Aid And Attendance For Alzheimer's

[TiredCoastie]

I'm in a similiar situation with my in-laws. My father-in-law, a WWII vet, is very frail and my mother-in-law has advanced Alzheimer's. Fortunately and unfortunately, my wife's dad has no service connected disability. His attorney suggested that we investigate the VA pension (non-disability related) process which will reimburse some portion of his out-of-pocket medical bills, esp if we need to pay out of pocket for in-home care. Considering that it will take up to nine months through our RO and her dad doesn't have the credit available to float thousands in care expecting a fat retro payment to pay it off, the option's not really on the table. I wouldn't do that with a disability claim and won't with a pension claim either!

John's advice is spot on. I recommend seeing if your dad qualifies for Medicaid. It should be administered by your local county department of social services. If he does qualify, then there are more options available in home, and he has the long term financing for a facility of your choice which may include the veterans home. You should also seek out an elder law attorney as John suggests. This type of professional should be able to help you navigate the various aspects of your dad's long term care, financing, and any legal aspects. For instance, does he have a durable power of attorney? Did he designate a health care proxy? Is guardianship required at some point?

Meanwhile, start checking with the county for specific programs that provide assistance to your mom and your family as they care for your dad while waiting to get him into a home. We've gotten home health aid assistance without cost to my in-laws through various programs thus far.

Another option is to seek in home care through the VA, if your dad is enrolled as a patient in the VA Medical System. The VA advertises that it will provide assistance in the home, and the health care company that sent an aid to care for my in-laws a couple times a week told us that her company works for the VA in providing that care in our local area. I've gotten conflicting reports, though, from social workers at the VAMC. My father-in-law hasn't been seen by a VA PCP in a number of years, so I need to re-enroll him to even explore the possiblities. Apparently the Outpatient PCPs have a social worker who addresses these needs based on the PCP's opinion of the patient's condition and in home needs.

There are advantages to being in a state or federal veterans home rather than out on the economy using Medicaid. Under Medicaid, most patients are left with only $20 to $25 per month for incidentals. Looking at a state veterans home for my in-laws yesterday, my in-laws would keep at least $100 each, and maybe more to cover other approved expenses. It's not a lot, but my father-in-law's pre-pay cell phone costs $50/month, for instance. What if he wants a haircut, a greeting card for his wife, or a candy bar for his grandchild? It would prevent more of the out-of-pocket costs from coming out of the combined family wallet.

While there are horror stories in veterans homes, I've been in an out of commercial nursing homes/rehab centers this past year caring for my in-laws. Let me confirm that there are horror stories there too - even in the best of them. If you can't afford the Cadillac version, which my in-laws cannot, expect whatever home to not meet your expectations. It's incumbent upon the family to manage the patient's care closely and keep after the facility but in a way that keeps working relationships intact, using the power of attorney and health care proxy or guardian designation to the patient's advantage.

This is a very hard patch on life's journey, and it's made much harder by the nature of the "long goodbye" as it weighs on the emotions of the family. At least you have one another as a family. Hang together, help and spell one another, and work hard to make these final days of your dad's life the best they can be, even if he doesn't have the capacity to appreciate them. May God bless you as you go forward.

Edited April 20, 2014 by TiredCoastie

[fortitudine]

TiredCoastie, Pete53, and John999, I would like to thank you all for the great information you have taken time to provide me. I also apologize for the time it has taken me to reply. Unfortunately, this has all become moot. I was told this week that my father's name came up on the list for the home, and that my mother accepted (as she had no other choice). If she had declined, it could be years before his name came up again, and they could decline to take him if we had turned them down the first time. I am distraught because I had hoped to have this summer to spend some more time with him, and also because I don't think he needs to be in a home yet. But today, at our Easter dinner, he told my brother-in-law's friend that I was his old coworker from when he worked at a utility company. I told him that I was his son, and he seemed surprised. So, although I am deeply saddened by this, I realize that there is no other way.

Again, thank you all for your help. I will need your knowledge again when I appeal my compensation claim in the near future.

[TiredCoastie]

This situation is very hard, Fortitudine, but you're not alone. Many of us are going through it or have gone through it. For instance, I've been babysitting my mother-in-law pretty much full time for almost the last month because my father-in-law went into the hospital, had some very serious complications, and is now in rehab. She can't be here alone, their son (my wife's brother) stole a ton of money making Medicaid a real challenge, so we're trying to fill in the gaps and hoping my father-in-law can come home at some point soon while we figure out a sustainable long term plan. I'm typing this at their kitchen table. Because she can be hostile and violent, my wife has been reluctant to stay here by herself, but will spell me for a while today and then again tonight so I can sleep in my own bed for the first time this month.

She doesn't know our names but seems to recognize our place in the family. She does not remember that her husband almost died and that he's in rehab. She doesn't understand why he can't just come home when we go in to see him. She will occassionally decide that any of us are against her for whatever crazy reason and then lash out. My father-in-law has been the typical target but my wife and I have also taken the brunt a time or two. Caregivers often take a physical beating from their Alzheimer charges. If your mom has not yet, she likely will.

If you can have your father cared for in a good place that you and your family can monitor and have ready access to him, being there for him as much as all of you can, then he's in a place that will work for all of you.

We've all been called to difficult duty, and the scars of that duty are why we're on this forum in the first place. Now we're called to difficult duty again - staying strong in the face of the "long goodbye." I'll pray for comfort and peace for you as you take this one on. Please pray for us.

Edited April 21, 2014 by TiredCoastie

[john999]

I went through this situation with my grandmother, aunt and my mother. It was hard every time because they all swore they would never live in a nursing home but the time comes when that is beyond their control and our control. Unless you can stay at home with them 24/7 and care for them in every way a nursing home comes into the picture. Since nobody wants to think about being in a nursing home they don't prepare their finances. The elder care lawyers can help figure out how to arrange things in advance. If you wait until the time when the person must go to a home there is only so much that can be done to avoid the penalties.

Myself, I bought long term care insurance for my wife and myself. I did this because of my experience with my relatives being in different homes.

What I think is most important is that you keep your loved ones near to you. You need to check on them frequently. If you go to visit one day and you see a bandage on their foot make the nurse remove the bandage so you can look at it. I did this and discovered that my mother's foot had gangrene. I went directly to my lawyer. Later I sued the nursing home for 1 million dollars. They knew she had gangrene and tried to hide it from me. The gangrene led directly to her death.

I also would try and get all the relatives on board with what you are trying to do. If are the health care POA and have a DNR on your slowly dying parent try and get all the other siblings to understand. Even with a POA and a living will one family member can throw a monkey wrench into what is really best for the aging parent. It happened to me. Some people cannot face reality. They will do anything to sooth their guilt even if the aged parent has to suffer for it. All a relative has to do is start threatening the hospital or nursing home with a lawsuit and the shit will hit the fan. Courts do not want to make life and death decisions even when the law is clear. They will fool around and allow delays in hopes the aged one will die before they have to decide on a DNR or living will for instance. As a POA you have to make the medical decisions for the loved one, but an angry sibling can and will challenge every decision you make or don't make. This is no fun. If this were 1800 we would be taking care of our aged parents on the family farm. The first time they got the flu they would die. Now medical science can keep them alive for years in a vegetative state. This is not progress IMO.