From ALF to SNF but attempts to get out of wheelchair

ICalE

Mom 9 months in ALF. Lost ability to do most if not all ADLs. ALF suggested MC or Hospice or else can't stay. Chose Hospice and stayed at ALF.

Qualified for Medicaid in December to pay portion of ALF. Mom's personal money runs out in several months unless I sell her house which I'm still staying in.

Fell out of wheelchair last week, went to ER. Found subacute skull fracture. In ER she had to be restrained; thought she was at the gym, was fine, and was trying to leave. For the first time, she did not recognize me at the ER for about 20 minutes. Discharged back to the ALF under Hospice.

Hospice lowered her Risperidone to 0.5mg at night and Ativan as needed. IMO this is why she attempted to get out of her wheelchair; her agitation is back without the 1mg dosage of Risperidone.

Given financial outlook and her stage I thought it time to transfer her to a SNF which Medicaid will pay for (besides her SSI). But the best SNF around says that the clinicals document her trying to get out of the wheelchair one time recently. As such they want $20/hour for a sitter which we cannot do.

There are other SNFs, but none I'm excited about. Not quite sure what to do. I'm hoping Hospice can increase her Risperidone or something so she stabilizes. But perhaps this fabulous SNF is looking for some reason to charge more anyway.

harshedbuzz

ICalE-

I am sorry you find yourself in this situation. It's a difficult one to be sure.

It is not unusual for any facility to ask family to bring in additional help as their LO's care needs become beyond what they can provide. In many situations, hospice is sufficient but it isn't always.

My aunt fractured a hip and wrist in AL. It wasn't the appropriate placement for her for a lot of reasons as I would have put her at Stage 5 straddling 6 at times. The fall, the surgery and hospitalization fast-forwarded her into stage 7 and admission to a SNF. Her hip was pinned and the wrist in a soft cast (initially) but she couldn't remember the fall or the post-operative need to get help. She constantly attempted to get out of bed. It's against the law to restrain someone, so a sitter had to be employed 24/7 to redirect her if she tried to get out of bed. My aunt did not have the funds for this. She was in a Medicaid bed, her house had been sold with the proceeds funding a long-established Special Needs Trust for her daughter so there was no money. This meant, family had to step in. The SNF did leave the adjacent bed as the last they'd fill and my cousin often slept over and spent most of the day/evening. Another aunt (85 and guardian for another sister with dementia who she spoon-fed daily) or her son's widow would fill in as they could. I think there were some Aide & Attendance hours in there, but it was a harrowing time.

Have you consulted a CELA? Generally speaking, her assets are to be used for her care. There are some loopholes to this if you've been a long-term caregiver or if it's been put into a trust. I would check with an attorney to make sure not selling the home isn't going to cause problems down the line.

HB

ICalE

Yes, we hired a CELA to help with Medicaid, get DPOA, Lady Bird Deed, and set up a Miller Trust. I am the Caregiver and have a Personal Services Contract too which entitles me to some money if she had any. Not sure I'd ever enforce that but the CELA strongly encouraged it in case I sell the house or something. I set up a consultation with the CELA today to discuss.

Ok, I did not know that the sitter thing was normal. Thank you for sharing; that's good to know. The SNF Admissions did state that restraining was illegal. It's just that a sitter amounts to hundreds of dollars per day, and I don't earn that much. If I sold the house, it might net $130,000 for her.

harshedbuzz

@ICalE

I'm relieved you have the financial taken care of.

HB

ICalE

What I'm learning is that a SNF in Florida regulated by AHCA cannot deny a Medicaid patient for not being able to afford a sitter. I'm hearing this from the Social Worker. I will call AHCA to confirm.

But either way the SNFs workaround is to put her on a perpetual waiting list, I am sure.

Anyway, I think another SNF is best. I now don't trust the one I thought was so great.