Agonizing over care options for mom after she broke her. What should I do?

Brandee again,

Agree with other poster to list the house and sell the house "as is." Tell the realtor you are not doing any repairs.

We did this with Mom's house, got 3 offers and a bidding war.

Look at more places.

I toured places in two states and came to the conclusion that the older, smaller facilities in rural areas offer the better care and are cleaner.

There seemed to be a lot less staff turnover in the more rural facilities and more community support.

Talk to workers in the parking lot when you enter and exit. You would be amazed at what you learn. Some told me the place was not a good place to work and they were looking for a job.

I had private duty caregivers that worked in facilities 30 hours a week. They confirmed the smaller, older facilities in the rural parts of the county were better places to work.

Avoid places that constantly have Now Hiring Banners outside for CNA's and RN's.

Take a look at how the other residents look. Is there hair combed?

Facilities in working class to middle class areas appeared to be better staffed.
Facilities in upper class areas appeared to have chronic worker shortages.
If the facility is in a ritzy area and workers have to drive over 45 miles each way to get to work there will be chronic staff shortages.

New and modern physical structure is not necessarily better. I visited my girlfriend and Mom at what is supposed to be the best SNF in Florida and residents have large private rooms and the hallways are wide but you never see any staff.

Check the facility's website employment section. You can learn a lot there.

Look at other facilities.
But you mentioned other chronic conditions including oxygen and breathing treatments. It is possible that with all that she may qualify for Skilled Nursing Facility.
It is a long shot but you could find out if she would qualify for Hospice. If so it might be easier to find a Medicaid bed.

Knits, look further out for a facility, like in another county. Do look for a NH that accepts residents as “Medicaid Pending” and also has rehab services (so if she gets rehospitalized, she can go back to the NH for post hospital rehab). In my city, the NH that have Medicaid beds are somewhat dreadful and terribly short staffed (min wage $7.25 hr so folks quit a la minute & leave for $7.50hr job) with the exception of 1 which has a long waiting list. The joke is that the only way you are getting into it is if your elder marries someone already a resident there. Families end up going to adjacent more rural counties (parishes for us) to find a NH.

Im not sure which State you are in but by & large for LTC Medicaid - the program that pays for custodial care- it’s $2829 max in income and under 2K in assets excluding her home that is her primary residence and a (1) car. All States have a max value on home and car, most do 600K and under 50K, to be exempt assets. Find out precisely what the figures are for your State. It’s important!

So is your mom meeting these $ amounts for what her Dec bank statements will show for assets? If not, she will have to do a spend down. To me the amount of $ she has for her spend down can make a huge difference as to how much time you have to get her home cleared, decluttered and make market ready as she will have $ to private pay for a bit and also pay property costs.

If that short term rehab she is in right now does not themselves have custodial care beds they can segueway her to go from her current rehab patient status to custodial resident, then someone at this place (Social Worker) has a list of places that rehab patients leave to go to.

Now if your elder has the resources to private pay for maybe 5 months, to me, that would be ideal if the plan is to absolutely sell moms home. It gives you enough time to spend this month to get house ready (draft college kid to help starting this weekend as they probably don’t go back till the 14th or 21st), find a Realtor, determine if it’s tax assessor value is realistic for what it can sell for or if u need to get appraisal done. & have mom get any legal done or updated that needs to happen for you to be able to sell her home. Medicaid fully expects it, and that car, to sell at FMV - which is usually pegged at assessor or Blue book value - so sold for under that or sold not at arms length type of sale can pose glitches for her eligibility. House goes on the market in Feb as an “as is” listing with no repairs or price adjustment to be done. Your Realtor has to understand that neither mom or you are going to do any repairs or replacements nor can make concessions in the price to lower it 20K for new AC, as lower can take it below the FMV that Medicaid expects. Your Realtor has got to fully understand this AND make this clear to any buyer’s agent that this is really truly “as is”.

the goal would be to sell the home in 90 days and go to act of sale start of month 5. Mom gets the $ so that she is able to continually be private pay in the NH. If she files for LTC Medicaid now and goes onto it, then months later the house is sold, she becomes ineligible and you as her POA end up having to once again do a spend down but it will be on a more restricted spending terms and then go through the application process all over again. For more fun, a State can want a recoup of costs paid to date. Being stuck in the yo-yo of was eligible/ now ineligible/ back to eligible is something you want to avoid if ya can.

if your moms place has decades of delayed maintenance, can you post that? There are some things you might be able to do to make this situation easier for the eventual LTC Medicaid application.

This is worth the agonizing. If not this, then what is?
I think you understand she now needs full time care.
I would sell her home if you are her POA, and I would put this money into a GOOD assisted living facility OR into a Board and Care where there is a private room and only 6-8 residents. They are often family run.

There aren't good choices. Falls and disease are the arbiters of what "can be".
I am sorry, so sorry, and this is worth worrying and mourning. But the fact is that old age and aging, losses and illness and disability have no "fix". This is the age of one loss upon another and a downward trajectory that is painful to endure and painful as well to stand witness to.

Do the best you can, but if you wish to provide her best care, then get that home sold and get her into a good ALF or MC when needed. And then hope that she has funds she cannot outlive. WHATEVER you do please DO NOT attempt to take this care on to yourselves, even temporarily.

Again, I could not be more sorry.

Your mom’s needs are beyond what assisted living will provide, even if she could afford it. Bedsores and complete help with activities of daily living are beyond their purview. If you moved her into one, they’d soon be requesting a private sitter be added or telling you she needed to move. Skilled nursing is appropriate, and that’s always sad to both admit and do. When my mom moved into one, it broke all our hearts, including hers. Thankfully, we were blessed by good care throughout her time there. Don’t judge all places by the one you saw. Seek reviews from local families, I often see this done on NextDoor, people post asking what places others have used and would recommend. They quickly get replies of both the good and bad. Prepare the house for a quick sale, it doesn’t have to be perfect. My mom entered as private pay and transitioned to Medicaid when the money ran out, her care was the exact same no matter how it was paid. You’re wise to know your limits in this, that moving mom to your home is not feasible, and to have good legal guidance. And yes, you’re being guided and it will all work out. Wishing you rest and peace

Look for faith-based facilities. My MIL was in one on Medicaid in a private room in LTC for 7 years. She got excellent care.

Does your Mom have no assets at all? If she has some, I would pick out a good, reputable place (make sure they accept Medicaid) and go in on private pay first. Then when she is about 4 months away from having only about $2k left apply for Medicaid. It's not rocket science since she won't have any assets. You'll only need access to her most recent bank statements, her SSN, address, DOB, whether she owns a car or home, and what medical bills she has.

In most facilites, Medicaid means a shared room. Not sure why my MIL never shared her room.

Once a person is in a good facility that accepts Medicaid, they have "dibs" on the first openings, whereas if one is already on Medicaid before looking for a facility, they have fewer options and may be on waiting lists for better places.

"We might be able to have her do some sort of assisted living..."

By what you describe she does not seem like a candidate for AL, but this is an assessment that is made by the facility itself.

(Edited my comment bc I don’t know enough about the Medicaid to give advice! I’m in the process of learning to help another family member with Alzheimer’s.) We were in the same situation with my mom. A family friend works as an occupational therapist in the area and she recommended the best facility for mom to stay at while we got things set up with assisted living (which was the appropriate setting for my mom after she recovered a bit from her fall). It was not a place I would have wanted her to stay long term - very understaffed. She had to wear diapers because it took an hour to respond to requests to use the bathroom. But the staff was caring, not negligent, just overworked. I would keep looking to see if there is a place you are more comfortable with. If you do need to move her home for a short time, you should be able to at least get homebound visits through Medicare. Not constant care, but visits for bathing and physical therapy and wound care.

Sounds as if Mom needs skilled nursing care right now anyway . Look for another SNF . This is too much to have her live with you .

This will give you time to sell the home and see how Mom does , and see IF she would be able to go to assisted living . Depending on how much help she needs , an assisted living facility may not accept her if they think her needs would be too much or will be increasing rapidly . Most probably she would need to have those bedsores healed first before assisted living would even accept her .

It’s unfortunate , but it is the reality of the situation.

Keep looking for a better Skilled Nursing. The first rehab I visited for my mom was super depressing but the second was as different as night and day. Also, if she needs breathing treatments and care of bed sores, she won’t qualify for Assisted Living yet, she literally needs skilled nursing not just someone available to check periodically and take her to the bathroom. This is beyond what you can provide in a home setting starting from zero, so don’t fool yourself or feel guilty. Do the best you can right now, even if it isn’t ideal. You need her safe and taken care of so you can work on preparing her house for sale, researching future options, and all of the admin work. You couldn’t do that if you had her in your home, you wouldn’t even be sleeping.

See if there are some other facilities that are nicer than the one you saw. If not, then put her there temporarily while you sell her house. Agonizing and worrying just degrade your own health, so put your energy into working with the lawyer and making plans for preparing the house for sale, if necessary. Good luck; it is rough, but you'll get through it.

Thats too bad that in your state Medicaid will only pay for skilled nursing facilities. Are there some better ones? Sounds like she needs some nursing care in the short run. Assisted living would be ideal, but yes, for that you may want to sell the house ASAP to get funds to cover the costs. Can you rent the house out for now to get some income?