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[quote=Anonymous]

OP -  It makes the most sense to have your inlaws remain in the state with good Medicaid services and a circle of friends and cultural supports for you MIL.  There are two issues from  your post - finding the right level of continual support for FIL and ensuring that MIL is able to remain where she has friends and a lifestyle suited to her so that she can be a support to FIL in a more supervised setting.

One might first contact elder care services or the office of aging where the in-laws live to see if there is an agency or individual senior health navigators that could help DH or SIL if they went out to the area to visit nursing care facilities as it seems like FIL is beyond the level of assisted living.  By phone contact alone, one might also be able to find out if most facilities have a waiting list for Medicaid patients or which have openings.  In any case time to get out to see what the nursing homes look like and put FIL on the waiting list at least.  Also, find out if the nursing home provide rehab services and/or have a dementia unit, too.  If there are not in-house rehab services, then when certain things happen like a fall for example, one might be shipped to a rehab place for a time AND then you have the issue of keeping the Medicaid bed.

Also, try and find out if there is an agency or individual that would work with MIL to hire Home Health Aides and oversee the overall care of FIL.  If DH and SIL could cover this management cost, perhaps it would relieve MIL of the stress.  And she would have a place to turn to help bring in coverage.

One also needs to be sure and go with FIL and MIL to the appropriate doctor dealing with FIL's dementia or general health care.  You need to know firsthand what the doctor has been told is happening, that a complete list of all medications and supplements/herbs and OTC meds are given to the doctor to rule out any toxic interactions and to get appropriate medications in place.  One would then need to try and simplify the medication distribution for MIL as much as possible.

It really sounds as if FIL does need a placement with 24/7 support as soon as possible.  I would also get in touch with the local DSS to get a Social Worker involved again to check in on their overall state if possible and if other senior Case Management can't be afforded.  When aides are present, MIL needs to learn to take a break and get some respite.  Again, you are quite correct that some states such as Virginia are just horrible in funding all sorts of Medicaid services.  Given that SIL is expecting, maybe she could do the phone leg work and DH could go out and do on-site research, get to doctor with FIL/MIL and most likely they would respond more to his suggestions given their background.

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