I am on the west coast, Mom is in NC. Her friend texted to let me know she was taken yesterday by ambulance to the hospital and returned home 12 hours later by my nephew (her grandson). She can’t walk, and didn’t want anyone to tell me that this happened. They found nothing on the CAT scan to explain her extreme pain, and told her she should see an orthopedist. Gave her intravenous fentanyl, morphine, and a prescription for oxycodone + nausea meds. She has ordered diapers for herself, in case she can’t get to the bathroom, but can’t tell me how she will change them.36 years ago, she ruptured two discs in a fit of rage because her boyfriend wouldn’t come help change her tire, she had no jack, so tried to lift a ‘76 Pontiac LeMans. Titanium rods in her lumbar spine, with severe curvature above that. She’s been told that she would benefit from a full hip replacement, and has increasingly struggled with walking over the past year, due to hip pain. But she can’t seem to get a clear answer about whether that can happen with her lung issues. Because of her advanced autoimmune interstitial lung disease, she is taking a transplant drug (Celcept) to slow the progress. She also does nebulizing treatments twice a day, yet she is breathless during conversation, and doesn’t have the strength to squeeze a stapler. She feels her cane is too heavy at 2.13 pounds. I visited her mid-March to tour 3 assisted living facilities. She was fairly pleased with one of them, but is reluctant to decide because she’s obsessed with her half-wild cat, who is unlikely to thrive at the AL. I could go on and on, of course. Complicated medical diagnoses, so many drugs, successive UTIs, she’s OCD with obsessively organized hoarding tendencies and very stubborn in her slippery southern way. I am shocked she was discharged from the hospital when she cannot get around at all and was clear (so she says) that she lives alone. I suspect she will be back before her orthopedist appointment on Wednesday, and I’ve asked that she have the hospital call me. I’m not sure how to proceed in the meantime. She’s asked me to call her preferred AL to find out if they have any openings, but doesn’t want me to disclose her current condition. At least she’s coming around to the fact that she can’t be alone, but will she even qualify for AL at this point? Or should I be focusing on SNF care? I’m just not sure what to do from here. She does have POA/MPOA paperwork in place, but it is a triggered POA. I’m hoping she’ll agree to grant me that authority, but should I even be hoping for that? Any advice about any of these many layered issues would be massively appreciated. Thank you.
You need to be educated about Medicare, Medicaid and timing the filing. See if you can convince her to have an attorney visit her to get things in order. It seems like you should plan a trip to see what is what and maybe talk to her neighbor.
Also, from what you describe, it might be time for hospice to come and talk with her. She suffers from a lung disease that sounds at end stage with no cure. She suffers from pain that required heavy narcotics in the hospital. She cannot receive the doses to make her comfortable because of narcotic rules. However on hospice, those doctors can make her much more comfortable in death. Certain ones will help with her shortness of breath. Realize that these doses will need to be given, if at home, by someone like you. It is difficult to find a care company that can legally give these meds under their licenses. A RN might be the only one and costs will be high. Unless you can convince insurers to admit her in a hospice house.
If Mom is in the hospital again, call and tell them she iscan "unsafe discharge".
My nephew’s wife is an OR nurse & agrees with me that she can’t return home, so I think we’re all on the same page there, as long as they refuse to bring her home with them. They are in their early 30’s and I strongly feel they should not take on this responsibility.
Can home health aides go into rehab facilities to clean people up, etc?
I am hoping she’ll be referred to rehab and that will give me time to arrange whatever is next.
No one needs to really "qualify" for AL as a senior... you just decide you want to live there and the facility has the opening. But is seems your Mom may need more than just AL -- the question is will she be open to SNF or LTC? If she's willing to go into AL, this is a win if she can afford it. Make sure it is a place that has a continuum of care (AL to MC to LTC to hospice) and accepts Medicaid.
Your Mom is not the one who triggers the PoA authority, you need to read the doc to see what it is (usually an official medical diagnosis of sufficient impairment). As you research facilities, the admissions person will be able to tell you if they are willing/able to handle someone with all her issues. She will only get worse, and probably quicker now.
My Mom broker her pubic bone last spring and it was very painful, and other than pain meds there was nothing to do but rest. It took at least a month for it to heal while she did very little. Basically stayed and even slept in her recliner but she did eventually fully heal, at age 96.
I'm going to predict that she won't go anywhere that doesn't accept the cat. And, she needs to be able to fully care for the cat herself in any facility, while keeping it in her unit.
The priority is for her to heal her pelvis. This will require a lot of resting, so she will need in-home help. An AL won't be bringing the food to her or anything else besides laundry and administering medication. She needs in-home help or a stint in rehab. Even then, a rehab facility doesn't really do custodial care, so won't really help with hygiene or eating, etc. This was the case for my AUnt with dementia after she broke her hip: family had to come in to make sure she was cleaning up, and eating/drinking what was brought to her.
Have your Mom sign the HIPAA Medical Representative form, allowing her doctor to legally discuss her private medical situation with you without requiring further permission or presence from her. Maybe see if you can descretely get the impairment letter from any one of her doctors so your PoA is active. Your Mom won't like it, fyi.
Plan for a long-ish visit, 1 week at a minimum. It will take time to assess her needs and get her to actually agree to cooperate. If she won't you will need to have a clear and strong boundary that your helping her cannot be onerous to your daily life or you will resign your PoA and allow the county court to assign her a guardian.
I really hope she’ll let me take over because her decision-making has been baffling for at least three years. But she is technically able to decide everything for herself.