Is it best to care for my Mom at home? Overwhelmed....

Sorry that your question has fallen through the crack for 4 hours. It normally does not take this long for someone to answer, but not many people are up as late as a few of us are. I really need to know a bit more about your situation.

Just how mobile is she?

How much time before she is discharged from rehab?

Whats does the doctor say about where she should live?

Is there somewhere that she lives now where she can go on a temporary basis until the assisted living place comes open? Do you have any idea how much longer she will need to wait?

Is she mobile enough to handle assisted living?

How limited are her fiances and should she be looking at applying for Medicaid?

How far apart do you live and could she handle the trip to your home?

Could you reasonably take care of her in your house with her mobility problems?

Does your mother have any dementia?

Thank you for this quick answer! I was feeling fairly stressed when I posted, as my mother is now due to be discharged next Monday, tentatively. A few people have confirmed to me that this is a reasonable idea, so I'm feeling better....

My mother is considered "stand-by assist"....she is up to taking about 20 shaky steps with a walker, with someone following. She has no dementia, and is extremely sharp. She is in Tucson and I am in DC, so the major flight here is something that does need to be done, at some point. I'm planning to take her straight from her nursing facility to the airport. Yes, my care manager in Tucson, an independent nurse care manager who has been checking in with my mother, thinks assisted living is best, as does her caseworker at the nursing facility. Her finances are extremely limited, although just above Medicaid level, at least in Arizona. She may qualify here in Maryland (DC suburbs). I discussed all of this with a medical staffing company this morning, and they think it's reasonable, my caring for her with aids coming in a few times a week. I'm a stay at home parent, so her care will overlap with my life. My sons are older, 10 and 14, so they could be somewhat useful. We have a den on the main floor that could be converted. I think it's feeling reasonable, at least for the months until the permanent spot she's waiting for becomes open.....not sure how long, but at least a few months.

Thank you for any thoughts.

Tracey, just curious when was the last time your Mom had flown? Is she comfortable flying? Has your Mom flown going through airport security? Just wonder is she knows what to expect. I know I couldn't fly with my Mom as she wouldn't allow anyone to go through her purse or vanity carry-on :P

A flight from Arizona to BWI or Reagan would probably be 5 hours, hopefully non-stop, thus numerous trips to the restroom without a walker. Is that something your Mom would be able to manage?

One idea is to box up your Mom's clothes that she will need and have them UPS or USPS to your home, far cheaper than flying them on the airlines.

I share freqflyer's concerns.

I may be wrong, but " "stand-by assist"....she is up to taking about 20 shaky steps with a walker, with someone following." does not sounds like a candidate for assisted living to me for it can be a long walk to the dinning room.

Again, what has the doctor said if anything about her future care?

I'm also not sure how useful a 10 and 14 year old son can realistically be expected or even should be expected to do for an 86 year old grandmother with mobility problems.

How do your sons and your husband feel about this?

Have you already transformed your den in preparation for next Monday?

Many caregivers bring a loved one into their home or move into their home for what they think will be a temporary move that then becomes a life time. Such a move completely changes family dynamics in one's marriage and in one's relationships with children who as in your case still live at home and are still at ages that require much parental involvement.

I wish you well in getting all of this set up and dealt with. Keep in touch and let us know how things work out.

Thanks for the responses....No, my mother hasn't flown in decades, and is a little unprepared for what this will will be like, but she really has little choice now that she's medically capable of the trip. There's no family in Arizona, we can't afford full-time nurses, and she's being discharged next week. I think she's prepared to make the trip in Depends, if it keeps her from having to use the walker to get to the bathroom. This certainly won't be my favorite day, nor hers, but we'll get as much support as we can before we make it.

All her caregivers think she is definitely an appropriate candidate for assisted living, so the comment above surprises me.....perhaps the standards or terms for care different in different states?

I actually have an ex-husband, rather than a husband. As an extended family member, he is very supportive. My sons are a little unsure what will happen, but I think the experience of caring for a family member contains important lessons, which I quite think are appropriate for a 14-year-old. I certainly expect him to lend a hand by asking his grandmother if she'd like a yogurt every morning.

Thank you for the clothes boxing suggestions; that's a good idea.

Best to you all.

My mom was also unable to walk much when she moved to AL, so her care level included wheelchair transpo to meals, activities, whatever she needed/wanted to do. She loved chatting with the aides. She had enough mobility to get around her little studio apartment. And she could pivot and transfer, which they required.

I think that there are valuable lessons for your sons. Just a word from having been there - take extra care that as time goes on, you keep focus on them. It's so easy with an elderly parent to have their needs and wants scoot up the priority list and the kids feel it.

First and foremost ask the MD if it is safe for her to fly. Everything hinges on that. Avoid a md-air emergency PLEASE.

Flying is not good. And I think you'll regret very quickly taking her into your home. I hope a spot in a facility comes up fast. It sounds like she needs skilled nursing care. AL might not meet her needs.

Has she used up her Medicare days (20 days after a 3 day hospital stay at 100%; days 21 to 89 at 80%)? You can ALWAYS appeal the discharge if she is not able to take care of herself (Where is she in doing dressing, bathing and personal care - ADL's ) perhaps she is just being rushed.

If you decide to fly - Will she be able to sit with no room for her legs for 5 hours? Is there someone who can fly with you and your mom? A friend, relative etc? That way there is someone for each side for transfers. Arrange for wheelchairs in advance and priority boarding. May need to ask her Doc for anxiety meds for the trip... (consider for yourself ---perhaps) Check everything you can (so hands are free) My mom drinks (rum and coke -Even for morning flight) as soon as she can on flight and we use the nice depends with a heavy pad inserted in that can be changed if needed. You need to be in row nearest to bathroom - just in case. Dress is easier than slacks. Take some chucks (disposable pads) may make your mom feel protected...

Take this time to get bathroom and bedroom prepared...mount grab bars, remove throw rugs, count steps between bed and toilet etc. Have mom practice the 14 steps sit on toilet. get up 15 steps to chair, with therapy people before she leaves. (so that she has better stamina for your place or her assisted living.) Remove barriers BEFORE she gets there. Much easy than when she is there and can't fit through doorway with walker...

Best wishes...I hope the AL comes through soon! Let us know how you and mom make out.

Primary Care will have to order in home care. Have you set up a local PCP in your area (DC) to accept her right away and evaluate her???

Geez - so many different issues on this,
Where was mom living before the fall? and why can she not return to that place and have home health come in till she gets back to her prior ability? and how does she feel about all this? If mom is sharp as a tack, then what does she really really want to do? Where is her voice in all this?

if it is that she just has to leave AZ and move to DC, my suggestions are:
1. I would do whatever (beg, plead, boxes of donuts) to get mom on additional days for rehab. I'd talk with the PT, OT or whomever in rehab and her doc and the medical director of the facility to have her rehab extended - I'm somewhat surprised that if she still has days & days before her 100 Medicare days is used up that they are discharging her. Get it extended.

2. Reality check - I think you are going to find all of this is going to be quite a lot harder than you thought. A good reality check would be for you to go to her rehab facility (assuming you get the extension) and stay there with mom 18 hrs a day from a Friday - Sunday. Weekends are good as there is less staff so you have better opportunity to do what is needed. It will put to the test just what mom's ability is Ask the facility about adding a meal so that you do all your meals there. You get there an hr before mom's day starts and are there till when she goes to sleep and you do all the assistance that is needed for her. SHe needs to get up and get dressed, you do whatever is needed to make that happen only if she cannot do for herself; ditto on potty - you help only if needed and are her shadow on getting out of bed and to the bathroom; you shadow her to all meals and assist only if she just cannot do what is necessary. Then when you get back to your hotel room, make yourself notes.

When the weekend is over and you return home, go to the chosen AL and spend the afternoon there and note IF mom is like the residents of this AL are like. If this is a busy, active resident AL and mom could not keep up, probably not the place for her.

3. The AL that will accept her….have they sent anyone to see her (like from an associated facility in AZ) or have they gotten an ADL report on mom or spoken with the care manager? I'd be somewhat concerned that the AL will find that mom is just not suitable 3 months after move in. AL are real profit centers and I've found that they do over promise accommodations and then once the resident is in either find the need to add on 1-on-1 aides or find the resident needs skilled nursing care (a NH)

4. How is the AL to be paid? If private pay, ask clearly about what level of accommodation are routinely provided for the set rate. If she needs a dedicated aide to help with her ADL's find out just what that is going to cost. If Mom is going to apply for Medicaid waiver for AL, please speak clearly with admissions as to the criteria for the waiver - some may require 2 years private pay; others may only have 4 AL beds that are waiver beds so mom may be looking at a long wait to get one of the 4. Also waiver funding is not dedicated funding (like NH Medicaid is), many states are not doing waivers and instead using the diversionary funding for PACE programs; or the AL can stop their participation in waiver program.

Also if mom's $ is limited, how are the aids to be paid while she is living at your home? For my mom when she was at home recovering from rotor cuff surgery (so she was able to walk & use the other arm), the home health was a minimum of 4 days @ 4 hr day per week @ $ 20 hr. Days to MD appt or to rehab were 7 hr days, so about $ 1800 mo. If all mom's funds go to pay for home health, does that work for your budget?

5. If mom's Medicaid ineligibility is that her monthly income is above the state's limit but she qualifies in every way but that, mom can do a Miller Trust. Miller is totally legit and done all the time. It will need to be done by an elder attorney in your state as they have to be in compliance for however your state deals with trusts. How it works is like this: mom gets 1500 in SS, 1K in dad's retirement and 500 in her retirement = 3K every month guaranteed. State max income for Medicaid is 2K. So the Miller gets the additional 1K and voila! mom is now @ 2K. Some states have Miller so that it builds each month by the overage and reverts to the state upon death; other states have it so that each month the whole amount goes to the facility as their co-pay except for their small personal needs allowance. The income has to be guaranteed type of income to go into a Miller but if so can make mom medicaid eligible.

6. I vote with those that suggested that you have a 3rd person travel with you.

7. As far as the boys, well you may find that although they love grandma, that having their home become a home for the aged & infirm will cause many problems. They will probably find ways to be anywhere but your home.

Im in my 50's last time I flew a few months back, it almost killed me... My legs, and my right side felt really awkward. I was not comfortable at all. I have never felt that way before while flying. Make sure she gets an aisle seat. The window seat did not lean back at all. Maybe that was my issue. Maybe its my blood pressure? Havent been to doctor in a very long time. They always fins something....I couldnt wait to get off that plane.

My child has taken a backseat for a very long time.....It is a lot to think the kids will step back and cooperate, well, they will at least 50% of the time. Don't fight them. It's going to be a bigger adjustment than you think.. How does your mom feel about living with you and two teenagers, again? It's a big give and take situation for everyone involved....And your mom knows.. she is physically depleted than before. Mind over physical handicaps become an issue as well....

Make sure you have a transport wheel chair or some kind of wheel chair.. Check on craigslist in your area, Goodwill,,,, talk with hospice in your area. Caseworker, to help you out in setting up bathroom, shower, grab bars, safety features. Porta potty near bed if that is feasible.... Depends with Tena pads as more absorbant pairing. Calmoseptin ointment, is in the pharmacy department, but is considered over the counter. Good to help keep bedsores away. NO BEDSORES!!!! Bad news if she gets any kind of pressure sore. Watch out for UTIs. HOw about Adult Day Care in your area? Do the have discount taxi or city rides for the elderly?What does your city offer the for the elderly and delicate?Maybe a church has a volunteer program to help out people in your situation. Perhaps your local counselman has something to offer. There may be something posted in the public library. Ask a local ADULT DAY CARE. SALVATION ARMY.

HOW IS YOUR MOM? IS SHE EXCITED TO MOVE IN WITH YOU OR CLOSER? DO YOU HAVE SIBLINGS WHO CAN HELP? Your Ex husband sounds like a nice guy, family....My parents were divorced over 25 years...He came over every holdiay after the divorce...When he was dying of liver cancer, he asked me to bring over her homemade chicken soup...They both yelled at me, when I was too tired to drive from on end of town to the other end to deliver a cup of the stuff.....We are human....Sounds like your mom has her witts about her,which is importmant.....If all of you can get through this with laughter, and being happy, you basically have this game won. Get a huge roll of bubble wrap, and have your kids fashion an outfit for grandma when she gets home. Maybe she will get some humor out of it. If not, then your kids will have hours of fun jumping on p;opper paper

The more games and fun times you cn bring into your home, the easier it will be..Momand your kids both have to be will partiipants.

Whew, so many answers.

There's a lot of info in there, but I do think at this point I should change my query....from "is it best" to "please help me do this." Every elder care professional I've consulted, numbering 6 now, thinks that this is the best solution for the current situation. A main factor is that my family simply cannot afford many of the options listed--people to fly with me, 24-hour home care in a state across the continent, etc. My mother lives on such a limited income, and I have already strained myself financially flying out to Arizona twice and hiring a care manager there, etc., that it's just really hard to read all the posts above about what I should be doing if I were willing to take money out of my chldren's college funds (which are certainly not burgeoning, by any means.)

So, that said, thanks for the helpful thoughts about stretching her legs and anxiety medication and chucks for her seat. Of course I have consulted with her MD about flying. I also do not agree with the idea that her skilled nursing facility is discharging her because she is not meeting the Medicare standards of "progress", but that is certainly the case, and I do not have the means nor the energy to fight that decision, especially when it is quite clear that she will do far better in a place where she has family (here), as opposed to there, where she has no one. I have also considered the flying question pretty carefully, but putting her on the train to cross the country will only nauseate her (she struggles with motion sickness), require a change of trains, and take far far longer than a flight.

I am arranging medical care to assess her as soon as she arrives, which is really somewhat difficult when changing states, but I think I'm finding assistance. I also absolutely do not plan to keep her with me longer than a few months, during which time I will have the time to apply for various subsidies that will bring her into consideration for assisted living group homes, which are more likely to fit her miniscule budget, while waiting for our preferred assisted living. But I simply do not have the time right now to visit them all, assess the social dynamics of them all, fill out the subsidies, all the while that my mother is stressing over the fact that she has no one at her facility that really understands who she is.

So, I'll read the above through for suggestions, and if anyone would like to give a few more "good luck" and "we know you can do it", that would be super. Those who have (again, along with the SIX professionals I have consulted, who either know me, my mother, or have talked to me at length, and all feel that this is the best solution), I thank you so much.

I got my mom from PGH to LR on Southwest flights. Transfers were a bear, but they were helpful and stowed her wheelchair both times. She enjoyed the trip.
Yours is in better shape than mine was, both mentally and physically.

I think this may work out OK. Travel as light as you can, have stuff shipped rather than try to carry a lot, keep the meds with you and check in with the special needs agents in advance. You won't know for sure how tough it will be at your house til you get there and deal with it a while. An OT pre-eval to help,you uncluttered and put in any equipment could be good. Line up a good new primary care doc, maybe even a geriatric center, and maybe some follow up outpatient therapy options too. It's going to be a really busy time! Hope she settles in well and you can put together a comfortable routine for everyone pretty quickly.

oh yeah...make sure she's got a valid DL or photo ID! Details, details.

Unfortunately, medicare only pays as long as the person is making progress according to their standards. My mother ran into that in the nursing home when PT tried to help her walk once again after hip surgery. She did not make the needed progress with them and thus they stopped their efforts because medicare would no longer pay for her PT.

Good luck and keep in touch.

Hi! I am in Tucson. We are all from IL. My in laws brought grandma from IL. to Tucson, in order to help her, once. It was a nightmare. The climate change, the time change and lack of familiarity was a nightmare. She immediately went into psychosis and said that they were trying to poison her.

This was not what she had been like, at all. But the change was just too much.

My father in law had to fly her back to IL., first class. She looked at her check book the whole time and announced that he had stolen money from her.

Once back in IL. she was put into a nursing home and regained her senses.

My own mother in law, is now in assisted living at Mountain View and all of the residents there are independent and need no help other than bathes, meds and meals.

Chicago 1954, my mother is at Mountain View Care Center...on Magee Road, the north side of Tucson? The assisted living must be in a different building. Her building has two wings of skilled nursing and a few wings of dementia/Alzheimer's, which are closed off. I'm sorry about what happened to your grandmother-in-law.

My mother wants to come here, by the way. She really likes the idea of the facility I think is best. We'd been talking for a long time about moving her further east, to be closer to me. My care manager in Tucson has been talking about the plane flight with her, and she remains very much on board. She hasn't been in Tucson her whole life--in fact, she was born in Illinois---and has moved around a decent amount.

I have a call in to her MD to discuss this all in detail. I appreciate the thought.

Try seeing if she would qualify for Medicaid. If you cannot afford to put her in a facility until she has a place, then bring her to your home. You can get help with her mobility needs from a doctor in your area, and there is help available. Do your research on how to manage a person with a hip replacement, mostly getting them up and moving again. Flying should not be a problem with airline personnel able to get her settled, but you should be there to assist too. Good luck!

Good Luck. Been there, done that. Let us hear from you after you've had mom in your home 6 weeks. You have no idea the stress you will be under and the difficulties you will face. In my opinion, a nursing home will be able to best handle needs of your mom and be more affordable on Medicade. I am guardian of my aunt (90). I put her in a nursing home and she is on Medicade. All her needs are met and I can visit whenever I want to and be a loving niece. I check on her, have meetings with the staff considering her care and am very pleased with her treatment.

You are very brave to do this. From the responses here not many would attempt it. Good luck, will watch for an update. Hope all goes well!

Just noticed the above postings, so I'll respond.

1. Medicare does not "automatically" pay for 100 days. The patient needs to be making progress. If they are no longer making progress in their rehab, then the Medicare payment stops, as well as any other insurance.

2. The flight sounds like it would be unmanageable for your mother.

3. If you move her in "temporarily" from across the country, I can almost guarantee that it will become permanent. The relationship with the family will never be the same and it may be extremely stressful for your boys. In addition, your home may not be able to be altered enough to be elderly-friendly.

4. Miller trust or not......there is the still look-back period which is 5 years in most states. Any attempt to hide or transfer assets (even if legit as a trust) will be scrutinized and make you ineligible for Medicaid until the look-back period has ended.

5. She may be too infirm for assisted living. AL assumes that the person is independent and only needs a little help. If she needs things like a 2-person assist, help with getting on/off toilet, etc. - she needs to be in a Nursing Home.

vstefans brought up a very important piece of information... make sure your Mother has a valid up-to-date photo ID that is government issued, otherwise Mom won't be flying that day.

As for motion sickness, I am the poster child for that, the best thing I found is Dramamine, but make sure her doctor approves of her taking it because of interactions with other meds, it will make her sleepy.

When is your flight time, if it is during a very busy time at the airport don't be surprised if the airline cannot supply a wheelchair as requested due to the fact they are all already in use. Be sure to reserve a chair far in advance to better your chances of getting a chair.

Oh, the airlines will not allow your Mom to have her walker in the cabin, mainly because it is too wide for the aisles and a trip hazard for other passengers. Don't be surprised if the flight attendant takes the walker to be placed in cargo, as it is probably too large even folded up to go into the baggage bins.

While sitting on the plane during the flight, make a little game around moving one's legs, stretching, wiggling the toes, making circle motions with your foot, this will help limit the risk of a blood clot which could happen to anymore, more so as we age. Hopefully you won't have a seat mate that need to run to the bathroom a dozen times, with the airplanes being so very cramped with less leg space, you and your Mom might need to stand up to let the seat mate come and go.

Please let us know how all this turns out on your flight. Here's hoping it will be a smooth one :)

If you are terrified at the thought, then you answered your own question. That emotion compromises your ability to care for her. This is assuming you were not terrified at the thought of bringing your children home from the hospital. If you are financially able, find out the per diem at an acceptable place - ask your discharge planner - and pay for it. You CAN negotiate the fee - don't be afraid to try. I'd like to echo the others and suggest that you be present at the facility anyway. Hospitalizations and moves to ALF/SNF cause transfer trauma. She will be vulnerable and will need you.

As far as the comments on flying go - there are other options for getting someone cross country. When we brought my grandfather to our house, my father rented and outfitted a large RV for him to make the trip. The family was with him, cared for him and he made the trip without incident. The local paramedics were happy to assist getting him in and out of the RV in a safe manner. My father was a doctor and understood that a safe room on wheels is better than a flight. Anything can be done if you want to - if you are on the fence, it can't.

Cat I want to just gently disagree with one thought you implied - that if you are terrified of doing somethine, that means you really can't or should not do it. I've had to do lots of things I've been scared to death of doing and in general I've done them anywhere from OK to really well :-)

I wasn't terrified at the thought; I was overwhelmed. I'm not any more. And, yes, I think it's a similar reaction to any parents' first reaction to the idea of being responsible for a newborn.....most of us, as parents, felt that way at some point. Vstefans, I agree. My gut reaction wasn't "don't do it", my gut reaction was "think about this idea, despite the fact that it sounds like a lot and you don't yet understand how to do it....." One thing about me has been proven true, and that is that I don't shy away from challenges that I don't understand. I figure them out. I home-schooled my son for two years when he was having trouble getting his needs met in public school, I sold my fixer-upper house by myself, I took my two kids to Turkey by myself...I've always been good at doing things that seem outside my wheelhouse.

Again, my mother isn't staying in my house permanently; that's not an option. I so appreciate all the suggestions and details for ways to prep her for the trip, take her trip, etc. Her driver's license....I would never have thought to ask.

Update is that my mother was deemed to be making sufficient progress to stay at her nursing facility through the 28th, at least. So now I have a bit more time. I bought a toilet chair, an adjustable bed, disposable pads, set up home care, including an initial LPN housecall from a geriatric service, I'm changing her banks, I've talked to the special needs agents at the airline three times, I've told my caregiver support group all about the plans, talked to my sons....I think it's going all right.

Thank you all. I'm going to move further questions from the "Tough Issues" thread, I think. I will be following much of your advice in the meantime.

Tracey, it sounds like you've made a sound plan. Some mild antianxiety meds for your mom for the day of the trip (provided it something she's tried before) might be an idea. Make sure your mom is okay with the idea of a wheelchair before the trip; some elders balk at using them.