Send Mom to nursing home?

[Anonymous]

Anonymous wrote:There are a lot of aspects to this, but one thing needs clarification and I have one suggestion for OP to reflect on.

1. Who owns this house? Both legally and in understanding/practice? At the time of whatever happened to the deed, did everybody understand that it was to protect an asset upon death and that it was still mom's home to live in until her death?

2. OP, think hard about whether you are trying to make decisions in your mother's best interest or your own. If you are thinking about your mother's best interest it seems that the answer is to do what is necessary for her to stay in her home OR sell the home so that you have the means to provide the quality and type of facility that she deserves.

She already explained that she and the sister own the house.

[Anonymous]

I have a lot of sympathy for where you are. Mom lives with us but she needs full time care. I’ve been doing it for years and it’s grueling thankless work. I understand your need to get back in the workforce for your sanity.

You’ve gotten some great advice here, I’ll add that there are nursing homes that operate in private homes that are significantly less expensive. They can be very lovely and loving. They don’t have the same level of activities as a bigger home, but it is much more intimate and nurturing.

We recently added weekend aides so we could have family time and night aides so we could sleep through the night. It’s 32-34 dollars an hour. It’s about $2500/week. $6500/month doesn’t go as far as you think. There are senior programs the counties run that will provide day care if you’re interested. The fees are minimal ($100/month). I know about Fairfax if you need some guidance but not elsewhere. IME, the people who run these programs are very helpful. Everyone in the program has some level of dementia and mobility issues.

[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.

I agree.

[Anonymous]

Since you can’t keep her safe at home, she needs to be in a nursing home.

[Anonymous]

Anonymous wrote:

Anonymous wrote:There are a lot of aspects to this, but one thing needs clarification and I have one suggestion for OP to reflect on.

1. Who owns this house? Both legally and in understanding/practice? At the time of whatever happened to the deed, did everybody understand that it was to protect an asset upon death and that it was still mom's home to live in until her death?

2. OP, think hard about whether you are trying to make decisions in your mother's best interest or your own. If you are thinking about your mother's best interest it seems that the answer is to do what is necessary for her to stay in her home OR sell the home so that you have the means to provide the quality and type of facility that she deserves.

She already explained that she and the sister own the house.

but she also said her mother still has a mortgage on it. It doesn’t make sense.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:There are a lot of aspects to this, but one thing needs clarification and I have one suggestion for OP to reflect on.

1. Who owns this house? Both legally and in understanding/practice? At the time of whatever happened to the deed, did everybody understand that it was to protect an asset upon death and that it was still mom's home to live in until her death?

2. OP, think hard about whether you are trying to make decisions in your mother's best interest or your own. If you are thinking about your mother's best interest it seems that the answer is to do what is necessary for her to stay in her home OR sell the home so that you have the means to provide the quality and type of facility that she deserves.

She already explained that she and the sister own the house.

but she also said her mother still has a mortgage on it. It doesn’t make sense.

OP here. Mortgage is in her name.

However from an estate planning perspective the life estate (which was set up 6-7 years after the mortgage) passes the property on to my sister and I if anything happens to Mom. As long as the payments continue (and they have) the bank really doesn’t care about this structure (nor frankly do they even know about it) - we asked the same question at the time. That’s the legal advice we were given, and assume still applies.

If push comes to shove we can liquidate some investments in the span of a few days (which DH is not happy about - at all) and pay the mortgage off in full, and have a clean slate going into this.

[Anonymous]

I’d go a middle road for now. Hire daytime help.!If you find someone independent (not an agency) you may pay more like 25/hr; if you can get away with 8 hours then that’s 6k/mo. Stagger work schedules if possible to cover gaps. The aide should take care of bathing,feeding, socialization (senior center). Yes she may still fall in the middle of the night but that happens all the time at assisted living or memory care as well. Also you will still be going over multiple times a week—ask me how I know. The facilities are expensive and are not panaceas; there are medication issues, falls, confusion etc. Get alarms for doors etc if she is a wanderer. Try to make sure she is in a good sleep regime (medication can affect this both ways) so that she sleeps more at night.

[Anonymous]

I get that you don’t want people coming in to the house. But it is her house - ethically- and she wants to stay in it. If it proves impossible then that is another thing. But I would say you have a duty to try.

This might all be over in a few weeks or months. I would try to keep her at home.

[Anonymous]

Anonymous wrote:Since you can’t keep her safe at home, she needs to be in a nursing home.

News flash. Safe is not necessarily the ultimate goal for the infirm. Sometimes you respect their wishes to live as they’d like and let the chips fall where they may.

[Anonymous]

I'm in a house with Mom and caregivers now.

For now I'd hire caregivers M-F while you are out of the house. The caregivers can get Mom up and going.

Weekends you might get by with 4 hours in the morning, again to get her up and going.

We are in rural Maryland and pay $29 per hour. Almost all of our caregivers are direct hire. I think we have one now through an agency.

[Anonymous]

Anonymous wrote:

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.

The mother stupidly gave it to her daughters who will not inherit it, but keep her mom’s cost basis from probably 1975. Now they won’t even pay for moms’s care.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

It's not easy to get an elderly person declared incompetent. You need have a doctor sign off on it, which most are reluctant to do.

We had no issue getting a doctor, but actually it's two doctors, not one and the court appointed an attorney for the person who also has to agree. However, if Mom owns the home, it really sounds sketchy.

[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).

You should be paying more than 50% given your family is living there and she is one person. This will not be as simple as you think. You will have to pay off that mortgage with the estate money and then buy your sister out. If you go via Medicaid you may be able to stay in the house for a while but they will put a lien on the house and take all but $70 or so of her pension check.

You are best off buying off the house, using that money to pay for a nursing home till you spend it down and then go via medicaid. Or, get an aid to help.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:There are a lot of aspects to this, but one thing needs clarification and I have one suggestion for OP to reflect on.

1. Who owns this house? Both legally and in understanding/practice? At the time of whatever happened to the deed, did everybody understand that it was to protect an asset upon death and that it was still mom's home to live in until her death?

2. OP, think hard about whether you are trying to make decisions in your mother's best interest or your own. If you are thinking about your mother's best interest it seems that the answer is to do what is necessary for her to stay in her home OR sell the home so that you have the means to provide the quality and type of facility that she deserves.

She already explained that she and the sister own the house.

but she also said her mother still has a mortgage on it. It doesn’t make sense.

OP here. Mortgage is in her name.

However from an estate planning perspective the life estate (which was set up 6-7 years after the mortgage) passes the property on to my sister and I if anything happens to Mom. As long as the payments continue (and they have) the bank really doesn’t care about this structure (nor frankly do they even know about it) - we asked the same question at the time. That’s the legal advice we were given, and assume still applies.

If push comes to shove we can liquidate some investments in the span of a few days (which DH is not happy about - at all) and pay the mortgage off in full, and have a clean slate going into this.

Your mom owns this house. It doesn't matter that you are contributing to the mortgage. And, that contribution is really rent. If she dies, you may have to refinance. If she's in the house, they don't care who pays.

[Anonymous]

Anonymous wrote:Would love the board’s thoughts on a difficult situation that my family is facing.

My mother is 88 and for the last several years her mobility has progressively worsened and she is now showing signs of dementia.

My family (husband and 2 boys, ages 6 and 2) live with her - we have been here since July 2020. We were living in another part of the country and moved back in with her when we returned to the area. Even then, her health was not great and we didn’t think she ought to be alone, certainly not during the first months of the pandemic. We expected this move to be temporary, but ultimately decided to stay here and have refurbished/updated the house to make it more family-friendly. And since our arrival, Mom has not had to lift a finger. Everyone has been happy although living with an 88 year old and two small kids has not been without its challenges.

Fast forward to today - Mom is not doing well. Her first hip replacement took place in 2015 and the second in January of this year. She has progressed from walking with a cane to now using a walker, and falls often in the house. We’ve woken up in the middle of the night several times to find her on the living room floor. She no longer can consistently remember how to use the television, phone, check her email etc. She does not feel comfortable showering without assistance. She stopped driving a few years ago. (FWIW, my dad passed away in 2006 so only need to focus on Mom)

Despite our best efforts, her diet is terrible - does not cook anymore. She does not eat very much at meal time, but still likes to snack on sweets throughout the day. She prefers to drink tea and Pepsi (her beverages of choice) - and as a result is not well-hydrated and generally not very energetic.

As this year has progressed, she has been increasingly disoriented, which exacerbates her already being unsteady on her feet. She was never a great sleeper, and being tired only makes everything even worse.

Over the last year she has been to the hospital 5 times. Three of these were trips to the ER in ambulances coming to the house - in September she fell in the bathroom and hit her head on the sink (bleeding all over and requiring stitches), and in October she (not her fault) also spent a week in the hospital because she caught COVID.

Earlier this month she fell in the driveway and hit her head on the sidewalk. They feared a hemorrhage but it “only” was a concussion. After a week in the hospital, she went to a rehab center - and on the first night, tried to get out of bed and fell once again, only to be brought back to the ER first thing in the morning. She has virtually no recollection of any of this.

The doctors have said any of these situations could have been fatal.

We now know she needs constant supervision. However all Mom wants to do is “go home”. My sister thinks we should honor her wishes and hire 24-7 care for Mom at home, while my view is that bringing her back here solves nothing - and that she needs to be in a nursing home. DH and I don’t like the idea of random helpers coming and going at all hours, nor having them around the house during the day when nobody is home - or even being here when we are home, as we don’t have a bedroom to spare. (DH works, I recently started a new job after being SAHM for 6 years, and kids are at school/daycare all day). We don’t want our children to be witnesses to the decline of their grandmother day in and day out.

Mom gets a pension check totaling about $4500 per month. My family could pay ~$2000 a month as well. So I am hopeful we could find something that is suitable and comfortable for her. (My sister and her husband are not high earners, and have already told us that they cannot help defray any of the costs.)

I will listen to sister’s input (we generally have a good relationship) but I do not feel it is really her decision to make - The burden for having Mom back home here falls 100% on to me and my family. Sister does not live here, and furthermore DH and I will be paying. Mom will not like this decision, but I strongly feel she is at the stage now where she needs to be in a nursing home.

Hope this all makes sense and thanks for reading if you have made it this far.

WWYD?

Typically with caregivers you don't get random helpers. We have a core of women. They really are top tier. One is close to getting her RN Degree, one is getting her masters degree in social work, one just graduated with her mortuary degree (she has been working on this for 3 years), one is a new Mom, and two caregivers are close to 70. All are CNAs. Most have extensive Assisted Living and Nursing home experience.

We have never had any theft in 15 years of caregivers but we are in rural Maryland where people have old school values.

At your level of care I'd recommend CNA's only. Ideally you get CNA's with a lot of Assisted Living experience and also Nursing home experience. Many unskilled women are called home housekeeping aids. Avoid them.

Does Mom have her own room? Can't you put two comfy chairs in their and a tv in Mom's room so if you have someone in 3 or 4 hours on Saturdays then Mom and caregiver can hang out in Mom's room while the family is home.

We don't have people coming and going at all hours. In your situation you could probably get by with 8-4 or 9-5 M-F.
Give standard shifts. Have the same people on their designated days.

We started with 4 hours per day M-F fifteen years ago and 0 hours on the weekend. Very slowly we built up to more hours.
Now we run 12 hour shifts but Mom is now bedbound.

Three of our caregivers have been with us over 10 years. We pay well and treat them well. They all get the WiFi code on the first day. Many are in college so do their studies on line. If Mom is napping caregivers are allowed to nap. Almost all of our caregivers work 2 jobs. Some work 3 jobs. Three have bought their first homes since working for us having clawed their way out of section 8 rentals.

Decline of family members is a part of life. It has only been around the last 40 years ago that seniors in America got shuttled off to nursing homes. In much of the world elders are cared for in their homes.