Moving elderly mother out of rehab and across country; what do I need to plan now and after move?

Buffalogal, welcome!

Encourage mom to work hard at PT. This is how Medicare pays, progress made. However, the average stay is only 20 days and they usually give you 48-72 hours notice. Her being in rehab until the end of November being paid by Medicare is a pretty slim chance.

I would find out what her insurance is and get that sorted out now, it's a process that takes time. If it is an advantage plan, they will cancel her because she lives out of the service area and that will allow her to get supplemental plan and standard Medicare, I highly recommend this route. If she already has that, she probably will be covered by everything but her prescription plan.

You need to find aides that can start helping her in California on short notice. She doesn't need to bathe everyday but, she might need other daily assistance. You want to get this sorted out because of the severe shortage of caregivers.

I would encourage you to get rehab to do a needs assessment. This will help you know what needs to be done, west coast or east coast. She may not be able to live alone and you need to know that asap.

If you are looking at Medicaid, you need to find out what NYS requires to be a legal resident. That would be required for her to get that assistance. It doesn't cross state lines.

Because of her age and injury, you want her doctor in CA to clear her for air travel to NY.

Good luck. The beginning of parental care is overwhelming and we find out how little we know about this.

Oh, contact the area on aging in both locals, they are a gold mine of information on resources.

So you haven't seen each other in 17 years and according to your profile, "Mother and I somewhat estranged she now wants to move back to east coast and live close to me."

Why? Does she expect you to become her caregiver? What happens if she refuses to allow help into her apartment?

What are her finances? I hope you aren't expecting to pay for her home help (if she allows it).

"Once she gets here it will be ok"

Are you sure about this? You really must know her capabilities when she is discharged. And then decide how (if?) you are willing to take care of what she will need.

Are you an only child? If not, is/are your sib/sibs also estranged from her?

I would slow this down a bit. So many stories on this site start with bad decisions made during a disaster/ panic situations. First question is do you want her to move close to you? Once she moves it will be hard to undo. What is her expectation and yours once she moves? I would start with a short term solution that keeps her in CA and let the dust settle before I moved her. See if her shoulder improves.

Buffalogal, moving at any age isn't easy.

First, one will miss all their old time friends.

Next, Mom will need all new doctors, dentist, hairdresser, grocery store, clothing store, the list goes on and on how, and learn how to get to those places.

Next, banking. If Mom has a nationwide bank, no problem. If not, a new bank would be needed with a branch close to Mom's new home.

Next, moving. Since Mom lives in an apartment, the moving companies don't send a half empty truck across county. They will stop to pick up another load. It may take weeks before Mom's furniture arrives.

As for becoming Power of Attorney, only your Mom can appoint a person to do that, and it has to be a legal document. It would be best for your Mom to find an Elder Law Attorney, as there may be other legal documents that your Mom might need.

There is so much to think about. I would think it might be easier on Mom if she continues to live in California, and if she can budget it, move into senior living, be it Independent Living depending on her rehab, or in Assisted Living.

Talk with rehab discharge people and be friendly so that they take a personal interest in you and your mom. Ask about Medi-Cal, which is a California plan that I know nothing about other than it helped a relative of mine who was about your mom’s age and had little money. California has great resources. That’s one reason their taxes are so high. You’d better check carefully before moving her near you because you don’t want to bear expenses that California would have paid if you left here there. Ask about home health visiting rehab people and nurses who will help her at home after her discharge. The fact that your mother left where you live years ago and you aren’t close tells me that if you move her near you, you’ll both be miserable. She could live 10 more years with you at her constant beck and call. Is that what you want? And don’t move her into your home. You only have to read all the other posts on here to understand that having a sick older person on the premises is often the fifth circle of hell. Don’t think it’ll never happen just because she’s in her own place. Her own place is just one fall away from your place. Just sayin’.

Medicare Stays with your mom, are you thinking Medicaid ? ..

I moved my mom across the states last year. Out of an AL . It was difficult because she didn’t want to leave anything behind…what a tug of war. Any case , I furnished her memory care room off of Facebook marketplace. Bought the mattress from costco.. curtains off Amazon..new recliner.. all in place when she arrived. I had the pain dr visit made along with a GI dr as well. The facility had a Physician Assistant call on their patience. You will need to have your mom request medical records to be transferred to wherever she will be seeing a Dr.

When you open accounts with your mom, have her sign the POD , payable on death, to stream access after her death. If your mom doesn’t have all the legal papers drawn up, you can download them on the computer, I believe I used uslegalforms… but there are choices. You can have the papers all filled out, for when your mom arrives, have them signed and witness at the bank . Durable POA, medical POA , living will, dnr, and a will . I did my personal papers this way. If your moms estate is complicated you may want a lawyer instead.

keep all receipts, and have good record keeping.

I planned to fly first class, but our flight was cancelled. Had trouble getting out on a flight. Ended up in a hotel for a second night , so plan for just in case….

a good place to get information would be to contact your county office aged and disabilities…

I wish you luck with all of this…

Don't do anything unless she's given you Power of Attorney, because everyone will stop you in your tracks (banking, Medicare, Social Security, nursing home/apartment folks) without it.

You should have both medical and durable power of attorney. You don't need to activate them right now, but if she can't make decisions or OK whatever you're needing to do, you need to have them ready.

If mom is on assistance and Medicare you need to find out the rules in your state. We moved my Mom from California to Minnesota. She didn’t need it but I found out that she had to live in Minnesota for one year before the state will provide assistance. Also be careful how you spend Mom’s money. Most states have a look back period.
Also from what I understand POA means nothing until mom is deemed incapable of making her own decisions.
I knew nothing about any of this until I had moved my Mom. With the help of this site and a lot of googling I have found out a lot.
just be aware, I feel taking on this has been like a part time job.

I am so sorry you and your mother have been estranged. Was she abusive to you when you were a child? Does she have a mental illness (such as narcissistic personality disorder, bipolar, etc.)?

So often on this site we see adult children of abusive or difficult parents moving heaven and earth for someone who wasn’t there for them, trying to finally get the love and approval they were denied as children.

I would run your plan by a counselor or therapist before going any further.

You say you haven't seen mom in 17 years. That's a loooonnnnnggg time.

Before you start any sort of move, just HOW certain are you that mom is "totally sharp mentally"? Because if you are completely honest with yourself, and your answer is anything OTHER than 100% certain, you need to take a big "time out" and rethink this plan.

I think if I were in your position, and I could swing it, I would make plans to go out to CA once mom was out of rehab and spend a few weeks with her IN HER HOME to see just how competent she is, how much help she really needs, and whether or not you want to commit to being her caregiver on the East coast.

I imagine you have a valid reason for not seeing your mother in 17 years. I don't need to know why - but YOU need to consider that reason before you commit to this. It seems you're doing this planning in panic mode, and that won't work out well for you OR mom.

I think ur jumping the gun here before you have all the information. Mom may rehab well with a broken shoulder. I would also ask the PT about her mobility issues. I would also make the PT aware that you live on the opposite side of the country so u need to investigate options before you can make any plans for Mom. So u need to be kept in the loop about her progress explaining u have been estranged for 17 yrs. Do not allow these people to bully you into making snap decisions they may effect you drasticly till Mom passes. Think "lets get her back in her apt with help" before you consider moving her across country to a place she is no longer familiar with. Your going to be expected to be her entertainmemt.

Medicare pays the first 20 days 100%. The 21st to 100...
50%. This means if its felt Mom needs more therapy passed the 20 days, she will be paying out of pocket for the other 50%. Unless she has a good suppliment. Nothing is guaranteed. Mom can be discharged at any time within those 100 days if she is not progressing or has hit a plateau.

You need to find out what insurance Mom has. The Rehab finance office should be able to help here. Straight Medicare goes from State to State. Supplimentals, unless Medigap, don't. They are written in the State the insurer resides. So if Mom has straight Medicare no problem but unless her supplimental is also written in ur state, she will need another supplimental.

Then there are Medicare Advantages. Medicare contracts out to these companies. They are suppose to cover Part A&B of Medicare and then have some additional advantages. These are networked based meaning you need to use providers they contract with. These are State based again meaning you need to find if they can write policies in your State. If not, Mom needs a new company and has no Medicare till you do. Or, you go back to straight Medicare with a suppliment that provides prescriptions. If prescription plans not provided, Mom needs to pay for a prescription plan.

Medicaid for heath is also State based. So you will need to find out if Mom needs to declare residency in your State to received Medicaid for healthcare.

When you find out what Mom has, call your County Office of Aging and they can help you navigate through all this insurance stuff.

Your other problem is how are you going to get her and her belongings to NY. Maybe she can fly? But who is going to pack up her belongings and move her to NY. I may want to tell her there will be no move if she can't do for herself. I am sure the reason she wants to be near you is for you to be her caregiver. In 17 yrs and at 86yrs old, I doubt Mom has changed. So if ur estranged for the reason she tends to be abusive verbally or will expect you to be at her beck and call...then you may want to leave her where she is with the State taking over her care.

Please, do not make this decision too quickly or because you are being pushed. If Mom is an "unsafe discharge" she can be transferred to a LTC facility or an AL till you research all your options. The SW can also set up in home care for Mom but it will be at Moms expense if she has the money for that, the AL and the LTC. If not, Medicaid may pay for LTC or in home help not an AL. Its the SWs job to make sure Mom is safe. Not much you can do from your position and without a POA also not much you can do.

One step at a time. I would look for options to keep her where she is before moving her across country.

Sorry. Double tap.

Lots of problems here before we get to personality difficulties or estrangements. When you are sure she is ready to leave rehab,(follow excellent advice here; many hospitals will try and dump her) I would see if you can get her into a respite at an AL or Memory Care (get this accessed a bad fall at her age can be a slippery slope) place with access to PT, OT, etc. But find out! It will be much easier than coordinating cross country home care. Also, transition from place to place might make the move easier than going home, and leaving home again. Find a good one, and she might just want to stay for a while, or forever. Moving is very hard on us old folks. It is likely that the place know movers who have managed elderly moves and can help you with your Mom's place. DO NOT attempt to keep her at her home when you are cross country!!! Even if you are a millionaire, it is not safe. Make that billionaire these days. It is a bad idea even if you are across town. Be assured that any difficulties we have with our families will be multiplied when we are caretakers. No one needs to be blamed; it is just a very stressful situation. She will complain about the place, just like I complain about this place, and would probably complain if living in the lap of luxury at a child's place. Aging ain't no fun in spite of the ads for senior living.(I don't mean to suggest you shouldn't watch the place, they vary a great deal even from time to time. They are as good as the caretaker caring for your Mom at the time, at a place or in her apartment). By the way, if it should be convenient, consider adult homes, many people find them much more user friendly than larger places for the real elderly (ahem, like my husband and soon me.).

https://www.medicareplans.com/medicare-advantage-plans-new-york/

I was walking in your exact shoes. Moved my mother from WA to east coast. Estranged for 12 yrs. Because of her abusive narcissistic borderline personality. She was in rehab for 3 mos. Social worker helped me set up durable POA so I can manage her finances. She has NO assets. Only SS.
I was told it was unsafe for her to go home and live alone. If I left her she would go on a Medicaid bed after the 100 days so the Rehab would collect their money. Also, after 6-8 weeks she would be moved to a group home and she would loose all her SS and small pension. I could not let that happen so I moved her back east to AL that accepts low income seniors. They in turn get a tax credit. But, my life was hell during this transition. I got all her furniture off Marketplace. Remember, she has 0 money. Never was a saver. People took advantage of her finances out West so I felt it was time to stop that situation. They had her ATM card and access to it. They wrote $1,000 checks from her checking account and cashed them. paying their utility bills from her account t in auto pay. POA gave me the access to her account to stop that. She hates where she is which is a beautiful and clean building with really nice staff. She would complain if she lived in the White House honestly. She is a hoarder (newspapers, magazines, paper cups)
it’s awful! So think before you act!
you are not responsible for her! I felt guilt and badly too. But she does not appreciate anything g I do for her back here. I am her only family member to help her. My sister does not want to ever see her again. She was so mean to my sister. Her siblings and cousins want no part of her. She is going to die a lonely death some day. It breaks my heart but these actions of hers were all her choice. I have been in therapy for 2Yrs to help me stay strong.
You need support and cannot do this alone like I did. Most stressful thing I have done in my entire life.

Traveling Mom?? So much to think about before moving your Mom across the states. Since your post was October 22nd, how are you both doing today? I'd like to know your updates. Take care and God Bless.

Thank you all for your insightful, well thought out and helpful answers. My mom has decided for now to stay in California and return to her apartment upon discharge. She said she can do that and will hire in some help. She admitted things were moving g too fast. Like I said- she’s stubborn. There nothing much I can do from here. My concern now ( and I’ll cross that bridge when I get to it) is that the next time something like this happens it will be more difficult o arrange and plan bc she’ll be older and it could be more severe. I think I’ll take someone’s advice on here and note the bullet , go for a visit and have a heart to heart about planning and future realities. This has also taught me a lesson for my own future planning purposes. None of us will be forever young. Thanks again everyone. Be well

Apologies in advance if I posted same/similar: Internet dropped, not sure my original answer/response went through or not.

So sorry you are dealing with this. No contact for 17 years is a long time. NOT criticizing; I made a similar decision a couple of years back w/my mom (she is almost 86 and is in a nursing home). The toxic, narcissist type (long story, explained in my profile).

As other have said, rushing to jump back into this may not be optimal. Do you really want to do this? Making a decision to "self orphan" is not easy. And not sure if that was your decision solo OR you and your mom came to the same or similar decision? Can she listen to you, will she? Can you listen to her? Is there so much resentment on both sides from the years of estrangement that it is not reasonable or realistic for the relationship to be put back together in some basic way to make moving her to where you live and you taking over on care, or the management of her care a workable solution at the point?

As others have said, telling her facility that "it is NOT safe" for her to return to her apt and that you "ARE NOT, handling all the details or coordination for a safe discharge/return to her apt" will put the responsibility back on them to work out a "safe discharge." That "safe discharge" should likely be to a nursing home or AL for a period of time, yes she may have to pay out of pocket for this. But this would give you time to really process what is best for you and for her.

Guilt and obligation can take over in these situations and drive one to take on something that is not in one's best interest, especially when it is in a crisis situation. And hope -- hope for reconciliation -- when estranged is hard to give up on. That hope lingers for a very, very long time. You likely need more time to process this, rushing is not likely in your best interests or her's.

Some proof of concept steps are key here IMHO. Is she will do the following immediately:
1) Executive a durable medical and financial POA naming you as having "full rights" immediately upon signing? Cannot be limited to when she is "not competent" as that is a road block that could result in years of delayed "full POA rights". A elder care lawyer in CA can draft this, and have it signed notarized (many lawyers are also notaries) and witnessed (aides there can witness). Make 3 originals, 1 she keeps, 1 is fed ex to you for receipt the next day, 1 lawyer keeps if he/she needs to present an original on your behalf to a bank, the landlord, on and on.
2) Execute an "advanced directive" naming you as the "health agent" -- most states have boiler plate draft ADs or the lawyer can draft and execute it. Do the 3 originals again and who gets one. PS if you have to pay the attorney yourself, do it and reimburse yourself from her bank account once you have access, just keep records.
3) She must immediately give you all the bank, financial and other account info so you can set up on-line banking to pay bills now AND to: hire/pay someone to pack her, sell items that need selling and to move her stuff, etc., etc., etc.

If she is NOT willing to complete each of these 3 steps, THAT TELLS YOU SOMETHING! This cannot be a game, with round and round arguments or explanations. Simple, do these 3 steps this week or say the deal on my end is off (assuming you really have processed this and have decided that you indeed want to do this, to move her and to take over on care or management of her care).

This may sound mean spirited, but IMHO both parties need to know and agree on what is expected. Realistically, you cannot handle her care and the move her if you do not have all 3 pieces so you can easily and without much fuss just take over and get things done.

Social workers at her facility in CA can likely give you a few elder care lawyer names to work with. Most in this "elder care" space know each other in their local area.

Best of luck, this is not a fun journey.

Sohenc had good advice. If you move forward, you may need all the same documents drawn up in New York… our attorney advised us that some of ours may not be recognized or may be limited in other states. The eldercare attorney in California could advise, but also check with an eldercare attorney in NY to be sure you are covered on both ends for the transition and going forward. If your mother is stubborn, she may agree to move to NY later then decide not to sign the NY documents. I would think this may even help doing things now long distance. If you start helping with finances, you may decide having some local accounts would help. Remind her that her total independence was put on temporary hold when she fractured her shoulder but it may be much longer if she breaks a hip or has other health issues requiring you to become more involved. Without proper long term planning, it will be hard enough if you are local but cross country will be more difficult and may become next to impossible… especially if you start having issues of your own and can’t travel. First convince her long term planning will make life so much easier for both of you for future issues and will allow her make her own choices about her future… otherwise the state may have to step in at some point if your hands are tied due to lack of planning.

Rehab will discharge her when she is "no longer improving" or when Medicare Rehab allotment for her shoulder fracture is over. If she stays longer or moves to another care facility, you or she will pay out of pocket but she would have continued care and help as needed. Similarly she could return to her apartment with hired Home Health care until you picked her up and moved her to New York.

How about letting the professionals take care of Mom? Placing Mom in Assisted Living will add a layer of safety and protection. Call A Place for Mom or the Care Advisor here on the right hand side to find the right fit.

Please set emergency appointment with an Elder Law Attorney to educate you on what the laws are in New York and how to set up her finances (close old accounts and start new ones or eliminate what you can). BTW, do you have Power of Attorney? How can you take charge of when Mom is discharged? Put her bills on autopay or just pay them off.

Do you have siblings or close friend who can assist you with the moving part of this situation?

So, get that appointment with the lawyer and go visit a couple of assisted living facilities so you can give her some recommendations. If Mom is as stubborn as you say, she won't appreciate you orchestrating her life, so tread lightly and do this with the perspective that you're there to assist in her making choices, but you're not going to make decisions for her: try to present everything as a choice. Try something like this, "I've visited 5 assisted living places and can recommend 3 of them, would you like to visit those three to make a choice where you'd like to live?

Try to chat with her about what she wants and what activities does she enjoy? Does she use a computer? Is she still driving? Do not push your agenda on her and don't letter push her agenda on you: learn to do mindfulness meditation if you don't already do it................deep breaths/long exhales.

i think traditional medicare is nationwide but the supplemental is probably state based unless you have a medicare hmo etc than thats probably all state based? Even if mom is staying in California for now, I would still get Power of Attorney, Health Care Proxy, Advance directive - put everything in a folder in her home and in your home so it can readily be faxed/emailed(scan it) etc. Also, figure out her financial situation and medications she takes so that you know what she can afford and also you can instruct aides as to what meds she needs to take and when. I have all this in a folder for mom with copies of insurance cards in case she needs to go to hospital(im staying with her as a caregiver the last few years) - she had covid in march 2020 in NYC and when they were taking her to hospital in middle of night, i gave the EMS her Health Care proxy ie didnt want intubation ,etc......good lucjk!

Buffalogal: Perhaps you can speak to a social worker as your questions are many. I just saw your post of thirteen hours ago where you stated that your mother is going to remain in California.

You've had lots of good advice here. At 86 years old, pretty much anything you do will be "moving too fast for her". She's retired and set in her ways, and you are still a working lady...and we all know how fast change happens at work and everywhere else. I know I'm used to 50+ hour work weeks that are packed full and ever changing, so we can roll with changes. She can't.

She might be able to take some change, but it will be slow, and at her pace. SHE has to want it, and she is not likely to listen to you. Dave Ramsey says it best, "It's the powdered butt syndrome...once they've powdered your butt [like when you were a baby], they don't want to listen to you"

I think do all the research you can, but try not to let it take over your life or cause you health issues. I started helping my dad semi-long distance (3+ hours one way) at the beginning of the year, and my diet and exercise that I had been so good at went right out the window. 30 pounds later and not even a year has gone by. It can totally take over your life.

I'm not saying not to help, just that you will be met with resistance, so expect it and don't get too frustrated, though that will be hard, I know. I don't see that you ever responded whether you have a sibling that can help...? If you do, or even a cousin that you are close to, perhaps you can tag team?

Best of luck.

Myadvice on the legal matters is to make sure she has a will, power of attorney and living will, but that can take weeks or longer. Short term, add your name to all of her checking accounts and saving accounts, so you can write checks to help pay her bills when she's unable to.