Getting Mom into Assisted Living is proving impossible!

Mommabeans

WHY is this so hard? Mom is currently in a subacute unit at a local NH recovering from an accident she caused while driving a month and 1/2 ago. Her license has been suspended, her car is totaled. And ever since her accident her cognitive state has been sooo much worse. It's like she went from early-middle stage to middle-late stage overnight. The dx of Dementia came while she in the Trauma center. She has yet to be actually dx'd with a specific type of dementia. The trauma center she was in for about 2 weeks ignored all symptoms of a UTI and didn't run a culture because her UA looked good….while they were pumping her full of IV fluids and encouraging her to drink constantly. She was transferred to the SubAcute facility and it took them nearly a week to decide, maybe she should have a culture done. Multiple Bacteria. Antibiotics in, 7 day course, Mom's behavior improved significantly, but she still had some problems doing what she was asked to do, namely stay off her broken ankle. She has a cast on her leg, which has taken WEEKS for her to accept that her ankle is broken. She didn't believe it until just recently. Her original cast was just a "temporary" cast, and it was a walking cast. The new one that was put on July 2, nearly a month after the first one was put on," is not a walking cast. When I tell you that that new cast sent her into a SPIRAL. Although she was not supposed to be trying to walk around on her broken ankle, due to the UTI and the Dementia together, she wasn't listening and was constantly trying to walk on it. I think her dementia brain was "proving" her ankle wasn't broken. They put a wander guard on her because she kept trying to leave the unit. The day the new cast was put on, I was informed that if she had a wander guard on currently, the Assisted Living facility were hoping to get her into wouldn't accept her. They took it off and she has not wandered. HOWEVER, because the new cast she got on was not a walking cast, was slippery and she was afraid of falling, she completely FLIPPED OUT! Demanding the Rehab staff take it off or give her a tool to take it off. The NEXT day, the ALF came to assess her for admission. She would not participate. She wouldn't talk to them, and rehab couldn't get her to stand up and walk on her new cast. The director of the ALF then, apparently, rejected Mom's application. However, according to the admissions rep I've been working there, there were some "reconsideration options." The caseworker, however, was not aware of this and told me the director said no. When I told her that no one at her facility informed me of this, her answer was, "Because the director said No so there was no need for further communication." Huh? Not even to tell the people who needed to know that the answer was no? Someone please make that makes sense. While speaking with the caseworker the other day, she was also very snotty with me, and asked, "What would be the difference between the first attempt to assess your mom and now?" I explained to her the cast problem. She said, "I didn't know she had a cast." HOW? It's OBVIOUS that she's wearing a cast? Well, longer story shortened. Here we are 4 days before Mom is due to be discharged from SubAcute and we have NO answer as to whether she will be admitted to this ALF, ALL of ALFs have said NO. AND I'm also being told by the Rehab place AND the ALF that I'll have to apply for Medicaid for mom, but every person I talk to, whether they offer their services of apply for Medicaid for Free or at a fee of $3000 PLUS, have said Mom won't qualify. However, I have the adult services agency that I'm working with, the ALF AND the subacute telling me that her rent of $3100/month at the ALF IS spend down and she WILL qualify. The SubAcute place she is at won't kick her out on the 18th of this month, Thank God, BUT the insurance won't pay any longer at it will be $600 PLUS PER DAY, NOT including healthcare. Just her stay. Her wheelchair transportation to Dr's appointments is $160 per trip, which the SubAcute did not tell me was self-pay. They didn't even inform of her appointments. I had to find out from a yellow sticky note in her room. She has a Neuro surgeon appointment on Tuesday, that's going to be another $160 some dollars, plus the cost of sending an Aide to go with her so she doesn't freak out, because no one asked me when is a good day for ME to accompany her before they made the appointment. They also made the ortho appointment to have her cast off without notifying me, and it's for AFTER she was already supposed to be discharged and at time on a day that I CAN'T take her. I am so absolutely FRUSTRATED with this process! This is absolutely RIDICULOUS! I told the SubAcute because of all this nonsense, Mom will just have to go home until we can get her into someplace. They said they CAN'T allow her to go home because she needs "Memory Care Assisted Living." Well, I can't get her into one. It's IMPOSSIBLE. They say she doesn't need lock down, so they won't tranfer her to their Memory Care unit. But where do they think this $600 plus dollars a day is going to come from? My Mom has NOTHING. She owns NOTHING. She has NO money. What she does have will be gone paying for Wheelchair van rides, "rent" at the Subacute after insurance stops paying, AND she has to have a "move in fee" of at least $5000 to enter a Assisted Living place. NO ONE can move in with Mom. Mom Can't move in with any of us. We do not have the space or the mental/emotional/physical capabilities to care for her 24/7. They wont let mom leave the NH Rehab/LTC/Memory Care facility unless she goes to Assisted Living or someone lives with her. And it all costs more money than ANYONE has. AND we can't get ANY help with ANY of it because "mom doesn't qualify." WHY is this so damned Impossible? Also, btw, Mom does NOT have a POA. And I've had two attorneys tell me it's not possible to have that done now. I am literally STUCK. And everyone I talk to doesn't say very much, or says very different things from the last person I talked to. I've talked to lay-people who have had similar situations and they say something about all of this is not right, because it was complicated and stressful, yes, but they had no where NEAR the issues I'm having getting their loved one into Assisted Living or Memory Care. What in God's name is going on? Can anyone help make sense of all of this for me?

mabelgirl

wow! Sorry for all that you are going through. I have few comments that I don’t think help but maybe springs a thought in you.
I did not use a lawyer to get my mom on a Medicaid waiver which is different than full Medicaid. I accessed their portal and found most of my information and applications. My mom did not qualify for full Medicaid by $15 ! She did however qualify for Medicaid waiver which got her long term care assistance. She also qualified but does not need institutional skilled nursing care. Your local area agency on aging may help with the Medicaid waiver.
My mom also did not have a DPOA in place and she refused to do one until we told her it was needed if she wants to move from my house. I had talked to legal services available to her for free but they said they couldn’t do it because she was not cooperating. I found them at our local senior center. However, you can get legal DPOA done and witnessed without an attorney which is what we did. So far no one has rejected our DPOA. Otherwise your recourse is having the state determine guardianship. You need to check your states familial law as some do require children to take care of aged parents.

What state do you live in (besides your frustrated state 🫢)? It is a very tough situation to be in for sure. I pray you get some assistance and some peace of mind.

H1235

I have got the impression that Medicaid really can’t do much until she has spent down. So you almost have to wait til you barely have money for next months AL or MC payment then apply and cross your fingers that she is not disqualified for some other reason. All these extra costs will just eat up her money til she has so little that she does actually qualify. I know it’s hard to look at it that way. If the AL facility is giving you such a hard time you will probably need to consider MC. You could always start her in MC then move her to AL after her leg heals. If things go well. Maybe a place that offers both MC and AL. I don’t know how are you going to have time to find a place in 4 days. But if they wont/ can’t kick her out where she is at, maybe they will have some insensitive to help you find a place for her. What reason did attorneys give for not being able to do a DPOA? It’s my impression the bar is pretty low there. Is she willing to go to MC. If not you may need an emergency guardianship. I hope it all works out well.

OhDear

I am facing similar madness with my DH, except with the added roadblocks of Aetna's Medicare Advantage plan. I am exhausted and so is my DH. We ended up in the hallway of the hospital waiting with an ambulance that I paid for out of my pocket - only to be tripped up between rehab, hospital care managers and Aetna. Now on the third day of rehab, they want us to leave because my DH who weighs 117 lbs "lunged" toward one of the nurses. Meanwhile, I have not witnessed any problem, nor have any other nurses/therapists. This system TOTALLY FAILS the Alzheimer's community.

Victoriaredux

OhDear —

Don't take him home unless that is a truly safe option. Just keep saying "I can't provide care- not safe for for either of us" . If they say he has behavioral issues - then make them provide a geripsych evaluation and a stay in a geri psy ward to try and adjust meds. Call their bluff .

It's the annual enrollment period - maybe look at what other insurance choices are out there.

Ambulances, sighs-I've learned too much about them recently , there are different levels of them - be sure any future trips the hospital describes them all - the full crew treatment, a non critical horizontal, , a wheelchair etc. to you and why THAT level is medically needed . The desk may just pick the one they use the most when they order it.

And to explain in writing before you use that service WHY he can't walk out, drive himself, be in an uber alone or with someone and that that level ambulance ride is medically needed.

I don't know Advantage plans but in regular Medicare the trips out of hospitals to home automatically get rejected. Then begins the appeals process. And it is really hard to get ERs to backfill file notes. The ER Doctors can be floaters etc. and impossible to reach. If you do end up appealing then get the ambulance company notes - and read them very carefully. They get more from a private pay ride than a Medicare covered one - like thousands- so they can sneak in little verbal surprises to help the claim ge rejected.