Parent stuck in the middle, what can I do about placement?

Bob249011

My parent is 65, and I am 27 their only child. They have a diagnosis of unspecified dementia, their progression has stalled so to speak. My parent is on Medicaid, but unfortunately given their level of functionality they have not qualified for many home care hours. They mostly require prompting and supervisory care, been quoted since they lack a skilled medical need they do not meet the requirements for extra hours, I have done three hearings so far, and have had assessments done by five different MLTC's. 

I feel stuck at a crossroad I have been supplementing care for them with my time for two years now, and I have been given a wonderful job opportunity but the catch is I have to move, and my wife does not want to be near my parent, and my parent does not move to either. I have been trying to find placement, and it appears based off many assessments they have recommended residential care, catch is Medicaid does not cover this. AL is a busted since my parent is a wander risk and is completely ambulatory. I do have them on a few lists for MC, but that may take years for a Medicaid bed to open up, and those within the MC get priority. My wife will have my balls in a jar if I even think about using my income to pay privately.

I have reached out the various agencies and I have been told the middle area of dementia is rough because the markers used for assessment do not scale well with those that can still function. Their doctor also told me the roughly the same, they are at the wait and progress stage. Problem is I cannot wait, if I want this job I need to head out by 4/1. I have spoken with Nursing homes, and I have been told my parent does not meet the requirements cause they need active assistance with at least 2 ADL's my parent needs zero, just companionship  and someone to watch out for their safety. 

My parent appears to require more social assistance then anything, what exactly are my options? Am I better off just lying and saying my parent does not wander and get them into AL? I rather they go into AL verse a NH if it can be avoided. I have no family support, I have been taking care of my parent myself. I have kept my wife's involvement to as near zero as I could get. Part of the reason why my wife wants her no where near us if we move, since they do take up a large amount of my free time. I know in theory they claim my parent can be on their own, but I do not trust it. With the amount of time I have spent with them idc what the assessment nurse claims 3 hours 7 days a week is not enough. 

M1

Bob welcome to the forum; I wish I had advice, but all I can offer is that I work for our state Medicaid program, and what they are telling you is correct:  they cannot, by law, provide safety monitoring/supervisory care unless there is a need for hands-on assistance and household chores.  The times offered are based on actual estimates of the time needed for such tasks (i.e., 10 minutes per day for dressing, 20 minutes for light housekeeping, 10 minutes per day for toilet visits, etc.).  It's a difficult system, and in our state and most, is subject to estate recovery after death for costs.  Wish that weren't the case, but I can confirm that they are being truthful with you.  The shortage of caregivers is making everything worse.  While there are usually separate payment waivers for folks with other disabilities (in our state the Department of Developmental/Intellectual Disabilities or DIDD), acquired dementia is not included in those and under current budget restraints is not likely to be.

I am so sorry for your difficult situation.  I am sure others will chime in, and you have come to a good place for support.  I wish you well.

King Boo

My first 'go to' for many situations is the input of a Certified Elder Law Attorney (CELA) www.nelf.org.  They have 'sight' on so many resources and the ins and outs of this phase of life.  Some have Geriatric Care Manager referrals, which are many times RN's who can be our LO's monitor when we are not around, and provide care advice.   Both of these can also provide some strategies to facilitate an easier entry to a care facility.   The concept of 'key money' if sufficient can also smooth the way in certain instances - i.e. pay privately for a certain time then Medicaid kicks in.

No matter where your parent lives, it will help to have your first, second and third choice of a nursing home for that eventual hospitalization - many people are more easily placed from a hospitalization first via a short term rehab stay that then converts to a long term stay.  You want to be sure your rehab stay is done at a facility that provides long term care Medicaid beds (the facility receives insurance payment for the rehab stay which then converts to the lower ltc reimbursement).   

You are so young to have to be dealing with this, I am sorry.  At 27, I also imagine your  marriage is fairly young (and perhaps your wife is too).  It must be terrible to be in a place where you feel forced to choose between leaving your parent at risk of great harm and your wife who wants nothing to do with the situation.  

I might suggest that if your wife learns more about dementia, and it's care needs, she might come to understand that she can't have her cake and eat it too.  Your parent needs to move with you and you need to provide the care, or you have to spend some money to cover that time so you can be with her.  She may just be very young and in the pretend dreamland all of us experience at some point, wishing this situation would go away.      If she realizes that to leave your parent alone, without supportive care, is condemning them to great great harm, either through self neglect or predators  the light bulb will hopefully go off.  You cannot leave a person who wanders to fend for themself.    Would she do this to her loved ones?

If it does not, this may bear very careful thought for you about the implications of this unwillingness.

Concrete questions to ask yourself:

1.  How will I feel if I move away and leave my high care need parent?  Who will make sure they eat?  Get to the doctor?  Remain safe?  Find them if they get lost?  (even in a care facility, it is challenging to moniter and advocate for care from far away).  From experience, it is not easy to manage life and death decisions from a distance.  

2.  What new options are available where I would move that can help my parent?  Does it impact eligibility for services in a positive way?  Adult day care? 

3.  Moving your parent doesn't always involve 'the moving' conversation.  It often is a fiblet designed to accomplish the goal.  Is there a house sale involved?

4.  The above mentioned professionals may have some plan input for you.

5.  Many adult children have to provide some financial assistance to help their parent to cover the hole that Medicaid does not.  The key to this is a budget, like anything else.   What can we afford?  Am I still saving for my retirement?  Providing for my family?  A child cannot become destitute to do elder care, but paying for supplemental care when finances permit is not unusual particularly when it frees them up to be with their family or to work.

6.  Sometimes an assessment by a Geriatric Psychiatrist MD and PhD Neuropsychologist can add additional valid care needs by their evaluations; the cognitive impact on self care can be supported by additional documentation and can tip the scales in their favor for care needs.  Screenings are just screenings; there are deeper layers to uncover.

7.  As young marrieds, we all to some extent seek to please our spouse.  You may have some precedent set up here to manage.  Compromise goes a long way.   I would suggest a conversation with your wife somewhat along the lines of "I love you and our marriage is so important.  I know my parent's situation is difficult and adds time demands but until they qualify for placement I cannot just abandon them to whatever bad thing happens to them.  I have to be there some, and I will hire help so we still have time together."     It's all about balance.  You will have to be careful to attend your marriage and your parent.   But it is all about balance for your wife too.  She should not be demanding 100% from you without compromise.   Your earnings can be planned and budgeted together; but your wife should not be determining the well being (or lack thereof) your parent.

I hope more resources become available.  These can be state specific.

Bob249011

King Boo wrote:

My first 'go to' for many situations is the input of a Certified Elder Law Attorney (CELA) www.nelf.org.  They have 'sight' on so many resources and the ins and outs of this phase of life.  Some have Geriatric Care Manager referrals, which are many times RN's who can be our LO's monitor when we are not around, and provide care advice.   Both of these can also provide some strategies to facilitate an easier entry to a care facility.   The concept of 'key money' if sufficient can also smooth the way in certain instances - i.e. pay privately for a certain time then Medicaid kicks in.

I have spoken, and I have paid for the service of Medicaid Specialists, and Elder Care Lawyers. Their advice I cannot follow, it is not fair to my wife to ask her to cover majority of our expenses because I am paying for my parents care until they get a Medicaid bed. With their help I did manage to get them on waiting lists so was not a complete waste of time, and also got coverage for day services.

No matter where your parent lives, it will help to have your first, second and third choice of a nursing home for that eventual hospitalization - many people are more easily placed from a hospitalization first via a short term rehab stay that then converts to a long term stay.  You want to be sure your rehab stay is done at a facility that provides long term care Medicaid beds (the facility receives insurance payment for the rehab stay which then converts to the lower ltc reimbursement).   

You are so young to have to be dealing with this, I am sorry.  At 27, I also imagine your  marriage is fairly young (and perhaps your wife is too).  It must be terrible to be in a place where you feel forced to choose between leaving your parent at risk of great harm and your wife who wants nothing to do with the situation.  

I might suggest that if your wife learns more about dementia, and it's care needs, she might come to understand that she can't have her cake and eat it too.  Your parent needs to move with you and you need to provide the care, or you have to spend some money to cover that time so you can be with her.  She may just be very young and in the pretend dreamland all of us experience at some point, wishing this situation would go away.      If she realizes that to leave your parent alone, without supportive care, is condemning them to great great harm, either through self neglect or predators  the light bulb will hopefully go off.  You cannot leave a person who wanders to fend for themself.    Would she do this to her loved ones?

My wife does understand what entails with dementia, as she put it. She married me, not my parent. This was something I knew going into this that when it came down to it they will not be part of my parents care which I fully understand and respect. This is not her burden it is mine, she has no love or bond with my parent, and most certainly has not responsible for their care and it would be selfish of me to make her life any harder because of my parent.

If it does not, this may bear very careful thought for you about the implications of this unwillingness.

Concrete questions to ask yourself:

1.  How will I feel if I move away and leave my high care need parent?  Who will make sure they eat?  Get to the doctor?  Remain safe?  Find them if they get lost?  (even in a care facility, it is challenging to monitor and advocate for care from far away).  From experience, it is not easy to manage life and death decisions from a distance. 

I do not feel great about it, but I have a choice to make either my future or past. I wish both timelines could coexist, but I have done much research and have read countless articles. Marriages often do not survive family issues around dementia when you put a spouse in a position where they have to adjust or do something they are not willing to do. I do not wish to lose my wife I love her deeply. 

2.  What new options are available where I would move that can help my parent?  Does it impact eligibility for services in a positive way?  Adult day care? 

I cannot move my parent with me, it will cause major issues in my marriage and I am not ready, willing, and capable to handle such stress. So what is available is moot, this is also meant to be a fresh start for us, and how can that be if I am bringing along parts of my past with me. I have already neglected my wife for over two years caring for my parent. It is not fair to her for me to keep putting her second because my parents "needs" require for attention.

3.  Moving your parent doesn't always involve 'the moving' conversation.  It often is a fiblet designed to accomplish the goal.  Is there a house sale involved?

My parent rents, it has less to do about the conversation and more so with the fact that my parents past is here, and she still somewhat recalls this area, neighbors, and friends.

4.  The above mentioned professionals may have some plan input for you.

I have spoken with them yes, and their plans are either private pay which they do not advise since they state you should never use your own money for your parents care, or wait out until the disease progresses. 

5.  Many adult children have to provide some financial assistance to help their parent to cover the hole that Medicaid does not.  The key to this is a budget, like anything else.   What can we afford?  Am I still saving for my retirement?  Providing for my family?  A child cannot become destitute to do elder care, but paying for supplemental care when finances permit is not unusual particularly when it frees them up to be with their family or to work.

I have been also told that one should never use their own money for their parents care, that is not financially responsible. It is an option people use, but as I said I cannot do such because I cannot ask my wife to cover my share of the expenses, or minimize my future savings because of the astronomical cost associated with elder care. 

6.  Sometimes an assessment by a Geriatric Psychiatrist MD and PhD Neuropsychologist can add additional valid care needs by their evaluations; the cognitive impact on self care can be supported by additional documentation and can tip the scales in their favor for care needs.  Screenings are just screenings; there are deeper layers to uncover.

With such documentation I was able to get her 3 hours of homecare, and on waiting lists.  

7.  As young marrieds, we all to some extent seek to please our spouse.  You may have some precedent set up here to manage.  Compromise goes a long way.   I would suggest a conversation with your wife somewhat along the lines of "I love you and our marriage is so important.  I know my parent's situation is difficult and adds time demands but until they qualify for placement I cannot just abandon them to whatever bad thing happens to them.  I have to be there some, and I will hire help so we still have time together."     It's all about balance.  You will have to be careful to attend your marriage and your parent.   But it is all about balance for your wife too.  She should not be demanding 100% from you without compromise.   Your earnings can be planned and budgeted together; but your wife should not be determining the well being (or lack thereof) your parent.

I have spoken with my wife, and in truth I cannot also maintain the balance. I miss my time with my wife, this is not just about her putting her foot down. I miss not having to worry about what exactly will I do with my parent if I wish to have a date night with my wife. I am sick of always being worn out between work and caring for my parent that I barely have the energy to spend time with my wife. It is not far to her that because my mother is ill she has to spend our younger years concerned about factors we did not ask for. Dealing with an adult child is not exactly fun. 

Quilting brings calm

There was another young married male  only child  on this forum a while back.  Also stuck  between his wife and his mom.  His mom however had emotional and a mental illness on top of it.  I’ve not seen his posts for a few weeks, but he was left with no real help from anyone. 

Unfortunately you are going to have to come to terms with a couple very real truths,  If you do not move your mom with you, you will most likely lose that dream job even if you take it. why?  Because you will find yourself making multiple trips back to your moms location at a moments notice.  Trust me, I know this for a fact.  Leaving her with limited supervision will allow her to wander, get injured or otherwise need medical attention that she won’t follow and you will be the emergency contact.  An AL is not going to keep your mom if she repeatedly wanders. In fact it is against state laws so then to keep someone who needs more care than they can provide.  

The even worse hard truth is that this is just the start of a possible decade or two of her slide into the terminal illness that is dementia.  It will consume your life.  Your wife is under the impression that she doesn’t need to support you with your mom in any way.  What does that mean when your mom is needing a shower or a diaper change or is the subject of a silver alert because she’s missing?  What does that mean if you yourself suffer an accident or an illness and your wife needs to take care of you for a decade or more? What about if you have children and one of them isn’t a perfect physical and mental human being? Will she  be around for that for decades?  Is she going to be there for you?  The truth is that when you Marry  someone, you do indeed marry their family. In my opinion, your marriage will not survive the decade that is to come.  Many marriages don’t.  

Please go over the spouses forum and read the first couple of pages for threads.  Particularly those of  Lady Texan. Josey Wales, Ed1937.  Their posts will give you some idea of what is ahead of you - and anyone that is married to you.  

I wish I could sound positive for you.  

Bob249011

Quilting brings calm wrote:

There was another young married only child  on this forum a while back.  Also stuck  between his wife and his mom.  His mom however had emotional and a mental illness on top of it.  I’ve not seen his posts for a few weeks, but he was left with no real help from anyone. 

Unfortunately you are going to have to come to terms with a couple very real truths,  If you do not move your mom with you, you will most likely lose that dream job even if you take it. why?  Because you will find yourself making multiple trips back to your moms location at a moments notice.  Trust me, I know this for a fact.  Leaving her with limited supervision will allow her to wander, get injured or otherwise need medical attention that she won’t follow and you will be the emergency contact.  You won’t be eligible for FMLA because it’s a new job and you have to have worked a certain number is months abs hours away to be eligible.  You will burn through any personal and vacation days that you may accumulate as fast or faster then you accumulate them. 

I do not want to give up this job, it is a great opportunity for myself and my future family. The benefits are wonderful, and the location is in a wonderful area to start a family. Everything you said is something that has been on my mind which is also why I am not keen on moving my mother with us. I will have to start the Medicaid Process over again in the new state and it was a hassle here. I will have work around a new job and handling assessments. I will have to find her new doctors and deal with those appointments. I will have to do all of this on top of dealing with a new home, new job, new location, new everything. I do not have the headspace for that. 

I am also not keen with leaving her with limited supervision, I am already a nervous wreck when it comes to leaving her at night. They are not a handful to be honest, I know in the grand scheme I have it far easier than most. She is fairly independent, but on the same token it is also not fair to myself or my wife that we are expected to use our income to cover the missing hours. Homecare is not cheap, I am already doing that now, and it has been rough on my marriage. I feel like a deadbeat relying on my wife to cover my share of expenses. We also want to start a family, and that cannot be possible if I am dealing with my mother. 

The even worse hard truth is that this is just the start of a possible decade or two of her slide into the terminal illness that is dementia.  It will consume your life.  Your wife is under the impression that she doesn’t need to support you witn your mom in any way.  What does that mean when you’re mom is needing a shower or a diaper change or is the subject of a silver alert because she’s missing?  What does that mean if you yourself suffer an accident or an illness and your wife needs to take care of you for a decade or more? Is she going to be there for you?  The truth is that when you Marry  someone, you do indeed marry their family. I’m my opinion, youe marriage will not survive the decade that is to come.  

Tbh, I would not want my wife to be my primary caregiver. I would not want my wife to give up any aspect of her life to care for me if I needed care. I know what it is like to stop living trying to care for another person. It is not easy, nor would I ever expect or want my wife to give up her life for my own because I became ill or disabled. 

 You are right I also agree if I move my mother with me my marriage will not last. I have seen it myself I have changed ever since I started caring for my mother. I am not the same person I was. I feel as if I aged 30 years, in just a mere two, I am no longer any fun to be around, I have a ball and chain tied to me, even if I am away my mind is still with my mom. She lives rent free in my mind day in and day out. I cannot even have a proper evening without having this sense of worry overshadow it.

Placing my mom is not much about my wife, but also about me being able to let go of some of the worry. I want to go back to being a son, not a caregiver. 

Fairyland

I am much older only child than you, with less affected mother, an understanding manager and remote-doable job which I could afford to leave (retire) if I chose, a stable marriage of over 30 years and a very supportive DH who likes my mom and has never had a bad word to say about her or the situation we have ended up in.  

I have also become extremely stressed and consumed about the right thing to do, and struggling with the many decisions and problems that crop up. 

Just saying, 1) that you are doing the best you can in an impossible situation. 2) most people don’t want to or expect to become a burden to their family and friends 3). I would be proud of you if you were my son, ....or my other half. 

My entire family is proud of me for stepping up to deal with it. No one assumed I would, to the extent that I have done so. They are a good bunch! 

My advice to you at your age and stage is to put your own life first. And to make sure you think about your own long-term future too, because your other half doesn’t sound so far like they have inclination to love and to cherish in sickness. Maybe in health, and maybe with maturity will come understanding of what really matters in the end.

mommyandme (m&m)

Are you POA for your mom? 

If not, maybe add that to your “do not do” list.  

If you don’t have it, and she is abandoned, then possibly the state will take over when the inevitable happens, the crisis, and you won’t be held legally responsible for whatever her outcome is.  

Maybe your wife could be happy with that option? 

Sounds rough and you are so young and I’m so sorry.  

Phoenix1966

Have you reached out to APS to see if they might pursue guardianship of your parent?

From what you’ve said, I get the sense that you do want to sever yourself from your parent financially as well as from the daily care and management your parent requires now(and the increasing care they are going to require as the disease progresses, which it will sooner or later despite being “stalled” at the moment). Having someone appointed guardian for them might be a solution, where the guardian takes over the financial and medical well-being of your parent without you having to supply any input. 

Bob249011

No one wants to something harmful to happen to my parent, but we are afraid of exactly what QBC pointed out. This is not going to be an easy or even short journey. If I go down the route I currently am it will delay our life together. I cannot imagine having children, I will be torn in three directions. We are afraid of the health issues associated with caregiving, the stress will eat at us. I also do not want to give up control either, I am okay with advocating for them, I am okay with being supportive element, I am okay with taking them vacation, I am okay being pillar of support, but I also want to just be a son. I want our time together to be less about what I need to do as a caregiver and what I can do to be a son. I want to have fun again with my mom. I wish I could do it the way my cousins did but their were 11 of them together so splitting cost and time was easy when you could do it 11 ways, 12 counting my uncle.

I have thought of guardianship, neither of us feel it right to pawn them off to the state, she does not deserve that. On the same token I also do feel we deserve to have a life of our own. I will look into APS though to see if they can help get extra aid or support in place. It is not safe for her to be alone for extended hours.

Phoenix1966

I hope you get a sense of direction soon. You sound as though you kind of want both things(freedom to live your life with your new family member and also be a guiding force in your parent’s life) and I don’t think that’s tenable. 

Your parent(and, in your heart you know this) has a terminal illness. They are going to get worse. That’s not “if”, but “when”. Despite being currently “stalled”, your parent will decline and need more and more help with everything. You want to start on the next phase of your own life, with your relatively new wife and a new career opportunity, which does not include being a caregiver to your mother.

You’re not stuck in the middle so much as standing at a crossroads, in my opinion. Going by the start date of your new position, you are going to have to pick a path very soon. I don’t think you’ll find a way to have it both ways. My experience with APS was frustrating and not a source for additional aid. I hope yours is different. 

Bob249011

Yeah you are right I am at a cross roads, I do feel as if it is my mom that is stuck in the middle, while I am at the cross roads. You are correct I want to do come up with a perfect solution in an problem that has none. Engineer in my solving problems is what I do, but what you said is 100% what I feel right now.

Tfreedz

Bob, I feel awful for you and your situation!

 You really have to live your life and put your marriage first. Unfortunately, you will be so mentally taxed from feeling worried and guilty if you just abandon your mom that you might not even be present in your marriage.

I know your wife doesn’t want you to move mom to the same area as you because she’s worried about your time. Also Mom doesn’t want to relocate and start over somewhere else. The best advice I have for you is to suck it up and force yourself to take the week or two to research Medicaid available beds in your new location. Another option is to contact a senior care manager and have them do the legwork for you. Even A Place for Mom can be a resource even though they primarily deal with private pay. It is amazing what you can get accomplished in a very short period of time when you are desperate. 

Once you find a place near your new location, you will be shocked at the peace in your life. You will be able to worry less and move on with the rest of your life. You are so torn up right now because you know she is not safe if she remains where she is. I’m telling you, take a day or two to make all the calls needed especially office of the aging tell them of your situation and get things moving. Mom won’t love relocating but I bet she will adjust. Wife won’t love the idea at first but once she sees that this will eventually put her first again she will come around.

Positive vibes that you figure out the best answer to your problem and can move on from there.

Iris L.

Hire a GCM and turn over care.

Iris L

harshedbuzz

Bob-

This, indeed, a difficult situation. 

Dementia sucks on many levels, but your situation seems to a be confluence of complications that can make a difficult task so much harder. You seem to be ticking all the boxes for "how to make dementia care harder".

Only child with no family help? Check.

Potential for long distance caregiving? Check.

EO dementia and 20-something trying to launch their own family/career? Check.

Relying on Medicaid funding for care? Check. 

PWD who is in that difficult phase where they're too impaired to be left alone safely but on the ball enough to present as more capable than they reliably are? Check. 

Resentful and unsupportive spouse at home? Check. 


Your options are really limited here. 

You can commit to the hands-on care for your mom until a bed open up by putting your career in limbo and your family plans on pause. Or you can throw money at it- money you should be investing in your own future- and delegate that care. You could attempt to make you mom a ward of the state but in doing so you will lose control over her and her care and there's always the possibility those making such decisions will deem her competent to manage her own affairs. 

Sadly, you are in a place where all of the options suck. 

HB

King Boo

Thanks for the addtional information.

You've done a lot for your parent.  2 years of supplementing care and a lot of advocacy and hearings.

-visit and research and find your top 3 choices of a nursing home.    If you can provide these to the social worker upon a hospital admission, it increases your chance of success. Particularly important if you are moving.  Many of  us placed from a hospital admission.  You'll be doing this all by phone.  

-agreed.  You should not be responsible for funding 10,000 plus in long term care costs.  But if you have any discretionary income, paying a GCM or someone to take Mom to the doctor can be done.  Not spending a dime (if you have the discretionary dime) - kind of a tough ask.

I had a friend who did know a woman who had been a caregiver.  No qualifications per say, but experience, common sense and a whole lot of kindness and patience.   She had no home - so part of her reimbursement was the ability to stay in the home to provide care, with meals and a stipend.   Just tossing that out there. 

Once placement is achieved, you will go back to being a son.  Hands on caregiving is tough.

ButterflyWings

Dear Bob-

As a mother of adults and also a full time caregiver, I feel for you. I was advised by a VERY caring AD spouse caregiver who eventually placed her husband in an MC for his safety and the well-being of both. She gave me some excellent advice that I will pass along to you: put yourself first. It is not selfish, it is realistic given this is a terminal disease, the crushing expense, and fact that you are only 1 person who must prepare your future. Your mom’s EO can definitely take down all 3 of you, no fault of her own. I feel your wife is being practical and realistic though some may see it as harsh and putting you in a tug of war. But you cannot win a wrestling match with dementia. That is really the enemy here and perhaps the dream offer and move is a blessing in disguise. Many of us in this forum, in hindsight, wish we had made certain decisions sooner. Because the fact is, no matter what, our LOs will only get worse. 

Put yourself first right now. In her right mind, this is what a loving mother would want for you. Take the job, build a life with your wife, putting your marriage first, and follow your own heart re: not abandoning your mom. How to accomplish that last point? Take the advice of longtime member Iris (who also lives with cognitive issues and has unique experience in that regard) and hire a Geriatric Care Manager to care for her back home. If any of your funds need to be used temporarily to supplement her Medicaid, (I don’t mean huge amounts) perhaps it can be done as an official loan against her eventual estate.  Certified elder law attorney is best to advise about that. Good luck to you!

https://health.usnews.com/best-assisted-living/articles/when-to-hire-a-geriatric-care-manager

Bob249011

Thank you for the feedback from both sub forums, I made a few phone calls towards MC around the area where I will be moving and I was not given great news exactly in terms of funding for facility care, but the state does offer extensive home care support. I also was given helpful information and contacts regarding the applying for Medicaid in a different state. 

One facility even held a zoom assessment with my mom, they said in terms of ability she is a level one, main issues is the reminding, and constant need of redirection, would put them in the level 2 care which puts her out of reach of most AL, but given age they also did not personally recommend MC or SNF, granted without a skilled need SNF is out of the question. 

I was given information and a contact to call regarding programs meant to provide in home care, but was also warned it would not be a complete hands off process I would still need to make up the hours. It appears the main issue is the fact my mother has working memory issues, which requires a constant degree of supervision, in which they cannot comfortably provide due to the staffing shortage.

I have googled a few care mangers and will be making phone calls. If I can get a solid game plan it will make talking with my wife easier since everything would be put in place. 

I am still looking though.