Is there a kind of guide that can help us to begin the emotional process of moving Mom to a facility as we retire next year?

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daveandvicki Asked April 2022

Is there a kind of guide that can help us to begin the emotional process of moving Mom to a facility as we retire next year?

She has Medicare and Medicaid, so the money is not the issue. Her physical health is declining and the work is endless.

The issue is the 7 siblings that live far away. They help once or twice a year. They all know that this plan is in place. however we used a NH for respite last year for 2 weeks and because of high emotions, we were told we are unkind and cruel.

I live with and take care of my MIL. I love her. I want to have the process be as easy and comfortable as possible. I feel we should begin the conversation and maybe do some respite...so she can tell us which place feels most comfortable. I don't feel we should just spring it on her..

Does anybody have experiences that worked?

Family Caregiver Moving Respite Skilled Nursing Facility

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score 0 · Answer 1

The sibling situation is a bit confusing. Your original post says that when you “used a NH for respite last year for 2 weeks we were told we are unkind and cruel”. You also say that “siblings have stated to us clearly that she will go to a Skilled nursing facility when she leaves here. They actually came and visited a few.. and they’ve made the choice”.

It sounds as though one of the seven siblings is the main problem, most are OK. Perhaps you invite the difficult one/s to come and stay for a few days, see what’s involved in care, without you doing all the spade work. And talk to the OK siblings about being supportive for you (and you are in the most difficult situation), not just staying quiet if and when the insults start.

You are planning to travel. That is the perfect option for saying that mother’s care is needed while you are away, and you will see how it goes when you eventually get back. That story worked well for a recent poster, whose mother adjusted remarkably well. Can the siblings work out a way for mother to be visited regularly in the first weeks? You certainly don’t want her to feel that she has been dumped! Visiting may be difficult for them, but caregiving has been difficult for you. Fair’s fair!

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score 0 · Answer 2

daveandvicki: Since you're the one doing the hands-on caregiving by having your MIL living with you, the decision for which managed care facility in which your MIL will reside is your's. If the seven siblings object, then they can take on the role.

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score 4 · Answer 3

Just find a place with good reviews and let mil know the plan ahead of time. If the siblings find the decision cruel, then THEY can choose to move mil in with them, their choice.

My folks knew all along they'd be living in IL then AL and lived longer as a result. All this nonsense you read here about the horrors of managed care come unfounded in most cases, from people with agendas to push and no firsthand experience at all. The key to managed care is that you find a reputable facility first, and then you visit often to advocate for your loved one. If they're dumped off and forgotten about forevermore, then problems can and do crop up. But, if you're there visiting and having meals with them, etc, then you KNOW what's happening and can keep the management's feet to the fire if/when necessary. Plus, the elder gets socialization and entertainment and activities they'd never get cooped up in a house 24/7. #Truth

Best of luck!

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No disrespect, you are entitled to your opinion, but to call others experiences"nonsense" and suggest they have"an agenda" or leave their loved one "dumped and forgotten" is very hurtful. On April 1st I walked into my father's NH and found him sitting alone, in the dark, covered in blood with blood all over the floor. I was told he had a UTI and pulled out his IV. No, the IV pole used had to be propped up between his bed and wheelchair because not one of the 4 wheels touched the floor. That, and the IV being placed in his hand with the cord constantly getting wrapped around his fingers was the cause. The pole fell on me while I was there, and as they changed his clothes he fell back into his wheelchair after saying 3x that he was about to fall and they ignored him, simply holding him up by his t-shirt. The next morning I received a call from the hospital telling me he was brought in, the NH didn't call me. My sweet father ended up with a severe UTI and a blood infection - from the IV the NH placed. He spent 6 days in the hospital and has declined mentally due to all of this. My father lived with me off and on most of my life, and for 13 years before his stroke left it too much for me to care for him. The decision to place him in a facility broke my heart, and the day he entered was when the Covid lockdown began. The past 2 years have been the most difficult time. He suffered neglect in the first NH, the same neglect and now this in the 2nd. I won't even get into the condition of his dentures, hair and fingernails. Now I've had to place him in the 3rd NH, 40 min away, and I'm not feeling safe with this place either. I picked up his belongings from the NH and most of his clothes are missing, he doesn't even have enough clothing now for one week. I was given other residents clothing and even one residents wallet. That's how much they care for our loved ones. I visit my father at least twice a week, advocate for him constantly, and I still can't keep him safe. I was off of work all last week just to be with him in the hospital and to find him somewhere else to go. I am single, my income is all I have and now I have to figure out how to buy him new clothes. Every time I brought issues up to the administrator I'm told "we're understaffed" as if that permits them to neglect our loved ones, that makes it "ok". Just because you haven't experienced this heartache, don't diminish what some of us have been through. Go to medicare.gov/nursing homes and see how many are rated "below average" and how most have had citations and penalties for the same offenses over and over. It's insane that our elders are merely warehoused until they die. It is definitely not nonsense nor rare. You got lucky, I'm glad to know someone has. And I pray for those of us crying every day, helpless. (The hospital filed a complaint with IDPH, the NH will make corrections temporarily and go right back to their same practices. I know because I also work in healthcare for 30+ years)

(3)

score 1 · Answer 4

There are terrible facilities, and awful home care situations, and awful family care l.There are good ones as well.I don’t think many that are not private pay. I hope someone knows better. However any of these situations require supervision by caring family or friends. I think ones with associated nursing homes rated by Medicare can be a beginning search. Also, different states have different requirements for assisted living. Make sure the level they provide meets your needs. Some states have unlucky available records of their inspections. Contact your state department of health. Any relative who criticizes without providing concrete help- money, time, or care deserves a special place in Hell.

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score 3 · Answer 5

NO! Every place they put my sister in was HORRIBLE! They put on a show for you when you visit and make it sound good. Then when they are in there the abuse and neglect begin. They of course blame the patient and if anyone in the home tries to tell you something, they shut them down. Please look into in home care where you can bring people in to help. If you need help financially there are programs like IRIS which will help provide the care and things she needs in the home. She can choose whoever she wants as a caregiver ...that includes YOU as one of her caregivers. Family is ok and she is in charge, giving her hope that she still has say in her own life (as it should be).

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See Leas postings about how her parents lived longer in al and mc.

Plus not everyone lives in Wisconsin and most of those who do aren’t up to doing tge work of three people when they’re retirees themselves.

(4)

score 3 · Answer 6

Did MIL like (well enough) the place she was in for respite last time you went away or might she have been complaining to siblings the whole time or worse yet frightened and saying she had been “dumped” there? With 7 of them one would expect you should get back up any time you want to go away but obviously that isn’t the case so perhaps they feel guilty about that. Whatever the case they have all been a part of the planning and know the plan, it’s just that it’s been “in the future” and now that the future is fast approaching they need to face this new phase of Moms life and it’s hard on all of us to make this step. Everyone has different ways of going through this process emotionally and some put off acceptance as long as possible, knowing what is best and feeling a peace with it are two different things so try not to take the accusatory words as personally as they sound there may be a lot of misdirected emotion in them.

Since she is cognitively able to understand and remember and it doesn’t sound like she was actually included in these plans from the beginning personally I think you are absolutely right it’s time to include her and warm her up to it. You could even start by simply saying you will be traveling more and it just isn’t practicle for her to travel to “the girls” houses each time and they simply aren’t able to come each time so we thought it would be a good idea to try a few options out to see which one she likes best while your trips are shorter. You don’t have to say just yet you are looking for a permanent living situation. I’m assuming it’s been decided for whatever reason that she will stay around your home base rather than moving closer to one of the other siblings so they really do need to back you up on making this easier for Mom and probably your husband should say this to them, all of them. It’s not as though you haven’t included all the siblings from the get go. No placing of guilt or accusations just that it’s time to start the transition, which you want to do gently and they need to be part of it. The other thing to remind yourselves and the siblings about is that getting her settled in sooner rather than later when she might not be able to understand as well is much better for her. It may be hard now but it could be much harder a year or two from now if she’s failing more.

Good luck, it sure sounds to me that you are caring for her very well and that you all love her and want the best possible for her. Keep up the good work and enjoy your retirement and travel!

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score 0 · Answer 7

My mother moved to a 'continuous care' facility when my father passed away. this is a facility that has independent living and also assisted living, memory care and skilled nursing units. It's designed to be a place for someone to be for the rest of their life as their needs increase with aging. My mother realized that taking care of a house in a rural area was going to be too difficult to do on her own. She was showing signs of early dementia at that time, so she made the move at just the right time. Some people do not realize that they have dementia. My mother was one of them, and she was also a wanderer. If your mother is capable of thinking about her own capabilities in a realistic way, I think it's best to start the conversation with her. She needs a Plan B, for when her capabilities may decline, if she'll need more assistance and possibly a higher level of skilled assistance. Be honest about how much you will be able to do as she gets older, as you also are getting older and may not be capable of doing everything that she will need. If she can afford it, you can consider hiring aides to come in and help her (and you). Could you do this so that she can stay with you in your home? Hiring people to help with housework and laundry can also take some of the burden off of you. Basically there are 2 possibilities: staying at home and getting aides/nurses to help, or living in an assisted living facility. Get connected with a local social worker who can help explain what the options are in your area. Check out some assisted living facilities close to you so that you can visit often and oversee her care. Arrange for her to visit the ones you think she might like. I looked for caring and friendly staff, friendly residents, facilties and activities. An advantage of being in a facility is that she'll be surrounded by people, they have professional staff, and she can meet people her own age. Are you POA for her medical and financial matters? While she is still capable of signing legal papers, make sure that all of her paperwork is in order (powers of attorney for medical and financial matters, a living will so that you know her advance medical directives, a will if she has assets.) Most banks and financial institutions have their own POA and beneficiary forms that she'll need to sign, and her POA needs to be on file with Social Security/Medicare to be able to speak on her behalf. You can do this as a phone call with her sitting with you. All the best to you and your mother!

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score 2 · Answer 8

Since the plan is for MIL to move into assisted living/skilled nursing care facility, expect there to be high emotions. Let her know what will not change - keep emphasizing those aspects of her "new life." Then, start asking her what she wants to experience in her new home. Look for places that meet her criteria - and yours. Have plenty of day time "visits" - look at rooms, eat in the dining facility, partake in the activities, go to the chapel/worship services on the weekend.... When you can narrow the choices down to 3 places, it is time to try a weekend visit. She should do respite over weekends in those 3 places - but you visit her throughout the daytime so she realizes that none of them are permanent. After each respite visit, ask what she liked about each place and what were problems that need to be addressed. Get her onboard with choosing her new home and then help her to pack, decorate, etc. for "move day." Since she should have already done some respite weekends there, it won't feel so much like abandonment.

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score 2 · Answer 9

I had this situation with my MIL several years ago. She was living with us short term while we looked for a long term care situation. She didn't see any problem staying with us, but we couldn't give her the care she needed. I think she kind of thought she was doing us a favor; giving us the opportunity to be of service. We transitioned her with a bit of a "white lie" that it'd be for a short time, but she acclimated and didn't object too much when we told her it turns out she'd be staying there. We were polite but very firm. I don't know about your MIL but it would've been hard on my MIL to deal with change- moving from one place to another. I also have a feeling that no matter how wonderful a place is, it is never going to be as nice as living in the home environment she was used to. We went in with the idea of it is a place to stay for the "moment." She did become acclimated and I think it helped her to know she'd still see us. I think the big concern for her is that we'd no longer be part of her life- that's we'd just drop her off and not visit. Once she realized we'd drop in a few times a week, she was ok. She was a sweet women, but as she got older she was much more narrowly focused on meeting her needs and forgetting that other people had their own. Once she saw her needs were still going to be met, she seemed to adjust well enough.

And as far as the siblings; that's just unfair they'd think that way. I suspect much of that response was from guilt. Perhaps a sit down with them to say "if you'd like her to come live with you..." or "if you'd like to be more involved, this is how you can help." It always gauls me to have armchair advisors telling you what the wrong/right thing to do is without being willing to do it themselves. Good luck on that, stay strong.

I'm luckier with my mom. That's who we are working with now. She has always been one to "take care of herself" and doesn't want to be a burden to her family. I hope I remember that when it comes my time. I think the key thing is for you MIL to know that you'll still be a part of her life; just in a different way.

Moving to a nursing home is hard for family, but it's turned out to be best for my mom as she is really getting much better care- the care that she needs. I know it's different for every family. What works best for ours may not be the best solution for everyone. You need to do what works best for yours. And then be at peace with your solution.

Good luck!

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score 0 · Answer 10

Thank you for all the input.. she does have her faculties most of the time.. she’s repetitive, but I believe it’s because this stories make her happy. The house is all set. Plans were made years ago and all siblings are on board.
Siblings have stated to us clearly that she will go to a Skilled nursing facility when she leaves here. They actually came and visited a few.. and they’ve made the choice.
we are having continual conversation about traveling when we retire next year.. mom says the girls will take her to their home. LOL.. Guess they’ll have to tell her the scoop.

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She's repetitive most likely because she has short-term memory impairment. Respectfully, to attribute her behaviors to choices rather than to her cognitive decline (which she cannot control) does no one any good. I'm hoping she has had an actual cognitive/memory test given by a doctor. Knowing where she's at medically will be the most helpful for her, even if it is difficult for some of her children to accept.

(2)

score 2 · Answer 11

I've been going through data collected at caregiving expos I attended in the past, and found a number of printouts from the elder care attorneys in my area who participated. These expos have been d'c'ed, so I don't know if the attorneys might still be distributing handouts, but it might be worth a try to ask if they have generalized information on moving from home to a facility.

I've also seen articles like that on websites of elder care attorneys. You might check the state bar directory for elder care law firms, skim their websites, and see if you can find articles. They'll provide insight into guidelines and factors that may arise.

You're wise to address this now and make plans ahead of time.

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score 5 · Answer 12

Congratulations on your retirement! From *all* your jobs ;-)

Your profile says your MIL is 92 yrs old, but you don't mention dementia so I'm assuming she has all her cognitive faculties and memory to make reasonable decisions.

For clarity, who is your MIL's PoA? If it is one or more of her children (the authority is not yet active since she is not incapacitated) this person/people are the ones who should also have a say in where she lives since they will eventually be managing all her affairs and advocating for her. If she hasn't assigned a PoA and also created an Advanced Healthcare Directive, this will surely be a recipe for family in-fighting. More info about this would be helpful.

That being said, I like your idea of explaining it to her and "test driving" for the right place, however her choices may be limited if she's already on Medicaid. Not every facility accepts Medicaid and of those that do, the current residents get first dibs on those beds so there may be waiting lists. Also, almost without exception a Medicaid bed means a shared room. Medicaid is run independently by each state so maybe your state will cover a private room. You may want to check.

Do not be surprised if she doesn't like any of the places. It's a huge change for her, scary, and it's also what is represents: the last stop before heaven. Please be very sensitive to this.

If the other siblings have an uprising then you will tell them that you'll pack her up and move her to their home. It's as simple as that (unless they're not the PoA). That usually shuts them up. If your MIL is savvy enough she will know that your residence is her legal residence and if she chooses not to leave, then you can't force her without an actual eviction. Just want to make you aware of this.

This process is emotional for everyone, but mostly your MIL. I wish you much clarity, wisdom and a peaceful retirement.

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score 5 · Answer 13

Contact your local COA and ask which aging services agency covers your location? Then, call them and ask for information on how to choose a place and how to support mom in the transition. They can also locate resources to support you in the process. Not sure what her cognitive status is....with dementia, giving a simple explanation in the few weeks before the move may be about right.
One of the first things to find out is whether or not a facility accepts Medicaid. Mostly it is nursing homes that accept Medicaid for residential care.
If her house is sold, the proceeds of the sale will go to cover her care in the nursing home. You can prepay for funeral services.
If house left empty, Medicaid will put a lien on the title and recover Medicaid costs before any other money is distributed.
A 'hidden agenda' for some of the siblings may be that they are expecting to inherit from sale of house. May or may not occur.
Good on you and your spouse for taking care of your MIL so well. And for realizing that retirement means it is time for retirement from caregiving as well.

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Is there a kind of guide that can help us to begin the emotional process of moving Mom to a facility as we retire next year?

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