Got MIL set up on Medicaid and a placed in nursing home and now wants to come home. This took many many months of hard work on my end to complete everything and get her approved.
We discuss her discharge/care plan this week with the facility. She will have an aide Mon- Fri but not sure if it’s not enough hours to cover what nursing home recommends. She can figure that out since it’s her decision to come home.
Husband and I are both at the point where we’re going to let her make her own decisions, assume no responsibility for her care and tell the nursing home this.
We’re basically wiping our hands clean of it. She’s on her own now.
It strikes me that if you are participating in discharge plans you are there for a reason: because she explicitly cannot make decisions on her own. If she did not do the paperwork for Medicaid and placement because she couldn't, then she cannot do the discharge plan either.
Because my mom lives semi-independently in her home, I am not familiar with placement and discharge, but my gripe would be with the NURSING CARE FACILITY and not your MIL. I presume your MIL no longer drives. She is placed in a nursing home and I presume she does not have a credit card or cash. Does she have the simple ability to call a cab, tell the driver where she wants to go, and pay them when she arrives? Does she have the ability to get food? Clean her home? Perform all the basic ADLs? Call for help in an emergency? If the utilities are turned off at her home, is she able to re-establish them? Does she have the skills and ability to pay her property taxes and all the bills to keep water/electricity/gas going? When an appliance breaks, can she get it repaired? Can she manage her basic care to schedule and attend Dr appointments? During the hours no one else is there can she call for ourside help if needed? If there was a physical disaster (fire/flood/freeze) would she be able to evacuate to safety and sucessfually repair damage to her home?
I understand you are discussing partial skilled nursing/unskilled care assistance, but there is SO MUCH MORE to fully independent living than a caregiver during the day M-F. I knoe. The above list are all the things I do to support my mom because my mom cannot live completely independently on her own and she understand the limits of her abilities and appreciates my support.
It strikes me that if the answers to all of these questions is YES your MIL should not have been placed in a facility. If the answers to any of these questions is NO, then documenting this for the record is NOT WASHING YOUR HANDS. Rather it is doing the due diligence needed to care for someone when they are unable to care for themselves. Refusing to enable is not the same as doing nothing.
Ideally, you choose to continue to work to document your MILs skills, abilities, and needs for all the things that independent living requires. Ideally, you learn to set healthy boundaries for what you are or are not able to provide to her on the LONG list of needs. Ideally, you understand those needs and refuse to enable when it is something you are unable or unwilling to do. But, I'm my humble opinion, none of those things are "washing your hands."
It may be that your MIL is competent to live independently now. But, keep this list. Medicare/Medicaid does a similar assessment that includes social and emotional wellbeing, safety, and security - things I didn't even touch on in my list and do for my mom daily) refer to thsee lists as tools in the inevitable change a long live brings. Your role is to continue to monitor these lists and ensure the support she needs. That does not mean you doing everything. It does mean getting her to the living situation that is approx to her skills and abilities. *warning, there are BAD nursing facilities, too. So, placement does not mean the job of monitoring and making decisions is over.
Love is not doing everything.
Love is doing what is best for someone's physical, emotional, mental well being to ensure they are safe, secure and as healthy as possible on a daily/weekly/monthly basis - which encludes the maintenance of their physical surroundings as well as their person.
Love is not enabeling.
Stay engaged to ensure all those things are provided - whether she is at home or in a facility she will continue to need you to monitor and support.
I wish you luck on setting appropriate boundaries and expressing frustration to the appropriate place- the nursing home.
Hence it also isn't a matter of letting your mother in law make this particular unwise decision. You can't stop her. But you are absolutely right that what you can do is make your own decisions about how far you will go to support her in it.
Make it clear that you understand that while she is mentally capable of making this decision you do not approve of it and make the clear statement "We will not be enabling this move in any way". Make it clear that your MIL will have what anyone else has, the 911 number. That you will not be cooking, cleaning, transit to appointments, shopping and etc. Make clear her finances and the cost to her and that you will not participate in getting her re-enrolled for in facility care. Make this clear to MIL and the Social Services and make it clear that you believe this to be an unsafe discharge due to history and your MIL general condition.
I think you need to be short, sweet and adamant. Tell them you do not approve of this move, and will not attend further discharge planning. That you want your opinions DOCUMENTED. When my brother contemplated moving home I told him what I would/could do, and what I could not. He tried some nights at home and then made his own decision not to do it, and sold the place. I was across the state. Sometimes that's the best place to be.
Thank you for all of your replies. She has been home about a week now and is doing well.
Slightly mad we’re not jumping and doing more for her, but setting firm boundaries.
Her aide was able to do 8 hours a day. 730-1230 and then 6 to 9.
As of now, she’s managing okay and no “crisis” has happened…. Yet!
The first step is to have facts. This would mean knowing if she is competent or not.
Don't help her move, don't aid her at all in leaving the facility. If she talks about it change the topic. Do nothing and see how far she gets.
I worked hard to help my jerk of a stepfather-in-law apply for Medicaid. He had Parkinsons (6'5"), his wife (my MIL) had dementia and memory loss. They lived in a house with stairs. And were completely broke and in debt. SFIL thought I and my family were going to be his care solution. I told him it wasn't possible. He refused to sign the Medicaid form. I told him if he didn't sign the form I'd report him to APS and allow the county to get guardianship of him. He didn't sign. He became a ward of the county. He was transitioned into a facility and was protected and got medical care.
You have to truly stick to your guns on wiping your hands clean of your involvement with her care in home, because it's highly unlikely a CG 5 days a week will suffice. What about the other 2 days, and the hours nobody is there Monday thru Friday??? An elder who requires 24/7 care in a SNF is not going to thrive with part time care at home. So leaving mom to make her own decisions knowing it won't work only leaves YOU back at square one again when she's floundering and you're asked to pick up the slack.
When you discuss her discharge plans with the SNF, do let them know your true feelings on the matter and that you won't be available to caregive when the aides don't show up or on the days they don't work. See what they have to say and go from there. If your mother doesn't drive and is depending on you to do everything for her at home, and you aren't planning to do so, I wouldn't agree to her coming home. And I don't blame you for NOT doing the in home caregiving after spending months getting her approved for long term placement with Medicaid. Sometimes, an elders wants aren't aligned with their needs and that's when we have to step in and override their wishes.
Don't invite the inevitable disaster into your house if you're even considering the latter.
Now, plan your vacation and start imagining yourselves there.
Let go, with love.
P.S. If mom's plans don't work out, please call Adult Protective Services to help her with appropriate placement.
It's perfectly understandable if you and your husband refuse to become caregivers to her. None here can fault you for that.
In fact making sure everyone involved knows this is the best thing you can do.
Have a meeting at the nursing home with your MIL's care team and have her present there too. You and your husband speak plainly to everyone (including MIL) that the two of you are 'washing your hands of her' and refuse to help in any way. If this is truly your plan then make sure everyone is clear and understands. Especially your MIL. You would do well to have someone bring up the idea of AL living or an independent senior community if this could be a possibility for your MIL.
Also, I'm going to let you in on a little secret of the care industry that most people don't know. I know things because I was a caregiver for almost 25 years. I had a lot of clients recently discharged from nursing homes. A nursing home will insist that a person needs 24-hour care and supervision when they really don't. This is because a nursing home never wants to lose a resident that's already on Medicaid. Especially one that's easy to care for and doesn't need a babysitter 24/7 because they're out of it from dementia. Is your MIL a resident like this? If so then that nursing home is going to fight to keep her and is going to tell you that she needs all kinds of care when she might not.
If she's still with it and wants to try homecare then you and your husband should be supportive of this. Many of our beloved seniors are not willing to allow any kind of outside help because they expect their adult kids to become nanny-slaves to their needs and demands. You and your husband are very lucky your MIL is not like this and is on board with trying homecare. If she's already on Medicaid that won't change when she goes home. There are plenty of nursing homes. If she comes to need one again I'm sure you'll find her one. Make yourselves clear that you will not be her caregivers, then let her decide her own life.
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