After power of attorney

ICalE

I just got durable power of attorney for financial and also health surrogate and so on.  What is a good next step for my situation?

She is wetting the bed through her depends up to 3 times per day some days, and is increasingly struggling with the walker to use the bathroom and shower.  Most of the time she wants me to be next to her through it.  She sometimes calls out to me up to once every 2 hours for minor things, but it means I never get a break and cannot really sleep more than 5 hour shifts.

She's on Risperidone.  It has calmed her.  She went from denial of it all to now talking about her death and getting outside help.  I'm discussing nursing homes with her now all of a sudden.

towhee

Glad you got POA, from your previous post it has been a long hard slog. You mentioned before that you had contacted Medicaid, it would be a good idea to reach back out to them. You need to know if medicaid in your state will pay for memory care or only a nursing home, what level of care a doctor would certify her for, MC or nursing home, and you need to become aware of what facilities are available in your area. If you can private pay for even a few months, you might have more choice. In the meantime, if medicaid can provide even a few hours of care it will give you some time to work on finding placement. I would discuss nursing homes with her as little as possible, you never know when something will set her off.

Hope things work out.

Marta

An increase in the risperidone dosage may allow her ( and you) to sleep for longer periods. 

Search these boards for threads about the best incontinence products.

Research facilities in your area, but first meet with the lawyer who did the POA about Medicaid planning.

Your mom may even qualify for Hospice and all of its benefits.

ICalE

An ALF was recommended by a friend of hers.  We visited and she liked it a lot and wants to go ASAP.

I have a consultation scheduled with the Elder Law attorney this week.

She has an IRA worth $50,000 that the financial person at Wells Fargo in charge of it says that my durable POA is not good enough to convert it or anything; they apparently have their own POA form.

My own instinct is to use that money for the ALF immediately, and then to apply for Medicaid.  But I'll wait to speak to the attorney to be sure.

She's now trying to call 911 every few hours claiming she needs "help" but it's not specific.  She says she's afraid I'm going to let her die.  I am beyond irritated by this.

I scheduled a Home Health Aide finally to start this week.

Found some incontinence bed pads and moved the commode to her bedroom.  Big help so far.

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ICalE

Yes, the ALF evaluated her.  I'm supposed to hear back this week.  They also have a memory care unit there.

First time visit to neurologist this week diagnosed her with dementia based on a first (memory?) test.  She scored just low enough for the dementia diagnosis.  She told them the year was 1985 or 86.  Surprisingly, she did somewhat better than I expected, and I strongly suspect that the Risperidone is helping keep her calm.

MRI scheduled for this week.

I took her smartphone and unplugged the landline finally.  Great idea.  I don't know why, but I had been afraid to do all that even though the police and doctors were all telling me to.

Come June I will have been at the house for two years if that matters.  Utility bill in my name and driver's license show it.

The house is homesteaded as well.

CanyonGal

I think I sent the DPOA and health surrogate forms to financial organizations (bank, credit card companies), and medical (hospital medical records department, medical offices) and especially anyone involved in billing (mortgage, utilities, medical bills)! I started closing credit cards and turning off services she didn't need.

I understand the frustration of someone calling 911 because "her leg hurt real bad" and "she needed a doctor to take care of it". The person who received the chewing out was me even though she called from her facility, and they knew from the address that it was an assisted living facility. (Front office told them they didn't need to come.)

We had enough in saving to get her in the initial first year before I got her LTC policy on board. (I was so appreciative that she invested in getting that policy, as it has paid for her care so far.)

I hear stories from my ALZ group meetings about the Medicaid paperwork. Hope it all goes well for you.

feelsad

Hi, what kind of Medicaid you're referring to? Regular or Waiver (COMP)? I think the regular one can only apply for when all saving is spent down... Is that correct? My wife is 57+ and is about to start receiving Medicare (2 years on Disability) but I'm strugling with her care without Medicaid...

ICalE

All set to go.  The attorney gave great advice.  We'll be applying for the Medicaid Waiver program coming up.  In the meantime he advised how to pay for the ALF in the meantime without touching the house or car at least for now.  It's Crisis Planning, so to speak, instead of Estate Planning.

We are to get the ALF lease today and I expect to sign it this evening.  There is a $1000 one-time discount offer if we take financial possession by April 1st which I expect we should do.

I think the ALF will immediately be able to tell if she should be in memory care, which they also do, or else a nursing home.

I can't wait for some relief!

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ICalE

Lease in her name signed today on her behalf.  Working out the logistics tomorrow, but she should be there in 7 to 10 days.

They qualified her as needing Level 2 care out of four levels with Level 1 being the least amount of medical care needed.

It's hard for me to understand how she will get around well enough there to get her meals or to keep her place clean between the weekly housecleaning visits.  She seems to always ask for help with getting up and sitting down claiming she can't walk or that a bone is broken, yet she always does it herself anyway.

In any case, what's the next type of place if it turns out that she needs more than an ALF can provide?

harshedbuzz

ICalE-

TBH, it sounds to me as if she's a better candidate for MC. 

I don't know how weekly housekeeping works if a PWD is routinely soaking their bedding. 

There are some ALFs that will do a kind of bait'n'switch with families, luring them in with a fancier AL knowing full well that their LO will need to transition to MC in a matter of weeks because of needs around personal care. I hope you have toured that place as well.

You need to consider the phone. With staff on site, I would suggest you disappear it or the phone calls will continue.

HB

CaliforniaGirl-1

My LO sometimes calls 9-11 times a day. It doesn't matter if I have just spoken to them or seen them. They are in MC. I spoke to the doctor about it and the doctor said it was up to us to decide if we wanted them to have the phone but that we didn't have to answer it. Even not answering getting 11 calls a day and 11 messages is disturbing,

There are phones and phone systems like Telecalm (I have not used it but keep thinking about it), that are made specifically for people with dementia. They can detect repeated dialing of the same number and instead of ringing play a message saying that number can't receive calls right now. You can also program quiet hours.

ICalE

She moved to the ALF yesterday! Nevertheless, 12 hours later, she told them she broke her leg. Since they do not yet know her baseline they had to call 911 per protocol.

She told the transpo driver returning her from the brief hospital visit (nothing was broken, of course) that she doesn't live at the ALF and demanded that he call me. She was upset, demanding I pick her up, and had no idea she had moved in there.

I called the ALF to explain. Hopefully, it worked out. This never ends!

jfkoc

No, it does not end until she dies. You are responsible until then and the road will always have bumps, twists and turns.

I am concerned about her diagnosis and hope you will go online to make certain that all steps in the proper protocol are taken. Until then yu really have no idea what is causing the dementia.

I am also concerned with the unit she has been placed in. When you visited di it seen that the guests were functioning at her level?

ICalE

https://alzconnected.org/discussion/comment/170612#Comment_170612

What do you mean by go online to make sure that all steps in the proper protocol were taken? Or that I have no idea what is causing the dementia?

I can't tell yet. The guests I've seen have been a wide range.

harshedbuzz

ICalE-

I am sorry you are dealing with this very common behavior.

Most POAs would elect to meet the ambulance at the ER because an AL would not send someone to advocate for her. You being there could circumvent the confusion about where she would be sent on discharge.

I would also add that a higher acuity MCF would have trained staff at higher levels that would check her out and may not transport without a concerning fall. When dad was in MC, they were to contact mom before transporting. He was a DNR, so he would have been transported for a bad fall or perhaps an infection. Most medical care came to him.

HB

Jo C.

I can imagine the concern you are feeling; it is a very uncomfortable place to find oneself when there are no crystal balls to be had to tell us the future. Been there.

Basically, a concern after reading your Posts would be that your mother may not be at the appropriate level of care for her needs and those needs have a 24 hour seven day a week schedule so to speak.

My mother, step-dad, MIL and GMIL all had dementia and it certainly has a learning curve. Based on experience both personally ad professionally (RN), it may be that the facility wishing to fill their ALF spaces may not have done a full enough evaluation of your mother. From what you describe, she needs much better access to ongoing supportive and direct care than what an ALF can provide. Do keep an eye on this. It is always best to make placement at a level for the worst days our Loved Ones (LOs) have rather than the good or better days as those worst days will become more and more common.

As for the ER; my LOs were a frequent flier on that dynamic. I found it far best to go to the ER with the LOs or as soon as I heard about it whether at home day or night, or at work. So much can go sideways and my LOs were NOT good historians re their conditions or meds, etc. It really kept things much smoother if I were to be with the LO to interact with the physicians and to directly hear the results of tests, etc. In fact, I got to carrying a copy of my LOs DPOAs in a manila envelope in the car. I had to use that so often; for some reason, hospitals and doctor's offices never could fine a copy no matter that I had provided them.

Best of wishes are being sent to you; it will take a bit for this to all settle out and it may be that a bit of adjustment may be needed, but it will get smoother as things begin to fall into place. Your mother is blessed to have such a caring daughter by her side. Let us know how things are going and how you are; we will be thinking of you.

J.

jfkoc

Diagnosis of Alzheimers is basically the elimination of things which can cause dementia. Some are treatable. This is from Mayo Clinic;

Physical examination: Checking the patients for their reflexes, ability to get up from a chair and walk across the room as well as their muscle tone and strength.

Neurological examination: Check for the sense of sight and hearing, coordination and balance.

Complete blood count (CBC): To check Liver functions, Folate (folic acid) test, Vitamin B12 concentration, Electrolyte (sodium, potassium, creatinine, glucose, calcium) and blood glucose levels, Thyroid function tests, HIV test (ELISA).

CT scan: CT scan of the head is performed to check the severity of brain degeneration.

Magnetic resonance imaging (MRI): MRI scan of the brain provides more detailed aspects of brain, like the presence of a tumor or nerve damage etc.

Electroencephalogram (EEG): To find abnormal brain wave activity.

Positron emission tomography (PET): Identifies amyloid proteins which are associated with Alzheimer's disease.

Usually the complete blood work up and history is done by the PCP. The short "memory test is usually done by that Dr before a referral is made to a Neurologist.

I hope I have answered your question......J