Mother doesn't recognize me or her home

Jimbob59

My soon to be 93 year old mom wants  to go home almost every evening she ask me to call her son Jimmy to please come get her. I am Jimmy and she has been living in this house since it was built 60 years ago. I quit work at 57 because she was not safe at home alone that was 6 years ago. She is bladder incontinent with occasional bowel accidents. She brushes her teeth with help and showers with help daily. She feeds herself if you set it in front of her, have to hand her pills one by one. I have no family of my own and lived with her since 2007 since she had to stop driving. With all her issues we were coping OK the stress of her begging to go home and trying to tear the front door down in the middle of the night seems to be the straw that is going to break me. I am ready for her to be in a nursing home. She has about enough money to pay for 6 months in a semi private room then she will need to be on Medicaid, she has a appointment with her PCP Monday she is the only doctor mom sees I intend to talk to her about placement but the doctor made the remark before about nursing homes not being good places or something like that. How does one actually get someone into a nursing home especially if she doesn't want to be there. Oh yeah the doctors visit is for her annual plus she fell during one of her attempted escapes and is sore all over .

Cynbar

I am assuming her legal affairs in order and you are her DPOA, medical power of attorney or health care proxy. The PCP needs to state in writing that she cannot make her own health care decisions. That gives you the ability to arrange placement, even if she is opposed. Explain to the doctor what you have told us, and that you can no longer safely care for her --- the doctor may not like nursing homes but I can't believe she would insist you keep her at home, sometimes placement is necessary. Then, you research and contact local facilities. Tour them, talk to the direct care staff and not just the administrators, observe if the residents appear well kept and content as well as how the staff interacts with them. Fill out an application for the ones that would be suitable. Having six months of private pay will give her an advantage in the admissions game, just make sure they accept Medicaid. As her money runs low, the business office will help you apply. As far as actually getting her there, their staff will have suggestions and help with the adjustment --- most patients are not happy about going so staff has lots of experience. Plus, you can come here for advice where lots of posters have had to make this decision. But the first step is talking to the doctor, followed by picking out a facility.

Salsam

Is your mom on medicare?  Hospice companies are paid without needing medicaid.  I am so sorry you have to go through this.  Hospice can help you find a place that is good, sometimes.

I had to change hospice companies...at age 92 and 90 I moved my parents. from my home. ..and it was traumatic for me(and them) .  In my case, their pensions covered the amounts the facility charged....but would not have covered a nursing home, and I heard that the nursing home would not take them if they were mobile. 

My dad died after a month in the second facility but they called the police on him in the first facility.  I got a call at 2 AM from the head nurse at the first facility because my dad was "violent."   I spent 8 1/2 hours from 2 AM to 10:30 AM and really saw what was going on in the facility.  My dad hugged me and said I was the only thing he had left in this world.  He was not violent...he was scared...and he was a large man....and the nurse who did this was more experienced with paperwork than elders with Dimentia.   

My mom is much better cared for in the new place...which is smaller and less expensive.  She got angry at me when I moved her, but she is adjusted now, even though she forgot how to walk after my dad died.  She also tells me she wants to go home but is content when she lays down.  I have brought her home and she also tells me at home she is ready to go "Home" so I take her back.

Check out different hospice companies ---use rehab centers, social workers, and word of mouth to help you locate possibly even a private home that is licensed by the state.   

Another option is respite care--different states handle this differently---sometimes you can get help for a short period.  The first hospice social worker gave me a phone number for that...and I didn't do that--my cousin in a different state did that and her father was cared for at a hospital for a couple of nights so she could get some rest. 

Best of luck.  

Cynbar

Yes, Medicare will cover hospice services, Medicaid is not needed for that. But Jimbo is asking about nursing home placement for his mother. Hospice does not pay for long term custodial care in a facility. He may well want to apply for hospice services, whether she is living at home or elsewhere, but that doesn't solve his immediate problem. It's another discussion entirely.

Jimbob59

I don't think she would qualify for hospice she eats good  no wait loss and has no real health issues other than dementia. She has actually gained about 10 lbs in the last year because she forgets eating and wants to eat again. For someone her age if it weren't for the Alzheimer's she would be a spry little old lady she still walks with a cane. My doctor told me a while back if I didn't loose some weight and cut down on the stress of 24 hour care mom might outlive me. I am starting to believe he might be right.

Cynbar

From your description, I think you're right, Jimbo. Concentrate on the nursing home placement and finding her a good place, you should have a good choice with 6 months of private pay to start. Once, there, the home will suggest hospice when/if they feel she is ready.

Jimbob59

Well we have cleared the first hurdle the doctors appointment was productive I collected urine specimen before leaving home and they took blood. They are checking for UTI and blood work for liver and kidney function and dehydration either one of these could explain hallucinations. It's only been a day since her appointment no word on labs. Time drags when someone you love is in despair.      

Cynbar We have two nursing homes in our small town both of them have a pretty good reputation, both of them are owned by the same family who also live here in the same county as us. I don't like that they are still closed to visitors so I want be able to tour the building or just go visit mother, even though at this point she want know me but I still want to make sure she is alright. They have scheduled one on one visits by appointment only in a room with mask on. I would imagine they will have her looking as best as they can for a scheduled visit. A guy I know had his mother at the one I have an appointment with tomorrow afternoon with admissions coordinator. He liked the way they took care of his mom she passed a short while before covid lock downs so he was able to see her regularly.

My mother was up all night trying to get us to take her home, I called my younger brother he came and sit up with her so I could sleep some. I didn't fall asleep until daylight, but having someone beside me and her at the house was still comforting

Jimbob59

Mom,s motion detector just woke me and I went to help her, we took care of business put her on a fresh depends and back to bed. She slept from 3-8 pm in her chair then walked her to bed she slept their from 8p-4:30 am now back in bed. We both got some good sleep.

Now I can't fall back to sleep I have doubts about putting her in home, not sure I can do it. If they were open so she could be visited and checked on maybe it would not be so difficult. 

Rescue mom

Your mom does not know where she is now. She probably won’t know where she is at a facility. Many residents will be in a facility, say they want to go home, and are taken home. They still say they want to go home, even when they are.  They occasionally say they are not happy in a facility, then when home, they’re not happy there either. Etc.

Meanwhile, about a third of caregivers die before the PWD, largely from the stress involved. If you die or get sick  trying to keep your mom at home, than what do you think will happen to her?

As has been said here a lot, PCPs are invaluable and meet many needs. Unfortunately, they cannot be experts in everything, and many PCPs can’t deal well with Alzheimer’s/dementia. 

There are huge differences  in facilities, and different terms used to describe the various types of facilities. They cannot accurately be grouped into one big category called “nursing homes.”  If someone has not visited a facility in the last 20-30 years, they probably are thinking of something they saw long ago, that is generally not how it is now. Dont take an offhand past remark as set in stone.

Today’s “memory care” facilities, which primarily serve Alzheimer’s and other dementias, can be super-nice. I hope to stay in one myself if/when the time comes. Two that my mother stayed in were also great, with staff 24/7, 365 days. I would stay in either in a flash. My mom loved them after a short adjustment. She liked the social aspects, and staff attention.

If a patient has more “physical” medical needs, such as serious disease that needs constant regular treatment,  wounds, or surgery, they may instead want what’s called SNF, skilled nursing facility. (Sounds like your mom does not need that). 

In between are assistant living facilities, which cover a huge gray area and services can vary from place to place, and by cost. . But a very general start IME is that a resident must be able to ask for help. If they do not know to ask, then then they probably need a MC (memory care) facility

If your mom does not know you, or her home, she is almost certainly past the point of assisted living, and needs memory care. some ALFs may have a memory care wing or building.

You can meet with your local Alzheimer’s Association to learn about the different facilities in your area, including which take Medicaid. Their advice is free, they are a great starting point, not just on facilities but the kind of legal stuff you need, counseling available. They provide tons of help, all free.

Rescue mom

Places in my state and many other states are open now for visitors and prospective residents. You have to wear a mask, and may need a staffer with you, but they’re open. You should call a few and ask. Things are changing fast, and by location and facility, on just how open they are.

Jimbob59

I visited the Nursing home I had in mind got the virtual tour and some information today. They now allow in room visits with appointments or you can visit in the open air porch outside also need appointment. The information packet I received include a surprise one of the needed documents in addition to DPOA that I have, is Guardianship documents. In addition to limited visits you can take her out as much as you like as long as you get her back by Midnight that don't sound like a dementia patient kind of thing I would like to but not a good idea. I like the place but I don't think they are what she needs.

Jimbob59

And the beat goes on, 2 hours of why am I sleeping here she eventually wears out and sort of accepts that jimmy is working and will pick her up in the morning. Last night she slept from 8:30 pm till 7 am got up peed in the floor helped her with dry depends back to bed slept till 9 am that was a good nights sleep for her and me. They are now making staff in SNF around here wear a shield in addition to mask. My neighbors daughter is a nurse at one of the local homes she says they will be locking out visitors shortly if the covid numbers keep rising here in the deep south.