Newbie questions about 24/7 caregivers: legal questions, etc.

Parent Cafe
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<p>Nice work, DW. Hope this is peace of mind and frees you up to accelerate the house sale in order tosecure her placement post-rehab or hospital if pacemaker is to be done. </p>

<p>PSA as this came up on the parents caring for parents thread as well: skilled nursing rehab can be the greatest benefit your relative can receive post-hospitalization. If you are looking into any type of Medi-gap policy, IMHO, this variable is one of the most critical to address. Having coverage to 100 days rather than @21 days can allow fuller recovery, tend elder while new arrangements for increased care are made, and put off a move to more care while it is determined how close to baseline an elder will return post setback. There are specific requirements to be eligible to enter and remain covered for a rehab stay (see Medicare.gov site). It is very pricey to cover this service out of pocket. As others have said, connections with hospital discharge staff from day one can be critical to obtaining this placement. DW shows us not to be afraid to ask. Hospitals are dinged for rapid re-admit of elders for the same issue, don’t want liability and can help find the SNF placement, though do your own checking for best option or vetting of recommended places. </p>

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<p>Dharma, I agree with those that say: no going back home.
Once in SNF, mom’s next move is to the 5 star ALF.</p>

<p>You do NOT need that magical 10-day phase the realtor is referencing. That is her perspective only if you need the profits from the sale to proceed.
Your mother has the funds for the hefty deposit and a couple of months beyond that; by the time she needs more money, the house will be sold.
If it isn’t, tap into the HELOC (which I doubt you will ever need)!</p>

<p>Time to tell Barbara she needs to look for another placement.</p>

<p>Best to you.</p>

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<p>Wow, that’s great, Dharma. You never know with case managers. I have dealt with some who are very receptive to SNF, and with others I have begged and literally cried, and they still said No (and in one case, Dad ended up back in ER within hours, just as I told her he would!). Huge win for you!</p>

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<p>Oh yes, things are going fine with the house sale moving toward signing contracts. jym626, we didn’t need the buyer’s “approval”–the thing was, he wanted us to split the cost of testing the oil tank and the septic tank 50/50. Our realtor wanted us to be fully in control of the oil tank inspection and negotiated back that we pay for the oil tank; they pay for the septic. It took them a few days to get back to us on that for some reason. I left a voice mail with the company who performs this test, recommended by our fuel supplier. And before we sign contracts, the house is still on the market and open for viewing. Its better for viewing that the house will be empty for a week. </p>

<p>I am printing out the 35 page (!) application for the two Maplewood Communities. You will groan to hear this, but my mother’s first choice is almost an hour away. So evidently she doesn’t care whether or not she sees much of me or the grandchildren. I told her clearly that if she wanted to go to CVS for toiletries etc, she would have to take their minibus, (The driver does help the residents disembark and help them step in.)and with one D in college and one on the way, I will be doing a lot of driving and she won’t see so much of me. )The Danbury agent got my mother on the phone and urged her to view an open unit in East Norwalk so I got sucked into another lunch/tour. The unit is gone already, but I have to fill out the application and put down a refundable (hefty) deposit to go on the waiting list. But the administrator, food, accommodations, and residents are the best of the lot I’ve seen so far. This is her big first choice because there is one resident has her own studio set up in the art room and the Director agreed to let my mother leave–set in place and not move–her painting table, easel, supplies, etc., into her own space in the art room. This is incredibly generous and makes my mother very happy.</p>

<p>This “artist” thing is by far the biggest thing in her life. She was very proud of the eulogy she wrote for her funeral and asked me a year or so ago to read it. It opens with a long account of her life as an art student, paper-sculpture maker, designer, book illustrator, and teacher. Then she tells us she was also a wife, mother, and grandmother. </p>

<p>Because my mother’s first and second choice ALs are full and she’s going on a waiting list, I’ve been calling places where I can put her until she can transfer to her first choice. I found a great sounding one in Rhinebeck and the administrator explained that NY State laws require about a month of preliminary paperwork, nursing assessment, and other stuff before you can move in (Choices I and two are in CT but there seems also to be a lot of advance work. You can’t move in fast.) About this place with open apartments in Rhinebeck,I agreed to visit and if my mother is pleased, put down a deposit in October and move in when the closing is scheduled, predicted now to be Nov. It is more expensive than any of the others (it is a one bedroom instead of a studio) but they have several units available and I am not anxious anymore about “what if I can’t find a place to put her and she has to come to my house.” So Somemom, your outline sounds great, but she will only be in the nursing home for a week and I can’t get her right into AL. She will have to come home to her house first. </p>

<p>ECmomx2 I will definitely call the cardiologist after I pick up my daughter from school. Your post was very interesting and made me realize we have choices.</p>

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<p>Dharma- what happened to the first two places you saw and that had openings? Are they filled?</p>

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<p>Don’t create more problems for yourself. You’ve seen enough of these places to know what you’re looking for, and you know your mom well enough to know that she’s not going to like it. Go see it by yourself and if it’s acceptable, start the ball rolling. If she objects, tell her it’s temporary until she can get into the one she likes.</p>

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<p>Are you talking about the skilled nursing facility where she’ll be for a week or are you now adding more ALFs to the mix? Agree with LasMa. Dont add more work. Too many decisions is not a good strategy.</p>

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<p>Great to get those deposits in and waiting lists secured. Find out how many are ahead on each list, stress smooth transition for your mother. Let them know you will take bed immediately upon availabilty. That way if someone backs out, you may be in luck. If lists are long, do add a couple of more to them. </p>

<p>Consider pre-screening any new places alone while mother is in rehab. Then if it looks good, bring her. No need to bring that up unless it is worth pursuing; neither of you wants to be de-railed. Time to ensure she can go somewhere ASAP. </p>

<p>Also, while plan is for a week of rehab, know that it could take more time to optimize her regaining of strength and be flexible about/encouraging of a longer stay if she could benefit. </p>

<p>Here’s to a quick closing. I continue to hope that her move and the closing of the house could be uncoupled if need be. I hope the oil tank assessment can be done fast, as problems with that could bog you down. </p>

<p>Fingers crossed for sealing the deals, DW! </p>

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<p>Mominva, I am coming round to your way of thinking because it is very clear that the buyer wants the house. Yesterday, on his own, he raised his bid $10,000. If someone else bids, he may even raise his bid. Barbara said he was a single older man and we wondering if he is a divorced father who wants a place where he can have his kids. </p>

<p>Somemom, YES, just as the guides told me, the units go FAST but the waiting list also moves FAST. I am filling out the residential commitment forms on choice #1 and sending a big check that will not be cashed until a unit is available and we put down the big money to move in. </p>

<p>LasMa, I get your point…if I take my mother, it doesn’t matter to me so much; during the drive I can listen to my book on CD (she is deaf and it is difficult to talk in the car unless she yells). My mother and I have nothing to talk about. Now that she has accepted AL, I don’t RULE OUT yelling but she is much less aggressive. The Taconic Parkway is pretty and is is near my school Bard College so a nice drive down memory lane. And the old me has not completely died…I know she would extremely object to move to a place, even temporarily, without seeing it. BUT from the web page it is GORGEOUS. It is also expensive, more than any of the others and judging from the many pictures she is sure to like it.</p>

<p>jym,626, today she goes to a skilled nursing home to await the pacemaker next wk. As I wrote to Somemom, all the ALS she viewed are full. So yes, I are forced to add a temporary AL not “to the list” - just to find a place she can go temporarily while she is on a waiting list. Unfortunately, she will have to move her furniture twice.</p>

<p>ECmomx2, my mother’s cardiologist will be in the office and the nurse said he will call me then if I have HIPA rights; I may not. But what are the advantages of medications over a pacemaker? I will do some internet research. </p>

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<p>Travelnut, thanks for your note. When you go on a waiting list for one Maplewood you are actually on their waiting list of all their five locations. The great looking place in Rhinebeck has several rooms available and we can secure one with a deposit in mid-Oct-soon–with a November closing in view. Ugh, I have a 35 page document to fill out for Maplewood.</p>

<p>The AL-alternative start was dreary and depressing because all the places I called had patients sharing rooms. But then I called this great place in Rhinebeck and was very satisfied. Will look up advantages/disadvantages of pacemakers now.</p>

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<p>If you’re lucky, your mom may adjust well to the “temporary” AL and not want to move again once there’s an opening at her preferred ALs.</p>

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<p>Yes I thought of that! But the cost is rather shocking. It is a one bedroom; the other places are studios. The cost is $6,1000 a month as compared to $5,450 in East Norwalk. But as I pointed out to her when we saw a one bedroom in another place, she could put her art studio in the bedroom and her bed in the main suite.</p>

<p>I told the Director at the Rhinebeck place about how caregiver costs double on 1/1/14 which she knew all about. She praised me for taking on the duty honestly/legally. But, you know, all the aspects involved took days sitting all day at the computer. When I wasn’t doing that, I was driving between nursing homes, hospitals, picking up caregivers to interview.</p>

<p>I talked to a technician at an oil tank inspection facility, learned a lot, passed the info to my realtor via email who will pass it to the buyer’s realtor. 45 minutes. Researching ALs today. Several hours. </p>

<p>So it just occurred me to chat, have others spent hours and hours making arrangements and managing affairs for elders? I have scanned the reception form for Maplewood and it is 35 PAGES and will take me all day tomorrow. </p>

<p>Is this commonly what happens?</p>

<p>PS I read up a lot about pacemakers. They don’t sound so bad. ECmom, what were your objections? And I forgot to answer your questions about extending life. Yes, I was present when in the first nursing home the SW interviewed my mother and asked her how far she wanted efforts to be taken should her life be endangered. She said all measures.</p>

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<p>With our mom, after we selected a place with an opening, things went quickly. Instead of personally assessing her, they called the rehab and spoke with them and took their word that AL was the best for her. I put down a deposit, we moved her furniture in and then moved her in and did the paperwork the same day. The problem is that you hesitated. If you had gone with the place you had first chosen when they had an opening, all of this would be in the past. You would just be concentrating on selling the house. Learn from that and don’t let it happen again. Believe me, the AL places want your mom. They don’t get Medicare funds and are dependent on elders like her that can full pay. If they can’t pay, they go to NH. Your mother is in a privileged position. Don’t forget that when looking at AL. They need you despite their “waiting list”. I also advise selecting the place closer to you. You think it is only a disadvantage for her, but believe me you will regret it. Soon you will need to supervise every dr. apt, give her extra care if she gets ill, run to the emergency room - things only get harder, so make it as easy as you can on yourself. You can always tell her how lucky she is to get her second choice since her first choice remains full. This is the time for lots of little white lies. Avoid moving her twice if at all possible.</p>

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<p>I agree on keeping her closer if at all possible. You will likely end up doing a lot of driving anyway, but if she’s close, it won’t be so bad.</p>

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<p>By the way, we had to send our mom to her second choice and I’m glad we did. It is a little older and smaller and has worked out well. Glossy brochures, etc. don’t mean a whole lot. I’ve been shocked by how little participation there is in the activities provided, and they are always prompted to try. For the independent living people there is a good bit, but not much for AL. What matters is good staff and good attitudes.</p>

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<p>“Soon you will need to supervise every dr. apt, give her extra care if she gets ill, run to the emergency room - things only get harder, so make it as easy as you can on yourself. You can always tell her how lucky she is to get her second choice since her first choice remains full.” </p>

<p>You have some immediate tasks and some longer running. Make the latter easy on yourself. You said there were some less expensive choices for AL, some 4-star. Why not start with what’s closer?</p>

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<p>We visited a REALLY close place, only 10 minutes away. But while we were waiting for a meal, in the full sight of all, the director of admissions had a temper tantrum and chewed out an employee.It was not normal behavior. She was perfectly fine during my mother’s nursing assessment (my mother told every possible lie about her mental health during the questioning - what a cool character), but I was very wary after that terrible outburst. Plus, she has not returned either of the emails I sent her. They place is fine-ish/acceptable, and so close, but fading out of the picture.</p>

<p>Preironic, you are right in your first email. But you know what? We ( I mean I) was/were totally ignorant about the competition/scarcity of rooms. I had no idea - how could I know? Who could inform me? The Social Workers gave me no clue. I though…move in anytime. We knew we couldn’t move for months (till the house was nearly sold) but had no idea availability was such a vital issue. Now I know better and have my eye on this place in Rhinebeck</p>

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<p>DW- If the Assisted Living Director at the really close place, along with other staff are good, I would not necessarily let an admission director determine placement desirability. One typically has zero contact with them after the resident is situated. Perhaps she is on her way out as public outbursts usually don’t fly at these places. If you feel it is worthwhile, pick up the phone and talk to someone there. </p>

<p>Close is very important, as others have stated. </p>

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<p>Dharma, you were all set to move her in early September, before you had even an offer on the house. They had openings then. What happened? …</p>

<p>In early Sept you wrote "LF,GOOD memory. There are two reasons was it was pushed back (actually there are 3 reasons,i’ll explain.)
I thought by the end of the day Friday at the Plaza, she would–as scheduled–have had BOTH her planned meal and her nursing evaluation. Both were scheduled. But because of the confusion, the meal was a miss and the nursing evaluation was postponed because of the delay until the EARLIEST opportunity, Friday the 5th. Because of her fondest for the proximity, I thought the PLAZA was a done deal; everything would be wrapped up by Fri pm,I thought. Now,second meal and Friday’s nurses’s evaluation come this week.</p>

<p>Now, because my mother has made me insecure that she will pick the Plaza, I have emailed the director of Maplewood and asked her to schedule the necessary nurses’evaluation,which they will do at my mother’s home, the week of Monday, Sept. 9.(It is too much to add THAT too to my mother’s schedule next week.) After that nursing assessment, my mother immediately chooses between the two"</p>

<p>On 09-03 you wrote “Maplewood is sending the nurse and tour director at 3 pm to my mother’s house.”</p>

<p>On 08-30 you wrote “To quote HI MOM “It is unanimous!” This is the group’s last chance to make me think, and thik STRONGLY upon a difficult turning pont. . Weell, this Al place is merely ten minutes away. If she still rejects the place after her second hot meal, she has run out of choices and will move to eitiher Maplewood in Danbury (we still have our credit card number being held there) or this nearby place, whether or not she likes the second mel=al. take your pick. Or go yo Reno to my sister. Or be put in the hands of NY State elder Protection care”</p>

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<p>Dharmawheel, when my stepmother’s son was doing the paperwork to take her to Colorado (also many, many pages) and put her in a memory care unit, my stepmother’s current caretaker helped him fill out the paperwork. Maybe you could pay for Barbara for a day to take care of it? It’s just paperwork, you’ll get through it and it will be DONE.</p>

<p>Yes, you are spending a huge amount of time now. But it is an investment for your freedom, and it will be done.</p>

<p>Also, if your mother has to move home for a very limited amount of time after the nursing home, the NH’s discharge office can provide the names of agencies for aides. They will not be Polish, will not work hard to ingratiate themselves to your mother, but they will likely be cheaper than the Polish ladies and you’ll pay the agency–the aides will be the agency’s employees, not yours. And if your mother doesn’t like them, so much the better–she will be more inclined to move to the AL.</p>