Mom has turned violent in rehab with sundowning (never had it before) and removed to hospital. What now? Does hospital find LT memory care?

The hospital will help you with this if you tell them that she lives alone and that it would be an unsafe discharge to release her back to her house. Make sure they know it's not possiblr for her to live with you and no one is going to move into her house to take care of her. The hospital will keep her unti they find her a nursing home/LTC. That facility will also do her Medicaid application. The hospital will do this.

You don't have to keep her in whatever facility they find. You can shop around and check places out that you like better or that are closer to you.

Your mother needs facility care now. Don't let the hospital or rehab talk you into taking her into your home. Don't believe them when they make promises of unlimited homecare and resources if you do. It's always a lie.

Lett them place her and you check out places in the meantime she can go to.

Ebbrat, so glad your second post tells us that your Mom has returned to her "old self". That buys you some time to get a good "plan" in place, were the disturbing behavior to reoccur or: were she to have a bad fall. Please find a good Elder Care attorney and get assistance in making a plan. As you could tell from the chaos of the recent horrific episode: There is currently no plan in place. Medicaid application requires a "spend-down" process. As you wrote, "How could I do this all at once"? No, it's no possible, but getting a good plan in place with the help of an Elder Care attorney will give you much peace and reassurance. Are you her POA for person and Estate? Right now while she has returned to her lucid state, get those two 'powers" in place if you have not already done so. I hope your Mom continues to be her old self, but my belief is that she is not safe attempting to live at home alone with the fall risk and with increasing memory problems. You have been a dutiful daughter for many, many years, and no one want to plan to remove a parent from their home, but were your mother to develop a "UTI": I fear that her former uncontrollable behavior will return. Use the time you now have at hand, to visit with an attorney and to make a plan. It's as though you now have been granted a Grace Period where you can get some groundwork laid, understand what the financial picture is, identify possible placements for your mother, and make sure that the attorney helps you do all this "by the book".

I’m sorry you and mom are experiencing this. So often, a fall can be a huge game changer and set off a big chain of events. You’ll do this much like the adage of eating an elephant, one bite at a time. Meet first with the hospital social worker, discuss the current situation and what’s next. This person will help with finding an appropriate care setting, and please make it very clear no one is available to provide the level of care mom will require in a home setting. Look through mom’s legal documents if you don’t already know who’s POA for healthcare and financial decisions, if you have the authority to sell her home, and if there’s an advance directive. Many place will accept mom Medicaid pending, this is likely a nursing home setting. Mom should receive meds to help her calm her behavior, know this isn’t only frightening for others to watch, it’s hard on her to feel so out of control, and the meds are a kindness. Your role will change to being mom’s advocate in her new setting, a very important part of her team. There are people who can walk you through the Medicaid application process. I wish you peace in this storm, mom is blessed to have you looking out for her

It is difficult so enlist the help of social workers right away. Tell them where you are at. Are you the POA? If that is not set in place then an emergency guardianship the social workers may get for you might work better. Placement is also much easier from care than from home, so simply speak to the social workers. Step at a time and day at a time.

Care plan discussions and meetings re plans for medication for your mother should already be in place; if not speak to nursing about that or social services. Rehab is never a long term option and you are correct that placement will be needed.

Start gathering all information about assets, accounts, home, car and etc in your mom's possession.

There is going to need now to be more diagnostic work so that you have some direction. Dependent on outcome of mental and physical exams and the diagnosis and prognosis some medication attempts will likely be needed.

I am so sorry. I know you are reeling with shock. Try to slow down and take it a day at a time. And remember, get hold of social services and case manager right away.

One step at a time with all the resources made available to you.

My MIL became belligerent and physically violent upon her move to an ALF. She was in the process of being evaluated for a locked down Psych facility when she passed away.

Oddly, the family all looked at her as if she were really still pretty competent. I was in the room as OB discussed her 'abilities' and I think my jaw was on the ground, b/c he was so desperate to get her approved for care, he was painting a picture that didn't exist.

I'll never know if he was simply desperate or he really thought she was capable of her ADLs. The fact she hadn't bathed for over a month and smelled to high heaven wasn't a clue enough??

Had she lived another 3 days she would have been moved within the facility to their MC unit, which wasn't horrible, but it's what she needed.

My Mom at 89 was perfectly healthy but she had Dementia. She was 24/7 care. I had no problem getting her into LTC with Medicaid paying. There were lots of people walking around her facility or scooting around in wheelchairs. Not everyone was bedridden.

My Mom had 20k and that paid to get her in LTC for 2 months. During that time, I filed for Medicaid and it started the 3rd month. If Mom has just enough money for a month in LTC use it to get her in. Pay as much privately as she has. This will spend down her money.

Ask the Social Worker to have Mom evaluated for 24/7 care. If found she needs it, tell the SW sending her home would be an unsafe discharge. That you can no longer care for her and could she help you get her into a LTC facility with Medicaid paying. In my State, the process can take no longer than 90days. So keep on top of the SW. Get her info needed to complete the application ASAP. Make sure ur cc: in all emails between the SW and the Medicaid caseworker.

My mom was in a LTC facility starting January. Her Medicaid did not get approved until August. Then Medicaid paid back until the time she was admitted. Mom was not required to pay anything in that time as the facility said they knew she would get approved and they would be paid.

I had an elder lawyer help with the Medicaid application but after that, I did the recertification and was surprised it wasn't that hard. I live in KY and an ombudsman here was very helpful.

This is a horrible disease. I'm sorry you are going through this. It is an emotional roller coaster from one day/hour to the next.

It's now been over two years for me since my dad passed and I had to take care of mom. I spent a year kidding myself that I could take care of mom myself in my home. Then reality set in and the second year I found a LTC with memory care that took Medicaid and placed her.

Here are a couple of websites helped me a lot when looking for places:

https://www.medicare.gov/care-compare/?providerType=LongTermCare
https://health.usnews.com/best-nursing-homes

I hope they can help you. One thing I did find though, the facility that was last on my list ended up being the only one that was close and I could get mom into. But now, I'm pretty happy she is there. After learning the ropes I now know what really matters in these places and to just be her advocate. I watch her like a hawk and ask questions if anything changes.

Things are finally feeling a little easier for me although I know it can change tomorrow.

I wish you good luck!

I'm sorry for this distressing situation. You mention Medicaid and LTC but these rules vary for each state. In my state (MN) and many others, Medicaid only covers LTC, which is assessed as medically necessary by a doctor and usually means one is bedridden (cannot get out of bed, cannot do any ADLs, is not mobile on their own). Then, one must also qualify financially and there is usually a 5-year "look back" period on the application.

You should consult with either an elder law attorney who is knowledgeable about Medicaid, or an estate planner or a Medicaid Planner for your Mom's home state.

A year ago I was in a similar dilemma with my 100-yr old aunt with advanced dementia who broker his hip shimmying out of her bed when she really couldn't walk without a walker. She was in rehab, still attempting to get out of bed. Because of this, she wasn't a true candidate for LTC (because one cannot be restrained to stay in bed, by law). She passed away in rehab, we think from a clot, which is a common issue with large bone breaks. This happened on a Sunday and the next day, Monday, she was supposed to be assessed for care level need by an admin person from a facility.

Rehab/PT can't work with people who aren't cooperative or progressing so she probably won't go back there until this happens. At the hospital, she may go into their psych unit she cooperates they can get some meds in her that will hopefully help. Once she's compliant and stabilized then she has more options. This is how it went for my cousin with ALZ when she became violent. It took a while for her to get to the point of accepting meds (a month in the psych ward). So, have tempered expectations of how long this may all take. Once she's stabilized then you will have a better idea about future care needs and whether she needs to sell the house, etc.

See below and look at this website:

https://www.medicalnewstoday.com/articles/dementia-and-anger-at-loved-ones

In part, it says: There may sometimes be warning signs, such as changes in voice and facial expressions, when a person with dementia becomes angry. However, this anger may also occur spontaneously without apparent cause or due to seemingly small things. 

Anger in people with dementia may present in physical or verbal forms:
yelling, screaming, and calling out attempting to attack physically verbal abuse such as making threats and insults physical abuse such as pinching, biting, scratching, pinching, and pulling hair

throwing things

Learn about the early signs of dementia here.

According to the Alzheimer’s Society, aggression may have links to a person’s personality before dementia. However, people not known to be aggressive before having this condition can also change. 

These behavior changes may begin in the middle to later stages of most types of dementia. They may become more noticeable as a person needs more hands-on help to perform daily activities such as dressing and eating. It increases with time and is observable moreTrusted Source  in older adults within institutions.
Learn more about the different stages of dementia and its progression.

Causes______Dementia occurs when once-healthy neurons and nerve cells in the brain stop working and die. This results in the loss of cognitive functions such as reasoning, memory, problem-solving, and judgment. 

These symptoms may make a person with dementia feel embarrassed, frustrated, and patronized, causing them to react with meanness and anger.
Below are some potential causes of anger relating to symptoms of dementia.
__________________________
Did you ask hospital social worker or your contact there about their procedures? This would be the first thing I would have done - since your mom is there.

* Do your own researach, too.
* Sounds like she is hallucinating.
* Discuss meds with medical provider.
* Her behavior is not unusual.

Remember, her brain is / has changed. She is confused, scared and doing what she can.

If you need long term care, it seems like you must sell the house asap.
Do you have all legal authority to manage her life, including selling the house?
If not, you need to contact an attorney asap.

Gena / Touch Matters

Please talk to the case manager/social services worker assigned to your mom's case. She needs help with Sundown Syndrome - mostly anti-anxiety medications. She may also need a new place to stay - something case management excels at.