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I don't understand why we were told 89 y/o dad doesn't qualify for respite care...Somebody pls explain...


msh789
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Question

Dad is 89 years old and is rated 110% disabled. At his most recent VA visit with the nurse practitioner (he goes every 4 months, and I go with him to all his appt's),  the nurse practitioner suggested respite care,  in particular bc the VA suspended the adult day health care program due to the coronavirus. So somebody from the VA respite care called us. Now, I am my dad's 24/7 caregiver, I have been his 24/7 caregiver for over 10 years now. I get no help at all, 2 brothers refuse to help (claiming they can't, and no, it is not debatable with them, they refuse to help). I get groceries for dad, pick up his prescriptions, laundry, cook for him, clean for him, I even help him shave. I help him into and out of bed, and sometimes getting out of his chair (he has a mechanical chair that will help lift him, but he refuses, and if I try to do it, he gets very combative, to say the least...). Anyway, when this person from respite called, wouldn't you know she called on the time I was out getting groceries. I was gone barely half an hour (because dad has anxiety and borderline panic attack when left alone for an hour or so). She called and talked to dad, who told her I was simply "out"...making it sound almost like I was out partying or something...ugh...He asked her what the call was about (because he is paranoid and always been very nosy, to say the least..sorry, but I am so burned out..), and she told him it was about respite, having someone come to his house to help take care of him...OMG, I knew if he found out, her would say he doesn't need help....She still called me back about an hour later when I was home. She proceeded to tell me that dad doesn't want help, so basically too bad. She also said he doesn't need help with the ADL (like bathing, brushing his teeth and toileting...she picked all things he does pretty much on his own...) so she said he does not qualify for respite. The man cannot be by himself.  He breaks things, and him falling is a worry. Plus the panic attacks/anxiety. I really don't understand why she says he doesn't qualify. I would think him going to the adult day health care is also evident that he  can't be alone. Plus his nurse practitioner who sees him every 4 months recommended it. I have read on the va.gov site that it is also for caregivers who experience burden, and I am beyond burned out.  I guess she also said bc he refuses help, they won't come to his house. But isn't this to help the 24/7 burned out caregiver..? So then she suggested placing him in a CLC...really..?!?! I mean, she says he doesn't qualify for respite care, how would he be able to be placed in a CLC permanently..?!?! She told me to call the social worker about getting dad placed in a CLC, but I'm not sure he is 'that bad' yet...I was thinking/hoping we could get him respite care...Perhaps the respite care lady misunderstood...? Perhaps I misunderstood..??? Oh and his nurse practitioner also got him signed up to use the Wellness Center last week, so the respite care lady said 'looking at his chart, he is signed up to use the gym...'...suggesting him going to the VA gym would give me respite, but dad wants me there with him, waiting, the entire time (like everything else!!), so how is that me getting respite...?? But I feel like she must think 'if he can use a gym, he doesn't need respite'...I am so confused...Is there any way to have someone else look into this...?  Any suggestions..? The stress level is terrible...He is very combative and draining...I literally can't get away bc I worry about him falling or hurting himself (breaking things, I want to get plastic cups, but he borderline violently refuses, saying he wants to use regular glasses....insisting he can do certain things, and then he has already fallen a couple times bc he is so terribly stubborn and again borderline violently refuses refuses help...it is very sad and frustrating, to say the least...)

 

 

 

Edited by msh789
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It sounds like your Dad "hornswaggled" himself.  I was the caregiver for my father, so I know what you are going through.  

ITS possible Aid and Attendance may help.  If he qualifes for A and A, this would be about an additional 700 per month, and you could hire someone to take care of your dad for you for around 35 hours per month  (700 dollars divided by 20 dollars an hour would be 35 hours per month).  

I would recommend hiring a doctor to basically do an in home exam for him to qualify for A and A. (Unless your dad already has documentation in his medical file that he needs A and A)

You can explain to the Dr.  that your Dad is 89, with some mental issues.  Now, you are going to need POA for your dad, if you dont already have that.  Get the POA filled out, and have him sign it (it may need to be witnessed, if so, arrange for a witness yourself).  POA would also mean you manage his money affairs, which I kind of assumed you do now, but, of course, I have no idea.  There are several types of POA, you need the general POA to include health care and finances.  Or, if he refuses  to "let go" of finances, then at least for his  health care.  

The person on the phone is correct.  If your father is competent, then he can choose his own health care.    Only if he gives you POA or if he is declared incompentent with you as the POA, then  you can make good decisions on his behalf.  

My father asked me to "take him to the ranch" and leave him alone.  I explained he would die there with no one to help him.  He said, "Yes, exactly".  

Once you have POA, then you can, and should, decide his health care plan and needs.  

An alternative to A and A (which is SMC L) is SMC S Housebound.  Housebound is currently 370 per month.  However, if you did apply for housbound, it will be effective at the date he first met the criteria, and that could mean retro money for you to hire caregiver(s).  

It sounds like your Dad is "substantially confined" to the home, which is the defination of housbound, but he probably has to have a "single" 100 percent disability to qualify for housebound.  There are 2 ways to get housebound:  1. Housebound in fact.  2.  Statuatory housebound.    More on housbound and A and A criteria here:

https://benefits.va.gov/BENEFITS/factsheets/limitedincome/EnhancedorSpecialPension.pdf

You have your work cut out for you.  My father has passed, but I continue to receive blessings in no small part because I "honored my father and my mother and your days will go well if you do".  

 

Edited by broncovet
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Will  your local VAMC continue Day Treatment after the Corona situation? I sure hope so.

My husband could not be left alone due to a 1151 stroke and the VA called it Respite for me.

The VA Van picked him up and dropped him off a few days a  week at Day Treatment . It was a blessing.

I raised livestock and was afraid to even tend to the animals , while he was alone in the house.

 

He was very combative and violent  too, brain damage in 6 areas plus SC PTSD and dementia.I fully understand what you are going through.It can be horrible and overwhelming. 

I believe the CLC is for 100% SC vets- we have a wonderful CLC here in Bath NY

but with the Corona situation, 

I heard on TV that many nursing homes and adult care facilities  are even prohibiting family members , and I have already been screened for Corona myself, by my non VA PCP.

If he can get to the Wellness gym, you ( and maybe a nurse could back this up)could say  that you are not allowed to stay with him in the gym while he is there- I don't know if that would work.

Broncovets ideas are good if he in fact is eligible for A & A.

I was a caretaker for two disabled vet husbands.

Many here can relate to what you have said.

Does your locale or county have an Office for the Aged?

Maybe they would have some suggestions.....dont know....

 

 

 

 

 

Edited by Berta
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He applied for Aid and Attendance last year and was denied. Seems A&A is awfully hard to get. again, he 'hornswaggled' himself as Broncovet said, bc he told the examiner that he goes to church once a week and the VA 'daycare' 3x a week, so his denial letter literally said they were denying him bc he is able to go to church and daycare. My goodness. My brother has POA and when dad was examined for A&A, they had him get a fiduciary bc I or my brother write checks for him, pay his bills, etc. He is rated 100% due to hearing loss via the VA, but only 10% due to his knee (which his rehab VA doc and the DAV lady at the Va who handles claims both think he is much above 10%, but the examiner didn't give him an increase when examined last year. I suggested trying for A&A again or an increase on his knee again but dad once again refuses. He claims it is 'a lot' for him to go thru all of that.   Which yes, true, it's not easy, but it's not intended to be easy. If it were easy lots of people would try. But he truly is his own worst enemy, denying so much. I did suggest having me as medical POA but he refused that. He wants to keep things how they are. But my brother who is the POA and also his  fiduciary lives over an hour away, works long hours, and is rarely available to do anything. He comes to dad's house on Sundays to write out the bills. Dad wanted the brother to be fiduciary because he has a law degree. IMO dad feels/thinks women are not as smart or capable as men.   

At this point, I might see about having him placed in a CLC as the respite lady suggested, but I don't see how that is possible if they won't even get him respite care, plus he refuses...not sure if he can go there unwillingly...?  

Thanks both for the replies...and Berta, I sure hope they bring back the adult day health care..But geez even with that, he refuses to go the full day nor ride the bus to and from..I have to take him at 9:30, he gets there roughly 9:45, then I leave the house to pick him up at 12:45,  so that leaves barely 3 hours when all is said and done. If he were to take the bus, he would leave at 8AM and not get home until 2PM. So that is an extra 3 hours that would be wonderful. But he leaves soon as they're done playing Bingo, they exercise at 1:00, but he refuses to do that and wants picked up.  

It really is maddening bc he refuses basically everything, he refuses having someone come to the house to help put, he refuses to go to the CLC, and the brother who is POA also refuses to take over taking care of dad, saying he 'can't...So I guess maybe I will see about having him placed in the CLC...although I still don't see how he is going to qualify for that if the VA already denied him AA and in home respite care...We did finally start getting him Meals on Wheels about 3 weeks ago, and that was even a battle...but boy, is that a blessing...He was getting very combative at dinnertime, screaming at me about how I cooked things, etc...it was to the point that even the little dog would run and hide when he saw me getting pots and pans out, bc he knew dad would have a horrific meltdown that repeats and repeats and repeats himself....So that alleviates that stress, at least...I just hope they don't discontinue MOW (Meals on Wheels) due to the coronavirus...it has been a blessing...

Edit: Forgot to mention, we need to get copies of dad's living will and POA to the VA...the respite lady basically said nothing can be done otherwise...which, really, every vet in CLC or getting respite has a living will and POA...???? Anyway, brother has been dragging his feet with that, too..I asked him months ago for copies of them...He finally claims he has copies of both and will bring them up this Sunday...I know he has them, but he drags his feet with EVERYTHING...Ironically, he did claims for veterans for over 20 years (another reason dad chose him), so I don't understand why he drags his feet with everything... Oh, I want to bang my head against the wall, sometimes...Dad's nurse practitioner also scheduled an appointment for LST (life sustaining treatment) discussion, for if/when it comes to that...That appointment is in a little over a week, she suggested all 3 of us children be there, or via telephone, and bro who is the POA 'can't make it'...So he will do it 'possibly' via telephone...Again, I want to bang my head against the wall sometimes...All I can say is the POA and living will papers better be here by that appointment...I called the social worker and left a message, her voicemail says she will get back by the end of the next business day...Oh and I did try the local area on aging and they said nothing can be done unless he is a 'danger to himself or others,' which the VA sees him as not a danger...and his mind is not 'bad enough' to be considered mentally incompetent...

Edited by msh789
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Most of us have been denied.  This is SOP for VA.  You will/would need to hire an IMO to make a favorable opinion.  He can review your dad''s records, and does not have to come to the house.  If its been over a year, apply again.  You can still get it backdated (retro) because SMC is based on the facts found, not the date you applied, because an application for SMC is not supposed to be necessary.  

We have posted here what needs to be in an IMO.  

Since your brother is POA, you will need to discuss all/most of this with him, that is, if he needs CLC.  He has POA so he can insist he go there.  Its important families "work together" on this.  Hopefully their is no hard feelings, and if there are forgiveness is in order for your Dad's sake and well being.  On both you and your brothers part.  However, even if he does not want to forgive, you need to forgive for your own well being.  

You have a huge problem.  But, God is bigger than all our problems and can solve them all.  But, not always in the way or in the time frame "we" think is appropriate.  In his time, not ours.  Sometimes it seems bad to start, but, everything eventually works out for good.  

You "may" need to ask your brother for money to cover the respite care.  You can not be expected to work 24/7/365 days a year.  Nobody can do that.  You should get away each weekend, and do something away from your father.  Pay someone to care for him on weekends.  Tell your brother you are not capable of 24 hour days, seven days a week without rest.  

There is a secret Alex told me:

When you are applying for A and A (as you should, again), have HIS doctor explain if he does not get help from an aide (A and A) , he will have to go to a nursing home.  Thats key.  It costs VA much less for A and A, than a nursing home.  

Caregiver support:  https://www.caregiver.va.gov/

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Thank you Broncovet..I feel like brother is in as much denial as dad..Brother claims he understands, but he truly doesn't....Brother even told me/dad to not apply again for A&A and dad listens to him bc he worked for the VA so dad thinks he knows more....Brother also refuses bc dad refuses and dad is tough old bird, to say the least..I did mention to dad that unless we get somebody in here to help out, he will have to be placed, and he claims it is in his "living will" that he can stay where he wants until he dies....(and again, he gets borderline violent about it..)

Oh my....What sucks is I am basically stuck bc brother has POA and brother isn't willing to get help/he also refuses...Dad signed the house over to me and the POA brother about 15 years ago, so I had to move back here to take care of dad, and it's like I am stuck now...POA brother tells me to go get a p/t job, but he knows we would need help with dad, and both refuse to get help...(dad being the main obstacle there, he seems to think he can be alone by himself for hours on end, but I leave him for an hour and he has a huge scary meltdown...he also refuses to see a counselor or VA psychiatrist.......)

Is there a link for the IMO you mentioned here..?

Edited by msh789
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Great Advice from the above Ms Berta And broncovet.

Just wanted to add my 2 cents

First off I commend you for taking care of your Dad  your a strong woman for doing that very strong and caring.  God Bless you.

Sometimes some of these employees from the VA do get confused and getting the wrong information out and from  she should confide in you after she talked to your Dad if he mention he can take care of himself he don't need any help  this person that was on the phone with your Dad should have been more professional and thanked him and got off the phone  asap  and got in touch with you  so you can tell them all about whats going on and what your requesting from the VA.

IF you can get someone to sit with your Dad  (incase you need to be gone more than the hour or so)  check with the VA  care management team at your local VAMC..ITS BETTER TO GO SEE THEM IN PERSON so you can tell them exactly what you mention here on hadit...discussing care about your Dad over the phone is not a good Ideal  especially to some one that is a bit ''squirrely'' in the first place. (SHE SHOULD HAVE JUST MENTION TO YOUR DAD SHE WILL CALL BACK WHEN YOUR DAUGHTER IS THERE OR SOMETHING LIKE THAT.)And got off the phone with him.

Just remember to take the necessary paper work  your like Dad award letter and his rating or a letter to show what he is service connected for. you may need your Dad personal information  SS # ADDRESS /PHONE # Ect,,ect,,,,,  Normally they can look his status up on the computer and get the information they may need...so be sure you have his SS#  OR Claim # incase!!!

So I highly recommend you go to your Dad Local VAMC and discuss this with VA Care Mangement , or have them to point you in the right direction so you can sit and talk with the persons FACE TO FACE that make this decision that you request.

  if it needs an application ask if you can fill it out there or if they will and send it in to your Regional Office.

 Hopefully things can be worked out to better you and your Dad

And by the way Welcome to Hadit  and ask any questions you have anytime.

Thank you for coming to Hadit.

Buck

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