A year ago, my wife, my six-year-old daughter, and myself moved in with my grandparents (who raised me in the same home) to temporarily help them. My grandmother had cancer and we took care of her for months full time (I took all of my vacation time) before she died.
In the meantime, we have bought the house, but my grandfather still lives here. He has mobility issues (is prone to falling), but he was scheduled for a knee replacement surgery. He is also exhibiting some mild dementia (had him to the PCP to confirm). Now he has had a stroke after hitting his head from a fall and I found him in the bathroom (thankfully).
He is getting ready to come home from the hospital because he refuses to be in-patient therapy.
His three kids are back and forth as to what to do about his living situation, but they seem like they just expect I'm going to care for him. Unfortunately, I work 60 hours a week, my wife works full-time, and he will be alone for 8 hours at a time, five days a week. His being here has also put a strain on my wife and my daughter, and no other family is willing to take care of him in their home.
So, how do I continue this conversation with everyone involved? I feel selfish for the fact that I think he would be safer in long-term care, but I genuinely worry about him being home alone for so long.
Thanks
Are you the owners of the house free and clear? Does he pay rent or a stipend for caregiving?
Have you talked to the discharge planners at the hospital about the fact that NO ONE will be available to supervise him during the day time hours?
This is clearly an unsafe discharge (use those words).
Leave the guilt out of it. He needs more care than is available at home and you are under no legal or moral obligation to provide hand's on care.
What are his financial resources at this time? Does he have long term care insurance?
I'm sorry to ask so many questions, but you will get better answers if we can see the whole picture.
Thanks for taking the time to ask your questions.
We own the house. Our names are the only ones on the deed. We purchased it from him at market price, so medicaid can't come back and say it was a gift. He does not pay anything to us for caregiving or rent (we haven't asked for anything, either).
There is no POA. My aunt (his daughter) has been encouraging him for the better part of a year to let her be the POA, but he is hesitant because his sister's daughter is his sister's POA and takes all of her money, so he worries about that.
I have talked to the nurse and to the social worker, who have advised me that "it's his decision."
He does not have long term care insurance, but has about $30K in cash assets as well as social security and retirement benefits.
Thanks again.
He lives in YOUR home. You are allowed to say who lives in your home. Push back at discharge and tell them that it will be dangerous for him to be home alone.
If they insist, make them send out an occupational therapist to assess the home for safety. Make them set up in home care BEFORE he is discharged.
Ad make sure they know that if he becomes ill or falls, you will be calling 911 to have him readmitted to their hospital.
Hospitals don't get paid by Medicare if there is a readmit within 30 days. If they know this and let them know he is coming back, they might play nicely with you.
It is HIS decision not to go to rehab. But it is YOUR decision as to whether he resides in your home. He can only reside there if he is independent or has sufficient in home care not to need your unpaid services.
The arrangement might have come with expectations that the grandparents would be able to stay at home until death?
You stated 'temporary help', but now have bought the house.
(Where did you expect grandfather to go?)
Was it at full market value? You need to consider how the siblings would view the purchase as a hostile take-over and now you are 'kicking him out'. These things happen no matter what, and often in the process of caring, it ends with "No good deed goes unpunished". Or, "damned if you do, and damned if you don't".
One choice available to you is to use grandfather's income to pay for a caregiver for the 8 hours a day that he will be alone. Or, talk to the siblings, who can contribute for a caregiver.
You could have done everything right, but still be guilty, or feel guilty. The key is to be sure all care and housing is in the best interest of Grandpa.
We did expect him to stay here as long as possible. Now with the stroke, the orthopedic surgeon won't touch him, so no more promise of increased mobility. And at the time there were no signs of dementia or stroke. All of these medical issues have come about in the past few months.
Don't get me wrong -- if it would be safe for him to be here, I'd keep him here.
We have discussed getting a caregiver. We're in the middle of rural nowhere, so options are incredibly limited. If you know of any resources (this is our first time handling something like this) to help locate caregivers, I'd be more than willing to research it. Thanks for your time.
So there are a few options.
He can pay for caregivers that will come in and care for him. And not just when you are at work. If he needs 24/7 care that is how long the paid caregivers are hired for.
He should also pay for any adaptations to the house if any need to be made.
(I hope he is also paying his share of the household expenses)
Given these 2 expenses will the rest of the family have anything to say about how and where he gets his care?
Another option is he move in with another family member that can care for him if they do not want his funds being used for caregivers and adaptations to your house.
And last option would be to go in Rehab then possibly a move to Assisted Living if that is the proper placement for him.
If you cant find the AAA, tell us what State and County you're in and we will find them.
I do not know his age, but maybe he can recover enough to have the surgery?
I 'feel' that emotionally, most siblings and especially your grandfather will view your home as his home, no matter who's name is on the deed.
The time to plan other housing for grandfather was at the sale of his home.
For your own protection and that of your family's peace, maybe you should consider selling the house and moving yourselves?
You could sell it back to family, grandfather, or on the open market?
You could 'rent' out the house. Or even rent it back to grandfather, so other family could move in to do the caregiving.
Of course, these are only ideas. Perhaps you have done enough caregiving? It is complicated, I see that. It is also beyond my purview to offer much more. Maybe you can consult an attorney to avoid family relationships going south. Not that they will, because so far, you all have done well by your grandfather.
How does your wife view the situation?
Thank you for allowing the opportunity to speak into your life in a very personal way, and for taking it as well as you have.
The warnings may not come true, we hope!
1) he has been diagnosed with dementia
2) he has not designated a PoA
He may no longer be able to legally create a PoA with a dementia diagnosis in his official medical records, It can be contested. The next option for anyone to legally handle his affairs is to pursue guardianship through the courts. Being related to someone, or being "raised" by someone, doesn't count in court. I'm in the same boat with 2 aunts.
You don't mention what his pension is, but unless it's extremely robust, he will eventually need to apply for Medicaid within approx. 2-ish years of entering LTC. The sale of the house may be problematic if you live in a state where the Medicaid "lookback" period is more than 2.5 yrs (here in MN it's 5 yrs).
If I were in your shoes I would make an appointment with an elder law attorney that has experience with estate planning and Medicaid and DON'T DO ANYTHING or make any decisions until you talk to this attorney. It will be money well spent. Right now it seems no one has any legal authority to make decisions on his behalf. This needs to be remedied asap. FYI his guardian should be someone who is significantly younger than him (you) and who knows him (you) and will make decisions in his best interest (you). I'm not sure if more than 1 person can be a guardian (I think they can) so please consider this (if you are worried that someone might misinterpret your actions). Laws differ from state to state so this is another important reason to see an attorney who operates in your state. I wish you all the best on this journey!