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She is 88 , has dementia and seems to be miserable.


She can’t function on her own. I do everything for her. She refuses to bathe, wash her hair or dress herself. I fix her meds and food. She can’t see very well so doesn’t drive. She feels lost.


She stays in her room most of the time. She doesn’t read, watch TV or have any hobbies. I think she could benefit by having a better quality of life at a nursing home where there are other seniors for her to talk to.

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To the OP and isthisrealyreal: My error - I thought thet you were talking about a Long Term Care POLICY. Please disregard my original post.
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Talk to Her Doctor for the Screening process, May have to Pay for this. They will Fax this over to the Nursing Home you have chosen, Get this ball Rolling.xx
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Ffirst of all, have you or you and your mother (If able) toured any skilled. nursing facilities(preferably one's with memory care units)? A good place to start is getting a list of facilities in your area from your Area Agency on Aging. Contacting your local hospital's social services department for a list may be an option as well. Once you have a list,you can evaluate their performance through medicare.gov or your state's department of health for care deficiencies. Once you choose some facilities to tour, you can contact the facility to arrange it. Facilities typically have an application for you to complete. The admissions director will then want some medical information from your mother's primary care physician which will need to include her medical history and list of medications. Once you select a facility, I would suggest that you take an additional unscheduled tour to observe how the facility is staffed on off shifts. There also is a form online that provides you with guidelines on what things to ask and observe during a facility tour. You can find it through medicare.gov. Good luck!
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NH would likely require some kind of referral, but as noted in discussions, sounds like your mom needs Memory Care, not a nursing home. Some NHs do have a MC section, but I would suspect that would be more appropriate for someone with cognitive issues AND a need for specialized nursing care. The BETTER thing about AL/MC is it is a lot less expensive than NH - not as much need for specialized nursing care. (The closest nursing facility to where we are is about double the cost of the MC unit.)

While your mom might still want to stay in her room if she moves, at the least some of the personal care might be more likely to get done. It will free up your time so that when you do visit, you are her daughter again, not her care-giver. Then you can focus on her, and perhaps the repetition won't seem quite as bad! That is one thing our mother is good at - the broken/skipping record! It can get to be very annoying, like a toddler who asks 100 times a minute if we are there yet! Don't bother with detailed answers/response. Just somehow acknowledge or give a very simple response (even if it is a fib) and try to "bump" the record needle to get off the "scratch."

The staff is/should be more adept at coaxing residents to do things they balk at when at home. She might surprise you and actually come out of hibernation though. Staff might be able to encourage that - our mother doesn't really participate much (if it requires hearing, she can't hear much, but she joins the gang some of the time.)

Search your area for Assisted Living with Memory Care. Check out as many as you can. Ask a lot of questions, such as what the cost is and what that covers. Most "services" are included in the cost, but I noted some places my brother down south pointed out were "ala carte", aka base price for room and add on costs for everything else. Our mother is in a non-profit and most everything is included. Her "rent" covers up to one hour of "personal" care, such as bathing. Hair cuts and nail trims are outside sourced/paid, but provided in-house.

While first visit should be arranged, so you can be shown around and ask questions, do go back at random times to observe. Also inquire whether they have "respite", so that you can at least try mom there (although generally the adjustment is longer than a normal respite period.) Ask if there is a long-term commitment, in case it really doesn't work out. Generally it takes months to really get adjusted, but some never do. Also, if you move her, you can ask staff how she is doing, but also try to stop in and observe for yourself before she sees you. Often you will hear all the complaints, how awful it is, how bad the food is, how they want out, but when you are not there, many actually get along fine or even enjoy their time with others!

BTW, it is unlikely you are going to find any place that will allow smoking.
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Peanuts56 Oct 2019
There are facilities that allow smoking. Few and far between, but they exist. My friend's parents are currently living in one. "A Place for Mom" helped her locate one.
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My wife, 79 with years of Alzheimer's dementia, was similar in many ways: not bathing, isolating self in the bedroom, unable to do the things that used to bring her joy. A day care program over the last year did help, getting her out of the house and with others in a social program with activities. Because of repeated wandering off, I placed her in a secure memory care unit one month ago. It is very expensive, but we fortunately have long-term care insurance. She adapted well. I am very pleased with the place (the best of the 4 I visited). It was a difficult decision, but the right one at the right time. It has been a big adjustment for both of us.
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How about taking her to a senior daycare center during the day? That way, she has people to talk with/be around, and you have the day to do things yourself. I would check out more possibilities than just a N.H. Also, I would take her to her next doctor's appt. and ask for advice as to where to go from here. My mom has been in Asst. Living and Memory Care for nearly 4 years now because she was doing the same things. She got involved with others at the facilities, and she enjoyed part of it for quite some time. Now she is in physical decline, but she had something to look forward to doing for the time that she could do things. Also, take your mom out and to lunch or a brief shopping trip ( even going to Walmart is about all they can handle at one time). Anything to get them out and about and show that you care. Visit often and call as well even if all you have to say is talk about the weather, or the turning of the seasons, etc. Something, anything is better than nothing.
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Consider state-subsidized Assisted Living unless she needs 24 hr nursing care. My mom is in the nicest AL home in the area and because it is subsidized the cost is only $1800. They offer assistance with bathing, require everyone to come to meals in a beautiful dining room, dispense meds, and go to their rooms to get them for daily activities. Laundry is done & rooms cleaned. Chapel services daily and a hairdresser weekly. This is in Alabama but check in your state. It’s awesome!
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Riley2166 Oct 2019
How on earth did you find state assisted living? To my knowledge, Medicaid only pays nursing homes but never assisted living. Is Medicaid paying this? I would like to know more how this works. I do know some assisted living places will keep the residents after they can pay for about three years and have not given their money away. If they run out of funds, they will be kept on subsidy. Who is paying the extra money? I never heard of this in assisted living.
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She probably won't need LTC in a Nursing Home environment.
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Isthisrealyreal Oct 2019
Isn't LTC long term care and isn't that is what a nursing home is? I am confused, please explain LL. Thank you.
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If you have LTC insurance apply immediately, the LTC approval and payment process, is the most painful part of LTC.

Any LTC policy, you need to submit caretakers, facilities for approvals.  As you start considering LTC, submit to LTC insurance all possible facilities and caretakers in your area for approval. They will take 2+ weeks to  inform you if they accept that facility or caregiver.  By having approvals early you can make better decisions on where and how you go forward.  No approval, they will nt even start their paperwork processing that takes 30-60 days.

The LTC insurance company will throw up multiple roadblocks and drag their feet every step of the approval process. It can take 6 months before you receive any $$, and they will continue to collect premiums for a few months after they start paying.  

Plan on having 2-3 months of your own $$ available at the start. Once all approvals have been processed, you will be get money. Note they pay after a months service, and 2 weeks after facility submits proper forms after the month is over.  Facilities want to be paid ahead of time. So you are always 6 weeks from when you pay till you get paid for services rendered.
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cwinter Oct 2019
You described the miserable process with LTC insurance extremely well... it's a nasty experience... and my premiums are never waived though we now have an approved open claim, and premiums were raised 70% last year. Your suggestion of get as many resources approved is a good one... I wish I had thought of that. Thank you. Carla
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Medicare does NOT pay for any Long Term Care(Nursing home) Medicare will pay for a limited time of "rehab" usually following a hospital stay. Most nursing home residents are on Medicaid after their assets run out or if they have nothing to begin with. Maybe you might look into Adult Day Health and see how she does there. For ADH, you can get some help from your state home care (Area Agency on Aging) Financial help,depends on her assets.
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mykidsmom67 Oct 2019
Medicare is paying for my mothers LTC Nursing home and shes not there for rehab or aftercare following a hospital stay. Of course her SS check goes to them also but I now have her home in my name. She was accepted 5 weeks ago.
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If you think that these facilities are “a holiday inn”, you are wrong.
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For nursing home (SNF) she needs at least nursing assessment which is about $100. The nurse can come to the house for this. Or she can have 3 days stay at hospital & Medicare will cover for short time. After that she should go on Medicaid if she qualified. My advice is to tour nearby SNF to see if residents taken care of, clean & place don’t smell bad. Ask residents if they like it there. Most will probably say that they are only there temporarily & then going home...but most will stay.
Hugs 🤗
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A "referral" is usually only needed when you are trying to have a medical expense covered by insurance. Adult Day Care and Nursing Homes homes and AL's are private pay. As DollyMe said, you don't need a referral, just $$$$!

I am worried that she still smokes, but she's 88! so smoking hasn't been the end of her yet.
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Some memory care and assisted living have short term and day care. I suggest you enroll her with day care and them a overnight stays and she how she is with others. It's not cheap and she will be evaluated by the staff and there are forms and such her doctor will be involved . People without means have less options so if Medicare gets involved with her care all her assets will be taken to help . Be aware pay most assisted living and memory care are private pay, nursing homes are more Medicare friendly but some are not as nice so visit often
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Have you looked into adult daycare?
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It sounds like she needs an Assisted Living Memory Care. A nursing home or LTC is for those who need a nurse on duty 24/7 due to health needs. You might check out several in your area and find out what’s required. I think it could be helpful to her to be around others and have activities. The ones in my area run around $5-6K a month. LTC is around 10K a month
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Sounds like you have a houseful and I envy you. All except the Mother part. Her depression will only end by complete memory loss or death. I had 3 pregnancies, two sons with one living 1,000 miles away for 12 years now. I just lost my oldest son of 37yrs (who was closer and saw him more often) 21 months ago; I still cry every day and some days are worse. You love her but, you cannot be all three children for her. You said she just moved to your town and maybe didn't see each other that much. I visit my son once a year if I can. Talking with other parents that have had children pass before them may be a better setting for her. Give it a three month trial period more or less. She can always move back in if you agree and get the 4 year old grandchildren to talk to her if you have any that age, they love repeating conversations.
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DalesMom Oct 2019
I’m so sorry to hear you lost a child! It must be the most awful pain there is.

My husband is retired military so I didn’t live close to my mother until he retired. We retired to the same city she lived in for 50 years. My youngest sister died soon after and we tried to raise her children. They were a handful and when they became 17 they left. We lived there for 22 years and when we retired (2nd retirement for my husband) we moved to a lake that is a 6 hr drive. My second sister died last year. I mention all this because I believe it is all involved in my mother’s diagnosis.

My kids all live within a couple hours drive. We all gather a couple times a year and it is hectic!

I hate it when I get frustrated with the constant repetition of the same questions. I know she can’t help it but I don’t know how long I can continue to answer like it was the first time she asked. I don’t know how long my husband can stand it either. I guess it’s a good thing she doesn’t remember when I lose it.

Thanks for you understanding and suggestions. All the best to you.
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Thank you all! Your responses helped a lot!
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That's heartbreaking :(
It sounds like she would probably qualify for both a nursing home and an assisted living. For AL, no referral needed, just research and money! For nursing home, you will need a doctors referral, this can be the PCP, or if all else fails, you can take her to ER for failure to thrive, and tell them you can't care for her, and the ER doctor can make referral. However, it's very hard to find a LTC nursing home bed (not sure if you have medicaid already), and once a MD writes order, they are only obligated to find you "a" bed, not necessarily a bed in your preferred facility, so you never know where she might end up. I know it's sad, but you can't sit with her all day, you also have a life and things to do. If you are willing to pay for an assisted living, maybe those funds can be used to hire a caregiver to sit with her?? I know, but it's not you. You'll have to allow yourself to maintain some boundaries. I'm sad for you, it's hard.
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CaregiverL Oct 2019
Hi Sofia..SNF would also need at least nursing assessment to see if they can meet her needs ..I already called admissions Dept of one my mother was in before I took her home, Hugs 🤗
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Because there are no hard and fast rules about facilities and what they are called and what services they provide I would recommend going to facilities and talking with them about the services that they actually provide and how the pay scale works.

Have her doctor fill out the paperwork for submission for a facility. In AZ it is a list of health issues, help required for activity of daily living ie bathing, dressing, preparing food, etc. Mental status and overall health, with requirements for managing their status, like daily walks, activities etc.

Doing these steps while you are waiting for a needs assessment from the area on aging will put you a step ahead. You will know what facilities can meet her needs, how much it will cost and how to apply for public assistance if needed.

You could always try a month respite and see if she does better. However, if she is having separation anxiety, she may just want to stay in your home. If that is the case then you will need to decide what you are willing to do.

Best of luck. Such a difficult situation.
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There is really just no answer to this grief at the end of life, and I fear we fight it too much. Is there any better response to what we meet at the ends of our lives than depression and grief? It is loss upon loss upon loss. To me it is better to try to talk about it. To say "How are you. Is this hard? What is the worst part for you? Are there things I can do to make this easier for you? Do you know how much I love you?"
They get very tired. The patients I saw at the ends of their lives, I kept trying as a nurse to tell their families, desperate to help them, that they are tired. That they are ready to go. That they have lived long lives full of happiness and pain. That they are tired now. Many patients literally turned their faces to the wall to disengage with their loved ones, ready for their next and last journey in life. The families were often desperate to re-engage them. I came to so empathize with the elders. They were ready. WE the young, the middle aged, the late middle aged could not get it. But they were ready. And they had done this life. It is very difficult to explain. I can only say that I learned from them, and I will never fear the end of life. I fear the torture before it, but not the leaving. I believe it is the "trip of a lifetime".
We cannot get it. We may begin to as we come more near.
Those who live long are ready. I saw patients who lived so long that they curled speechless into a fetal position. I am an atheist. But if anything could ever make me a believer, that would have been it. It was the full circle. The full cycle. It is quite beyond our comprehension I suspect.
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jjmummert Oct 2019
A beautiful and thoughtful response.
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Most nursing homes have some kind of "criteria" that the person needs to be meet to be "eligible" to become a resident there. Every nursing home or assisted living I know of has waiting lists a mile long.

I agree that her quality of life would be better in some type of senior facility.
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I should have used a different word than seems. I have asked her and she says she loves it at my house. I question it because she cries or tells me she cries all night.

She wants me by her side every minute of the day and when I ask her to come to the living room with us she doesn’t want to. I sit in her room or outside with her when she smokes. She even wants me to sleep with her. She has separation anxiety and we just got meds for that today.

She has dementia and repeats the same thing and talks about nothing else. When I try changing the subject she doesn’t hear or listen and goes back to her topic of discussion.

I think I meant nursing home but maybe memory care is where she needs to go. She can’t function on her own. I do everything for her. She refuses to bathe, wash her hair or dress herself. I fix her meds and food. She can’t see very well so doesn’t drive. She feels lost. She not only lives in a strange city our house is unfamiliar to her. It breaks my heart to see her struggling with everything. She has always been very independent.
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Bigsister7 Oct 2019
She still smokes? You may have to use the cigarettes as a small reward when she cooperates with bathing and dressing. Also, some facilities do not allow smoking.
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We didn't need anything to place step-father and wife in AL, except $$$$.
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"Seems" is the word that I find most intriguing here. Have you asked her? I once asked my very quiet aunt who told me that she was tired, very content to sit looking out the window at clouds and birds, and that she thought about her life, all the things she had done, and was quite content with that.
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RNHere Oct 2019
My great grandmother would sit in her rocking chair and look out the window for long periods of time. As a kid, I thought that it was sad but she was happy and also content. Now in middle age, I understand it. I still want to do so much more but there are periods where I could easily imagine contentedly doing the same.
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So, consider calling the local Area Agency on Aging and having a "needs assessment" done. That should tell you what level of care she needs.
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To begin with are you sure you mean Nursing Home vs. Assisted Living. What are her main and daily needs? What is she capable of?
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