Up until about 6 weeks ago, my grandmother lived on her own. She has a neighbor that at that time willingly came over and assisted her whenever she needed help with something. As that help has increased, the neighbor decided it was just more then she could do. Grandmother was in hospital and has been in a SNF 2 times over the last few months. The last time she was released I brought her to my home which I thought would be temporary, however it gave me the true picture of just how much she couldn't/wouldn't do for herself. My father already lives with us in my small 2 bedroom home. With my grandmother there my husband and myself were sleeping in our basement on an old couch and recliner. Grandmother ended up going back to hospital - and I finally admitted the living situation just isn't working out and I cannot give her the care she needs, while also caring for my father and working full time. My health isn't that great right now either, and it is mostly due to stress. Currently my grandmother is back in a SNF for rehab, with potential to become permanent - however there are 2 issues -
1) She can do things on her own just enough to be discharged from a SNF - when she gets home and has to do it all on her own however.....
2) She financially makes too much for any assistance, but not enough to actually pay for the Nursing home full time. I was told about Nursing home Medicaid, which I will be contacting the financial person next week to discuss - once they take all her income (no assets lives in an apartment, still has a car that she is making payments on) she should then qualify for Medicaid. Not how I wanted things to go, but I am out of options now.
My question is - if she does well in rehab, can they discharge her even if I want her in there permanently? While she doesn't want to be there, she agreed when I told her that is where she needs to be. She tends to sleep most of the day, uses a walker but is not very mobile. If she doesn't absolutely need to get up, she won't. As guilty as I feel putting her in a nursing home, she just cannot be home by herself anymore, and I just can't add another person to care for in my house. HELP! Thanks!
DO NOT TAKE HER INTO YOUR HOME even temporarily. ALSO make it known to any discharge planner that you feel she is unsafe in her own home and you will not cooperate in caring for her on discharge so as to enable an unsafe situation.
If she insists on discharge, do NOT enable her by giving care. Let the system take care of it. Report her as senior at risk to APS when the catastrophe you KNOW is coming does come.
Your setting things up, checking, being constantly on the phone with and for her, shopping, cooking, taking to appointments enables an unsafe discharge. Pull back.Make it clear to her if she returns home she is on her own and better be able to be so.
You are going to have to stand strong now for yourself. They are going to be willing to dump her back home the first they even see you are involved. You need to step back and away and tell them you will not be involved in her care and if they send her home it constitutes an unsafe discharge. It is hard now to find care with Covid very rampant. And SNF/Rehab payment will be gone when Medicare sees no further need of it.
To be short and sharp about it, your plate is already full to overspilling. Stand strong for yourself and don't take this on.
The only thing you can control in this situation is yourself and your home. Make it clear to the rehab that grandma will not be living with you and she will need help to setup services that she will need.
LAST step, establish and hold YOUR boundaries.
If it is determined GM doesn’t need SNF level care after rehab after a needs assessment, it will be hard to keep her there. It will have to be private pay as without many deficits Medicare will not pay past rehab services.
Maybe explore other options like a small private group home setting? One that provides support with ADL’s, med management & hygiene?
What are your grandma’s deficits? What does she need help with? What can she do independently or with minimal assistance? Those are the questions a need based assessment will determine.
Work with the social worker/DC planner to find options. But if grandma’s ADL skills are such that she needs supervision vs care you will need to find another place with the appropriate level of care consistent with what her insurance will pay. They won’t pay without documentation of need.
Assisted living or group home setting may be a viable option. Be prepared to write the checks. Many seniors face this same dilemma these days unfortunately.
If the eval says that Gma can be on her own with help you get addimate that you cannot do the help. For one you work and need to. Second, that Gma can no longer stay with u because there are only 2 bedrooms and u have been sleeping in the cellar to accommodate her. That if sent home she does not bring in enough to pay an aide.
If found that she needs 24/7care then place her in a NH. But ur problem with Medicaid is what she brings in monthly. If over the cap, you have a problem. Some states have a Miller Trust. The overage is put into that trust so Gma qualifies for Medicaid. When she passes, the money reverts back to Medicaid. She is only allowed about 2k in her accounts. (This varies from state to state)
I am just giving u the basics. Each state is different. First, get that eval done. Then u can go from there.
You need a SW to help you navigate these waters. Just let them know that you do not have room or ability to care for Gma., as you don't even have bedrooms for everyone and certainly not the capability to care for all these people (yourself included).
I don't know if you can say 'unsafe disharge' from a SNF, but you will need to have a place to send her straight from the SNF with NO stops along the way at your house.
Other posters will have better ideas--I just feel for you. 24/7 CG is exhausting.