Dealing with my moms living conditions; she doesn't want to leave, but we don't think it's safe anymore.

So sorry for you and your family. You haven’t stated exactly why you’re worried about her at home except that she’s fallen.
First and foremost! You need to assess her living environment and apply safety standards!
Get rid of throw rugs and extra furniture that could be safety hazards. Make sure she has phone nearby at all times in case she falls. Get handicap rails everywhere she needs them and so on...
As well as the aides suggested already: walkers, etc.
This will be a good step in starting to clear the house. I told my mom that if she wants to stay at home, that’s what we have to do. Now anytime I say “SAFETY FIRST!” She knows she can’t resist and that it’s for her own good.
You can find guides here on what kinds of safety hazards to look for as well as Red Cross and the Aging Agency.
Goid luck to you all.
Charlotte

Lots of good info already provided. Here are some more ideas. Sit down with the siblings and brainstorm solutions. Write down every problem (food, laundry, doctor appointments, cleaning etc) and every solution idea and evaluate them later. Solving one problem at a time is a better strategy than trying to fix everything today. Find and use every resource in the community, there are more than you think. Does she have a walker? Can you get her to use it in the home? A 4 wheeled walker is usually more accepted by the user. A walker cuts down significantly on falls. Many falls occur at night. Get a commode for beside the bed. Do you have a faith community or friends? See if they can help you in any way. There are several people in my faith community that I am willing to help in any way they need, but they are reluctant because they think they are imposing. I have the time. I'm willing to sit with their family member while they go shopping, I have offered, but..... Trying to get your mom to see what's best for her is a steep uphill battle. Take some time for yourself. A walk, a quiet cup of tea etc.

First question that comes to mind is if you could move in with mom, or might mom temporarily come be with you, if she was agreeable? I get it, it's her home, her house and she knows the end is close so want to be in her space...but she needs to take all precautions and keep herself safe and get some help in. Suggestions are in other responses, but hospice, local office on aging should help...

The town where she lives should have an elder case worker. Contact that person. They should, oftentimes, also have on staff a social worker. Start there.

Personally, I am not in favor of Reverse Mortgages, their fees are outrageous. She is in end stage renal failure. If she has to stay somewhere else, she very probably will not be coming back home. So, sell the house, you will have more money because you won't be paying the outrageous fees. I agree to see what the Doctor says her prognoses is. I am so sorry you are facing this. My heart goes out to you.

If she has assetts well over $2,000, excluding the house and her car, I suggest looking into hiring Nursing School Students, or people who worked in Care taking before, but need flexible hours more than benefits. Agencies jump through a lot of hoops and pay staff to do Admin and bookkeeping. The employees make 40-50% of what is charged.

Try to find someone in school or recently divorced, who would love to house share in exchange for hours worked, to help coordinate workers hours, be there for delivery of supplies from Amazon, or food from Grocery that delivers.

It sounds like you need someone to remind your Mom to always use her walker, or other safety practices. Bring it to her when she forgets, and walks away from it. This is only normal when she is feeling capable at that moment.

Split meal prep between something like Meals on Wheels ( Free if she has Medicaid Waiver Services), and meal delivery that just needs to be microwaved or warmed in the oven.

If she is closer to the $2,000, like within $10K - $50K, do the things above and apply. Report what has been Spent Down on Services, general household expenses, and personal spending. Right now she can spend her money on a Care Companion to go with her on a trip, all expenses paid, plus $ for her time. Maybe you and your siblings can join her. Make sure the Caretaker is doing what you need.

Then she can adapt to her new normal. If she loves her caregivers, most can get hired on by a Medicaid Approved Company. Perhaps part of their salary can help pay for classes to get them qualified to stay.

Use your local Agency on Aging to find out what she qualifies for now, or will qualify for later. Be persistent! Like any place, some people are more knowledgeable than others. Some won't tell you about everything she is or will be qualified for, thinking she has you all to help. Money is tight. Be the squeaky wheel!
Getting that first person in the door is hardest. Maybe it will mean paying a friend or neighbor. Then you can use your families energy doing research and making other arrangements.
Move her bed to the 1st floor. Make the family or living room her Master Suite. Clothes, TV, music, books close by. If you don't have a first floor bathroom, is there any way to build one. This is a good use for a Home Equity Loan, the kind for Seniors who own their home. It will also improve resale.

Spend your Inheritance, not your health! Your job is to get the best helpers in there, and then make sure the do what Mom needs in a caring way. She will get used to actually living in a smaller space, while at home.
Get her rides to outpatient PT that take her doorway to desk. Or get in home PT. Have Caretakers take video so she can practice exercises properly.
Then, if she has to go temporarily or please to a NH, the adjustment will be easier. If she is not on Medicaid, you can still use her house for the holidays, if funds allow.

Two important notes of caution:
If she ends up with Medicaid paying for NH, they will Claw Back what they paid from any & all Estate Assetts, and what they dead to be gift expenditures (i.e., the cost of travel for a sibling on one of those trips), but to 5 years back from her date of death.

If you use a Reverse Mortgage, they have to be paid when she dies or last resident under qualified age leaves the home. So if there are not funds to pay back the loan. You need to refinance it, if you qualify, or they take it, sell it, and maybe you get the balance....but know the rules ahead of time. Know how long a NH stay they consider "leaving the home".

You might want to hire Geriatric Case Manager to help. This person would meet with your mom and do an assessment of her needs and then come up with options to address her situation. This Case Manager would also include her family in the assessment process.

You can go online to the Aging Life Care Association and find a Geriatric Care Manager in your area.

As to the real estate issue, there may be local property management companies who - for a fee of about 8 to 10% - can do everything from vetting renters, to property maintenance, etc. So if you found a company to manage the property headache-free, you might be able to manage an income stream for your mother to supplement whatever money she may have to pay for a private-pay group living home or a larger, commercial facility.

I agree with others who have said that simply being in an assisted living place (or other type) is no guarantee of safety; but they can respond adequately and more timely than you or your sibs could do on your own. In a local support group I attend for caregivers, I've heard more stories about the LO falling after they leave home. So these places have their place, but no solution is without potential issues or complications. We can only do what we think is right in keeping our LO as happy and safe as possible. Good luck.

Safety is the key here and you don,t say if she uses any aids to help her with walking. Is she using a walker, wheelchair, cane etc? Her doctor should order a mobility assessment by a physical therapist who will determine what your mom needs in the way of an assistive device and what will be safest for her. Many ALFs are leary of residents who fall all the time so get her the aid she needs. She may need a LTC facility rather than AL.
Also, some medications contribute to dizziness. If she sits all day then her legs are also probably very weak making it worse. Until she moves out, get her a lanyard with the call button so she can get help when she falls.

Would a board and care small facility be less intimidating than a large facility? The recently widowed mother of a church friend is in a home that has about 10 people and seems to be doing OK.

My mom was a practical person & decided on her own to move into the local senior apartments. However, a few years after the move she started progressing into dementia. She began falling often & not able to get up. Several times I would stop in after work to check on her & she would be in a pool of urine. Along with the falling she became incontinent to the point of not being able to go on outings. Even the EMTs knew her by the address that came across their radio! We tried home health but she became paranoid that they were stealing from her. After several nasty falls the hospital wouldn't release her without 24/7 supervision. So after exhausting every possible solution, the doctors said she would have to be put in a memory care facility. She protested but went willingly. She referred to the Bible verse (John 21:18) that states "I assure you and most solemnly say to you, when you were younger you dressed yourself and walked wherever you wished; but when you grow old, you will stretch out your hands and arms, and someone else will dress you, and carry you where you do not wish to go.” (Amplified Version)
Mom didn't have to stay there as long as most patients. She passed after only 10 months. She didn't want to go to the NH but she made all the staff fall in love with her. The day she passed there were 5 of the six staff in her room with tears trickling down their cheeks. Maybe your mom will adjust better than you think.

You say your mother has lived in her home for 55 years. Have you looked into Reverse Mortgages ? It may be an option to help cover in home care and let her stay in the home she dearly loves.

If that is not an option then perhaps in touring assisted living or long term care facilities she could talk with residents there and join in an activity, perhaps even eat a meal there. These could all give her a better feel for what it will be like there. The need for medical help should be balanced with an environment that she is comfortable in. I have worked in long term care for over 3 years. I will say it never hurts to do a surprise visit on your own to see how things go in the facility when you are expected. As well ask to speak to the families of residents who would be willing to tell you of there experience at the facility. Having a meal there with your mother could provide an opportunity to sit and talk with family and residents that are not hand picked by the administration and give you a more accurate picture of life in the facility.

We got my mom to try out an Independent Lliving place (after it became clear to us she was not longer safe living alone) by blaming the weather. Mom always worried about the Nor-easters in October which always brough basement flooding and the snow that followed. So we said "how about you move into IL just for the late Fall and Winter? We can talk about going forward in the Spring".

Mom moved in mid-October; by March, she was all on board with staying. She made friends, enjoyed activities and told us that every time there was a storm, she realized what a sense of dread she'd had living alone in the suburbs.

Update: We had a meeting with mom and she is reluctantly allowing us to toru some assisted living places on her behalf. No committment just tours. We can get care at home but for the care she needs it would end up costing more or the equivalent of what she would pay in an assisted living situation. She actually likes the rehab center experience but wants to go home more of course. All 3 of us kids have our own homes so no moving into her house isnt a possibility. Renting out the house is an iteresting idea but then we would have to deal with the issues of turning into landlords. I like the Idea of a trial run to see how she does in an assisted living place. I didnt even know that was a possibility.

Is there some way she can have in-home care? As you say, if someone were with her the risks wouldn't be so severe.

Once us old folks start falling we tend to do it at home, in a facility, alone, or with someone there. Being in a care center would reduce some risks, probably, but is not guaranteed to keep her "safe."

If Mom can self-pay for a facility, she could use that money for in-home care instead. If she would need Medicaid, they provide in-home care, too.

Have you been given any kind of prognosis/expected timeline for her?

Toward the end of our lives safety isn't always the most important consideration to us, as Dr. Atul Awande explains in his book, "Being Mortal."

Did your mother hate every minute in the rehab facility, or was she grateful for the care she was getting? I like Margaret's idea of a trial period in the facility you think would be good for her. No long-term commitment, and no sale of her house, until she decides if it is the right place for her.

One idea might be to see if she can have respite care somewhere nice for a month. No-one wants to leave their home, but some people are quite scared about 'going into care'. Perhaps some pleasant experience would help.

The idea of selling a long term home is also a real wrench. Would it be feasible for you or a sibling to live there? Or find a friend who would 'love to rent it just the way it is'? My guess is that your mother is also finding the situation overwhelming. Breaking down the steps might help.

OMG your all so young for serious health issues.

If Mom is competent then not much you can do. Maybe another member can give you a suggestion.