DH and his brothers are approaching a decision point with FIL. FIL has plateaued in his PT, so the Medicare paid part of his stay ends Friday. The next step will be either staying in the current facility as self-pay, or moving to another facility, or setting up 24 hour care at his house. The case worker gave BIL a brochure from a home care company that serves the area where FIL’s house is.
FIL wants to go home, but doesn’t yet know that going home comes with the price of having caregivers present 24 hours a day. He thinks going home means being independent and getting the car keys back. We’ve told him it doesn’t, but he thinks we’re wrong.
BIL has talked to the home care company, who will interview FIL and look at the house and tell us what we would need to do to make home care even possible. We’ll also need to figure out who will be in charge of monitoring and managing the home care services if we go that way. (HINT: not me. Maybe a geriatric case manager?) FIL will probably end up staying in the care center while we figure that part out. Home care looks like it would be about 50% more expensive than care in a facility, but is probably affordable given FIL’s assets and probable life expectancy.
The other issue is FIL’s mental competence, which is fading but has so far never been measured, documented, diagnosed, or otherwise quantified. The case worker mentioned that he might benefit from memory care services, but the current facility does not have a memory care wing. So if he needs memory care services in addition to all the physical support, would even 24 hour care at home be enough? I have a call into his PCP, who is out of the office until Wednesday. The nurse confirmed that he does not have any dementia diagnosis at all on his chart now, and doesn’t know what kind of evaluation could be done, so I asked to have the doctor call me.
24x7 home care is very complex to manage, unless you’re using an agency that can guarantee backups and substitutes that you don’t have to call. We needed 6-8 people to fully cover MIL. Getting weekend overnight coverage wasn’t easy. People get sick, they have cars that break down, they are required to work overtime at the nursing home or hospital that provides their core employment,…
There is also a lot of training and coordination challenges when you have so many workers.
I talked to Visiting Angels a week ago about getting home care for my mother. They handle dealing with backups and substitutes. That’s one thing we’d be paying for, the certainty that someone would be there to take care of Mom even if her regular caregiver had the flu or her car broke down. For live-in care, which is what we’re likely to end up with, Visiting Angels would pick up the caregiver at the train station and deliver her to Mom’s apartment, and take the other caregiver back to the train. So we’d know that 24/7, the caregiver was there.
You might talk to the doctor about getting a letter confirming his incompetence, so that you are empowered to make decisions
Also, you might check into Board and Care homes, they are a nice interim between home and “the home”
After attempting aides with my mom we saw a live in residence was way more practical, offered more services and was a fraction of the price of visiting angel type places. It’s a lot to manage, every aide needed observation, cars broke down, some were wonderful, some just sat and watched tv. Plus mom hated having someone around 24/7 when she didn’t need them every second if she was just sitting there.
That’s the nightmare I foresee - FIL firing aides because he doesn’t want them around HIS house all day. Hope the doctor calls back today and can give me some input on what needs to happen to get a diagnosis on the record.
My mom might need a live-in aide, but she won’t need skilled nursing. I got a quote for something like $250/day for someone who lives in, does light cooking and housekeeping, helps my mom to dress, helps her to chair and walker, helps her get ready for bed at night.
@dstark, are you going to go with that home care? Does it include a case manager to make sure there are no gaps in care due to scheduling issues? How much care - how mobile and alert is your dad? We’re trying to figure out what the real cost of home care is, not just the opening teaser.
FIL is back in the hospital. The doctor sent a palliative care nurse to talk with me - I told her to talk to BIL who has power of attorney if she wants to talk about FIL being anything but full code. But clearly the doctor thinks bad things are likely to happen before long, and that extreme intervention would not lead to long term good results.
Interesting, she said that it was the family’s decision, because anyone could see that FIL cannot make informed medical decisions. He has consistently said when asked over the last couple of months that if his heart stopped he wants full efforts to resuscitate. But it’s not his decision?
The agencies in our area based a live in person on 10 hours x hourly rate working plus room & board, $220-$250 daily.
Another agency said it would be about $6k for round the clock aids, different people.
Part of the fee difference, if I recall, is whether you have various aides up and awake and paid their hourly rate or if you get one main person who is on and off work through the day & sleeps there with the food and living place included.
It was an agency. Maybe I misremembered the number. But as somemom says, it would be a matter of one person living in who is on and off work throughout the day and gets to sleep through the night (possibly with one interruption).
My mom had the first of I’m sure many appts with a neurologist. The various tests she’s had at her regular dr, DSHS assessments, etc. didn’t begin to cover what the dr really needs to know. He made a preliminary diagnosis, but has 12 months of hospitalization and medical and rehab charts to study before he makes a firm dx.
There is no way she can ever live on her own and full-time, in-home care on top of rent is prohibitively expensive. We are pleased that we spent the time to find the right care home for her because she won’t be leaving.
The laws here are such that there has to be someone awake at all hours, and given mom’s propensity to try and get out of bed, that nighttime aide is a godsend.
This week one of the residents died, the 2nd in a month. When there are only 6 residents at any given time, deaths are incredibly hard. The aides are very broken up.
We found Visiting Angels 24hr live in care to be higher in price than other agencies and they offered the same oversight, coverage, case management, etc. Try Griswold Agency, we’ve had good luck with them.
These are tough choices, big trains of responsibility and cost bearing down on us and our elders. scary!
I am going up to see my Mom next week. The hospice nurse has been really nagging me to move her. I don’t want to do that. I could spend the extra cost it will be on more time for the private care givers. But I have found out that they are falsifying their check in/out times. The one girl comes and goes several times a day. She has other clients in the building, but I am only paying her to get Mom dressed and to meals, so 3 to 4 hours a day. But she signs in at 8am (arriving between 8:30 and 9) and at that same time signs out for 6pm. ummm, it is still 9 am, you can’t be gone yet. So this is why the staff thought she was supposed to be with Mom all day and ignored Mom getting up and then roaming the halls. So now the solution of having the private care givers is a bit rocky.
But I am asking if anyone moved a senior from assisted living to Memory care? Mom has a little apartment now and would go to a single room connected to a big open space. I don’t know how bad the other patients are there, that is one of the things I will check out. Mom is social and might like to be around the bustle. On the other hand, on the days she struggles to find her words and knows it, she is very embarrassed by that and wants to hide in her bed and not get caught being stupid. She is a very proud lady. Plus I have heard many tails of moving a fragile person is the death knell.
So I am really torn, muddle along with the limping private care but she stays in place or move her where there is more professional care. Mom IS heading to where she needs more care (incontinence increasing and private babysitters not really qualified to care for that for example). Maybe it would be better to make the jump to skilled nursing, but that is way more $$$. Now it is about $6000/month, Memory care is about $8000/month. Skilled nursing I haven’t checked. Her long term care insurance would pay a little more for skilled nursing, but only a little since they are already paying 60% of her benefits. I hate to make these choices! Any advice?
Eso - tough stuff. Moved father from AL to skilled nursing memory care in same excellent facility 3 years ago. Best decision ever. While he has always been very social, he was losing the ability to initiate dinner plans and keep track of opportunities. Assisted living staff tried, but ratio wasn’t high enough to provide multiple daily prompts. He could do personal care fairly well at that point, but the memory loss made for more isolation than fit his preferences or temperament. Additionally, bed availability in memory care varied; there were no beds for 11 months at one point. I was afraid the other shoe would drop.
He was with it enough to know that some on that unit were very confused, I walked him through it a million times: "everyone is there for different reasons, just like AL. Some need more help, some less- just like AL. You’ll get what you need. " He never looked back. It has been good as his physical status has changed and he lost much mobility also. Medical care, dental care etc. are all built in. I can no longer transport him due to his inability to get in a car. His memory has diminished further, but he had a good opportunity to settle in and charm the staff before needs increased.
The socializing and activities are built in at his memory care unit. Staff prompts and escorts to meals and activities. Health is well monitored and they are memory loss finessing pros. They helped make good matches for meal tables. It has made all the difference. It is a more vibrant place than the skilled nursing home, which is excellent, but has many fewer group activities due to physical health limitations. Skilled nursing residents become Medicaid eligible if they are spent down to a certain point.
I’d look at built-in activities, staff ratio, how medical needs are met, atmosphere, and number of residents who are at a similar level. That number need not be high and is a moving target.
I have done aides almost full time for my mother in AL due to physical needs. Very pricey and complicated. Having the specialized care streamlines daily life for the resident and makes family’s role more manageable. I also found that as AL aide time increased, staff involvement diminished.
thanks for the account, travelnut. That is what one would hope for. I am worried that moving her will cause a big downturn and then I’d have to move her to skilled nursing right away. The memory care isn’t “qualified” skilled nursing. This memory care is a new addition to the facility, opened about a year ago. When it opened, the resident RN said not to send Mom there because they were disorganized. Since then, they stopped taking patients, I think to give themselves time to get good help and establish their procedures. Didn’t help that they haven’t been able to keep a director for the entire time either. Spend down isn’t an option, but cash flow is a real concern.
Eso- can you go observe for a couple of hours, on an informal basis? You don’t want the dog and pony show. May even cross paths with a relative of a current resident for feedback. Can another facility be considered if need be?
How much private care is allowed at AL? At what point would she be deemed ineligible to remain there? If she already has issues that are ultimately unmanageable in the setting, that is a big part of your answer. My other thought is transition with more faculties available to process the change has advantages, assuming that it is the appropriate placement.
Moves vary in degree in trauma. I have found that with my folks trusting me, and a smoothly orchestrated (without burdening them with logistics), matter of fact transition, the distress was minimal. I also think the right environment would be extremely supportive around word retrieval issues and preserving dignity.
Understandable that this is not clear cut. I hope others will weigh in with their perspectives. There are lots of variables.