when is it time for a nursing home

JTG

 My husband is 69 he was diagnosed with moderate alzheimer's 2 years ago. The last time we saw his doctor in October, i  asked what stage is he at now and doctor said almost late stage. he was not able to follow simple intructions that the doctor was giving him during the examination. My husband can still get in and out of bed, he still walks and able to go up and down the stairs. Non stop walking around and up and down the stairs specially around late afternoon. 

He doesnt clean himself well anymore when he goes to the bathroom but wont allow me to help him. i see some accidents that he tries to hide from me once in a while. Used toilet paper are ending up on places they are not supposed to be, drawers, closets sometimes the kitchen counter.

I basically do everything for him when it comes to hygiene, getting him to shower is always a challenge. I am the sole caregiver- we dont have kids together- his only son died of drug overdose last december. 

i have been working from home since covid due to my own medical condition, leaving my job to take care of him fulltime is not option since i need my health insurance.  

I will have to go back working in the office in March-cannot afford Memory care, the adult day care i visited have shorter time available due to covid.

is it time for a nursing home?

Ed1937

JTG, welcome to the forum. Sorry you have a need to be here. But you will get honest answers here, as well as compassion, and a family atmosphere.

I'm sorry it is so hard for you. My wife is still at home, but that doesn't mean others should be. The way I see it is that it will be time for placement when she will get better care somewhere else than I can give her. What that means is that if I don't have the time required, or for any other reason, like burnout, physical limitations, stress, etc., it will be time. You will be the only one who can answer that question. But your health is as important or more important than his. If for whatever reason you feel it's time, it probably is. Best of luck to you.

Rescue mom

Will he qualify for a nursing home? You said memory care is too expensive. But often, a nursing home, also known as skilled nursing facility, requires them to have other, more “physical,” medical conditions or problems. And/or, be confined to a bed. Much depends on what a place requires as condition of admission.

Can you do a different adult day care? Or maybe the hours will change at that one between now and March? You said you don’t have kids “together,” are there any kids who step in and help?

I don’t think it’s so much a matter of “is it time” for him; were you ready to place him in memory care? It sounds like he needs constant supervision, and you definitely need help with that. So  it’s whether you can find a place, or what place you can find. 

If you can’t take care of him—and you can’t, if you need to be away at work—then it’s time. Caregivers are the ones who decide that, no shame in placing him if you can’t, for whatever the reason is.

JTG

ed1937 thank you- im all of the above right now, stressed out, burn out and its starting to take a toll on my health, plus i cannot leave my job bec i need my medical insurance.

thank you

JTG

rescue mom-thanks a lot for responding,,, my step son died last december due to drug overdose. we dont have anybody- no support at all...

can i ask please- when do alzheimers patients qualify for nursing home/medicaid?

thanks again

Marie58

Hi JTG, and welcome to this forum. You will get lots of good advice here from many caring people.

I don't know what it takes to qualify for a nursing home or medicaid. Hopefully others with that knowledge will respond. But I do know from experience, that what you're doing is a lot for one person with no support. My DH is in memory care now. Prior to placement and pre covid he went to a day program at the facility he now resides in. That was a life saver for me, even though it was only about 12 hrs/week. Other options for you could be in-home help if the day program isn't enough. Or do you have any friends or family that could stay with him when you go back to work? 

Rescue mom

Medicaid qualification is based on finances, how much money you have (in very short, basic terms). A lot of things factor in to that, it’s not simple, and it can vary from state to state.

My opinion is that you need an attorney to help you figure that out, especially when a spouse is involved with joint finances or holdings (like a house).  But many people qualify for Medicaid, even though they thought at first they would not.

A lot of attorneys will meet with you once about it at no charge, just to see where you stand and help you understand the process. 

Not all facilities accept Medicaid payment, but many do. You have to pay, whether with Medicaid or out of your own pocket. 

Then each facility will look at the patient, and decide if they will “accept” him. Some will take anyone who can pay. But some nursing facilities, especially,  require certain conditions, while memory cares can have different conditions.

You would probably be helped by talking with a care consultant from the Alzheimer’s Association. They have a 1-800 number you find if you Google for it., they can give expert advice, free. 

Jo C.

Hello JTG; this is indeed a challenge and you have already received some excellent input from some of the Members.

The contact information for the Alzheimer's Assn. 24 Hour Helpline, available 365 days a year, is:  (800) 272-3900.  If you call, ask to be transferred to a Care Consultant.  There are no fees for this service.   Consultants are highly educated Social Workers who specialize in dementia and family dynamics.  They are very kindly supportive, have much information and can often assist us with our problem solving.

As for what a facility will or will not accept as a new patient resident can vary from one facility to another, so you will want to do a little online searching for which facilities you feel may be acceptable to you, (that have a contract with Medicaid - not all do), and then contact the Director of Nurses to ask questions. 

As for Medicaid; sure wish I knew what state you are in.  The Medicaid you will be looking for will be, "Long Term Medicaid;" that is different from regular Medicaid.   You can find information by doing the following:  Use Google:  enter the year's date - 2021; (if you do not do this you may get old, invalid information.) Then:  2021 insert your state's name, along with the words - Long Term Medicaid Qualification Criteria.  You will then get a lot of information; look at several sites.  If I knew the state, I could find the more informative site for you, but you can do this.  It is good to have an idea what is what.

In most states, the well, at-home spouse can keep about $160,000 to $200,000 of savings depending on the state.  In most states, the at-home spouse can also keep all of the retirement benefits, social security, etc. in the well spouse's name only.   If the placement spouse has his/her money or over the amount of the at-home spouse's allotted savings, then that must be "spent down" to $2,000 balance. 

Sometimes, the spend down is done, BUT the qualfication is missed because there is "too much income."  If this happens, most states have a way out; it is called either a, "Miller Trust" or a, "Qualified Income Trust."  In this, a Trust is established to take the income of the nursing home patient (not the at-home spouse's) . . . it is placed in the Trust; then each month when the bill for the care facility comes due, the money in the Trust is paid to the facility and Medicaid makes up the shortfall. 

NOTE:   Some NHs, even if they have a contract with Medicaid, are not fond of taking a patient who is "Medicaid Pending."  What works in such a case, is that if the family can pay for a month or two up front while the Medicaid application is pending approval, the NH is much more likely to accept the patient because IF the application is rejected for some reason or another, the NH is not out the money for the cost of care - AND - when Medicaid is approved, in most states, Medicaid will reimburse for up to three months private payment from the date the application was made, so the family then gets that money back that they had put in.

Some NHs have accommodation for persons with dementia but do not have "formal" titled, Memory Care Units.  You will find all sorts of variations as you begin looking. 

I do understand the predicament you are in; it does seem that things cannot continue as they are.   It sounds as though it is time to do some good research for that Plan B for care that seems to be pretty much upon you as you cannot give up work and you must stay healthy so you can continue on.   No matter what; no matter which choice you make, nothing is written in stone, you can always make a change or reverse course in the future.   Trust your instincts; our bodies will often tell us what is needing to be done.

Let us know how you are and how you are doing; sure will be thinking about you and sending you best wishes for all to go well.

J.

JoseyWales

So much about nursing homes, memory care, and Medicaid is dependent on where you live and the facility you decide to use.

Unless you have TONS of money, you probably could get your husband qualified for Medicaid. It will take work. It's nothing you can do yourself, you'll need a lawyer.

 In my area, memory care facilities WILL take Medicaid, and you can move in already qualified for Medicaid. The same is true for nursing homes. BUT that's not true everywhere. Or even of every facility in my area. Some facilities near me take Medicaid for their nursing home areas, but not the memory cares. I know in other parts of the US, you have to agree to private pay up to 2 years before qualifying for Medicaid. Honestly, it's all VERY confusing. 

Talk to an eldercare attorney. Talk to the admissions people at different facilities, then talk to the people in the financial portion of the facility. Ask them about eldercare lawyers they know of.  They won't tell you who to use, but they can provide you with names.

I can't say if your DH is ready or not, but as I've found out, searching for placement ahead of time (as in months and months ahead of time) is a really good idea.

JTG

hi Marie58- no i dont have any family, rest of my family are in the Philippines. My husband's cousins/family are all in Kansas, he has a nephew in florida but wont even call my husband to check on him. Unfortunately- its just me

thank you

JTG

rescue mom- thanks for the info- i will look for elder care lawyer

JTG

Jo C- thanks a lot for the info- i will definitely look into all the info you gave me. i appreciate you. I am from the Philippines and my husband is Caucasian- been in the US since 2007. I am glad i found this forum- i have been really lost and feel like iam alone in this battle- my husband's son passed last year- he doesnt have anybody but me.

Stuck in the middle

JTG, your husband is fortunate to have you.  

In general, I think people qualify for placement when they can't be left alone while you go to work.  Your husband is there, and I think you should start placement ASAP so you get it done before you have to return to the workplace.

I stopped work to care for my wife, but I was 72 years old.  A young person can't be expected to do that.

JTG

JoseyWales-thanks i will start calling the elder care attorney tomorrow. i appreciate you

JTG

Stuck in the middle- thank you so much. if only i have the option to retire- i would do it just so i can take care of my husband. I am 54, and with my own medical condition- i need my job to keep my health insurance