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xinabess Asked July 2016

How do I choose between home care and nursing home care for my Mom?

My mom is 83 and in rehab recovering from a stroke. She was living alone, completely independent, and now she is completely dependent. She can't walk or use one of her arms. She's been in the rehab for about 60 days and has reached her "baseline" so it's time to think of the next step.

I am so torn about what to do, and it is really my decision, as I'm her only child. She is not demented, but in huge denial about her abilities. She wants to go back to her apartment, but without any care, which she needs 24/7. She insists she does not need care (many of you have heard this story before, so sorry for the repeat!) I spoke to her PT who was saying that in addition to thinking about what's best for her, I need to think about what's best for me. I guess a SNF would be better for me in a way. I think it would be so weird for her to go home and be there alone with this person all day/night (two people). Only one of my mother's friends is still alive, and other than my kids and me, she would have very few visitors.

I don't know how to make this decision! Her large one-bedroom apartment would have to be set up somehow with a bed for the night nurse, etc. Her rent is very low, which is great, so I'm thinking maybe she goes to her apt during the day and the SNF at night? The cost is comparable (i.e. outrageous) for home care and SNF.

Every day my mom tells me how miserable she is and how she wants to go home. She is not into the rehab place's little activities, like bingo and stuff, so I doubt she would participate in those types of things in a SNF. Maybe we should try home care and if that doesn't work, a SNF?

Honestly, I'm terrified to tell her she has two options, period: SNF or 24/7 care at home. She will say neither!

freqflyer Sep 2016
Xina, to send a message back to someone who wrote on your message board, all you need to do is click on their screen name... then you will see a box you can write in.

As for my parents, I had to wait for a major crises. My Mom [97] has a major fall with head trauma, lived in long-term-care for her final 3 months. During those 3 months my Dad welcomed caregivers on day one as he couldn't manage on his own. The poor guy couldn't make himself a sandwich as my Mom use to do everything for him.

When my Mom passed, 2 weeks later Dad said he was ready for senior living as the house was too big for him to manage, plus he was scared of the stairs [even with a caregiver helping him]. Dad moved into Independent Living and loved his full size apartment, then 6 months later he needed to move into Memory Care, which he also likes. Now I can finally breathe after 7 years of catering to my parents :)

xinabess Sep 2016
Freqflyer, what ended up happening? Did your parents go to a SNF?

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xinabess Sep 2016
Hi all. I've received some "hugs" and private messages from some of you and I have no idea where to go to respond to those. (This website is great, but it could be better organized.)

Anyway, nothing much has changed with my mom. She still needs 2 people to get her in and out of bed/wheelchair so going home is not an option. It's really sad because now that she is no longer a rehab patient, but now a longterm patient, she gets little to no PT/OT. It feels like they've given up on her. I think she is getting more confused and out of it now that she's been there for 3 most (is that possible?) We have started going to the corner restaurant for snacks and a drink (which she loves). Otherwise, she mostly just hangs out in her room, laughs and chats with the aides, and awaits visitors. She has a new woman on her floor who screams all day that she wants to die, or is calling the police, etc. What a nightmare. All I can think about is how do I avoid ending up like this??

Lingxiang Sep 2016
Xina,

If it comes to a point you need to find an SNF, you might want to use https://www.seniorary.com. You can compare lots of local SNFs there.

Best regards

Tattoochick Sep 2016
My mom make the deision to go home from rehab with in home care 24\7 after a 4 month stay at a rehab. That was June 1st, she had 3 ambulance called, one 4 day hosiptal stay and 4 falls since then. Three weeks ago she fired the home care service. I made the decision she could no longer be home. Moved into an ALF one week ago. Best decision in my eyes, hope some day soon she sees that. Bascily there is no easy answer. All me can do is try to keep them safe, and even that can only be what they allow us to do.

freqflyer Sep 2016
Zina, tell Mom her next step is to go into SNF until she gets stronger. She can't leave SNF unless she can prove to the Staff and to you that she can manage in a wheelchair, be able to transfer herself from the bed to the wheelchair to the toilet. That she can prepare meals and clean up. That she can take a bath by herself and dress herself. She would need a lot of Occupational Therapy to make this happen.

In your Mom's mind she thinks she can do all these things. And that is normal for an elder to think that way. Both my parents [who were in their 90's] kept telling me "we can manage" and I had thought they could, too. The inside of their home always looked presentable on the main floor [I never snooped upstairs, I should of as that would have been a walk-up call for me]. I always thought my parents were clear minded, as that is how they presented themselves any time I brought over groceries and talked to them on the phone.

jeannegibbs Sep 2016
I don't really see home care as an option for someone who denies she needs help. I foresee a revolving door of people she fires and you replace.

I suggest you tell the discharge planners that you will not be able to supervise your mother's care in her apartment, and that you get her name on the waiting list for the places that would be most suitable.

I think Babalou is probably right. If Mom goes home you may ultimately have to involve APS. I hope you can avoid all that and get her into a nice care center.

CindyCBlair Sep 2016
You have to think what is best for both of u. Take it from me taking care of parents an kill u. Take care of u first. You need a life of ur own. Ur lo needs 24 hr care. Please for you.

xinabess Jul 2016
I do need to set some boundaries for sure and not keep engaging on this topic with my mom. Fortunately, her bf is there on the weekends, so I get a break. My gut is telling me a group setting is the right way to go for many reasons. All the places have waiting lists, though, so for now she'll have to stay where she is.

cwillie Jul 2016
Baba gives good advice. We can read a lot on this forum about setting boundaries, your mom may choose to wallow in misery but you don't have to join her. When the negative talk starts the visits can end, "I'm sorry you aren't happy mom, I wish I could make you well but I can't", if we can't talk about something positive then I can't stay". Then try to steer the conversation toward something else. If she won't be distracted then leave or hang up the phone, at the very least leave the room and go out for a break and try again in 10 or 15 minutes. It may sound cold and cruel, but focusing on the negative isn't good for either of you.

BarbBrooklyn Jul 2016
Xina, let me clarify. I dont mean that you sound like you're going off the deep end or anything. But if you were to step back, purposefully and without anger or much emotion (" mom, it's been a tough couple of months, I'm going to take a few days to recharge my batteries"), it might give you both a little perspective.

Your mom6life has changed. She neds to make peace with that. She may need some space to do that. Leaving her may force her back on her own resources, which she may begin to evaluate more realistically.

And again, let the discharge team meet with her. Let THEM tell her, specifically, what she needs.

BarbBrooklyn Jul 2016
Xina, how about taking a few days off from visiting? It sounds like you need a break.

xinabess Jul 2016
Actually, I'm not terrified to tell her the truth. I'm terrified that she will rail against it forever, no matter where she ends up. I have told her the truth (i.e. you need a wheelchair, you can't get out of bed alone, etc) over and over and over again, as has the entire staff at the rehab place. The problem is that she refuses to accept it. It's very tiresome and upsetting, since she acts like she is being held against her will. I just dread this ongoing "conversation" with her as it never goes anywhere.

BarbBrooklyn Jul 2016
It's the discharge team that needs to have this conversation with your mom. Ultimately, the choice is hers. You are not responsible for her life or her happiness. If she choses to go home with home health care, you help her find an agency.

And if she fires them after a week, you call APS and report her as a vulnerable adult.

I'm always in favor of a group setting over individual, at home care. More eyes to oversee the situation, fewer opportunities for bad things to happen, in my humble opinion.

cwillie Jul 2016
You're "terrified to tell her" the truth? There are times in life, whether we are 18 or 83, we have to accept reality over fantasy; you may not be cut out for the career you dream about, or the one you love may not feel the same, or you may never be able to afford that dream home. Getting old and losing your heath sucks, but your mom needs to go where she can be cared for, end of story.

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