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Yes. CM is dead on.

And yes Barb, the facility is going on the assumption, likely reported per SIL, cognitive abilities firing on all cylinders.

I don't care if there's a blow up. I won't argue or justify.

I was asked valid questions as to why MIL isn't calling them and as to her ability to orient/confusion.

I answered honestly.

And I'd do so again.
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"you know . even a broken pelvis .. doesn't qualify as inpatient".

Let me tell you, even a fractured BACK didn't get my aunt admitted!
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You rock, Dorker!
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Something I just realized. There were PT people with MIL yesterday morning, yet she says she hasn't seen a soul all day?

A distinction between cognitive SCREENING and cognitive testing; the facility neds to know what MIL's capabilities are RIGHT NOW. Her safety and her ability to participate in rehab are very much dependent on that.

Yes, if the screening indicates deficits, that might be due to some of her current disorientation, discomfort. But isn't that all the more reason to pursue a thorough workup once she's feeling better?
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A referral was made previously for full cog work up. This at having found some deficits in a screening done during hospitalizion.

SIL got that nixed. I fought it hard... very hard. I lost.

Her agenda . .. let's don't uncover that dilemma .. I might be told she can't be left alone. Or that's my suspicion.

At that time SIL would leave ..assurances she'll manage ... has a TEAM, etc.

I suspect if cog work up ordered .. same thing would occur ..

With same excuses..."she doesn't feel good .. she's not in familiar surroundings ... her world upended ... they shouldn't test people in that setting and consider the results as valid"

All, what was heard before.
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Part of me is concerned that you're stepping in again, Dorker. It's really SIL's or H's place to ascertain that MIL isn't as competent as rehab was told she is. Calling the nurse because MIL is cold is starting along the steppin' and fetchin' path again.

BUT if it results in that long-delayed, long-awaited COGNITIVE EXAM, it is all worth it. Just beware that the questions are VERY basic -- one really has to push for a more detailed examination.
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Dorker, maybe when you get done speaking with MIL on the phone, you call the nurses to "clarify" some of what she's told you. For example, moving the chair. "Nurse, I wanted to ask about the chair she's been trying to move. In the hospital, just 3 days ago, she was allowed to get out of bed for the first time in x days, and that was with PT. She had a bed alarm then. I was wondering if she should have an alarm now. And how frequently does she have someone check on her? She's been telling me she hasn't seen anyone all day."

Yes, you have her on the radar for a work up, but tell the weekend staff the same thing and maybe prevent a fall.

Or not. If she fell and broke that hip, maybe she would be in a NH full time.
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You guys surprise me. With all the talk of narcissism on this thread. MIL KNEW she was supposed to call them. She did not want to as she knew best. Been there and done that.
My mom, no dementia, but plenty of “I’ll do it my way” got up to use the bedside commode in an acute care rehab. It was next to her bed. She had been told to call the nurses. Down she went. Took three or four to get her up. She was very embarrassed. Not hurt. Later she made the comment that “they” let her fall which I called her on.
I’m not saying MIL doesn’t have decline. I’m just saying she’s doing what she wants to do.
Plus since she just came from the hospital, SIL assessment would not have been the only one they had to go by. Old people fall. That’s a complete sentence.
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"Old people fall."

Should be on a t-shirt.
Should be on a poster on MIL's wall to remind her.
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SIL is definitely afraid of finding out her mother has Dementia no doubt. Like you said Dorker, with that diagnosis MIL can’t be left alone and SIL will most likely fall off her hamster wheel.
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I've got grands for the wknd.

Had a talk with SIL who wants to call in a SW to maybe navigate how to help MIL come to terms .. placement in future.

Saya her mom does NOT WANT to go back to IL ever. No surprise there. She can't stay here indefinitely. Says she can't keep up the pace required to care for her mom. That her husband . How many good years does he have left .. and he has lost his wife to this cause.

I didn't get the sense this is imminent

But at least SIL even utters the consideration going forward... placement.

She is so sick .. can only talk in whisper.

ANd she talked of how she'd so hoped caring for her mom in IL would bring about some better health.

She now realizes and I concur .. not possible.

Intresting
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“I was asked valid questions as to why MIL isn't calling them and as to her ability to orient/confusion. 
I answered honestly.”

Gee, it just occurred to me that this may be the secret in getting sil from asking Dorked to step-n-fetch while mil is rehabing.

Actually tell sil exactly what you told Nurse Betty regarding MILs mentality. When sil starts to gnash her teeth and wring her hands over you exposing MILs dirty undies - Dorker, you reply “Sil, YOU asked me to call the nurses - they asked me - and I told the truth”. Sil just may ban you from the rehab altogether if you’re gonna be honest - for Christ’s sake!!

As for Dorker taking this small step back into the monkey cage in suggesting a mental evaluation be done...

At the risk of repeating myself: Halle-frickin’-luja.

If there is to be any realistic planning for MILs future therapies, living environment- everything MIL - the doctors and therapists must have accurate knowledge as to what her capabilities are. Mental and physical.

Waiting for The Brain Trust to make this suggestion to the rehab folks meant it was never gonna happen. Ever. Hell, they can’t even be honest about it.

I say “Bravo”, Dorker.

But as well - Do you have golf shoes, Dorker? Traction for that slippery slope.
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Wow.....

Well I wouldn't have believed the triangulation of MIL calling a FAMILY MEMBER to come bring her BLANKETS b/c she is cold--when 10 ft away are nurses and CG's whose JOB it is to do just that---

I wouldn't believe it, but my mother did the exact same thing. every time she needed something, she'd call me. (and normally, she doesn't call me, EVER)
The rehab center was close to my house, but I'd have to run to HER place, get the items (hand lotion, hairspray, that " one nightie that has the kittens on it"..it never ended. I'd show up sometimes 3xs a day and the nursing staff got darn sick of seeing me--it's a slap in their faces, for sure.)

This is just MIL being MIL. I hope the cog eval shows w/o question that she is not hitting on all cylinders. If SiL isn't standing right there feeding her the answers, they'll get a better baseline.

And WHY in the name of heaven is she moving furniture????????????? 5 days ago she was babbling incoherently and couldn't even stand--and now she's redecorating her room. I'm SURE that there are people within the rehab center whose job it IS to make the rooms "comfy" and safe for the patients, and if that means moving a chair, then they do it. This was just ridiculous on MIL's part. She's trying to look tragic "Look at me, I've been abandoned by my family and I am cold and I want that chair moved and I won't eat b/c that upsets my daughter and makes her feel bad....." Oh, she's clever, that one.

And it's not something every doctor and nurse hasn't seen a million times.

Yep, she's making those squawks of "I wanna go home. I'll be fine" already. It' so great that SIL is too sick to go to the rehab place. MIL is going to HAVE to deal with being "alone".

Her failure to plan for this situation many years ago is what has been her undoing. And that's NOT your problem.

As far as sharing your viewpoint with her medical CG team--most are happy to have a separate viewpoint about a pt. My DH is very deaf. Nurses or drs would come in to the room, talk to him, assume he heard them and walk out. Finally I just got to the point that I would (out in the hall) tell them that he is VERY hard of hearing and you have to be facing him and them have him kind of repeat back to you what you say, or he doesn't "get it". One night nurse just laughed at me and said "THAT'S why he freaked out about the suppository!! I told him about it, and I thought he heard me, then I came back to give it to him (2, actually) and he FREAKED OUT). It was a guy, which I don't know if it was worse or better, but I sure heard about the experience for a while!)

IF DH could handle it--I imagine the staff would appreciate a quick little tutorial in all things MIL. That would help them to see what she is and isn't capable of, instead of playing this game with her.

Odd that MIL is complaining of boredom when at home she did absolutely nothing. There must at least be a TV in her room. Mother watches it 12 hours a day. And does puzzles and word games. They also probably have a common room she could go to--but, I know, she's not like that.

welp--hope SIL takes a long time to shake this off and that she simply rests and gets better and pays some attention to B. That man sounds like a saint. Most hubby's would have cut and run long ago.

Oh, and the nursing staff will also be happy to pile those blankets sky high and also, make sure she's covered, as much as she'd like. My DH is 6'5". Hospital beds are agony for him. I asked for, and got, an over-length one and extra long blankets.

Never had any probs with nurses, or docs in all of DH's hospital stays. HUGE platters of homemade cookies with a very gracious TY note seemed to help get him quicker care when he'd call for help.
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Rainmom, I was only asked to call MIL who is sad and blue.

I did that.

Found her complaints about the covers she can't get on her, the chair she's struggling to move.

Trying to get her to call the nurse, was doing no good.

I took it upon myself to call nurse desk.

But even still ...not a bit sorry I walked into some dialogue that questioned how oriented (or not) she is.

And yes I told SIL about that convo... as I also told DH.

Told both of them ..."do what y'all want but if you don't take this opportunity to get that issue looked at ... and hey .. who knows ... get a professional to weigh in, then you guys are gunna continue with living, walking, breathing, thinking for her ... she isn't capable. But do whatcha want.
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How did it go with your daughter going to rehab to do MIL's hair today?
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I won't likely hear much from DD on her visit til she picks her kids up from here tomorrow.

She's taking a much needed break from the kids. I'm the last person she'll call right now. LOL

DH spent the AM today visiting her.

He said she's a little down in the dumps. Said she talked of (likely the first time she hasn't had SIL at her elbow)...talked of how horrible and too long, too cold in IL.

DH said he set her straight on all that saga .. that's where she needed to be to avoid hurricanes ... and if SIL had done as she should've... she'd of come for you beginning in June and had you back here mid October.

But she had to entertain her son and family and dog sit for her daughter for 2 weeks. The dogs should've been back burnered and she should've gotten on down here.

And none of us can predict the weather.
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Dorker; if SIL is going to be talking to SW about placement, I think you've made your point and gotten these folks to where they need to be.
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In the same conversation she said she wishes she could find a live-in care giver.

To which I answered .... "I'd like a home on the French Riveria. Not gunna happen for me. SIL look what toll it's taking on you to do 24/7 care. Who is gunna do that and for free ... that's not reality"
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With SIL directing from afar, I can see the live-in caregiver running for the hills before lunch time.
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Wow. Just wow.

We sane people don’t need any more proof that MIL has definite cognitive defects...... but flaking out on the call-button and fixating on moving the chair & adjusting the blinds are Huge Red Flags.

To those of us with the benefit of hindsight, that is.
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Omg,

Just catching up.

What were you going to do, lie to Nurse Betty? I mean Bethany. LOL

I don’t think I read of any blow back from DH and SIL about you spilling the beans to Nurse Betty. I sure hope not. Seriously, how long did they think they could fool the staff.

From one with the Holey T-shirt, all this about moving the chair, not being able to use call button, probably hobbling to toilet alone is making me twitchy!

If this place is truly posh I can’t imagine the food is crummy. Surely it at least smells good.

I wondered if the food smells good how long will it be before MIL starts polishing off her plate.
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Another thought, if MIL had so much difficulty walking even with a walker..how is she pushing a chair around the room without toppling over. I’m sure someone would hear the chair moving.
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I’m questioning if MIL even attempted to move the chair or if it’s just a dementia-related lie. Maybe lie is harsh. But maybe in her mind she did try to move the chair but....in reality she never got out of the bed.
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Where do they think they are going to get a live-in caregiver for free? This is a circus complete with flying monkeys if they are entertaining that fantasy.
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She "wishes".

I wish a lotta things were possible. We all do.

Doesn't mean it's ever gunna happen.

I told her if it were me I'd be all over it as to a cog workup. Maybe MIL hearing it from the pros would drive the point home. "Maybe".

Bottom line. ... They've got a real problem. MIL says she never wants to go back to IL again (saw that coming) ... SIL now has some realization how grueling/taxing/all consuming this role is and can't stand up to the rigors of it.

She also... even if she did think she can keep wearing that hat. Has zero desire to move to FL and uproot she and her husband's life to that degree.

Hmmm.

What to do?
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Has anyone started a Medicaid application? That's going to be the only way any sort of care gets paid for, at home or in a facility.
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Of course not. These folks don't talk/plan as to contingencies.

Remember... I tried to talk to SIL and her only response was, she'd do this as long as she can ... until she can't anymore.
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Well, that time has clearly come. Tell DH and SIL that they need, asap to sit down with sw at the facility and talk about getting a Medicaid application started.

Whether it's for community Medicaid or NH Medicaid depends upon whether MIL makes any progress in PT and is deemed eligible to stay for 20 days under Medicare...or if she resists and gets discharged from rehab as noncompliant. At that point she'll either need to become a long term care patient or go home.

Either way, the financial information will be needed in short order and someone needs to get it together.
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Dorker, this is a general comment, not a criticism, on your approach to the issue of MIL care. Bear with me....

In finance and investing ( my other passion) we often point out to folks that the "historical" performance of a stock or fund only tells you about past performance, not about what is going to happen in the future.

In the past, SIL, MIL and DH said and did all kinds of stupid stuff.

But things have changed, and only because you stepped back and allowed them to experience mom's decline for themselves. The house of cards tumbled because YOU stopped propping it up.

Things that were dismissed in the past (rehab) are now happening.

The fact that SIL once said something should not, imo, keep you from pointing out what the next logical step should be, especially to DH.

You have shown that you are strong enough to weather their withering or angry remarks because you KNOW that you are right and that MIL can no longer be safe in her ramshackle home without 3 shifts of caregivers, and not even then during hurricane season.

So go ahead, tell them what they need to do next. The worst that can happen is that they'll ignore you.
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I wonder if that talk with the SW will ever happen to discuss permanent placement. I think Poochy might well be the ointment in the works to ever get placement for MIL. Just how often is SIL going to fly to FL to bring Poochy to visit MIL in a NH? I think MIL will staunchly refuse to be placed (and she still can, since she hasn't been declared incompetent yet) because of Poochy.

Dorker, stay firm in refusing to take Poochy in. As it is, if MIL is placed in a FL NH, someone will be steppin' and fetchin' enough for that. I know, as my mother is now permanently in a NH, and I'm on a short leash with the NH. Every week it's something different. There was an ER visit (unnecessary) just Friday -- I was called away from what I was doing and had to spend 9.5 hours on elder issues. There have been numerous falls (a call every time), calls re "agitation," vaginal bleeding, a multi-drug resistant bacteria scare, more meds to calm her down, etc. One weekend I had to hire an agency to eldersit her at night for four nights -- over $1100 for that (because I refuse to do it, even for my hourly rate -- I got reimbursed for hiring the agency). I am pressured to put her on "comfort care" measures, and two of my three brothers don't agree (yet...). And this is supposedly one of the best NHs in the area.

I'm not saying YOU will be the stepper and fetcher if MIL is in a FL NH, just that someone will be. Not everything can be done long-distance. So stand firm on refusing to take care of Poochy. We all know what THAT routine with the dog is like -- up multiple times a night to let him out????
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