Help, advice and suggestions - elder care related

[WOT?*]

My dad has Alzheimer's. His wife has been his main caretaker, with help from in-home nursing not often enough (2 days/week). She had a heart-attack last Monday and is hospitalized and undergoing a multiple bypass. She won't be able to care for him any longer, obviously. (We have tried unsuccessfully to get her alternatives but she's a stubborn old Kentucky gal, along the lines of Hatfields and McCoys stubborn. Same neck of the woods and same independent streak.)

Problem one is her stubbornness and her insistence on caring for my dad. She knows she can't take care of him now and will appreciate assistance, but she is the type that will be overseeing the way they take care of my dad. Are they washing him well enough? Changing him properly? etc. And she'll let them know if they're not doing it right. That will not help her health-wise.

Problem two. Dad is stage IV Alzheimer's. We can't have him admitted to just any facility. He needs advanced care in a nursing home setting. His insurance won't pick it up unless he has been hospitalized for at least three days prior to the admission. We can't just hospitalize him for the sake of hospitalizing him.

My siblings have been taking care of him since last week. I will be flying down on Thursday to do a rotation (week to ten days). His wife should be getting released from the hospital then, unless she goes into rehab herself. (I would love to see them both in an assisted living facility together but the one that I talked with can't take dad because he is stage IV. They have Alz care and do *have* stage IV but they need to be admitted in stage I or II and deteriorate.)

Right now, we're looking at having him placed in a VA facility for 30 days while we explore other options for his care. They have an emergent facility near my brother's house where they can place him on a temporary basis when a bed becomes available.

They have no assets. The social worker at the hospital where wife is staying is trying to get him expedited onto Medicare. I am looking into hospice care for him as well. I will be speaking with his doctor when I arrive in town.

What experiences has anyone had in a similar situation? What suggestions and avenues would you explore for care and treatment? What questions would you ask and what answers would you look for?

[sarahbear]

I used to work in an Alzheimer's Assisted Living and am familiar with nursing homes too. I currently work for hospice.

1. Nursing Home will only be covered for a short period after 3 day "qualifying" hospital stay and only if he's receiving rehab. If he's custodial care (beyond the point of rehab) then Medicare won't cover a nursing home stay, which would be short term anyway.

2. Make sure he is receiving all his VA benefits. See if he qualifies for Veteran Aid and Attendance Benefit, which would cover Assisted Living expenses.

3. Contact the local Alzheimer's Association for advice. Sometimes there are local caregiver agencies who work off grant funds to provide cheap care.

4. Look into Adult Day Care for Alzheimer's patients. This would give your husband's wife a break during the day while he is cared for outside the home (might not be physically appropriate for him at this point though).

5. If he needs advanced Alzheimer's he can't be in a regular Assisted Living with her. He'll need to be in a secured unit, and if he's past AL level then you're right, nursing home is where he needs to be. Some facilities have both levels of care but they won't be in the same building-- it might be a wing, or seperate area (licensing issues, different care given).

6. Look into Medical as well. Many nursing homes will accept Medical payment, but not all.

7. Hospice isn't 24 hour care. It's supplemental care for those who qualify (he probably does). A nurse, home health aid, social worker or spiritual counselor will visit at varying frequency to see your father. This might be one nursing visit every two weeks, or 2-3 times a week. It depends. And the visit might be 30 minutes long, or maybe an hour. It all depends on his needs. But it isn't 24 hour care. If he has Medicare it's free. TriCare will pay as well.

8. If he isn't safe at home, and they have no assets, then you're looking at if he has VA benefits or Medical benefits to HELP pay. After that family will need to provide the help/assistance he needs.

[WOT?*]

Thank you so much for your response Sarah.

DH's grandmother was hospitalized for surgery (abdominal abscess) and after surgery went from being quite mentally competent to onset of dementia. She's now at about stage II or III(capable of sitting in a gerry-chair and occasionally conversant for short periods but not generally mentally cognizant.) She was moved to a rehab facility in September/October. She has private insurance and her treatment has been taken care of by hospice in the nursing home in addition to the private insurance. MIL says that hospice is taking care of all the expenses related to her health issues such as meds, feeding tube, diapers, etc. and private insurance is paying for the majority of the balance (thank heavens they have assets.) This is what I was figuring as hospice care rather than the occasional visit from a pastor or HHA.

Social worker is looking into Medicaid which should cover most if not all expenses. What expenses aren't covered we will have to pay.

I was hoping to find a facility that would cover both, even if not on the same floor or in the same building, but at least where she could visit him regularly. :le sigh

They are living in one of my brother's houses rent-free. Dad is not service-related so I will have to speak with his coordinator to see what he qualifies for. Ex was service related and covered by Tri-Care so he was so much easier to get figured out with the VA stuff.

Ugh.

[hockeywife]

Look for nursing homes that accept Medicaid (note: not medicare).

Most nursing homes around here (and, yes, even the really nice ones) accept Medicaid. There are income and resource levels that your dad and stepmom will have to meet before being eligible, however.

Here we have nursing homes that have specialized Memory Care units designed for advanced alzheimer's and dementia.

This may sound terrible, but if you think your stepmom can't care for your dad at home and you're concerned with their safety, then NOW is the time to find a facility (when your stepmom can't contest) that will accommodate his needs.

I'm sorry you're going through this, it is definitely very hard on families.

[CloudBee]

My grandmother has advanced alzheimers, and is in a Vets/VA home. The care is fantastic.

I agree with hockeywife, that now is the time to get him admitted somewhere. Your stepmom will be recovering for months. Also, with your father being so advanced, I'm wondering if he's even safe at home?

[vanillacourage]

You can look into respite care, where your dad could get help until your stepmom comes home. But, it's very expensive if you private pay.

One long term option you could look into is a facility that offers the full spectrum of care. My grandparents are in such a residence - they offer independent living, assisted living and skilled nursing. Your stepmom could live in IL or AL and still spend most of her time with your dad.

[GailGoldie]

i have no advice but want to just say I'm sorry you are going through all this. My husband's mom needs assisted care and it's been hard to figure it all out- what she'll agree to go into, etc.... it's draining on a family- mentally, emotionally, and often financially, too.

prayers for you as you go through this - alzheimers is hard - my grandfather had it... and my dad shows some early stage signs though he won't admit it.

[pugz]

You got some great info/advice above.

I think you'll definitely need to look into division of assets if you apply for medicaid, that way she will still have money to live on, either at home or independent/assisted living. Start the medicaid application ASAP as it can take quite awhile for it to come through depending on your state. Some facilities will take you "medicaid pending", others won't. Checking out his VA benefits is very smart. I believe that for all vets, service connected or not, they get a certain number of free respite days a year. That could help bridge the gap until medicaid comes through.

in my area there are many facilities/communities that have all levels of care, including independent/assited living, skilled nursing/rehab, long term care, and a locked dementia unit. So a place like that would probably be "ideal" in that she could easily see him daily and eat meals with him.

I can't remember if you said who his power of attorney is. Unfortunately if he doesn't have one at this point it is likely too late to designate one unless he has times where he is fully alert and oriented.