Hi all,
I am trying to understand why the social worker at my mother's current nursing facility stated that neither a board and care home nor an assisted living facility would take my mother because she has incontinence.
When my mother first went in to this nursing home a year ago, the SW stated when I met her that if I wanted to consider another place for my mom down the line once her rehabilitation in her current nursing home stopped, she would be the one to support me with it and could give me a list of board and cares, ALFs, etc., that take Medicaid.
Now that rehab has been discontinued at my mom's facility as of months ago, my mother and I want to explore 'all' options for her to leave her current facility. Her coming home with me is one option, but trust right now that it is the least likely option. I have posted her before, so I have received many many kind warnings already regarding not bringing her home. (This is not a thread soliciting opinions on whether or not to bring her home.)
With that said, a few months ago right after my mom's rehab had stopped I asked the SW for the list of options. She told me to Google them. And then during the last care team in-person quarterly meeting with the social worker, NH Administrator, Rehab director, etc., when I asked the social worker again if I could get this list, that is when she stated that my mom wouldn't likely qualify to go in to a board and care home or an ALF because of her incontinence.
I'd like all thoughts/opinions on this. I have pretty much already decided that the social worker just doesn't want to help (she is the not first social worker I've had this type of experience with since my mom's stroke and moving to SC). Based on my research and calls already, ALFs and community care homes provide care, which means incontinence care is typically included. I mean, I thought incontinence was one of the primary factors that put people into these types of facilities.
Anywho, of course, I do understand I'd have to talk to said facilities because I know ALFs don't have the staff that NHs do, however, I also don't want to be ignorant or naive if perhaps the SW knows something I don't or that I'm not grasping, such as if ALFs and care homes tend to decline residents with incontinence or something.
Your thoughts?
My mom is in an ALF and has incontinence which is well managed with pullups. If she needed lots of help getting to the bathroom or frequent wardrobe changes, I don't think her current ALF could really handle it. One of our former caregivers used to talk about the ALF she used to work for that they would put liners in everyone's pullups and have people who needed it on a 2 hour pee schedule.
I'd call some facilities yourself and not rely on the SW info at this point.
The incontinence severity is...high, I guess? It's hard for me to judge because I put it this way - she has never wet through clothes when out with me. I have never had to change her clothes while 'out and about'. I have to change her clothes 'all' the time upon picking her up from the facility though, because when I get there, I am finding her to need a change more and more. On days I see her, I take her to the restroom before leaving the facility, once while out (we're usually out for 8 hours), and then upon getting back into the facility. Again, I've never needed to change her clothes while out with her.
However, when I visit her, she is frequently sitting on the bed and wet through her pull ups and the clothes 'and' the bed. As well as through clothes she has put under herself to sit on - last time I was there she wet the clothes she had on through her pull ups, a pad in the pull ups, and a shirt plus a towel she was sitting on, including through the bed linens and bed mattress. In other words, if I come in the morning or early afternoon she is now sometimes obviously sitting in quite a lot of urine for a long time. This has been an issue moreso in the past month or two. So I'm not sure what has changed. I tend to think she is 'giving up' on asking for help and starting to become ok with things just being as they are meaning she'll just sit in urine all day if she presses the button and no one comes for 3 hours (so sad but it happens all the time). Could be a combination of that plus the staff 'getting to her later than usual' in the mornings, so she is often not being changed out of the night pull ups fast enough. Our next care team quarterly call is tomorrow so I am going into the facility in person and will raise it during that care team discussion.
You have asked this question twice, and it may just be that you think you have to ask the question again in order to have it appear under the correct "subject line". You don't. Once the question is asked we will see it.
As said above, it is time for you to explore places in your area. You Mom is safely placed now. If you want to find out what other facilities are available to her and the costs, do visit or call them. As you observed above, they may overpromise. And the costs of care for someone wheelchair bound, in need of bathing assists, meal assists, incontinence care would place that person at level 4 care, resulting in a very expensive monthly cost.
Do explore. For now, mom is in care. You have time to visit other facilities, as you mentioned.
I apologize for asking the same question twice. In hindsight I thought I had differences between the two posts (one being moreso about if incontinence is a 'no go' at certain types of facilities vs. the other post being about the best kind of place to focus on getting my mom into next considering her health situation holistically). Apologies that in reality they ended up practically being the same question I guess.
Another suggestion would be to call a "senior placement advisor" or a service like A Place for Mom (they own this site).
They will ask you a bunch of questions about mom's needs and resources and suggest facilities that would meet them.
Remember that the SW is an employee of mom's current facility and she may be experiencing pressure from her supervisor to keep beds filled.
If you want mom transferred, have the new facility request it.
I do think that at the end of the day this is going to be a process of me doing 'boots on the ground' research to see what place would best fit her needs, meaning a lot of visits to a lot of different places to assess.
Definitely agree that there's likely a conflict of interest with the social worker; I noticed multiple empty beds on my mom's wing over the past few months and its a bit shocking to me because there have got to be so many people that need those beds. Side note, the CNA I liked best at her facility recently left, and texted me that the facility could no longer staff contractors because they owe so many hundreds of thousands of dollars to every agency in the area now so no agency will staff there, which is why he got 'pulled' from working there.
Your Mom has a lot wrong with her. Not sure if an AL would take her, she may need more care then they can give. Same thing for a Board and Care. Not saying they won't but it may be awhile before u find one that will.
https://www.carepatrol.com/locations.html
No endorsement. Just an example of the sorts of folks who do this work.
I would be careful about letting your mom "drive the bus" about where she moves. In many dementias, lack of ability to plan, to see consequences is often a problem. As to therapy, due to lack of insight, this may be problematic. But developing a trusting relationship with a mental health professional could be priceless.
She's never been a decision maker. Always had a tough time doing so and always relied on me even for small decisions; she prefers others make her decisions for her actually. I do want her to be informed though, and have a 'say', but I'm pretty 'convincing' in that once it's determined what is best, I know how to put it to her such that although she will likely be very scared of change despite desperately wanting to leave her current place, I do know she will agree to whatever path I recommend to her as the best option.
Not that I won't expect plenty of complaining at the next place too, ha. But complaining is just par for the course with my mom (it's admittedly where I get it from and thus something I'm always having to work on).
That's horrible that they don't change her pullup and she soaks through everything! Totally unnecessary and unprofessional.