Rehab hospital back to AL

Fairyland

 I doubt there is a standard answer to this, but to those other long-distance caregivers out there - looking for experiences ...

The rehab is discharging mom a week earlier than the 3 weeks they said initially (next week). I can’t be there, and neither can the other relative who is 82.

The AL mom’s stuff is in, no longer has any spaces in their MC.  Yesterday, they had several and the relative was supposed to tour despite being stressed out and having no spare time (I had said just take the cheapest room - why tour? I already did and know it’s ok). 

Is it normal to load all the details onto a local 82 year old in-law of the LO, and leave them to figure everything out? Or is relative just being overcontrolling plus uninformed having never dealt with these sorts of residential facilities before?

Regarding coordination between the hospital (who are incapable or unwilling to communicate with me as I am abroad) and the AL facility? 

Regarding the facility doing their assessment of whether mom is able to return to AL with some help? Or if she could return with extra help, even temporarily which I have already arranged, as needed?

Transport?

Moving furniture, if necessary?

What would have happened if mom had no one? The facility have been continuing to be paid in full, and not providing any meals etc so are quids in, to some extent.

dayn2nite2

If she is deemed unable to go back into AL even with help and they have no space in their MC, what is the plan?  She will be without any place to live.  The reason she is being discharged sooner than expected is likely that her insurance won't pay for any more time (either she is not or cannot make any progress in rehab) and so they certainly won't keep her there for an extra week for free.

When people have no family, usually a social worker at the hospital will arrange admission to the closest place that has a bed and takes the form of payment that is funding their stay.

For private pay residents, it doesn't matter if they haven't eaten or used services.  You are paying their monthly fee to keep the room for them - otherwise the room would have been given to the next person who is willing to pay.

Example - if the funding was Medicaid and you are in the hospital in my state for more than 7 days, you lose your bed at the nursing home.  My mother was admitted for 5 days and I was busy trying to get her out before she lost her bed because they had no other Medicaid beds available and I would have had to move her to a different facility.  Luckily she was discharged on day #5 and I didn't have to deal with that.

So she has been paying to keep her space HER space.  

I wouldn't burden an 82-year-old with the task of getting someone readmitted to their AL but if she has nobody else then I guess it's that person's misfortune to deal with.

harshedbuzz

Fairyland wrote:

 I doubt there is a standard answer to this, but to those other long-distance caregivers out there - looking for experiences ...

The rehab is discharging mom a week earlier than the 3 weeks they said initially (next week). I can’t be there, and neither can the other relative who is 82.

As day pointed out, this is likely because she is not meeting expected benchmarks because of infirmity, inability to comply because of dementia or both. 

The AL mom’s stuff is in, no longer has any spaces in their MC.  Yesterday, they had several and the relative was supposed to tour despite being stressed out and having no spare time (I had said just take the cheapest room - why tour? I already did and know it’s ok). 

This is unfortunate. Population can be very fluid in MC, if you can self-pay in the rehab or bring additional aides into the AL, it might buy you some time until there's an opening. 

Is it normal to load all the details onto a local 82 year old in-law of the LO, and leave them to figure everything out? Or is relative just being overcontrolling plus uninformed having never dealt with these sorts of residential facilities before?

"Normal" is a dryer setting. IME, 80-somethings as primary caregiver is not ideal. They tend not to be resilient, are often blown off by professionals because of agism and generally have their own significant issues with which to deal first. 

If you cannot or will not move closer to your mom (or vice versa) it may be prudent to hired a professional Geriatric Care Manager to be your eyes, ears and advocate going forward. 

Regarding coordination between the hospital (who are incapable or unwilling to communicate with me as I am abroad) and the AL facility? 

This is where a locally respected Geriatric Care Manager would be really useful. 

Regarding the facility doing their assessment of whether mom is able to return to AL with some help? Or if she could return with extra help, even temporarily which I have already arranged, as needed?

This is entirely up to the ALF. If you live in an area where AL rooms are at a premium or your mom has been more challenging than most, you may find they won't help you make this work. In such an arrangement, it would be on the family/GCM to arrange and pay for the extra help. 

Transport?

The ALF should have the numbers of medical transport companies in the area. The hospital discharge planner will arrange transport from the hospital on discharge. 

Moving furniture, if necessary?

There are generally companies that can be hired to do this. The ALF/GCM should have a list. You could also privately hire through Dolly.com or Craigslist for such help. 

What would have happened if mom had no one?

The state would appoint her a professional guardian.

The facility have been continuing to be paid in full, and not providing any meals etc so are quids in, to some extent.

The AL has been her home.  As such, there are still operating costs-- a mortgage, staff, utilities, taxes, maintenance, etc.-- that need to be paid whether she's "home", on vacation or in the hospital. I'm sure meals are only a miniscule part of her monthly fees. 

MN Chickadee

I know how hard this has been for you from your previous posts. My first thought after reading this post was geriatric care manager. It has already become apparent you cannot count on the elderly relative to be the go-to for a variety of reasons. You should be able to find medical transport and a moving service via the internet and phone to deal with the situation at hand, but that is a band-aid on a much bigger problem. These things are going to continue to arise. This will certainly not be the last time your mother needs a local person who is the advocate and decision maker and rational thinker. Being in a different country seems to be exacerbating the problem due to calling out of the country, time differences, and the fact that the elderly relative is the one in front of the doctor and you are not. If this relative in front of them is willing to take on the work it is much easier for them than communicating to someone in another country. I'm guessing they are just doing what is easy and the relative may or may not be controlling. You are probably correct that they are uninformed on how to deal with all this.  I would look into a hired geriatric care manager. They will be a highly trained professional who can trouble shoot issues locally and will also be far more committed to keeping you in the loop and communicating with you when the health system/facility staff do not. It will be constant  as she progresses. There will be trips to the ER where she will need an advocate and someone to sit with her. The ER is stressful for a PWD and they usually need a 24/7 sitter, which will fall to a family member. ER staff are not always in tune with dementia and we need to be there to decide how invasive to be and other important decisions because our LO cannot think for themselves. Once my mother was in memory care I would say I got at least one call every couple months that required me to be within a short drive. As her dementia progressed, this increased to nearly once a week in the later stages. Seizures, falls, declines, and many things necessitated I be there and ready to help and advocate. I met the ambulance at the ER in the middle of the night countless times. Usually nothing was wrong and she was discharged after a few hours. Until your mother is late stage and on hospice they will likely call an ambulance after any fall or incident to rule out breaks and problems for liability reasons, it's just the protocol. Falls become quite common in later stages and are somewhat inevitable. I can see that phase being extremely hard for you to be so far away. I personally would get her moved to the higher level of care now. It may be easier on both of you in the long run. If she returns to AL it will likely be a short stay so you will have to do this all over again in a few months and she will have to adjust all over again. If you get her in a place she can age in place for the long haul it will be less complicated in the future which seems important given how far away you are.

mommyandme (m&m)

I hope your 82 yr old helper will tell you when she no longer feels able to manage your mom with you.  We also did long distance care and depended on her neighbor, who was older than my mother, to be our eyes etc… She was absolutely wonderful and able but finally told my brother and I that she couldn’t be a primary any longer, as mom progressed.  Was easy to decide next steps because moms friend and neighbor was clear on her boundaries.  

My second thought is it’s time for a Geriatric Care Manager. The rehab or a SW should be able to help find one quickly.  I imagine that wouldn’t be too difficult to discuss with you by phone. Maybe your 82 yr old would find working with them easier to manage.  

Third thought is hire someone to help at the AL til MC comes available. The GCM could help with that too. 

Long distance caregiving is another level of difficulty in this disgusting disease process. So sorry for your struggles. 

Fairyland

Right! Thank you one and all. What a wealth of knowledge is here. Meanwhile it seems like the machinery is beginning to creak and shake, to do the needful!  I keep thinking, surely this is an everyday sort of occurrence with the AL population, most of them seemed very impaired compared to pre-second stroke mom. So the staff know the ropes.

She passed the AL assessment to go back to her apartment, phew! No need to move furniture and less confusion for her I hope. They will arrange transport and the rollator, extra help from their own staff and want a private caregiver initially to cue. I had already lined a private one up anyway for other stuff, they have been great so far, and had kept that person in the loop, so I asked them to communicate directly with one another and figure it out- hope that works out! I am in effect trying to use this person as my geriatric care manager, that’s not her job title but I think she basically does that.

She scored 15/30 on her MMSE which they are attributing to be down due to the stroke so I guess working assumption there is some potential to improve (she did before- I feel like an imposter on here sometimes because she seems to have purely vascular problems so not the steady one-way losses of AD- but still a lot of the same behaviours and  results - it’s local cumulative brain damage in the end).

I think they are throwing her out (actually discharging is a better term) a week early (Medicare pays for up to 3 weeks, she will have had 2) because she is better and they are very busy, probably have more desperate  cases - she was strong before, is doing well and trying hard. 

She seems to have a happy demeanour apparently and doesn’t remember she had a stroke (same as the first one). I and relative feel she would be better off back in AL, she had even started to like it and told relative she dearly wanted to go back! That was a surprise, I think it has been a huge improvement to her wellbeing and safety to go into AL at the start of April and I couldn’t provide all that by myself, she has even gained weight which she needed, so on balance it makes sense even though bye-bye investments. At least I stopped the scammers taking it.

Really I never wanted the older relatives to end up fretting all the details but they WANT to, despite not really being in a position to deal with it all. They are all very stubborn and won’t ask for help. I’ve tried to tell them to leave it to the paid professionals and just visit and be supportive like they have been.

We are very very fortunate that dad left her comfortable unless she lives a long time which seems unlikely, sadly, and he guessed right to some extent as to which sort of coverage to have (not LTI unfortunately).  We will see how she does and if she needs to move to memory care, I will look around more when I am there in just over a month in case there is a better option. I now THINK I understand that her SS and little widow’s pension are going to mean she can’t get Medicaid when all the savings is gone, and I have had to sell her house, but we have some time.

Can I breathe now?   I’m trying to hyper down and get back to my own many issues for a few weeks.

Fairyland

I would have been happy for her to go to MC, but it didn’t work out this moment in time.

mommyandme (m&m)

Thank you for your update! Glad you may have some “down” time. Yeah, that’s not a thing.