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Please help us get my mom into memory care!
May 31, 2014 5:36 AM   Subscribe

Central Indiana - I need elder care help today! Please help us!

Long, ugly story short...My mom (who has Alzheimer's/dementia) was found wandering Thursday evening. Police took her to a hospital in Indianapolis (I'm in Muncie) My name and number was in their system as primary contact. My brother, who is supposed to care for her, is nowhere to be found and has turned-off his phone. After an overnight stay, the hospital strong-armed my wife and I into taking her home with us to Muncie. This already isn't working. We aren't trained in the sort of constant, skilled care an Alzheimer's sufferer needs. We got no sleep last night, and this morning is already going downhill.

Yes, she needs to be in a memory care facility. Here are the reasons why she isn't...
• She does not have the funds/income to private-pay. Thus, no facility will accept her.
• Even if she could scrape-together the funds to see her through until Medicaid could kick-in, I do not have the legal authority to sell-off the assets necessary (the infamous spend-down) to qualify for Medicaid. She owns two small, run-down properties, one she lives in and the other my brother lives in.

We had been talking to an elder-care attorney about possibly petitioning for guardianship in order to get my brother out of the picture so we can get mom in a facility, but, in our last meeting, he told us he needed $2000 up-front to proceed, that the cost could easily jump much higher, and he didn't feel confident that the Indianapolis courts would decide in our favor. He basically sent the message that he didn't want to proceed, but if we did, it would be very expensive. We barely have a spare $2000, and there is no way we have multiples of that to pay him, especially if he doesn't feel like there is a good chance of us prevailing.

I just feel like we've been tossed into a dead-end of misery. As I said, my brother (mom's primary caregiver) has disappeared. Because of that, we can't simply take her back to her home and leave her there, hoping he will show up and manage her meds and resume care. Everyone in the system, from the hospital social worker, to Adult Protective Services, has abandoned us and basically washed their hands of it and left us to fend for mom on our own.

This is a very dangerous situation. Our nerves are already frazzled and frustrations and tempers are boiling. We literally have no bloody clue what to do, but we know we can't do this. At this point, we are actually considering taking mom home and hope she goes wandering again and ends back at the hospital. At that point, when they call us, we would refuse to help. The way the system treated us, strong-arming us into taking her home with us, has taught us that that is the only viable response.

Please...If there is anyone in central Indiana reading this who can help us, or knows someone who can, we are desperate. Today. If you have resources, please MeMail me. If you want, I can give you my phone number.

Please.
posted by Thorzdad to Human Relations (106 answers total) 16 users marked this as a favorite
 
Alzheimers Association Helpline 1.800.272.3900 (24/7)

Alzheimers Foundation connect to a social worker by phone or Skype 9:00 a.m. to 5:00 p.m. (Eastern) Monday to Friday (they are not open until Monday but I thought I should include them)
posted by cda at 5:55 AM on May 31


Seems like the first step is to find your brother.
Maybe he had some sort of accident and that's why your mom ran off? Could the police conduct a welfare check on him? Did you report him as missing?
posted by travelwithcats at 5:58 AM on May 31 [4 favorites]


I've been on-hold on the Alzheimer's 800 number for 15 minutes now. My experience with them, though, is that they mostly just lend an ear and then refer you to a local support group. They don't intervene.

As for my brother...The last we heard from his was an angry, yelling phone call blaming us for mom being picked up by the police. I have no clue what logic he was using. He said he had stepped out for a couple of hours and that's when mom went wandering. I'm not clear what a welfare check is. Haven't reported him as missing, though I think APS wants to find him.
posted by Thorzdad at 6:12 AM on May 31 [2 favorites]


Taking your mother home may be a good idea regardless. She might do better in familiar surroundings and you're going to need stuff that's there (meds, clothes, etc.). Presuming that nothing has happened to your brother, that also gets her back on his turf and you'll be closer to Indy-specific care that you line up. Good luck; this sounds awful for everyone.
posted by carmicha at 6:14 AM on May 31


We have her meds and some clothes here. She is unable to self-medicate, though. That was my brother's primary job. That, and keep her from wandering. I agree about her home being more familiar than here, though, obviously, that won't curb the wandering if no one is there with her. We wouldn't be able to stay there.
posted by Thorzdad at 6:18 AM on May 31


I have no clue what logic he was using.

Possibly the kind that comes from trying to be the primary caregiver for somebody he can't actually help much either, who gets too little sleep and whose nerves are frazzled and whose frustration and temper is boiling?

If you can find a way to reframe him as a temporarily MIA source of help rather than yet another obstacle to be overcome, it might help your own mental state some.

So sorry you're having to deal with this, because fuck Alzheimer's.
posted by flabdablet at 6:19 AM on May 31 [18 favorites]


It sounds like your brother's behavior can be construed as neglect, which means you can contact the hotline Indiana Family and Social Services hotline: 800-992-6978
posted by carmicha at 6:20 AM on May 31


Regarding obtaining guardianship of your mother, here are three Indianapolis sources of help and information:

Mental Health America of Greater Indianapolis
Adult Guardianship Services
301 E. 38th St., Indianapolis, IN 46205
317-251-0005, www.mhaindy.net

Families First
Vistas Program
615 N. Alabama St., Ste. 320, Indianapolis, IN 46204
317-634-6341, www.familiesfirstindiana.org

Wishard Volunteer Advocates Program
1001 W. 10th St., Indianapolis, IN 46202
317-630-6254, www.wishard.edu
posted by carmicha at 6:23 AM on May 31


Welfare check = wellness check. But it sounds like your brother is fine, so disregard please.
posted by travelwithcats at 6:24 AM on May 31


...and you'll be closer to Indy-specific care that you line up.

Sorry to threadsit, but this is sort of the problem...What Indy-specific care? Without a boatload of cash, no facility will take her in.

flabdablet...Yes, I know my brother is probably completely at wits-end...But, he refuses to sign-over his authority to me so we can hopefully get mom somewhere. He's living for free in the old house mom owns and stands to lose his roof through the Medicaid spend-down. He doesn't work. He'll be homeless.

carmicha...I called that state hotline earlier this morning. Got a recording. Left a message. Weekends are hell. Every recording says to call 911 if it's an emergency. Not sure if that is the way to go.
posted by Thorzdad at 6:27 AM on May 31


Every recording says to call 911 if it's an emergency. Not sure if that is the way to go.

There's probably a police non-emergency number (maybe (765) 747-4838 for Muncie) if your concern is "Is this a real emergency?" I'm no expert on these things and don't know how police involvement could backfire, but if letting her wander off in Indianapolis is feeling like an appealing option, phoning the police has to be worthy of serious consideration.
posted by hoyland at 6:37 AM on May 31


This sounds very overwhelming, sad, and frustrating. I can't provide any specific resource in your area, but I would encourage you to, first, take a deep breath, you WILL solve this. Try not to catastrophize this situation, it's bad, but it can be dealt with.

Identify the specific problems/issues to be dealt with, make a list and sit down and prioritize the list. Determine a reasonable goal, day by day, to deal with these items. Looking at the HUGE big picture can immobilize us... focus on the details.

Hang in there....
posted by HuronBob at 6:41 AM on May 31 [1 favorite]


So this is very hard. You and your brother need an elder-care advocate immediately. S/he might have some ideas about how to structure a way for your brother to keep the house where he lives while accomplishing the spend-down, e.g., given to him as compensation for all of the unpaid care he has already provided.

If your brother knew that finding a way to keep him in the house is one of your objectives, perhaps he would be more willing to join forces with you. I know you're frustrated right now, but the language you use about your brother isn't very respectful or appreciative; if that's typical, he may feel very wounded about not being appreciated for what, as you've discovered, is an awful job vis-a-vis your mother, even if he is getting free housing out of it. And in reality, even if he's a perennial fuck-up, your brother's ability to find work may also be negatively affected by his responsibility for your mother: the time, the energy suck, the despair. He may feel stuck.

Try to be a team. Don't win the battle at the expense of the war.

Oh and just in case it isn't clear above, I wasn't talking about using the Hotline system to charge your brother with negligence, just using the language they need to hear before they provide help.
posted by carmicha at 6:43 AM on May 31 [12 favorites]


Some ideas for places to look for pro bono legal help:

1) Law school legal aid clinic
2) State bar
3) National Academy of Elder Law Attorneys (naela.org)
posted by HotToddy at 6:51 AM on May 31


You and your brother need an elder-care advocate immediately

How does one find an advocate?
I don't mean to sound ungrateful or argumentative, but that's exactly the sort of direction we've been getting for over a year from all corners...Great-sounding suggestions without explanations of how. We've already been working with an elder-care attorney, and he basically abandoned us unless we forked-over a lot of cash up-front. Cash we don't have.

If your brother knew that finding a way to keep him in the house is one of your objectives, perhaps he would be more willing to join forces with you.

We've told him we intend to try and keep his home. But, we can't guarantee it, and he simply shuts down and walks away.
posted by Thorzdad at 6:54 AM on May 31


This is tough.

The first priority has to be physical safety. Your mom's, your wife's, and yours. If it looks like you're mom will be with you any length of time I recommend getting The Complete Guide to Alzheimer's Proofing Your Home. In the meantime get rid of throw rugs, sharp knives (you can try putting those child locks on cabinet doors), anything that could cause harm or that is valuable and she might hide. Keep pathways around the house clear. Keep the bathroom clean. You also may want to take the doorlock off the bathroom, or have a key ready in case of an emergency.

Check into a geriatric/elder care social worker. If a private social worker comes to your house it'll probably cost $100-200 for a consult, but they'll be able to provide you with the resources that are available in your area. They will also know of ways to, for lack of a better term, work the system, to get your mom the care and funding help that she needs.

Also look into getting someone into the house to help out. There are professional businesses and individuals who provide homecare service. It sounds like your mom isn't medically complex (or, at least, her medical issues aren't the problem here), so you could get by with a homecare aide instead of a nurse, which will be cheaper. Also, if you have any friends or community contacts (church, volunteer organizations, or whatever), see if anyone would be willing to come and sit with your mom for awhile. That will at least give you and your wife a break as you plan. It's the end of the school year, but call up your local nursing schools and ask if any students are looking for some work.

There are also day programs for seniors with memory problems. Some long-term care facilities even have them. We had pretty good luck with SarahCare; there's one in Indy. The county may also run a similar day facility, and it may be cheaper. I just looked around on Delaware County's website and couldn't find one, but a social worker would be able to tell you for sure.

Hang in there. This is a very tough road you're on. Memail me if there's anything I can do.
posted by lharmon at 6:55 AM on May 31 [1 favorite]


I suppose I need to give more background on this...

We've been dealing with mom and her Alzheimer's for over two years now. Throughout this time, we've been working with the elder-care attorney I mentioned earlier, trying to untangle and manage the messy legal documents mom had prepared over the years...dueling POAs, empty trusts, unsigned documents, etc. As a part of this, he was also endeavoring to construct a financial plan that would accelerate the Medicaid spend-down in order to secure funding for mom in a care facility. The lawyer came highly-recommended by others in my Alzheimer's support group. The guy worked without a contract with us, positioning himself as working on mom's behalf, with the expectation that he would be paid from mom's assets once things were completed.

At every turn, though, his plans were thwarted by the fact that, according to mom's messed-up legal papers, my brother held controlling (or dueling) legal authority over everything. Legally, the lawyer felt he couldn't move forward when there was a chance my brother could step-in and reverse whatever moves we made. The best solution was to have my brother sit-down with the attorney and go over the plans and get him to agree to go along. My brother ignored every attempt to get him to even talk with us.

Plan-B was to try and get my brother to sign-away his POA and trusteeship. Same result.

Plan-C was to attempt to secure guardianship. This is where our own meager savings come into the picture. The lawyer's position was that, if we went for guardianship, he would then be working for us, not mom, and he would need $2000 up-front to proceed. However, he said he was not at all confident that the Indy courts would rule in our favor. He said it could easily end-up costing us a lot more. If, somehow, my brother actually contested the guardianship, we could be looking at north of $10,000 (which we do not have) and still not get guardianship. He basically left us with the impression he wanted out of this mess. Our last meeting with him was last Tuesday. On Thursday, this latest shit hit the fan, and here we are.

I'm especially seething over the actions of the social worker at Community East hospital. She knew how bad my mom was and she surely knew there was no way my wife and I could safely care for her. Yet, as I look back on events, it seems that her every action was simply dotting i's and crossing t's and checking every box in order to get mom out of the hospital. We felt strong-armed into taking her home with us. I simply don't understand how a huge healthcare corporation like Community doesn't have protocols or connections to deal with people like my mom, who land in their care. This is the point where my cynicism kicks-in and I start mumbling "But, profits!"

I've also become extremely disappointed with the Alzheimer's Association over the past few years. I've been in contact with them off and on over this period, and have been a regular participant in one of their local support groups for almost three years. I've also called their 800 number on occasion. I've grown to see the AA as an impotent resource. They're good at lending an ear and handing-out brochures with a lot of executive-level suggestions, but I've also come to realize that they don't actually provide any real help. There's no hand-holding or individual advocacy. They aren't going to help you navigate the system. They'll hand you a couple of brochures and suggest you contact a nebulous "elder care professional".

Sorry if this is ranty. We're at our wits end. This is not going to end well. We needed real help yesterday and no one was offering any. Nor could they point us in any direction than "she needs to be in a care facility". No shit. Insert "healthcare in America" derail.

Sorry.

I'm off to cry. This weekend isn't going to end well, one way or another.
posted by Thorzdad at 7:35 AM on May 31


IANYL. I second calling adult protective services. You have a vulnerable adult in your care, without the legal protections necessary to provide the care she needs, and you are not able to meet her needs because of your brothers actions/inaction. They may be able to provide some stop-gap resources while you find your brother, and may be able to look into whether your brother's control/mismanagement of your mother's resources and care reaches the level of neglect that could trigger a court modifying or removing his authority. They may not be able to do any of these things. However, there is usually someone on call during the weekends, and they may be able to direct you to a social worker who can help you with practical planning and maybe even working with your brother. Stay strong.
posted by freshwater at 7:51 AM on May 31 [7 favorites]


This definitely isn't the best answer, but if you took in your brother so he had a home, would he work with you to get your mother qualified by selling her property?
posted by michaelh at 7:56 AM on May 31 [1 favorite]


This is an awful thing, but I'd suggest viewing this less as everyone abandoning g you. To me, it sounds like your attorney is trying to tell you that your idea about guardianship probably will just waste your money. And if course you know your brother better than we do, but he's been living your last day 24/7 for however long he's been living there. He's likely kinda fucked up by now.

I'd avoid losing your savings or going into debt over this. Alzheimer's is a terrible thing, and it's claimed your mother. That can't be helped. The secondary effects may have taken your brother too. That can't be helped now either. What you can do is watch out for yourselves and try to prevent your mother's illness from robbing you of your future too.

Topic for local attorney: if your brother has been living with your mother and caring for her for over two years, y'all may be able to transfer the house to him.
posted by ROU_Xenophobe at 8:07 AM on May 31


Can you call the hospital back and ask them "if we weren't able to take my mother in and if you couldn't reach my brother, what would happen to my mother?" That might give you some information about emergency care. Good luck.
posted by Beti at 8:08 AM on May 31 [1 favorite]


I second calling adult protective services...However, there is usually someone on call during the weekends

I called my local area APS this morning...The recording simply said they were closed til Monday. The Indy APS number had a lot of phone-tree options to report a case but no option to actually speak with anyone. It seemed geared more for social work professionals to use. The state 800 number simply had a recording and I left a message.

if your brother has been living with your mother and caring for her for over two years, y'all may be able to transfer the house to him.

He doesn't live with her. He lives in the old house she owns. She lives in her second home, that she and dad purchased many years ago. Dad's long gone. As for transferring the house to my brother...I forgot to add that he owes the IRS a boatload of back taxes. Like, a couple hundred thousand, if his ex-wife can be believed. This debt ended his marriage. On the rare occasion when he does work, I believe he gets paid cash under the table, in order to not have any traceable assets the IRS can seize. He drives around in mom's car. He has no bank account. In fact, he had been siphoning off funds from mom's checking and savings until I stepped in and took control of that mess. I get the impression that he knows if he had something like a house in his name, the IRS would be on it asap.
posted by Thorzdad at 8:28 AM on May 31


Well, there's another option, and I say this ONLY because you've said you're thinking about leaving her alone--take her to Ball Memorial and claim that she is having symptoms of some medical problem (say, a severe UTI) but that she can't communicate adequately. If it's not working, claim she told you she's having chest pains.

This will subject her to a serious amount of unnecessary testing and obviously you have to lie, but it's better than abandoning her.

Put your brother's information down as emergency contact etc.

Then when she's been admitted to ER, leave. Do what your brother did; get some sleep.

If they can't discharge her, they'll likely admit her (a "social" admit) or keep caring for her in the ER, possibly for a prolonged amount of time. This will give you some time to get your wits about you and figure out what to do.
posted by the young rope-rider at 8:28 AM on May 31 [14 favorites]


And frankly, you might need to contact the police about the stolen funds and about him leaving your mother alone like this.
posted by the young rope-rider at 8:29 AM on May 31 [1 favorite]


If all else fails take her to an emergency room. Say something about a decrease in behavior or that your not the primary caregiver and you have no idea. Pick something. Paranoia , not eating, fall risk what have you. Once she is seen make or very very clear you are not taking her home because you cannot do it safely at all and that you have no training or resources and you have no control over the estate to arrange for care. Also that you cannot under any circumstances provide 24 hour care.
Somebody there will eventually figure it out.
Yes it will cost tons of money but the fact you have to liquidate(that's not the word) for medicaid means that there isn't likely going to be anything left for you or your brother anyway.
posted by AlexiaSky at 8:37 AM on May 31 [6 favorites]


Honestly, I have to say I concur with the young-rope-rider. This is an emergency that you are not equipped to handle right now, and it's a nuclear option, to be sure. But, it will keep her physically safe for a while, you can regroup, and they may indeed be forced into helping find adequate care.
posted by tristeza at 8:38 AM on May 31


And frankly, you might need to contact the police about the stolen funds and about him leaving your mother alone like this.

Well, thing is, he was having mom sign checks made-out to him. So, it looks perfectly above-board. Then, he discovered that, at some point in the past, mom had added his name to her account. So, then he could just help himself.

At least we got mom's debit card. He had been draining her account pretty quickly using it.

Taking her to the emergency room is very tempting. We've actually thought about it. As good as it sounds, I'm hesitant as I'm really afraid how badly it might blow-up on us in a cops-and-a-perp-walk way.
posted by Thorzdad at 8:43 AM on May 31


As good as it sounds, I'm hesitant as I'm really afraid how badly it might blow-up on us in a cops-and-a-perp-walk way.
posted by Thorzdad at 8:43 AM on May 31 [+] [!]

What do you mean? How could it end in jailtime??
posted by tristeza at 8:46 AM on May 31


No, but abandoning her might, which is why you wait until she's admitted and then leave.

Seriously, you're not thinking straight because you've had no sleep.
posted by the young rope-rider at 8:57 AM on May 31 [2 favorites]


Would reporting your brother to the IRS get him jailed, and would his jailing invalidate his guardianship?
posted by Mistress at 9:02 AM on May 31 [1 favorite]


Would reporting your brother to the IRS get him jailed, and would his jailing invalidate his guardianship?

Dunno. The IRS knows he exists. They had been garnishing his wife's wages before they divorced and she declared bankruptcy. I have no idea why he isn't in jail already.
posted by Thorzdad at 9:06 AM on May 31


Kind of off-the-wall, but have you thought about alerting your mom's bank's fraud department to potential elder abuse? Banks I've worked at have investigated that, and have assisted with getting the ball rolling on getting the person taking advantage of someone's decreased mental state off of accounts.
posted by Verdandi at 9:08 AM on May 31 [3 favorites]


Well, does he smoke or sell weed? Pirate things? If (and only if) his imprisonment would move things forward guardianship-wise it is worth considering.
posted by Mistress at 9:11 AM on May 31


Hugs to you and your family, Thorzdad. What an awful situation. I agree with TYRR and Alexia - go to the hospital ER, make them admit her, and tell them that you canNOT care for her. IME, hospital discharge planners are notorious for trying to shuffle off patients onto their families without regard for said families' physical and emotional resources, and you have to be really, really tough with them and do your best to not put up with any BS. It's really hard to do that when you're emotionally vulnerable, as most patients' families are. (That's how they strong-arm families like yours!) Remember the magic words, "That will not be possible" and repeat as necessary.

If you can get some breathing room (and good sleep!) after getting your mom admitted to the hospital it will give you opportunity to plan as to what to do next.
posted by Rosie M. Banks at 9:14 AM on May 31 [10 favorites]


It can still be elder abuse even if she signed the checks. That's not what elder abuse is about. It's about conning somebody without the mental capacity for them to ever realized they been conned.

But if her bills are paid and she is fed most likely there isn't much you can do.
posted by AlexiaSky at 9:14 AM on May 31 [2 favorites]


Prioritize getting everyone physically safe, fed, and rested and then start worrying about your brother. That's a distraction until everyone is in a sustainable and safe situation.
posted by the young rope-rider at 9:16 AM on May 31 [2 favorites]


*Not all elder abuse but most financial elder abuse.
posted by AlexiaSky at 9:17 AM on May 31


~No, but abandoning her might, which is why you wait until she's admitted and then leave.
Seriously, you're not thinking straight because you've had no sleep.


There is that, to be sure, re: lack of sleep.
I'm concerned about providing false identification. Won't they ask for my ID when admitting her? I even get a little paranoid about my being identified via security tapes (I know, I know...)

~ have you thought about alerting your mom's bank's fraud department to potential elder abuse?

I worked very closely with the managers at the bank in getting her funds moved-around and they heard all the sordid details. No one at Chase once mentioned elder abuse.

~Well, does he smoke or sell weed? Pirate things?

No. He's just a 54 year-old itinerant laborer who drinks.

~But if her bills are paid and she is fed most likely there isn't much you can do.

My wife and I pay her bills. I've had her mail forwarded to us for the better part of a year now. Mom lives entirely on Boost. that's all she will consume. We take her 7 cases of the stuff each week.
posted by Thorzdad at 9:18 AM on May 31


Don't worry about the police. Be open and honest l. You are not the primary care giver. You do not have access to her fianances. You do not have power of attorney (unless you do). You and your wife work. You cannot provide 24 hour care without support. Your House is not proofed for alzheimer's care. You have no resources. It is way easy for her to wonder. Your bathrooms are not handicap accessible. You don't know type mothers medications or health conditions to monitor for changes. And because of that you cannot keep her at home. You had no idea she was this bad.
posted by AlexiaSky at 9:22 AM on May 31 [10 favorites]


Tell them you're you then, and once she's admitted you can go home and sleep. Number one priority is physical safety, number two is rest.

We can handle everything else once you're all safe and rested.
posted by the young rope-rider at 9:23 AM on May 31 [2 favorites]


Oh, this is hard. I know, I was dealing with it just two weeks ago, when I had Mom come visit me and I spent the entire visit in panic mode over the realization that I cannot take care of her, and I am only one person.

I don't have an answer for your immediate problem, only advice: there are (at least) two of you. Get some rest in shifts. Being sleep-deprived leads to poor judgment and frazzled tempers. You have to take care of yourselves.

I do have a suggestion for some long-term relief, once you get a handle on the existing crisis, though: look into the VA's Aid and Attendance benefits, if your dad was a veteran. Apparently the application process is lengthy and complicated, but once she is admitted, the benefits are retroactive to the date of application.

No one at Chase once mentioned elder abuse.


OF course they wouldn't. Chase is not on your side in this and the manager works for Chase; it took me the better part of six months with a POA, to get Chase to stop treating me like a potential thief so I could pay her Chase Visa bill. YOU have to mention it. It's your weapon, and it gets attention and action. Use it.
posted by caryatid at 9:27 AM on May 31 [1 favorite]


The fact she cannot eat solids should practically be an automatic admit in my non medical opinion. She needed a nursing home a long time ago.

I'm not sure that your brother is 100 percent the bad guy. Think about it he had lived with her for the last two years and you have managed 48 hours.
posted by AlexiaSky at 9:27 AM on May 31 [5 favorites]


Would your own primary care doctor be any help in this? Can you page him/her and get some emergency help there in terms of getting her admitted and transferred to a local nursing home? A doctor you have a relationship might be more useful.
posted by leslies at 9:29 AM on May 31 [1 favorite]


~You do not have access to her fianances. You do not have power of attorney (unless you do).

I do have access to her checking and savings. That's how we pay her bills and buy her Boost. However, it's a pittance. She lives on Social Security and a widow's pension. With careful budgeting, we've managed to get her savings up to about $4000. But, that won't pay for a month in even the cheapest alzheimer's care unit we've found. The starting rate seems to be around $6,500/month and up.

I do have a POA. My brother also has a POA, and his was the first POA assigned. This where the problems begin. They conflict with each other. Some places (like Chase) have been gracious enough to look the other way and accept my POA when it became obvious what I was trying to accomplish. Other places aren't as helpful. The competing POAs is why the elder-care attorney declined to move forward. He saw it as a real legal stumbling block.

What my brother absolutely has over me is Trusteeship over mom's properties.

~Think about it he had lived with her for the last two years

He doesn't live with her. He drives over and looks in on her and gives her her pills. He only lives a mile away. I, on the other hand, live an hour and a half away. I know I'm no angel here, but my brother has, on numerous occasions, said mom needs to be in a home. But, he seems to be under the delusion that all you have to do is drop her off at a nursing home and Medicaid immediately starts paying for everything. When we approach him trying to get him to listen to the plan the attorney drew-up, he balks and runs away. Deep down, he knows he will probably lose his home, and is in survival mode.
posted by Thorzdad at 9:38 AM on May 31


Would your own primary care doctor be any help in this? Can you page him/her and get some emergency help there in terms of getting her admitted and transferred to a local nursing home? A doctor you have a relationship might be more useful.

I intend to contact mom's PCP Monday. I have a good working relationship with him, and he's already signed-off on her incompetency. I'm unsure what strings he can pull for us, but it doesn't hurt to ask. He's in the same Community Health Network as the hospital she was at. I believe that's how they got my home phone number. I'm in the PCP's system as primary contact.
posted by Thorzdad at 9:42 AM on May 31


You must be overwhelmed and upset about this. It's great that you're thinking about all the different ways to handle everything long-term, and getting support from this community. I don't think your brother's culpability or lack thereof is relevant right now to the emergency you described in your question.

Since this is an emergency, you can feel free to have her PCP paged immediately to help you deal with it. His office should have an answering service that can help you. Again, though, you're getting sidetracked by the sheer overwhelming amount of details here (understandably)! But this will all make 100% more sense when you have your mother somewhere safe and you and your wife can get some rest.
posted by the young rope-rider at 9:48 AM on May 31 [3 favorites]


Agreed that you should have her PCP paged. That's what pagers are for, emergencies.
posted by desjardins at 9:50 AM on May 31 [1 favorite]


If he admits her to a hospital she can be moved to a nursing home if he can help with the whole Medicaid thing. My understanding is that in Michigan (and no idea if this is true in Indiana) you can be admitted to a nursing home and then start the Medicaid process but you need a nursing home that will work with you. Her doctor, especially if he is a gerontologist, should be up on this. I would absolutely page him under these circumstances.
posted by leslies at 10:06 AM on May 31 [3 favorites]


Try care.com or home health care agencies to see if they can dispatch someone tonight for respite care if you don't want to take mom to the ER. spend $500 for care, a restaurant meal, and a hotel. Come back to this tomorrow clear-headed.

Tomorrow's task, again if you don't want to go to the ER, is to camp out in front of your brother's house and convince him to tear up the POA papers.

Give him consideration in exchange - six months at your place, perhaps? Community college course for retraining? Think about what you can offer your brother, seems distasteful but buying him out is cheaper than paying for mom's care.

Might as well bring mom with you and have someone watch her in her home. You can go for a walk with your brother towards mom's house while having this conversation. If somehow you can get him to see mom and put her back in his care, he might be more amenable to settling.

If you can get your brother to mom's house on foot with your car at mom's you and your wife can also jump in the car and leave.

Sounds awful, but desperate times call for desperate measures.
posted by crazycanuck at 10:07 AM on May 31


I am so sorry you are having this experience. It is frustrating and exhausting, to say the least.

I found some help with the local Seniors Helping Seniors franchise. I see there are locations closer to Indianapolis than to Muncie, but one might be helpful to you.

It was a great relief (in contrast to the non-answers and odd "referrals" I was getting) to have in the space of one phone call, a person listening and responsive to our needs, and to have scheduled 2 appointments, one with the local franchisee to meet me and my parent and discuss our needs further, the second to be introduced to two caregivers, for us to choose one as the primary caregiver and to know the other as the backup.

This might at least provide a temporary and/or partial solution.
posted by jaruwaan at 10:13 AM on May 31 [1 favorite]


I advise caution about the plan to dump her off at the ER. It seems you are inviting an enormous bill (which will get sent to a bill collection agency who will then hound you) in exchange for a few days' respite. In a few days, you will be back where you are now, plus a monster bill. Every day spent in an ER can cost thousands just for the bed and nurse making rounds. If you tell them there is chest pain and they do tests and keep her for a few days, you could get a bill of tens of thousands of dollars.

People are casually dismissing that with "oh you will have to liquidate anyway" but you would be closing off options. In exchange for a short time de-frazzling, you would be signing up to declare bankruptcy in a certain time frame. That would be incredibly stressful to me.
posted by cheesecake at 10:21 AM on May 31 [5 favorites]


IANAL, obviously, but I don't think that the hospital could bill Thorzdad for his mother's care. They can bill the estate, but not relatives. I googled and here is what I found; I wouldn't take it as legal advice, but I don't think Thorzdad and family would have to pay. But again, IANAL, TINLA, maybe calling a lawyer is a good idea. (Since the brother's finances are tangled with the mom's, the brother would be the one they come after and would be SOL. That may be a mess for Thorzdad to wipe up after. Ugh.)

Naturally, that doesn't mean that the hospital wouldn't try to collect and strongarm Thorzdad into paying. They strongarmed him into taking his mother home, so it seems that they are no stranger to emotional blackmail and dirty tricks. I do think he needs to be prepared. (And fuck the hospital, seriously, they don't deserve any concessions from the family.)

To Thorzdad - definitely page your mom's doctor and tell him what you told us. It's not possible for you to care for her at home, what can be done with her? I feel for you and hope you can find some help here, and get some sleep! Keep us posted.
posted by Rosie M. Banks at 10:34 AM on May 31 [3 favorites]


I'm an ER doctor.

People do the drop off of elderly demented family members because they're not safe at home every single day. It's unfortunate, but we just socially admit them for geriatric psych evaluation and placement, and we do whatever is safest for the patient. Nobody wants elderly people to be living in an unsafe situation. I am not aware of ANY legal or criminal implications for you with this, I have never heard of anything like that - I mean, you could talk to your lawyer but if you really feel she's unsafe in your home and you can't care for her, how could that be criminal or abandonment or anything like that? You do not have to make up medical complaints, and you do not have to worry about giving fake ID information! All you have to do is say that she's not safe in your home. And you do not have to agree to take her back to an unsafe situation once she is admitted.

One other option that I didn't see mentioned was respite care. It's less of a nuclear option and would buy you some time to figure out what to do. But honestly it doesn't sound like there's any quick fix for your situation, and it sounds like you need help right now and are worried something bad will happen just over the weekend.

I agree with Rosie M Banks that I don't see how you could be stuck with the bill for your mother's care. She has Medicare. They cover ER visits. I do not deal with the financial side of medical care, though, but while you're in the ED, there's often a financial counselor on hand who could advise you. As a social admit, she would likely be an observation admission (i.e. expected discharge in less than 24 hours), which creates a problem in terms of being able to get placement at any facility - but it's not your problem, and if she doesn't have any place to go and ends up staying 3 overnights, that could help her get Medicare to cover her being placed in a rehab facility. Ask about this.
posted by treehorn+bunny at 10:45 AM on May 31 [28 favorites]


By the way, to elaborate on the fake complaint thing, I'd really ask that you not try to embellish on her situation if you decided to do this. I feel like patients' families do this to me a lot because they feel guilty about the situation, and it puts me in the position of having to chart that the patient has had some sort of sudden change in their behavior that doesn't sound like a normal progression of dementia, which then means I have to work them up with a head CT and various other testing for other causes of altered mental status, even if I suspect that it really is just their same dementia that is chronic. I'd much rather the family just said to me that there had honestly been no sudden change. I'm not going to give people a hard time like "what? you can't take care of your severely demented parent and hold down a paying job at the same time?" because obviously that is something that very few people have the means to do, i.e. requires hiring private in home caregivers.
posted by treehorn+bunny at 10:51 AM on May 31 [8 favorites]


~As a social admit, she would likely be an observation admission (i.e. expected discharge in less than 24 hours), which creates a problem in terms of being able to get placement at any facility - but it's not your problem, and if she doesn't have any place to go and ends up staying 3 overnights, that could help her get Medicare to cover her being placed in a rehab facility. Ask about this.

This was how she was admitted to the hospital Thursday...for observation. There was one ER doc who was literally yelling at the other doctors that they needed to do whatever it took to keep her there for three days in order to get her into a facility with Medicare. he kept telling them it was the right thing to do. Unfortunately, no one else agreed with him.

~I'm not going to give people a hard time like "what? you can't take care of your severely demented parent and hold down a paying job at the same time?" because obviously that is something that very few people have the means to do

You'd have been dismayed, then, with how blithely the Community Hospital social worker ignored this exact argument that I made. It was as if I was speaking Martian.
posted by Thorzdad at 11:02 AM on May 31


I know you are in Indiana but I know of a very reasonable and very good place in Minnesota - less than $3,000.00 a month for assisted memory care. I have relatives there and they like it.
posted by Tullyogallaghan at 11:11 AM on May 31


What about getting her admitted to a geriatric psych facility? If she's not eating, not taking care of her activities of daily living, confused, paranoid, and being dangerous such as making threats to your family or leaving fires burning or anything of that nature, she's could meet criteria for a psych admission. See if you can look up geriatric psychiatry inpatient treatment in your area. The fact that she wandered away and put herself in danger a couple of days ago will help the admission. If she has Medicare, as long as the doctor certifies that she needs inpatient admission it will cover psych treatment. Then, the social workers and treatment team in the geriatric psych unit will know what the resources are for placing her in longer-term care, and can help you fight the fight.

I am on my phone, so I can't Google what facilities are near you right now. Another thing, there's a difference between a financial power of attorney that just says someone is responsible for paying someone else's bills and managing their money, and a health-care power of attorney which means they can make healthcare decisions for the person. If your brothers power of attorney isn't a health-care power of attorney, your mother can either sign herself in to the psych unit or she can be held because she's unsafe. Don't let the power of attorney scare you too bad. It depends on exactly what the wording is. In any case, your brother may want her signed in to a psych unit because it gets her out-of-the-way. That buys you some time and some additional resources to work with.
posted by MultiFaceted at 1:46 PM on May 31 [2 favorites]


As far as I can determine, there isn't an actual geriatric psych facility here in Muncie. I don't even think the hospital here has a regular psych unit. There are centers that offer psych evals, but they are not admitting facilities. They're like private diagnostic labs. All outpatient stuff.

I can't find anything in Indy, either.
posted by Thorzdad at 2:08 PM on May 31


I googled "geriatric psychiatry in Indiana" and found this.

(And I've had the same experience with discharge planners - not all, but many - who seem to suddenly not comprehend language when I've tried to explain about no-one being available to drop everything and care for the person being discharged. I do not know if it's a funding issue, a patient load issue, or sucks-at-their-job issue, but so many hospital discharge planners don't have the first notion of how to plan. "It's the patient's/family's problem, and there's nothing I can do about it." And families are usually in no state to stand up to these people, and they know it. /bitter)
posted by Rosie M. Banks at 2:08 PM on May 31


I googled "geriatric psychiatry in Indiana" and found this.

Yeah, I did, too. It's all psychiatrists. No admitting facilities or hospitals that we could take her to today.
posted by Thorzdad at 2:18 PM on May 31


Here's a geriatric psych inpatient unit at Morgan Hospital in Martinsville.
posted by lharmon at 3:09 PM on May 31


I suggest you take your mother to the ER at Eshkenazi or Methodist. I grew up on the east side of Indy, and spent a lot of time at Community Hospital East. It has all the problems of being a Level II trauma ER on the second worst side of town, and absolutely none of the funds they need to deal with that. They end up doing a lot of indigent care, and in my experience, their main goal is to turf anybody they can possibly turf.

Eshkenazi used to be Wishard, which was the Level I trauma center/indigent care hospital in Indianapolis. Methodist is the other Level I trauma center in Indianapolis, and they are much less concerned with treat n' turf, especially for elder patients.

I've taken my father there many, many times for cardiac care, both through regular admission and trauma admission. My husband was also admitted there with a trauma, and in all cases, social workers and other advocates are all *over* the place there and very, very helpful. We got a lot of support and advice and guidance on what to do next with my father. I have no doubt they can help you.
posted by headspace at 6:05 PM on May 31 [8 favorites]


We felt strong-armed into taking her home with us. I simply don't understand how a huge healthcare corporation like Community doesn't have protocols or connections to deal with people like my mom, who land in their care.

They do, but if they can push it off on you, they will (and so they have). When my father was admitted to the hospital with his third stroke a year ago, a coworker of mine with experience in this regard told me in practically all-caps, "DO NOT LET THEM PUSH YOU INTO SENDING HIM HOME WITH YOU." Regardless of where you are, it seems, they try to do this in many cases, because it helps their caseload. But luckily, we had a good social worker assigned to my father's case, who helped us get him into rehab and then assisted living.

Anyway, at base, your job, as so many above have more eloquently stated, is to do what's best for your mother. Among other things, that's likely what your power of attorney agreement states—you have the authority to act on her behalf, provided you do so in her best interest. In this case, it seems pretty clear that it's in her best interest to be admitted to a hospital for something, stay there for three days, and be admitted to a rehab facility if possible, then transition into memory care in assisted living at a facility with Medicare beds. I would do whatever it takes to make that happen.

Others above have, again, much more eloquently laid out next steps. But I wish you all the luck in the world—I went through this sort of thing almost exactly a year ago, and now I'm finally coming to the end of a year's worth of weekends spent cleaning my father's house and/or visiting my father in assisted living (I just came home exhausted from working at his house again, in fact). None of this is easy. But you will find a way to do it. Get her admitted—then get some sleep. You'll get there.
posted by limeonaire at 8:11 PM on May 31


Haven't read all the comments, but I've read all your responses. I don't know what your budget is for helping with this (outside of the obvious not wanting your mother's issues to bankrupt you), but as a right-now thing you can do to save your sanity and at the very least get through the weekend till Monday, you could look at Care.com and/or Sittercity.com for eldercare help in your area. They will do background checks and generally come with references, and for an hourly rate you can have someone in your house to help you keep an eye on your mom and dispense medications. It's not a long-term solution, and I don't know how many prospects there are in your area, but it's a way to find someone who is both qualified to help and looking for work so the burden isn't all on you.

Best of luck through this - it sounds like a heartbreaking nightmare.
posted by Mchelly at 8:29 PM on May 31


What a difficult situation. I know a few geriatric care managers and they help with these situations. I suggest searching the national association listings online. I saw a few listed in Indiana at National Association of Professional Geriatric Care Managers
posted by Lil Bit of Pepper at 10:58 PM on May 31


I worked very closely with the managers at the bank in getting her funds moved-around and they heard all the sordid details. No one at Chase once mentioned elder abuse.

Call their 1-800 number and ask to speak directly to a fraud department representative. Most likely, you worked with branch staff, who are not as well-versed in fraud and account abuse as an employee directly working in fraud (nothing against the branches--they just are not familiar with that line of work).
posted by Verdandi at 11:53 PM on May 31


A factor not mentioned by anyone yet is that Indiana is one of the states that have filial support laws, requiring an adult child who is able to do so to support a parent in need. See this article for more information. Although I am not an Indiana lawyer, this might mean that the hospital could require you to take her back when she is ready for discharge.
posted by megatherium at 6:51 AM on June 1


I thought I should update everyone today...

First, I want to thank everyone who have participated in one form or another in this public airing of my family laundry. I've been overwhelmed by the support, help, suggestions and well-wishes. This place epitomizes the concept of "community".

Soooo...Saturday night, the proverbial shit hit the fan for us. Just as we were trying to get her and ourselves to bed, Mom went into a spiral of anger, yelling, arguing and lashing out. She became physically violent, hitting my wife and scratching me. She was uncontrollable. I am ashamed to say that my being sleep-deprived and frustrated ended up adding to the noise, yelling back at her. I ended up calling 911 and they dispatched the sheriff to see what could be done.

The officer who arrived, it turns out, had had his own history dealing with a family member suffering from Alzheimer's. He knew exactly what we were going through and was pretty amazing and understanding. Easily the best encounter I have ever had with a police officer. He suggested I call my mom's PCP and speak with the on-call doc, explain the recent events, and see what he might be able to do for us.

The doc was great (his cat was helping him on his computer, too) Since he is in the same network as Community Hospital, he could pull-up the charts from mom's Thursday stay. He was not pleased with what he saw. It sounded like they hadn't done so much as a urinalysis. I any event, he said they definitely should have held her longer for evaluation. He suggested I take mom to my local ER and have them do a complete work-up on her and a new psych eval.

So, we get mom to the ER around midnight. Our local hospital is part of the IU Health network. The encounter was like night-and-day compared to Community. Everyone understood exactly what was needed and without question agreed that there was no way she could go back with us. All efforts were immediately focused on getting her stabilized and work on ways to get her into a car facility asap. As it turns out, the ER doc she saw also has dealt with Alzheimer's and a family member and knew exactly what we needed. While we were checking her into the ER, mom had another violent outburst and hit one of the nurses, requiring security to come to the room. In a way, that was sort of a good thing for us, as it provided a good example of what we were dealing with.

As of this writing, mom has been moved to the hospital's geriatric psych unit. We came home to try and get a little sleep before we went back to see how she was doing. We missed the visiting window, but the nurse was kind enough to brief us on what was happening. Apparently, mom was none too happy and had been violent toward the psych team, too. We'll be going back over tomorrow to talk further with the doc. Tonight, we hope to get the first sleep we've had since Friday.

So, for the first time in literally years (and certainly since Thursday) we have experienced a glimmer of hope that something positive will finally be done in this sad state of affairs. We aren't out of the woods by any means, but it sure looks like the forest is thinning finally. I will post further updates as things become more concrete.

Again, all my thanks to everyone, both here in-thread, and those who MeMailed me. You folks made me cry.
posted by Thorzdad at 2:03 PM on June 1 [33 favorites]


I haven't posted anything in this thread because what you're dealing with is utterly outside my realm of experience, but I've been watching it and hoping for the best for you and your mom. Thanks for the update - I'm sure I speak for a lot of other lurkers when I say I'm so glad to hear you were able to find the help you and she needed, and I hope things only get better from here.
posted by DingoMutt at 2:49 PM on June 1 [7 favorites]


Thorzdad, I'm so glad to hear things are looking up. Caring for an elderly parent (or other loved one) with dementia is one of the most stressful things that anyone can go through.

It sounds as if you lucked out in getting a sympathetic police officer, on-call doctor, and a better hospital this time. Yay! And it sounds as if Community Hospital really, really fucked up (it could be reportable, or worthy of a scathing review on Yelp, if and when you have the time and energy; it doesn't sound like the kind of place I'd want to take an elderly loved one to). In any event, I'm glad to hear you have a care team that is on your side and wants to help your mom and you/your family. Hope tonight is a night of restful sleep!
posted by Rosie M. Banks at 3:32 PM on June 1


I'm so glad you have stayed top Hey the help that you need and some much much needed rest
posted by AlexiaSky at 5:29 PM on June 1


I'm so glad things are improving for you and that you got helpful support from police and medical folks. Hoping it continues and that you'll have a safe and financially feasible answer for your mom!
posted by leslies at 5:30 PM on June 1


Today will be our first visit with mom in the psych unit. I'll certainly have something to report on later today.

I did want to share one more wonderful little thing that happened to us this weekend that adds to my feeling that we are on the right path now.

As we were all sitting in the ER, waiting to be called back to a room, mom started to become a little agitated. It's an ER and, of course, unless you are bleeding out, you will have a wait. Anyway, my wife went and asked how much longer we would have to wait and explained that mom was becoming agitated. It was then that a young nurse came to our temporary rescue. She showed-up at our table with an arm-load of towels and washcloths and asked if we could help her fold them for her. She knew that Alzheimer's sufferers can often be distracted and entertained by small tasks...like folding clothes.

That's all it took to make mom happy and cut the agitation. We just kept folding (and slyly unfolding and dropping back onto the pile) until we were called back to a room.

So cool.
posted by Thorzdad at 8:05 AM on June 2 [15 favorites]


That's all it took to make mom happy and cut the agitation.

And thank you for sharing this. Now I have another method to use to distract Mom - funny how I never put two and two together. It is true that if I give her a simple, repetitive chore to do - feeding my pond fish one pellet at a time, mending clothing, sweeping the patio - it keeps her calm and happy. I think I will see if she'd like to take up knitting again.
posted by caryatid at 8:23 AM on June 2 [2 favorites]


Late to the thread, but I ran this by my ex who's a pro in this field in Tx -- her respons:

I would suggest that these folks contact their local AAA (Area Agency on Aging). This a national program (federal funds) that is supposed to be a clearing house/resource network for elders and their families. Here is the list for Indiana
posted by Devils Rancher at 8:32 AM on June 2


So, we went up to see mom for the first time since she was put into the psych unit. Talk about night-and-day. She was happy and smiling and chatty. Bubbly, even. Had a good talk with her social worker and got a better view of how they expect their plans to unfold as to getting mom into a permanent facility. She recommended a place here in town that they have a good working relationship with. So, we went over there after we were done with mom.

The facility wasn't deluxe, by any stretch, but none of the places that take Medicaid are, in our experience, especially memory-care units. What it lacked in ambiance, though, it made-up for in an incredibly dedicated and knowledgeable staff. We learned more from them about working the legal system and Medicaid than we ever learned over the past three years. They were so helpful, my wife actually started crying. It's frustratingly impossible for lay people like us to know the ins-and-outs of elder care, the law, financing, Medicaid, etc. etc. and these two women were wizened sages.

So, the hopefulness is still good.
posted by Thorzdad at 2:37 PM on June 2 [12 favorites]


Thank you again for the update, Thorzdad. I've been following this thread for days, too, hoping desperately that you could find the help you and your family need. I'm so relieved that things are moving forward and that you are feeling hopeful.
posted by scody at 5:07 PM on June 2 [3 favorites]


Hello, all.
I, again, want to thank you all for the continuing support. My MeMail has never been busier :)

So, today, we got word from the hospital social worker that they are planning to release mom on Monday or Tuesday, which meant that we absolutely had to decide on a care facility today. We had been hoping to have a little more time to sort things out, but it was not to be.

I don't know if you've ever had to evaluate nursing homes, but it's a trying time. Quadruply-so if you're looking for a place that will accept Medicaid. You know those really nice facilities you see in tv ads? The ones that look really nice and shiny, like the big, warm family home you never had? Yeah...Those don't take Medicaid. Those are all private-pay. Medicaid facilities tend to be a bit more...basic. Older. Not quite as well-kept. Needs some work done. Not as large a staff, etc. Think, if private-pay is the Enterprise D, a Medicaid facility is Serenity.

We picked a place that was a more spartan Serenity.

What it came down to is the place we chose for mom had a business staff that were far more open and flexible on how the whole payment ordeal is going to unfold. They said that they regularly admit residents as "Medicaid pending" and they explained how they manage the financing and left us pretty assured that the payments will be worked out within the confines of mom's ability to pay.

Because of the still-unresolved issues with my brother and the tangle of legal papers my mom amassed, we needed help in order to secure Medicaid. This morning, we sat down with a local guy who seems to be the go-to person for navigating and securing Medicaid for people like my mom. He definitely had never seen quite a mess as ours, but felt confident it could be resolved, but it would probably take a few months.

So, now we're committed. Mom's going into a place early next week, backed by nothing more than a handshake and assurances. Personally, I'm fearful it's going to implode before me and take me with it, but it's all we can do at this time. My brother is still AWOL and, frankly, I'd prefer him to just stay away forever. Though, if he did show-up and finally sign-away his POA and Trusteeship, things would run so much smoother.

Thank you all again. I'll be posting more updates as long as the thread stays unlocked.
posted by Thorzdad at 2:07 PM on June 5 [8 favorites]


I keep following this thread. I'm glad things are looking up.
posted by AlexiaSky at 6:22 AM on June 7


Hello again. Here's today's update...

Friday was a very busy day. We spent the bulk of it down in Indianapolis, driving all over creation. Our first stop was downtown in the Recorder's office, to investigate whether the second trust my mom had drawn up (the one that makes me trustee of her properties) had ever been entered and the properties moved from the first trust (the one my AWOL brother controls) into the second one. Alas, the second trust had never been recorded. And, since we don't have the actual signed original of the second trust, we couldn't record it. While we were there, we did go ahead and record the second, signed POA mom drew-up, so that there would be no question as to whose POA would reign...mine.

Next stop, the county sheriff's office in the same building, to file a missing-person report on my brother. Our Medicaid adviser said we should do this in order to show Medicaid that were were, in fact, looking for him, if he had to argue for my right to take-over Trusteeship. Unfortunately, they couldn't do it at that office, as it had to be done in the police district that my brother lives in. No biggie. We had to go out to the east side anyway.

One of the other items on our list was to investigate some papers that indicated mom might have a pre-paid funeral arrangement. We went out to the funeral home and spoke with a director there. Alas, mom had gotten a quote decades ago, but had not followed-through on paying for it. She and dad do have a paid-for mausoleum space, though. So, since Medicaid requires you to have a pre-paid funeral plan in-place, we sat down and planed her funeral. Not fun. But it was interesting how much you can add-on these days. I remarked to my wife that it's been a weird year...I married my daughter off, and I planned my mom's funeral.

After that, we made it to the police district office and filled-out the missing-person report. The ladies in the office were great and understood entirely why I was doing it. Interestingly, they told me that, since he is not mentally handicapped or in any other way deemed incompetent, even if the police do find him, they have to ask him if he wants me to be informed. Weird. Oh well.

Finally, it was off to mom's condo, to gather-up a few things for her move into the memory care facility. We were wary of going, since we had no idea whether we would run into my brother there. That could be ugly. Luckily, he wasn't there. We didn't stay long, though. Just long enough to gather a lot of pictures and what clothes she had that were still wearable. I also rescued the most awesome cookie jar in the world...the one we had as kids growing up in the 60's. It's really the only thing I even thought about having for myself out of all this mess. This one memento.

That's it for now. Monday packs the potential to be very eventful. We don't know if her discharge will be then or Tuesday. Shit gets really real next week.

Thank you, again, everyone.
posted by Thorzdad at 12:09 PM on June 7 [6 favorites]


You can fight the discharge if you've not finalized your mom's care arrangements.

Terrible to say but you could disappear from hospital or induce agitation in your mom. Crying in front of the discharge nurse and guilting them into not leaving a memory impaired woman homeless might trigger their humanity. Be dramatic. This shit is real.

Your perseverance is paying off in results. I admire you for doing this. Keep going. Get the neighbors to bring you food and do your laundry, you must be exhausted. We are rooting for you.
posted by crazycanuck at 12:16 AM on June 9


We met with the doctor on the psych unit yesterday. It was actually the first time we've had a face-to-face with him since she was admitted. It sounds like her release is going to be delayed a bit. She has a UTI that went unnoticed due to (I kid you not) an interface peculiarity in the reporting software the hospital uses. It also appears that her thyroid meds are not working as expected. So, he wants to get those two things under control before he releases her. We were also able to give him our impressions of her before and after her being admitted, so he had a baseline from which to evaluate her.

One issue we were fearful over, was the possibility she would not be released with any doctor's orders for rehabilitation. Having her in rehab will be key in getting Medicare (and her Medicare supplement insurance) to pay for her stay at the nursing home through most of the Medicaid spend-down period. Without that, her ability to pay would be blown out of the water. It sounds like that's not going to be something we need to worry about, though.

In the meantime, the nursing home sent over their own person to evaluate mom for admission to their facility. She was approved and, with that, we could start moving things into her assigned room in preparation for her arrival sometime in the future.

This particular facility is very unique in that the residents in the memory-care unit all have single-occupancy rooms. The more common arrangement is double-occupancy. This point, in fact, was really the determining factor when we chose the place. We are able to make her room just a little more like her own tiny apartment. That, and we we weren't exactly sure what her reaction would be to having another person in her room, especially given her recent aggressive outbreaks. She'll still have to share a bathroom with her neighbor, though, which could be worrisome.

Her furniture and bedding and whatnot were all in really nasty condition (she had a dog, that wasn't exactly housebroken. Paint your own picture of what that could mean.) so, we helped her Medicaid spend-down a bit by buying some new bedding, a small tv, and a new dresser and side table. The latter two were Sauder flat-pack pieces I had to assemble (yay! a little fun finally!) Nice looking pieces! I wish my furniture was that nice. :)

Got a follow-up call from the Indy police asking a few more questions and whether I'd heard from him. This is probably the biggest sword hanging over my head at this time. It's certainly the one causing me the most psychic anguish. You see, if everything falls into place, one of the end results, along with getting mom into a facility, will be that I will effectively make my brother homeless. He's a semi-skilled laborer who has hasn't had regular work in over three years. He's been living in a second property my mom owns (the tiny house we grew-up in) rent free. Once the Medicaid spend-down begins in earnest that house will be sold-off. He will lose the roof over his head and, as far as anyone knows, he doesn't have anywhere else to go. He's also been using mom's car ever since we took her keys away several years ago, and that will have to be liquidated, too.

Now, at this point, there's no real love lost between us, but I'm having a really hard time dealing with the idea that I'm having to cold-heartedly kick a fellow human being out into the streets. I assuage my guilt by telling myself that he put himself in this spot (and he really did. There are eye-popping details which I don't want to air here. Let's just say he made a stunning series of bad moves and ended up where he is today) Still, I'm not comfortable with taking such a hard-core position, and I'd be lying if I said I wasn't just a bit afraid of him. He's an angry man who drinks and has a weapon or two. But, my prime focus is on what's best for mom, and I really can't let my brother's problems derail that. He's the reason this has dragged-on this long as it is.

Today actually looks to be a quiet one for us. My wife can actually go to work (she's been having to take days away from her job ever since this fiasco started. Luckily, she has an amazing boss whose only words to her were "Do what you need to do. Don't worry.") This event has definitely brought us closer. I'm the first to admit that she's the rock in our relationship, and I've thanked her many times throughout this ordeal for being there. Our next milestone will probably be mom's transfer to the nursing home. That'll be interesting. I don't expect it to go well.

Thanks, again, for all the well-wishes. I only hope none of you ever have to deal with something as messed-up as this. If you have any particular questions about any of this, please feel free to MeMail me and I'll be happy to give you my thoughts or suggestions.
posted by Thorzdad at 5:41 AM on June 10 [1 favorite]


If your problem is having your mother shed assets for which you have no personal ambitions as quickly as possible, and your brother needs a house and a car, could your lawyer perhaps advise on selling him the ones he's currently using for one dollar plus other valuable considerations (i.e. his care of your mother up to shortly before the present day)?
posted by flabdablet at 7:26 AM on June 10


Absolutely check with an elder lawyer first before selling anything of your mother's!!! My grandfather is in a nursing home and has a car that he cannot drive but cannot be sold because the income will be counted against his medicaid eligibility (they go by blue book value, not how much you actually sell it for). I assume the same is true of your mother's house.
posted by desjardins at 7:34 AM on June 10


flabdablet: The car and home would have to be sold at something close to market value. He could rent the house and we'd be kosher. It's all moot, though, since he hasn't any income to speak of. Not only can he not afford to buy the car, he can't even afford rent. And, owing to his tax problems, any property that suddenly shows up in his name would most likely be in jeopardy.

desjardins: The car your grandfather owns is already counting against his Medicaid, since it his personal property. Medicaid is looking at that personal property and penalizing him in terms of what they're willing to pay. Once he sells it, the money from the sale would be given to the nursing home. Technically, yes, this income would count against his Medicaid at the time, but that shortfall would be made up by the income from the sale of the car. We've worked with both an elder-care attorney as well as a Medicaid specialist, and they both say the car and the homes have to be sold in order to get mom on Medicaid asap. Perhaps it's the speed at which we need to get Medicaid enacted which makes our case different than yours?
posted by Thorzdad at 8:08 AM on June 10


And, yeah, Medicaid is as ponderously labyrinthine as it sounds.
posted by Thorzdad at 8:09 AM on June 10


I think the administration of medicaid varies by state. My grandpa's state allows a personal vehicle (even if he can't drive it) and it doesn't count as an asset unless he sells it.
posted by desjardins at 8:21 AM on June 10


Thorzdad - thank you for keeping us updated, and please continue to do so. I am so glad that you and your wife are such a solid team on this. She sounds like a brick! And how wonderful that her boss was so understanding.

The bureaucracy and red tape is a PITA. It's too bad about your brother, but you need to do what is best for the dependent person in need - your mom - and also protect yourselves.

Having been the caregiver to my dad, I can tell you that UTIs are very common in the elderly and can cause symptoms - such as mental confusion and combativeness - that you wouldn't associate with a UTI. Treating that, and adjusting thyroid meds, will make a difference to your mom's quality of life. I really hope the transfer to the care home goes smoothly. It sounds like you found a good one and put some nice furniture and bedding in it.
posted by Rosie M. Banks at 8:24 AM on June 10 [2 favorites]


A bit of melancholia...As part of getting mom's finances in order, I cancelled her phone service this morning. It's kind of sad that the number I grew-up with, and was as much a part of the family identity as anything, is now no more.

A silly thing, I know, but still...

*sigh*
posted by Thorzdad at 6:47 AM on June 12


That is hard. Maybe you can think of it as a baby step to helping you get over the inevitable sadness that will come with selling the house. You're slowly making it less of a home.
posted by Mchelly at 7:17 AM on June 12


Not much to update at the moment, I'm afraid.
Mom is still in the hospital geriatric psych unit. They're still working to get her UTI under control, as well as her general anxiety and excitability. Apparently, her sundowner's is giving the night shift nurses fits, as she stays up all night (and most of the day) wandering around the floor and getting into other patients' rooms and things.

So, at this point, there is no date for her release to the nursing home. But, at least I know she's getting the sort of care she needs.

We're meeting with the Medicaid guy this morning to go over our next steps.
posted by Thorzdad at 5:24 AM on June 14


Am so glad that she is now getting appropriate care and that the longer term housing arrangements are in place - been thinking of you and glad you're updating us! This stuff is so hard and so stressful!
posted by leslies at 9:27 AM on June 14 [2 favorites]


Glad to hear things are better under control. Rosie M. Banks is spot on about UTI's and acceleration of dementia symptoms. When my Aunt was at the nursing home, it got so that I could alert the staff that she had some kind of infection because she'd get an especially anxious look. UTI's made her delusions paranoid which began to make sense to me as it was almost as if she was being poisoned from within.

The facility I chose was not well rated and looked kind of ratty, but I chose it for how I felt there. Also that it would accept a medicare patient with infection issues. I visited often, made sure that staff knew who I was and were welcome to contact me whenever there were any questions and I was happy with the quality of care. It helped that my aunt had a sweet tooth and I would bring in treats that she would share. She loved to have something to 'show off' - a regular visitor bringing a tray of mini cupcakes is always a prize.

Initially I thought the private room would be best, as my aunt had always lived with her mother then alone and did not want to share. but once she did, she liked it for the most part. It helped quell her fears at night to have someone in the room with her, even if the person was bed ridden and slept 20 hours a day.
posted by readery at 11:00 AM on June 15


Got a call from the hospital social worker this morning, updating me on where they stand right now. Apparently mom got into it with the nurses last night, fighting with them. Her sundowner's seems to really be bad right now. The last couple of times I visited with her, they had her in what they call a Geri Chair. They use it when a patient is wandering and getting into things too much, or is prone to acting out. Sort of a time-out chair for dementia patients. She seems ok with it, at least when I see her. She never tries to get out of it, anyway.

The doctor previously had her on a small dose of Risperdal, in order to better control her anxiety and acting-up, and has now upped the dosage due to this new wave of aggression. They are, of course, watching her closely in case she exhibits any bad side-effects.

The social worker also mentioned that mom really needs to have her teeth worked on. This is something we already have in the plans. As soon as she qualifies for Medicaid, we plan to have her few remaining teeth pulled (she never took good care of her teeth, even when I was a kid) and dentures fitted. We're also well-aware that she's likely to lose the dentures, but at least she'll be in a care facility where they're more likely to be able to find them.

Still, the social worker said they hope to release her later this week. Of course, they said that last week, and mom didn't cooperate with those plans.

Our next big job is to get the properties sold. We've decided we're going to need to enlist someone who specializes in distressed properties to get them sold quickly. There's just no way I can sell them on my own. I'm just too busy with everything else to have to run down to Indy every time someone wants to see one of the homes, and I'm just not versed well enough in the business of selling a home myself. There's also the issue with the house my brother is/was living in. It probably still has his stuff in it (clothes, tools, hunting gear, etc.) and I don't have a key to the place. It's one thing to take the roof over your brother's head away, but it's another thing to also sell-off his stuff. Mom can't afford to rent a storage place, though, and Medicaid won't allow that expense, so I'm not real sure how this is going to work itself out.

Thank you all, again, for the kind words and support. It means a lot to both of us.
posted by Thorzdad at 9:35 AM on June 16


Your mentioning the state of your mom's teeth makes me wonder: Is she acting out due to chronic pain? It is possible she is in pain (with her teeth or something else), she obviously can't articulate it, so she becomes combative. She might need to be evaluated for pain and given painkillers. I had no trouble getting Norco for my dad - I don't think the FDA is worried about a frail 80-something becoming addicted to pain meds.

Getting the urinary tract infection under control will also help, I'm sure. My dad kept getting UTIs (because he had a catheter) and one of them turned out to be resistant to Cipro, which is the antibiotic Dad's doctor usually prescribed. They wound up giving him two or three different antibiotics until the UTI cleared up.

Re your brother's stuff: is there room in your house to store some of it (the more important/expensive things)? He's disappeared and isn't communicating with you or anyone; he can't really expect you to hang on to all his stuff forever. Bottom line is, you have to do what you have to do, and what is best for your mom, who is the vulnerable adult in this situation.

Good luck with all this and continue keeping us posted.
posted by Rosie M. Banks at 11:18 AM on June 16


I was surprised at how much my aunt had done for her once she was in a nursing home, dentures, new glasses, podiatry...but then I realized the business model of a nursing facility makes them keenly aware of what they can bill Medicare/Medicaid for. I reviewed the billings to Medicare just to keep updated on the meds and was often surprised at the services she received. She enjoyed the attention and any interaction was good, but I don't know that they needed to bill Medicare for podiatry to cut her toenails.

So expect that once she is actually in the facility they'll make sure she gets whatever services she qualifies for. Also the place my aunt was in allowed residents to use the discretionary set aside from their monthly Social Security check on manicures. There was a very positive response from the female residents when they'd get their nails done once a month by traveling manicurists. I think a lot of it was the interaction and touch, but also allowed the ladies a bit of glamour. Aunt Sis may have been confused by most things, but boy did she like a fresh manicure. She'd look at her hands all day in awe.

I hope things work out for your mother as well. Once she was settled in and medications were figured out the combativeness faded and she enjoyed the best quality of life she'd had in years. It was for the most part watching TV all day, but the end of the constant fear and anxiety was great.
posted by readery at 11:48 AM on June 16


Your mentioning the state of your mom's teeth makes me wonder: Is she acting out due to chronic pain?

I think, definitely, her teeth are probably causing some pain. They're pretty bad, and I feel horrible for not getting them done earlier, but it's pretty expensive to pay for on your own (something she didn't have income for) and she really, truly would have simply hidden them somewhere in her house, never to be seen again. She already lost her two partials a long time ago. Well, according to her, my son stole them. Everything that she's hidden is stolen, according to her. And usually by my son, for some reason. I can't imagine what we're going to find once we start seriously rummaging through her condo.

Getting approval for Medicaid is like suddenly having a gate thrown open, as far as getting needed medical work done for a senior.
posted by Thorzdad at 1:25 PM on June 16


Random update thoughts...

Went to see mom tonight. I'm guessing the UTI has been cleared-up because the woman I saw tonight was more lucid and aware than I can recall seeing her in at least a year. Don't get me wrong, she's still very definitely an Alzheimer's sufferer, but she was very clearly better than she's been in a long time. It was so different, I started having second thoughts about the course I've set this ship on, that of putting her into a memory-care facility, liquidating her assets, etc. My wife very quickly assured me that, no, she's still in need of constant care and attention and still definitely was floating in and out of different time-frames. She's right, of course. Still, it was nice to actually be recognized as her son tonight. And, sometimes as her grandson.

They still have an issue with her sleeping patterns, her sundowner's, and her total lack of understanding of another person's personal space. She's become very friendly and wanting to get in everyone's space. As you might expect, some of her fellow patients aren't very welcoming of this.

I'm now fearful that this new clarity is going to allow her to understand that she's being put into a nursing home, and engender some very negative reactions. Time will tell, I suppose. The downer in me says this could get ugly.

The rumor is that the hospital might release mom to the nursing home tomorrow. No one has contacted us with any definite news, though. I really would hope they'd give us a day's notice, at the very least. The geriatric psych unit has been one of the best things to happen in this long ordeal, without any doubt, but they are a bit lax with the family communication.

We bought her a comfy recliner for her nursing home room, as part of the Medicaid spend-down. The room is looking nice. Well, as nice as a large hospital-ish room can look, I guess.
posted by Thorzdad at 6:06 PM on June 17 [4 favorites]


So, mom's not being released today. I guess she got angry and argumentative with the doctors at some point either last night or today, so the doc has adjusted her meds. I guess they're shooting for releasing her tomorrow now.

If it does happen tomorrow, I hope it's in the afternoon. We plan on going to the condo tomorrow morning to gather-up whatever remaining valuables there might be, as well as any important papers. A realtor is supposed to meet us there, to take a look at it. He says he has a line on investors who purchase distressed properties to rehab and flip.

He also might be able to help us with the other house mom owns...the one my brother has been living in rent-free for several years. He's unemployed and pretty adamant about not leaving the house. I completely understand and sympathize with his plight, but my hands are tied. Medicaid requires us to sell the property, unless it can be rented. Being unemployed (and in-debt up to his eyeballs) there is no possible way he can rent the home. He's also been driving mom's car, which I have to sell as well.

So, yeah, I'm going to be the bad guy who makes his brother homeless. I'm losing a lot of sleep over this aspect of things.
posted by Thorzdad at 11:45 AM on June 18


I'm going to be the bad guy who makes his brother homeless.

I'm so sorry this is coming down on your shoulders like this. If it helps, I wonder if there might be a way to (gently) start reframing this in your mind, in order to ease some of the stress and pain you're feeling (and hopefully to help you sleep a little better, both literally and figuratively!). Maybe something like "I know my brother thinks I'm the bad guy who made him homeless, but I know I did my best under circumstances that are out of my control to try to make it right with everyone involved." Because that's really closer to the truth, I think -- and it allows you to accept the existence of your brother's point-of-view (you're taking away his home) without having to share it (you know that his joblessness and debt are not your fault).

My best to all of you.
posted by scody at 1:04 PM on June 18


Wow Thorzdad - you have been on top of this 24/7. You have incredible strength and fortitude.

Have you asked the social worker at the hospital for a referral to Alzheimer's caregiver support for yourself? There should be resources, even if only peer groups, available for you personally. Caregiver burnout is A Thing and you are at risk of it.

I also just wanted to give you a note that my grandmother, who suffered from Alzheimer's, passed away from a UTI. When things have settled down a bit with your current situation, and your mom is ensconced in her long term abode, you might want to have a very frank discussion about what you will or will not treat in the future and write some paperwork to this effect. Assigning some cash to legal representation for a detailed advanced health care directive would be useful.
posted by crazycanuck at 1:56 PM on June 18


I'm going to be the bad guy who makes his brother homeless.

This is false. If you don't sell the house and car, your mother has no place to go. His staying in the house would make your mother homeless. She can't get a job or make other arrangements. Your brother, hopefully, still can. You are being forced to "choose" (for want of a better word) your mother over your brother, due to circumstances he was partially responsible for. If he tries blaming you for putting him on the street, you need to remind him (and yourself) of that.
posted by Mchelly at 2:34 PM on June 18


~You have incredible strength and fortitude.
I have the greatest, most amazing wife standing with me. I'd honestly have crumbled a long time ago had it not been for her. I'm always amazed at my good fortune to have had her by my side these 34 years now. She's really organized, too, which you really, really have to be in this sort of situation.

~Have you asked the social worker at the hospital for a referral to Alzheimer's caregiver support for yourself?

I've been a regular at a local Alzheimer's support group for about three years now. It meets once a month. I had to miss the last meeting because we were neck-deep in this emergency at the time. The next meeting is in a couple of weeks and, boy-howdy, will I have a story to tell.

I've also been making use of the local university's psychology practicum clinic, and have been seeing a counselor for awhile now. I started going for other reasons, but it's really come in handy ever since this event happened.

~You are being forced to "choose" (for want of a better word) your mother over your brother, due to circumstances he was partially responsible for. If he tries blaming you for putting him on the street, you need to remind him (and yourself) of that.

Oh, absolutely. This is exactly how I frame the situation in my mind, and it's the absolute truth. My brother's particular rabbit hole goes even deeper than what I've laid-out, believe me. My sleeplessness comes more from a simply basic moral qualm in my mind about putting anyone out in the street. A moral person simply doesn't do that to another human. But, it's not a perfect world and, as you say, this is a "choice" between mother or brother due largely to his actions. It's not really a choice, of course. The properties are hers and must be liquidated. This must be somewhat how a general must feel committing troops to battle, knowing most of them won't come back. It's what has to be done.
posted by Thorzdad at 3:06 PM on June 18 [2 favorites]


Thorzdad thanks for keeping us posted. Hearing about your experiences is useful for those who may have to face it someday.
posted by magstheaxe at 2:12 PM on June 19


Random piece of info about UTIs in seniors: I was told by an infectious disease doc that taking a high dose of Vitamin C is a good preventive (especially for women, who are more prone to UTIs) because it keeps the plumbing more acidic and thus more unwelcoming for bacterial growth. You might talk to someone on the medical team about this, whether it might be a good idea to incorporate into her daily meds.
posted by LobsterMitten at 3:45 PM on June 19


Just a day shy of three weeks ago, I sat down on an early Saturday morning, and tapped-out a plea for help and guidance. In the days that followed, I experienced a ceaseless outpouring of support and well-wishes that I honestly hadn't expected, but was excited and amazed to receive. Everyone's kind words and wishes, here in the thread, via MeMail, via email, via snail-mail!, buoyed me and did more to keep my head and hopes up more than you will ever know. I've been a MeFite for nine years now and, while I've always felt at-home here, this experience has really cemented in me what it means to be a part of this community.

Yesterday afternoon, my mom was released from the hospital psych unit and transferred to a local memory-care facility. We all have achieved the goal I was seeking with my opening plea.

...........
We aren't exactly out of the woods quite yet, of course. We still need to secure Medicaid for mom, and there's still the issue with the old house and my brother, which will resolve itself one way or another.

We didn't get to see mom yesterday, though, as we were down in Indy continuing to clean-out her condo of valuables and other items of worth. Mom kept everything. If you ever sent her a card or letter, she still has it. Decades-old utility bills. Decades-old bank statements. It was never ending. And the photo negatives! I feel sad about it, but I ended-up tossing thousands of strips of color negatives, because I just couldn't take the time to look through them all. I'm sure I trashed entire chunks of my childhood in those negs. The only negs I did save were a ton of medium-format black-and-white negatives, which I plan to scan and see what they are. Please take note...If any of your parents are hoarders like this, slap them out of it and help them start culling now. You really don't want to wait til you're in a spot like this to have to wade through, and perform triage on, their memories . It's easy to say you'll be mercenary about it, but you will get caught-up in the "Am I erasing history?" mental debate.

And, for god's sake, make sure their legal and financial paperwork is in-order, and you have signed copies of it all.

We met with a realtor yesterday, as well. He came to look at the condo and he was far more hopeful about the potential of getting it sold relatively quickly. The old house, on the other hand, he had more issues with. But, at least we have a solid start on those two problems, now, too.

...........
I want to thank the MeFi powers-that-be for allowing what amounts to the mother-of-all-threadsits to continue on unabated or closed. I certainly understand that this Ask thread probably violates a raft of Ask guidelines. All I can say in my defense is that the past three weeks would have been much more difficult had it not been for this thread. I promise my next Ask will be more mundane (I hope.)

...........
So...I guess this is it. With mom in a memory-care facility, I guess this thread is officially, successfully, resolved. I'll check back in now and then in case anyone pops-in with a question or comment. But, if any of you happen to find yourselves in or near the Muncie area, please contact me and the beer is on me.

Thank you, again, everyone for the support, well-wishes, and encouragement. You all had a part in getting us to this positive resolution. I applaud you.
posted by Thorzdad at 4:27 AM on June 20 [16 favorites]


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