Would home health be helpful for MIL in assisted living?

I'm a Operating room nurse and know for a fact they can fix hammertoes under just straight local. Meaning just numbing up the area without having to give anesthesia. If she has dementia too bad and will be moving around then yes they'd have to give her some anesthesia for the procedure. I would get second opinion for the hammertoes. If she has bunions, a bunionectomy is much more involved, definitely need anesthesia and very painful and longer recovery. Is she overweight? Diabetic? Does she have heart issues? These are the things that make you a much riskier candidate for surgery. If she's not a candidate for knee surgery she can still have steroid injections into her knee for pain relief

Seems like your mother-in-law is reaching a point of diminishing returns living in assisted living. It appears she may need to transition to skilled nursing care or memory care. Try a telephone appointment with the provider. Ask about home health versus transition to higher level of care. Also ask about palliative care - care to make her more comfortable rather than trying to cure disease.

This answer is from a 38yr + retired registered nurse. I had 15 yrs in Home Health, 2 yrs of that was as Executive Co-Director in ATL area, 15 yrs in Hospice and Palliative Care, 5 of those yrs as a Clinical Co-ordinator in the WNC mountains, the 10 other yrs in the ATL area, 2 yrs in Assisted Living as a Wellness Nurse and Executive Director both in the Alpharetta and Kennesaw areas. First thing to know is that if your loved one is in AL and is needing more care, less mobile, if she is unable to "ambulate" , walk herself in a wheelchair, they can request you move her to a nursing facility. Each AL is owned by a corporate or individual entity and decide for themselves whether as their resident declines whether or not to ask them to leave, or to file a waiver with the state in order to let the person "age in place" to keep her from suffering mentally from the transfer which can precipitate more decline faster. Yours has already expressed that she needs to move. So they will not keep her needing more care regardless if Home Health Care comes in or not. Either way it's going to cost you. In nursing home, unless she has medicaid, you will pay for it all. Medicare does not pay for nursing home care unless there's been a 3 day minimum hospital stay and then only for the time after discharge she can progress. If she has dementia, that won't happen, but they'll take medicare as long as they can. Usually 120 days or sooner if she refuses. Home Care is expensive but it's one on one and they do everything. You have to do your homework though. Get references, make sure they drug test their employees. If you hire them privately you must do a National or State and Federal Background check for motor vehicle, criminal, and sex offender registries AND do your own blood test. Ask for proof they've been trained by an agency for Dementia care. There are state regulations for everyone running an agency but I've seen shortcomings and skirting the regs all over (was a consultant for awhile). A person can also get Home Health Care in either AL or at home but not in a nursing facility unless they're on Hospice. There can't be duplicate services however, like CNA can't give 2 baths a day (one by SNF and one by Hospice). Nurse can go in and assess anytime. We have personally opted for Private Home Care where we pay for caregivers who we have vetted, trained (agency has trained), we pay dearly for this but she can afford it. Private Care is the most expensive, SNF (Skilled Nursing Facility) is next, AL is next but can be equal to SNL if you have to add care (unless its Home Health Care as this is through Medicare) (Max CNA visits are only about 3 a week, 1 hr at the time). Hospice care is almost like Home Health Care but more specialized for terminal illnesses and they're not limited to amt. of time they can stay in. Home Healthcare is. Any long term care insurance? Any property to sell to fund care? Any of these programs require a Dr.'s checkup minimum 1x a yr. Medicare's requirement. Private Home Care can take her with a transport chair (small portable wheelchair). You can call and leave a report of your concerns and have them return your call with answers. Do you have a DPOA (Durable or Medical Power of Attorney)? If not the Dr. might still speak with you privately without it. Hope all this helps. Any questions go to your county senior care department to get a social worker to help you further.

Overwhelmed23: Perhaps it's time for a nursing home.

It's time for a nursing home. If your MIL is convinced that you're trying to kill her, the dementia is more advanced than you realize. She needs skilled nursing and memory care now.

I will tell you honestly from 25 years experience in being a homecare caregiver. Don't get homecare aides to go to the AL for your MIL. All that is is an extra cost that will be for nothing. She needs a higher level of care and that means a nursing home/memory care.

As for the next doctor's appointment. You might as well have her go. It will give you and your husband a chance to talk to the doctor and ask him to help get her placed in a higher level of care. In fact, if I were you I would call the doctor's office ahead of time and explain about the dementia and that your MIL doesn't remember anything so she cannot truthfully answer anything they ask.

She needs placement now not homecare.

Based on the letters written in response to your need, what came to my mind is her need for encouragement and love. It would be great if you could find art therapy for her. Also music therapy. Check with a nearby church of your choice to see if there is a Bible study or a hymn saying that she might enjoy. You didn’t mention that she was on an antidepressant but a tiny dose might really help her at this stage. Even a librarian or a retired teacher could come and share some children’s books with her or books of past interest Such as gardening flower arranging, sewing, etc. Although she may not be able to do those things she could certainly enjoy a story about them. These are ways to help her mental health and encourage her in these final days. You might even enjoy doing these activities with her For a little good mental health for yourself! It’s a hard road. It takes a village as they say. Kind volunteers in your area would be a great blessing to you and to her.
Hopefully you will be encouraged as you find people willing to help you encourage her.
as an aging wife with a husband in early Alzheimer’s, I am interested in how CNA or traveling caregivers and helpers might help us as well. Kitty Larsen

You could try private care (not an agency). As a relationship and level of comfort is built with one or two people care can easily be expanded based on needs. Example, aid could start with the Epsom salt soak, lotion on feet and gentle leg rub with biofreeze or aspercream on knee. Or heat pack on elevated knee. In my experience as comfort level increases so will tasks. At some point she will need help to shower, put on socks, shoes, etc. Activities with an aid who can help her adjust to the group setting would be helpful. Start slow, build trust and let her direct her needs.

If you didn’t see the benefit of home health before, I doubt you can now. Unless, of course, you choose a different one.

I think home health is one of the best decisions a senior can make the minute they can qualify for it. It kept my mom at home until her death at age 97. I could not have done w/o. I counted the visits as priceless.

Now my DH aunt, 98, in a NH for the past three years bedbound, has the same aide my mom had years ago, now through hospice. The same aide is still my right arm. Counting my dad’s care before my moms, I’ve had over 25 yrs experience dealing with home health. It is truly a blessing for those who fit in the sweet spot that qualify and can understand the services they offer, which they have been paying for since age 65. The fact that her health will decline, so what? Doesn’t all of our health decline. All any of us have is today. And the older we are, the more important today is. If you can extend her stay in AL by a few days or weeks or months vs a NH, hallelujah. Job well done.

ALF will charge you for every service they perform. Home health is covered by your mil insurance. Find one that also offers hospice and the same co can follow your MIL as her needs change. It can even help kerp her in ALF and out of NH while on hospice.

Based on what you have written, the doctor can give an order for MIL feet to be soaked. The nurse can check her feet, her vitals and whatever her comorbidities are. This helps with any future doctoring needed. She has someone watching out for her on a weekly basis. The aide has to touch her. She doesn’t have to bathe her. She could help her soak her feet. The doctor can decide if it helps or not. If it is a good doc who understands the issues of travel, a virtual appointment can be made for follow ups. The feet show up great on camera. Probably better than in person as it can easily be magnified.

Tell the home health your primary concern is mil feet when you speak with them. What do YOU have to lose by having home health check on MIL?

Oh and home health does do wound care. Again, they follow the doctor’s orders. If the doctor orders wound care three times a week, that’s what it will be. A good home health will have a schedule of what days they will be there. They use telephones. If MIL is in an ALF then she would most likely be there whenever they arrived. In rural areas I found them much more punctual than the doctors appointment times.

My dad had home health many times, all with little result. He didn’t have any dementia, he enjoyed their visits just for the conversation. Honestly, they weren’t nearly as skilled, or at least didn’t act like it, and spent as little time as possible (giving them grace for being on a schedule) It really was pointless. This seems like a bandaid to me, just putting off what the AL has already indicated is coming in a move to skilled care. MIL is on a path to losing walking, unfortunately, that’s a huge game changer. Not sure she realizes the consequences, or maybe isn’t able to understand fully. Accept no blame or guilt for this, it’s the sad path she’s on, the time of increasing issues with less fixes. Wishing you both peace

The PA was our choice, the wait for her regular doctor was too long. This was only because MIL told us to cancel the day of her last appointment with him, for reasons that weren't clear, and we wanted to get her in while on a winter break that made it easier for my husband to juggle work and taking her to appointments. He frequently tips out of work hours early to take her to appointments, and it's very hard, so we schedule what we can when he's off work. I think she just didn't really want to go on that last one and was having a bad day cognitively.

Thanks for the tips, but we won't be finding a new gp or gerontologist for her (couldn't find a good one nearby when she moved here) - she knows and likes this gp, and even still barely wants to go. I really just wanted to know what home health could possibly do to help, though it's seeming like not much, as I suspected. Just trying to decide if I should cancel this, which I hate to do again on short notice, but hate even more going through the stress to all of us to get her out if home health won't help. And she will not like hearing about what the podiatrist said and think it's all just lies we made up because we're out to get her, and it is something I volunteered for and suggested, but dread as we get closer and see how she acted when we told her she had an appointment - she was not happy about it. If it's pointless, I need to save us a shred of our mental health by not doing it.

I myself suggest palliative care consults AFTER switching MDs from the current one who has you seeing PA and would instead move to a good Gerontologist. What MIL is staring down now is aging care concerns--and many if not MOST of those aren't going to change. At 82 I can assure you that a whole lot now won't be fixed, but must be dealt with. Whether PAIN as our toes hammer, our spines compress and our knees hurt or balance when we realize much as we weigh we are a feather in the wind. The time for surgeries is over. Now is the time to try staying on our feet best we can hoping we can use it so we don't lose it.

MIL needs now a doc who sympathizes, understands we are on our way out, but helps us stay on our feet long as we can and deal with chronic problems. Again, these are aging issues and there will be more the longer we live. Not a lot a home care worker can do other than what ALF already does. Try to keep us upright as we toddle toward the MC down the hall.

So yes, some of this is about the right MD.
Some of this is about the right care.
Some of this is about MIL's own determination and/or lack of, right walker, right footwear, best arthritis rub.
Some of this is about balance.
Some of this is about pain.
Some of this is about acceptance.
But it all adds up to a downhill trajectory. And no amount of going to doctors is going to change it. At some point a "make me better" attitude has to change to "How can I be comfortable and as self-sufficient as I am able to as I await the Grim Reaper's knock at the door".

We are all different, and as you can see, there isn't going to be one answer for everyone or everything. A lot can't be fixed. Some things can. But a good gerontologist will take more time in knowing which is which, and will help us accept and make as tolerable as we can this last time we have.
Practice the serenity prayer with MIL> I say that as an atheist who uses it all the time.

I wish your MIL all the best. As my brother said of his ALF when he was alive "We all sit about and discuss our medical woes and watch the ambulances and hearses come and go". We laughed. But it's kind of true. MIL and I would have LOTS to talk to one another about!