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My mom recently had hip surgery after a nasty fall. She is currently in a skilled nursing facility and may be released to go home soon. She lives alone in an unassisted living apartment complex. She cannot afford to live in an assisted living facility, so that is not an option. We would like her to be able to live on her own back in her own apartment. What can we do to ensure her safety in her place when we are not there? She is on Medicare. I have POA for both her financial and medical. Thanks

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SueC1957: That is exactly right! What will happen is certain-#1 the elder ages forward and #2 chance of another fall is imminent. Don't bring her home. Period.
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I'm with Llamalover and Freqflyer, once a senior starts falling (regardless of the reason) there is a huge risk that they will fall again. They've started the instability and will be a "fall risk" in every facility they're in, even at home with all the preventatives.
The rehab will have the Physical Therapist evaluate your mom near the time of discharge. They will make suggestions for her, based on her capability. They may suggest she not return home for her own safety.
I would start a search of facilities that would be within your mom's income. Try board and care homes. They traditionally are much cheaper than nursing homes or assisted living facilities. Also, speak with the Social Worker at her rehab. They are a wealth of knowledge for resources. Good luck.
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Once an elder starts to fall, don't be surprised there will be future falls. My Dad was that way for a number of years. Thankfully Dad loved his rolling walker to that helped catch a number of falls from happening, but elders don't always remember to be glued to their walker.... [sigh]

You mentioned your Mom wouldn't be able to afford Independent Living or Assisted Living, which are different from skilled Nursing Homes. Price varies from area to area. Nursing homes in my area are $12k per month... I know, yikes !!

There are professional caregivers that could help your Mom adjust back into her home, but they can cost from $20-$30/hour. My Dad had 24/7 caregivers. Talk about sticker shock. Then Dad decided he didn't need the overnight shift so we tried that for awhile. Eventually he moved into senior living.
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The alert buttons are now motion sensitive. As long as the person wears it outside their clothes (my mom kept tucking them inside her top) if they fall and the button hits the floor it will alert the company and they will come on the speaker and ask if everything is Ok.
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How old is Mom? How far do you live? Can you supervise the caregivers and let them into and out of the house? Does she have steps? What about a walk in shower with a chair and bars? She needs a raised toilet seat....can she pull herself up from the toilet without assistance? Need more info
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You can consider Independent living and hire caregivers each day, but they will only be there for the time you hire them, longer they are there the more you pay. Then paying for both may not be much difference in price than assisted living.


If you do your home work and research all different assisted living facilities you can get them as low as $3,500 per month. Size of her rooms will vary in price can range from $3,500 - $5,000 per month depending on what style / size room you choose.

Nursing home my mother in law dreaded going into one but has now been there 4 weeks and loves it there. Your mind is at rest in a nursing home and she will also meet new friends, these vary from $5,000 - $7,000.

Medicaid
You say she has no money then you can apply for Medicaid for her to go into a nursing home.
Very few assisted living accepts Medicaid but there are some not many and usually a waiting list !
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The PT and OT will do this for you, or advise you.
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A little note about the "medical alert" items, bracelets, pendents...
Once any form of dementia is suspected, diagnosed anticipate that the "user" will not know how to call for help at some point. Unfortunately you may not know when that point is until some catastrophic event occurs.
You can explain to someone how they work, they can press the button but will they press it at the correct time? Will they be able to respond correctly? Yes I know the company can contact a designated person in an emergency but that may not be good enough if you are an hour away. (even 30 minutes might be too long)
So while they can be a great product there are limitations.
I have heard there are systems that will alert the company if there is no "normal" movement for a period of time but I do not know if this is an extra system or not.
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Meet with the social worker at her SNF. It is the social worker's job to plan for a successful discharge.
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Generally it is NOT a good idea for the elder to return home.
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These are all good comments. They may work to her advantage for a while, but unless you are planning that she stay in her house till the bitter end, don't spend TOO much on remodelling the house. She WILL need a caregiver coming in, if not now, later on down the road. My mom had dementia and fell countless times, the visiting nurses came in, did a safety survey and made suggestions, and a physical therapist came along to show mom exercises to strengthen her rubber-band muscles (to prevent falls!) ! Like they thought giving mom legs like iron were going to prevent falls?? (well, I suppose they had to do something, and it might have helped). The medic alert button is useful. Are there any neighbors who can check in on her during the day? (some are reluctant to get involved, beyond bringing over food, the mail, paid to mow the lawn, an occasional ride somewhere. ) Your mother should have a home health care aide to assist her in bathing, under no circumstances should she try doing this when she's alone!
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Assisted Living benefits are available to some people in some states. What state is your mom located? Some states provide for the costs of Assisted Living for seniors, disabled or dementia patients who a doctor prescribes AL for, IF they qualify financially. The qualifications are often similar to Medicaid. If you think that she's close to doing that, I'd check with her state to see if her state has one. In NC, the program is called Special Assistance.

But, if she's going to stay home, I'd get the advice from a professional on how to help set up her house. I'd see about a local county/state program to come into the home and provide you with a check list. There are some great suggestions here above, as well.

One thing that I would keep an eye on is whether she is able and willing to use safety measures that are put into place.

Do you know what caused her to fall?
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I worked for a Visiting Nurse assoc. that leased medical equipment. Here r some ideas.

A shower chair and a hand held skower head. You can get an extra long tubing for these and a holder that can be put down on the wall so a person sitting has easy excess. If soap dishes are too high some stores will have suction cup ones. I found one that was to hold a cup and toothbrushes. My friend used it for her shavers and bottle of shampoo.

I would not recommend a high riser for some who needs rails which ur Mom may need. You can use a commode for this purpose. The back bar can be taken of and the lid and seat can be lifted up or taken off since the commode has these. There is a splashguard that is put in place of the bucket. The commode legs cab be adjusted for height. This way the person has the handles to help push up and the cmmode legs make for good support

Bars should be put in the tub. I know people won't agree but the suction ones are a good alternative till u can have bars installed.

For her bed there is a bar you can get to help her pull herself up. It goes under the mattress for support. It also helps with not falling out of bed. It is only 18 in wide so doesn't hinder them from getting out of bed. You may want to consider a hospital bed but if u don't want to go this way then get a six in boxspring. That way if Mom does fall out of bed, she has a shorter distance to fall.

If she is wheelchair bound, make as much as you can excessable to her. My girlfriend used her bottom cabinets for dishes and such and used her top ones for things she didn't use on a daily basis.

Hope these help
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I am sorry to hear about your mom's fall. I think one of the most important things is to make sure that the home is safe. I agree that she should get the home assessed and install grab bars in the shower if not already done so. With the medical alerts, make sure that it is water-resistant. You can also contact home care agencies that accepts medicare but biggest thing is research.

Once a person falls, they are likely to fall again so know how they fell and take steps to prevent it.
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Raylyn,
Sorry, never heard of an assisted living charging by scale. Do u mean 55 and up or disabled low income housing? Then yes, its done by scale and is a good option. But facilities that advertise as Assisted Living are expensive costing 5ooo or more a month ending on ur needs and they are limited to what they can and will do. There comes a time when a person may need LT care.
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All great advice, please keep it coming! Thanks so much!!!
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If you get an alarm for falls etc make sure if it is a pendant that they will sleep with it on - a lady I know took hers off for a nap then woke needing to go to bathroom - tripped & fell - 2 to 3 days on floor with broken arm etc - we found that there is a wrist band for these devices [bought hers at Walmart jewelry counter & staff switched it for us] - but again must sleep with it on - at least she will have a choice

Having her pick which items [like above] after YOU narrow choices may make her more friendly to changes - say 'mom, I have done research & here's your best options ... which would you like?' - no person likes things thrust upon them so this will help her adjust -

Also if a rental, can you do much change? - however the landlord may put up shower bars etc. as they can write it off as business expense then when she moves out her place will be a 'senior friendly' rental - see if they will help because you never get a 'yes' to a question you don't ask!

There is a relatively inexpensive device that goes under a toilet to raise it up - the toilet is removed - this unit is bolted in & toilet bolted on top - also have seen a unit that goes between toilet & toilet seat that raises height - it is amazing how much difference 2 to 3 inches makes - ask occupational therapist for suggestions - here's another place for her to choose from options like the height as what might be good for you may not be for her

If she has a double bed or bigger that takes lots of room in her bedroom think about switching to a single bed against the wall to give more manouvering room there - rent a hospital bed for her if you can find a good price - here Red Cross rents them - this might be temporary while she heals - place a small TV where she can watch it comfortably as she will be used to this while in rehab
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In home cameras can also help with keeping an eye on her. I assume there is no dementia involved.
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Agree with Rosyday, Grandma and Bigsister, definitely get medicare or medicaid to do the assessment. Usually they hospitial or skilled nursing facility has them contact you before someone is discharged so the visits/assessment starts as soon as they get home.

Let's see, I got a hot shot water dispenser for my mom to make tea when she got home as she couldn't reach the microwave in our house. They probably would recommend nursing visits, PT, OT and a CNA to help her bathe and dress if needed.(this was before she moved to an AL facility at the end of May). Toilet assist with arms, tub/shower chair, a tray for her walker ( when she's ready for a walker), bed assist so she can help pull her self up to go to the bathroom etc. Pull bars in the bathroom definitely. I will see if I can think of more.
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You can get an occupational therapist to evaluate home setting and suggest adaptations for safety and easier living environment.(Facility where she is now should offer this service) Additionally, don't know where Raylin got info about assisted living being based on income. Most are expensive and not for fixed income clients. Some have a limited number of spaces for people with lower income. State homecare services ARE based upon income and charge on sliding scale. Contact your local AOA for a needs assessment. She can receive help to stay in her home.
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Raylin is incorrect. Assisted Living charges the same amount regardless of income. Unless you live in another country. There are sometimes financial assistance available through veteran's programs or (depending on the state) Medicaid assistance, but it is still expensive. However, I would ask the social worker at the nursing home if they can do an assessment of your mother's apartment. Generally, they will not charge you for that. You will then know what is important to do for your mother's safety.
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Medicare should pay for some Home Health visits from an RN and a PT. They can assess her needs. Call the social worker at the facility for a recommendation. Meanwhile, visit during the therapy session to get a better idea of her mobility.
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Assisted Living is supposed to charge according to your income.

You can't hardly make too little to be eligible for Assisted Living. Have you checked into it anyway?
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Get the medical alert device that lets you know when she has fallen. Get dorm sized fridge, freezer, and microwave for her bedroom if she is a night eater and tends to wander around at night. Walk from her bed to the toilet and see anything she could grab as she is falling that would break and allow her to fall (like towel bars). Remove all sharp edged furniture. Get the raised toilet seat with arms! That's a start. I will think of more later
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Need WAY more info to give a good answer.
What floor does she live on?
Is there an elevator if it is more than 1 floor?
Are the bathrooms large enough to handle a walker and or a wheelchair?
Can she shower or bathe safely?
Are there grab bars place in the bathroom by the toilet and shower/bathtub?
Can carpet be removed if she has carpeting? Moving a walker or a wheelchair over carpet is difficult and may pose a trip hazard.
How and or why did she fall?
Is she loosing balance? If so for what reason.

As you can see there is a lot of information that is necessary to answer this question.
You can contact the Social Worker where she is now and ask if there is someone that can come to the apartment and make an assessment to determine what needs to be done to make it safe or I should say safer. While these companies charge a fee for the assessment if you can do the work yourself the cost will be less.
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There's a lot left out of this question, such as how far away family members are, and what your mother's abilities/disabilities are and were apart from the recent surgery, and what kinds of help she usually requires. One thing I can suggest is, if you haven't already done so, get her an alert system so that she can contact family members or 911 if she should fall or if she becomes ill and can't get to the phone. By mother has had an alert pendant and has used it quite a few times, because she has a problem with falling.
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