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My brother-in-law had a stroke almost 4 years ago and has lived with my husband and me for 41 months. He has a vascular dementia according to his doctor. Until recently he was able to ambulate with a walker but he started having difficulty and showing increasing weakness in his left hand and leg and he started pushing his walker with his left hand on the middle bar instead of on the side of the walker. Then he started just falling straight down like his legs buckled under him. This has gotten increasingly worse and starting the past couple of days he can't stand without falling. His doctor ordered an MRI to see if he has had another stroke, results pending. But, yesterday, when we had picked my brother in law up five or six times and could not physically do it again, we called an ambulance and had him taken to the ER. The ER doc ordered labs, a CT scan, EKG, and urinalysis, none of which had any abnormal or acute findings. We are frustrated because all of a sudden BIL has become bedridden and totally dependent on us to help him get around. Our home is not equipped for full time wheelchair access. He would still need help getting into the bathroom because the wheelchair won't fit. I was wondering if anyone had experience with this kind of decline and what you were able to do to help your loved one. BIL is not eligible for Medicaid due to income being too high and some other issues that were not handled properly when he first had his stroke. We are at wit's end. We can't keep picking him up off the floor. It takes both of us to get him up and in the bathroom or in the den to his chair. He seems content to be in bed all the time. I think he has decided he doesn't want to do anything for himself anymore and has given up trying but he still wants to live and be cared for. He is fed enterally and is totally incontinent too.

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Here is more information regarding Miller Trusts/Income Trusts and Medicaid in case it is helpful:

https://www.agingcare.com/articles/how-to-use-a-miller-trust-for-medicaid-eligibility-207367.htm
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Quickly googling here it looks like South Carolina does allow for an “income trust” to be set up for people needing Medicaid to pay for nursing home care but who have too much income. Have you consulted with a Medicaid-savvy lawyer?

His care sounds beyond what most people are capable of doing for year after year in the home.
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I had this issue with my mother last November but it was after a septic infection. She completely lost the ability to stand alone or walk.

I think you definitely need to look into a home Healthcare aid,very soon. He could become more injured if dropped. If he is in bed most of the time try to make sure he changes his positions often. If not he could develop bedsores and then your problems have multiplied. An air mattress on top of the regular one could help

I think the best solution would be skilled nursing. I realize that is easier said than done. I hope you find a solution soon.
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This sounds like a very difficult situation. He's in pretty rough shape. I don't understand the. part that he can't get medicaid due to his income being too high. I though medicaid was to pay for a nursing home when a person runs out of money? If that's true, wouldn't he just pay his money until he's out and apply then?

Anyhow, do you expect to keep him at your home until he dies? Regardless, I would consider getting him evaluated for hospice. And I would get some additional help caring for him. If you can't keep dealing with this, next time he falls and you have to call 911, have them transport him to the hospital and you could then refuse to take him back home as it is not a safe discharge. He may need rehab or may just need a nursing home.

Good luck.
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If your brother-in-law has vascular dementia, then I'm sure you're aware that it is the most aggressive of all the dementias, with a life expectancy of only 5 years, so his decline should be of no surprise to you.
My husband was diagnosed with vascular dementia in July 2018, but had many of the symptoms about a year earlier. He too was severely incontinent and had to have a supra pubic catheter put in, and his gait was way off and he started falling a lot. He then developed aspiration pneumonia in Nov. 2018, which about killed him, and when he returned home after his 3 week stay in the hospital, he was completely bedridden, where he remained in our home under hospice care for the last 22 months of his life. He died Sept. 2020.
I would suggest that you now get hospice involved, as they will supply a hospital bed, and any other equipment needed, along with any supplies such as diapers, bed pads, etc. and any needed medications, which will all be covered 100% under his Medicare.
They will also send a nurse out once a week to start, to check on him, and will also have aides come about twice a week to bathe him in the bed, again all covered 100% under Medicare.
And please until you get hospice in place for him, next time he falls, call 911 and they will send out EMT's to pick him up, check his vitals, and put him where he needs to be free of charge. The only time they will charge you is if they have to transport him to the hospital.
I wish you the best in getting things lined up for your BIL.
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I used to compare Alzheimer’s decline like a long ramp that you descend in a fairly even manner.
Vascular Dementia decline is like stairs with landings between the decline where there may be a period of time where there is no decline before another round of decline begins.
I think my Husband had both.
There were a few times when he could do something one day and literally overnight he could no longer do it. Walking was one of them. He went from walking with a walker to a wheelchair in 2 days.
This might be what is happening with your BIL.
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