Looking for placement, my mother was turned down how do I approach?

Bob249011

Hi, back again. I have been looking for placement for my mother near where I will be moving in April. She has been turned down for each facility in question. Reasons being POA and her exit seeking behavior. I do have POA of my mother, but it is not active as the doctors have stated she is not at the point where she is considered to lack compacity. This is not enough, each place wants an active POA in place. 

I have tried for AL, but her exit seeking, wandering, and need for constant supervision have made it so those are impossible. Another issue I have been sighted is my mother is not on an active care plan for her dementia. As her doctors have put it, my mother suffers more so from separation anxiety that has a trigger that sparks her behavior. Even with medication if she experiences the trigger she will feel how she feels. Her memory is not robust enough to use therapy to address her fears and concerns. Which is the case my mother is on Zoloft, it does not do much of anything to curb the issues others have when she is left alone. She is fine in her home with me around, but that is not realistic.  

I am trying to have her placed as soon I as I move, they are using the records from her current doctors. I will not have time to get her adjusted, find new doctors while also maintaining my new work related responsibilities. It seems the greatest concern is the exist seeking behavior, and fire exists. If she wants to get out she will get out. They do not have the staff and I understand it is unrealistic to have someone watch her 24/7. Idk if it is a liability issue.

Is my next step to put her in geriatric psych after I move to maybe find a treatment plan? I have heard horror stories and Idk if it do more harm than good. It never crossed my mind here because she is generally okay with me around or in her own home. I just know she is one bout of forgetfulness away from hurting herself or others in the apartment building. It can be annoying but for the most part I have always been able to bring her back to reality. Was I wrong for being transparent and honest? Everything I have mentioned have been issues I have faced but only under certain circumstances. It is far from an everyday thing, but in a new and unknown location with someone that is fully capable of figuring out how to hold a door for a few seconds to get out, and has done so. 

I have spoken with her current doctors regarding my plans, and they do not feel comfortable upping the dosage to try and see if it will prevent the behavior from happening, since such behavior is not common for her in her everyday routine. As I explained it it will be for a time in the coming future if I were to place her. 

loveskitties

If you can't find a facility, in-home care when you are away from the home, may be your only option until you can have her re-evaluated in your new location.

ST_niece

My sister has active PoA over our LO, even though she has not been deemed to lack capacity. Our LO gave consent for the active PoA, and signed a document. Have you talked to lawyer about this possibility?

Rescue mom

I don’t understand all the issues you mentioned around the POA, but maybe you need to check with an attorney? We always had one, can’t recall it being an issue.

But regarding the exit-seeking…are you looking at memory care places, or just ALF? That’s a pretty common behavior. Most, maybe all, MCs could handle that; not all ALFs could. Anyway, it’s not unusual, many facilities deal with it, but you may have to look at more or different places.

Bob249011

I have, my mother will not willfully sign over her capacity, I do not blame her. I also looked into guardianship, the lawyer told me I would most likely lose and it is not worth the money. We do have PoA and maybe in the new state it can become active, but even after the interview she had with the lawyer he did advise me that I will be hard pressed to get a doctor to sign off. She is just not at that stage yet. Was advised to just let the disease progress and come back when she becomes worse. I do not have the luxury or head space to wait for her to get worse and hurt herself or someone else before she can get the supervision she needs. I get what I am looking for is to have Medicaid cover custodial care. Which is not what Medicaid is for, I get that 100% but on the other hand I am also being advised I should stop paying for her care as I have been. 

Trying to avoid in-home care because it will come out of my money she has no assets to her name, and I am trying not to rock the boat with my own marriage any further. The rates for in-home care range from 27-35 an hour. No flat rate for the day. Applying for Medicaid in the new state will take sometime, and if it is anything like where we currently live she is will be granted a small handful of hours. 

Wracking my brain here, this is frustrating. I have looked into AL, MC, and SNF. MC is largely out of the price range, Medicaid here covers the medical cost of MC, but not the room and board. SNF requires a skill need as I have been told but is my best shot at getting Medicaid to cover it, but she needs a skilled need which she currently lacks. 

Oddly enough even the MC I spoke with then went to visit with my mom in tow shot her down the moment they saw her. I think people down play how active and capable she still is despite me being 100% transparent. Even on my tour my mother nearly tried to live through the fire exit. I did find one place that would take her but I would have to pay for a 1-to-1 privately. I told them if I could afford that I would not be looking for placement.  

abc123

What a nightmare for you and your wife. Your mother seems to have a stubborn streak a mile wide. Either she signs off on the paper work so you can help her or she doesn't. I'd be tempted to call her doctors and tell them since they think she is so together, would her staying with them be an option. Let them know you'd be more than happy to deliver her to their home or office. I'm sorry I have no good suggestions for you.

King Boo

Hi Bob,

I don't remember your earlier posts, so on the basis of what you have written.....

Things should be easier if you shift your focus to dementia specific Memory Care.  You are just barking up the wrong tree, so to speak.  I have 'been there, done that."   I sobbed and sobbed that they had rejected him.  But it was really a good thing.  We ended up where he belonged and found an amazing facility.  It was a Memory Care in a "High acuity Assisted Living' label.   This is a hard, complicated process.  It was so very annoying and stressful.

By the time most members  have found the discussion boards, the ship for Assisted Living has long ago sailed.   AL is 'supportive' and ill equipped to provide the extensive care, monitering, redirection and rarely has dementia trained caregivers.

Yes, it's a lot more expensive than AL, but her care needs are what they are.    Most of us have loosely held 'assistive living' in our minds for a long time for our loved ones, 'until they are bad enough/need it'.     By the time that lightbulb goes off, the time is long passed.

It's a good thing, though very stressful, that Mom has been turned down.  Her stay would have been very, very short, and the facilities recognizing that they cannot care for her at her care level is ultimately a good thing.

Investigate Memory Care (if it has a good affiliated skilled nursing facility too this is a very good strategy for longevity of private pay and then conversion to Medicaid upon spend down, particularly in non profits who provide a benevolent policy sometimes to their residents who have chosen to spend their life savings with them - it's never in writing, but is part of the philosophy at some).

Free standing Memory Cares can also be an option, as the above is not always possible.

A Geriatric Psychiatrist MD (sometimes along with a PhD Neuropsychologist who does test of function if needed) is the go to professional to prescribe medication for behavioral issues that result from dementia or for anxiety, depression, etc.    My experience was that while GP's and other specialties are able to prescribe, it is NOT their wheelhouse and my LO was very underdosed.

I encountered a fair number of non dementia specific practicioners who fed me a lot of very inaccurate information that led to a delay in receiving care and a catastrophic illness.   I'll venture a guess (only a guess) that her PCP has it backwards - separation anxiety does not drive the dementia, the separation anxiety is a by product of dementia.  There is a very specific characteristic during dementia called shadowing - read up on this for deeper understanding.

There are also medications that can sometimes 'plateau' her symptoms for a longer time period at an earlier stage.

PCP's and neurologists generally want nothing to do with documenting 'capacity' - while to do so can be a very long involved process via in depth neuropsychological testing, by the time MC is needed usually a Geriatric Psychiatrist MD is able to do this with basic evaluation.  Be there for the consult.  Our LO's mask well sometimes.

Exit seeking, however, is a part of the disease - and thus, the need for monitering and Memory Care.

I had a Springing DPOA, and did not require the documentation to be admitted to a care facility, but it was needed for certain financial situations.

Generally, upon admission to a MC their function upon evaluation qualifies them, just as choosing an evaluation at too low of a care level disqualifies them.

Shift your focus and you will be more productive.  Good luck.

loveskitties

You might also try contacting the Agency on Aging in your new city.  They may be able to offer suggestions to deal with this situation.

My own experience with trying to locate an appropriate care facility was a bit easier and also harder.  Getting doctors to specify type of care needed since we were dealing with a heart issue as well as dementia.  Prior to hospitalization, he was doing well at home with my mom.  It was a toss up after if  he needed skilled nursing or memory care.

Even finding the appropriate type of care facility, finding one with space available was the next hurdle.  Only those with space would even consider review of his medical records to evaluate their ability to provide the care he needed.

I realize you are trying to be as honest as possible about the level of care you feel she needs, but if doctors don't agree then you will be hard pressed to find a facility to take her.  None want the responsibility of a higher level of care than medically approved...it would be like trying to put her in jail without legal cause.  It would also cause issues with Medicaid approval.

Getting her re-evaluated sounds like the next step.  It sounds like if they say she is "not there yet" in needing additional supervision you must accept that and move on.  Some of us have to wait for a crisis to occur even though we personally see the need now.

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