How can I make a move of my unhealthy mother to San Francisco be successful?

August 12, 2009 3:03 PM

I would like to move my schizoaffective, obese, diabetic, IBS mother to San Francisco from Maryland so I can help manage her health and get her healthy again. What resources should I look into? What problems should I anticipate?

My mother lives in Maryland, where I grew up, while I live in San Francisco. I have lived here for four years. Her health is slowly but surely getting worse and I would like to move her close to me so that I can go to medical appointments, help her grocery shop and eat better, go on walks with her for exercise, etc.

She is currently in a program in Maryland that she goes to several times per week, and also gets housing through them (with four roommates with similar mental and physical health issues). She is on Medicare, and she receives disability and social security money, about $1000/month. My brother and I will be covering the balance of her expenses.

I will be taking advantage of any and every free and discounted program I can for her. What do I need to watch out for? Are there programs I should know about? Will there be significant issues with her being a new resident of California - ie: will she have to wait a year or something before being able to take advantage of certain resources?

Thanks for any help you're able to provide. Also, I am sure there is plenty of other information that I could offer here that I'm just not thinking about.

posted by fourmajor to health & fitness (5 comments total)

Not to snark, because I think your intentions are charitable, but this post has the wrong focus; in its wording, it is all about what you want, and not much about what your Mother wants. Frankly, it sounds like she has a stable living situation in Maryland, and is just slowly having the ravages of age catch up with her. In the long run, that is inevitable, but you might forestall the progress of some of her problems by more involvement in her life. But to do that in the way that is best for your Mother, you may have to open up to more basic adjustments.

It might be the best thing for your Mother, that you do the moving. In Maryland, without disturbing her benefits or living situation at all, you could bring whatever caring and support you can provide to her, and if that does improve her life substantially, she would have more options regarding living situations. For her, that's a far lower risk strategy, than moving to San Fransisco to join you, because if after such a move, her circumstances didn't work out, she'd be in what is for her, a strange city, with few connections or resources.

A lot depends on your Mother's state of mind, and how willing and capable she is to remain on medications. Generally, people who have multiple physical health problems, in addition to psychiatric problems, are very prone to going off medication spontaneously, or to have very unpredictable reactions to small changes in their physical health. The regularity of their schedule, down to simple eating habits, quite often determines even the absorption and day to day efficacy of such medications as they normally take. It sounds like she is past the point of being able to live independently, but I wonder if you are fully willing to assume a 24x7 care responsibility, for a person that is marginally stable, and may be less stable as time goes on, and that may go on for years.

You can probably begin to assess the practicality of doing this, by taking a month or so back in Maryland with your mother, and talking with her current doctors and care givers about your ideas. Get a list of her medications, an inventory of her Social Security benefits, state benefits (if any) and other financial resources, and see if she is still competent to handle her own affairs with minor help, or if she really needs substantial assistance in living. Discuss what you find with the rest of your family, and listen to their advice.

As for social programs in California that can help with your Mother's case, I think you have to recognize that the State is in a long term financial bind, and that state resources for social programs are being cut left and right. Federal programs, like Social Security and Medicare would likely remain your Mother's principal stipends in California in the foreseeable future. But you could begin with a thorough search of the California Department of Social Services Web site, for ideas on what assistance you might find in that state.

Good luck with your efforts. And I say that sincerely, as one who moved to help aging parents, and assumed the care of my schizophrenic brother, who lived with them for many years, when they died. There are rewards to caring for family members, but the responsibility and the cost of the effort can be overwhelming at times, if you are not fully prepared for the needs that they can present.
posted by paulsc at 4:19 PM on August 12

Can you clarify whether this is something your mom wants? 'Cause if she doesn't then it's not going to work.
posted by Brandon Blatcher at 4:37 PM on August 12

paulsc: Thanks for the comments. I'm not willing to move back to Maryland; I love my life here in San Francisco and it would be a huge mistake for me to move.

Her living situation in Maryland actually isn't very stable. She tends to live in the same places for a couple of years at a time, but her health problems have gotten worse and worse generally. Her mental health has been good over the past seven years, but now the bigger concern is her physical health. Her declining health isn't natural; it is something that she could turn around to a large extent with a better lifestyle. Her current environment isn't conducive to that. I fear that if she stays in her current situation, she will be dead or her problems will be severe and irreversible within the next five years.

She is able to live independently on a day-to-day basis, but definitely needs someone more involved in her life to make sure she is making healthy decisions. Things like cooking basic meals, bathing herself, getting on public transit, etc, she is able to handle.

Also, thanks for the link. I'll take a look through that website.

Brandon: I am guessing my mom will want this. My brother and I are going to talk to her on Friday about it. I wanted to arm myself with information before we talk to her. Obviously, it is her life, and therefore it is up to her whether she moves or not.


Other information that I should point out - I guess she is actually on Medicaid (I will find out for sure on Friday), and she is 55 years old. I think if we can turn around her health problems she can have 20 quality years ahead of her.
posted by fourmajor at 4:55 PM on August 12

"... I'm not willing to move back to Maryland; I love my life here in San Francisco and it would be a huge mistake for me to move. ..."

Supposing your mother can't, or won't move, are you content to let her continue to decline alone, in Maryland? Will you meet your filial duty with phone calls and e-mails, until she gets too weak to take care of herself, and then swoop in, have her declared incompetent, and wheel her off to S.F., regardless of her wishes?

Every family has its own dynamic. I can't tell you what is reasonable, within yours. I can tell you that elder care, unless the elder has independent means, is an expensive, bureaucratically difficult proposition. To be successful, I find it best to remain flexible in terms of mindset and method, and focus on quality of outcome for all concerned.

Within my own family, given the long respect for my hopes and dreams my folks always held, and the support my parents offered for my independence at some critical early junctures, it was only right that I respect what was practical, when the time came, to help them maintain their lives comfortably, until they died. Even so, it cost me more than $20,000 to move myself a few hundred miles, take a hit on the sale of my home, and care for my parents for the last few months of their lives. It costs me more than my schizophrenic brother receives in SSI benefits each month, to house, clothe and feed him, but we are grateful that his prescription benefits, worth several hundred dollars a month, are covering his medication and psychiatric management. I buy his eye glasses, and pay his dental bills, because there are no public programs in our state that do that. All of that is just the sunk cost of being a member of a family, according to our family's ethic, and I am happy to do it. My "reward," though none is needed, is to know my brother is not out sleeping under a bridge tonight, muttering to himself, and afraid of others who are looking for a dry sleeping place, too, this stormy Southern night.

Here's hoping for your sake, and your Mother's, that she has been waiting to have you ask her to move out to San Fransisco with you, and that you are financially able to help her do so, for as long as she may need.

"... Obviously, it is her life, and therefore it is up to her whether she moves or not. ..."

Maybe it is, and maybe not. Many elders of limited means must protect their eligibility for public assistance programs, first and foremost.

"Other information that I should point out - I guess she is actually on Medicaid (I will find out for sure on Friday), and she is 55 years old."

A 55 year old Medicaid patient can't generally have the financial resources to entertain cross-country relocation on her own (the money it would take to make such a physical move almost certainly exceeds Medicaid eligibility guidelines). If she is a Social Security SSI or SSD recipient, there is a low ceiling for her total assets to remain eligible for those Federal programs, too. It's very tricky to engineer a move like you are talking about, without running afoul of those kind of eligibility guidelines. Given that her prescription benefits and housing are probably keyed to her Medicaid eligibility, and that Medicaid eligibility in Maryland is probably keyed to her Federal SSI/SSD benefit eligibility, you are potentially undertaking several thousand dollars a month in personal expense, to keep her at the same living standard she now has in Maryland (which is pretty minimal), just to move her to California, if by paying for her move, you are determined to have pushed her annual income/assets above program eligibility limits.

Whether she can again qualify for California's State Supplemental Payment program and related housing and prescription benefits in San Fransisco is not at all certain, especially in a timely manner. Could you support your Mother entirely for at least 1 year, while she waits out housing waiting lists, or goes through housing eligibility review in a new, nearly bankrupt, state bureaucracy? Can you find doctors and psychiatrists to treat her, that accept payment at state levels of reimbursement, and that treat and prescribe with an eye to state funding of prescription benefits and medical services?

Good luck with all this. It's never easy. You might check in your area with NAMI, too, regarding resources for folks with schizoaffective disorder. It's a volunteer run organization, so you may need to work at finding the right people to talk with in your local chapter, but that is the fastest route to accurate information on local resources.
posted by paulsc at 9:31 PM on August 12

My brother and his wife are also in Maryland, and want to eventually have my mother move in with them, but they aren't ready for this yet. They need a bigger house first. This is why it isn't necessary for me to move back to Maryland, because he is there. Besides, I would never move her back to San Francisco "regardless of her wishes." It is her life, not mine.

Additionally, I didn't ask the question "is it ethical to move my mother to San Francisco." I asked how to make it happen. I have no doubt that, if the pieces fall into place correctly, a move to San Francisco where I can help my mother would be beneficial to her.

I will do some additional research on what will happen to her income should we move her.
posted by fourmajor at 5:35 AM on August 13