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I'm in NY, traveling up Boston. My mom was living independently, pretty much house-bound the last 4 years. She fell 18 days ago, nothing broken, but now is, after 10 days in rehab, having trouble regaining even the very limited mobility that she had before. She turned out to have severe anemia and a UTI, and was treated for both; also got some cortizol and steroids in her very bad arthritic knees. Chronic diarrhea. I've spent $3k in the last 3 weeks on plane flights, taxis, cars, elder care manager, other. Am at my wit's end on how to continue to care for her while working full-time. Don't have anyone local (i.e. friends or family) who can really take on the role of coordinating her care. Should I just hire a $150/hr elder care manager (insane) and take out a home equity loan on her house?

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ps hoyers are free through medicare, just ask the doctor for a prescription, hospital beds too, get electric if you can. I paid an extra $30 or electric and well worth it, after a year you own them all, as I do. If you get a bed ask for the new foam mattresses, not the gell pad, those are awful. I replaced my moms mattress with a memory foam one I bought, then found out they now give them thru ,medicare... Just FYI
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oh boy, the fun begins. we took in my mom six years ago. it was snowing and my husband plowed the front yard and he built a ramp with my son. How many steps? If you get 2-4 strong people you can lift her into the house iin her wheelchair until you get a ramp. I have a ramp, and a hoyer lift now because she cannot walk. We are sitting her now in front of the fireplace, she is chewing on nothing, has no idea where she is and doesnt understand much, but will smile and kiss me when I ask her to. she is comfy and warm with a full belly, what else matters? lol bless you for taking her ho :o) its priceless. soon going to hoyer her into bed and change her diaper, she up late tonight! Amazon might have temporary ramps or your police dept, good luck. oh, they also have door hinges on amazon that will make your door open just a couple of more inches so a wheelchair can get through them.
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Maksik, if you want to bring someone home on wheels, see if you can get an in-home PT or OT visit to help evaluate accessibility and try to make the rehab staff work with you on transfers to bed, to bath, and selecting and obtaining equipment that will make it possible to manage. I remember when I thought maybe I'd get my mom home with help...I moved some furniture and would have had to use a commode as the bath would not have been easily accessible, though we might have managed that a few days a week (she'd already been washcloth-bathing for the most part before she fell and went into care) but we never did get to try it, even for a visit. Sometimes community organizations will help with ramps. You may even be able to rent things like patient lifts if mom's transfer skills are too limited and she's too heavy for you to lift or provide enough assist. There are some gadgets like transfer boards, turning discs that you stand on, and gait belt or vest you can even find in catalogs you can order from yourself that are less expensive if a total lift is not required.
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Well, her PCP has cleared her for it. But first doctor we went to said that he thinks she might have ostopenia, and that if he replaces her knee,e leg might fracture. But he also couldn't find her x-rays at first, and it seemed a little breezy. Said to do PT for 3 months and come back, maybe bones will have strengthened.

He's the same guy who wouldn't do her knee 5 yrs ago b/c BP was high. So I want to get a 2nd and 3rd opinion.

And yes on care mgr. It only occurred to me sort of midway like -- why does she keep siding with the facility over me, on my dime? b/c they're source of clients. Oh well - live and learn!
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Ha! sure they make nicey nice with the facility in the hope of picking up more clients.. I was afraid of that. As far as surgery, if the primary will not clear her for surgery, nobody will take the case. Too much risk.
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Hi everyone, I'm the one who originally asked the question.

I did end up hiring an elder care mgr, but after 3-4 weeks, I can definitely say it was money wasted -- it was kind of comforting at first to feel like someone was helping, and I did get some initial info. But, overall, I ended up taking care of everything myself -- I was the one who caught a mistake in my Mom's scripts, did all the negotiations with the rehab on the premature discharge, etc. Was a waste of money and also stressed me out b/c I kept expecting her to help and she really didn't -- also seemed to be developing relationships with the rehab mgmt, and triangulating...it was weird. Don't recommend it.

My Mom got one consult on the knee surgery. Doc said no. Going for two more. Now paying out-of-pocket at another rehab so going to try and bring her home soon. Would love any advice on how to bring elderly parent in chair home!!
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I agree with Standing Alone. Sounds like an ALF would suit mom's needs fine. If she is the surviving spouse of a Veteran she may also be entitled to a VA Pension ($1,113.00) per month to offset her costs of care, Bob.
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Blannie is so right! Anethesia causes dementia, especially in the elderly. They didnt want to give it to my Mom to repair her broken hip but due to arthritis in her back they couldnt do a spinal. My friends Dad is in assisted living and is contemplating knee surgery right now, he is 94, yes 94 and of sound mind completely. Even his Doctor said he would not give general anethesia at his age. Beware, research, and don't chance it if you dont have to. good luck
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To share a difference experience. My mother whose heart, lungs etc. are healthy had a second hip replacement at 99. her first one was at age 85. She outlived the surgeon who did the first one They gave her fully anaesthetic for the second op. I know she is somewhat unusual and is now 101 and survived the ops and the anaesthetic with no ill effects. She has a good surgeon who did not hide the possibilities from her, but she opted for the surgery as she was in such pain, even though there were increased risks. Mother does not have Alz, and makes her own decisions. She does have Borderline Personality Disorder, narcissism and now some paranoia and short term memory loss, but is still in an ALF. There are dangers with increasing age. What does your mother want?
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Also, I don't know about going rates in your area, but you might want to try an assisted living locator and see if they can beat that price. $400-500 a day seems steep. We managed to get in the under 200 range, which means 5-6k/month and it was only a few years ago.
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There was a recent article about a woman who survived a Whipple procedure in her late 90s and lived three more years afterwards...died of something else not cancer related and family considered it very worthwhile. (Would not likely have had more than 6 months without it.) I think anesthesia probably is most likely to make vascular and/or diabetic brain issues worse. My mom got a new knee for real bad osteoarthritis, and ended up not walking on it much, at 77 or 78, and it is still hard to say if her already downhill course with her brain function was worse after that or not. It seemed that way initially....I do wish she would have had it under epidural and sedation as her doc proposed; she'd had her 2nd hip fracture pinned with that about 10 years prior. It was still worth doing the surgery because at least after that, the knee didn't HURT any more. She still needed a lot of Tylenol for her shoulders, but once she got that regularly and could let a therapist get them mobilized it was not so bad for her either. Mom was allergic to things that could have been related to Synvisc or similar injectables, or we could have tried that first too. The literature is not all that good for that, but even something to just take the edge off can be worth a try. P. Steigman is sure right to be very, very cautious about our elders getting surgical procedures and anesthesia, I would just say "never say never."
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I would guess that there are private agencies that can help you find paid care for your mom...you'll pay them for the help but they well be able to put you in touch with competent, reliable help who won't be charging such an outrageous amount.

You don't mention anything about her financial situation but assisted living or a long term care facility might be options. Again, depending on her finances and her medical condition, Medicaid might be an option.

Check into all options, including the loan, but keep living YOUR life.
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Surgery at 87 has a high probability of disaster. MD's are all too eager to profit from the insurance and ignore the risk to the patient. Recovery will be compromised by back issues and age. Anaesthesia will do more damage than good at her age. Get her a Nursing Home and good pain management. Synvisc will be no better than a postage stamp at her age. If her primary approves her for surgery, fire the idiot and get a Geriatrician.
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My response to you would be to place her in a Assisted Living facility they can care for her better than you can. If I was there I would greatly take the job because this is my profession. I have my own Companion Services for the Elderly, but I am here in Pensacola Fl. Take a week or two off if possible either search in your area, or hers, but do background, drop in at night, check for staff turnovers, check with them about the state req. when they come in and have the facility been sited, make sure you ask plenty of questions and what is their policy and procedure. If you place Mom make sure you have the full control of everything and if Mom is telling you something Is not right check into and don't just say "Oh she is getting forgetful ,or she is just old and don't remember" You know you parent listen when they speak to you. Check around, pray for the right decision and go from there.
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Do not hire a care manager, you would be throwing money out the window. You may consider a caregiving service, which runs about $20.00 hr in California, but your best bet would be move her into an assisted living facility near you.
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I should add something about my Mom. She is in good health (BP is finally down after years of being too high), except for her back and her excruciatingly painful arthritic knees -- bone on bone, per the recent x-rays. She was hobbling before, and living independently, but now is having difficulty standing, let alone hobbling. She doesn't want surgery (if Synvisc could help, we'd love to try that), and is afraid herself of dementia, but is also not eager to live in a wheelchair w/constant pain.

Kind of a rock and a hard place. :(
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She is anemic because she's not eating properly and that is probably why she fell. Plus the UTI was because she is not changing her depends or not keeping herself clean. I went through this two years ago with my mom. I was making her batches or soup/stew in small containers that she only had to put in the microwave but she stopped doing that. She fell twice in one day, refused rescue the first time but I came the second time and had her transported to the hospital. Any issue like this causes them to not be able to walk safely, as was my mom who used a walker. Then, they aren't safe to be left at home by themselves. Since your mom still lives at home, you should be able to hire a "helper" who would take care of her and watch out for her pretty much for room and board. She doesn't need a medical person at this point (been through that) just a companion and roommate whose job it is to make sure your mom is safe and that she eats and that her personal hygiene is taken care of. Good luck (my mom now lives with me even though I work full time and as long as she can stand up and walk safely, we are good).
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Maksik please do some research on the elderly and general anesthesia's effects on them. Many people who have surgery at your mom's age develop Alzheimers or dementia as a a result of the anesthesia. My uncle had heart bypass surgery and had hallucinations and was never the same. My good friend's mom had two replacement surgeries in her 80s (shoulder and knee) and developed dementia as a result. It doesn't happen to everyone, but it happens enough that you need to add that to your considerations if you haven't already. It's a serious issue.
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Hi. Thank you so much, everybody, for your responses. I really appreciate your wise words, sentiments, hugs, etc.!!

A lot has happened since I first posted. I did hire an elder care manager and felt relieved immediately after talking to her. She knows the ins and outs of stuff, and that way she can do the research or help do it, and it's not just me and google. My Mom is getting discharged from rehab next Fri (maybe week after, but not likely -- doesn't look like I'm going to win the stay in rehab longer battle) and has an appt with a knee specialist on Nov. 22. We (our rather, my mother) decided, with elder care manager presenting the options, that she will stay in some type of long-term care place (we'll be paying, ca. $400-500/day) until the appt. She can't go home alone now; she could come to my home but I'd need to hire someone full-time, and it just seems easier to stay in a professional area, with minimal travel (5-hour trip to my place).

A lot will depend on Nov. 22 -- too much, I feel like! If the doctor agrees to do knee replacements, she's going to get them done. Has never wanted to in the past (well, tried once, but BP was too high). So, that would mean Nov. 22, then full work-up pre-surgery, then surgery. Would likely stay in the area (again, in the place we pay for) and then rehab post-surgery.

If he doesn't agree to do it, then she will come with me and I will get someone full-time.

I hope there is some kind of option that will enable her to walk a little (since the falls, she can't walk -- before, she was doing a good job of shuffling slowly w/a cane) and be more pain-free. That would be optimal.

I can't even imagine the hopeful option of her getting a knee replacement and being able to walk again. Maybe I'm a bit of a pessimist. My husband says it's possible.

I have read those 2 books (Gross and the Slow Medicine one) -- both were excellent, and helped prepare me for all this.
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glornorth59, I did the same, I left my job after almost 3 years of juggling both. My Mom couldnt be alone a minute so I hired a 2 hour morning CNA to help Mom dress and get her to Daycare, then I picked her up after work. Eventually she couldnt walk anymore and the dementia was getting worse after a stroke, and her savings ran out. Those all contributed to my leaving my job. Now that I am home fulltime for still 3 more years, going to work was a heck of a lot easier that fulltime care, lol. I too sometimes feel insane so I hired morning and weekend help with moms ss. I think someone has to step up to the plate and be there fulltime for her, that "alone" feeling is much too scary for anyone, never mind an elderly person. Call a home care agency and set up your Mom, or look on care dot com and hire someone, or get a live in. My Mom is in late stages of dementia and its hard work but she would do it for me, so I am in this for the long haul, she is priceless. Good luck.
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Your mom's story sounds like mine.

She had been increasingly housebound but had a good neighbor who was helping her a lot more than she wanted to let on. She messed up with her meds and had side effects and fell while cleaning a closet that didn't need to be cleaned. She grudgingly agreed to go to subacute rehab because she was too weak to even turn herself over in bed...

My mom wanted nothing more than to go back home and be on her own again there, but things were worse than they seemed, and it was not going to happen, but it took me a couple years to accept that. During those years, I spent over $16,000 trying to be a long distance caregiver to my mom.

Finally, I moved her. And it turned out to be the right thing because once when she was having a heart attack, despite being on all the right meds and getting the best care we could, she cried out "I don't wanna die alone!" And since she lived in Pgh and I lived in Little Rock, that would have happened if one of us hadn't moved.

Sometimes I look back and think I should have moved, and maybe I should have. That became water under the bridge fast. If you find yourself wondering if mom will ever realistically go home again, get a really good comprehensive geriatric eval and ask them to be realistic with you. I needed to do that before I sold the car and even considered selling the house; I hoped she would listen to them and accept the idea of moving to Arkansas where at the time she could have been in a very nice assisted living facility. My mom wasn't ready, and your mom may not be ready to listen or hear it, but you can, and then you can plan accordingly. It is possible there could be significant recovery; lots of people make it back from subacute rehab to home and get to stay there for at least a few years. It is also possible that as much as you will want to hope things could turn out better and you want to respect Mom's wishes in everything, you will have to face reality and make other plans, either telling Mom this is how it has to be or cajoling and temporizing her into it. And, you do have to get POAs for finances and health care if you don't have them. Once I had that, I used online banking to handle everything...that was the easy part.

If they tell you she can't be by herself and you have to work full time, you really will have to have an assisted living or homecare option either way. Even using sick days, personal days, flexible hours etc. and keeping up with my duties quite well under the circumstances, I was warned that I'd better fill out an FMLA form. If you use a home equity loan rather than Mom's regular funding, be aware that will come out of the proceeds of selling the home when that time comes...only you can judge whether selling now or later will make more sense.

I wish this was easier. Glad you are asking for help and ideas and getting it, I felt like I was out on a limb on one very steep learning curve.
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I am caring for my 88 year old mother by myself with no help from family or friends. I could never work a full-time job and care for her even part-time since care giving is a 24/7 responsibility. If your mother hates strangers coming into her home, hates the mere thought of having to pull up roots from a home she has lived in for 25 years and be moved into a nursing home or assisted living facility...like my mother....then find some way to keep her in her home even if you have to temporarily reduce your hours on the job or stop working completely. I realize everyone is different and can only do what they are able to do. However, hiring a care manager at $150.00 an hour or hiring someone for $2400.00 a month would be way off limits for me, so it was my decision to quit my job and move in to her home and take on the role of caregiver. It was a tough decision to make but now that I am actually doing this, I have to rethink of strategies to keep myself from going insane while at the same time be sure that my mother is getting the best care from me as possible. I try to take walks intermittently each day, weather permitting, paint, (which is my hobby) and get plenty of rest. Isolation is the most challenging part of care giving. I am a social person and not being able to get out with friends is depressing. Care giving by yourself is a very difficult decision to make however if aides are working for you than continue on that path until you are able to focus on what would be the ideal situation for both you and your mother. The home equity loan sounds like a good solution to help steer you to the right situation for both of you. Take care of yourself and don't feel guilty for any tough decision you have to make. Good luck.
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yes u r right about hospice. I really think. my mom could have it but she refuses it.
I feel mom can think what she wants - she deserves it and to go the easy she wants to. she wants to be in her home and not a retirement home. they r sure expensive anyway.
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Hospice is only if her physician feels she has six months or less to live. She has to qualify for hospice and be referred by her physician. They will then come to her and evaluate her eligibility. Get help, do not go it alone. I have four siblings and we are very much in sync, while I am the primary caregiver I have their support. Good luck.
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ees=was
u=I
live= love!! :)
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sorry a couple typos I was typing from my phone...
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Maybe u can hire caregivers. my mom has live in and it's much cheaper than hourly at least here in Or. I feel guilty at times but I too work full-time plus I'm not in good health. I have fibromyalgis plus arthritis in my back that is constant. I wrote a couple weeks ago cause I was in so much pain I ess crying. everyone was so nice. u still am hurting daily have decided to go to a new dr. my mom continues to go downhill but the caregivers she has are awesome. I would have to be really strong to lift my mom and I just can't. I feel guilty at times but I love her caregivers. so please don't feel guilty if u have to ask for help. what about hospice? my mom won't accept it she says it's too morbid she is in denial but I live her and spend time with her and try to make her laugh. sorry this is a book. lol..
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What kind of person rips of everyday people at 150$ an hour. AN ABSOLUTE OBSCENITY!
People in need, my advice is, get her over to your place, as best you can, and organise for yourself a full time residential care home.
Check it out like stink.....my mother in law paid 750$ a week, an ended up, I quote from their own records, 'being left on brim filled commodes with faeces and urine' on several occasions....
Hang your head in shame those who think your service is worth 150$ per hour.
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This sounds like an assisted living situation to me. I went through trying to do all this on my own too, but no one can do that. A manager would be helpful short term to help you make the best arrangements for both of you. Caregiving alone is a no go.
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I don't know in your state, but here in Florida there are organizations like Senior Friendship and others that gives lots of help and advice. Also medicare has programs for situations like yours. There are so many programs that we don't know they exist if we don't search and ask. Good luck to you and God bless you!
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