How to get your parent to a SNF when they refuse to go

JustPyrfect

I'm new here & so thankful I found this forum! I have been caring for my 88yr old mom for over 2 years now. Diagnosed with Alzheimer's in July 2023. Steady decline since then, and last night was the realization that now is the time for SNF. She had a terrible outburst of anger, agitation and aggression and I feel that it is not safe for her be on her own at all any longer. I go every morning before work and give her her meds & make sure all is ok from the night before. Get her to restroom, take care of her kitty etc. She has a caregiver everyday from 9am-7pm but no one overnight, and I cannot afford it (lives in income adjusted independent 55+ community). Unfortunately she does not have any money - just SS that covers her rent and basics, I am her DPOA we are applying for Medicaid but it has been a process and its not over yet! I did get a elder lawyer to help, but it hasn't proven to be worthwhile. I have looked at SNF in our area that accept Medicaid, and they seem decent?? My question/concern/dilemma is how to physically get here there? She has not been out of her apartment for 6 months - she refuses to get out of bed to do anything but go to the bathroom. Telling her we are going out - going to lunch - going anywhere will probably not work as she is extremely defiant and difficult to deal with. What are some other strategies? Doctor wants her in in-patient physical therapy? She needs to go to the hospital for infection? She thinks she takes care of herself & doesn't need any help. And at this point, our relationship has deteriorated - I know its mostly the disease, but I have been dealing with her personality disorders all my life and have definitely taken my share of abuse in the past (when she didn't have dementia) and now its worse. I am worried for her safety and the safety of those around her and I'm worried about my own health and wellbeing. Any suggestions would be welcome! Thanks in advance :)

harshedbuzz

Just Pyrfect-

I am sorry you are facing this; it sounds especially challenging.

Given that your mom can get agitated, it might make sense to leverage that in the ambulance ride to the ER in your community with a geriatric psych unit where she could have a brief stay for medication management and be transferred directly to a SNF on discharge. The social worker at the geri psych hospital could probably assist with the placement piece as well.

My county has a SNF that accepts many residents of our Low-Income Senior Housing communities when the time comes. Almost everyone there is on Medicaid from Day 1. It's not fancy in terms of decor, but it's a well-run facility and the staff are amazing. When my BFF's older brother needed a SNF after a massive stroke and his wife was unhappy with the 3 religiously affiliated SNFs she'd tried first, I suggested it and she was quite happy with his care.

HB

JustPyrfect

Thank you - I think you're right - the psych eval may be necessary - that's a good suggestion. So I need to find a hospital with geri psych unit. I live in suburban Houston so I'm sure there's one somewhere!! I am worried about her behavior once she gets to a SNF. I'm looking at a SNF tomorrow that accepts medicaid - just don't know if they have beds. Hopefully they will also be able to provide some guidance

M1

Welcome to the forum JustPyrfect. when reading your posts, I found myself wondering about whether they will accept her if she doesn 't have skilled nursing needs? I think that is definitely something to ask about tomorrow when you go, what are their criteria for admission. Good luck, and let us know----

JustPyrfect

I will let you know - trying to get all the questions together!

My mom is unable to care for herself & needs assistance with daily living. She can’t make meals, has difficulty ambulating , hasn’t bathed and refuses to - has no short term memory, has fallen 3x in 2 weeks…. It’s definitely time. But her lifelong personality disorders I think will be the challenge. She is so certain that she takes care of herself, does all the cleaning in the apartment, drives to the grocery store and shops for herself - none of which she does. She’s becomes arrogant, aggressive and agitated when someone (especially me!) talks about having to get some help even though She’s had the same caregiver for 6 months now who is awesome with her, but she’s leaving in the beginning of June so I need a plan in place by then. I also have hospice for her, and I will need to talk with them about transitioning as they indicated her care with them would follow her to SNF. I was hoping for some suggestions and support from Hospice, but haven’t really gotten it. But I’m not sure if they can and Is this something I look for from them ? The other thing about her is that she can put on a good show when needed! I’m sure this is the same for most - they don’t want to look weak and the struggle to keep independence is strong. The natural order of things!

thanks for the help! I’ll let you know what I find out today

mlowe6

Just Perfect I totally understand where you’re coming from. My mom knows.how to put on the show too and manipulate and use me as her personal punching bag. It’s tough but as a caregiver we have to learn to get a thicker skin and realize it’s not your parent it’s the disease. They always have difficulty accepting and live a life of denial. It’s hard to watch the ones we love go thru this and want to fix it for them but it’s just a part of the circle of life and an unfortunate thing we have to deal with.

JustPyrfect

UPDATE - the tour of the SNF went well. Very nice & clean - just built 3 years ago. We looked at the survey book and it had no infractions. All public areas are clean, staff was friendly, and rooms are standard. They are not a memory care facility, however she did tell me most of the LTC patients there have dementia. My mom is not a wanderer - at least she hasn't to this point! I don't know if any SNF with memory care take Medicaid?

I was told that if she falls again, or for any reason has to go to an ER she can be admitted directly to the facility. She will also be asked to leave if she becomes violent or physically aggressive - which has never happened. She is verbally abusive! I know when I move her she will be so confused and scared and it really breaks my heart that I have to do that - but I have to remember I'm doing it FOR her not TO her. But she will never understand - I just have to remember and know in my heart that I have done everything possible to keep her comfortable and safe.

Biggest lesson I have learned is to try to plan for this time in your life... if you can. My mom did nothing to plan for her older years. I guess she assumed I would take care of everything... which I am :)

M1

Glad the tour went well. And she's lucky to have you in her corner. Yes, planning ahead is a huge deal. I for one do NOT want to be a burden on my children. I will have some serious planning to do when my partner dies and I sell this farm. Can't see that chapter yet, but I know it's out there (Good Lord willing and the creek don't rise).