Caring for Mom since admission to a nursing home

[cc84374458]

Problem: I seem to have been written off by the nursing home as not having any legal standing in regards to my mother's care or spending money at all. Legal Aid drew up the FPOA and DPOA in 2007, and I thought we were all set. I never saw it coming. My mother was kidnapped from my care as far as I am concerned: an ambulance ride to the hospital for a UTI, because she had a no-injury fall because she was up to pee every 20-45 minutes around the clock, with rehab at a nursing home. She did need rehab to improve her arm strength to get out of chairs, but this was new-onset, and I had seen rehab work wonders in the past. With Medicaid, it is whatever bed is open anywhere in the state is where you go, and was quite surprised only the two local ones were offered. I expected to pick her up and bring her home on Day 21 as in the past. Except this time she told me she was scared she could not get out of a chair or her bed, so I returned her that same night, despite my noting her getting out of the lift chair to toilet three times. I thought she would be back after getting more rehab but she got sucked into the system instead.

I felt it was going to be an easy sail to her 90th birthday by summer's end, and she has had painful cellulitis twice. I feel they are killing her and have stated such right to the nurse's face.

My mother lived independently with my oversight in senior housing. She had her lift chair, her cat, HBO, Netflix, take-out food, etc. In weeks, with their penny-pinching ways, my mother had cellulitis in both legs because she no longer had a chair, other than a wheelchair. Their "solution" was to tell my mother to stay in bed with her legs on pillows, and if in the wheelchair, to put pillows under her feet. She has midstage Alzheimer's, it has been pretty stable over the last seven years on medication, but her near-term memory has grown increasingly short. She is not going to remember the new rules regarding pillows under her feet when seated, and without leg elevation, she will get cellulitis. (She never had this in the community.)

My mother's income is just below the poverty line, and she had assets low enough, excluding her funeral and burial irrevocable trust, to qualify without a spend-down. As her FPOA, I furiously spent money on her as soon as I learned someone determined she needed to stay: clothing, a magazine subscription, a prepaid flip-phone, a new TV-DVD player, a Joy for All (Hasbro) robotic cat to help her mourn the loss of her cat (cat's okay, at a relative's).

Now I am stuck in this loop that everytime I complain about something, "Resident Right," and "You are not her legal guardian," is their retort. However, they are rather selective in how that term is used. I looked them up, and in my state it is a Resident Right to select someone to manage your money, the $45 personal needs allowance in this case. (And regular cable TV plus an analog phone cost pretty close to the $45) A copy of the FPOA was left early in her admission, and since I had no idea how much a cut and perm was going to cost, I left $100 in her trust account there, and initially was unconcerned about there being $50 left. The paper I was presented did state "recurring charges," with the price, and I was presented with no alternative form, but I did scratch out beautician service and verbally stated emphatically, it will be on an as-needed basis. Then 6 weeks later, there was a bill for an unauthoized "six-week touchup." I sent a letter via fax, because this seems to be the only way I can get them to respond.

I have a feeling services for low-income seniors, supplied by Legal Aid, Council on Aging, Long-term Care Ombudsman do not supply the needed protections with FPOAs and DPOAs. I am left to wonder if I really do need to apply for guardianship because after a week of back-and-forth via email and phone tag, my original question to Licensing was looking for a referral to handle six current issues, and all she wanted was to file the report and stated she could not give referrals. And Licensing as has already been over there with no findings, and that nurse whom I expressed "they are killing her," made sure I knew they were there and found nothing. 

It seems to be a club, with the LTC Ombudsman and Licensing and people who work at the nursing home all patting themselves on the back for a good job, and I need to find my mother an independent advocate and my Google searches today do not show any hints of an answer, except for family councils, and I am pretty sure this home does not have one, and if they do, they already do not listen to it.

How do I become relevant in my mother's care again? Do I really need to go to court and be named her guardian in order to be heard?

[JaneCares]

Hi cc,

Amanda Singleton is an attorney and I always learn from her posts. I'm thinking, since Legal Aid was helpful to you, perhaps go back to them, which would be much less expensive than seeing an elder law attorney, so that's an idea. If there's still a viable Legal Aid where you are.

When i was working as a geriatric care manager, there was always this period in an ailing elder's life between independent & continent, and bed-bound with a foley catheter. That period is the one in which the elder has to pee a lot, doesn't want to use Depends, and is at risk of falling. I tried all kinds of things to make it better: use a walker by the bed. Put a bedside commode at the, you guessed it, bedside so it's really close! Use very bright 'night' lights.  But all of that is too late for her. Sounds like she's declining. At 90, maybe she would have even at home but you don't know that.

I have one idea. Call the constituent services person at your congressperson's office, or senator, preferably one you'd actually vote for. Complain that the ombudsperson is not doing the job, you suspect neglect, you're not getting a straight answer.... The constituent services person will put a knot in their mane, so to speak, and you'll at least get a phone call.  That's their job.

Try that? Keep us posted?  Your mother is lucky to have you advocating for her. Now if only you can get some traction!!

Jane

[AmandaSingleton]

Hello:  Thank you for your post.   Your mother is so fortunate to have a child/caregiver as hands-on and thorough as you seem to be.   I'm sorry for the struggles that are presenting themselves as your mom is in the care of others. 

There are a few flags in your email that may be cleared up quickly by an attorney in your state.  Consider reaching out to a law firm that practices elder law, including guardianships.  To find an attorney who practices in these areas, you may wish to consult the National Association of Elder Law Attorneys website or the Bar Assocation website in your state.  If it is a firm that is local to the facility where your mother presently lives, that may be helpful because they may have familiarity and relationships established with the facility.   They will be able to advise you on the use of your Powers of Attorney (for example, in Florida, we had a big modification of our POA laws in 2011.  Pre-existing Powers of Attorney are still valid, but they may not have the operative language needed to use them) as well as the process and effect of obtaining a guardianship.  At a minimum, they may be able to advocate for you or help you reach an understanding with the facility. 

I hope your mom's cellulitis clears up with adequate treatment and that her care providers raise their awareness of her needs.   Please keep us posted on your progress and her wellbeing.  Thank you, again, for reaching out.