Need info on getting help for our father!

Dgt 166, There are NO Medicare beds in a LTC facility. Those are Medicaid beds. Only facility care paid by Medicare is for rehabilitation which is short term care. Medicaid has strict rules for qualification. He will need to deplete his assets. Consult elder care attorney or your local Area Agency on Aging.

Apparently it's my sister who is wavering and not giving a firm NO! She's saying maybe... so then they talk about teaching us proper form for picking him up if he falls, etc. She seems to be realizing she has to be honest about the situation.

I also think my dad is finally realizing how serious his condition is too. He's finally calmed down enough to broach selling the house. It's also spurred him on to take his PT more seriously and hopefully he can get some strength back.

He's out of diapers and is able to use the bedside toilet with assistance from the staff.

One weird thing my sister told me when I visited last night is they refuse to give him his prescription pain pills. I don't know why that would be, but she's started sneaking one to him every day, which may be why he's suddenly able to tolerate the knee pain and walk a little. Is it normal to deny patients their pain medication?!

At least this gives us a little time to make other arrangements. I was a mess when I first came here... everyone has been so kind and helpful!! I'm feeling more hopeful that we'll be able to get in-home care or get him to accept he needs more care than that.

If he does get strong enough to come home, I'm going to insist my sister stop feeding him junk and see if we can get him down 100 lbs.

As for his insurance policy... my mom took care of that and we always assumed he'd go first since he's been in bad shape for years. But she seemed to think there would be some type of partial payment for increased care because she'd say with the insurance and dad's pension, they could just afford a basic place - though nothing fancy. I'll have to go through the paperwork and see what I can find.

Your Father should have a Social worker assigned to him that can give you information on services that are available to you. Also after a hospital stay of 3 days Medicare will pay for a nursing home stay for up to 30 days. This will give you enough time to find a service for help with him at home.

I sent you a private message.

CaliSisters: Speak with his town's elder case worker and social worker, who should also be on staff. You and your sister are not able to care for him at home since you aren't medical professionals. That alone should be evident to the doctors insisting on this.

Ask to talk to somebody in the convalescent home. Usually, they have social workers who have access to all the information you need and can help guide the process.

Almost all Areas have a senior center. Locate and call good nursing homes and ask them for advice.

As ArtistDaughter posted, "Could it be that the doctors are telling you, instead of that you have to care for him, that you have to find and arrange care for him, and that they will be releasing him to you?"
 CA is one of the "filial" states, which relates more to laws regarding children being responsible for paying for care, but likely relates to ensuring the parents have a safe place to go and will be cared for as well, not really in doing the hands-on care. THIS may be why they keep telling you that it is your (you and sister) responsibility.

This is a distinct possibility. It is not the doctors' job, per se, to find a place for him, especially if he is still competent (aka no dementia.) One would think a competent Social Worker could provide assistance in how to find a place/help, but who knows how competent this person is?

Now, since he wants/insists on going home, they may well send him there. If they set him up for discharge and no one shows up to pick him up, what will they do, send him home in a cab? I don't think a cabbie would take to assisting a large man in/out of his cab with a wheelchair and then help him into the home!!!

One question that hasn't really been addressed is whether you have any POA (medical/financial.) Keep in mind please that NEITHER of these gives you the right or power to make him move into any facility OR to accept aides to help him at home. Everyone (here and there) telling you to find a place needs to understand that CaliSisters have no more right to make him do this than we on this forum do. The POAs ARE important for going forward for various issues, but the current situation does NOT fall under the POA umbrella. Even with dementia, we were told by the EC attorney that our POAs did not allow us to "drag her out of the house" when she was refusing to consider a facility. POAs allow you to make decisions about many things, but generally only after certain conditions apply. Dad isn't incompetent, so even with these you can't force him to a facility OR to accept in-home care.

Also, if you have no access to his finances/financial standing/income, how would you know if he could afford either in-home care or a facility? How would you know if he qualifies for Medicaid, or MediCal in your case? This is a situation where an Elder Care attorney could help, however without POA AND dad's buy in, this isn't going to happen (his assets should pay the costs.)

ArtistDaughter also says "Since he wants to go home, you could hire care givers in his home. Of course he has to be on board with this idea in order to pay them."
 If he isn't agreeable to hiring help, then what? This discussion should be had between him and you and the Social Worker. Clearly he is a large man and the SW should understand that physically you can't do it, and should work with him to get him to accept other arrangements.

You *might* be able to get a aide service to do an assessment prior to hiring (don't sign anything yourself!!) They assessed mom first, before arranging anyone to come in. She told me that Medicare (NOT Medicaid, Medicare) would cover X number of hours/week IF she needed help with personal care in addition to other care, like med management. Mom refused any help like that, so we never used it and I don't know all the details. The assessment DID get charged to Medicare. At the very least, you would have someone/documentation to back you up on the needs!

IF they send him home without any arrangements, the best you can do is check on him, ensure he has food and supplies, etc, but shortly it will likely become an issue (if he needs help getting to bathroom, cleaning himself, getting in/out of bed or wheelchair, feeding himself, etc.), so I would likely contact APS or whoever (have heard they are sometimes useless) BEFORE they release him and let them know the situation - discharge with no plans and the man needs help that you CANNOT physically provide.

I haven't read through all the answers, but what you need to do is inform the social worker at the nursing home that you and your sister are unable to provide care for him. Period. Or exclamation point if needed. It is upon them to find suitable placement. They cannot release him to an unsafe environment so it is up to them to find one. You then may want to contact an elder law attorney for him to help him with the finances. Paid for by him, not you. They will arrange for his finances to be structured for his care, and eventually qualify him for Medicaid if necessary. But make sure they do not release him to you expecting you to care for him. You do not have to, it is up to them to find a suitable care environment.

Contact an elder law attorney they will be able to help you
Also the local adult family services services should be of done help
The social worker where your father is should be of some help
Do something ASAP time is passing and he will be discharged
The attorney will help with getting finances in place
Do you have power of attorney for medical and financial
Does he have a Will
Does have any kind of medical directive
Where is he now
Do not take him home he may not be happy but stand strong

Also, don't spend the money on in home care as if you run out of money, which goes quick, you won't have the money for a decent nursing home.

It's helps to have his doctors tell him needs to go to a NH. Ask for their help to make it clear to him. I know how hard it is and my father would have never agreed to it.

However he passed after going into the hospital and then we had to move our mother to a NH, which was the hardest day of my life, but 24 hour care is what she needed due to Alzheimer's.

I wish I could have taken care of her but that would mean leaving my full time job, never sleeping and constant care as she was incontinent. She only slept in 15 minute intervals and would roam all day and night. So not an option as it could go on for years.

Could it be that the doctors are telling you, instead of that you have to care for him, that you have to find and arrange care for him, and that they will be releasing him to you? Since he wants to go home, you could hire care givers in his home. Of course he has to be on board with this idea in order to pay them. I'm hoping you can talk him into something reasonable before he is released. I suggest you NOT be the person to pick him up from convalescence. I don't know how you will manage this, but spend some time researching. Apparently the doctors are not giving you advice on this, but usually there are senior centers or other agencies that will talk to you about different alternatives. Eventually, he will need to go to assisted living, so you might also start looking into those places just to have the information handy, and maybe get him on waiting lists. But most definitely make it clear to everyone that you cannot be his caregiver.

We went through the same thing and I don't know why it's a big secret to find the answers. The social workers were worthless. Research the assisted living/nursing homes in your area and visit them. You will want to choose somewhere that has all levels of care, as once they decline they will need more care and it's best not to have to research again and move them. Make sure it's a place that has "Medicare" beds. Here's how it works, at least in the Chicago area. You need to show he has at least 200,000 - 300,000 in assets, which may need to include their home that can be sold. This cost is per person. They will then be "accepted" and that money will be used for their care. Once the money runs out, they can put him in a "medicare" bed, which is most likely the same one he will be in from the beginning and medicare will take over the payments. Bottom line you need that amount of money for them to take him. They need to make a profit aside from Medicare. Getting the information is like pulling teeth and the research will fall on you. Once he is there, make sure you visit at different times and you need to be sure he is getting the care he is paying for. None of the places are great but some are better than others. Ask what the nurse/assistant to patient ratio is. Also helps if they have visiting doctors, so you don't have to worry about taking him out to appointments. Also you will need to have POA for their medical and finances. You will need to consult with an elder attorney for that which will cost about $600.00. Good Luck and God bless.

It is very common for a family to be given a list when leaving the hospital or rehab.  Families are bewildered in what to do.  As a consultant in helping families finding a place, we look at medical need, financial situation, and area wished to live.  There is probably a consultant in your area to help you.  They are generally well versed in the best choices of care for a loved one, constantly monitoring communities.

There should be a Discharge Manager at the Convalescent Home whose job it is to evaluate your Dad's needs after discharge and can define those needs for you. If there is no such person at the CH then go to the management, with an attorney if necessary and demand help. If Dad is not capable of some of life's necessities such as getting dressed, using the bathroom, personal hygiene, showering and so forth, the Discharge Manager should be well aware of this and should interview you, assuming you are the one who is to be his Health Care Provider. If Dad can be sent back home, and should desire that, then you should find home health care agencies that will provide the necessary help. They can usually do everything that you don't want to do or feel incapable of doing and in my experience do it better than you can and are cheerful and willing. Before that however you need to figure out how you might afford this help, and what resources Dad has. You allude to some insurance: if this is life insurance it won't help at this stage. If it is health insurance there may be provisions for home health, maybe not. Medicare will be no help. If Dad is cooperative all this will be much easier.

Anyway your first job is to get all the info on Dad's condition from the CH. Then you will be able to see better where you can go from there.

Medical insurance will pay for rehab but not nursing home. Medical insurance will also pay for home health care visits if dr prescribes. That may be your first step. Alternatively, have him transferred to a nursing home that has rehab also. Use his income/savings/retirement to pay for it. Tell him he can go home when he is fully recovered (may be never). Eventually, the house may have to be sold to pay for his care.

I went through the same thing here in FL and finally tripped across Senior Connections Center which has been a ton of help and of course Good Shepard Hospice center has been another for us.

First I'd call your fathers Insurance company and see what they do and don't cover just to be on the safe side especially if it's not a long term care insurance.

Then try http://www.aging.ca.gov and start asking questions they'll either know or be able to point you in the right direction hopefully.

Seems no one ever wants to tell the Caregivers anything to help us, it's always some big hidden secret of where to go and who to call in the medical industry.

Google search homecare agencies in your father’s zip code and you will find many. These agencies are family private pay. For example. Visiting Angels, etc. The agency will usually send a nurse to evaluate the potential client for level of care needed and their ability to provide it. That may take some phone time to set up appts & either your dad but most likely you will be doing the calling. Make sure whoever you hire can help with blood sugar monitoring, etc. There are certain tiers and scope of practice for each discipline (RN, LPN, CNA, CPT). The intake coordinators will explain this.

Do you have POA? Does your sister?

It sounds like your father is not on board with your decision to place him in long term care. If he is deemed competent, his decision counts over yours. If not competent you will need to apply for guardianship which requires two physicians to evaluate him and declare him mentally incompetent, coupled with attorney fees and court time that you or your dad will pay for out of his resources. (Worst case scenario).

What’s the plan to get him there?

Rehab will not be keeping him much longer. He had a pacemaker insert and has obesity and difficulty walking.
He wants to go home. His level of acuity & his own self progress at rehab will determine how long he is there. He will soon need to be transferred or discharged as rehab can use his bed for another acute case.

You can’t stay in rehab for long with that diagnosis and level of acuity.

So- two options ....spend down his assets and have him apply for Medicaid & place him in a NH, don’t wait to apply for Medicaid, just be a private pay in a NH to do his Medicaid spend down, or in the interim use his assets to pay for in home care until his money is gone. He’ll need to spend his money on his care which means his house must be sold to pay Medicaid if applicable. Don’t you or your sister sign any forms that make you responsible for his bill.

Medicare doesn’t pay for long term care. Usually supplemental insurance will not cover the entire cost either but that is for you to confirm by calling his supplemental provider & asking.

Sounds like your poor sister needs a break. Do you live close to them? You’re going to have to take over for your sister for awhile as she sounds at wit’s end.

I hope your father improves!

My jerk of a stepFIL thought we were going to drop everything in the middle of the night to pick his 6'5" body up off the floor because he didn't want to deal with his Parkinsons. My MIL was 5'7" and nearly 200lbs and she had balance issues. My DH and I ran a business so worked full-time, had kids in school and it took 2 men to get them off the floor. Nope. We need our backs and our sanity. You disclosed that your dad has "always been abusive" to you. Now the chickens come home to roost. This is the retirement he "planned" for. Let him have it taking care of himself and you and sister just keeping a healthy boundary. Even if he was never abusive, it is more than you can handle, Because I have a conscience I arranged safe, reliable care for my in-laws so that I could sleep at night. If you want to go that far, it's up to you. Please read the posts on caregiver burnout, especially the ones by children of abusive parents.

I’m not sure what more info you are expecting the rehab place to provide. It’s good that he has good medical coverage for surgery and drugs and probably 100 days of rehab like he’s getting, but don’t confuse that with any kind of insurance coverage for a permanent stay in a nursing home, or in-home care that would be covered by a LTC insurance policy. It’s 2 entirely different things. At best they may send him home with a few hours a week of a visiting nurse or some PT for a while, but if he needs more care than that make sure the social worker knows he will be alone.
You have 2 courses you may take...keep him in his home with more paid caregivers or nursing home placement, as he sounds like he may be passed the assisted living option. Either way you need to start calling around local agencies to understand their services and costs, and visiting nursing homes in your area. The rehab place is not going to do that for you. You have to do the legwork. Once the course of action is decided, you tell them where he’s going and they send his records. (I guess the 3rd option is tell them he’s an unsafe discharge, do nothing else, and let the chips fall where they may)
Do either you or your sister have POA? That may make the future a little easier paperwork-wise, for accessing his savings, paying his bills and selling the house.

My grandmother was placed in a skilled nursing home a few years ago. I was there with her every day until she blamed the entire situation on me. After a year or so, she became so nasty that the facility actually let her go home in a taxi with a wheelchair because that is where she wanted to be. So, if that is where your father wants to go, he will go there. He will learn how to adapt or realize he needs an alternative. Fortunately gran has been able to stay in her home now, we've mended our fences but I did not do anything for her for nearly two years because of the way she treated me. In that time she accomplished learning to live independently and as a nondriver at that point. I now go up every couple days, she is in her wheelchair all the time with the exception of transferring to bed, chair, toilet. If you teach your dad he has to do it on his own, he will either succeed or fail and have to deal with the realities of his situation.

I have to agree with Riverdale, Bottom line it. You need to speak with the social worker, Let them know that officially he has no family that can continue to care for him, and NO ONE lives with him & it will be an UNSAFE DISCHARGE ( as CM said). No one can tell you that is your responsibility.
You CAN NOT handle a 350 lb cranky old man. (My father was abusive verbally and physically especially in his old age, especially with family that's trying to take care of him!) But you need to advise the social workers/doctors of that fact and that if they send him home in his condition they are ultimately responsible if anything happens to him. The most you can do is check up on him and after that you could call and ask for a wellness check up so the authorities can get involved. IT'S NOT your fault/responsibility. He really should go to an assisted living facility and you can visit him there everyday. Maybe after explaining this to the socila worker they can speak to him and explain why you CAN NOT PHYSICALLY do this (emotionally too). and also call those nursing homes VISIT them with his insurance and see what they have to offer... Praying for you in this situation. W

Who is the named person planning his proposed discharge and what is that person's job title?

Can he not stay where he is? He needs assistance but not nursing care (or will do) so a retirement or convalescent home sounds the right place for him.

Cali, CM has given you many good answers. Do you know if he has a LTC policy? You have to bottom line all of this. He has no family that can continue to care for him. No one can tell you that is your responsibility. They can say it but it is not the truth. You need to find a social worker overseeing his care and relay that strongly. If they are all so happy with his insurance then they can find the next plan. They would need to do it anyways regardless of his insurance. Are you being as emphatic with them as you are with your statements here? This might be a situation where you simply go MIA. It may seem cruel but so has his described behavior to you over the years. You just simply walk away and let him and those taking care of him presently deal with it. Consider the alternative. His care is way beyond your means and in engaging in it will feel as though your life is worthless most likely very quickly. Just read through this site and generally you will find so many others who are in that situation. You must stand tough and understand your rights.

Sending you a private message, if you'd like to look at your profile page.

It's such a shame.

As you say, the guy is only 74. He's young enough for his life to be turn-aroundable.

Have you considered finding a different kind of rehab for him? Supposing he lost a hundred pounds, had his knee(s) sorted out, and underwent therapy - just say.

Pin down those health insurance details and find out what's possible.

He's not a veteran by any chance, is he?

Ah! I understand. Well done to you for supporting your sister in her decision to say "enough."

Does he need live-in care, actually? Or does he prefer to be waited on? It's not quite the same thing.

Next discussion that comes up: the aim of rehab has changed. Your father cannot be discharged home until he is able to function either alone, or with an agreed package of care. There is NO ONE else living in his home, they must amend whatever records they have that state otherwise. It would be an "unsafe" discharge (use that word). Make sure everyone has that written down.

I must sound very unsympathetic to your father, but I don't mean to be. I'm guessing that he was helpless when he lost your mother, that he's done nothing to address his bereavement, that he is not the best or most compliant cardiology patient ever?

The man needs and deserves a wide range of support; but that does not make you responsible for doing it. He's got good insurance - about time he started using it, eh.

I'm just curious - who *are* these health professionals who keep browbeating your sister and you about your duties?!

Thanks to Dr Google, I have just found five, 5★ rated home health agencies serving Palm Desert, California.

You need the name and policy number of your father's health insurer. Go to their website and find out what cover he has and whether they have a list of approved suppliers.

How much have you and your sister habitually had to do with your father, from day to day? Has it been becoming a problem over time?