For those well-meaning social workers

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Medicare services are based on medical necessity as ordered by the physician, not on what is easier for the social worker. However even for people who qualify for in home personal care services (people who meet nursing home level of care and meet Medicaid income and eligibility requirements mostly) it is extremely hard to find qualified workers right now. Also extremely hard to find nursing home beds. Social workers can’t fix that.

So since my aunt is end stage pancreatic cancer, lives alone ,has no kids, I guess the hospice will leave her in bed to die and rot,right? Because I am leaving in a week regardless - I have no choice.

Do you think the social worker has more choice to move in with her than you do? Or more responsibility?

I'm not saying you have responsibility to do so. I'm saying your problem -- and it is a problem, since you are taking it out on other people -- is in insisting others have more responsibility than you. It is not sufficient to compel you, but that does not follow that that it must then be sufficient to compel them.

It’s not my problem. And I won’t make it my problem.The state MUST step in as the situation is unsafe. That’s the damn law.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Medicare services are based on medical necessity as ordered by the physician, not on what is easier for the social worker. However even for people who qualify for in home personal care services (people who meet nursing home level of care and meet Medicaid income and eligibility requirements mostly) it is extremely hard to find qualified workers right now. Also extremely hard to find nursing home beds. Social workers can’t fix that.

So since my aunt is end stage pancreatic cancer, lives alone ,has no kids, I guess the hospice will leave her in bed to die and rot,right? Because I am leaving in a week regardless - I have no choice.

Do you think the social worker has more choice to move in with her than you do? Or more responsibility?

I'm not saying you have responsibility to do so. I'm saying your problem -- and it is a problem, since you are taking it out on other people -- is in insisting others have more responsibility than you. It is not sufficient to compel you, but that does not follow that that it must then be sufficient to compel them.

If your aunt is under hospice care and they are aware she lives alone, they will work with her physician/medical team to either bring in more care (as needed) or advise her to go into a full-time facility. They are the ones who should have had that conversation with her directly and would be surprised if they have not, since she is at the end stages. If you have been the go-between then you must make it clear that you are just a "visitor"who has no input (legal or familial) and will be leaving in a week.

Then go home. I think it's best for everyone if you just step out of the picture permanently as it is obviously taking a serious mental toll on you, as your logic and compassion are questionable now.

I have absolutely done that. Stated flat-out I am the visitor. The new hospice we are hiring fully understands that and said the state will step in and do what they can. I told them they are welcome to her pension+social security and her vehicle, which is pretty new and highly sellable.

It is indeed taking a serious mental toll on me. My logic and compassion are intact, however, but I’m mad as hell after being accused of stealing her narcotics (they are accounted for AND that was witnessed by three of her friends). I plan to report them to the state, once my aunt is in the care of the other hospice, who will make sure her pain is managed properly (they said it is decidedly NOT now). I never want to witness again, what I witnessed this AM - an old woman barely standing, in severe pain, peeing her pants, and staggering to try and get back into bed, due to a narcotics error on the nurse’s part

[Anonymous]

Anonymous wrote:Grow up. Your aunt needs a nursing home and 24-7 care. Stop expecting others to deal with it. She can not care for herself.

DUH! She is refusing to go and that’s that.

When can I expect you to come and step in?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Medicare services are based on medical necessity as ordered by the physician, not on what is easier for the social worker. However even for people who qualify for in home personal care services (people who meet nursing home level of care and meet Medicaid income and eligibility requirements mostly) it is extremely hard to find qualified workers right now. Also extremely hard to find nursing home beds. Social workers can’t fix that.

So since my aunt is end stage pancreatic cancer, lives alone ,has no kids, I guess the hospice will leave her in bed to die and rot,right? Because I am leaving in a week regardless - I have no choice.

Do you think the social worker has more choice to move in with her than you do? Or more responsibility?

I'm not saying you have responsibility to do so. I'm saying your problem -- and it is a problem, since you are taking it out on other people -- is in insisting others have more responsibility than you. It is not sufficient to compel you, but that does not follow that that it must then be sufficient to compel them.

It’s not my problem. And I won’t make it my problem.The state MUST step in as the situation is unsafe. That’s the damn law.

The state must step in to make decisions for an adult that meets the legal definitions of competence in this area, against their explicit and expressed wishes? At gunpoint, or just by having the police drag them and then, I guess, handcuff them in place?

[Anonymous]

^^Let me be clear -- I don't think you can do it right now, either, OP. But that doesn't mean other people can.

[Anonymous]

Weird how EVERYONE you encounter is just the worst and so incompetent...

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'm a social worker and deal with situations like this frequently. OP, your expectations are way off. First of all - our job is to help our clients self determine. If you and I were having this conversation, I would be empathizing and validating your concerns but nothing else. Your family members don't want to do what you want them to do. As far as I can tell from your post they are competent and making their own decisions. So what you want really doesn't matter. If you want something to change, work with your family members directly. We social workers are not in the business of pushing our clients to do what their nasty/entitled/condescending relatives want them to do.

Also - our elder care system sucks and is lacking in so many ways.

. We social workers are not in the business of pushing our clients to do what their nasty/entitled/condescending relatives want them to do. . Wow, here you go, OP. This is pretty telling as to what SW think of the tired, stressed, scared, overwhelmed family members with all the responsibilities but none of the authority, trying to help.

NO surprise at all. I was actually shamed today for asking what benefits my aunt was entitled to - that she's paid for involuntarily for most of her life.

Boohoo. OP is shamed, accused... when will the terrible abuse of OP end?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Grow up. Your aunt needs a nursing home and 24-7 care. Stop expecting others to deal with it. She can not care for herself.

DUH! She is refusing to go and that’s that.

When can I expect you to come and step in?

DP. I’m willing to help. What, exactly, are you looking for?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Grow up. Your aunt needs a nursing home and 24-7 care. Stop expecting others to deal with it. She can not care for herself.

DUH! She is refusing to go and that’s that.

When can I expect you to come and step in?

What does your aunt think is going to happen if she doesn’t go, and she can’t care for herself at home?

[Anonymous]

OP, go back home. Go back to your house and your husband, and reopen your business. It's time for you to step back now.

Why isn't your sister helping more?

You say that you have a very large family and that you are one of 32 nieces and nephews. Why is no one else volunteering?
Why should it be YOU?

I was in a similar position years ago, when my father (a widower) was very ill but he refused to move to more appropriate accommodation and he also cancelled the home aides I had organized for him.

I am an only child and my husband and I live 6 hours away.
DH and I would drive to my father's house whenever we were able to, to help at weekends (DH and I both work) but in the end it was unsustainable to drive there every weekend.

Most of my (able-bodied) relatives lived about 10 minutes away from my father's house but NO ONE volunteered to help, even just checking in or calling my father to see if he was OK.
To be fair, one of my uncles and his wife did buy and deliver my father's groceries for a while but they grew tired of it eventually.

The burden landed on my shoulders in the end, even if I lived 6 hours away.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Medicare services are based on medical necessity as ordered by the physician, not on what is easier for the social worker. However even for people who qualify for in home personal care services (people who meet nursing home level of care and meet Medicaid income and eligibility requirements mostly) it is extremely hard to find qualified workers right now. Also extremely hard to find nursing home beds. Social workers can’t fix that.

So since my aunt is end stage pancreatic cancer, lives alone ,has no kids, I guess the hospice will leave her in bed to die and rot,right? Because I am leaving in a week regardless - I have no choice.

Do you think the social worker has more choice to move in with her than you do? Or more responsibility?

I'm not saying you have responsibility to do so. I'm saying your problem -- and it is a problem, since you are taking it out on other people -- is in insisting others have more responsibility than you. It is not sufficient to compel you, but that does not follow that that it must then be sufficient to compel them.

If your aunt is under hospice care and they are aware she lives alone, they will work with her physician/medical team to either bring in more care (as needed) or advise her to go into a full-time facility. They are the ones who should have had that conversation with her directly and would be surprised if they have not, since she is at the end stages. If you have been the go-between then you must make it clear that you are just a "visitor"who has no input (legal or familial) and will be leaving in a week.

Then go home. I think it's best for everyone if you just step out of the picture permanently as it is obviously taking a serious mental toll on you, as your logic and compassion are questionable now.

I have absolutely done that. Stated flat-out I am the visitor. The new hospice we are hiring fully understands that and said the state will step in and do what they can. I told them they are welcome to her pension+social security and her vehicle, which is pretty new and highly sellable.

It is indeed taking a serious mental toll on me. My logic and compassion are intact, however, but I’m mad as hell after being accused of stealing her narcotics (they are accounted for AND that was witnessed by three of her friends). I plan to report them to the state, once my aunt is in the care of the other hospice, who will make sure her pain is managed properly (they said it is decidedly NOT now). I never want to witness again, what I witnessed this AM - an old woman barely standing, in severe pain, peeing her pants, and staggering to try and get back into bed, due to a narcotics error on the nurse’s part

Hospice are not full time caregivers. You need to put her in a nursing home.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
All I was looking for was why my aunt was legally entitled to via Medicare. Why be cagey about that? Surely there is a directive?

OP, I'm a caregiver for my husband, and I get where you are coming from.

The entire system is set up to assume and expect that the "loved one" will do everything to take care of the patient. With no training and certainly no compensation from the insurance company.

I learned that there is a diagnostic code that essentially says something like "no caregiver able or willing"

Here it is:

The following code(s) above Z74.2 contain annotation back-references that may be applicable to Z74.2:

Z00-Z99 Factors influencing health status and contact with health services
Z74 Problems related to care provider dependency

Approximate Synonyms
No able caregiver in household

ICD-10-CM Z74.2 is grouped within Diagnostic Related Group(s) (MS-DRG v39.0):
951 Other factors influencing health status

The Social Worker doesn't have anything to do with a diagnosis of course. But I assume her life is made easier if there is an able caregiver. Otherwise she has to do more work to ensure care for the patient.

Social worker here and I just want to emphasize it is not our job to "ensure care" for the patient. If the patient is competent to make their own decisions and doesn't choose to hire help or declines the paltry amount of care Medicare generally pays for (think 1-2 visits per week from a RN lasting about 30 mins at a time) then there isn't much we can do. We can report to Adult Protective Services if we have active safety concerns -- generally they do nothing unless there is a question of competency. The landscape is bleak, but the issue is not that it's easier for me if the family takes care of it. There really isn't much else to offer. If someone is admitted to the hospital then I suppose they could get one of those ICD diagnoses and potentially be placed in a nursing facility, but that isn't really something I would be involved in.

+1. Unfortunately, some people seem to think there is some seamless process “the state” has for transitioning elderly people from their homes to care facilities where they will be well taken care of. This does not exist. There is not a social worker or doctor that is trying to trick OP into doing all the work because they don’t want to, they are just extremely limited in terms of what they can legally do to help. PP is right, they can call APS if there are very serious safety concerns but the social workers aren’t holding out on some wonderful program because they are mean. OP has unrealistic expectations around the level of support that is available to elderly people. If she doesn’t want to involve herself in any of this that’s her choice but lashing out and expecting more than what the system can legally offer isn’t going to help anything

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
All I was looking for was why my aunt was legally entitled to via Medicare. Why be cagey about that? Surely there is a directive?

OP, I'm a caregiver for my husband, and I get where you are coming from.

The entire system is set up to assume and expect that the "loved one" will do everything to take care of the patient. With no training and certainly no compensation from the insurance company.

I learned that there is a diagnostic code that essentially says something like "no caregiver able or willing"

Here it is:

The following code(s) above Z74.2 contain annotation back-references that may be applicable to Z74.2:

Z00-Z99 Factors influencing health status and contact with health services
Z74 Problems related to care provider dependency

Approximate Synonyms
No able caregiver in household

ICD-10-CM Z74.2 is grouped within Diagnostic Related Group(s) (MS-DRG v39.0):
951 Other factors influencing health status

The Social Worker doesn't have anything to do with a diagnosis of course. But I assume her life is made easier if there is an able caregiver. Otherwise she has to do more work to ensure care for the patient.

Social worker here and I just want to emphasize it is not our job to "ensure care" for the patient. If the patient is competent to make their own decisions and doesn't choose to hire help or declines the paltry amount of care Medicare generally pays for (think 1-2 visits per week from a RN lasting about 30 mins at a time) then there isn't much we can do. We can report to Adult Protective Services if we have active safety concerns -- generally they do nothing unless there is a question of competency. The landscape is bleak, but the issue is not that it's easier for me if the family takes care of it. There really isn't much else to offer. If someone is admitted to the hospital then I suppose they could get one of those ICD diagnoses and potentially be placed in a nursing facility, but that isn't really something I would be involved in.

+1. Unfortunately, some people seem to think there is some seamless process “the state” has for transitioning elderly people from their homes to care facilities where they will be well taken care of. This does not exist. There is not a social worker or doctor that is trying to trick OP into doing all the work because they don’t want to, they are just extremely limited in terms of what they can legally do to help. PP is right, they can call APS if there are very serious safety concerns but the social workers aren’t holding out on some wonderful program because they are mean. OP has unrealistic expectations around the level of support that is available to elderly people. If she doesn’t want to involve herself in any of this that’s her choice but lashing out and expecting more than what the system can legally offer isn’t going to help anything

Understood.

But the question one should ask is the following: why does the full burden of giving care to her parents and her clearly very ill aunt fall solely on OP's shoulders?

She has a sister. What is she doing to help?

OP stated in an earlier post that she has a very large family and that she is one of 32 nieces and nephews.
Why is no one else helping?

OP lives 3000 miles away from her parents and her aunt.

She has a husband and a business to run.

Why is no one else in her family volunteering to offer practical help to the parents and the aunt?
Does anyone one in OP's family care? Do he not realize that the current situation is unsustainable to OP?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Medicare services are based on medical necessity as ordered by the physician, not on what is easier for the social worker. However even for people who qualify for in home personal care services (people who meet nursing home level of care and meet Medicaid income and eligibility requirements mostly) it is extremely hard to find qualified workers right now. Also extremely hard to find nursing home beds. Social workers can’t fix that.

So since my aunt is end stage pancreatic cancer, lives alone ,has no kids, I guess the hospice will leave her in bed to die and rot,right? Because I am leaving in a week regardless - I have no choice.

Do you think the social worker has more choice to move in with her than you do? Or more responsibility?

I'm not saying you have responsibility to do so. I'm saying your problem -- and it is a problem, since you are taking it out on other people -- is in insisting others have more responsibility than you. It is not sufficient to compel you, but that does not follow that that it must then be sufficient to compel them.

It’s not my problem. And I won’t make it my problem.The state MUST step in as the situation is unsafe. That’s the damn law.

The state must step in to make decisions for an adult that meets the legal definitions of competence in this area, against their explicit and expressed wishes? At gunpoint, or just by having the police drag them and then, I guess, handcuff them in place?

According to hospice, she no longer meets the legal definition of competence. Such is the dying process

[Anonymous]

Anonymous wrote:Weird how EVERYONE you encounter is just the worst and so incompetent...

Not everyone. The new hospice is wonderful!