Send Mom to nursing home?

[Anonymous]

Anonymous wrote:

Anonymous wrote:This isn't as easy as you seem to think. You can't really force her to leave her own home, and to enter a nursing home against her will unless she is shown to be incompetent to manage her affairs and someone with Power or Attorney makes this decision on her behalf. Power of Attorney would need to have been signed when she was competent, or you would need to petition a court for it now.

Yes, you can. We put my MIL in a nursing home against her will when I could no longer care for her (I tried my best) but she lived in our home. No POA. Eventually we got guardianship but not for that reason. However, if they move her to a nursing home, they should pay full market rent if they plan to live in the house.

Completely different situation. Your MIL was essentially homeless when you would not allow her to return to your home. And she was not in your home at the time of the decision.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I would hope for her sake and yours thar her next fall is fatal.

+1 I agree with this with kindness.

OP, your mother is 88, has dementia, and is clearly failing physically. You should be thinking in context of supporting her comfort until she makes a graceful exit, hopefully sooner rather than later. What is her current joy in life? Right now it’s probably just living with you and having her grandchildren around.

My dad was 90 and living in our basement when he began having mini strokes. We had an aide come during the daytime to help him in case he fell and to help with bathing. His diet was pretty much cheese pizza and water. But he was happy reading all day and knowing his family was upstairs. He had a DNR. Unfortunately he had a stroke that was severe enough to put him in the hospital but not severe enough to kill him. He had to go to a nursing home after that. They are very good at hydration and diet - his body was well taken care of, but to what purpose? He lived 6 more years parked in front of a TV, with visits from the three kids once per week, burning through his life savings, unhappy about the situation because he was DNR and this was exactly what he didn’t want for his end of life. He eventually passed from pneumonia during the winter.

My suggestion is to make the house as suitable for your mother as you can and to have an aide during the day when you aren’t there. Let her drink all the Pepsi and tea she wants. Focus on quality of life, not “health.” It’s definitely hard to manage this type of care at home, but it will likely be for a shorter amount of time than if she’s in a nursing home.

^ Solid advice, here. OP, try the least disruptive option first. Which is to hire daytime help. (I am a bit confused as to why you don't have this already. Do you mean your mom is alone all day while you work?) At a minimum, they can help with ensuring she is not dehydrated which may be exacerbating her signs of dementia. Quality of life is key here. Remember there are also agencies/volunteer organizations which can assist, like meals on wheels etc.

[Anonymous]

You cannot keep your mother from returning to the home SHE OWNS. This isn’t your house.

[Anonymous]

She should probably have in the neighborhood of 170K from the rent you've been paying since 2020 (back of the envelope of course, might be a little high). Would that help with the expenses?

[Anonymous]

Anonymous wrote:You cannot keep your mother from returning to the home SHE OWNS. This isn’t your house.

In terms of getting her into a nursing home, Medicaid would require a spend down of all of her assets (including the house) before it would cover anything. I don't see how - in clear conscience - you can keep the house and send her to a sub par nursing home.

The PP above is right - hire helpers for when you are out of the house and put an alarm on her bed. That is the kindest thing to do at this point.

Also, contemplate the values of freedom versus safety. She would probably rather have a modicum of freedom than live a "safe" low quality life at a nursing home.

[Anonymous]

Medicare homes take patients who spend down all their assets, then live there until end of life on the government’s dime.
This means you need to move your family out because the house will have to go. Or that you buy the house at an advantageous price now so it’s not hers on paper.

While you figure this out, hire an aide.

[Anonymous]

Anonymous wrote:Medicare homes take patients who spend down all their assets, then live there until end of life on the government’s dime.
This means you need to move your family out because the house will have to go. Or that you buy the house at an advantageous price now so it’s not hers on paper.

While you figure this out, hire an aide.

Even if they buy the house at market value wouldn’t it be part of the 5 year look back?

[Anonymous]

A relative has an alarm that alerts her any time her mom gets up at night. Worth looking into.

You have to make sure she drinks more water, UTIs are a real danger at this age.

I agree with you that your sister's opinion cannot be the deciding factor here.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Medicare homes take patients who spend down all their assets, then live there until end of life on the government’s dime.
This means you need to move your family out because the house will have to go. Or that you buy the house at an advantageous price now so it’s not hers on paper.

While you figure this out, hire an aide.

Even if they buy the house at market value wouldn’t it be part of the 5 year look back?

Yes. It’s Medicaid and it’s too late. OP can buy the house from her, but the money that OP gives her for the house will have to go towards her care costs. OP will have to purchase it at market value or Medicaid can claw back the value of the “gift.”

[Anonymous]

Anonymous wrote:You cannot keep your mother from returning to the home SHE OWNS. This isn’t your house.

Well, yes you can, if you show that she is incompetent to make her own decisions and take care of herself. Which sounds like the case here.

[Anonymous]

OP, this is your mother's home. Not yours. The situation has nothing to do with what you are uncomfortable with in your mother's home. Move out if you're uncomfortable.

You either have care workers in your mother's house or you sell her house in order to pay for a nursing home.

I am shocked that you seem to think you can do what is comfortable for you in your mother's home. This would be entirely different if your mother was living in your home.

[Anonymous]

Thank you everyone for your responses and giving a lot of food for thought.

A few more points that may matter:

-Mom set up a life estate in 2010 - to protect the home (which is her only asset) against the “reach” of any nursing homes etc - precisely the situation we now face. She lives in the house but technically it is owned by my sister and I. Look back period has passed.

-It whenever Mom passes, DH and I will find a way to buy my sister’s share out (approx. $350k) and take full ownership. Sister and I have already agreed on this. Home has been in the family since 1921, good school district etc. so unless there is a disaster, we have no intention to sell.

-There is still a $100k mortgage on the house that DH/ I have been paying with Mom. (She made a dumb decision after dad died to remortgage the house to pay off some debts and “improve” her cash flow). Payments are roughly split 50-50. She has covered taxes while we covered food and utilities. I handle all of her finances to ensure all goes smoothly. Between this, the home refurbishments (more on that below), and being her servant for 3+ years, believe me we have not benefited financially as much as you might think
from all of this.

-The house was a total wreck when we arrived - it’s an old house that needed some TLC anyway. Mom has slight hoarding tendencies and there were several dumpsters of junk that we cleaned out and had taken away. The total spend on refurbishments was at least $100k and many of them were to help Mom - Eg converting bathtub to a walk in shower, redesign her bedroom etc. If she stays here, we may have to do more.

-I returned to work 6 weeks ago. For this month we had actually made plans for her to have meals on wheels get delivered, to be picked up and brought to the community senior center a few days each week etc. So while her situation progressed, I was basically still at home to help during the day. Not an ideal time to start a job, but for my sanity I want to get back into the job market (and we may need to cash anyway…) Yes, perhaps we overestimated her capacities - she seemed to be “getting better” though the scary fall in the driveway has been a reality check.

-Mom remains in rehab (arrived one week ago), and we have until Xmas/New Year to decide on the next step(s).

[Anonymous]

Anonymous wrote:

Anonymous wrote:Medicare homes take patients who spend down all their assets, then live there until end of life on the government’s dime.
This means you need to move your family out because the house will have to go. Or that you buy the house at an advantageous price now so it’s not hers on paper.

While you figure this out, hire an aide.

Even if they buy the house at market value wouldn’t it be part of the 5 year look back?

DP. The money for the house sale (regardless of who bought it) would be used for nursing care. If it is a significant amount of money, mother would no longer qualify for medicaid, and then she would have to go into a private pay nursing home, paid for by her pension and proceeds from the house.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Medicare homes take patients who spend down all their assets, then live there until end of life on the government’s dime.
This means you need to move your family out because the house will have to go. Or that you buy the house at an advantageous price now so it’s not hers on paper.

While you figure this out, hire an aide.

Even if they buy the house at market value wouldn’t it be part of the 5 year look back?

DP. The money for the house sale (regardless of who bought it) would be used for nursing care. If it is a significant amount of money, mother would no longer qualify for medicaid, and then she would have to go into a private pay nursing home, paid for by her pension and proceeds from the house.

The house is no longer the mother's to sell.

[Anonymous]

Anonymous wrote:Thank you everyone for your responses and giving a lot of food for thought.

A few more points that may matter:

-Mom set up a life estate in 2010 - to protect the home (which is her only asset) against the “reach” of any nursing homes etc - precisely the situation we now face. She lives in the house but technically it is owned by my sister and I. Look back period has passed.

-It whenever Mom passes, DH and I will find a way to buy my sister’s share out (approx. $350k) and take full ownership. Sister and I have already agreed on this. Home has been in the family since 1921, good school district etc. so unless there is a disaster, we have no intention to sell.

-There is still a $100k mortgage on the house that DH/ I have been paying with Mom. (She made a dumb decision after dad died to remortgage the house to pay off some debts and “improve” her cash flow). Payments are roughly split 50-50. She has covered taxes while we covered food and utilities. I handle all of her finances to ensure all goes smoothly. Between this, the home refurbishments (more on that below), and being her servant for 3+ years, believe me we have not benefited financially as much as you might think
from all of this.

-The house was a total wreck when we arrived - it’s an old house that needed some TLC anyway. Mom has slight hoarding tendencies and there were several dumpsters of junk that we cleaned out and had taken away. The total spend on refurbishments was at least $100k and many of them were to help Mom - Eg converting bathtub to a walk in shower, redesign her bedroom etc. If she stays here, we may have to do more.

-I returned to work 6 weeks ago. For this month we had actually made plans for her to have meals on wheels get delivered, to be picked up and brought to the community senior center a few days each week etc. So while her situation progressed, I was basically still at home to help during the day. Not an ideal time to start a job, but for my sanity I want to get back into the job market (and we may need to cash anyway…) Yes, perhaps we overestimated her capacities - she seemed to be “getting better” though the scary fall in the driveway has been a reality check.

-Mom remains in rehab (arrived one week ago), and we have until Xmas/New Year to decide on the next step(s).

This is exactly the sort of situation that causes problems between siblings at the end of a parent's life. Your sister wants mom to stay in her home because while you have done a lot of work you have had the advantage of not shelling out downpayment, buy for a reasonable if not advantageous amount in a good neighborhood, while you don't want her to stay in her home because it will cause you more work and responsibility and people in the house you're not comfortable with.

When we were making decisions I made sure we all understood that this wasn't just about the parent, but also how it would affect the longterm relationships between the siblings. Maybe you don't care, OP. But you sound very much as if you are trying to do what is best for you and your family, not what is best for your mom.