seeking residential care suggestions near Boston/Quincy, MA, WITH INSULIN SHOTS

gradomomhama

Hello,

I posted here once before but didn't get many good suggestions, and perhaps my subject line was confusing, so I am trying again with a clearer subject.

My mother has both Alzheimer's and diabetes, and is at the stage where she can't be trusted to take her own meds (really, hospitalized and nearly died this past May, very serious), but she can still do other things she loves, like dance and art, and she doesn't want to be in a nursing home. Also I looked and there appears to only be one nursing home in her area that takes her insurance (Medicare/Medicaid/PACE Harborhealth) and doesn't have terrible reviews, and that one has her on the waiting list but it will likely be at least a year or 2 before they have an opening for her. She is in the PACE program but they are not helping us with this -- they told us they want her to have overnight care and she obviously needs her daily insulin shots, but they won't provide that care or help us find it for her.

I live in Washington state where we have adult family homes that allow for more independence than a nursing home but slightly less than assisted living, but where meds and meals can be provided, and PACE here works with them. The staff and even supervisors at PACE in MA told me that Massachusetts does not have such facilities. Also apparently in Massachusetts there are no assisted living or memory care facilities that can handle insulin shots; both PACE and a professional who helps place people in temporary care for a month told me that. That placement professional places diabetics from Massachusetts in Rhode Island. A few weeks ago PACE in MA told us they were opening a brand new facility that was a test run of an adult family home, they got my sister and I to fill out a long application with tons of paperwork but between the two of us we got it done, and today my sister said actually after all of that, this facility told her that they also won't handle insulin shots!!!! How is this even legal? Are there even any diabetes advocacy agencies out there? I haven't been able to find any.

Does anyone here know of any options to get overnight care and daily insulin shots for my mother in the Boston/Quincy area? She currently lives in independent housing and there isn't room for a live-in aid even if we could find and afford one, which we can't.

dayn2nite2

Your last posting wasn’t “confusing” at all - what you want for her doesn’t exist where she lives.

Given the financial limitations and her requirement for insulin injections, if she stays where she is, she will need nursing home placement.  She may have to go to one that may be less than you want for her to be placed sooner.  PACE in her state isn’t required to find skilled nursing level care for her (injections) in the community setting.

Your other option is moving her to you and pursuing care there, but we told you it will probably be at the cost of your relationship.

Those look like your choices.

M1

Grado, I remember your other posts also and it sounds like a very difficult situation.  This is from left field, but have you thought about talking to her doctor about whether she absolutely has to have insulin at this point?  If she's a type 1 diabetic, then the answer is clearly yes, but if she's a type 2 diabetic, it might not be so clear cut.  Older diabetics--and especially those with dementia--don't necessarily need really tight glucose control.  Just a thought that it might be worth discussing, given your limited options.

jmlarue

If your mother is insulin dependent, one possible solution is to work with her doctor to transition her to a single injection of long-acting insulin (like Lantus) taken once daily after eating breakfast. She should have no other fast-acting insulin to use. The advantages are: 1. Long-acting insulin is less likely to cause a hypoglycemic (low blood sugar) reaction requiring rescue glucose and extra food intake; 2. Needing only one injection daily at a dosage that is the same every day is much easier for her to remember to take; 3. Taking a single dose of insulin only requires a single finger stick for a fasting glucose check each morning before eating/drinking; 4. Not having fast-acting insulin on hand takes the decision away from you mother about taking extra injections to cover a high blood sugars that are really normal up to 2 hours following a meal; 5. Long acting insulin taken in the morning tends to lose effectiveness overnight and relieves the worry of having a low blood sugar reaction while she sleeps.

A person with memory loss can remain independent and able to self-treat their diabetes much longer when they are not required to check their blood sugar levels 4 or more times a day or take a couple of different acting insulins 4 or more times per day. If remembering how to fill a syringe with the prescribed dose of Lantus is difficult for her, a visiting nurse can be utilized to fill a week's worth of disposable syringes in a single, short visit. These syringes can be left at room temperature in a cup on her breakfast table. Perhaps she is still capable of putting a check mark on a calendar after she has taken her injection - to remind her later if she has doubts about whether she took her shot that day. Her new routine should be written down to remind her to: do a fasting glucose finger prick, eat a balanced breakfast, and take her Lantus injection at a standard daily dose. Blood sugar levels need to be controlled largely by eating sensible, low carb meals 3 times per day or smaller meals 6 times per day.

If this simplified routine is beyond her capabilities, the best solution would be to have her move close to a family member who can assume the role of the visiting nurse to fill her syringes and keep a check on whether she is following the directions to take a single injection per day. You should know that it takes many days of extreme high blood sugar levels to be in danger of life-threatening acidosis. Low blood sugars, however, are very risky every single time they occur. Also, depending on your mother's age, experts are now saying that a 3-month A1C of 8.0 is acceptable. That means an average daily glucose reading of 183 would be no cause for alarm.

I hope this helps. If you have any questions, feel free to message me. My mother, 2 older sisters (all now deceased), and I transitioned ourselves to this single injection routine quite successfully. My mother had dementia and only needed assistance during the final year of her life.

AyaanWhitney

jmlarue wrote:

If your mother is insulin dependent, one possible solution is to work with her doctor to transition her to a single injection of long-acting insulin (like Lantus) taken once daily after eating breakfast. She should have no other fast-acting insulin to use. The advantages are: 1. Long-acting insulin is less likely to cause a hypoglycemic (low blood sugar) reaction requiring rescue glucose and extra food intake; 2. Needing only one injection daily at a dosage that is the same every day is much easier for her to remember to take; 3. Taking a single dose of insulin only requires a single finger stick for a fasting glucose check each morning before eating/drinking; 4. Not having fast-acting insulin on hand takes the decision away from you mother about taking extra injections to cover a high blood sugars that are really normal up to 2 hours following a meal; 5. Long acting insulin taken in the morning tends to lose effectiveness overnight and relieves the worry of having a low blood sugar reaction while she sleeps.

A person with memory loss can remain independent and able to self-treat their diabetes much longer when they are not required to check their blood sugar levels 4 or more times a day or take a couple of different acting insulins 4 or more times per day. If remembering how to fill a syringe with the prescribed dose of Lantus is difficult for her, a visiting nurse can be utilized to fill a week's worth of disposable syringes in a single, short visit. These syringes can be left at room temperature in a cup on her breakfast table. Perhaps she is still capable of putting a check mark on a calendar after she has taken her injection - to remind her later if she has doubts about whether she took her shot that day. Her new routine should be written down to remind her to: do a fasting glucose finger prick, eat a balanced breakfast, and take her Lantus injection at a standard daily dose. Blood sugar levels need to be controlled largely by eating sensible, low carb meals 3 times per day or smaller meals 6 times per day.

If this simplified routine is beyond her capabilities, the best solution would be to have her move close to a family member who can assume the role of the visiting nurse to fill her syringes and keep a check on whether she is following the directions to take a single injection per day. You should know that it takes many days of extreme high blood sugar levels to be in danger of life-threatening acidosis. Low blood sugars, however, are very risky every single time they occur. Also, depending on your mother's age, experts are now saying that a 3-month A1C of 8.0 is acceptable. That means an average daily glucose reading of 183 would be no cause for alarm.

I hope this helps. If you have any questions, feel free to message me. My mother, 2 older sisters (all now deceased), and I transitioned ourselves to this single injection routine quite successfully. My mother had dementia and only needed assistance during the final year of her life.

Thanks a lot for your input. My dad has diabetes type 2. He was on a diet to decrease blood sugar level for a long time. However, now he's prescribed meds. He needs to have injections once weekly. I buy trulicity from https://www.canadapharmacy.com/products/trulicity, and once a week seems not too often, but I'm worried how he'll cope with that.