worried about getting fed, where she was, etc. I and the rest of the local family saw the toll on my former wife, and her mental health was suffering. Finally, her other daughter who lives on the east coast with her husband, agreed to take her, and my ex flew with her mom mid June so she could stay with them. The money my MIL gets from SS and her husband’s pension now goes to them, and as my SIL doesn’t work, and has the time, it was a good solution. It’s a much calmer environment, and they have a very structured schedule.

One thing that was both helpful and kind of a surprise, was when my girlfriend started going over for a few hours twice a week to be with her. She is a very caring and empathic person, would slow down to my MIL’s speed, and do activities like art projects, going to the beach, and just hanging out. My MIL always remembered who she was, the number of days since they last met, and enjoyed the time so much. One day they drew pictures with markers (my MIL was a lifelong artist) and her drawings were very revealing, with HELP written in shaky red letters. My DIL said it was the saddest thing she’d ever seen.

If you can get some help in, with the right people, it can make a huge difference. I have friends taking care of the wife’s mother, and they have someone coming 6 hours a day. Otherwise it’s just too overwhelming.

There are some things that can help, like visual aids and one on one time visiting the past through photo albums, but it’s so hard seeing someone who lived a very independent life always on her terms, for the most part gone and confused. We made signs for the rooms, including her bathroom in the MBR, because she wouldn’t remember where it was.

I hope you are able to get the best support network, including in home care as far as the $$ will go. Feel free to PM me. What you’re going through is playing out throughout our society, and unless someone has personal experience they have no clue how hard it can be for caregivers.
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Old 06-26-2020, 02:32 PM
rllink rllink is offline
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I do not have much to help, but we put my mom in a nursing home when my dad could no longer take care of her, and we should have put her there sooner than that. But we got her into a home in just a few days. It was not that difficult and if I remember the doctor who was seeing her for her dementia was extremely instrumental in getting her placed. Someone from the clinic where she was being treated helped with the financial aid and all that. As I remember they had lots of resources to help. We didn't have to do much ourselves. That's probably why I don't have a lot of advise.

For my mother it was too late and she was too far gone to get her into any assisted living, but we got my dad into it. He had Parkinson's. The place my mom was in was really depressing, the place my dad ended up was like living at an all inclusive resort. The thing is, we got him in there early and they let him stay long after he would not have been able to get in if we had waited. It was a deal where once there they keep them. Believe me, after seeing the difference I won't fight it when my kids tell me it is time for assisted living, because I don't want to be in a nursing home if I can help it.
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Old 06-26-2020, 02:41 PM
buddyhu buddyhu is offline
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I donít have much to add: already some great posts to this thread.

My dad went to assisted living first. The girlfriend (that he met there) had been admitted because she was wandering at night. They both did well in assisted living for a bit less than 2 years, until she started sneaking out (leaving through the loading dock, etc). They moved her to memory care, and then my dad got paranoid and then violent with staff and other residents. We moved him to memory care in a different facility. He was happy there. But it cost a ton.

The financial limitations can be overcome...follow the recommendations offered by the other posters. My MIL went into a pretty nice memory care facility that accepted Medicare and Medicaid (after the savings were depleted). She had 3 roommates, which she hated, but the basic care was quite good.
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Old 06-26-2020, 05:25 PM
Neil K Walk Neil K Walk is offline
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Quote:
Originally Posted by seannx View Post
Unfortunately, if you MIL doesnít have enough income to cover a memory care facility, you donít have good options through Medicare or Medicare, as sheís in good health. My first wifeís mom (93) is in the same condition. She came to live with her about 3 years ago, and steadily deteriorated. My daughter, her partner, and our two grandkids live there too, and as you know itís a lot of work. When she got to the point of leaving a few times, having some difficult nights, and recognizing hardly anyone but her daughter, and two grandsons in their 40ís that she had lots of contact with over the years. It reached a breaking point after the new year. There wasnít much money to get outside help, which she didnít understand and resented, and they tried trying to place her, with no success. She had periods where some memory would return and could name people in old photos, but had no clue who her great grandkids, my daughter, my younger son, or I was.

It got to the point where she was so disoriented that she fixated on her daughter, and constantly worried about getting fed, where she was, etc. I and the rest of the local family saw the toll on my former wife, and her mental health was suffering. Finally, her other daughter who lives on the east coast with her husband, agreed to take her, and my ex flew with her mom mid June so she could stay with them. The money my MIL gets from SS and her husbandís pension now goes to them, and as my SIL doesnít work, and has the time, it was a good solution. Itís a much calmer environment, and they have a very structured schedule.

One thing that was both helpful and kind of a surprise, was when my girlfriend started going over for a few hours twice a week to be with her. She is a very caring and empathic person, would slow down to my MILís speed, and do activities like art projects, going to the beach, and just hanging out. My MIL always remembered who she was, the number of days since they last met, and enjoyed the time so much. One day they drew pictures with markers (my MIL was a lifelong artist) and her drawings were very revealing, with HELP written in shaky red letters. My DIL said it was the saddest thing sheíd ever seen.

If you can get some help in, with the right people, it can make a huge difference. I have friends taking care of the wifeís mother, and they have someone coming 6 hours a day. Otherwise itís just too overwhelming.

There are some things that can help, like visual aids and one on one time visiting the past through photo albums, but itís so hard seeing someone who lived a very independent life always on her terms, for the most part gone and confused. We made signs for the rooms, including her bathroom in the MBR, because she wouldnít remember where it was.

I hope you are able to get the best support network, including in home care as far as the $$ will go. Feel free to PM me. What youíre going through is playing out throughout our society, and unless someone has personal experience they have no clue how hard it can be for caregivers.
Unfortunately our elder care and special needs system is priced in such a way as to be prohibitive and the burden falls to the family. That often translates to a family member becoming the full time caregiver and any additional family support - such as respite for the caregivers is often farmed our to family members as well. Families who see this coming set up trusts years in advance and if a family member has to be the caregiver there are ways to get paid for it through social security by getting qualified as a nurseís aide, getting hired by an agency in the patients health care systemís network and essentially getting paid by social security. It seems like an odd arrangement but I personally know families with disabled teenagers and adult children who are either mentally or physically disabled and they are paid caregivers.
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Old 06-26-2020, 06:14 PM
Mandobart Mandobart is offline
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My wife has been an RN for over 30 years. Her patients are all imuno-compromised. She is very well aware of the current status of COVID in our area.

Her advice? Don't put ANYONE in ANY type of senior care facility right now, unless you want them to die.
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Old 06-26-2020, 08:33 PM
agfsteve agfsteve is offline
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Thanks everyone for the responses, I will show them to my wife; I'm sure they will be very helpful.
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Old 06-27-2020, 07:42 AM
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Quote:
Originally Posted by agfsteve View Post
Thanks everyone for the responses, I will show them to my wife; I'm sure they will be very helpful.
If her or her husband served in the military during wartime she may also qualify for VA benefits. Be sure to check that out as well.
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