Help me understand possible options for my ILs

[Anonymous]

My in laws are eligible for Medicaid. They qualify for food stamps, so very low income. Their children (including my spouse) have been supporting them by subsidizing their rent and monthly costs for 18+ years. They only have their social security.

We have recently reached a point where more care is needed. They are in their mid 80s and MIL needs memory care and FIL needs meds managed at the least. We have priced DMV area assisted living and group homes, and they are extremely expensive and a lot of us to take on with kids in college and our own expenses. MIL is in great physical shape and could live for 8-10 more years.

My understanding is that Medicaid only pays for nursing home, but I am wondering what other seniors would do in my ILs situation. Say their kids hadn't been supporting them and they reached the point where they need more care, what would happen to them? We are just trying to understand if there is any other option than for us to pay for all their care out of pocket.

Thanks so much for any ideas.

[Anonymous]

I have a relative who was in a nursing home temporarily and I saw a lot of indigent patients there. I hate to tell you this, but it seemed like the Medicare patients with dementia were parked in wheelchairs in the hallway with belts tying them in and/or parked in a day room all day. I’m not sure how these patients would have been handled were they more ambulatory.

My relative with dementia and a very healthy body is lucky to be in another country where more care is covered, but it’s still not a great situation and other relatives are there daily to help with care.

[Anonymous]

I have a lot of relatives who only have social security but live in a low cost of living area. Several sold their homes (worth like 100k) and bought into a nursing home. They started off in a cottage but gradually moved into more care and finally they were just in a Medicaid bed on the top floor. Another currently is in low income housing that takes his social security. He gets meals and help with meds but not constant around the clock care. Most move in with relatives. Social security really isn’t bad if you’re in a low cost of living area and especially if your house is paid off.

I have an aunt who was in a Medicaid only nursing home and it was ugly. 3 beds to a room, food was awful (like boiled chicken with applesauce), minimal activities. She got a dresser and that was basically it. Everything she owned was stolen nonstop. We bought her slippers almost weekly.

[Anonymous]

Anonymous wrote:I have a relative who was in a nursing home temporarily and I saw a lot of indigent patients there. I hate to tell you this, but it seemed like the Medicare patients with dementia were parked in wheelchairs in the hallway with belts tying them in and/or parked in a day room all day. I’m not sure how these patients would have been handled were they more ambulatory.

My relative with dementia and a very healthy body is lucky to be in another country where more care is covered, but it’s still not a great situation and other relatives are there daily to help with care.

I thought physical restraints were illegal? I've definitely heard of medication being given to prevent ambulatory dementia patients from wandering.

[Anonymous]

Medicaid only pays for skilled nursing facilities, not assisted living which is cheaper. AL is expensive here in the DMV. It’s cheaper in more rural areas.

Any chance your FIL is a veteran? If he served at all when he was young there are programs which may pay for some assistance for him.

[Anonymous]

Yes, FIL is a veteran - we are working on applying for this assistance.

My understanding with this combo of -less mobile, declining FIL plus physically fit MIL in need of constant supervision due to dementia- is not a good fit for assisted living because FIL would have to "supervise" MIL. Level of care would not be high enough for MIL otherwise.

Is it possible a group home situation might be best for them?

[Anonymous]

Anonymous wrote:Yes, FIL is a veteran - we are working on applying for this assistance.

My understanding with this combo of -less mobile, declining FIL plus physically fit MIL in need of constant supervision due to dementia- is not a good fit for assisted living because FIL would have to "supervise" MIL. Level of care would not be high enough for MIL otherwise.

Is it possible a group home situation might be best for them?

They may need to live separately.
This was the case with my parents. They paid out of pocket, but it was just the difference in level of care--she had dementia but was still very ambulatory and constantly escaping so she needed to be in a locked facility. My dad had no health issues. It was during Covid and often my mom's memory care unit was locked down for weeks, which upset my dad that he couldn't see her.

[Anonymous]

The 'belts tying them in' are for their own safety. It prevents them from slipping out of their chairs or flopping over.

[Anonymous]

Anonymous wrote:The 'belts tying them in' are for their own safety. It prevents them from slipping out of their chairs or flopping over.

I understand that, and I think it is fine personally, but I was just under the impression that it still wasn't allowed.

[Anonymous]

OP, geography is key to affordability. They likely can not afford to live in the DMV. Where else do they have -some- connection? Meaning he feels some connection to a place, to another person (sibling, friend). Doesn't even need to be so strong a connection, but something. Someplace he once lived, or someone from his past.

Now, I'm going to backtrack and say, I don't know who, but if you could find a social worker who could tell you if there are ANY options locally, I guess that's where you start. But I don't know a person.

[Anonymous]

Do they own any property?

[Anonymous]

Living "separately" for my parents meant the same facility, in different wings. Mom who couldn't walk much would get on her electric scooter and drive it down the hall, make a few turns and be buzzed into Dad's Dementia Wing. She spent almost all day with him. I know that might have been an unusually good arrangement.

[Anonymous]

Anonymous wrote:Living "separately" for my parents meant the same facility, in different wings. Mom who couldn't walk much would get on her electric scooter and drive it down the hall, make a few turns and be buzzed into Dad's Dementia Wing. She spent almost all day with him. I know that might have been an unusually good arrangement.

PP who mentioned living separately here.
Yes, that was how it was supposed to be for my parents too. My dad lived in the "independent living" section of the same facility. He was supposed to be able to go visit my mom as much as he wanted, but because of Covid they often had to lock down the memory care unit for weeks at a time. Eventually, after about a year, my mom deteriorated to the point she was no longer mobile/escape risk, and they moved out into a regular apartment and he hired a caregiver (which was a disaster on another level....)

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have a relative who was in a nursing home temporarily and I saw a lot of indigent patients there. I hate to tell you this, but it seemed like the Medicare patients with dementia were parked in wheelchairs in the hallway with belts tying them in and/or parked in a day room all day. I’m not sure how these patients would have been handled were they more ambulatory.

My relative with dementia and a very healthy body is lucky to be in another country where more care is covered, but it’s still not a great situation and other relatives are there daily to help with care.

I thought physical restraints were illegal? I've definitely heard of medication being given to prevent ambulatory dementia patients from wandering.

I’m the PP you’re replying to and I think physical restraints were allowed because the patients were designated as fall risk patients, so they could be considered safety measures rather than actual physical restraints. But yeah, it gave me pause. They were the kind of sturdy cotton strap belts that are used in PT/rehab.

[Anonymous]

Anonymous wrote:

Anonymous wrote:The 'belts tying them in' are for their own safety. It prevents them from slipping out of their chairs or flopping over.

I understand that, and I think it is fine personally, but I was just under the impression that it still wasn't allowed.

I'm surprised they used belts, too. At the rehabs and memory care places I have experience with they don't allow anything that a patient can't remove themselves. That means no mittens, seatbelts on wheel chairs, bedrails, chemical restraints like Haldol, etc. Even if you request bedrails to keep someone from rolling out of bed, they won't allow them because they "restrain."