How do we get our mother into a nursing home or memory care facility when crisis or rehab facilities believe that she is "ok" but she isn't?

I know back in 2014 when my dad had fallen again for the umpteenth time and had to go to ER, they were going to release him back home.  Now my mom was his caretaker at the time, but she was diabetic and the stress of his dementia moods and everything else was taking a toll on her.  I told the ER doctor there was no way my mother could handle him any more and that he could not go home.  They had him placed into a nursing facility that we had already checked into.  he was there for a short term until we got the paperwork filed for long term care.  We had been in touch with an Elder attorney to get things lined up (it just turned out that he had fallen while my brother and I were at the attorneys).  We had to pay up front the full first month for his care, but then with help from the Elder attorney we got things straightened out and he was put on Medicaid after that.  Had to keep "his" financial monies below $2400 each month (they did not include my mothers).  But you will just have to insist that NO ONE is capable of taking care of her 24/7 because she lives alone and can't take care of herself.  Get in touch with an Elder Care attorney and good luck.  Keep track of everything (when she falls, the condition of the house, her not taking meds, not eating, not keeping her hygiene clean, etc) in a book and show the doctors, etc.

As a former admissions director of a LTC facility and a Certified Assisted Living Administrator, I'm not quite sure what is happening here, but perhaps I have missed a few posts and don't have all the information.
If your LO's doctor has documented that she needs to be in a facility for safety and medical reasons that should be enough to get her admitted (although in the midst of a pandemic admissions for any reasons are done haltingly and rightfully so) on medical qualifications. Now the other half of the equation is financial. Hospitals, nursing homes, assisted livings all need money to pay staff, buy foods, keep the lights on and buy all the now necessary PPE equipment, not to mention maintenance of the building. I don't know about your state but in NJ LTC costs approx a min of $9000 per person (shared room). Now most people do not have long term care insurance and few can afford the above costs for more than a month or two so the question becomes can your LO afford to be in LTC (we are only talking about her money now, not yours or other family members). If the answer is no, then you will need to apply for Medicaid for your Mom; Medicare is a health insurance and will not pay for long term care. Again states differ, but in NJ Medicaid will take a 5 year look over Mom's shoulders to make sure she has not given away sums of money in order to qualify for Medicaid. Generally a person can not have more than $2000 in savings/assets in order to qualify for Medicaid. If she owns a home/condo - get ready to put it up for sale because that is her asset to be used for her support and benefit. The social worker at the hospital (next time she is in one) or the social worker at the local Office on Aging can help you with the application. Be prepared to present several years worth of mortgage payments, rent receipts etc to confirm her expenses and spending over the past few years. You may find that most facilities will not admit someone who can not guarantee private pay for several months until Medicaid kicks in. If you opt to pay privately, you can probably get her to a LTC facility but make sure you get the guarantee in writing that they will keep her when her Medicaid is approved even if they don't have a Medicaid bed available at that time. Most facilities only allot the min beds possible for Medicaid occupancy because they don't get paid very much for them. As and example at one of the facilites I worked at, our standard daily rate was $275 (covered food, room, bed and overhead expenses - no rehab or skilled nursing). Medicaid paid $179 - that stayed the same regardless of how much nursing care was required unless the resident had traditional Medicare, was admitted to hospital for 3 nights and was discharged back to us with a need for rehab or skilled nursing; then Medicare picked up full costs for a max. of 20 days. It can get complicated.
Anyway, I think your best place to start is with the Office on Aging in your state or county. Good Luck and keep us updated.

As far as I know, the State will pay for a nursing home, which I would guess, they want to avoid at all cost. If your mom is not sick, she does not qualify. A nursing home is a medical model, assisted living is not.
Most assisted living and memory care centers are private pay. I suggest working with a referral agency (free to the family) and find a place near you that will take mom. (They will pay the referral fee)
Then you will probably need to have her tested for Covid prior to moving.

DearJourn3y777,
This is truly a terrible situation and what makes it even worse is that you're trying to place her during a pandemic which has been and continues to be filled with uncertainty.
I cannot believe no one is listening to you especially since you would know her and her situation the best!
In 2015, I placed my mom in an assisted living facility. She had just turned 90 and had been diagnosed with Alzheimer's related dementia after ruling out Vascular Dementia. I knew she could no longer stay in her home alone even though that's what she wanted. She's 95 now, completely mobile - I did notice her walking more slowly and losing her balance occasionally at the end of last year so I decided to buy her a walker. She was also able to dress herself but, she couldn't take medications on her own. Then the lockdown of all facilities took place due to COVID-19 and everything went downhill from there. My husband and I weren't able to "see" how she was doing and her apartment was facing a center courtyard so we couldn't "window visit". We did get her an iPad which was difficult for her to use but, it worked for several weeks until...unbeknownst to us she was so ill she wasn't able to get to the iPad which was in the living room as she couldn't even get out of bed. One day out of the blue a nurse practitioner with the mobile doctor's office we hired for her called and said my mom was near death due to severe dehydration AND she has COVID. The nurse then said "what do you want to do? - leave her at the facility or have her taken to the ER"? We were in shock that this was happening and that we had to make a quick decision. I called the facility and told them to call for an ambulance. Further testing showed bi-lateral pneumonia as well as a severe UTI. My mom survived and then was sent to rehab as she no longer could walk and wasn't eating or drinking. There was no way I was going to send her back to the facility where I truly believe there was negligence. So through the rehab's discharge director, she gave us the name of a placement agent as she would keep calling and asking us where will my mom be going when she's released? This was extremely stressful because of the pandemic. Very few facilities were taking in new residents and especially someone who had the virus and was still recovering. Every week the director would call and ask if we were actively looking for a new place as she had to justify to Medicare keeping her there since my mom wasn't cooperating with the physical therapists. I called hospice to see if they could be involved but, they too had to wait and see if she would qualify. We were extremely fortunate that the rehab facility kept her for almost the full amount of time allowed by Medicare. By then we had just one viable option where she could go into memory care, they had no COVID cases and they had four apartments on the first floor with a window to choose from. I put down a deposit quickly after looking at a map to see the layout of the facility (because we couldn't go in and see it) but, there was one condition - she had to get another COVID test and it had to come back negative - it did. By then hospice said she qualified and now they would be involved in her care at the new facility.
So with all that being said, I don't understand why they won't help you. You hold the reigns here - can you call the last rehab facility and ask the discharge person if she has a placement agent and if so, call the agent and do what we did. They have the knowledge, the contacts and the ability to do it much more quickly then you both trying to call place after place after place to see if during this pandemic they can take your mom. We didn't have to pay the agent either since it was done through the rehab facility. She is receiving much better care now and I feel like hospice is a "second pair of eyes" for us. I wish you all the best and I hope you will update us!

Hi,
I'm not sure if every state is different, but in NC my husband's primary care physician evaluated him and completed an FL2 form which was a document needed for placement in a facility. In his case, I moved him into an AL Memory care unit. I'm not sure about Wyoming, but your Mom's doctor would be able to assist with that. I hope this helps you😊

Stay away from nursing home and assisted livings until at least 1 year after the virus is cured  and the homes can prove that you loved ones is being taken care of properly. As you know over 40,000 senior citizen died because NYS Governor Cuomo sent positive patients from  Hospitals in April, March, and May infecting these poor seniors in the homes. My poor wife was one of them, please let her rest in Pease. She was infected with the virus and passed away.  She will be terrible missed by me and my family. Please don't go their now.

The very next time she is in the hospital and they want you to take her home, FLATLY RUFUSE. Stand your ground - DO NOT, NO MATTER WHAT HAPPENS, GIVE IN. I don't think legally they can force you and if no one takes her, they must put her somewhere. Try to talk to the hospitals and Office on Aging and possibly get input from an attorney. But no matter what, DO NOT TAKE HER HOME.

Yo.ur Mother has a diagnosis of dementia. YOU are her guardian. YOU are in charge now, not your mother. Take your papers with you, find the best living facility you can that she can afford, and enter her into care. Keep a careful diary if you aren't already of diagnosis, of all her papers, of recommends by her doctors. Tell any facility, after showing them the diagnosic papers and the guardianship, that any discharge will be considered and "unsafe discharge" and they will be held legally liable for the results.

Imho, as your mother's guardian, YOU are the person in charge, e.g. if she must be placed in a facility.

Having guardianship basically puts you in the drivers seat, making it your responsibility to find a place to put mom when she is released. She would be best in some form of dementia care unit. While nursing homes are not bad, she would be better with people specially trained in the care of people that have memory lapses. I was in this situation with my dad. He was failing miserably, but the hospitals and rehabs were just sending him home. Sorry you have to deal with all this. Best wishes

Talk to the doctor again and tell them about the falls and no one there to provide 24/7 care. The next time you can get her in hospital, be very clear with the caseworker/social worker that she cannot return home, cannot move in with any of the children and they need to start the process for nursing home or assisted living care. If rehab discharged her to home - who picked her up?

You really need to ask the doctor why she gets sent home if his orders are that she cannot live at home. Someone is not doing what is supposed to be done.

The fact that the courts adjudicated her means that she is not able to make sound healthcare decisions for herself that why you were awarded guardianship. You don't need anyone's "blessing/permission" to place her in a long-term care facility, your guardianship gives you the right to place her.

I would find an appropriate place and then place her. The fact that she has declined since being out to the crisis short care community shows you that she need more consistent care.

I think in your case having guardianship hurts you rather than helps you. The responsibility falls on you to place her in a SNF. You need to research and apply to places you'd like her to go. You also are going to have to work out how the NH is paid, whether private pay or Medicaid. If you didn't have guardianship perhaps the hospital wouldn't send her home if it was unsafe or if no one was able to look after her. But since you have guardianship, you are entrusted to look after her needs.

I am legal guardian for my father but I cannot move him without a recommendation from a physician and notifiying the court of my intentions. There was a provision written into his original guardianship that said I could not move him from his home without a physician's recommendation. Last fall, he needed to be hospitalized for dehydration while still living on his own so at time of discharge, he had to be moved directly to AL as the doctor said the dehydration would happen again if he stayed by himself. Now, 10 months later, after numerous falls, compression fractures, worsening of his dementia, and a stint in skilled nursing, we are shopping for memory care (again, another physican recommendation) and I hope to have him moved by the end of this week, although we've already been turned down by one facility and have 2 others pending. He will be moving directly from skilled nursing to the new facility. We started on self-pay at the SNF last Friday so I am pushing hard to get him approved somewhere. Even with all the power I have as guardian, I could not have moved him directly from his home to AL because he would not go on his own. It's a tough situation but luckily the doctors here have been cooperative and done the right thing.

Have you had a needs assessment done?

That is the 1st step in getting her the care she needs.

Perhaps she doesn't need full time caregivers, maybe having someone come in a couple hours daily with your brother stopping in would be enough for now.

I encourage you to think of other solutions to help her get the care she needs until she is bad enough to need 24/7 care. Get that needs assessment done by calling the local counsel on aging in her area.

If she is still mobile and can toilet herself memory care may be a better choice to start. Maybe it's easier to move her to MC with her present diagnosis. Unfortunately now you will not be able to visit with the Covid. Make sure you check out the place as best as you can prior to moving her. Does mom have a social worker? Ask her PCP to recommend one to assist. The best of luck to you.

Not certain how guardianship is defined here and whether Mom refuses to go to a long term care community. If that is the case, it woul be helpful to document events with dates in a notebook and take pictures, which can be presented in court and to a doctor to support your request.

I was in a very similar situation with my dad. I had to set-up respite care with a facility and then have an intervention appointment with his primary care physician. I let the doctor know in advance all of the self neglect issues with meds, eating and safety prior to appointment. The doctor made it clear my dad was unsafe in his own home. Thankfully, we drove directly to the assisted living facility from the doctor’s office.
After a month of respite, he is now living there permanently until his level of care changes. No matter what some say... there are safe, quality facilities available. My dad is definitely safe, eating well, taking his medications, having social interaction and is being monitored by many.

If you have legal “guardianship” over your mother, a court judge has ordered you completely responsible for your mother’s care and eligible make all decisions. I think there is often confusion with this term.

What about an assisted living or memory care facility? Nursing homes usually are either for short- term rehab, or for those who need a lot of nursing care - except for some have Medicaid residents who stay when there is nowhere else for them to go. The issue may be financial - Medicare won’t pay and the nursing homes can’t keep her if she could do well in a less restrictive or less medical environment - but that doesn’t mean she needs to go home if she could pay for assisted living. Entry into AL doesn’t require a hospital stay first because you pretty much have to be private pay. For low income elders there are other options - subsidized group homes, Senior apartments with support services, or Medicaid application to then cover some sort of “custodial” care in a facility that accepts Medicaid. Check w your local Area Agency on Aging if you need information about low income options.

Nursing homes are ****NOT*** safe. They fall all the time and they do not feed the patient so they often get malnourished and dehydrated

You need help from her PCP and get her tested and a definite diagnosis. You need another social worker to help get her placed. If you have legal guardianship it may be easier. Are you her POA? How about a memory care facility?

I can relate. It's downright scary when the situation you're in comes up. Family knows elder is not "fine" but no one else seems to understand (sometimes including other family members - but not enough space for that here!) I don't know the legalities of your guardianship. But what I do know is that I wholeheartedly agree with you that many elders SEEM ok when they are in a facility, but are lost in the outside world - even if the "outside world" is actually their own home. I was willing to let my LO give it a go at home, but I was nevertheless shocked at her rapid decline and lack of effort at home - in spite of my best efforts to assist her. I knew she needed to be back at the facility but I wasn't sure how to get her there since she refused to go didn't think anything was wrong with her. A family member (who didn't assist me in any way) was telling LO that I was trying to have her "put away." That certainly didn't help either. I could go on all day about everything that was wrong. In the facility, they are sheltered and have the routine they need. They are much less likely to skip meds or meals when in a facility. At least in my elder's case, she got significantly more interpersonal interaction and physical activity in a facility than she would get at home. One day, she suffered a fall at home and was deemed unable to ever return home. Now, back in a facility, she's again seeming "fine" because she's getting the care she needs. I understand the spot you're in with this. As other posters said, make sure you're clear where you stand legally. One day the solution will become obvious and you'll be able to see it through the darkness. I never thought it my situation would ever work out - but it did.

As Geaton777 says, if you are her legal guardian, it should be you who determines where she lives and how she is cared for. Are we talking court ordered guardianship, or just using this term informally?

If this is a court ordered guardianship, what, if any, restrictions are there? I wasn't aware until reading someone else's post that guardianships are not always 100%. If you have full guardianship, then it is up to you to start looking into places, and determining if she needs financial help, in which case you would have to file for Medicaid, if she qualifies. You could contact the court to ask for referrals for EC atty and/or SW. EC atty could assist in applying for Medicaid and giving advice. YOU were appointed guardian, not the doctors, not the staff at rehab.

If, on the other hand, you are calling yourself guardian because you help care for her and watch over her, then you really really need to seek out legal help. If she has any assets, those should be used to cover attorney and court costs. If not, you might need to find a pro bono or low cost attorney to help.

We were on the other side - POAs and all that set up before dementia kicked in, but she refused to consider moving ANYWHERE. The EC atty told me we couldn't force her to move and suggested guardianship. The facility we chose would not take committals, so we had to get "creative". Staff told me just get her there, they would take it from there! Took some fibbing along with her leg injury that required an ER trip just prior to the move, but it was enough! Madder than the old wet hen, but she went with my brothers (I stayed OUT of the actual move!)

So, if you are legal, start shopping for a facility or in-home care givers. If you aren't, start shopping for legal assistance.

Where I live rehab and LTC are in the same building. So when a person is in rehab, thats when you tell someone you need your LO evaluated for LTC. When rehab is over, and its found they need 24/7care then the transferring is easy. This just happened to a friend of mine and it wasn't her decision. She needed 24/7 care and there was no one who could take care of her. Since it would have been an unsafe discharge, she now is in LTC on Medicaid.

Your Mom would qualify for LTC just because of her Dementia. Have her PCP put in writing that she needs 24/7 care and start looking for a nice facility.

If you are her legal guardian YOU are the one who has the responsibility and authority to find placement for her, not the hospital or rehab social worker. Why is she still in her own apartment? It sounds like you may not understand what legal guardianship entails. You research facilities. You figure out if she can private pay or needs you to apply for Medicaid for her. Then you choose a facility based upon that. Or does she not have enough funds but still doesn't qualify for Medicaid? Even so, the responsibility is still all yours. Perhaps you need to do some research on guardianship? Laws can differ from state to state so you'd need to look specifically at Utah guardianship rules.