My mother in law fell and broke her hip and she has stage 6 dementia. The entire story is a bit crazy. Her caregiver, which was her oldest son, was incarcerated for abusing her and also has 10 felony charges that are VERY severe. The entire house was in a hoarder status and stunk so bad of cat pee. We live out of state and quit my job to care for her for the last month. My husband, her youngest son, can't quit his job as he is the bread winner and we can't afford to be out of work. He also has been traveling on the weekends to come visit and keep me from losing my mind. We have a teenager in a very tough program at school so she can't miss much school so that adds to the dynamic.
We worked so hard for the last month getting the house back to where it needed to be, figuring out the financials and everything that wasn't done due to the laziness and neglect of her older son. He would leave her alone for hours and hours to roam the house and she fell 7 times in less than a year. We finally had all the paperwork finished to transition her into an assisted living facility in the state we live in and then the fall happened. She just had surgery today on her hip, had to have it replaced. Can anyone tell me what the next step is after the hospital because she can't come back to the home? We are not in the position to handle this level of care. The house is not equipped for that plus I have to get back to work. She also is stubborn and will not sit down! I would watch her on the Ring cameras from my phone when I went to the bathroom because she would be up and moving in less than a second! She is an extreme fall risk due to her thinking she has a 20 year old body and forgetting every 10 seconds.
I'm so exhausted being the 24-7 caregiver with very little help. Our life is upside down so I am very nervous about all of this. I have been reading that she will go to a rehabilitation center until she can transition into an assisted living memory care facility. She has enough money for a very nice assisted living unit as her and her husband set up long term care decades ago. What happens next? We had 24/7 care set in place this week coming up as I need to go home but I don't know if that's possible now. How long will it take to get her into a facility? How long is the average time in a rehab for hip breaks?
Any advice, input or information would be greatly appreciated.
Genworth will have a waiting period b4 they will kick in coverage. Find her policy, read and reread it. Often there is confusion as to whether rehab days included in the countdown. Most LTC insurance do not include rehab days. Y’all need to be clear as to timeframe.
Advantage Plans usually are boundary lines limited. So will not transfer to new State. The good part is that she can now go onto Original Medicare and whatever secondary health insurance that seems best for someone in a NH and not yet a “dual”. Dual as in on Medicare and Medicaid for health insurance and abt 70% of those in NHs are duals. Ask someone in billing or the SW at the SNF as to which health insurance seems to work best for their residents who are NOT a dual. May not be many choices.
fwiw that your BiL is in jail is a good thing as it will make the selling of MIL house way easier as he is not there to interfere. I would suggest you proactively check the courthouse property records just to make sure bad bro. did not place her home as collateral for lending or other liens placed on the house due to his misdeeds.
Be aware that if possibly LTC Medicaid will be on her far off horizons after Genworth stops, that Medicaid program tends to want their home sold for FMV & usually based on the last tax assessor bill. If her house isn’t close to assessor FMV because of the hoarding, take lots of pictures of its nasty so you can show why it had to sell for less than FMV. Also when her Genworth tapp’s out and MIL has no $ to private pay so she files for LTC Medicaid should there be any issues with her bank account showing transfers of $ from MiL to that son, you have APS report, police reports, etc to be able to show she was a crime victim (bad bro the perp) so there cannot be an penalty placed on a LTC Medicaid application.
If bad brother was a drug user, his friends may come back to the house. I’d keep that Ring camera up till house gets sold or bulldozed. Staying atop an out of state property of a parent is not easy. Doing this with hoarding and jail and APS stuff, I flat cannot imagine. Kudos to you for doing all that you have!
The pain after surgery is considerable, but most providers have told me that would dissipate by the end of next week.
Medicare will pay for the first 21 days. Day 21 through 100, she or Medicare advantage will pay.
thanks!
With dementia it is very difficult for them to follow directions and then to be active with supervision after so most people will get an hour (and often much less) of PT and OT
Normally I would say a person with dementia should not be in Assisted Living but I doubt very much that your MIL would elope.
That said she will probably be a 2 person transfer and more likely she will need equipment to safely transfer her. If that is the case chances are the only facility that would be able to take her as a resident would be a Skilled Nursing facility.
You can talk to the rehab she is in (or will be sent to) and they may be able to keep her for Long Term Care.
You might also want to ask about Hospice. Due to the broken hip she may be eligible. Quite often facilities will accept a Hospice patient.
(hate to be blunt but the reason is they would not expect the resident to be long term. But as long as there is a documented decline that meets Medicare guidelines Hospice will keep her. Hospice is not just end of life, my Husband was on Hospice for almost 3 years after he broke his hip)
They are 100% discharging her to SNF where they will TRY to do PT but if she doesn't cooperate then of course she will be wheelchair bound in a LTC facility (memory care). Most likely she will be level 3 which is one step below hospice for a while. We have everything lined up, she has really good medicare NOT medicaid. She also has VERY GOOD long term care insurance with a very large maximum per month. Not enough to cover in home care 24-7 but enough to cover a very very nice LTC facility.
Right now it's just a waiting game to find out when the hospital will transport her, or do we have to put her here in Richmond VA. Her only family which is her youngest son and myself (daughter in law) and we live 4 hours away in Charlotte. We have no other options other than to put her in SNF and then long term care. We are in no shape to take her in our home as the house is not safe for her, the house here she lives in is not safe for her level of care needed.
We are working hard everyday to make this work and we believe GOD is in control!
Thanks for your response!
When MIL is in rehab, you will know more. Prepare for home sale and her going into LTC. She will need to spend down before qualifying for Medicaid. Keep good financial records. Of course if there are no legal papers, your option is to let the state probate assign a professional to her. You are under no obligation if you live long distance and want to go back to your home. You ask about getting her in a facility. Someone goes out to visit a few and picks one. Her doctor will sign their required paperwork indicating that she cannot live alone. Some states require 2 doctors but it should not be a problem. Expect a couple of months of turmoil and do not plan on taking her in. The term of unsafe discharge should be your family statement.
Tell them what you told us about the caregiver.
Tell them you were there in an emergency and attempted cleanup but that the home is not safe.
As that discharge planners call in APS.
Ask that the state accept guardianship as you are unwilling and unable to do so.
The social workers will take this to the courts and get a Fiduciary assigned.
Help that person ascertain where financial documents, and etc are.
Good luck.
Also retain an eldercare lawyer for her NOW. This will set into motion the medicaid long term care process to legally spend down any over the limit assets. Even an hour consult will provide valuable information.
most likely due to her short term memory impair she will continue to get up and fall. I would talk to her doctor to see if she’s a LTC candidate, which Medicaid would cover the medical portion and her SS would cover the custodial part.
if no one is her PoA you may need to consider allowing the courts to appoint a legal guardian for her. Then everyone’s problems are solved.
Welcome to the forum.
It sounds like you had been making great progress with your MIL. So sorry for all regarding the fall.
Truly a lot will depend on how well she does with recovery from her hip. Since she isn’t one to sit still and she has been falling often before the break it might be a difficult rehab. She probably won’t remember that she can’t walk and will most likely try when she isn’t in pain. If even that stops her.
How does she seem cognitively since the fall? Have you been able to speak with her? She may not recognize you in strange surroundings but hopefully she will be comforted by your presence.
It’s not unusual for a much less traumatic event to cause advancement of dementia. Change is also another accelerator and being in the hospital, recovery from anesthesia (which she may or may not process quickly) dealing with constipation from pain meds, etc. there will be a lot for her to deal with and you by default.
I have seen elders progress steadily with and w/o therapy from broken hips. Usually a lot faster w/therapy and in your circumstance it would be great to have the extra help of a facility. If she lets the hip ground her, she might actually be easier to care for than before. You didn’t mention incontinence but that’s a real possibility with dementia and the trauma.
She may or may not be a candidate for Memory care. It will depend on her recovery. She may still need skilled nursing when she completes her rehab.
When you choose the rehab look it over well to see if it would be appropriate for her to stay in after the rehab. She may be better there for awhile before moving. It’s early days if she is still in the hospital.
I’m glad you found the forum. I hope you find it helpful.
We are making progress with getting her into a SNF. Trying very hard to get her down to NC into a SNF next to the LTC facility that we had already paid for! This is just another hurdle to get over!!
I have toured a place here in VA and 2 more tours today just as a back up because she might have to go her short term then transfer down to NC but again, she is 80 with a new hip and stage 6 dementia, that is going to take a MASSIVE toll on her. IDK what will happen next.
Unfortunately , you are in a wait and see whether or not she makes enough progress to go to memory care .
If she is not making progress in 2-3 weeks she will be discharged ( per Medicare ) from rehab and may need SNF nursing home .
Sorry about your situation .
My nephew is also in the wait and see stage as his mother ( my sister ) is in rehab as well for a repaired fracture and waiting to see how well she does . Currently she is wheelchair bound .
So I've been told if she doesn't rehab well and is wheelchair bound, she can go into a assisted living in the memory care unit but her level of care will be a level 3 which is one step down from hospice. She has enough LTC insurance to cover it but it's just unfortunate to think she may never walk again.
Good luck in your nephews situation! I hope it goes the way they want it to!