Is it time to move my mother into assisted living?
I am trying to decide if it is time to move my mother into Assisted Living.
Currently, my mom is living in independent living, where they offer 3 meals a day, transportation and some activities, but no medical. If a resident needs a home health aide, they can contract with the company that is management-sanctioned (they have an office in the building).
I'm hearing conflicting reports about her capabilities, also muddied by my own observations.
I've asked my mom's doctor what she thinks, and she says mom is fine where she's at, but needs a little help with medications and housekeeping. (That sounds like entry level assisted living to me.)
The management where she lives treats her as completely incapable and my mother constantly asks me to call them for her requests because they won't listen to her. They have all but forced her to give up her cat due to her not managing the litter box. She is very upset to lose her friend. (On this I agree with the management and wish I could thank them, at least for the cat's sake.) The management is supposed to provide light housekeeping, clean towels and linens. Due to COVID they are not housekeeping at all. They drop off sheets and towels every week,and then they are appalled at her lack of housekeeping (she has never been one of those spotless types) and said pre-COVID that they can't clean because she has too much stuff. So, she has her own vacuum cleaner and mops the tile areas, cleans the bathroom as best as she can. They charge to bring meals up when residents are sick, after the first three meals. This place is way too expensive to have to pay for someone to walk up one flight of stairs and hang a bag on a doorknob. I wish they would credit us for the unperformed housekeeping, and all the breakfasts she has never eaten.
In their defense, having lived with her all my life, I confirm that she can be challenging. What annoys me is their supposedly hands-off-independent-living-we-don't-mess-with-anything approach while still managing to meddle in an epically unprofessional scale.
Okay. Rant over. Point is that although they haven't said anything, it's obvious that they think she is overly needy in terms of their offerings.
My own observations... I think she could use a more structured environment where there are people looking in on her daily and helping out where needed. (housekeeping and the like). She is a social person, so I would like her to be able to make friends and to live somewhere where the staff is supportive and treats her with respect. You know, like an adult with a mind of her own.
A couple other things:
-My mother has asked for the home health aides to set up her pills every week. (leading me to believe that she is unsure in this area).
-She is incontinent. (I point this out from a housekeeping standpoint.)
-She does have some trouble with short term memory and I expect that will only get worse over time.
-My mother is really good at pulling the wool over strangers' eyes when it comes to her capabilities. Hence why I think the doc thinks she's good.
I have broached the topic with her, more as a threat than a reality, but I plan to bring it up again in the near future. Currently I am running the numbers, and doing the research to find places that will eventually take Medicaid.
Anyway. Do I go with my gut on this?
Thanks!
Dones that hurt to have her pills set up for her and that was smart of her to ask.
If you're worried, Set up a Camera in her place where you can check on her anytime.
You may think about this...Do you want to move your mom for your well being or hers?
In looking for AL with Medicaid (those could be hard to find), also make sure they have a MC section, as she may need that in the future. Best to keep her in one facility if you can.
NOTE: AL itself is not deductible, but any medical necessities paid for are. I would think if they determine a nurse has to dispense meds, you will pay for this service and therefore should be able to deduct it. Mom's MC is considered fully a medical necessity (as are most of the supplies and medications I have to supply), so she currently is a no tax status, aka income does not exceed expenses. More recently there has been some state tax, but only on the taxable portion of the trust distributions. Be sure to ask about what deductions (EC atty or tax person) might apply while she is self-paying and how to break them out of the bills you will get (lump charge for certain levels rather than getting a break out of all charges? Mom went from her own condo to MC, so we skipped the AL.)
Sounds like she is unable to do a number of ADLs which would indicate she should be in assisted living. If you or your mother are private pay, you should be able to contact the different assisted living facilities in the area and find out exactly what their services include. Some offer medication management; some do not, etc. Rarely, do they have a physician on site so you will still need to take her (or have her transported to) her different doctors. Regulation of assisted living facilities is fairly loose. Only nursing homes/long term custodial care is highly regulated by federal and state authorities. One also has the support of a federal ombudsman's office (at least in California). It definitely sounds like your mom is ready for assisted living. Your research will pay off. Good luck!
https://www.aplaceformom.com/caregiver-resources/articles/assisted-living-facts
https://www.after55.com/blog/senior-housing-regulations/
If 4 hours of increased home health care is within budget, this is probably her best option for now - less people in and out of her place, less exposure to others, and more independence in her own room/suite. Try it for 2 months and see how mom does.
I would also think they wouldn't need 4 hours/day yet. Certainly try to clean out the place to get rid of unnecessary stuff, making it simpler to keep clean. A 1-2 hr visit, even a couple days/week should suffice initially. How dirty can the place get in one day? While there was a lot of more intensive cleaning I had to do once we moved mom, it was areas that wouldn't get cleaned daily or even weekly. Wiped down maybe, but not intensive daily cleaning.
The aides (at least some of them) would sweep the kitchen floor and maybe give the bathroom a quick check/clean - I only was concerned with getting eyes on mom every day and checking that she took her meds. Any cleaning done was a "bonus." OP could maybe devote some time when clearing out clutter to get the place cleaned, and then 1hr or so every few days should suffice, for now.
That cat is more important to her than to anyone else. Isn't there anyone who could go in daily and clean out the box for her? Pay someone to do it. If she wasn't a great housekeeper in earlier days, she certainly can't do it now. I would talk to the facility and find out what they plan to deduct from rent to offset services they are no longer providing and use the money to hire a private pay person to do it. Can you or other family member go in and tidy up to make it a little easier to keep it clean? She's probably been sitting in there, alone, and just lets things go more so than she would have when there was a little activity. Anyone can get in to a rut of no motivation.
Actually, you have a contract with this company. They have to honor their end of it, covid or not, or reduce the rent comparable to services she no longer gets. Seems to me they are taking advantage of the situation. Call your ombudsman's office or aging council in your area and find out about the services that have ended.
Well I think I don't agree with everyone.
I think she needs a different place to live with more structure. And during covid, seems alot of things are in turmoil... at least wait for it to be over!
Her apartment sb clean. Her pills sb done. Her meals sb eaten in designated area. Not delivered if she's capable, she needs to follow rules.
Read her contract.
Goodluck with medi medi. By the time you finish that, she may be ready for a change.
Will she be in the same facility managed by the same people or will you move her to another facility that might have better management? (If the AL portion of the current facility is not staffed and managed by the same people then this question is moot)
If you plan on moving her to another facility make sure it will accept Medicaid. Often they will allow a resident that has been private pay for a number of years to remain on Medicaid. But there are some that will not accept Medicaid at all and you would hate to have to transfer her. Also the facility should have Memory Care as well.
As to the question when should she move..
When it is unsafe for her to remain where she is. If medication is a problem either not taking it, the wrong dose that is not safe. Not getting her apartment cleaned, particularly if she is incontinent (question also is does she need help bathing?) So it sounds like she is ready for the move to AL.
I am dealing with a lot of the same things-my Mom is 91 and lives in an independent senior building. She recently broke her hip and is in rehab but will come home to her apartment with 24 hour care. At this point I would say that your Mom needs more care, either in her own place with a team that comes in and helps her, or assisted-living. Yes go with your gut.
Since they have staff for assisted they offer assistance to folks in IL a la cart.
I don't tell you this since I expect that your mother lives in a facility with this variable care options. And not saying you must find such a facility. What I want to say is that a facility is designed to offer certain services. And if you need other services, the staff are in a difficult position. They may want to help you but really can't since they are not setup for that service. Maybe they want to help your mother keep her apartment clean but for IL that is not a typical service. They may not have staff trained and dedicated for that.
A cynical viewpoint that I had sometimes was that the facility wanted to move my dad to higher level care so that they could charge more. But eventually I realized that their systems work certain ways. When dad needed more care the staff gave him more care but it disrupted the care of others. They needed to move him so that the staff was not overworked and the other residents got what they need.
...
Lastly, at the end of the day all decisions are gut decisions. Listen to yourself.
I hope you find that your mother is still able to care for herself. But be prepared to step in.
It's time for Assisted Living. A person does not need to be totally incapacitated to require Assisted Living. Being incontinent, having a poor memory and the inability to administer her own medications is MORE than enough to qualify her!
Good luck!
I agree, time for AL. If she could not care for her cat, then she no longer can fully care for herself.