Need help with aging parents

January 7, 2009 5:22 PM

Aging parents question. My wife’s parents are in their 80’s and are both in poor health, and we don’t know where to start looking for help as far as care for them is concerned. All details inside.

They live in Georgia in a small apartment in a nice complex while we are in Virginia. My father-in-law is basically bed ridden and mom-in-law is his sole care giver except for a social services home care help that comes in a couple of times a week . Except for their small pensions from his military service and mom-in-laws career as a nurse they have no other income other than their social security. Medicare and Medicaid cover the prescriptions that are needed, but they are still having problems making ends meet.

Mom’s health is now causing concern and we think that she won’t be able to care for pop much longer. I believe the only option is for my wife’s father to be in some kind of assisted living facility where he can be cared for professionally and mom does not have the added stress of caring for him basically 24/7.

What are our options as far as assisted living is concerned for people on a limited income in the Medicaid system? Private places are out of the question as they want too much money. Is there some kind of state run assisted living facility we can look into? What about hospices – how do they work and what level of terminal illness do they usually accept? I have no idea of how to deal with this or where to start looking for help. They will not under any circumstances leave where they are (south of Atlanta) and come up to us. My wife is planning to go down for a few days in the next week or two, so this is the time to be contacting people to find out more about this. But who to contact? Doctors? Social Services? Who? Thanks.

posted by 543DoublePlay to health & fitness (8 comments total)

Your first step should probably be the local Council on Aging. I see there's one for Fulton County and there also seems to be a general Georgia state one. This group also might be helpful. They can definitely get you pointed in the right direction and talk to you about what some of your options are. They'll also have lists of all the nursing homes and care facilities and, hopefully, will be candid enough to tell you which ones should be avoided at all costs. Your other best bet is going to be a social worker. The one who came here to talk to me about my aunt was really, really great - she was affiliated with the local Rehab/Hospice/Therapeutic hospital. So you might also try calling the local hospital and asking them about a social worker. Here's a list of nursing homes who say they accept Medicare/Medicaid in the greater Atlanta area. You're going to want to research any home really, really thoroughly - unfortunately, there are some real snakepits out there. Even the expensive ones can be scarily bad. Go to the homes and look around and be persistent. Good luck to you and your wife! This is a long journey and not a fun one, as I have recently had a lot of cause to find out.

Oh and AFAIK, hospice will only take someone who has been diagnosed with a fatal illness and is not expected to live more than six weeks so unless that's the case, I wouldn't go there just yet.
posted by mygothlaundry at 5:50 PM on January 7

Do they have any kind of home health care available to them through their county? Just google Home Health Care (Their County) Georgia and see what's available. If you can't convince them to move, and they aren't ready to leave their home, it might be the most humane solution.

They'd be assessed by a social worker to decide how much care they both needed, in terms of hours per week, and what sort of assistance they needed. (nurse vs someone helps with the housework and makes their breakfast and dinner). Your wife and her parents might be able to interview possible carers and choose the one they liked best. A friend of mine did this for a while to pick up some extra cash when she was studying for her BSN, so yes, you can get some really excellent care if you're lucky. My home county in CA means tests people applying for carers through their home health care, but if the applicant is truly poor, the county picks up the tab for their care. It's cheaper than putting someone in a rest home, and oftentimes, the outcome is better.

Hang in there. Is there any chance at all that they might be able to move closer to you? Or you to them? I'm just thinking about the wear and tear on you and your missus. No travel is as wearisome as the travel to and from the home of someone you care about with a debilitating illness. And no worry is quite like the one about people you can't see on a casual basis.

Best of luck to both of you in this.
posted by Grrlscout at 5:53 PM on January 7

First, Hospice is for people with a life expectancy of 6 months (not weeks as stated above).

Yes, your Council on Aging will offer help all along the way. Medicaid will pay room and board in a Skilled Nursing Facility. There may be a few assisted living facilities who accept Medicaid, but they are tough to find.

This is not an easy time, but there is help and support available. Look for a caregiver support group. You'll get lots of tips from others in the same situation.
posted by Jandasmo at 8:16 PM on January 7

One of the best things I did was hire a licensed social worker familiar with the benefits and services available in my area. She helped my dad and I tremendously with navigating all the options/services available (and the associated administrative requirements) for caring for my mom when my dad could no longer do it himself.
posted by Raymond Marble at 9:08 PM on January 7

A close friend of mine just went through this with her father. I think he had Medicaid. It was the same cost for the family to hire home health care and rent things like a hospital bed so that their dad could spend his last months at home with his wife. The alternate option was a shared room in the state-run nursing home, a tiny bed and a curtain for privacy. I know that since the home health care givers weren't hired for around the clock service (It seemed like they did get something like +40 hours a week care, divided up between two or three caregivers), a big part of their arrangement depended on having a somewhat able bodied family member living at home to help with changings and feedings in between caregiver shifts.
posted by pluckysparrow at 9:28 PM on January 7

As a couple of people mentioned above, you definitely need to contact the local Area Agency on Aging. Within the state of Georgia, most of the Medicaid-covered supportive services for people who want to remain in their homes as they age is coordinated through the AAAs. There's a different one in each region; you should be able to find a phone number by clicking through this site.

I'd recommend talking to the AAA folks before calling up home-based service organizations for information. Medicaid is run differently in each state (ESPECIALLY in terms of what long-term care services they cover for older folks), and there are seriously byzantine rules about what is covered under which situations and for how long. I'm sure that most of the people who run home health care agencies are lovely people, but they are running businesses and aren't necessarily going to be motivated to tell you that you'd be better off going through a different state program or getting a different type of service. Area Agencies on Aging, on the other hand--which are run by the state department on aging, and generally tasked with hooking older people and their caregivers up with screenings and the appropriate level of care--are much more likely to help you find a good match of services. In any case, if this is to be covered by Medicaid, you'll probably have to end up going back there for a screening (to make sure that your father is eligible in terms of his level of care required), so you might as well start in the right place rather than backtrack.
posted by iminurmefi at 7:36 AM on January 8

Also--I see your father is receiving a military pension. I know nothing about the military health care system, but is he eligible for care through the Veterans Administration (VA)? Have you tried calling the VA up to see if they can offer any assistance in terms of home health care or other services? That might be one more avenue to investigate.
posted by iminurmefi at 7:40 AM on January 8

Late to the thread but another thing that you can do is work with a geriatric case manager. That site can help you find one.
posted by dog food sugar at 5:44 AM on January 9