We’ve just come back from solving a very stressful family situation that got worked out. We’d like to share the experience with you.
After my 63 year old brother, already disabled, had a massive stroke, I wondered. How could he be cared for long term? He went from the acute hospital to a rehab facility for speech, physical and occupational therapy. He has been making steady progress, but as many of you know, Medicare does not pay for long term care. The limit of time in a rehab place like this is 100 days. One must be getting
better in order to even qualify for that much. The limit loomed closer.
The prospects about where he would go next did not look good. He did not have enough income to pay for assisted living, which averages about $4000 a month where he lives. He has no other resources. He simply cannot live alone, as he is single and has no children and he needs daily help with a few different medical issues.
A nursing home? The thought of a nursing home bed, long term, in a shared room under Medicaid was depressing. My brother is capable of doing most daily activities by himself. He would probably be the youngest person in the place, at least the youngest who could walk around on his own. He would not want a family member to take him in either. He wants independence.
Working out how to care for him was problematic. I have siblings, but no one was on the same page. Does this sound familiar? Lots of families argue with each other and mine certainly did. No one volunteered an alternative to sending him to his apartment, which would not work, or sending him to a nursing home, which was not a good alternative either.
I asked for a care conference at the rehab facility. Nursing, rehab and social services representatives met with the siblings and discussed my brother’s care needs going forward. Assisted living seemed to be the best solution. Then an unusual thing happened: all siblings agreed that it would be better to chip in for assisted living in a good place than any other option. They agreed to come up with enough to cover his costs in a very decent place close to his apartment, where he knew the neighborhood and where his friends can socialize with him. His income together with sibling contributions would be enough to make it work.
As we are in the consulting business for those with aging loved ones at AgingParents.com, Mikol and I are very familiar with assisted living and what it can and can’t do. I checked out the place one sibling had found. It was fine! He will have a small one bedroom apartment with a kitchenette. He likes to make his own snacks, so that is great. He can eat a healthy meal in the dining room anytime he wants, with their policy of flexible dining. The place is tidy and pleasant with a little deck outside his room where he can get some sun and sit in the warm Southern California air.
I brought him over to see it before the paperwork was signed. I was half expecting resistance. While I’m sure he’d prefer to be on his own, he knows he can’t be right now. He has trouble with words since the stroke but he did say something important when he looked at his deck: “This is nice”. I was hugely relieved.
So my normally dysfunctional family has shown up, separately or together to help pack up our brother and get his new place ready for him. As the only nurse in my family, it will be up to me to coordinate his transition with speech therapy and other care needs. A home health nurse, which I used to be myself, will visit his new place, evaluate him and send a speech therapist. It takes a lot to make all of this come together but it can be done.
If you are dealing with any of these issues yourself, we would like to hear how it’s going for you. For some states, an Assisted Living Waiver Program is available to pay for the cost of care homes for those who would otherwise be forced into nursing homes because of being low income. Waiver programs provide nursing in a limited way in assisted living or board and care homes. We checked out that option too, but found that the places on the list for state support through that program were not very good. If you can pay anything more than a loved one’s Social Security or disability check, you have more good choices.
Meanwhile, keep your fingers crossed that the move goes well and he settles in. We’ll keep you posted.
Until next time,
Carolyn Rosenblatt & Dr. Mikol Davis