Nursing home or aides for Mom?

Ded tired

As I have mentioned here before, my mother is 103 years old and remarkable for her age. She is still living in her house with a great deal of help from me and my son. However, she is now almost entirely blind and cannot find her way around. Much more help is needed. I have applied for a place for her in the skilled nursing center of a a gorgeous retirement community near me. It costs a bloody fortune but you could not find a nicer spot. Fortunately Mom is well set financially, so that’s not an issue.


Now I am second guessing myself and thinking I should hire 24-7 aides for her instead. That would be more work for me since I would have to monitor the aides. I would hire through an agency so they would be thoroughly vetted. Her house is very big but it would take some updates in order to have someone else staying here. I have no idea what overnight aides would do. Sleep or stay awake to watch her?


Mom sleeps most of the day but needs help with meals, medications and getting to the bathroom. She can make it if she can find it!


I am so stressed about this, and also exhausted. She is ancient but I’m not young either. If my son did not pitch in, there is no way that I could do this. With the nursing home, she may not remember where she is but with the aides, she might not remember them from day to day.


What do you think is the better choice? Thanks for listening. I am totally fried.

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lily316

Keep her in her familiar house with aides.

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schoolhouse_gwagain

If she can afford it, I agree with hiring aides for several (or more?) years. The cost would be nearly the same as assisted living I would assume. She is also VERY lucky to have you and your son.

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patriciae_gw

Moving can be very hard on the elderly. You know her best of course as to how she would process a move. Some oldies love it but many dont. If the finances or care are a push I would base my decision on if she would find the move confusing. Confusion is not a good thing because they worry. I would not be sure that a home would required less supervision on your part. Lots of visiting is key to good care in a nursing home.

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HamiltonGardener

Why don’t you ask her?

That’s one of the complaints my grandmother has...people act like elderly people are children, unable to speak or think for themselves. Overriding their decisions and desires.

Provided the money is available, then whatever she prefers is what should be done.

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raee_gw zone 5b-6a Ohio

A very good SNF can be a good solution (my dad was also in a very expensive, but great quality facility - where the staff obviously knew him, his needs, his likes, and seemed to genuinely care about him). But even in a place like that, staff turnover could be high, and care could get sloppy once in while; so you still have to be vigilent.

My aunt and her deaf, mentally impaired son found and employed aides on their own, that were with them for well over a decade and very trustworthy - however my brother and SIL were still very involved in overseeing them - whereas my uncle's trusted household helper in the end tried to get her hands on his estate, even trying to turn his son (the same one mentioned above) against his mother and those caring for him.

With home aides, even though they are vetted by an agency, you do have to ask how/how often the agency will supervise them. And you do have to do supervision of your own to be sure that their care continues to be high quality.

Lastly, with home aides you need to be sure that she is protected from theft and deception. This would include (IMO) making you the only person who can access her accounts, and removing anything of significant value (jewelry, art, even some pieces of clothing or furniture) from her home.

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nickel_kg

I have a strong opinion. You did the right thing to find a place for your mom that is: 1) Safe for her, 2) Close to you, and 3) affordable for your family. Keep on that path, don't waffle.

1 - Even if home health aides are well trained, will they have 24/7 access to skilled nursing staff, quick and easy access to doctors? Will they be up to date on nutritional needs for a 103 year old woman? Will they do a wellness check on your mother every two hours at night? Would you feel comfortable calling your home health aide randomly in the middle of the night and asking for her to peek at your mom, "just because"? Will your home aide have back up there for him or her 24/7, if he or she needs an extra set of hands -- quickly -- for any reason? Will your mother's doctors and other care givers visit your home periodically, like they do most retirement care homes?

2 - You will still visit your mother frequently, both for social connection and to ensure she is being well taken care of. Drive to her current home, drive to the care home -- I didn't hear you express a big difference.

3 - It's affordable, so what else should she spend her money on?

My siblings and I are so. much. better. off. now that Dad is in a nice Assisted Living home. We actually relax together now, instead of one of us always having to be "on call". We know Dad is taking the correct pills at the correct time, and eating nutritional (and yummy) food at the appropriate times every day. We sleep through the night! We think of him with love, not with stress!

Really, I feel so strongly that assisted living *can* be a very good thing, both for the person entering into care and for their loved ones. I didn't hear you express any factor that argues against your mom's move, and I see your name "ded tired" as an indication you could use a break yourself! You've done your homework, found a great solution, your mom would/will approve of your judgement. Do not second guess yourself out of a good future.

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Elmer J Fudd

Your heading says "nursing home" but I think you mean senior residential facility, which is something very different.

My mother in law, also a nonagenarian, moved somewhat unwillingly to a senior residential facility a few years ago, at the urging (a polite description) of her children. It was at the end of about 12 months of her needing daily help. Agencies for home health aides can be flighty and inept, the aides themselves can be lazy or unreliable, unwilling to follow more than a few instructions, yada yada. For my wife and her siblings, having home health aides hired through various means (agencies, word of mouth, ads) meant needing to oversee two people - her mother and also the hired help. It got to be an unbearable and unmanageable situation.

I'm sorry if this offends anyone but while I think family members may have a moral obligation to see that family elders are properly cared for, that doesn't mean they need to undertake the caregiving themselves if better alternatives are available. In cases (as mentioned here) where the elder has adequate financial means to pay for whatever care is needed, it's a big mistake to not provide everything possible for her comfort.

My mother in law has been better cared for in the past two years than in the 10 years before that. She has daily help for various personal tasks - bathing, dressing, organizing her things - to help her do things she can no longer do on her own. She has a better and healthier diet now that she's not preparing it herself. Social activities and fun things to do (curtailed for Covid but reinstated now) immediate access to doctors and other care givers (who make house calls to the facility regularly and with whom appointments are easily obtained), a button to call for help when needed, and all the comforts of home. None of her children live near her old house and none wanted her living with them (a long story) so this worked out best.

The place she's at is decidedly upscale and priced accordingly, well beyond what she could afford on her own. All the costs are shared by her children and very gladly so. About six months after her move, she admitted that it had been a good decision and she regretted not doing something similar 10 years earlier.

I've never understood the "I want to stay in my own home" sentiment. If she's losing her eyesight and needs a great deal of help, I think you're making a mistake trying to do it as you are. Everyone would be happier if you found her a suitable place to live where she'd be happy and get all the care she needs and more.

Good luck.

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patriceny

Been there, have the battle scars to prove it.

Each option is very stressful. There are no perfect answers and no matter what you choose if you're like me, you'll still beat yourself up.

If finances are never going to be an issue, 24/7 aide coverage in her own home can be a blessed gift. HOWEVER, at least in NY, 24 hour aide coverage for a month cost more than 4 times what a beautiful assisted living facility charges. So when my Dad got to the point he needed 24 hour care, I was trying to stretch his money and so he went into assisted living.

There are other downsides to aide coverage. I kept Dad in his own home for a few years with several hours of aide coverage every day and have a lot of experience with this.

Aides will no show. I also had at least 2 people steal from my dad. (I removed all of his financial records, check book, and most valuables from the house.)

You will get a lot of phone calls about all kinds of weird issues, and you may find yourself still running over to her house a lot. Yes the home health company was supposed to "guarantee" coverage, but that isn't worth a hill of beans when no one shows up.

I was surprised how much involvement I still needed to have with the aides. Not that I thought they would do everything, but I think my involvement actually went up because of them. I was relieved, in a way, when he went into assisted living because the sheer volume of random phone calls about weird issues stopped.

I don't know if any of that helps. The short version is be prepared for no shows, and remove all valuables from the home if you go the aide route.

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nickel_kg

one more thing -- "she might not know where she is" -- you will be able to furnish her room with some of her favorite, most familiar objects, won't you?

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socks

As Hamilton said, start by discussing with her.

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Annie Deighnaugh

Yes definitely get her input on it. And read the book "Being Mortal" by Atul Gawande...I wished I had it to read when I was going through this with my Mom and my MIL. If nothing else, read the questions to discuss at the back of the book...so essential for making these life choices. There are many pros and cons to each choice, some of which will matter to the person and some won't. You don't need to take on the decision for her if she can help make that decision with you. And if she feels she has some control in that decision, the transition will go much more smoothly.

My great aunt was so angry when at 99 she was put in a nursing home that she stopped eating and died. My grandmother at 98 fought the nursing home tooth and nail, but after she was there, she was glad she was and wished she went sooner. My 96 yr old friend who is sentient but completely bedridden is in her own home with aides whom she seems to dislike, but she insists the last thing she wants is a nursing home, even though she's essentially isolated in her own home. Privacy, autonomy and more is lost while safety and security is gained by being a facility. There are so many tradeoffs. Not easy for sure.

Sending you thoughts of comfort, strength, courage, patience and wisdom as you go through this difficult time.

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maire_cate

I feel for you Dedtired. You will probably second guess yourself no matter what you decide. Considering your Mother's age and physical limitations I would definitely consider the continuing care facility. We had in-home aides for my Mother for 2 years because Dad physically couldn't care for her. He was fairly self reliant but Mom was in a wheelchair and needed more assistance than he could offer. One of the major problems we encountered was the ever changing roster of aides and the all too frequent late arrivals and gaps in coverage.

While no one can promise that any facility will be perfect at the very least they are staffed 24/7 and in an emergency can pull from other areas. That alone might provide some peace of mind for you. And while your Mother is doing fantastic for someone her age how long might that last? It might be an easier transition for her to move now rather than later when her mental capabilities might be even more diminished.

I hope you aren't feeling guilty about this. You have been a wonderful and caring daughter but this might be the time to think of yourself too.

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murraysmom Zone 6a OH

Tough decision but I agree with choosing a facility you like and trust. It will be a lot less stress on you and providing your mom is on board with the idea, much better for her to be around other people for company and stimulation.

Keeping her in her home with aides is a lot more work for you, not only monitoring them, but dealing with the constant turnover and the possibility of a no-show with short notice. Plus your mom would still be as isolated as she is now. She may like to have the company of others.

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Ded tired

I can’t thank you enough for all your words. I’ve read every one. I can’t fully respond at the moment, but will. In the meantime, I wanted you to know how much I appreciate it.


Quickly, I will add that she is beyond the point of making a decision or giving input. She does feel bad about the burden on me, which isn’t as bad as she thinks. Well ,to be honest, it is!

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bpath

It sounds like your mother still has all her faculties, as my father used to say. That’s a blessing and a curse! My parents resisted even getting in-home aides until the rehab facility mom went to after a fall wouldn’t release her without in-home help.

So, together we chose an agency. Some of the aides were good, some were not. Some were good in some ways but drove us crazy. My phone started ringing much more often. And I still had to do the things like managing home maintenance. Dad would make the phone calls, but I had to, for example, go to the basement with the furnace guy or walk the electrician to the box. And do the shopping. And buy clothes, then exchange them for a better fit. And come over when the paramedics were there at all hours. And take them to the doctor, to the imaging center, etc. It was heavenly when I found out that Medicare would cover house calls from a podiatrist! He was a sweetheart.

After two years of this, circumstances sent first Dad, then Mom, to the rehab and then skilled nursing (Dad from a stroke) and memory care (Mom, after pneumonia, the hospital recommended rehab, and things went so well and she was so content, and could spend time with Dad, she moved into the memory care) at the beautiful senior facility near them. We’d been tying to convince them to move to the independent living apartments there for 10 years.Now they couldn’t enjoy that, but the health center building is lovely, with wonderful views almost identical to their home.

My own life changed in a flash. I slept all night. No phone calls to come over. (Well, almost none, and it was rarely urgent.) Someone is sick? They took care of it. Someone fell? They can pick them up (home aides cannot) and check for injuries. No arranging of health care. THEY got care immediately when they needed it. Diagnoses and treatments in a flash. Transportation to the orthopedist. Meals. Dessert. Coffee. Entertainment! People to talk to! Dad especially made some good connections. There were some very interesting and accomplished people there, and even occasionally someone they knew from the neighborhood, church, or organizations, especially in rehab. When I visited, it was to share a beer, bring Culver’s, chat, look at old pictures (Dad could identify almost every boy in the group photo from summer camp), tell stories, work on finances, have a party. And, it freed me up to be more involved in my OWN family issues.

Dad wanted to be at home, but by that time he needed two people to assist him with transfers. And, they way their house was constructed, renovations to be appropriate for him would have been expensive if not impossible. Mom though, was so much better. She had a consistent schedule, people around her (she was a social butterfly and had felt isolated at home). She had her two-room suite for a bedroom and sitting room, with her own furniture. Dad would have appreciated a similar setup, but the skilled nursing floor didn’t allow that. He really would have liked that.

Mind you, I still had to maintain the house because Dad wasn’t ready to sell it. And there was always the hope that they could go home at least in the end stages. But no.

Do read Being Mortal.

Someone here said to me, when I was posting about the same thing, when they are living when they get good care, you can just be their daughter.

To be blunt, your mother is 103. How long will she live in the facility? Or at home? Where will she be safest, where you can visit easily and pleasantly?

(yeah, that was really blunt. I get it from my dad. Their dining room chair cushions had completely deteriorated after 40 years, though the fabric was still perfect. Mom couldn’t move forward on reupholstering because the foam rubber wouldn’t last. Dad said, “dear wife, we are 90. How long do they have to last?”)

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blfenton

I agree with everything that Elmer said and so would my DH.

We both have elderly moms and both are now in assisted living. Even though both our moms had home care (well, my mom stopped letting them in the house so that was an issue) it didn't stop the constant phone calls looking for help and having to run over to their homes.

Best thing either of us did was to find a care facility for them. (not the same one - that would have been a gong show). We knew that there would be a settling in period but the staff could answer all their questions, fix the tv, get them a snack, take them on outings etc, etc. We could visit (pre-covid) and just have a visit without having to do chores for them.

Yes, ask your mom and then ask your son and do what is best for you and your son. My MIL stayed in the house for far too long and wound up in the hospital with the geriatric care team telling the family that she could not go back to her home. You don't want to wind up in that position.

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blfenton

edit to add - I also agree with what bpath said (we cross-posted) and also about reading Being Mortal by Atul Gawande. It is such a great book.

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Annie Deighnaugh

Others have made the really good point that, with home aides, the pestering doesn't stop. A bud of mine had home aides with his mother and there were chronic issues...if she had a cold, they were calling him at work every 20 min. Sometimes she didn't know who they were and she locked them out. Stuff like that. And yes to them not always showing up, especially in bad weather. He did eventually switch her to a home.

My MIL started out in what was called "congregate" living..like you had your own hotel room and went to the dining room for meals. The staff there spent the night if there were any winter storms threatened so they would be there to prepare the meals in the a.m. A home health aide wouldn't necessarily be so diligent.

My only actual experience with home health aides who stopped by for several hours supposedly to help Mom shower when she had her broken leg...but they kept sending people who weren't qualified to give her a shower!! The whole thing was most annoying!

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bpath

By the way, and again I will be blunt but in a helpful way, given your mom’s age she might be eligible for hospice care in the care home you have chosen. You will be able to visit her any time. However, do some research on that, maybe without discussing it with the care home beforehand. They might not admit someone who is already signed up for hospice, but she can receive hospice after she’s moved in.

My mother was not in any end stages last October, but with cold weather setting in and ending outdoor visits, I knew I wanted to be able to see her, and “Window visits” with a phone were not going to do. I’m so glad I asked about hospice. Her need for assistance with ADLs indicated a move to the skilled nursing floor, where she would be in an unfamiliar space, no sitting room, and different fellow residents and staff. She was eligible for hospice based on her age and parkinsons. Hospice enabled her to stay in her suite, with a familiar schedule, people, and routines.

I went and had lunch with her most days in her same comfortable suite. Her hospice aides helped her with bathing and dressing. Her hospice nurse saw her at least once a day, and they had a lot in common so they had some giggles. And, by the time Mom NEEDED hospice 4 months later (her stroke surprised us, we thought she had another year or two in her), that relationship between all of us was already in place.

And when the time came, all I had to do was be there for her and hold her hand.

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chisue

Absolutely...the assisted living place! If not now, *yesterday*!

I can see thinking that at 103, you can 'hang on a little longer', but I'm afraid that's how you got into this mutually stressful situation.

Think of the many families who would LOVE to be able to AFFORD to have their loved on in assisted living in a wonderful facility!

bpath has already written a wonderful response about why this is the best plan...for all of you. I especially embrace that the move will free both you and your mother to enjoy one another without this wearing dependency.

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bpath

Besides Being Mortal, “Can’t We Talk About Something More Pleasant?” By Roz Chast. Totally different vein, but excellent.

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maifleur03

If she is at the point of not being able to give input here she would be beyond entry into most assisted living homes. If you have been a resident as your needs change some allow you to stay. Others transfer you to a separate nursing area or tell family that they must make other arrangements. Just a suggestion. Ask if you can take her to the home for a visit. It could be just for a meal and a tour to see how she reacts. One of the things people do not think about with keeping someone at home is the lack of people. Has the place you selected evaluated her recently?

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Michele

Ded tired!! I will read the comments when I have time.

I take care of my 92 year old mother. My sister is 10 years older than I am and lives in Maryland. Brother is eight years older. He’s got health issues of his own. COPD is one.

She’s legally blind. She is on eight meds since her heart valve surgery about 15 years ago. She needs more and more help. She wants to stay where she is. NO doubt about that.

I feel your pain.

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C Marlin

As said, whatever your decision, it is a bad one, just because you are in a bad situation needing to make a bad decision.

You've been given lots of good advise, carefully make your decision and DON'T second guess yourself, do what you need to do and know you are making the best choice amonst bad choices.

...and don't feel guilty for feeling relieved.

Best wishes

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Fun2BHere

I'm following the topic as we are in a similar situation except we are at the resistance-to-moving stage. Since I live 1,800 miles away, I would really like to see my parents move into a continuum of care community. There are two very nice ones in their area, but as I said...lots of resistance.

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Ded tired

Hello my friends. Another quick check in. I am exhausted from being at her house from 8-5. Really not much to do but encourage bathroom trips,, give medication, a couple meals and sit and chat. I have heard the exact same stories a thousand times. Mostly mental exhaustion for me.

I am more and more convinced that the care facility is the way to go, especially after reading your words about the problem with aides. Last winter was especially stressful with the bad weather. We had to take turns staying at her house so she would not be snowed in alone. That is reason enough for her to move. If it’s a disaster, which I doubt, we will not be selling her house so coming home would be an option. A poor one.

The facility is part of a rather luxurious continuing care facility. in the past I have described it as the place rich people go to die. The two final stages are skilled nursing and memory care. Some start in independent living and move along as needed, but they also take people directly into skilled nursing. I still have a lot to learn about this journey. Truth is, I am assuming they will take her.

Michele, I wish you and your mother well. We caregivers need to care for ourselves, too.

Back later. Big hugs to all of you.

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Lars

When my mother was in her late 80s, she had an aid visit to help take care of her, but my father was still alive, although not really able to take care of himself without my mother. My mother could still drive and do her grocery shopping, but my father was legally blind and would still try to drive. My father was 1-1/2 years older than my mother, but she died first and at home, which is where she wanted to be. Since there were two of them, it was not necessary for any other accommodations to be made.

After my mother died, my father became impossible to control, and my brother had to force him into assisted living, for the safety of everyone - except the nurses taking care of him. One day he threw a wheelchair at one of them. He only lived four months after my mother died, but there was no way our family could have taken care of him at his home, considering how belligerent and demanding he was.

When my grandfather died, my grandmother moved into a house near where my parents lived - her previous house was 160 miles away, on not the best roads, and so the drive took over three hours. She lived there alone until she broke her hip, and I think she moved in with my parents after that, but my father soon put her in an assistance living residence, which she actually liked better because she made friends there. It had a nice swimming pool, and so I would go swimming when I visited her there, and she would go in the pool as well. I don't think she would have tolerated aides coming to her house, and I doubt they would have tolerated her either.

There is no one solution that works best for everyone or for every situation, but I personally think that if the assisted living place is luxurious, then that would be the best place to go. I personally do not trust aides all that much, and it would be a huge job to monitor them.

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maifleur03

A word of warning do not assume that any place will take your loved one. They will need to be evaluated first so start contacting places before the need first to see if they have any openings then to see if they will accept the person. The better ones in this area have waiting lists and if they did not I would be cautious with placement there. You may receive mailings and other communications from them that make it appear someone can move in immediately but that may be far from the truth. A Congressman's wife had him on a waiting list for over 6 months before a spot in assisted living opened up. She was in my group and wanted that particular place because his mother had been there and he liked it.


Ask what the rates are and what they cover so you will not be surprised at what is not covered.

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salonva

Sorry you are going through this, Ded. As others have said, I really don't think there is a wrong or right to this. It's a tough situation. My mother had lived independently even with significant health issues....but one or two bad falls ( in the middle of the night, going to the bathroom) and broken hips and rehab- she soon needed to be in a skilled nursing facility). The care was really wonderful and she was fine with being there. She was mentally 100% but physically full of issues. So I guess I never had to make the decision.

For my FIL, we tried having him stay with us for a few months, and to get aides to help him a few times a week with showering and such (because unless forced to shower, he wouldn't. it was not pleasant). He would send them away. He really was a sweet and lovely man, but he really got depressed and angry. DH needed some surgery and it was just too much managing it all. We found a really great nursing home near where we used to live, and he did well there.

Someone above mentioned hospice. That was a very good suggestion. It doesn't mean they are at death's door; but the care is more palliative. That actually worked out best.

I know you are weighing it all and I am sure whichever way you go, it will work well.

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Elmer J Fudd

"The facility is part of a rather luxurious continuing care facility. in the past I have described it as the place rich people go to die."

My mother in law is not wealthy - as I said before - but it is a pricey place and even SHE commented that she enjoys being around people who are educated and have better things to talk about than Dr. Phil, Dr Oz, and Judge Judy. She's thriving and enjoying herself beyond her own expectations. And the rest of the family is far better off as well and at peace knowing she's getting the care and attention that WERE NOT possible with home aides in her home that was not set up for her needs.

I understand that some resist change because it is change, not because they have any notion of what the consequences of the change may be. It's sad but I know that being opposed to change, new things or new ways, is not limited to old people.

Keep at it until you have her safely and comfortably where she can have a better quality of life and better care. She deserves it and you deserve to have your own life back to spend time as you choose to, not as you have to. Don't let the decision be reversible.

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eld6161

Hugs to you Ded. No matter what you will decide it will be the right decision and the wrong decision.

So sorry you are going through this.

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Judy Good

I have worked in long term care, assisted living and rehab over 35 years. If she can afford it, keep her home. At that age, she will go down soon after transfer. Realty is.... she will not be around much longer, 103 is very old. You will not regret it EVER. Good luck on a tuff decision.


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hallngarden

Ded tired, you are in my thoughts. Take care of yourself, and know we care.

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cyn427 (z. 7, N. VA)

Ded, if it is the place that is a hop, skip, and a jump from you, I think that would be wonderful. The mother of a friend of mine has lived there for years and years. She couldn't be happier and you know your mom will be taken care of very well. Same goes for the one across from the high school, but I think the one near you is nicer actually.

We had help for my grandmother and my parents. Some were good, some not. The one who was there at night for my grandmother didn't work because she would fall asleep and Grandma would end up calling for my mother.

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Bookwoman

Ded tired, if the place you're talking about begins with a W, it is indeed a wonderful facility. My mother-in-law was there for a couple of years before her death (we moved her up here from her home in Florida when she could no longer care for herself properly), and she was very well taken care of and enjoyed the amenities. There are of course other comparable places nearby, and I've heard very good things about them as well.

On the flip side, I managed the care for my mother, long distance, in the last months of her life. She remained in her apartment with 24/7 aides, who were mostly very good, but coordinating them and running back and forth to NYC was a huge strain on me. I lost 10 pounds in 3 months and would definitely not want to repeat the experience. You are fortunate to have your son to help you, but I venture to say that you will all be happier if your mother's basic needs can be taken care of and you can simply enjoy visiting with her. My best to you, whatever you decide.

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Ded tired

Cyn and Bookworm, yes the W place. Pretty nice and I can almost walk there .


Still reading all comments!

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Annie Deighnaugh

Yes, my Mom was emotionally and physically exhausted with dealing with her Mom. Once she moved her into the nursing home, then visits became pleasant instead of chores. They played bingo, listened to musical concerts and more. It made it so much easier on everyone.

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whatsayyou18

I'm curious as to why the "W" place can't be named?

Both my MIL (102 y.o.) and my parents (both deceased) were resistant to moving into assisted living but all agreed the time had come and, though they missed their homes, were/are better off in A/L. We investigated in-home care but the challenges of finding responsible, caring, honest care givers was too daunting not to mention the ongoing maintenance of their homes. I think they all enjoyed the activities and new faces at the facilities, being cared for and letting go of the worry involved in staying in and maintaining their homes.

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kathyg_in_mi

I moved my Mom into an assisted living place after living in her home 52 years. She really did like it. She was a very social person and they had cards, bingo, exercise, she got together and had breakfast with 3 other ladies and they called themselves, "The Breakfast Bunch". Wish I could have gotten her to move a few years earlier, but she wanted to stay in her home as long as she could.

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Bookwoman

I'm curious as to why the "W" place can't be named?

Privacy for Ded tired, who apparently lives very close by.

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nekotish

Skimmed through the comments, just adding my own two cents. My dad is 93 and was in a "senior's living facility" up until last fall. His declinging health and cognizance necessitated him moving to long term care. The place he was in previously did have long term care, but the waiting list was months long and the "per diem" additional costs for his care while he would have waited were astronomical. Also, we found that they called an ambulance for every little thing, as they had no medical staff (other than first aid) and a 9-5 RN. The peace of mind that we have now is wonderful. He has fallen a couple of times and rather than call an ambulance (which during covid resulted in him being in isolation for two weeks when he got back) the on-staff RN checked him out and upped his wellness checks to every hour from the regular every two hours and there is always a doctor on call should the RN decide he should be seen.

We did have care aides in the interm, but had problems with no-shows or them being there for far less time than they were supposed to be. Another big issue was that for the majority of them, English was not their first language and Dad had a hard time understanding them.

Whatever you decide, I wish you peace. It's a tough row to hoe for sure.

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rob333 (zone 7a)

I'm with lily

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lisa_fla

I think Elmer is spot on in his comments. I couldn't agree more. We actually briefly hired Visiting angels when my Mom was at her previous assisted living facility. She had ear crystals and needed a a 'sitter' until her dizziness cleared up. The first one fell asleep during the night and her snoring kept my mother up , the second one made barely spoke to her, the third was fired on the spot when she ate my Mom's breakfast and offered her candy! Thank goodness there was a camera in the room.

Mom is in a new memory care center now. Your mothers needs are going to be more and more most likely. Has she been vaccinated? It may be a requirement, She will have activities, aides, meals, friends, checked on during the night, You could ease some of your worries by having a camera in her room.

There comes a point where you just can't do it anymore. You could do a trial run in a respite room for a few days if desired,

One last piece of advice-its far better to make the move when things are calm rather than during a crisis.

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jane__ny

I feel for you, Ded Tired. I am finding myself in a similar situation except it involves my husband. Not sure how to navigate this whole business.

We are 17 yrs apart in age and I have noticed cognitive changes over the years. But, it was tolerable and he still drove and volunteered a few days a week.


Suddenly in January he had problems speaking and getting up. i wound up calling 911. He was diagnosed with a small stroke but a bad kidney infection. Long and short, he spent a month in the hospital and was moved to a rehab facility where he has been for two months.


Because of Covid, I have not been able to visit him except through a window using our cell phones. He has forgotten how to use his phone.


I'm bringing him home on Friday and plan to get aids to help with his various medical problems which include a permanent catheter which will require care.


Our son moved home in March due to getting laid off his job due to his company going work from home. They laid off so many employees.


I'm not sure what to expect and how to handle it all. I need someone to come in and determine the safety of our home and set it up for him. My hope after being isolated from family and having little stimulation (Covid), he will improve.


He is my husband and I feel, even being 72 that with my son's help we can manage him with some home health aids during the day.


I feel for you, but tend to lean toward assisted living or nursing home for your mom.


I don't know how to handle my husbands situation and am so afraid he'll get hurt or fall at home.


Jane

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olychick

Maybe someone else has mentioned this; I didn't read all the comments, but also think about what will happen to your mom if she remains at home and something should happen to you. If she moves, not only will you be able to resume some sort of life of your own, but should you become ill or die before she does, you will know the care for her will be uninterrupted. You, since you are healthy (and alive) can help transition her to a new place to live and help problem solve any issues of that transition. If you are unable, in the future to help with that transition (if she stays in her home) just imagine who will do that for her and how that might look.

Stay healthy and give yourself permission to enjoy some of your own later years without the burden of day to day management of your mother's needs.

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Annie Deighnaugh

So sorry, Jane. Not easy. I hope your DH improves once he gets home too. Remember there are a lot of professionals and social services that can help you with your needs. Don't take on more than you should as your health matters too. I'm glad your son is able to help out.

Sending you thoughts of strength, courage, patience, comfort and acceptance.

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arcy_gw

"Thoroughly vetted" I can only speak from personal experience. #1 yes YOU will have to monitor these aids. In my world they are most likely people who did not, or barely got through high school. They take a few week course on general first aid and safety and are "certified" when they pass a test--I passed w/o going through the course. There is a HUGE turnover in this profession their work ethic tends to lean towards less work than more. They most likely will have "nursing home " in their work experience--but they aren't there now because they were let go. I am not saying they aren't preferred to a nursing home I am just saying it can be a search for the right fit and most often "the good ones" are in school or moving on to better pay better hours quickly. It's not a once and done hire. It's very upsetting to be in this world of PCA's and discover the caliber of help that is out there. Good Luck.

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sushipup1

As an aside, Ded Tired, you may be interested in this organization. Our neighbor did a retreat with Nancy's House recently , and says it was wonderful. The website also lists great resources. Do it for yourself.

https://nancys-house.org/

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maifleur03

A suggest for Jane then for others. Talk openly with your husband's doctor about what to watch for early stages of urinary tract infections. Each person responds to the differently.


For everyone have the local emergency services non-emergency number handy. One of the fire people suggested this to me after one of my husband's slides to the floor. If there is pain or the head is hit you need to use 911. You can also ask for no sirens where they are obligated if 911 is called. You need to ask in your own area what is allowed. Lights must be on for the safety of the crew,

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blfenton

I was going to comment on UTI's as maifleur did. My mom gets a lot of those and her care facility knows the signs by the change in her behaviour and her lack of ability to concentrate. If you see changes like that in your DH (or dizziness or lashing out) first check to see if he as a UTI. It seems that in the elderly, once they start, they are more and more frequent.

Good luck with your care for your husband and take care of yourself, Jane.

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patriceny

A UTI is actually what killed my mother. She was mentally competent, but her health was really bad. She had an untreated UTI that got into her kidneys. I don't think she ever really knew she was sick - she was so used to feeling so bad most days that the UTI never registered on her.

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bpath

Ah, UTIs. My mother was getting them, and then I learned the outward signs. It was almost impossible to get a “clean” sample to test, we had to take her to the doctor or hospital. Finally one day I called the doctor’s office, and insisted that they prescribe the med because there was no way I could get her to the hospital while I was also staying with my father in ICU. I called them FROM the ICU. It took two days for the doctor to okay the prescription.

Once she was in the memory care, I would occasionally get a phone call saying “she has a UTI/we strongly suspect a UTI, we would like to prescribe XYZ, do we have your permissions?” You bet. And I could continue with my day (like, getting my son to the hospital to have his appendix out).

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sjerin

Jane, have you asked for a social worker to help you figure out your husband's situation? I'm not sure what all they do, but I believe every hospital has some s workers on staff to help with logistics. I hope someone who knows more about this will chime in.

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Ded tired

Still keeping up with these knowledgeable comments. Still too darn tired to respond the way I would like, which is with gratitude.


Frustrating day for me since I never received a call from the ccrc as expected. Emailed my contact and got an auto reply that she won’t be back until Monday. Meanwhile I am writing this from my mother’s sofa where I am spending the night. No sleep for me!


Jane, I feel for you and hope you will take to heart the advice given here. Wise and generous people!

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chisue

An aside: Occupancy is dropping in every type of 'Senior Care' in the US. I'd think new residents would get an eager welcome, perhaps some enticements. I'd check a facility's financial ability to weather lower occupancy. Can it afford to maintain standards? Will ownership or management change hands?

Independent Living is at 81.8% occupancy nationwide; Assisted Living, 75.5%; Skilled Nursing, 75.3% These drops began six quarters back (predating the pandemic). Highest occupancy rates are in CA and Seattle; lowest in Houston, Atlanta and Cleveland.

We have an increasing number of elders, but their ability to finance care is dropping. According to financial advisors to senior care facilities, fewer than a third of people 80 and up have incomes above $50K a year. The average length of stay in assisted living is 2.5 to 3 years; people die or require more care.



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Elmer J Fudd

Interesting information, chisue.

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bpath

Occupancy in our facility has been down for a year because people aren’t having surgery or accidents outside of the home, and hospitals were not necessarily releasing patients to care homes for PT, and PT/recuperation actually often led to admission to assisted living and skilled nursing and memory care; and families are delaying entering their loved ones because they might not be able to visit, want to keep them ”safer at home”, etc. And of course, people go home or, sadly, die, and for awhile new residents weren’t being admitted. One unit was closed at our facility, staff was not let go but reduced hours; I think they were redistributed within the building.

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raee_gw zone 5b-6a Ohio

I did forget to mention that I would always have a strong preference for a not-for-profit facility if it is at all possible.

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chisue

DH and I are *inundated* with mailings from about a dozen senior care facilities in our area. We get something almost every other day. Maybe we're on a targeted list: 'Old + Prosperous' (by zip code). The Sunday newspaper contains inserts from residences and a "Senior Living" section that is a barely concealed promotional for senior residential facilities and services. We're 'a market'!

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nycefarm

Just know that whatever you decide, it will be the right decision. You have a clear understanding and a thoughtful, caring position. You will always feel some guilt no matter which course you take, but remember that you have done it with love and best intentions.

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whatsayyou18

" I would always have a strong preference for a not-for-profit facility if it is at all possible.:

Why?

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Elmer J Fudd

I had the same reaction as whatsayyou states and will speak up now that s/he has.


Don't other things that are substantive to a resident's experience matter more? How about the cleanliness of the place, the quality of the food, the competence of the care, the nature of activities, safety of operations, comments from existing residents, and so many more factors matter more than what kind of entity operates it?

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Bookwoman

Of course the details of the individual institution are the most important, but:

In general, the average for-profit facility has been found to have poorer quality of care relative to the average not-for-profit facility," says David G. Stevenson, an associate professor of health policy at Vanderbilt University Medical Center in Nashville. "That's been shown in previous studies over many years really looking at a variety of indicators, whether it's that they tend to have lower staffing, whether they tend to have worse quality scores, worse inspection ratings – things like that." (https://health.usnews.com/wellness/aging-well/articles/2018-10-30/is-there-a-difference-between-nonprofit-and-for-profit-senior-care)

Consistently, research in the quality of nursing home care since the IoM report has reported that not-for-profit nursing facilities have higher nurse staffing levels and fewer health care deficiencies than their for-profit counterparts. For-profit facilities, particularly those owned by multistate chains, are more likely to reduce spending on care for residents and to divert spending to profits and corporate overhead. While the research findings do not necessarily apply to an individual nursing home – some for-profit nursing facilities give excellent care and some not-for-profit nursing facilities give poor care – the general rule is documented in study after study: not-for-profit nursing facilities generally provide better care to their residents. (https://medicareadvocacy.org/non-profit-vs-for-profit-nursing-homes-is-there-a-difference-in-care/)

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bpath

i Believe it’s because a not-for-profit (or is it non-profit? I can’t remember the difference) puts all its income back into the facility, for facility improvements and staff and experiences for the residents, instead of corporate management and dividends. It may or not be as beautiful as the for-profits, but it might provide a better living experience.

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Judy Good

Agree 100% bpath! I worked for both profit and non-profit.



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rob333 (zone 7a)

Vanderbilt is non-profit.

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raee_gw zone 5b-6a Ohio

What Bookwoman posted is what I meant. Lower pay, lesser training, fewer staff, lesser attention to needs, and higher turnover for staff seems to be common threads in the for-profits. Also, what I observed in a couple of local for-profit facilities is that they seem to have "arrangements" with certain service providers to come into the facility and milk as much from the resident's insurance benefits as possible - resulting in unneeded procedures and services because they were among the services that would be paid.

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Ded tired

I’ve just gone back and reread the entire thread. I wanted to give special thanks to everyone who took the time to write such thorough and helpful comments. I was going to name names, but really, every one of you. I wish I could express how much this has helped me and how much I have learned.


I did speak to someone at the care home and she has been accepted as far as finances and physical exam from her doctor. On Monday I will find out when a room is available, I think. When I spoke to the person in charge earlier, she said she thought they would be able to move quickly.


Mom is more than ready to move there. I am surprised at how quickly she came around. She used to avoid the topic completely but now asks if I have heard when she can get a room. Hooray for that. Now I don’t feel like Cruella D’Ville.


The facility is a nonprofit and extremely highly rated. I could gladly live in one of their villas right now. It is probably a mile closer to me than her house. I love the idea of visiting and being able to just enjoy my time with her. We can discuss the exact same topics over and over again. Sigh.


I notice that some of the for profit care facilities in my area are sold from one organization to another. Another good reason for seeking out a nonprofit.


In the meantime, I will still be managing her finances and start working on clearing out her enormous house packed with stuff. I wish it were all just junk to be tossed but it’s not. That is a topic already discussed here.


Elder care is becoming a huge issue in our country as we Baby Boomers get up in years. I can see a true crisis looming, especially for those without financial resources and family to look over them. Fortunately there seem to be more and more services available to see you through your senior years. For those whose children may be less than responsible, also may be good to look into this. Planning ahead is essential.


Senior care facilities are being built all around here at an alarming rate. I wonder where all the qualified staff people will come from.


Once again, many heartfelt thanks for your wisdom and encouragement. For those of you also dealing with caregiving, I wish you best of luck and you are certainly in my thoughts.


Sushi, I never heard of the place you mentioned, but what a wonderful service. I am looking forward to getting some rest once Mom is settled. It is essential to care for yourself, too.



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maifleur03

Here some of the non-profit and not for profit, yes they are two different types, rely on volunteers to care for the people who live there. One good a couple of others not good. Do not rely on a home being of these types for any guarantee of quality. Some simply hire a for profit company to manage. The Methodist home that my niece had me look at was of this type but was still considered as a non-profit.

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Elmer J Fudd

I deleted a comment about someone else's contribution that I'd misunderstood and so it was incorrect.

++++++

"Also, what I observed in a couple of local for-profit facilities is that they seem to have "arrangements" with certain service providers to come into the facility and milk as much from the resident's insurance benefits as possible - resulting in unneeded procedures and services because they were among the services that would be paid."

The lower tiers of healthcare providers often have practices with a significant number of patients having coverage through Medicare and other similar programs BECAUSE that's the strata of the population available to them. Medicare fraud is not new and these practitioners, who I think of as bottom-feeders, are the perps. Such people also bill to the n'th degree what they believe they can get away with. I have a family member in a senior residential facility and there are providers of different kinds who visit regularly. The good news is that using them avoids having to arrange for what can be difficult appointments and transportation. The bad news is that many of them are not too impressive. My relative can only rarely see the Osteopath who oversees primary care there, a choice neither she (nor we) would make if she were living elsewhere, and is often stuck with a slightly bumbling nurse practitioner. Who doesn't seem to recognize when she needs to "bother the doctor" with something. But they're there.

As far as "arrangements" are concerned, you can bet your top, middle and bottom dollars that the residential facilities DO NOT BENEFIT ONE PENNY from the medical fees charged by the providers. Paying a finder's fee, a commission, or any kind of sharing like that, is very illegal.

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bpath

Dedtired, what a weight off your shoulders! Just to have a decision made. Not that everything will be smooth sailing, but you have a course now and your mother is on board, and THAT feels better. It won‘t always be sunshine and rainbows, but then what is? You can talk with your mom about what to bring with her, and help to arrange it so that she knows where everything is.

If it is a nonprofit, it might be easier for you to be involved. There may be an auxiliary, or a foundation, or volunteer opportunities. They are wonderful. Kind of like when your son was in school, it’s a good way to help out, and to get to know the admins, staff, and residents. One of my regrets at my parents‘ for-profit care home is that, due to privacy concerns, my parents (and I) didn’t know about anyone’s passing. At the nonprofit my parents had been involved with, there was always a service, and a mention in the newsletter. It was good to be able to support one another.

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maire_cate

That is really good news. You must feel so relieved that your Mother is actually looking forward to moving there. I hope a room becomes available soon so that your Mom can settle in. I don't envy you the enormous task that you're facing. I did my parents' place when Mom died but that was after they sold their home and moved into a smaller one. It was still hard because I remembered the history behind so many of her things and it was tempting to hold on to them merely for sentimental reasons. You definitely need to take care of yourself - maybe a getaway weekend or spa day.

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