Very narcissistic mom has taken to not showering and calling the police if her food in her assisted living apt is not to her liking. She won't let the staff do an assessment on her or my father to develop a care plan. Staff at this AL have decided they needed to bump up their "care plan" by $1K apiece for things like showers and medication management (they don't take any meds).
Medicare pays for 2 showers a week, but only places like SNFs can bill Medicare? Also, Medicare would pay for someone to cut my dad's toenails, I think? Not sure how to get parents assessed in order to proceed. Mom is losing competence but can probably still fake it. Help, I feel like I am drowning, so any guidance appreciated. We're in the SW US.
Providers are not always willing to provide all the services Medicare will pay for. They are not required to. You have the right to search for providers who offer the services you need.
Residents have a right to refuse services.
You might consider a home health agency for homebound who need less than 24/7 skilled nursing. But if your mom is refusing services you would probably have to be onsite when they come to get anything done. It still beats having them in your home, or you in theirs.
Perhaps your mom could use a visit with a psychiatrist to prescribe meds that would make her more compliant. You may need to separate dad from her to get him cared for.
Yes, there are services offered by private providers who will visit ALF to trim toenails. Again, you can set it up but it doesn’t mean mom will allow. Podiatrist come to NHs. I had one come to my moms house one time. I’ve had a company come to DH Aunts home to trim hers.
These are all private facilities. They are licensed by the state but again that doesn’t mean they have to do everything that you want or think Medicare will pay for.
I am sorry you are going through this. Facility care is not all that for every patient although some love it. Truly your mom sounds like a handful. If this is all new to her, hopefully she will settle down as she becomes more acclimated. Does she really need a phone? She may be better suited for Memory Care.
I’m surprised the ALF accepted them without an assessment to begin with.
There is a lot to learn about the nuances of elder care. You will get there. This is a good forum to find others who have dealt with what you are experiencing.
Mom has always been a handful, but they moved to this ALF when they were in much better shape- about 3 years ago. She has always been skilled at faking it in front of other people and then being abusive behind closed doors, but her mask is slipping. The ALF staff are not amused that she told the police she hadn't gotten any food all day, which of course was not true.
I am trying to keep my distance because the last time I went to see them to get all their tax stuff together, she kept urging me to put my hands on her throat and kill her due to her "unbearable" back pain. No thanks!!
This forum is a godsend. I've been a long-term lurker, but now a first time poster.
With my Mom her care was based on levels 1 to 4. Mom being a 4 because she needed everything, but feeding, and she could feed herself. Maybe for your parents showers and medication is level 1 doesn't matter if they don't need med management it just included in that level of care, then 2 is a group of other things and so on.
You need to get your Mom evaluated by a Neurologist and on Meds. Also, she is probably passed the care an AL can give and will need MC. I would say take her phone away but then Dad probably needs it. Can u block the police # somehow?
Back in the day (about 4 years ago) when dad was discharged from an SNF into a different AL, I did contact an agency to do showers, but mom never let them in. The staff there was more than happy to take the $$ to shower him. I don't know if that was somehow different? I'll have to do more research.
The podiatrist tip is helpful!
Mom will fight tooth and nail any attempt to evaluate her or to move her. I have POA but I wonder what it will take to force her to be evaluated. I would gladly surrender it and have a conservator appointed if that made more sense. It's a legal morass! (I'm an attorney, but I am a patent attorney, so this is way over my head). Dad is stone deaf and can't use the phone, but mom resists my taking it away. I may just cancel the plan though. I think she called 911 and dispatch probably thought it sounded like a police matter, not sure.
"Nursing home care
In most cases, Medicare doesn't pay for custodial care. , which helps you with activities of daily living (like bathing, dressing, using the bathroom, and eating) or personal needs that could be done safely and reasonably without professional skills or training."
You may be confusing Medicaid with Medicare. Medicare is a health insurance and you need both A&B. Medicaid, for NHs, pays what the recipient can't with just SS and pension. So custodial care is included. If you are privately paying, you are paying for your custodial care.
It sounds like this extra 2k is going to put a strain on your parents budget. If so, you may need to place Mom in Long-term care with Medicaid eventually paying and keep Dad in the AL. To do this though, you need to talk to an elder lawyer to have your parents assets split. Moms will go towards her care in LTC and when she is running out of money, u apply for Medicaid.
In any event, I will focus on what real Medicare actually covers! You've saved me a lot of time! (And now I sound better informed, also a bonus!).
They could probably swing the extra $$, I just have concerns that we'll get billed for it and my mom will refuse to let the care staff in, so it's money down the drain. My mom has a greedy sister who has some attorneys in the family watching my every step, so I want to protect myself against charges- frivolous or not- that I am draining their estate forcing care on them that they don't want or need. (They're not local, so it's easy for them to second-guess me. Do they want the POA? Heck no!!!). They're both still considered competent and how to change that without starting WWIII?!
Bless this community!
You might consider a camera so you can see what is actually going on.
Do consider giving your mom something for her back pain. A lidocaine patch might help. CBD oil did wonders for mine. Another poster on here likes the gummies. I used the drops under my tongue.
If she is in pain that can be causing her acting out to increase. Also the UTI test is always worth the trouble.
Even those who cry wolf occasionally need help.
I find it odd that the staff needs to evaluate her for a care plan after three years but that may be the rules for whatever they would recommend. Since they take no meds, I suppose they don’t see doctors….
She seems to be a strong advocate for herself which isn’t all bad. She probably gave the police something to smile about.
🤔😒🙄😇
Mom absolutely refuses to take anything for the pain. She has arthritis and probably just general stiffness, and is not at all pain tolerant. She winces and makes a big fuss when she has her blood pressure taken, like she is being murdered. So she is one of those who complains endlessly and then flips out when you actually suggest something that might help.
Definitely a personality disorder, probably narcissism with a dollop of histrionic. Those folks don't age well, but they sure seem to live forever. It's also super hard to parse out what might be dementia from the general personality disorder issues that have always been there. I told her once that she was acting like a little baby and she replied I AM a little baby. SIGH... Nothing like a 91 year old toddler.
UTI test is brilliant, especially in light of her hygiene issues.
I asked the care staff to try again on the assessment, possibly accompanied by the in-house doctor (who visits once a week). Mom is super deferential to doctors although she lies wildly to me about what they say to her. I don't feel comfortable authorizing a step up in the care plan (or implementation of a care plan, period) without them at least trying to get their consent. It's much easier for the ALF to deal with me, of course. The original management of the ALF changed in the past two years, with lots of turnover, which is part of the reason they are just now getting to evaluating my parents.
I feel so bad for the police since we have real crime issues, but it is certainly kind of funny (or will be, once some time passes...!).
You are all the best!! Turns out venting really is cathartic! My parents are 91 and 93 and most of my peers don't have parents that old, so it's tough. I don't want to horrify them with a possible preview of coming attractions.
The local dementia support groups are great, but it's kind of shameful when I feel like I just don't have that great a relationship with my parents to begin with!