Monday, October 4, 2010

Placed My Father In a Nursing Home This Weekend

My sister, for the past few months, has been trying to get my father approved for Medicaid Long Term Care to help pay for my dad's Adult Daycare costs. At the time she initiated the process, my father was deemed "too healthy" and has "too much income" to qualify for Medicaid.

With respect to his income, I finally filed my parents' Ch. 7 bankruptcy petition on 9/30/10. This will free up my parents' income for their own care, rather than paying back overwhelming credit card debts. My sister and I also set up a "Miller" Trust" to get past the Medicaid income requirement. In a nutshell, my dad's entire monthly income will go into the Trust, with my sister acting as Trustee. My sister is required to disburse my father's income for various approved expenses: my dad's personal needs, spousal support to my mother and reimbursement to Medicaid. At the end of every month, my father's monthly income will need to be spent completely for all approved expenses. Anything left over, gets handed over to Medicaid.

With respect to his health, my father appears to have lost all will to live. He won't eat and spends most of his days and nights just sleeping. He can barely remain standing or sitting upright for a minute before he has to lie down. He was approved for hospice care, which will be paid by Medicare. My father will probably undergo a second-round of health evaluation by a Medicaid nurse to see whether he now qualifies. (He undoubtedly will qualify now.)

My family concluded that my dad is now beyond my sister's or my mother's ability to properly care for him. My dad doesn't make his care-giving any easier with his disrespectful attitude towards my mother and my sister. (On the flip side, when standing in his shoes, I wouldn't want my last days being at the mercy of people I hated either.) No matter how you looked at it, we all felt that placing him in a nursing home was the best option.

My sister and my mother went to look at various Medicaid-approved nursing homes. What they found were shocking. All of the commercial facilities that resemble mini-hospitals were "private pay"-only facilities that charged upwards of $5000/month-$7000/month. When my sister mentioned "Medicaid," these private-pay facilities hung up on her.

All of the Medicaid-approved facilities were run by private individuals out of single-family homes. I had the opportunity to inspect two facilities - one was a depressing home with a wall-eyed "nurse" dressed in sweats and a dirty t-shirt. The room was dark and dingy and the carpeting looked stained and dusty. I didn't even bother to inspect the bathrooms.

The second home was a bright, clean home with the proprietor's licenses prominently displayed in the lobby. The nurses at this home wore medical scrubs and looked very professional. The bathrooms were handicap-accessible and clean. The second home charged $2,500/month for a small, private bedroom. My sister and my mother both agreed that this second facility was the best out of all they've inspected. There was an immediate vacancy on 9/27. My sister and I debated whether we should wait until my father was approved for Medicaid or whether we should place him immediately and pay out-of-pocket in the interim.

We concluded that the bigger risk was to wait for Medicaid approval and the nursing home would no longer have a vacancy. We sucked it up, paid $2,500 for the first month and placed my dad in the facility this past Saturday. My dad didn't argue, fight or resist the transfer. The nurses gave him a cup of Ensure blended with some ice cream (the only thing he will consume) and he went to sleep. We visited him again yesterday morning and the only thing he complained about was that his internet wasn't working. When we fixed his internet, he promptly went back to sleep.

Watching my father wither away makes me wonder - - is there any reason to keep someone alive who is clearly terminally ill and no longer has the will to live?


Leslie said...

My grandpa is in a similar situation, but refuses to go to a nursing home. He had a stroke several years ago and is now mostly paralyzed. In the beginning he tried really hard with therapy to get better, but lately he's totally given up and just watches TV in bed all day. The saddest thing to me is that mentally he's still there, its just physically he can't do much any more. He needs a nurse to come at least 3 times a day, and it is getting to be too much even with the nurse for my grandma to take care of him. (She's getting dementia at age 87) But both of them refuse assisted living or a nursing home. We don't know what to do - and it makes me sad every day.

Money Beagle said...

Wow, that's heartbreaking. I think many older people lose that will at some point. My grandma was steadily declining for months but still kept her fight until she was diagnosed with bowel cancer and then the life went out of her and she passed a few days later. But, she had a good life and a lot of happiness. Sad to say but it sounds like your dad had a bitter life and that his passing will end up being the same way.

I commend you and your sister for the hard and difficult choices that you are making. Stay strong.

Sallie's Niece said...

I'm so sorry you have to go through this. Your family is in my thoughts.

Louise said...

just wanted to say I'm thinking of you. it's hard having to do this for parents, it's emotionally exhausting. I think you and your sister made the right decision to put your dad into care,
don't forget to take good care of yourself as well! you've handled a very difficult situation really well.

DogAteMyFinances said...

I am so sorry you are going through this.

Revanche said...

I'm sorry you're at this point but glad that you found what seems to be a good, clean nursing home for him until he's ready. There's not much more that you can do for his state of mind, but you've done what you can for his affairs. My thoughts are with you.

FB @ said...

I am sorry to hear about your situation. That's heartbreaking :(

Abigail said...

Eesh, I'm sorry to hear all this... and be getting to it so late. Most of October has gone by without my checking Google Reader.

It must be very hard indeed to deal with all of this. I think, in the end, you have to respect his wishes and not push too hard. That said, it's my understanding that some people go through an initial period of depression that lifts as they get used to their new environs. But I could be wrong.

I know that his behavior must be exhausting/exasperating. But having been completely dependent on other people before, it's infuriating. Whenever I wasn't zonked out on meds, my time in the hospital (nearly four months) saw some huge fits of rage, bouts of utter codependency and everything in between.

I know being completely inert in a hospital isn't the same as dementia, but the dependency and frustration levels are somewhat comparable. When your head is somewhat clear, you realize just how helpless you are and it's maddening. And very upsetting.

Nonetheless, having seen my great-grandfather struggle with Alzheimer's I have some small experience (we only saw him when we visited my dad's family on the East Coast) with just how difficult it must be to deal with someone in those stages. After an hour, we'd all leave stressed, tired and emotionally drained.

I hope this moves takes some of the weight off your and your sister's shoulders.

Feel free to get in touch with me if you're ever in the area and need to get a drink. Or, from the sound of it, many, many drinks.

roadtofi said...

As someone who is culturally conditioned regarding the support of parents in their old age, I fully emphathise with your situation. Thankfully, I have reasonably responsible parents and life has been good enough to us so far. However, I still spend more time than ever worrying about my parent's retirement and old age and how I will be able to singlehandedly support all of us while planning my own early retirement.
I do wish you all the best in the road forward with your family. Take care.