If Spouse comes home from rehab after 90 more days, a tenant may work out as a paid caregiver p/t. What are the benefits/pitfalls of this?
Spouse is recovering from 4 broken ribs, a severely sprained R hand, can currently stand and walk with walker if attended; he's a fall risk after 9/1 and 9/5 falls. Tenant is 37, male, and has lived with us for 2.5 years. He's always been kind and helpful to carry things if I ask for help because he's strong; he works about 30 hours outside the home weekly, has his own car, and he and Spouse know and like each other.
Currently, he pays $450 for one upstairs bedroom (full house privileges) two doors down from the master bedroom, so he'd be within hearing distance of any call from Spouse for helping to the toilet, etc. I'd forego the rent, the hours would be about 6 hours daily. He hasn't any home health care experience and I've not mentioned the scenario to him. Thanks for any input.
Still feel it would be an attractive proposition for him? He'd have to like your spouse a heck of a lot.
Do a contract.
Pay him whatever is the going rate for caregivers in your area.
pay him by the hour for the actual hours he works.
So if he actually works 6 hours and the going rate is $20.00 per hour then you would pay him $120.00 for the day.
This way you have proof that your husband needed the care. The information might be necessary if you ever have to apply for Medicaid.
I would double check your homeowners policy and make sure it will cover any potential injury.
It seems like you don't want to feel guilty about possible placement and you're trying to talk yourself out of going this direction.
Do what's best for him and you, and that may be sadly, placement.
What would your tenant do if he himself becomes sick, or desperately needs a day or two off. Can he no longer go out at night to meet a friend for dinner? What if he wants to go on vacation?
What if he dates someone and wants to spend the night at their home? What if he needs surgery and time to recuperate?
There is also liability involved for your tenant. What if he doesn't properly take care of your husband, or injures him?
I know you want to save money, but this is not the way to do it. He's not a relative helping with caregiving. He's a tenant, and you're a landlord. If he skips a day or two - does he get evicted? etc
Too many loopholes in this situation, and it's not fair at all to the tenant.
Either: offer him a job and pay him a salary that follows the minimum wage rules/laws of your state, assuming you're in the US. Or hire another caregiver, or do the caregiving yourself if you don't wish to do placement.
I speak as someone who is a 24 hour a day caregiver with no pay for it, other than love.
Also, liability by you if he got injured. What if he hurts his back and becomes disabled. Could there be a lawsuit? I wanted to hire someone off Facebook to help caregive & lift, but realized it was just too risky for liability reasons. I can't afford a CNA, so just do it myself with a Hoyer Lift.
I used to be a 911 Dispatcher, so am very aware of liability issues and the necessity of following correct procedures. It's in your best interest to do so.
Sometimes the Area Agency of Aging can provide assistance by referring Caregivers for a lower price. Can they do an assessment? Would also hope the VA would help you.
Another option would be paying him a salary, and also giving him a discount on rent as a perk, but not as full payment.
Also, ask your husband's Doctor if they can provide Home Health Care visits upon his release. You should be able to get a Nurse, perhaps an Aide, Therapy etc and that generally is covered by insurance. But, that wouldn't help you at night time though.
Whatever you choose - I hope it works out for you and your husband.
@sp19690 I would likely live in a senior community in town; this would take some planning and probably there would be a gap between /my/ placement there and the vacating of the home. A trailer park Youngest Brother lives in is nice, about 75 miles away.
You need to know the tenant is working and can afford the rent, not slacking off.
Keep everything separate, even to the extent of hiring someone else. imo.
You take in boarders to make ends meet, so No, do not forego the rent.
If you hired a caregiver (if possible) for only $20/hr., you would not need a room for that outside caregiver.
Has a psychiatrist been consulted about DH's irrationality?
No psychiatric eval thus far. Spouse is afraid of dying in rehab, has told me he's "terrified" of ending his days not doing what he wants to do, right down to the precise things we did together prior to 9/1. He may die as he says.
Yesterday he begged me to come pick him up, saying "I just need one friend and you're it" and "I've told them I'm leaving today." I said I cannot give him the care he has earned by serving his country. It was a terrible conversation. After 1.5 hours, we reached a weary accord that he would remain where he is and ended with us both (4 miles apart) watching the Cubs/Cardinals game to see if the Cardinals' winning streak continued.
Your spouse has dementia and was unreasonable even before that diagnosis.
It sounds as if this marriage has been one long road of you being supportive, accommodating and flexible and of him being demanding, belittling and accusatory. To my eye, the man has a personality disorder and while these folks sometimes mellow with age, dementia can cause their self- centeredness to blossom to new heights.
He has a progressive illness that is going to get worse. He is already too large for you to manage at home and he has at least one instance of endangering himself by not comprehending the gravity of the situation (the car thing, remember?)
It seems to me that God or Fate has smiled upon you both and given you the opportunity to have him someplace safe for an extended period of time.
In your shoes, I would be using this time as respite, getting to a lawyer to talk about Medicaid/VA LTC eligibility and YOUR finances, finding a telehealth therapist and taking stock of where the best place for YOU to live for the next 40 years is. You mentioned divorce; I would consult a lawyer about that as well if that's on your mind.
I would not be struggling to figure out ways to cobble together a jury-rigged plan to bring him home with too little help.
Re: leaving your son the house...my parents brought me up with the idea that the "gift" they would leave us was that we wouldn't need to support them in their old age. That's better than a house or legacy of any kind.
If Pronker's household is low-income and on food stamps, they are also on Medicaid.
Medicaid will pay for the husband's homecare aides. They may not pay for 24 hour a day live-in servants, but they will certainly send some homecare.
I've worked for many low-income people on both Medicaid and food stamps. They were receiving up to eight hours a day of home caregiving services. All paid for by Medicaid. Most of them didn't need more than an hour or two of aide care.
Pronker needs to talk to her food stamp caseworker or her husband's. They will set this up for them.
It's already been established here on the forum that free rent is not payment for caregiving services. You're expecting about six hours a day of care (and if it isn't actual care every minute, that person has to be right there "on-call" if anything is needed) in exchange for a $450 rented room in your house.
I'm sure you're a perfectly lovely and reasonable person and are probably not aware of what a disgusting insult that offer is. Not only to your tenant as a person but to every caregiver on earth who does this kind of work as a living. This kind of offer proclaims that you think very lowly indeed of this person. How can it seem otherwise if all you offer for 30 hours a week of his labor is a room to sleep in with "full" house privileges (can eat, use the bathroom, and watch tv). This is no kind of an offer and if you haven't made it yet, I would strongly suggest that you don't. I've been in homecare for almost 25 years and I know exactly what 'helping to the toilet' means in these situations. So do you. That should be free? I don't think so.
So how about making a real offer to your tenant for caregiving services. The $450 to rent a room in your house automatically gets waived. That goes without saying. Then you, your husband, and the tenant/caregiver sit down and come to a dollar amount that everyone is comfortable with.
If you're not onboard with it, then call a care agency and pay for outside help.
I will point out that Pronker's household is on Food Stamps and thus very low income.
She is desperately trying to cobble together services so that she can accede to her unreasonable husband's unreasonable demand that he return home. He is currently in VA rehab and threatens daily to discharge himself.
I think in her heart of hearts she knows that this is not a realistic plan.
This is what I would do. Your house is an exempt asset under Medicaid. So is one car. Your monthly income, SS and Pension are not assets. So, you need to look at your assets. If substantial, you need to have them split. Your husbands split would be spent down and then u apply for Medicaid. You will be the Community Spouse and will get enough of your monthly income to pay bills. Maybe all of it if needed. An Eldercare Lawyer should be able to help you.
My GFs parents had 60k in the bank. It was split between them, his going for his care. She stayed in the home and had a car. She seemed to be doing OK.
When DH passes, Medicaid will put a lean on your house to cover the cost of his care. You will be able to continue to live in the house. But if you sell, that lean will need to be satisfied. If you pass, the house will need to be sold to satisfy the lean. A person could also pay the lean and keep the house.
Your profile says DH is 79. I will assume u have not updated his age and I know u have been here a while. So he is now in his 80s? Meaning you are too? I would consider placing him now. The cost and stress of caring for him at home will probably be too much for you. It would for me and I'm 72.
Physically, I dropped off some Chinese food of the blander kind to Dietician yesterday, who says he did not touch the other favorite foods I'd brought. Spouse said he took a walk in the hall with Aide and walker, felt weak in the upper body but not the legs. Dietician says the next step for the plan is feeding tube, which is not on his current POLST. She also said he ripped out his intravenous needle that was hydrating him. I've concluded he's throwing the world's biggest temper tantrum and will die to prove he's right about "let me come home so I can get stronger."
I'll do my best to enter his world as Teepa directs.
" Things escalated to "if our situations were reversed, I'd be overjoyed at having you back" ".
My ex (NPD) said stuff like that ALL the time.
In practice, he NEVER had my best interests at heart and immediately became disinterested or feigned illness himself if I had a baby or was ill.
Look, if this has been a mutually supportive marriage of many years, I can see trying to extend yourself to bringing him home with proper paid support (if you all can afford it, which it sounds like you can't--that's another issue entirely).
But if this has been a one way street, with you being endlessly supportive and getting little in return but derision for your efforts, I don't see the points in having these arguments, which are wearing you both out.
"The doctors say this is where you need to be; it's not up to me. If we can't talk about something else, I'll need to leave."
Believe me, I get how painful this is.
((((((hugs)))))))))
Yes, money has always been a problem..
Thanks for the thoughts and helpful reply - I'll use it, I'm certain, at some point. :) [[]]
His dentist said she couldn't do a house call to the facility due to covid to deliver and fit his repaired denture, so that won't work as a help. It's a trial for him to eat and he doesn't stay "on task" as the dietician described, putting her off that he'll "eat it in a minute" or "just leave it there, I'll get to it." Then he goes back to the TV, or sudoku, or a nap. There's some encouragement that his R hand recovered somewhat from its 9/1 sprain, unless he's using his L hand to write.
The facility discharges on the 7th because of 'non-improvement' so I'm scrambling to find a placement, with the most likely facility within walking distance. The admissions director at New Facility was very helpful and said 'get a referral from Original Facility for me to look over.' VA to contact me tomorrow as well as Original Facility social worker. I can recommend OF's skilled nursing, care and concern as they tried their best to get Spouse to eat to keep up strength. All family, religious leaders, doctors and nurses tried to encourage him to eat to no avail.
The dementia moaning was awful to hear, even through the closed window; he screamed when CNAs came to turn him over and do something to his catheter (I think it's a penis cap? couldn't see clearly). He's losing it, interspersed with periods of near-normal conversation. It's gratifying to confirm that this care is beyond my scope at home; I take no joy in the conclusion. It's grim all round.
Youngest visited, such a dear, and we enjoyed two days of camaraderie at home. He's doing his best to encourage his dad from far away. PACE says P for primary plan, which is placement near our home, A for alternate plan, which is placement farther away but still in the county, C for contingency plan, which is placement over 100 miles away, and E for emergency plan, which is release to home, with me gathering help as I can.
Medicare's quoted 100 days is deceptive and this forum helped me to realize that 21 days with 'unimprovement', leading to discharge was even on the table. Spouse tried in the beginning to work with PT and soon flailed in despair; he's complaining, well who wouldn't? He's simply irrational and says 'I know I would improve at home.' A complication is that the stairlift broke down so VA needs to come fix it; Plan B is to ask the firemen to come again and haul Spouse up the stairs if emergency plan ensues. He'd live upstairs only.
Admissions director says that Medicare time will reset if Spouse comes to New Facility; I need to find our more about that and other things like Medi-Cal which will fill in for expenses?
One thought on the eating; years ago, FIL was in the hospital and kept saying he couldn't eat. Long story short, someone from Speech came to see him--turns out he couldn't SWALLOW (he'd had a stroke which had damaged both his word retrieval and swallowing).
PR, he can't come home, even if the emts can haul him up the stairs. How would he get out in a fire--it's just not safe.
Have you consulted a Medicaid planner or elder care attorney? Not sure about Medicare re-setting--I think you have to be out of the hospital for 60 days for that to happen. It's a good question to ask the Social Worker.
(((((Hugs)))))))
The room is ready for occupancy and we'll see what happens down the road; taking one day at a time. Unsure of Medical-or aid - or VA status but I'm keeping them in the loop of current developments.
1) If you are still considering the tenant’s involvement, could you drop down the tasks involved? For example, just ‘night duty’ might help. It’s a long time at any hourly rate, but often with little work involved, and it might even work with the rent offset.
2) If your husband is deliberately refusing to eat or co-operate in other ways, remember that it’s his choice. If you can’t do what he wants, and he won’t compromise, he is choosing his own path to death. It seems wrong, but people do this all the time in many many different ways. It’s his responsibility, not yours.
Sympathy and best wishes, Margaret
Will he be moved to the Nursing Home "Medicaid Pending"?
Has anyone mentioned contacting hospice?
The TV takes 90 percent of his concentration, he has the remote constantly in his hand; the sprained R hand seems a tiny bit more functional.
Good aspects include him profusely thanking me for the visit and not asking to 'take me home.' We talked baseball, football and current events; I put through a call to his sister and they chatted for awhile. He talked to himself during an ad, saying "I don't know what's happening." I resisted the urge to explain long-windedly because prior attempts agitated and did not help him to acclimate to "new normal." I attempted to "just enjoy him as he is," per many folks' advice. He's agitated whenever an attendant enters the room and does something to his bedside tray, telling them to arrange things precisely within his reach; he's learned their names and introduced me to them.
Keeping information simple is such a good idea in his current state.
With regards to Hospice/palliative care, what we saw at some point was that trios to ER from the NH home were causing more rapid decline.
We didn't do hospice right away but asked the NH to call us before they transported to the hospital.
The thoughts keep recurring 'he'll never come in the front door again' and 'we'll never sit at the dining table again' and so forth. Every now and then memories wash over like a big wave and I drown rather than surf.
I can only imagine how painful this is. It's the end of an era in your life. Grieve, mourn, shake your fist at the heavens. But we move on to the new normal.
(((((Hugs))))))
The best news is that he's returned to eating. Plan of care says OT and PT for more days to strengthen enough for walking, I guess, because he says the aides move his feet and legs while he's in the bed. I do not know if he'll ever walk and will need wheelchairs all the rest of his time on earth. I'm pursuing research of LTC. The hand tremors are pretty bad.
Saturday his sister and he talked and he complained to her that the tramadol and OTC meds like tylenol that alternate with the tramadol aren't being given often enough for his pain; he can't turn himself over in bed so his back and butt get sore. I've witnessed this sitch enough times since 9/1 to know that he forgets when he's had pain meds last; his sense of time is skewed. SIL wants me to supply him with tylenol from home "so he can medicate himself when he's in pain in between supplied doses." I resolved not to supply him with any non-prescribed extra doses and refrained from fighting with her over the phone. She's 300 miles away and naturally enough doesn't want to think of him suffering; I don't, either.
Such a wise decision not to engage in an argument with SIL. Wishing for strength and peace for you in the days to come!