Anonymous
Post 01/07/2022 23:44     Subject: For those well-meaning social workers
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.
Anonymous
Post 01/07/2022 23:43     Subject: For those well-meaning social workers
Anonymous wrote:Here is what I had to remind myself. We all know we are going to get old. By middle age many of us have seen many permutations of what aging can look like from grandparents, aunts, uncles, friends' loved ones and we've heard the stories. Then we deal with our own parents. We can choose to bury our heads in the sand and we could end up in dire straits because of it. Or we can plan for ourselves and move to appropriate places in say our 60s. My own parents were conveniently too "busy" to visit their own parents much and all those they had buckets of money they refused to engage in conversations about planning beyond demanding they stay in their own home. They refused to explore what that really looks like. Everyone in their lives went into assisted living/memory care/nursing. You could not explain to them friends will move away, hired help won't always show and we may have to hire a stranger to live with them when they are no longer capable at all. Those conversations ended with screaming fits. Then life happens and there they are with a caregiver they abuse verbally who quits, family setting boundaries, a social worker they yell at and friends have stopped returning their calls. They had decades of retirement to explore things, but were too busy traveling, guilt tripping their kids and shopping to care.


BINGO!

My aunt is pissed at me because after being accused AGAIN by the incompetent hospice nurse (who didn’t look at the medicine chart I put on the wall for her convenience stating what meds were given and when, and thus gave my aunt a narcotic too early) of mishandling narcotics, I stated I would NOT be legal medical power of attorney. I’m sorry, but I’m not going to be sued by a hospice agency who’s own nurses are not competent.

This is after refusing to call in the best hospice in the area. I had them visit today for a second opinion and they were appalled at both what they saw regarding pain management for my aunt (no consistency, too many different narcotics, etc) as well as the accusations I was facing. Of course my aunt didn’t really understand much of what the nurse was saying due to the level of different narcotics in her system and it was all MY fault (I was trying to put her in a home, etc)

My husband: “You didn’t sign up for this. You’ve been kind. You’ve tried. And now you are being accused of narcotics abuse? Get out.”

I plan to hire in an aide for my aunt and get out
Anonymous
Post 01/07/2022 16:48     Subject: For those well-meaning social workers
Anonymous wrote:OP obviously your aunt WANTS to be at home, that’s why she is getting hospice care. Or do you think this is about you?


Not OP, but that also means that the aunt needs to be able to care for herself at home or has the means to hire an aid to care for her at home. OP does not live there and can't provide care unless she quits her job and leaves her own family.

It doesn't sound like the aunt or OPs parents are operating well intellectually.

When I was dealing with a similar situation I basically had to have a complete and total breakdown, complete with crying, before my parents understood the seriousness of the situation -and- that I wasn't going to leave my dh and job and house and live with them hundreds of miles away until they happen to die.
Anonymous
Post 01/07/2022 16:44     Subject: For those well-meaning social workers
OP, the only thing family can do in this type of situation is find the best nursing home care which will accept Medicare or whatever insurance they have. They have chosen to age in place, so they get whatever facility is available.

I was in your situation and I saw my job as fishing them the best possible place to care for them that they (or Medicare) could afford to pay for. You and your sister need to work together to make it happen, it really doesn't matter what your parents or aunt want, if they aren't willing to move near you. All houses need to be sold to pay for care. Tell the social workers that this is the x amount of money they have and go around to talk to different nursing homes and hospice facilities. It is going to take longer than a week, but less than a month. If you do some of this now, maybe sister can take over.

The key is to *never* allow the parents to be discharged back home, send them to a facility for rehab. Otherwise, you will not be able to pry them out of their house, and there is no way they can stay there without constant care, which is extremely expensive.
Anonymous
Post 01/07/2022 16:27     Subject: For those well-meaning social workers
OP obviously your aunt WANTS to be at home, that’s why she is getting hospice care. Or do you think this is about you?
Anonymous
Post 01/07/2022 08:03     Subject: For those well-meaning social workers
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.
Anonymous
Post 01/07/2022 05:02     Subject: For those well-meaning social workers
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.
Anonymous
Post 01/07/2022 02:56     Subject: For those well-meaning social workers
My favorite line from my mother is “I wasn’t ready yet” regarding moving. Now that she’s physically incapacitated, out of money and heavily in debt, NOW she’s ready but the burden is now wholly on me financially, physically, etc. Not an ounce of comprehension either, as to why that wasn’t a smart thing to do
Anonymous
Post 01/07/2022 02:53     Subject: For those well-meaning social workers
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.

Anonymous
Post 01/07/2022 01:24     Subject: For those well-meaning social workers
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.
Anonymous
Post 12/30/2021 14:13     Subject: For those well-meaning social workers
By the way...by moving to appropriate places in our 60s I don't mean assisted living. LOL! I mean ...we start thinking about "what is I need knee surgery and can't walk up the steps" or "Maybe I should be near good physicians and hospitals" and..."I would enjoy a walkable community." By 70 we need to think about continued care from independent living to the end in terms of where we live since as we get closer to 80 things change drastically with just a fall.
Anonymous
Post 12/30/2021 14:07     Subject: For those well-meaning social workers
Here is what I had to remind myself. We all know we are going to get old. By middle age many of us have seen many permutations of what aging can look like from grandparents, aunts, uncles, friends' loved ones and we've heard the stories. Then we deal with our own parents. We can choose to bury our heads in the sand and we could end up in dire straits because of it. Or we can plan for ourselves and move to appropriate places in say our 60s. My own parents were conveniently too "busy" to visit their own parents much and all those they had buckets of money they refused to engage in conversations about planning beyond demanding they stay in their own home. They refused to explore what that really looks like. Everyone in their lives went into assisted living/memory care/nursing. You could not explain to them friends will move away, hired help won't always show and we may have to hire a stranger to live with them when they are no longer capable at all. Those conversations ended with screaming fits. Then life happens and there they are with a caregiver they abuse verbally who quits, family setting boundaries, a social worker they yell at and friends have stopped returning their calls. They had decades of retirement to explore things, but were too busy traveling, guilt tripping their kids and shopping to care.
Anonymous
Post 12/30/2021 14:07     Subject: Re:For those well-meaning social workers
Anonymous wrote:Sorry social worker. Maybe I’m thinking of a discharge coordinator? They have to figure out a safe discharge plan. I assumed it was easier to do if they could just send them home with a caregiver, rather than needing to set something up.


DP, but they don’t *have* to send them home with a caregiver, absent a very specific need or someone deemed incompetent (which is a high bar). That’s the point.
Anonymous
Post 12/30/2021 13:39     Subject: Re:For those well-meaning social workers
Sorry social worker. Maybe I’m thinking of a discharge coordinator? They have to figure out a safe discharge plan. I assumed it was easier to do if they could just send them home with a caregiver, rather than needing to set something up.
Anonymous
Post 12/30/2021 13:04     Subject: For those well-meaning social workers
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.