I'll try to be as brief as possible.
My uncle, age 94, is nearing the end of his life. Along with diabetes, neuropathy, and on his second pacemaker, he was recently hospitalized for pneumonia. The resulting coughing left him with a stress fracture in his back. He was hospitalized again this morning as he is in excruciating pain from the fracture, which cannot be treated with anything buy Tylenol due to his limited kidney function.
Uncle's wife is in her late 70s, with Stage 7 Alzheimer's. She and my uncle are still in their home, with home care providers. My aunt has been approved for Memory Care, but is Medicaid pending. No nursing home in this area will admit pending Medicaid, Even if they did, there is nowhere for her to go. There is a waiting list of over 100 people. AND she has become aggressive, and unless that can be controlled, the nursing home would not take her even if they have an opening.
My uncle cannot return home if his wife is still there. She is unable to control her violent outbursts, even with Seroquel. Several aides have quit due to her attacking them. It is too dangerous for my uncle to be at home with her. He has never said she has attacked him, but we are sure she has. My uncle would never tell anyone this, or admit it if asked.
What if anything can be done to get one or both of them into a nursing home if there is no Medicaid (they can pay privately while waiting for Medicaid approval) and no room, they are unable to be safe at home, and there are not enough aids to cover them 24/7? They have one daughter who is married, has a three year old, and both she and her husband work full time. They live nearby, but still 35 minutes away. I know some will say "well the daughter just has to quit her job, abandon her family and move in with them". NOT happening. Even it she could quit her job and let her husband fully support the family, she cannot and will not abandon her toddler. She cannot take her daughter with her, as she cannot trust her mother not to hurt her. And separating the child from her father to care for grandma and grandpa is also not happening.
What does an elderly person who cannot care for themselves do when the nursing home says "no room, go home"?
Boll, you and the daughter need to understand this "game" of chicken.
She needs to say "no" and walk away.
If they send him home in a cab in a nightshirt, she calls 911, APS, the cops and the press.
Eventually a passerby wheeled her back into the hospital, half frozen.. Made the news. Got a BIG apology for her trouble but hopefully safer discharge for all!
I can only say keep trying. Call 911 for him - for the mom staying she is a harm to herself and to him. Call Medicare - Call local APS again an ombudsman is a good idea - call hospice - Local Counsel on Aging. You can request 911 EMT to take him to a different hospital. How does a hospital case worker not even send him home with home health? The daughter needs a social worker out there now. Where are you located? This is so not okay that elders just keep getting sent home - I would call a local news channel (email them for her). This type of care for elders has stop happening in this country. I’m sorry for this whole family. 🙏🏼
Has topical pain relief (BioFreeze, Pennsaid) been tried?
Did the daughter sign for the discharge or did the patient? How was he transported home?
While she is spending time getting her behavior medications sorted out on the unit, allow uncle to move back home with round the clock home health care. He probably qualifies for hospice with his multiple health issues.
Get a social worker consult for wife to place her into a memory care unit that can provide care for her through Medicaid - even if it is "quite a drive" from home. This way they can both be cared for safely.
If uncle is nearing the end of his life and in hospital, he stays there (state emphatically there is no one to care for him at home, get Patient Advocate involved if needed) or have him sent into hospice facility where he can live out the rest of his days without pain and in peace.
Most Nursing Homes limit the number of Medicaid beds because the payments are quite low.
IF you request a "self-pay" bed, you will pay MUCH more but will have a better chance of "getting in." Then, when the funds run out & you qualify for Medicaid, you are already "in."
Also, UTI's are (in my experience) way more likely to be the "cause" of anger, meaness in Alz than the Doctor's seem to realize. & tests are so simple.
Someone mentioned here calling 911 for her mom - having her checked for UTI and psych eval - I agree. Local paramedics are not new to this - they will take her in and at least someone will be able to review her medications and check for uti - bloodwork etc. I understand she cannot give up her life and has a child to care for but she should try to get there to speak with her dads drs - refuse discharge - report the unsafe discharge to Medicare if the hospital isn’t working with her and think about calling 911 to get her mom admitted so they can help her mom get a better medication balance now before entering a memory care (as I have seen/heard many people get their parents into Memory care and then are called and told either their parent or too much work and cannot stay or that they are required to hire an aide at their cost to keep the parent in memory care) - so finding a medication balance for her mom now will also help them both before memory care. Best wishes
Uncle is 94 and in poor health. Let him have morphine or whatever will relieve his pain. It is what it is. Allow him to begin his end of life journey. Do not allow him to suffer. Get palliative care involved also and possibly send him to a brick and mortar hospice facility.
Aunt may need to be evaluated for medication changes. Since the nursing home has no beds home care is needed. Get palliative care involved for her also.
Ask her primary care's social worker for help finding care.
This is what I suggest having cared for my dad and now mom and an aunt both with alzheimer's.
Good luck and God bless.
Neither of these 2 elders can live alone in the house, safely and independently. And they can't both live there, as you have clearly explained. Getting each of them into appropriate care settings now, before the funds are all spent down, is the best plan.
As another commenter said, 'unsafe discharge' is the mantra when dealing with hospital social workers.
INasrallah Cameras to be able to watch her 24 7.
Onice Dad is in the Hospital, the Hospital can not legally discharge him to an unsafe environment.
Tall with him and let it be his decision rather to go home or to a Nursing Home.
Beleven me when I sat Nursing Homes are Horrible! They are all understaffed and you don't get much care much less good care.
I have 1st hand experience and I would rather take my chances in my own home.
Prayers
How many month's worth can they afford (for her to go into MC)? Someplace should be willing to take her on private pay, just make sure it is a facility that accepts Medicaid. Have the hospital discharge her directly to the care facility if at all possible. You don't need to be her FPoA to apply for Medicaid for her. Is their daughter the PoA for either of them? If not she should absolutely refuse to go get t
If your uncle does not have cognitive impairment then he gets to make his own care decisions. It is very possible the pneumonia will take him out... I'm so sorry this is such a hot mess. I wish you all the best.
The story you tell does NOT mean APS is a joke. There are criteria for taking away a person's right of self determination.
The naked lady isn't hurting anyone.
The person in your story is a danger to others. There IS a difference.
1) Get her checked and treated for a UTI, which we know presents with behavior problems.
2) E.R. will arrange to have her evaluated and treated in a behavioral unit.
After being stabilized on medications that may help, they will discharge her to an approved facility. Easier if the discharge planning finds the facility for you.
This is all should be done by the daughter. Especially if she is the POA. If Social Worker can't help, then she needs to call Adult Protection Services because Mom should not be left alone.
The criteria has changed.
I was driving before but wanted to get you an answer quickly.
Please tell the daughter to hang tough, especially if the discharge department is telling her that it's her job to solve this problem.
As long as dad is "in a bed" leave him there. I was told that many years ago by a wise and compassionate discharge planner. If someone says they are discharging him, ask if it meets the criteria for a "safe discharge". It won't.
Make sure dad does not sign himself out.
And make sure dad is admitted, not under observation.
Getting mom into a psych hospital might be a good solution to DAD's problem.
If you are her caregiver, and she can no longer look after herself, when she is in one of her fighting moods, you call 911 and ask for help. Then when they want you to pick her up from the hospital, you say NO.
It sounds like the wife needs to be admitted to a psych facility. Caregiver should call 911 the next time she lashes out.
Placement for Dad is the responsibility of the hospital Social Worker. Refuse to accept discharge.
The daughter should under NO circumstances try to care for them herself.