She started on the third day wanting to go home. She has a mild cognitive disorder and doesn't understand that there's more to her therapy than walking to the nurse's station and back. We keep telling her it's up to the doctor/staff when she will be released, but she doesn't believe us. Now she's on day 20, and they are saying they are concerned about her safety living alone so they want to keep her a while longer. She can't qualify for Medicaid to pay for AL due to slightly exceeding the income limit. She asks daily if she is going home today, and the staff is so vague and won't give us any kind of timeline. Do I keep her there being miserable but safe, or take her out against medical advice where she may be unsafe at home but happy? I can only afford someone to look in on her for about 10 hours a week. Family visits on the weekend.
My father faced the exact same situation when he was in rehab back in 2014, so I had a choice as to whether to place him (and mom) in Assisted Living or leave him in the long term care section of the SNF he was in for rehab. I chose Assisted Living and had to hustle to move them out of Independent Living and into AL together. Safety is the #1 goal with elderly parents.
Good luck.
ETA that Lealonnie1 beat me to it, with additional great info as well. 😊
MOST newly placed residents, regardless of the type of facility, suffer difficult periods of adjustment when entering care.
Typically, we as caregivers suffer more than they do. I know that was the case when my LO entered her very nice MC.
After a few months, she loved the “hotel” where she was living.
Risking the damage that can occur from a fall risk is not worth putting an LO through the pain.
Get with an Elder Care lawyer licensed in your state to work through this before making any concrete decisions. Hopefully you have a durable power of attorney so you can handle your mom's financial issues and spend her funds as needed for "HER care" and to spend down if needed. Ditto for an Advanced Directive to make medical decisions if needed or to serve as her "medical agent."
Her care team should really be given time to do a full assessment, physical and cognitive/mental status and determine her real condition and IF it is safe for her to be home. Can she live independently -- handle all activities of daily living/ADLs like toileting, bathing, dressing, managing her Rx w/out any help and feed herself and IADLs (instrumental activities of daily living -- driving, shopping for food, cooking, cleaning, doing laundry, making competent medical and financial decisions, etc)? If not, what level of help does she need: aid twice a week to help with bathing OR she can do it all on her one safely all the time?
BUT DO NOT discharge her against doctor's orders. If you do that, the insurance coverage for what has been provided thus far may be denied!
This happened to a cousin of mine. He broke his back, had surgery and was discharged from the hospital to a "rehab facility" post op because he was in no shape to go home and they wanted to teach him how to put on and take off his back brace (to be worn 24/7 for 8 weeks). How to move (no bending/twisting/lifting) etc. To do PT with him and to handle IV post op antibiotics and pain meds (back surgery is very painful). NOPE, cousin hated the rehab facility and 24 hours later called his father to come get him (cousin is 50, uncle is 81), probably the post op IV pain meds gave him the feeling he was OK. And his dumb father agreed to drive him hom. Cousin discharged himself against doctor's orders and went home with his dad. 2 days later, uncle had to call 911 as they had no hospital bed at home and no appropriate pain meds much less antibiotics. So while trying to sleep in a recliner (dumb, beyond dumb) the stitches broke open and he was in agony. 911 took cousin back to the hospital and a 2nd surgery had to happen as he was NOT wearing the required back brace had not been fitted yet for his (each is specially fitted based on size). And the wound was all infected too as there were no IV antibiotics "at home." TOTAL HOT MESS
INSURANCE said NOT covering as you discharged yourself against doctor's orders! You can imagine the bill....
Do you actually plan on moving her home to live alone? SHE pays for the caregiver at home -- not you -- so can she afford that?
Rehab stinks. It stinks for everyone who goes to it, but it's something to get through while working as hard as possible for a successful discharge. Perhaps empathizing with Mom's misery and pointing out that she really does need to work hard to avoid having to return once she's sprung would have some effect. While she's still in there, you could be consulting an attorney who specializes in Medicaid to determine how to get Mom into care, because I have a feeling that's really where she's headed -- not home.
Day 20 is the last day that Medicare will pay 100%. The 21st to the 100th day Medicare only pays 50%. The other 50% is paid by the patient or their secondary insurance fully or partially. When my Mom was in Rehab just to get her strength back I told them there was no money after the 20th day. Moms secondary did not cover the 50% balance. She was discharged on the 18th day. She had Dementia and all I heard from the therapist was she couldn't follow instructions or remember her exercises from day to day. Duh, she had Dementia.
Medicaid does not pay for AL. Unless your lucky to live it a State that does. In my State u need to pay privately for at least 2 years to have Medicaid pay.
While Mom is in Rehab have her evaluated for 24/7 care. She may not be able to be on her own anymore. She can go right from rehab to LTC or an AL.
2. You may have to get doctor help to get court approved guardianship status for your Mom so you make decisions when she is cognitively impaired.
3. If she has a driver's license and access to a credit card to discharge herself, get a ride home and drive or rent a car, you could have a bigger issue.
OR 4. she could rack up big shopping bills if mentally she isn't her better self.
Yes, always error toward safety and you can't end up with a criminal charge for elder abandonment or neglect.
5. Medicaid for home care has in home support services. It covers about 100 hours/ mo.
That is why you would have to find and hire outside help for remaining shifts 24/7. Going rate for experienced quality care average is $28/ hr on up.
With cognitive impairment she can wander and get lost. She may need to be locked in residence.
There is a national shortage of locked facilities assisted living. Start searching now and get her waitlisted.
With guardianship status you can choose an assisted living for a temp stay or long term permanent. Do look at several. Contact licensing and go review the "fines file." How many. how often and for what? Some are nuisance fines, like a paper was filed a day late. Forgive that. Look for notable safety issues.
You are in role reversal now. It is your turn to be the parent. If you have her move in with you, it may be difficult to later say "no, it is time to go to assisted living. I can't give up my career responsibilities to help you or I won't have my retirement for myself and my family. The impact on my marriage/ relationship or children would be too heavy. Instead of being the loving adult kid you spend quality time with, I would be the one frustrating you often in order to protect you. You will be happier in assisted living."
Assisted Livings accept Social Security and SSI, not Medicaid. Skilled Nursing, Nursing Homes and Hospice take Medicaid.
As for Medicaid asset limit... if Social Security is paid direct to assisted living, her income assets will be lower and she should qualify. What counts is what hits her bank account. OR set up a Miller's Trust aka Special Needs Trust and Trust account accepts all income, then pays her a small amount monthly for incidentals after assisted living is paid.
Try to avoid nursing homes. Most are not good. Usually are depressing places.
Board and Cares can be okay, but your mom will likely be kept more active at assisted living. Most have physical therapy and / or a gym. Some have pools.
Memory care will cost $5000-7000/ mo as of Aug 2022. Avoid consigning to pay financial commitments. Sign as Power of Atty or Guardian and write that after your name once you have that status. You don't want your own assets at risk of lien.
The Trust can also sign as it has same rights as a person. Then any authorized board member(s) - whatever the Bylaws say - can sign as the financial party.
See an eldercare lawyer for Legal Advice. I am not a lawyer. I consult on eldercare legislation.
If you send your mom home, she can easily fall multiple times and not call for help. Seniors often have medical alert buttons but won't use them because they are afraid it costs more money or they don't want to incur an ambulance cost or bother anyone.
Trust the doctor. Not interns. Interns can make dumb mistakes... like trying to release my 93 year old father from hospital, who was high on pain killers, and weak, to drive himself home from hospital- Friday night rush hour traffic - to make an hour freeway drive.
I called at the "right time " in the middle of this, ( I was west coast, he was eastern US), found out was happening. Reached Physical Therapy Director who said he hadn't released him! He would stop this immediately- and did - while I was on phone hearing him chew out the intern.
He did go home Saturday. Had many falls. Died next week.