Can I do anything to prevent my MIL from being kicked onto the street?
March 28, 2017 12:46 AM Subscribe
I am in a dire situation with my mother in law who is poor and (now) homeless. She has been in the hospital for the past month+ due to a suicide attempt, which has also resulted in her being denied return to her independent living home. The hospital has decided she is no longer a threat to herself and needs to be discharged. The hospital social worker has been unable to find her low-income assisted living and is now threatening to put her in a cab and send her to a homeless shelter unless my husband and I take her in. We can't. What can we do?
More details and what we've done so far:
- She lives in the Seattle area and currently receives disability, SNAP, and social security - all of which amounts to <$1000 a month. She has no assets and is unable to work. She has been on the waiting list for Section 8 housing vouchers for 8 years and her name has never come up.
- Up until this incident we were paying for her rent and we had to wipe out all of our own assets to get her into an independent living facility that we thought would be a good fit for her. Obviously it wasn't because this incident happened. We can't afford to continue to pay for her housing and living with us is NOT an option (please don't try to argue for this to be an option; we have tried it already many times over the years and it was a massive fail).
- We had a legal review of her lease and confirmed that the independent living facility was within their right to refuse to let her return due to this incident. Their assessment is that she should be in assisted living but they do not accept Medicaid and we can't afford private pay.
- There are no friends or other family members who can take her in or give her money. Everyone is in an equally bad financial situation.
- We agree she should now be in assisted living as she obviously can't take care of herself. She was assessed for Medicaid but her daily rate is very low (something like $50/day). Combined with a suicide attempt, no Medicaid facilities the social worker has talked to will take her because she's not worth enough money + carries too much liability for other residents. We would be open to her moving elsewhere but we don't have the resources to do this research and it seems like the hospital social worker can only focus on the immediate region.
- We are open to the idea of her living in a regular apartment and having home health aides come visit daily, but we haven't found an apartment that she could qualify for on her very low income (us being on the lease is NOT an option). As mentioned, she has been on the Section 8 waiting list for many years. SHAG apartments (Seattle low-income senior housing) are too expensive. Sharing an apartment with a roommate is an option but MIL doesn't have the mental capacity to set that up and we don't have the time or energy to assist with finding a roommate right now either.
- She insists she is 100% fine and can take care of herself, even though years of accidents and falls and medication overdoses prove otherwise. I really believe she is out of touch with reality either due to early dementia or an undiagnosed mental health issue, but either she lies effectively enough or isn't sick enough for it to be caught by any psychiatric/neurological assessments she's had done.
We are at our wits end and feel like we've run out of options and time. It feels like the hospital is trying to shame us into taking her but we.just.can't. We want her to be in a safe environment but we can't be financially or legally responsible for this situation anymore. It has effectively damaged our marriage, our finances, our careers, and my own mental health. We need someone else to take the wheel.
tldr: what do other elderly poor people do when they are too unwell to live alone but not so unwell that the government will fully pay the bill? What options exist at this stage?
More details and what we've done so far:
- She lives in the Seattle area and currently receives disability, SNAP, and social security - all of which amounts to <$1000 a month. She has no assets and is unable to work. She has been on the waiting list for Section 8 housing vouchers for 8 years and her name has never come up.
- Up until this incident we were paying for her rent and we had to wipe out all of our own assets to get her into an independent living facility that we thought would be a good fit for her. Obviously it wasn't because this incident happened. We can't afford to continue to pay for her housing and living with us is NOT an option (please don't try to argue for this to be an option; we have tried it already many times over the years and it was a massive fail).
- We had a legal review of her lease and confirmed that the independent living facility was within their right to refuse to let her return due to this incident. Their assessment is that she should be in assisted living but they do not accept Medicaid and we can't afford private pay.
- There are no friends or other family members who can take her in or give her money. Everyone is in an equally bad financial situation.
- We agree she should now be in assisted living as she obviously can't take care of herself. She was assessed for Medicaid but her daily rate is very low (something like $50/day). Combined with a suicide attempt, no Medicaid facilities the social worker has talked to will take her because she's not worth enough money + carries too much liability for other residents. We would be open to her moving elsewhere but we don't have the resources to do this research and it seems like the hospital social worker can only focus on the immediate region.
- We are open to the idea of her living in a regular apartment and having home health aides come visit daily, but we haven't found an apartment that she could qualify for on her very low income (us being on the lease is NOT an option). As mentioned, she has been on the Section 8 waiting list for many years. SHAG apartments (Seattle low-income senior housing) are too expensive. Sharing an apartment with a roommate is an option but MIL doesn't have the mental capacity to set that up and we don't have the time or energy to assist with finding a roommate right now either.
- She insists she is 100% fine and can take care of herself, even though years of accidents and falls and medication overdoses prove otherwise. I really believe she is out of touch with reality either due to early dementia or an undiagnosed mental health issue, but either she lies effectively enough or isn't sick enough for it to be caught by any psychiatric/neurological assessments she's had done.
We are at our wits end and feel like we've run out of options and time. It feels like the hospital is trying to shame us into taking her but we.just.can't. We want her to be in a safe environment but we can't be financially or legally responsible for this situation anymore. It has effectively damaged our marriage, our finances, our careers, and my own mental health. We need someone else to take the wheel.
tldr: what do other elderly poor people do when they are too unwell to live alone but not so unwell that the government will fully pay the bill? What options exist at this stage?
The hospital social worker has been unable to find her low-income assisted living and is now threatening to put her in a cab and send her to a homeless shelter unless my husband and I take her in. We can't. What can we do?
You can call some women's shelters to try and get her into a place like Noel House which provides 24 hour access for up to a year, instead of having her dropped off at DESC or one of the more emergency shelters. And if they don't have a vacancy, or say that she wouldn't qualify to live there, they may know of other options that the hospital social worker is not as plugged into. Having her go to a homeless shelter may not be the worst outcome - there will be professionals who can help her set up a roommate if that's really all she needs, and she will qualify for extra help by being literally homeless.
posted by the agents of KAOS at 3:11 AM on March 28, 2017 [11 favorites]
You can call some women's shelters to try and get her into a place like Noel House which provides 24 hour access for up to a year, instead of having her dropped off at DESC or one of the more emergency shelters. And if they don't have a vacancy, or say that she wouldn't qualify to live there, they may know of other options that the hospital social worker is not as plugged into. Having her go to a homeless shelter may not be the worst outcome - there will be professionals who can help her set up a roommate if that's really all she needs, and she will qualify for extra help by being literally homeless.
posted by the agents of KAOS at 3:11 AM on March 28, 2017 [11 favorites]
When I have seen situations similar to this in the past -- and speaking from the side of the medical team, it really sucks to take care of a patient and then have to discharge them onto the street because we have no control over resources outside the hospital -- it often turned out that the patient being discharged actually had a need for skilled nursing or physical therapy upon discharge that needed to be provided at a skilled nursing facility or acute rehab.
An elderly woman who has been in the hospital for over a month is very likely to be quite frail and probably not walking or performing her activities of daily living as well as she did at her baseline, and therefore could benefit from intensive physical therapy to transition back into life outside the hospital.
None of these options would be a longterm solution, but could certainly buy you more time possibly covered by Medicaid (and really actually deliver care it sounds like your MIL would benefit from). In order to be discharged to a place like that the medical team has to be in favor and the hospital social worker has to find placement; it may take some social engineering to achieve those goals. If there's a physical or occupational therapist who sees your MIL in the hospital now, you might consider talking to them to see what their thoughts are.
posted by telegraph at 3:31 AM on March 28, 2017 [14 favorites]
An elderly woman who has been in the hospital for over a month is very likely to be quite frail and probably not walking or performing her activities of daily living as well as she did at her baseline, and therefore could benefit from intensive physical therapy to transition back into life outside the hospital.
None of these options would be a longterm solution, but could certainly buy you more time possibly covered by Medicaid (and really actually deliver care it sounds like your MIL would benefit from). In order to be discharged to a place like that the medical team has to be in favor and the hospital social worker has to find placement; it may take some social engineering to achieve those goals. If there's a physical or occupational therapist who sees your MIL in the hospital now, you might consider talking to them to see what their thoughts are.
posted by telegraph at 3:31 AM on March 28, 2017 [14 favorites]
Are there rooming houses in Seattle? Where I live in Savannah there are many of them, they provide a furnished room, sometimes a private bath, or a shared bath, and a shared kitchen. Costs are low. There isn't any kind of supervision/assistance per se but from what I've heard the tenants sometimes help each other out.
Good luck, I went through something similar with my mother and had to put my foot down hard with the social worker who wanted me to take her home with me. Like you, I could not.
posted by mareli at 4:58 AM on March 28, 2017
Good luck, I went through something similar with my mother and had to put my foot down hard with the social worker who wanted me to take her home with me. Like you, I could not.
posted by mareli at 4:58 AM on March 28, 2017
My sympathies! I don't know if it's because they are overworked or burnt-out or jaded because they see a lot of uncaring families, but, IME, hospital discharge planners can be awfully quick to scream "FAAAAMILY!" in your face and make all kinds of threats to get you to take in someone who you can't realistically care for at home. I was actually able to make a social worker back down, on behalf of an older relative - the worker was relentlessly bullying the man's wife, I took the phone away and said, "Care at home won't be possible. You have to make other arrangements." Voila, worker made arrangements and man had a care home! Being firm really helped. I know it's hard.
It's very possible that the social worker is bluffing when threatening to stuff MIL into a cab with a, "goodbye and good luck!" OTOH, if the social worker really does mean what they say, Agents of KAOS is right that a homeless shelter might not be a bad thing, in that they would have resources for MIL that the hospital social worker might not.
What might help you, and ease the guilt, is calling an agency that has resources the hospital doesn't, and can run interference between you and the discharge planner: Seattle/King County Area on Aging, Seattle Human Services, 211 Community Resources, Older Women's League of King County.
Good luck! I hope your MIL can find a place to live and everything works out. Keep us posted.
posted by Rosie M. Banks at 6:30 AM on March 28, 2017 [6 favorites]
It's very possible that the social worker is bluffing when threatening to stuff MIL into a cab with a, "goodbye and good luck!" OTOH, if the social worker really does mean what they say, Agents of KAOS is right that a homeless shelter might not be a bad thing, in that they would have resources for MIL that the hospital social worker might not.
What might help you, and ease the guilt, is calling an agency that has resources the hospital doesn't, and can run interference between you and the discharge planner: Seattle/King County Area on Aging, Seattle Human Services, 211 Community Resources, Older Women's League of King County.
Good luck! I hope your MIL can find a place to live and everything works out. Keep us posted.
posted by Rosie M. Banks at 6:30 AM on March 28, 2017 [6 favorites]
Sound Generations (formerly Senior Services) is a really helpful organization. You can speak to a social worker through them as well and that's a social worker who doesn't have the pressure of meeting hospital cost controlling demands to meet.
They helped me and my family find an adult day center for my elderly mother who had dementia, they provided tons of help finding a nursing home when that was needed, finding in home-supervisions, etc..
They also offer FREE caregiver support, advice, and help and that sounds like something you are very much in need of.
posted by brookeb at 8:57 AM on March 28, 2017 [2 favorites]
They helped me and my family find an adult day center for my elderly mother who had dementia, they provided tons of help finding a nursing home when that was needed, finding in home-supervisions, etc..
They also offer FREE caregiver support, advice, and help and that sounds like something you are very much in need of.
posted by brookeb at 8:57 AM on March 28, 2017 [2 favorites]
Try calling DESC and see if your MIL would be eligible to go straight into one of their supportive housing facilities, rather than a temporary shelter: http://www.desc.org/housing.html
Likely you will be able to make a better case than the social worker would/did for MIL being one of the "most vulnerable" that the "Housing First" model is supposed to serve, since you have a lot more background information. As somebody with a very low income, unacknowledged mental problems, a history of physical vulnerabilities, and a history of failed family stays, she sounds like she might fit the bill. The social worker may just be going through the motions of looking for housing, so she can palm the task off on you or whatever homeless shelter they would send her to.
If you call DESC and they accept your MIL, then the social worker didn't do her job properly. It's her job to know about these resources and make the call with all the relevant information to convey. DESC has a "Vulnerability Assessment" that takes into consideration ten aspects of a person's life:
1. Survival Skills
2. Basic Needs
3. Indicated Mortality Risks
4. Medical Risks
5. Organization/Orientation
6. Mental Health
7. Substance Use
8. Communication
9. Social Behaviors
10. Homelessness
You can get a rough idea of how your MIL would score by looking at the form at the end of this document: www.desc.org vulnerability assessment pdf
posted by r0w at 9:19 AM on March 28, 2017 [5 favorites]
Likely you will be able to make a better case than the social worker would/did for MIL being one of the "most vulnerable" that the "Housing First" model is supposed to serve, since you have a lot more background information. As somebody with a very low income, unacknowledged mental problems, a history of physical vulnerabilities, and a history of failed family stays, she sounds like she might fit the bill. The social worker may just be going through the motions of looking for housing, so she can palm the task off on you or whatever homeless shelter they would send her to.
If you call DESC and they accept your MIL, then the social worker didn't do her job properly. It's her job to know about these resources and make the call with all the relevant information to convey. DESC has a "Vulnerability Assessment" that takes into consideration ten aspects of a person's life:
1. Survival Skills
2. Basic Needs
3. Indicated Mortality Risks
4. Medical Risks
5. Organization/Orientation
6. Mental Health
7. Substance Use
8. Communication
9. Social Behaviors
10. Homelessness
You can get a rough idea of how your MIL would score by looking at the form at the end of this document: www.desc.org vulnerability assessment pdf
posted by r0w at 9:19 AM on March 28, 2017 [5 favorites]
Can you relocate her to Pierce County? King County, specifically the Seattle area, has kind of a regimented access to care, and there's a long waiting list for the nicer housing areas - they are trying to be nondiscriminatory, but in the short term, it takes away social workers' ability to exercise their discretion, which interferes with placement.
If you can, I'd try the Multi Service Center in Federal Way as a first stop.
posted by corb at 9:35 AM on March 28, 2017 [1 favorite]
If you can, I'd try the Multi Service Center in Federal Way as a first stop.
posted by corb at 9:35 AM on March 28, 2017 [1 favorite]
Oh also feel free to memail me for more specific questions about homelessness services in the King/Pierce area.
posted by corb at 9:36 AM on March 28, 2017
posted by corb at 9:36 AM on March 28, 2017
I agree with others above that social workers often do try to guilt family members into providing housing, by acting as if there are no other resources available, when there are sometimes other resources available. "That absolutely will not be possible" should be your response to any suggestion that it's your job to house your mom. It's the social worker's job to find housing for your mom.
If I were you, I'd also call APS or the local equivalent (looks like that may be Seattle/King County Area Agency on Aging & Disability) and ask for help or resources; in talking to them, I would highly emphasize the "can't take care of herself" and "possible dementia or mental-health issues" part of the problem.
posted by lazuli at 10:59 AM on March 28, 2017
If I were you, I'd also call APS or the local equivalent (looks like that may be Seattle/King County Area Agency on Aging & Disability) and ask for help or resources; in talking to them, I would highly emphasize the "can't take care of herself" and "possible dementia or mental-health issues" part of the problem.
posted by lazuli at 10:59 AM on March 28, 2017
I'm so sorry you're going through this. I'm glad that you are able to recognize that housing your MIL is a firm no, and I'm sorry the hospital social worker is pressuring you otherwise. This post reflects a tremendous amount of empathy and work towards your MIL's well-being in difficult circumstances, and I hope that you and your husband recognize that the social worker's guilt-trip reflects the hospital's interests, not objective reality.
In addition to the sage advice above: you mention that you and your husband "had to wipe out all of our own assets to get her into an independent living facility that we thought would be a good fit." If you mean that this was the kind of facility where there was an up-front lump sum of some sort in addition to monthly payment, you may be able to recover some portion of this -- consider consulting with an elder-law attorney on that point.
Good luck.
posted by LadyInWaiting at 12:42 PM on March 28, 2017 [1 favorite]
In addition to the sage advice above: you mention that you and your husband "had to wipe out all of our own assets to get her into an independent living facility that we thought would be a good fit." If you mean that this was the kind of facility where there was an up-front lump sum of some sort in addition to monthly payment, you may be able to recover some portion of this -- consider consulting with an elder-law attorney on that point.
Good luck.
posted by LadyInWaiting at 12:42 PM on March 28, 2017 [1 favorite]
Have you contacted Sound Mental Health? It looks like they provide housing services:
https://www.smh.org/housing-residential/
posted by emmatrotsky at 7:24 PM on March 28, 2017 [1 favorite]
https://www.smh.org/housing-residential/
posted by emmatrotsky at 7:24 PM on March 28, 2017 [1 favorite]
Not a direct answer but is it possible to ask the team caring for her if she has had a capacity evaluation by a psychiatrist? If you are worried that she does not have the capacity to make her own decisions but it's not absolutely clear, this would decide the issue. If she is found not to have capacity then you have the potential ability to get decision making capacity for her and power of attorney (i.e. finances, legal stuff), which would probably be really helpful in terms of her future needs for increasing care. If they say she does have capacity then at least you tried... and I'd ask them how she scored on her Mini Mental Status Examination....
If she has capacity and her MMSE is within normal limits, then "she's in denial"/personality disorder issues might be more the problem, and there is little further you can do until she becomes more impaired for some reason.
posted by treehorn+bunny at 8:30 PM on March 30, 2017
If she has capacity and her MMSE is within normal limits, then "she's in denial"/personality disorder issues might be more the problem, and there is little further you can do until she becomes more impaired for some reason.
posted by treehorn+bunny at 8:30 PM on March 30, 2017
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posted by Jon_Evil at 1:53 AM on March 28, 2017 [3 favorites]